Remote Resilience: Novel Applications of mHealth in Nicaragua's Cancer Control Program

远程恢复能力：移动医疗在尼加拉瓜癌症控制计划中的新应用

• 批准号: 10685467
• 负责人: Juan Ramon Almendarez Peralta
• 金额: $ 17.78万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-12 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10685467
• 关键词: Acetic Acids; Adopted; Age; Awareness; COVID-19; Cancer Control; Cancer Etiology; Cancerous; Caribbean region; Cells; Cervical Cancer Screening; Cessation of life; Clinic; Communities; Country; Cytology; Development; Disease; Early Diagnosis; Eligibility Determination; Enrollment; Feasibility Studies; Fright; Geographic Locations; Geography; Health; Health Insurance Portability and Accountability Act; Health Personnel; Human Papillomavirus; International; Intervention; Lesion; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Methods; Mobile Health Application; Modality; Modeling; Nicaragua; Nongovernmental Organizations; Outcome; Patients; Phase; Pilot Projects; Play; Process; Provider; Public Health; Recommendation; Reporting; Research; Research Personnel; Role; Rural; Scientist; Self Efficacy; Surveys; System; Technology; Testing; Time; Triage; Universities; Vaccination; Virginia; Visual; Woman; World Health Organization; acceptability and feasibility; access disparities; cancer health disparity; cervicovaginal; community based participatory research; cost; cost effectiveness; design; encryption; evidence base; follow-up; girls; health care availability; health literacy; high risk; human centered design; implementation/effectiveness; improved; innovation; low and middle-income countries; mHealth; mobile application; novel; patient oriented; pilot test; premalignant; prevent; primary outcome; programs; provider portal; research and development; resilience; risk variant; screening; screening program; screening services; survivorship; tailored health care; tool; usability

PROJECT SUMMARY / ABSTRACT Cervical cancer, a preventable cancer of disparities, is the primary cause of cancer death for women in Nicaragua. The World Health Organization (WHO) adopted an elimination strategy for cervical cancer within the next 100 years, and outlined specific targets to meet by 2030: vaccination (90% of girls before age 15); screening/early detection (70% of women get a high-quality screen by 35 and again at 45); and treatment (90% of pre-cancerous and cancerous lesions treated). As the majority of the burden of cervical cancer exists in low and middle income countries (LMICs), significant research into the development, implementation, and cost- effectiveness of community-based cervical cancer screening models using HPV primary screening has developed a strong evidence-base for the acceptability and feasibility of this modality. However, significant geographic variability exists in successfully improving patient health outcomes and preventing cervical cancer, particularly in rural and remote geographic areas. In Nicaragua, significant intra-country variability exists in terms of yearly participation in cervical cancer screening by eligible women, and likelihood of lifetime screening, depending on geographic region. There is a demonstrated need for culturally-tailored, regionally specific innovations in evidence-based HPV primary cervical screening programs. Based on a successful pilot study enrolling nearly 2,000 women in Bluefields, Nicaragua, researchers have identified the unique role mHealth (mobile health) interventions may play in improving health outcomes when integrated into an HPV primary screening program. Innovations presented herein include the development of a mHealth platform that combines a patient-centered mobile application (app) with a provider-focused portal, as well as integration of the provider- focused portal with the National Cervical Cancer Surveillance System (SIVIPCAN). Through developing this culturally-tailored, regionally appropriate mHealth intervention for women and healthcare providers (R21 phase) and then pilot testing the impact of this intervention when integrated into a community-based HPV-based primary cervical cancer screening program (R33 phase), this study will provide important evidence relative to the potential for novel mHealth interventions to improve cervical cancer screening follow-up and treatment, with a focus on rural and remote settings, often the hardest geographic regions in which to improve health outcomes.

项目总结/摘要 子宫颈癌是一种可预防的癌症，是2004年妇女癌症死亡的主要原因。 尼加拉瓜.世界卫生组织（世卫组织）在2005年通过了一项消除宫颈癌战略， 未来100年，并概述了到2030年实现的具体目标：接种疫苗（15岁以下女孩的90%）; 筛查/早期发现（70%的妇女在35岁时接受高质量筛查，45岁时再次接受高质量筛查）;以及治疗（90% 癌前病变和癌性病变的治疗）。子宫颈癌的发病原因有哪些？ 和中等收入国家（LMIC），对开发，实施和成本进行了大量研究， 使用HPV初级筛查的社区宫颈癌筛查模式的有效性， 为这一模式的可接受性和可行性建立了坚实的证据基础。然而，重要的 在成功改善患者健康结果和预防宫颈癌方面存在地理差异， 特别是在农村和偏远地区。在尼加拉瓜，国家内部在以下方面存在很大差异： 符合条件的妇女每年参加宫颈癌筛查的情况，以及终生筛查的可能性， 取决于地理区域。有一个证明需要文化量身定制，区域具体 创新以证据为基础的HPV初级宫颈筛查计划。根据成功的试点研究， 在尼加拉瓜的布鲁菲尔德，研究人员招募了近2,000名女性，他们发现了移动健康的独特作用， （移动的健康）干预措施可能在改善健康结果时，纳入HPV初级 筛选程序。本文提出的创新包括开发一个mHealth平台， 一个以患者为中心的移动的应用程序（app），带有一个以提供者为中心的门户，以及提供者的集成- 国家宫颈癌监测系统（SIVIPCAN）。通过开发这个 针对妇女和医疗保健提供者的文化定制、适合区域的移动健康干预措施（R21阶段） 然后试点测试这种干预措施的影响时，纳入以社区为基础的HPV为基础的小学， 宫颈癌筛查计划（R33期），这项研究将提供重要的证据， 新型移动健康干预措施改善宫颈癌筛查随访和治疗的潜力， 重点放在农村和偏远地区，这些地区往往是最难改善卫生成果的地理区域。