Developing and evaluating a mobile application-based intervention to support HPV-tested women and increase their retention to follow-up: a mixed-methods implementation study

项目摘要/摘要 宫颈癌(CC)是拉丁美洲妇女癌症死亡的主要原因之一。在 在该地区，筛查方案面临着确保随访/治疗的重要问题，这是一个主要问题 影响筛查效果的障碍。人乳头瘤病毒(HPV)检测已成为预防和控制艾滋病的主要策略 减轻疾病负担。然而，HPV阳性可能会对 受测女性的心理社会健康状况。此外，对于许多拉丁美洲妇女来说，由 卫生服务提供者对HPV的了解常常令人困惑；女性难以理解HPV检测结果 以及要遵循的步骤。HPV检测对心理社会的影响，以及缺乏关于 后续过程可能不仅会降低妇女的生活质量，还会减少她们对后续行动的保留。 该项目的具体目标如下： 目的1.开发和测试一款应用程序的可用性，以增加女性对HPV/CC/FU的知识，减少 HPV检测的心理社会影响和增加随访保留率。(R21阶段) 目的2.评估以APP为基础的实施战略和初步成效结果 采取干预措施，并确定执行工作的障碍和促进者。(R33阶段) 我们将开展基于APP的干预试点实施研究，旨在提供经HPV检测的 通过关于HPV的循证信息，减少HPV的心理社会影响，并增加 留存以进行随访。基于应用程序的干预将由提供信息和支持的应用程序组成 HPV检测的女性，由训练有素的健康提供者在筛查咨询期间提供给女性。我们 将以用户为中心的设计方法与行为模型和实施科学相结合 测试和评估PHC中心基于APP的干预实施策略的框架 在阿根廷。我们将使用一种混合方法的描述性设计，由定量的女性研究和 卫生服务提供者层面的定量-定性研究。继S教授的分类学之后，在女性研究中 我们将评估实施战略的可接受性、适当性和采用率。测量 初步成效结果我们将在不同的时间进行三次量化调查 筛查/随访过程，我们将分析常规临床记录中的数据。在健康研究中 对于供应商，我们将进行半结构化访谈，以分析CFIR选定的构件。 这项研究将提供基于APP的干预实施战略的证据，该干预将 准备在随机对照试验中评估其有效性。它将构成一个坚实而健全的 如何使用实施科学来产生严格的基于证据的信息的例子 实施移动健康干预措施以控制癌症。

PROJECT SUMMARY/ABSTRACT Cervical cancer (CC) is one of the leading causes of cancer death among women from Latin America. In the Region, screening programs face important problems to assure follow-up/treatment, which is a major obstacle for screening effectiveness. Human papillomavirus (HPV) testing has become the main strategy to reduce the burden of the disease. However, HPV positivity can have an important negative impact on the psychosocial health of tested women. In addition, for many Latin-American women, information provided by health providers about HPV is often confusing; women have difficulties in understanding HPV-test results and steps to follow. Both HPV’s psychosocial impact of HPV-testing, and lack of information regarding the follow-up process might not only diminish women's quality of life but also reduce their retention to follow up. The specific aims of this project are the following: AIM 1. To develop and test usability of an app to increase women knowledge about HPV/ CC/FU, reduce the psycho-social impact of HPV-testing and increase retention to follow-up. (R21 phase) AIM 2. To evaluate the implementation strategy and preliminary effectiveness outcomes of the app-based intervention and identify barriers and facilitators to the implementation. (R33 Phase) We will carry out a pilot implementation study of an app-based intervention aimed at providing HPV-tested with evidence-based information about HPV, reducing the psycho-social impact of HPV and increasing retention to follow-up. The app-based intervention will consist of an app to provide information and support to HPV-tested women, offered to women by trained health providers during the screening consultation.We will combine a user-centered design approach with behavioral models and Implementation Science frameworks to test, and evaluate the implementation strategy of the app-based intervention in PHC centers in Argentina. We will use a mixed methods descriptive design, composed of a quantitative Women study and a Quantitative -qualitative Study at Health provider level. Following Proctor´s taxonomy, in the Women Study we will evaluate acceptability, appropriateness, and adoption of the implementation strategy. To measure preliminary effectiveness outcomes we will carry out three quantitative surveys at different moments of the screening/follow-up process and we will analyze data from routine clinical records. In the Study of Health providers, we will carry out semi-structured interviews to analyze CFIR selected constructs. This study will provide evidence about the implementation strategy of an app-based intervention that will be ready for evaluation of its effectiveness in a randomized controlled trial. It will constitute a solid and sound example of how Implementation Science can be used to produce rigorous evidence-based information about implementation of mHealth interventions for cancer control.