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Obstetrics and gynaecology
Research
Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: mHealth and cervical cancer screening
  1. Ramin Asgary1,2,
  2. Helen Cole3,
  3. Philip Adongo4,
  4. Ada Nwameme4,
  5. Ernest Maya4,5,
  6. Amanda Adu-Amankwah5,
  7. Hannah Barnett1,
  8. Richard Adanu6,7
  1. 1 Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
  2. 2 Medicine, Weill Cornell Medical College, New York, NY, USA
  3. 3 Environmental Science and Technology, Autonomous University of Barcelona Barcelona Catalunya Spain, Barcelona, Spain
  4. 4 Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
  5. 5 Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
  6. 6 Dean, University of Ghana School of Public Health, Accra, Ghana
  7. 7 Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
  1. Correspondence to Dr Ramin Asgary; ga263{at}columbia.edu

Abstract

Objective To explore acceptability and feasibility of smartphone-based training of low-level to mid-level health professionals in cervical cancer screening using visual inspection with acetic acid (VIA)/cervicography.

Design In 2015, we applied a qualitative descriptive approach and conducted semi-structured interviews and focus groups to assess the perceptions and experiences of community health nurses (CHNs) (n=15) who performed smartphone-based VIA, patients undergoing VIA/cryotherapy (n=21) and nurse supervisor and the expert reviewer (n=2).

Setting Community health centres (CHCs) in Accra, Ghana.

Results The 3-month smartphone-based training and mentorship was perceived as an important and essential complementary process to further develop diagnostic and management competencies. Cervical imaging provided peer-to-peer learning opportunities, and helped better communicate the procedure to and gain trust of patients, provide targeted education, improve adherence and implement quality control. None of the patients had prior screening; they overwhelmingly accepted smartphone-based VIA, expressing no significant privacy issues. Neither group cited significant barriers to performing or receiving VIA at CHCs, the incorporation of smartphone imaging and mentorship via text messaging. CHNs were able to leverage their existing community relationships to address a lack of knowledge and misperceptions. Patients largely expressed decision-making autonomy regarding screening. Negative views and stigma were present but not significantly limiting, and the majority felt that screening strategies were acceptable and effective.

Conclusions Our findings suggest the overall acceptability of this approach from the perspectives of all stakeholders with important promises for smartphone-based VIA implementation. Larger-scale health services research could further provide important lessons for addressing this burden in low-income and middle-income countries.

  • smartphone
  • cervical cancer
  • sub-Saharan Africa
  • screening
  • community health nurses
  • feasibility
  • acceptability
  • VIA

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-030528

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    Footnotes

    • Contributors RA and HC made substantial contributions to this study including conception and design, analysis and interpretation of data, technical and material support and supervision, drafting and critical revision of the manuscript for important intellectual content, and the approval of final version of the manuscript. PA and RAd made substantial contributions to this study including conception and design, technical and material support and supervision, critical revision of the manuscript for important intellectual content, and the approval of final version of the manuscript. AN, EM and AAA made substantial contributions to this study including data collection and technical and material support and supervision and the approval of final version of the manuscript. HB made contribution to the analysis and interpretation of data and the final approval of the manuscript.

    • Funding This study was partially funded by the New York University Institute of Global Health, Global Health Challenge Fund.

    • Competing interests None declared.

    • Ethics approval This study was approved by the Noguchi Institute Institutional Review Board in Ghana as well as New York University School of Medicine (Protocol # s14-01466).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

    • Patient consent for publication Not required.