African American women in the United States continue to be disproportionately burdened by cervical cancer. The incidence rate is 41% higher in black women than white women. Black women are also twice as likely to die from the disease. The 5-year survival rate is 58% for black women. It is 69% for white women. And yet, it does not have to be this way. A multifaceted preventive approach could potentially eliminate all new cases. There are a number of challenges, however, to implementing this preventive approach among African American women. Only 41% of black female adolescents have completed the 3-dose HPV vaccination series. Due to this suboptimal vaccination coverage, promotion of safer sexual practices is another key HPV prevention tool. For men, increasing male latex condom use is a behavior. For women, it is a goal. Therefore, attempts to increase condom use for women must include condom negotiation and problem-solving skills training. Finally, cervical cancer is one of the few cancers where widespread screening (and proper follow-up) can eliminate most new cases. However, the time to diagnostic resolution and treatment initiation is slowest among African American women. To combat this, community health workers (CHWs) and patient navigators (PNs) aim to improve patient outcomes across the cancer care continuum. Both have been shown to be effective. The ongoing challenge is to reduce the cost of CHW/PN services while tailoring them to the particular groups most in need. One emerging cost-effective solution is the use of mobile technology. To our knowledge, no mobile intervention has been developed to reduce cervical cancer health disparities among African American women. We intend to fill this void. Our proposed program will aim to increase HPV vaccination coverage, promote safer sexual practices, increase cervical cytology, and improve follow-up to abnormal Pap results. It will be theory-based, targeted, tailored, and personalized. The Health Belief Model will guide the development of an assessment of preventive barriers. Users will receive three types of texts: reminders for screenings and follow-ups, educational, and supportive messages. Finally, the program will include three web-based video components: scripted vignettes, unscripted peer narratives, and educational instruction. By developing an intervention using a technology that is part of the everyday lives of the overwhelming majority of African American women, the aim is to reduce cervical cancer disparities. Eight healthcare staff members will be recruited for a focus group discussion to help shape the proposed intervention. Similarly, 42 African American women will be recruited for predevelopment focus group discussions. When the prototype is completed, the 42 target end-users will return for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.
This project aims to develop a mobile phone-based program designed to eliminate cervical cancer disparities among African American women. In clinics without established patient navigation services, the proposed intervention could be used as a stand-alone product. Alternatively, it could be integrated into existing cancer related patient navigation to further augment these services. For African American women, the skills contained in this program will help them prevent cervical cancer.
