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 decisionmaking
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 smartphonebased
VIA implementation. Larger-scale health services
research could further provide important lessons for
addressing this burden in low-income and middle-income
countries.
