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

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.

Grant Number: 4R33CA284314-02
NIH Institute/Center: NIH
Principal Investigator: Silvina Arrossi