JMIR Publications

ABSTRACT

Background:

An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap smear results. Low rates of completion of follow-up care particularly affects low-income, minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after abnormal screening results.

Objective:

Our aims were to: i) determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following an abnormal cervical cancer screening results and ii) examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP), and low-income, minority women.

Methods:

Study participants were 15 African American, low-income women who had undergone a Pap smear within the preceding 12 months. Semi-structured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Data were analyzed using a mixed methods approach. Responses to closed ended survey items were tabulated and descriptive statistics generated using Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software.

Results:

Nearly all participants (93%) were comfortable receiving a text message from a health care provider (HCP) stating that their Pap smear results were available (<40 years:100%; ≥40 years: 86%). Over half (53%) of participants were comfortable receiving a text message stating that their Pap smear results were abnormal, though many preferred to receive information via a phone call (40%). Most participants (60%) believed receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders to text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging.

Conclusions:

Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results, and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by not including explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to authorized individuals. While text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications.