JMIR Publications

ABSTRACT

Background:

Eight-five percent of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system level challenges in cervical cancer control. Yet, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.

Objective:

We aimed to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges to their implementation.

Methods:

A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from five academic databases and Google Scholar. Titles and abstracts were screened and full texts were reviewed for eligibility. A structured data extraction template was used to summarize information from included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.

Results:

In the 24 included studies, digital health strategies for cervical cancer control focused predominantly on cervical image capture, remote expert review, training health workers, and, less frequently, patient education. Most included studies were implemented in sub-Saharan Africa, with fewer studies in other LMIC regions such as Asia or South America. One study had low risk of bias, and three studies had a moderate risk of bias while the remaining 20 studies had a high risk of bias. Due to insufficient studies with robust study designs, matched outcomes or interventions, a meta-analysis of effectiveness was not possible. Existing strategies used digital health for improving women’s knowledge and awareness about cervical cancer, increasing access to cervical cancer services, improving training of health workers and availability of data, and ensuring continuity of care. Key challenges in implementing digital health strategies for cervical cancer control were related to the high burden of training, technology-specific issues, infrastructure challenges, challenges with technology reach and inequitable access to technology among target users.

Conclusions:

The current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with high burden of cervical cancer (e.g., South America), and test a greater diversity of digital strategies. Clinical Trial: The review protocol is registered with the PROSPERO database for prospectively registered systematic reviews (Protocol # CRD42017071560).