Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 14, 2021
Date Accepted: Apr 18, 2022
Effects of Theory-Based Educational Intervention and WhatsApp Follow-Up on Pap Smear Uptake (PSU Intervention) among Post-Natal Women, Malaysia: Randomized Controlled Trial
ABSTRACT
Background:
Despite the availability and accessibility of free Pap smear test as a screening tool for cervical cancer, the rate of Pap smear test uptake remains unchanged over the last 15 years in Malaysia. High coverage of Pap smear uptake is shown to improve mortality rate. Furthermore, factors that contributed to low Pap smear uptake in Malaysia were beyond individual factors and the use of mobile technology could help to improve Pap smear uptake. However, there is lack of intervention studies that go beyond the individual factors and evaluate the use of mobile technology particularly WhatsApp application.
Objective:
The study aims to determine the effect of theory-based educational intervention and WhatsApp follow up to improve Pap smear uptake among post-natal women in a district in Malaysia.
Methods:
This is a two-armed, parallel single-blind cluster randomized controlled study among post-natal women in Seremban District. Twelve health clinics were randomly allocated to be in the intervention and control groups with a ratio of 1:1. This two phase intervention module was developed using Social Cognitive Theory and was delivered via face-to-face in the first phase and WhatsApp follow up in the second phase. Participants were follow-up at immediate, 4 weeks-, 8 weeks- and 12 weeks post-intervention. Primary outcome was Pap smear uptake and secondary outcomes include scores of knowledge, attitude and self-efficacy for Pap smear screening and intention to adhere to Pap smear practice. The data was analysed using IBM Statistical Package for Social Science (SPSS) version 25 and generalized mixed model was used to determine the effectiveness the intervention. α value will be set at below 0.05.
Results:
A total of 401 post-natal women were recruited with total response rate of 82.5%. There was a significant difference between the intervention and control groups in the Pap smear uptake (F(4,1178) = 3.222, p = <0.001), knowledge scores (F(4, 1172) = 14.946, p = <0.001), attitude scores (F(4, 1172) = 24.417, p = <0.001) and self-efficacy scores (F(1, 1172) = 10.432, p = <0.001). However, no significant difference in the intention to adhere to Pap smear practice between the intervention and the control groups (F(4, 1180) = 0.878, p = 0.476).
Conclusions:
This study shows that Social Cognitive Theory-based intervention and WhatsApp follow up is an effective intervention for improving the Pap smear uptake among post-natal women in Seremban District in Malaysia. This intervention module can be tested in other women’s population to evaluate the effect of this theory and WhatsApp follow up on the Pap smear uptake. Clinical Trial: Thaiclinicaltrials.org TCTR20200205001; https://www.thaiclinicaltrials.org/show/ TCTR20200205001
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