JMIR Publications

ABSTRACT

Background:

Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian (AI) women. AI women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among AI women. This study utilized mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for AI women in a remote, rural community in the Northern Plains.

Objective:

This study aimed to assess the feasibility and efficacy of the mobile web app mammogram intervention (wMammogram), which was designed to motivate AI women to undergo breast cancer screening, as compared with the control group who received an educational brochure.

Methods:

Employing community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. Our study involved 122 AI women between the ages of 40 and 70, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention.

Results:

A significantly higher proportion of women who received the wMammogram intervention (42%, 26/62; p<.01) completed mammograms by the 6-month follow-up than the control group (20%, 12/60). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22, p<.001), increase in knowledge (t120=-4.75, p<.001), and satisfaction with the intervention (t120=-3.61, p<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (100%, 62/62 vs. 85%, 51/60) and were more willing to recommend the intervention they received to their friends (98.4%, 61/62 vs. 90%, 54/60) with statistically significant differences.

Conclusions:

This study shows the feasibility and efficacy of the mobile web app mammogram intervention to promote breast cancer screening for AI women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach AI populations. Clinical Trial: Clinicaltrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603