An mHealth Model to Increase Clinic Attendance for Breast Symptoms in Rural Bangladesh: Can Bridging the Digital Divide Help Close the Cancer Divide?

被引:53
作者
Ginsburg, Ophira M. [1 ,2 ,3 ]
Chowdhury, Mridul [4 ]
Wu, Wei [1 ]
Chowdhury, M. D. Touhidul Imran [4 ]
Pal, Bidhan Chandra [4 ]
Hasan, Rifat [4 ]
Khan, Zahid H. [5 ]
Dutta, Dali [1 ]
Abu Saeem, Arif [4 ]
Al-Mansur, Raiyan [5 ]
Mahmud, Sahin [4 ]
Woods, James H. [6 ]
Story, Heather H. [6 ]
Salim, Reza [5 ]
机构
[1] Univ Toronto, Womens Coll Res Inst, Toronto, ON, Canada
[2] Univ Toronto, Fac Med, Toronto, ON, Canada
[3] Univ Toronto, Dalla Lana Fac Publ Hlth, Toronto, ON, Canada
[4] mPower Social Enterprises, Dhaka, Bangladesh
[5] Amader Gram, Khulna, Bangladesh
[6] Int Breast Canc Res Fdn, Madison, WI USA
关键词
Breast cancer; Community health workers; Health promotion; Patient navigation; COUNTRIES; TRIAL;
D O I
10.1634/theoncologist.2013-0314
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective. To demonstrate proof of concept for a smart phone-empowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. Methods. This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door-to-door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/applications identical to Arm A plus CHW had training in "patient navigation" to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the "adherence" (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. Results. In 4 months, 22,337 women were interviewed; <1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. Conclusion. CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW "navigators" were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance.
引用
收藏
页码:177 / 185
页数:9
相关论文
共 21 条
[1]   Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study [J].
Abuidris, Dafalla Omer ;
Elsheikh, Ahmed ;
Ali, Majdeldien ;
Musa, Hassan ;
Elgaili, Elgaili ;
Ahmed, Anas O. ;
Sulieman, Imadeldien ;
Mohammed, Sulma Ibrahim .
LANCET ONCOLOGY, 2013, 14 (04) :363-370
[2]   Breast cancer screening: review of benefits and harms, and recommendations for developing and low-income countries [J].
Al-Foheidi, Meteb ;
Al-Mansour, Mubarak M. ;
Ibrahim, Ezzeldin M. .
MEDICAL ONCOLOGY, 2013, 30 (02)
[3]  
[Anonymous], 2009, CANC REG REP NAT I C
[4]   Experiences of breast cancer survivor-advocates and advocates in countries with limited resources: A shared journey in breast cancer advocacy [J].
Errico, KA ;
Rowden, D .
BREAST JOURNAL, 2006, 12 (01) :S111-S116
[5]  
Free C, 2013, PLOS MED, V10, DOI [10.1371/journal.pmed.1001363, 10.1371/journal.pmed.1001362]
[6]  
Ginsburg OM, J CANC POLI IN PRESS
[7]   Breast Cancer: A Neglected Disease for the Majority of Affected Women Worldwide [J].
Ginsburg, Ophira M. ;
Love, Richard R. .
BREAST JOURNAL, 2011, 17 (03) :289-295
[8]  
Knaul FeliciaM., 2012, Closing the Cancer Divide: An Equity Imperative
[9]  
Mechael P., 2010, Barriers and gaps affecting mHealth in low and middle income countries: Policy white paper
[10]  
mHealth, 2011, GLOB OBS EHEALTH SER, V3