Background: An estimated one in eight cervical cancer cases is due to lack of follow-up care for abnormal Pap smear results. Low rates of completion of follow-up care particularly affect low-income and minority women and women from rural areas (SEER, 2014). The burden of cervical cancer could be significantly reduced through interventions that improve timely follow-up and treatment. Mobile communications via text messaging may present a low-cost opportunity to increase rates of clinic return among women referred to follow-up on abnormal primary cervical cancer screening results.
Purpose: To determine the acceptability and feasibility of using text messaging as a means of increasing completion of follow-up care following an abnormal cervical cancer screening result. We also examined factors that may affect the acceptability and use of text messaging to increase communications between health care providers and low-income and minority women.
Methods: Study participants were 15 African American and low-income women who had undergone a Pap smear within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person, depending on participant preference. 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 women in the study (93%) were comfortable receiving a text message from a health care provider stating that their Pap smear results were available (age <40 years:100%; age ≥40: 86%).Over half (53%) of all women were comfortable receiving a text message stating that their Pap smear results were abnormal, though many preferred to receive that information via a phone call (40%). The majority of participants (53%) indicated that text message was the best way to receive a reminder to come back to the clinic, though 40% preferred a call from a provider. Most participants (60%) believed receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving such a reminder appeared to vary by age. Analysis of open-ended questions suggested that text messaging to communicate with providers appeals to some women because of its wide use and convenience. However, several participants did report barriers to text messaging, including the lack of texting proficiency and difficulty in texting and a lack of confidence in their comprehension of the content of a text message. Most participants also reported some concerns over privacy and confidentiality of health information communicated by text.
Conclusions: Most participants indicated a willingness to receive text messages from their health care providers on the results of their cervical cancer screening and believed that text messages were the best way to remind them of their appointment for follow-up care. Concerns about privacy of health information could be addressed by minimizing reference to the nature of an appointment in the message. While text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered in the use of this technology--possibly by allowing patients to opt out of text communications. Further research is needed to assess the feasibility and effectiveness of this approach to improve adherence to follow-up in high-risk populations.
Citation Format: LaHoma Smith Romocki, Leslie Cofie, Andrea Des Marais, Theresa Curington, Chelsea Anderson, Jennifer S. Smith. Acceptability of text messaging for communication of health information among Black and low-income women following abnormal cervical cancer screening [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B08.