Use of mobile phone short text message service to enhance cervical cancer screening at the Thika Level 5 Hospital, Kiambu County, Kenya.
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Cervical cancer is a major public health problem among adult women especially in developing countries and its control is of paramount importance. Organized screening programmes have led to a large decline in cervical cancer incidence and mortality in developed countries. In Kenya very few women at risk have regular repeat cervical cancer screening and there exists no effective recall mechanism to enhance scheduled screening. The Short Message Service (SMS) Text may be used as a recall tool to enhancing cervical cancer screening in developing countries such as Kenya where other communication means may not be easily available. This blinded randomized controlled trial where participants were recruited from among eligible women attending the general female outpatient clinic at Thika Level 5 hospital; randomly allocated to an intervention (SMS text reminders) arm and a control (no SMS) study aimed to determine the influence of using SMS text reminders in enhancing adherence to scheduled repeat screening for cervical cancer. Data was collected using interview guide and analyzed using STATA version 11. Categorical variables were summarized by frequencies and proportions while continuous variables were summarized by means, medians and standard deviations. Chi square test was used to establish the relationship between categorical variables while logistical regression analysis was conducted to evaluate the influence of the independent variables on adherence to scheduled screening while using the SMS reminders. The mean age of the participants was 38.8 ± 10.8, most were married and of low socio- economic status. Only 20% of the eligible women attending the general outpatient’s clinic had ever been screened with only 8.8% having had regular screening. A total of 7.4% of the study population had abnormal cytological smears of which 3.2% were invasive cancer. It was found that 67.1% of participants in the intervention arm and 20.3% in the control arm re-attended to rescreening at end line as scheduled. The participants who received SMS text reminders were 8 times more likely to adhere to scheduled rescreening than those who did not (OR 8.02; CI 95% 4.69-13.73; p-<0.001). The age group 30-34 years, participants those whose spouses were employed and those who used public transport to access the hospital were significantly associated with return to scheduled screening after sending SMS text reminders (OR 2.24 P<0.005); (OR 2.2 P<0.05); (OR3.29 P< 0.005) respectively. On multiple logistical analyses having owned a mobile phone for more than two years was found to be more important in influencing re-attendance if one was educated above secondary school level. It was concluded that many women attending the general outpatient’s clinic were not screened and almost 10% of such women had abnormal cervical lesions including cervical cancer. Screening such women and reminding them of the next screening dates increases their chances of adherence to scheduled screening by up to 8 times when compared to those not reminded. The study recommended that the Short Text Message Service (SMS) reminders should be integrated into the cervical cancer screening programmes and cervical cancer screening services should be integrated in the female general outpatient clinic.