Three Telehealth Interventions for Women’s Health — Cervical Health Awareness Month
January is Cervical Health Awareness Month.
Cervical cancer is a leading cause of death for women in the United States, and almost all cervical cancer cases are linked to infections with high-risk strains of HPV virus.
mHealth interventions can be used to educate patients and send reminders about screenings, and to increase HPV vaccine education.
Tele-Colposcopy is a strategy that can be used to increase access to specialized gynecological services by removing geographic and distance barriers.
January 16, 2021 — January is Cervical Health Awareness Month (1), and to do my part in promoting this, I decided to write an article on telehealth applications for cervical health.
Check out the National Cervical Cancer Coalition website for more information.
Cervical cancer used to be the leading cause of cancer death for women in the United States, however, in the past 40 years, the number of cases and the number of deaths from cervical cancer have decreased significantly (2). Among the many reasons for this decline is the widespread use of cervical cancer screening tools like the HPV Test and the PAP Test. In addition, the HPV vaccine is available, which protects against the high-risk strains of the HPV viruses associated with cervical cancer.
In 2017, the United States saw 12,831 new cases of cervical cancer, and 4,207 women died of this cancer. This cancer affects all women, however, hispanic and black women have a higher incidence. By age, middle age women — between the ages of 35 to 44 — are mostly affected by cervical cancer (3).
Worldwide, cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide and about 311,000 women died from the disease worldwide (4).
Since 2020 saw an accelerated adoption of telehealth and telemedicine given the COVID-19 public health emergency, let’s go over three telemedicine applications for cervical cancer prevention and screening.
mHealth to educate patients on the importance of cervical cancer screening
Digital notifications and texting can be an effective intervention for reminders and education on the importance of cervical cancer screening.
2020 — Zhang et.al. did a systematic review of eight articles related to the use of mHealth in low- and middle-income countries for education of cervical cancer screening. The authors found that the use of mHealth led to increased uptake of PAP tests (5).
Here are examples of some mHealth interventions:
South Africa — SMS to patients focusing on education of cervical cancer and the importance of screening
Tanzania — SMS to patients encouraging cervical cancer screenings, eVouchers via SMS, SMS with location and hours of closest screening clinics
Iran — SMS to patients with infographics, videos and podcasts about cervical cancer screening
Brazil — SMS to patients focused on education of cervical cancer prevention, SMS with reminders of cervical cancer screening
Malasya — SMS to patients with reminders about cervical cancer screening
Benefits of using mHealth for education on cervical cancer screening:
Increased access to quality information
Increased awareness of the patient about the importance of cancer screening
Cost-effective intervention using a widely available technology
Increased patient engagement and increased uptake of PAP tests
mHealth interventions to increase HPV vaccine education
The HPV vaccine can protect patients against high-risk strains of the HPV virus, which are a cause of cervical cancer.
Almost all cervical cancer cases (99%) are linked to infection with high-risk HPV viruses. Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women (4). The HPV vaccine can help protect patients against high-risk HPV viruses.
In 2018, nearly half (51.1%) of US teens were fully vaccinated against HPV (6). These numbers need to improve. Barriers to higher vaccination rates include: 1) misinformation received from the internet, and 2) parental vaccine hesitancy (7).
Dr. Henna Budhwani (medical sociologist) and Dr. Tina Simpson (pediatrician) at the University of Alabama at Birmingham (UAB) are developing and testing the use of mHealth interventions to increase vaccine education and to reduce vaccine hesitancy (8)
mHealth interventions in the form of digital notifications, SMS, and health apps can be used to:
Increase parental education
Establish a reminder system
Increasing access to HPV vaccine providers
Increase education for providers of HPV vaccine
Tele-Colposcopy
A digital Colposcope
When a woman has an abnormal PAP test, a Colposcopy can be performed to do an up-close examination of the woman’s cervix. During a Colposcopy, a physician can identify what area of the cervix is affected and require biopsy. With the biopsy, the physician can then determine if there is cancer or not.
The University of Arkansas for Medical Sciences (UAMS) developed a program to service rural areas where patients had limited access to colposcopies (9). An advanced nurse practitioner — trained in the mechanics of colposcopy — performs the colposcopy at the patient site, and collects biopsy specimens under the real-time interactive supervision of an experienced UAMS Obstetrics-Gynecology faculty located at the medical center. The program results were comparable to traditional examinations.
Benefits of the Tele-Colposcopy program:
Improved access to care by removing geographic and financial barriers
Positive patient satisfaction of the tele-colposcopy program
Good cost-effectiveness when compared to traditional colposcopy services
As digital technology continues to positively impact health care, these interventions will become standard of care. Spread the message during the Cervical Health Awareness Month. Share this article with everyone. Feel free to contact me if you have any comments or questions about this article.
References
National Cervical Cancer Coalition. Cervical Cancer Awareness Month. https://www.nccc-online.org/cervical-health-awareness-month/ Accessed: 01/15/2021
CDC. United States Cancer Statistics: Data Visualization. Leading Cancer Cases and Deaths, All Races/Ethnicities, Female, 2017. https://gis.cdc.gov/Cancer/USCS/DataViz.html Accessed: 01/15/2021
CDC. United States Cancer Statistics: Data Visualization. Rate of New Cancers, Cervix, 2017. https://gis.cdc.gov/Cancer/USCS/DataViz.html Accessed: 01/15/2021
WHO. Cervical Cancer. https://www.who.int/health-topics/cervical-cancer#tab=tab_1 Accessed: 01/15/2021
Zhang D, Advani S, Waller J, et al. Mobile Technologies and Cervical Cancer Screening in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol. 2020;6:617-627. https://dx.doi.org/10.1200%2FJGO.19.00201
Melissa Jenco. AAP News. CDC: Teens’ HPV vaccination rates improve slightly. https://www.aappublications.org/news/2019/08/22/teenvaccination082219 Published: 08/22/2019. Accessed: 01/15/2021.
Dilley SE, Peral S, Straughn JM Jr, Scarinci IC. The challenge of HPV vaccination uptake and opportunities for solutions: Lessons learned from Alabama. Prev Med. 2018;113:124-131. https://doi.org/10.1016/j.ypmed.2018.05.021
Holly Gainer. Study aims to reduce HPV and COVID-19 vaccine hesitancy among teens in rural Alabama. https://www.uab.edu/news/research/item/11683-study-aims-to-reduce-hpv-and-covid-19-vaccine-hesitancy-among-teens-in-rural-alabama Published: 11/11/2020. Accessed: 01/15/2021.
Hitt WC, Low G, Bird TM, Ott R. Telemedical cervical cancer screening to bridge medicaid service care gap for rural women. Telemed J E Health. 2013;19(5):403-408. https://dx.doi.org/10.1089%2Ftmj.2012.0148
