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mHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana

Asgary, Ramin MD, MPH; Adongo, Philip Baba PhD; Nwameme, Adanna MD, MPH; Cole, Helen V.S. MPH; Maya, Ernest MD, MPH; Liu, Mengling PhD; Yeates, Karen MD, MPH; Adanu, Richard MBChB, MPH; Ogedegbe, Olugbenga MD, MPH

Journal of Lower Genital Tract Disease: July 2016 - Volume 20 - Issue 3 - p 239–242
doi: 10.1097/LGT.0000000000000207
Original Research Articles: Cervix and HPV

Objective There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA).

Materials and Methods During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging–supported VIA training by an expert VIA reviewer.

Results Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen κ statistic was 0.67 (95% CI = 0.45–0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services.

Conclusions Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.

This article describes an mHealth intervention to train community health nurses to perform cervical cancer screening using visual inspection with acetic acid in Ghana.

1Departments of Medicine and Population Health, NYU School of Medicine, New York, NY; 2Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Legon, Ghana; 3Doctorate Program in Public Health, CUNY Graduate Center and CUNY School of Public Health, New York, NY; 4Population, Family and Reproductive Health Department, University of Ghana School of Public Health, Accra, Ghana; 5Division of Biostatistics, Department of Population Health, NYU School of Medicine, New York, NY; and 6Department of Medicine, Queen's University, Kingston, Ontario, Canada

Reprint requests to: Ramin Asgary, MD, MPH, Departments of Medicine and Population Health, New York University School of Medicine, 227 East 39th Street, Rm 639, New York, NY 10016. E-mail:

The authors have declared they have no conflicts of interest.

Partially funded by the New York University Institute of Global Health, Global Health Challenge Fund.

The study was approved by the Noguchi Institute Institutional Review Board in Ghana and New York University School of Medicine.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology