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An mHealth model to increase clinic attendance for breast symptoms in rural Bangladesh: can bridging the digital divide help close the cancer divide?

Randomized Controlled Trial

Affiliations

• ¹ Women's College Research Institute, Faculty of Medicine and Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada; mPower Social Enterprises, Dhaka, Bangladesh; Amader Gram, Khulna, Bangladesh; International Breast Cancer Research Foundation, Madison, Wisconsin, USA.

• PMID: 24396050
• PMCID: PMC3926788
• DOI: 10.1634/theoncologist.2013-0314

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Randomized Controlled Trial

Ophira M Ginsburg et al. Oncologist. 2014 Feb.

• ¹ Women's College Research Institute, Faculty of Medicine and Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada; mPower Social Enterprises, Dhaka, Bangladesh; Amader Gram, Khulna, Bangladesh; International Breast Cancer Research Foundation, Madison, Wisconsin, USA.

• PMID: 24396050
• PMCID: PMC3926788
• DOI: 10.1634/theoncologist.2013-0314

Item in Clipboard

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.

Keywords: Breast cancer; Community health workers; Health promotion; Patient navigation.

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Disclosures of potential conflicts of interest may be found at the end of this article.

Map of Bangladesh and its…

Map of Bangladesh and its six administrative divisions.

Map of Bangladesh and its six administrative divisions.

Study area map with insert.

Study area map with insert.

Study area map with insert.

Number of study participants who…

Number of study participants who had an abnormal clinical breast examination and their…

Number of study participants who had an abnormal clinical breast examination and their adherence rate. Adherence is the percentage of participants with abnormal breast examination who attended clinic for assessment (includes Amader Gram Breast Care Centre/Bagerhat walk-in clinics and local clinic/government hospital).

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