Project Lead(s): Ophira Ginsburg
Breast cancer kills approximately 500,000 women every year, with almost 58% of deaths in developing countries. Limited capacity for early detection of serious breast problems by frontline healthcare workers in developing countries is one of the main barriers to better outcomes and most women do not seek timely care for breast cancer. As a result, mortality rates from breast cancer in countries like Bangladesh are as high as 80%.
The project sought to demonstrate the value of 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.
The study was a randomized controlled trial conducted in the Khulna Division of Bangladesh. Women in the study were randomized to:
- Assessment by a CHW equipped with a smart phone, with applications to guide the interview, report data, show a motivational video, and offer appointments for women with an abnormal CBE.
- Use of smart phone/apps identical to the first group by a CHW who also received training in ‘patient navigation’ to address potential barriers to seeking care.
- A control group where CHWs did not have smart phones and recorded information on paper.
The main outcome measured was adherence to advice regarding a clinic appointment for women with an abnormal CBE.
The study found that CHWs guided by the mobile health smart phone applications were more efficient and effective in breast health promotion, compared with those without a smart phone.
In addition, CHW ‘patient navigators’ were more effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance than those who just had access to mHealth tools (63.3% versus 43.5%).
The study team concluded that trained CHWs who were guided by smart phones were more efficient and effective than CHWs without these tools.
Results of the study have been widely disseminated via a high-impact, peer-reviewed journal, The Oncologist (January 2014), and at international conferences. The model of care continues to be used to educate women and encourage those with serious breast symptoms to come for care at the clinic, or the local hospital.
The mHealth platform has been adapted to a Transition To Scale grant with another grant, ‘the Kilimanjaro Cervical Screening Project’, which focused on cervical cancer in rural Tanzania. The goal of the combination of these two innovations was to provide a more complete approach for managing breast and cervical cancer in low-income countries.