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Feasibility of implementing cervical cancer screening program using smartphone imaging as a training aid for nurses

Drishti Sharma¹, Latika Rohilla¹, Rashmi Bagga²

¹School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Public Health Nursing (Boston, Mass.)

|May 29, 2018

Abstract

Background:

The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone-imaging for continuous training of nurses.

Design:

A cross-sectional design to assess the reliability of the nurse-led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made.

Sample:

Hospital-based purposive sampling was used to recruit participants.

Measures:

A structured questionnaire for recording participants' details, VIA findings and follow-up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone-images of cervix.

Results:

During October 2016-June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA-positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26-0.63) suggested moderate nurse-expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link-up.

Conclusion:

Appropriately trained nurses can reliably conduct screening. Real-time expert feedback might improve reporting. Rigorous awareness activities and on-site treatment can reduce drop-outs. The medical institute's involvement and administrative will were instrumental.

Keywords:

Smartphone VIA early detection of cancer low-resource setting nurses uterine cervical neoplasms

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