title: mHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana.
abstract: 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).
  
  
  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.
authors.affiliation: 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.
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.forename: Philip Baba
authors.initials: PB
authors.lastname: Adongo
authors.forename: Adanna
authors.initials: A
authors.lastname: Nwameme
authors.forename: Helen V S
authors.initials: HV
authors.lastname: Cole
authors.forename: Ernest
authors.initials: E
authors.lastname: Maya
authors.forename: Mengling
authors.initials: M
authors.lastname: Liu
authors.forename: Karen
authors.initials: K
authors.lastname: Yeates
authors.forename: Richard
authors.initials: R
authors.lastname: Adanu
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Ogedegbe
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage*; D000328:Adult; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D005869:Ghana; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage*; D064691:Nurses, Community Health; D010865:Pilot Projects; D000068997:Smartphone; D017216:Telemedicine / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid