Implementation of human papillomavirus video education for women participating in mass cervical cancer screening in Tanzania

The reliability and quality of short videos as health information of guidance for lymphedema: a cross-sectional study

Background

The prevalence of lymphedema is rising, necessitating accurate diagnostic and treatment information for affected patients. Short video-sharing platforms facilitate access to such information but require validation regarding the reliability and quality of the content presented. This study aimed to assess the reliability and quality of lymphedema-related information on Chinese short video-sharing platforms.

Methods

We collected 111 video samples addressing the diagnosis and treatment of lymphedema from four platforms: TikTok, Bilibili, WeChat, and Microblog. Two independent surgeons evaluated each video for content comprehensiveness, quality (using the Global Quality Score), and reliability (using the modified DISCERN tool). The videos from different sources were subsequently compared and analyzed.

Results

Out of 111 videos analyzed, 66 (59.46%) were uploaded by medical professionals, including breast surgeons, vascular surgeons, plastic surgeons, physical therapists, and gynecologists, while 45 (40.54%) were shared by non-medical professionals such as science bloggers, medical institutions, and lymphedema patients. Patient-uploaded videos received the highest engagement, with median likes of 2,257 (IQR: 246.25-10998.25) and favorites of 399 (IQR: 94.5-1794.75). 13 videos (11.71%) contained inaccuracies. Medical professionals' videos generally showed higher content comprehensiveness, particularly those by plastic surgeons, compared to non-medical professionals. The GQS and modified DISCERN tool were used to assess video quality and reliability respectively, with medical professionals scoring higher on both metrics (z = 3.127, p = 0.002; z = 2.010, p = 0.044). The quality and reliability of recommendations provided by plastic surgeons surpassed that of other medical professionals (χ 2 = 16.196, p = 0.003; χ 2 = 9.700, p = 0.046). No significant differences in video quality and reliability were found among the three categories of non-medical professionals (χ 2 = 3.491, p = 0.175; χ 2 = 2.098, p = 0.350).

Conclusion

Our study shows that lymphedema-related videos on short video platforms vary widely in quality. Videos by medical professionals are generally more accurate and of higher quality than those by non-professionals. However, patient-uploaded videos often get more engagement due to their relatability. To ensure public access to reliable information, establishing basic standards for this content is essential.

Validation and usability of SeDAR e-health video for enhancing cervical cancer screening

BACKGROUND

The cervical cancer (CC) incidence rate is increasing among young women aged <50 years despite early screening is proven effective. Electronic health (e-health) has great potential for disseminating health education.

METHODS

This study validated a newly developed e-health tool "SeDAR®" and assessed its usability via evaluations by health experts (HE), media experts (ME), and women. The SeDAR® content was developed based on protection motivation theory (PMT) using the nominal group technique and in-depth interviews that involved HE and women, respectively. Content validation was performed among the HE (n = 12) and ME (n = 5) using the content validation index (CVI) to identify their agreement. Subsequently, the Video Engagement Scale (VES®) was used to validate SeDAR® among women of different ethnicities (n = 11) to achieve ecological validity. The experts and women also commented on the presentation of the video.

RESULTS

The validation yielded a good CVI among the HE (scale-level CVI-average [SCVI/Ave] = 0.986; scale-level CVI-universal agreement [SCVI/UA] = 0.900) and ME (SCVI/Ave = 0.979, SCVI/UA = 0.897). The highest VES® score [mean (±SD) = 92.90(±3.46)] proved the ecological validity of SeDAR®. The experts' feedback established that SeDAR® conveyed a clear message about awareness of performing CC screening and was suitable for public viewing. The women considered SeDAR® easy to understand, and it advised early exposure for early CC screening.

CONCLUSIONS

SeDAR® was valid and could constitute an important e-health tool to improve motivation and uptake of CC screening.

"In the Village That She Comes from, Most of the People Don't Know Anything about Cervical Cancer": A Health Systems Appraisal of Cervical Cancer Prevention Services in Tanzania

INTRODUCTION

Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations.

METHODS

We adapted Risso-Gill and colleagues' framework for a Health Systems Appraisal (HSA), to identify HCPs' perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018-participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology.

RESULTS

Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs.

CONCLUSIONS

Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.

The effectiveness of visual-based interventions on health literacy in health care: a systematic review and meta-analysis

BACKGROUND

Limited Health Literacy (HL) is an obstacle to accessing and receiving optimal health care and negatively impacts patients' quality of life, thus making it an urgent issue in the health care system. Visual-based interventions are a promising strategy to improve HL through the use of visual aids and pictorial materials to explain health-related concepts. However, a comprehensive summary of the literature on the topic is still scarce.

METHODS

To fill this gap, we carried out a systematic review and meta-analysis with the aim to determine the effectiveness of visual-based interventions in improving comprehension of health related material in the clinical population. Independent studies evaluating the effectiveness of visual-based interventions on adults (> 18 years) and whose primary outcome was either health literacy (HL) or comprehension were eligible for the review. After a systematic literature search was carried out in five databases, 28 studies met the inclusion criteria and thus were included. Most of the studies were randomized controlled trials and they focused on HL and health knowledge as outcomes.

RESULTS

The review and meta-analysis showed that visual-based interventions were most effective in enhancing the comprehension of health-related material compared to traditional methods. According to meta-analytic results, videos are more effective than traditional methods (Z = 5.45, 95% CI [0.35, 0.75], p < 0.00001) and than the employment of written material (Z = 7.59, 95% CI [0.48, 0.82], p < 0.00001). Despite this, no significant difference was found between video and oral discussion (Z = 1.70, 95% CI [-0.46, 0.53], p = 0.09).

CONCLUSIONS

We conclude that visual-based interventions, particularly the ones using videos, are effective for improving HL and the comprehension of health-related material.

Evaluation of video-assisted HPV education in government-supported clinics in Western Kenya

Despite prevalent preventative methods of human papillomavirus (HPV), cervical cancer remains the foremost cause of cancer-related death among women of reproductive age in Western Kenya. HPV self-sampling is a preventative measure that can improve accessibility and availability to cervical cancer screening. Correct education about HPV is crucial to combating stigma and increasing HPV screening uptake. In this study, we evaluated the workflow impact of a video-assisted HPV education to promote self-sampling in clinical settings in Kisumu, Kenya. We conducted a descriptive workflow study nested in a two-part cluster-randomized control trial in six government-supported health clinics in Kisumu County. We observed the workflow of HPV screening video-assisted and standard health educations. and evaluated community and clinic health assistant facilitation (CCHA), duration, and feasibility of the intervention. Thirty HPV screening-eligible women who participated in the video intervention were recruited for three focus group discussions (FGDs). The FGDs aimed to better understand women's experience with the video screening, their impressions on the content, and feedback about intervention logistics. Across 33 observations, 16.5 women per day watched the educational video at intervention clinics, and 14 women per day heard standard Ministry of Health cervical cancer prevention education talks at control clinics. Sixty-three percent of women participated in HPV self-sampling in the intervention sites, compared to forty-six percent who screened after standard health talks at control sites. The workflow observations identified variable video projection and viewing space, access to power supply, and CCHA availability and ability to utilize the projector as major factors impacting education workflow. Women in FGDs appreciated the video modality, length of video, and education location. HPV video education is a suitable intervention, with further research recommended to determine the viability of sustainably implementing the intervention in a clinic environment. This research is fully funded by the Duke University Global Health Institute.

The effectiveness of health education interventions on cervical cancer prevention in Africa: A systematic review

Low levels of knowledge and awareness on cervical cancer play a role in limiting cervical cancer prevention uptake. This systematic review aimed to identify effective educational interventions to increase cervical cancer awareness, knowledge, and subsequently screening or vaccination uptake in African women. A literature search was conducted in Medline and EMBASE databases. We examined original, peer-reviewed English literature published between 2005 and 2020. Nineteen studies examining health education interventions' impact on awareness, knowledge, and screening or vaccination uptake in African women were included. Ten studies were controlled trials, nine performed pre- and post-measurements in one group. Most studies were published between 2015 and 2020 (86%), many were from Nigeria (47%). Studies were mostly set up in communities and schools. The most frequently used intervention was lectures, alone or combined with videos and practical demonstrations. Sixteen studies evaluated knowledge or awareness, and all showed a statistically significant improvement following the intervention. Of the ten studies that evaluated screening uptake, either as the single outcome or combined with knowledge or awareness, six found a significant rise in screening uptake after intervention. Educational interventions increased knowledge and awareness in African women, some boosted uptake of cervical cancer screening, especially when using peer health educators and culturally tailored methods. Innovative approaches such as self-collected HPV testing and mHealth also demonstrated a potential to increase uptake of screening. More research is needed to identify and analyse barriers to screening uptake, which can still be present even after a successful educational intervention.

Empirical investigation of e-health intervention in cervical cancer screening: A systematic literature review

Cervical cancer (CC) screening can detect the cancer early but is underutilized, especially among the developing countries and low- to middle-income countries. Electronic health (e-health) has the potential for disseminating health education and is widely used in the developed countries. This systematic literature review investigates the effectiveness of e-health intervention for improving knowledge of CC and the intention or uptake for CC screening. We followed the PRISMA 2020 guideline and registered with PROSPERO (registration ID CRD42021276036). We searched the Web of Science, Scopus and EBSCO Medline Complete databases for eligible studies. Studies that conveyed informational material through e-health intervention were selected. The results were analyzed using narrative synthesis, and the pooled estimates were calculated using meta-analysis. A total of six studies involving 1886 women were included in this review. The use of e-health aids alone led to increased knowledge. The meta-analysis demonstrated that the mixed-education method of e-health movies and video education with didactic sessions increased CC screening uptake. A random-effects model revealed that CC screening uptake following e-health interventions were almost double of that of their comparison (odds ratio = 2.29, 95% confidence interval: 1.28–4.10, p < 0.05). Various areas of study demonstrated e-health intervention effectiveness (minority communities, urban areas, rural areas). Health education through e-health intervention has huge potential for promoting CC screening in the community. Nevertheless, the use of appropriate frameworks, user engagement and culturally tailored e-health need to be prioritized.

Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment

PURPOSE

Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi.

METHODS

We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience.

RESULTS

Both pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%).

CONCLUSION

Standardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.

The Impact of Video-Based Educational Interventions on Cervical Cancer, Pap Smear and HPV Vaccines

Background: Video-based interventions have the potential to contribute to long-lasting improvements in health-seeking behaviours. Ghana's upsurge rate of information and communication technology usage presents an opportunity to improve the awareness of HPV vaccination and screening rates of cervical cancer among women in Ghana. This research aimed to assess the impact of video-based educational intervention centred on the Health Belief and Transtheoretical Models of behavioural changes in promoting HPV vaccination, cervical carcinoma awareness and willingness to have Pap smear test (PST) among women in Ghana. Methods: To achieve the intended sample size, convenient, purposive and stratified random sampling techniques were used. SPSS v. 23.0 was used in the data analysis. Percentages and frequencies were used to represent participants' demographic characteristics, knowledge of (1) cervical carcinoma, (2) human papillomavirus vaccine, and (3) Pap smear test. The chi-square test by McNemar was employed to evaluate variations in the post- and pre-intervention responses. A p-value < 0.05 was considered statistically significant. The level of significance was adjusted owing to multiple comparisons by using the Bonferroni's correction. Results: Before the intervention, 84.2% of the participant had some knowledge or information about cervical cancer, but after the intervention, 100% of the participant became aware of cervical cancer which represents 15.8% increment at a P < .001. The willingness to have a pap smear test increased from 35.8% to 94.2% (df = 58.4%, P < .001) after the educational intervention. The willingness to be vaccinated increased from 47.5% to 81.7% (df = 34.2%, P < .001) after the educational intervention. Six months after the intervention, participants were followed-up. 253 (42.2%) participants had gone for cervical cancer screening (Pap smear test) while 347 (57.8%) participants had not been screened. In terms of HPV vaccination, 192 participants (32.0%) had begun their HPV vaccination cycle. Conclusion: The study results show that health education, using videos, may be influential in perception changing, self-efficacy improvement and the understanding of cervical carcinoma screening and HPV vaccination.