"I'm neither here, which would be bad, nor there, which would be good": the information needs of HPV+ women. A qualitative study based on in-depth interviews and counselling sessions in Jujuy, Argentina

Labels, Language, and Other Strategies to Improve Communication About Lower Grade Forms of Ductal Carcinoma In Situ of the Breast: A National Delphi Survey

Purpose: This study is aimed at generating consensus among women who had ductal carcinoma in situ (DCIS) and healthcare professionals on how to improve communication about low-risk forms of DCIS and reduce affected women's diagnosis-related confusion and anxiety. Methods: We conducted a two-round online Delphi survey with affected women and professionals from across Canada. They rated items sourced from prior research and key informant interviews on a 7-point Likert scale. We retained items rated 6 or 7 by ≥ 80% of panelists. Results: Thirty-seven panelists (17 women, 20 professionals) completed Round 1 and 94.6% of those completed Round 2. Of 42 items rated, 18 were retained, 13 discarded, and 11 did not achieve consensus to retain or discard. Women and professionals agreed on 3 language approaches (use plain language, distinguish DCIS from invasive breast cancer, specify the risk of recurrence and spread) and 9 other strategies to help discuss DCIS (e.g., use visual aids, provide or refer women to culturally tailored DCIS-specific information, ensure physicians can access interpreters). Based on rating and comments, women were more enthusiastic than professionals about referring to abnormal cells rather than DCIS and scheduling longer or follow-up visits to address concerns. To disseminate these findings, panelists recommended public awareness campaigns for women and continuing education and professional society endorsement for physicians. Conclusion: These findings address gaps in prior research that recommended changing the DCIS label, but had not fully explored label preferences, or identified other ways to improve and support communication about DCIS.

Information needs for cancer screening and associated factors of information-seeking behaviour: a qualitative systematic review

BACKGROUND

At present, the participation rate in cancer screening is still not ideal, and the lack of screening information or misunderstanding of information is an important factor hindering cancer screening behaviour. Therefore, a systematic synthesis of information needs related to cancer screening is critical.

METHODS

On July 23, 2024, we searched the Cochrane Library, MEDLINE (Ovid), Embase, EBSCO, PsycINFO, Scopus, ProQuest, PubMed, Web of Science, and CINAHL to collect qualitative or mixed-methods studies on information needs of cancer screening. We also searched for grey literature on OpenGrey and Google websites. Data were synthesised using Sandelowski and Barroso's framework. A top-down approach was adopted to group and synthesise the encodes and then generate analytical themes.

RESULTS

A total of 37 studies were included. The results of the analysis of cancer screening-related information needs content, cancer-specific information needs content, requirements and preferences for information, and associated factors of information-seeking behaviour were reported. Based on the event timeline, we summarised the information needs of the screening demand side into four themes. Their information needs focus on disease risk factors, signs and symptoms, the importance of screening, the benefits and harms of screening, the detailed screening process, and screening results and explanations. Regarding cancer-specific information needs content, we summarised the specific information needs of cervical, breast, colorectal, and lung cancer. By referring to relevant concepts in the Comprehensive Model of Information Seeking, we synthesised the requirements and preferences for information according to the themes of editorial tone, communication potential, recommended information channels, and recommended source place. The information-seeking behaviours of the screening demanders are mainly passive attention and active searching. The common factors leading to the passive attention of screening demanders are demographic factors and fear of cancer. The most common reason for them to actively search information is lack of information.

CONCLUSIONS

The list of information needs identified in this review can serve as a reference for health professionals and information service providers before carrying out screening-related work to help the cancer screening participants obtain valuable information.

Incorporating a mobile application to support communication about HPV testing among women and professionals: barriers and facilitators from the perspective of health professionals in a middle- and low-income setting in Argentina

Introduction

The delivery of positive Human papillomavirus (HPV) test results can have a psychosocial impact and act as a barrier for women to continue the cervical cancer (CC) prevention process. A previous formative research based on a woman's perspective indicated that a mobile app could be an acceptable and appropriate tool to help women obtain information and reduce fears related to a positive result. Based on these findings, we developed an app-based intervention that would function as a support for professionals who offer the HPV test and communicate their results. We report data on the perceptions of healthcare providers regarding the barriers and facilitators to the incorporation, in a low and middle-income context.

Methods

Qualitative study based on individual semi-structured interviews with health professionals. All the professionals (n =13) took HPV and Pap test samples and provided information on HPV testing, in the public health system of Ituzaingó, Greater Buenos Aires, Argentina. The themes explored were selected and analysed using domains and constructs of Consolidated Framework for Implementation Research (CFIR).

Results

Practitioners had a positive assessment of the intervention through most included constructs: adaptability, compatibility, complexity, relative advantage, belief in the validity and robustness of the intervention, innovation source and knowledge and beliefs about the intervention. However, some potential barriers were also identified including: adaptability, tensions for change, relative priority and leadership engagement. Practitioners conditioned the intervention's success to specific adjustments of the app (weight and interface usability), legitimmated institutions' support, and clear and sustained health authorities' commitment and directions.

Conclusion

Health professionals had a positive assessment of implementing an app to support the HPV test communication and information provision process, although they conditioned its effectiveness to specific adjustments. The results allow us to identify and develop recommendations for the app to be implemented effectively and sustained over time. The findings of this study have important implications not only for Argentina, but also for other low and middle-income countries, given that the implementation could be adapted, with the aim of improving communication between patients and health institutions in the CC prevention process.

Ten Steps to Design a Counseling App to Reduce the Psychosocial Impact of Human Papillomavirus Testing on the Basis of a User-Centered Design Approach in a Low- and Middle-Income Setting

PURPOSE

This study describes the 10 steps followed to produce the information architecture of a user-centered design (UCD) counseling mobile application, the first phase to develop an app. The app aims to reduce the psychosocial impact of the human papillomavirus test result and improve women's knowledge of human papilloma virus and cervical cancer.

METHODS

We used a UCD approach to produce the information architecture of the app (ie, how to organize contents into features). We analyzed field notes, meeting agendas, and documentation produced during each stage of the design process. We described the goals, methods, and outcomes of each step. We also discussed the critical challenges and the strategies to address them.

RESULTS

The steps are (1) knowledge, attitudes, and beliefs mapping: reanalysis of team's research findings from prior studies; (2) environmental scanning of apps available on the market; (3) stakeholders' point of view: The International Advisory Committee; (4) potential user's profile: building archetypes through the Persona method; (5) women's interviews: user's preferences and experiences; (6) effective features: scoping review to select app's features that address psychosocial impact; (7) the user journey: ideal interaction with the gynecological service and the counseling app; (8) women's focus groups: using Personas and Scenarios to discuss app's mock-up; (9) women's design sessions: prototype test and card-sorting techniques; and (10) team's design session: translating results into visual objects and features.

CONCLUSION

We provide here detailed descriptions of the UCD process of an app for human papillomavirus-tested women for those venturing into the area of mHealth strategies work. Our experience can be used as a guide for future mHealth app development for a low- and middle-income setting.

A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina

BACKGROUND

Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up.

OBJECTIVE

This study aims to understand HPV-tested women's perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing.

METHODS

We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing.

RESULTS

We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users' needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text.

CONCLUSIONS

Providing information that meets women's needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.