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Feasibility of implementing cervical cancer screening program using smartphone imaging as a training aid for nurses in rural India
Author(s) -
Sharma Drishti,
Rohilla Latika,
Bagga Rashmi,
Srinivasan Radhika,
Jindal Har Ashish,
Sharma Nikita,
Kankaria Ankita,
Jamir Limalemla,
Suri Vanita,
Singh Rakesh Kumar,
Duggal Mona
Publication year - 2018
Publication title -
public health nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 55
eISSN - 1525-1446
pISSN - 0737-1209
DOI - 10.1111/phn.12517
Subject(s) - checklist , medicine , referral , family medicine , cohen's kappa , cervical cancer , observational study , nursing , population , informed consent , cancer , psychology , alternative medicine , environmental health , pathology , machine learning , computer science , cognitive psychology
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.