THE EFFECT OF A VOICE-SITE ON INFORMED CHOICE FOR WOMEN CONSIDERING CERVICAL CANCER SCREENING IN RURAL INDIA: A PHASE II CONTROLLED TRIAL

Purpose: Low-tech screening using Visual Inspection with Acetic acid (VIA) and cryotherapy is an effective intervention for reducing the incidence and mortality of cervical cancer in low-resource settings. The implementation of this evidence poses many challenges, including engaging women with low levels of literacy to participate through informed choice. 

Method: Two villages in KV Kuppam block, Tamil Nadu, India were selected for a non-randomised controlled trial of a Voice site, providing pre-recorded information about cervical cancer, patient stories, information about clinics and the ability to record questions and concerns. An adapted version of the multi-dimensional measure of informed choice and a modified scale of involvement preferences was administered at baseline via a quasi-random door-to-door community survey to 100 women in each village. The Voicesite phone number was disseminated to one village (A) through women’s self-help groups and posters from October 2013 until March 2014. Useage patterns of the Voicesite were captured and informed choice, involvement preferences and awareness of the Voicesite were measured in a different quasi-random sample of 100 women in each village at the end of the six-month period. 

Result: At baseline, mean age was 38 and 36 years; mean knowledge was 4.0 and 4.7 (out of 16 maximum); mean attitude 4.8 and 4.7 (where 7 is negative attitude and 1 is positive) with 6% and 10% women ever-screened in Village A and B respectively. Involvement preferences were significantly different between villages, with particularly strong perceived roles for husbands in decision-making. Approximately 25% eligible women accessed the Voicesite over the six-month period. The post-intervention survey data collection will be completed by late May 2014 and the feasibility of the intervention and potential impact on informed choice will be assessed. 

Conclusion: Women in these two villages had very low levels of informed participation in cervical cancer screening at baseline. A Voicesite delivered via mobile phones was accessed by a substantial proportion of the population. An adapted measure of the multi-dimesnional measure of informed choice was feasible to deliver via a door-to-door survey. Our results will be used to inform the design of a phase 3 efficacy trial of this novel intervention on informed choice in a low-resource setting.