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).
Materials and 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.