Digital Behavior Change Interventions along Cancer Prevention, Education, and Screening Promotion among Latina(o) Adults: A Systematic Review of the Literature (Preprint)
Authors: Chavarria Enmanuel , Han Muxin Anna , Kumar Ankitha , Peterson Shenita R. , Operario Don , Escoffery Cam 
Published: May 2024

BACKGROUND

Cancer health disparities in Latina(o) populations stem from economic, cultural, linguistic, and systemic barriers, which simultaneously hinder effective screening and early detection, and directly contribute to lower screening rates. Fear, stigma, and challenges in navigating the healthcare system exacerbate this issue, underscoring the urgent need for initiatives aimed at increasing cancer screening rates in this population to enable earlier identification and treatment of cases. Digital behavior change interventions (DBCIs) offer accessible, cost-effective methods to increase screening and affect health outcomes in Latina(o) communities. Despite their potential, research on DBCIs' specific impacts on cancer prevention, education, and screening promotion among Hispanic/Latina(o) populations remains sparse . In our review, we use "Latina(o)" to reflect the community's preferences, as highlighted by recent studies, and "Hispanic" for broader Spanish-speaking groups, ensuring our language is inclusive and sensitive to diverse identities.

OBJECTIVE

This systematic review, spanning January 2000 – March 2023, aims to characterize the existing literature and findings on the impact of digital interventions on cancer prevention, screening, and education among Latina(o) populations. It critically evaluates the designs, participant demographics, intervention components, technological platforms, cultural tailoring, and measured outcomes of included studies.

METHODS

Adhering to PRISMA and PICOS , this review focused on English and Spanish articles that specifically address DBCIs for cancer screening, prevention, and education among Latina(o) populations aged 18-75 , excluding non-interventional and qualitative studies. We implemented a robust search strategy across databases: PubMed, Embase, ERIC, PsycINFO, Scopus, Web of Science, and CINAHL. Data were extracted, abstracted, and synthesized for a comprehensive analysis of present evidence.

RESULTS

The review analyzed 22 of 1,884 studies. Most, 95% (21/22) were US-centric with clinical settings common in 41% (9/22) of studies, alongside online and community settings. Study design were 68% (15/22) randomized controlled trials and 32% (7/22) quasi-experimental. About 55% (12/22) focused exclusively on Latina(o)s, with 72% (16/22) not specifying race, country of origin or subgroups. English and Spanish led in 68% (15/22) of the studies. In our analysis of cultural tailoring, linguistic adjustments encompassed 95% (21/22) of studies, yet only 40% (9/22) went beyond baseline surveys, literacy adaptations, or linguistics to integrate cultural values. In cancer screening studies, 45% (10/22) used smartphones to promote screenings. Of these studies, 70% (7/10) improving rates, notably in breast (75%, 3/4) and colorectal (100%, 3/3) cancers; and there was mixed results for cervical. Cancer education studies constituted 32% (7/22) of overall studies, all had a positive impact. A Majority of these, 71% (5/7), utilized smartphones for delivery, focused on breast cancer, 86% (6/7). A smaller portion addressed melanoma 14% (1/7), employing apps designed for symptom management and lifestyle advice. Cancer prevention studies comprised 23% (5/22) of overall studies; 40% (2/5) had positive outcomes. Specifically, 20% (1/5) utilized smartphone texting for HPV vaccine uptake, and 20% (1/5) employed a web platform for cervical cancer vaccine information-seeking.

CONCLUSIONS

DBCIs present a significant opportunity for addressing cancer health disparities among U.S. Latina(o) communities, however, effectiveness requires more than linguistic changes; cultural adaptations are crucial. While 95% of studies adjusted language, only 40% incorporated culture, highlighting the need for culturally nuanced interventions. In cancer screening studies, smartphone strategies improved breast and CRCS rates, although cervical cancer screening and CRCS outcomes indicate potential for further research and improvement. Cancer education studies utilizing smartphones increased breast cancer awareness, highlighting mobile technology's effectiveness in health information dissemination. Yet, cancer education interventions should expand to cover CRC, using digital tools for symptom management and lifestyle guidance. Cancer prevention showed limited success in HPV vaccination and information-seeking for cervical cancer, underscoring the need for enhanced DBCI strategies for greater impact. The need for future research for deeper cultural tailoring, to align with the cultural values and beliefs of U.S. Latina(o) populations is evident. Focusing on accessible technology, especially smartphones and apps, is crucial to enhancing cancer prevention, screening, and education for equitable health outcomes across diverse communities.