Abstract 22: Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua
Authors: Geba Maria , Hall Katherine , Rong Anneda , Estrada Michelet McLean , Dillingham Rebecca , Mitchell Emma McKim 
Published: June 2023

Abstract
Purpose: Nicaragua has the highest rate of cervical cancer in Central America. Cervical cancer screening is available nationally, however substantial barriers to screening engagement persist. Azulado is a telebehavioral, patient-centered mobile platform that was culturally, linguistically, and regionally created to specifically address the cervical cancer screening and treatment needs of women in Bluefields, Nicaragua, on the Caribbean coast. The app was successfully piloted in summer 2021. In summer 2022, the research team explored healthcare provider perspectives of Azulado, collaborating with providers to design an accompanying portal for the app.
Methods: The team conducted a mixed-methods, community-based participatory investigation to elicit healthcare provider perspectives to inform the design of a provider portal. Focus groups and individual interviews were conducted with providers at healthcare facilities throughout Bluefields. A tablet-based survey adapted from mHealth App Usability Questionnaire (MAUQ) and System Usability Scale (SUS) was administered. The team conducted thematic analysis and descriptive statistics.
Results: Three provider focus groups (n=8) and multiple individual interviews (n=18) were conducted in six unique healthcare settings in Bluefields. Twenty participants completed the survey (15 women and 5 men). Provider years of experience ranged from 1 to 37 years (average 17.0 years, median 16.5 years). Quantitative findings demonstrated that when asked if they agreed that the app would be useful for patient health and well-being, the average response was 4.89 (SD 0.32) on a Likert scale (0= strongly disagree, 5= strongly agree). The average response for the statement “I would recommend this app” was 4.68 (SD 0.58). Emergent themes included the importance of inclusivity and representation of different regional ethnicities and situations, clarity and functionality of the app, emotional support by community or provider, ability to input clinic visit reminders, and ability to anonymously and confidentially communicate with patients.
Conclusion: The study demonstrated feasibility and acceptability of the Azulado patient-provider interface. Providers gave suggestions for how to improve patient education and facilitate communication between patients and clinics. Future studies will include trialing the updated app with patients and determining its effectiveness in improving prevention and treatment efforts in Bluefields.
Citation Format: Maria Geba, Katherine Hall, Anneda Rong, Michelet McLean Estrada, Rebecca Dillingham, Emma McKim Mitchell. Collaboratively Adapting a Telebehavioral Mobile Platform to Enhance Patient-Provider Communication Regarding Cervical Cancer Prevention Efforts in Bluefields, Nicaragua [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 22.