Background: Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival.
Objective: The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening.
Methods: The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review.
Results: Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth.
Conclusions: mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.
Globally, cancer is the second leading cause of death; it accounted for approximately 9.6 million deaths in 2018 . Cancer incidence and mortality are predicted to increase to 30.2 million cases and 16.3 million deaths by 2040, respectively, because of aging populations and the adoption of unhealthy lifestyles [ ]. Delay between symptom onset and treatment leads to poorer cancer survival [ ]. Screening increases the chance of early detection and treatment and, ultimately, survival. In many high-income countries, population-based cancer screening is available for four common cancers and has contributed to reduced breast cancer [ ], cervical cancer [ ], prostate cancer [ ], and colorectal cancer [ ] mortality. However, cancer screening in the majority of low- and middle-income countries (LMICs) is opportunistic, and uptake is low compared with cancer screening in high-income countries, leading to delayed presentation, treatment, and survival [ ]; for example, the uptake of mammogram screening was 12% to 31% in Brazil [ ] and 7% to 25% in Malaysia [ ] compared with 66% in Germany [ ] and 75% in Spain [ ]. Low uptake of cancer screening might indicate poor awareness and knowledge of cancer and cancer screening among the public; for example, Asian Pacific populations with the lowest uptake of colorectal cancer screening, such as India, Malaysia, Indonesia, Pakistan, and Brunei, had correspondingly low levels of awareness and knowledge of colorectal cancer symptoms, risk factors, and screening tests [ ]. Poor knowledge about, and negative perceptions toward, mammogram screening are major barriers to mammogram screening uptake in Malaysia [ ].
Digital health care, that is, the use of digital technologies for health, is now commonly used in public health care as well as primary health care . According to the World Health Organization Global Observatory for eHealth, mobile health (mHealth) is defined as “medical and public health practice supported by the use of mobile devices” such as mobile phones, smartphones, and tablet computers [ ]. Worldwide, there are approximately 5.3 billion unique mobile phone users, representing 67.1% of the total population, and smartphones account for approximately 75% of the mobile phones in use [ ]. The high penetration rate of mobile phones allows timely data collection as well as transmission and analysis of the data. Thus, mHealth holds great potential for improving health outcomes because of its mobility, instantaneous access, and ease of use. Some of the common mHealth apps offer patient education and behavior change communication, data collection and reporting, population health registries and vital event tracking, and electronic health records, as well as provider training and education [ ]. mHealth interventions have a positive impact on clinical outcomes, adherence to treatment and care, health behavior changes, disease management, and primary care attendance rates with regard to various diseases [ ]. mHealth has also been used in cancer self-care and self-management among cancer survivors to improve sleep and quality of life; reduce fatigue, stress, and pain; and promote health behaviors such as weight loss [ - ]. The role of mHealth in promoting cancer screening has been explored in different types of reviews. However, it is unknown whether similar findings are observed across the reviews.
This scoping review aimed to map and summarize findings from systematic, scoping, narrative, and rapid reviews on the use of mHealth in cancer screening, as well as other screening-related outcomes such as attitudes toward screening and knowledge and awareness of screening. We also included implementation considerations for successful mHealth interventions in improving cancer screening uptake and screening-related outcomes.
This scoping review of reviews was conducted based on the framework of Arksey and O’Malley  and using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines [ ]. The protocol of this review has not been preregistered. As the use of mHealth in relation to cancer screening is a relatively nascent field of study, a scoping review is useful in mapping the published literature comprehensively and systematically. The review was guided by the following 5-step framework: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results.
We first searched Ovid MEDLINE, PyscINFO, and Embase for relevant literature on February 1, 2021, using two categories of key terms: mHealth and early detection of cancer. We then refined the search on May 17, 2021. The key terms were based on Medical Subject Headings indexing as well as free-text terms. We combined key terms from the same category with OR and between categories with AND. The search strategy was developed in Ovid MEDLINE () and adapted for the other databases. We also hand searched the reference lists of selected reviews for relevant reviews. All searches were exported into EndNote (Clarivate), and duplicates were removed.
Papers were included if they satisfied all of the following criteria: (1) a review of any type, (2) the reviewed interventions related to cancer screening (for any cancer type) that were conducted on mobile devices such as mobile phones and tablet computers, (3) described the effectiveness and implementation of mHealth interventions on outcomes related to cancer screening, (4) included adults aged ≥18 years from the general population, and (5) published in English in peer-reviewed journals from inception up to May 2021. We excluded reviews that did not specify the use of mobile technologies but instead reported modes of delivery such as web-based and computer-delivered programs and videos.
Selection of Reviews
We selected the relevant reviews using a 3-stage process: (1) MMT and WMKH conducted the initial screening of titles and abstracts to determine eligibility for inclusion; (2) WMKH retrieved full texts, which were screened by DS, MMT, and WMKH independently for inclusion, with discrepancies resolved through discussion with DS, MMT, and WMKH; and (3) MMT and WMKH extracted relevant data. The screening process is provided in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart ().
Data Extraction and Charting
The following data were extracted by MMT and WMKH from each selected review into an Excel (Microsoft Corporation) spreadsheet:
- Review identifiers (author, year, country, type of review, number of studies, time range, intervention duration, and follow-up duration)
- Study aim
- Types of cancer mentioned in the relevant studies in the review
- Types of mHealth mentioned in the relevant studies in the review
- Details of intervention procedures
- Outcome measures (awareness, knowledge, or attitude; screening uptake; and implementation-related outcomes)
- Key stakeholders in delivering the mHealth intervention, if any
If the aforementioned data were not reported in the selected reviews, we referred to the individual studies included in the selected reviews. For reviews that included studies that focused on mHealth and studies that did not, we only extracted information specifically reported on the studies that included mHealth. Information related to the quality of the reviews was not assessed.
Our initial search identified 2083 citations, resulting in 1981 (95.1%) unique citations after removal of duplicates (). The titles and abstracts were assessed based on the inclusion criteria, and of the 1981 unique citations, 24 (1.21%) were included for full-text screening. Of these 24 reviews, 12 (50%) were excluded after the full-text screen: 5 (42%) did not include cancer screening-related outcomes, 6 (50%) did not include mHealth components, and 1 (8%) included children as their target population. Hence, of the 24 reviews included for full-text screening, 12 (50%) were included in this scoping review. summarizes the characteristics of the included reviews.
|Study||Type of review||Aim||Time frame of search strategy||Total number of studies; number of relevant studiesa by cancer type||Type of mHealthb in relevant studiesa||Key stakeholders delivering mHealth interventions|
|Bhochhibhoya et al , 2020||Scoping review||To identify studies that examined mHealth programs that focused on increasing cervical cancer screening among women to determine if these interventions improved adherence to screening and what factors (barriers and facilitators) were most influential among participants||January 1, 2009, to September, 28, 2019||12; cervical cancer (n=12, 3 of which were qualitative studies)|
|Uy et al , 2017||Systematic review||To assess the effect of SMS text messaging interventions on increasing patient adherence to screening for breast, cervical, colorectal, and lung cancers||January 2000 to January 2017||9; breast (n=5), cervical (n=1), and colorectal (n=3) cancers|
|Zhang et al , 2020||Systematic review||To qualitatively synthesize published articles reporting the impact of mHealth on cervical cancer screening–related health behaviors||Up to October 10, 2019||8 (1 cross-sectional study); cervical cancer (n=7)|
|Halake and Ogoncho , 2017||Scoping review||To establish the extent and nature of the published and gray literature on the use of mHealth-based technologies for cancer prevention, detection, and management in LMICsc||1990 to 2014||15; breast cancer (n=2)|
|Choi et al , 2018||Systematic review||To investigate recent research trends related to the use of mobile technology in the prevention and management of skin cancer, focusing on how such technology is evaluated and what impact it has in each phase across the cancer continuum||January 1, 2007, to December 31, 2017||18; skin cancer (n=1)|
|Houghton et al , 2019||Systematic review||To determine how mobile apps are being used for breast cancer prevention among women across the cancer control continuum||Up to February 7, 2019||69; breast cancer (n=4)|
|Plackett et al , 2020||Scoping review||To map the evidence for social media interventions to improve cancer screening and early diagnosis, including behavior change, and how the interventions facilitate behavior change||2004 to June 2019||23; breast (n=4) and cervical (n=1) cancers|
|Musa et al , 2017||Systematic review and meta-analysis||To review the evidence of the effectiveness of provider recommendations for cervical cancer screening on screening rates in women at risk for cervical cancer||Up to August 2016||28; cervical cancer (n=5)|
|Duffy et al , 2017||Rapid review||To review the current evidence on effects of interventions to improve cancer screening participation, focusing in particular on effects in underserved populations||Time frame not specified||68; breast (n=9), cervical (n=5), colorectal (n=2), and stomach (n=1) cancers|
|Lott et al , 2020||Scoping review||To map the literature on interventions to increase uptake of cervical screening in sub-Saharan Africa and identify opportunities for future intervention development and research||Up to 2019||19; cervical cancer (n=3)|
|Déglise et al , 2012||Narrative review||To describe the characteristics and outcomes of SMS text messaging interventions for disease prevention in LMICs and provide recommendations for future work||Up to May 2011||17; breast cancer (n=1)|
|Peiris et al , 2014||Systematic review||To critically appraise the role of mHealth in improving health care quality for NCDsf in LMICs||Up to May 2014||48; breast cancer (n=1)|
aRelevant studies are studies that met the inclusion criteria for this review; for example, some reviews included diseases other than cancer. We only reported results from the studies evaluating cancer-related interventions.
bmHealth: mobile health.
cLMICs: low- and middle-income countries.
dBSE: breast self-examination.
eGP: general practitioner.
fNCD: noncommunicable disease.
Characteristics of Reviews
The included reviews (n=12) were published between 2012 and 2020 (). Of the 12 reviews, 6 (50%) were systematic reviews [ , , , , , ], of which 1 (17%) also included a meta-analysis [ ]; 4 (33%) were scoping reviews [ , , , ]; 1 (8%) was a rapid review [ ]; and 1 (8%) was a narrative review [ ]. The 12 reviews reported different outcomes of the studies that were relevant to this review of reviews ( ): 5 (42%) reported solely the effectiveness of mHealth interventions on cancer screening [ , , - ]; 4 (33%) reported outcomes in relation to cancer screening, change in cancer knowledge, and attitudes to screening [ , , , ]; 2 (17%) reported outcomes in relation to breast self-examination (BSE) practice [ , ]; and 1 reported outcomes in relation to BSE and cancer screening [ ]. Most (7/12, 58%) of the reviews included studies that were conducted mainly in high-income Western countries [ , , - ], whereas 42% (5/12) focused on LMICs [ , , - ], of which 20% (1/5) focused solely on sub-Saharan Africa [ ]. In total, 33% (4/12) of the reviews focused on cervical cancer [ , , , ]; 8% (1/12) focused on skin cancer [ ]; 8% (1/12) focused on breast cancer [ ]; 8% (1/12) examined breast, cervical, lung, and colorectal cancers [ ]; 25% (3/12) included any type of cancer [ , , ]; and 2 reviews focused on disease prevention in general [ , ]. In terms of interventions, 42% (5/12) of the reviews included interventions of various types of mHealth technologies [ , - , ], 2 (33%) focused solely on SMS text messages [ , ], 1 (17%) focused on social media interventions [ ], 1 (17%) was specifically about mobile apps [ ], and 25% (3/12) included any type of communication (mHealth, face-to-face, and other media) [ - ].
|Screening outcomes||Screening awareness-, knowledge-, and attitude-related outcomes||Implementation-related outcomes and measures|
|Bhochhibhoya et al , 2020|
|Uy et al , 2017||—c||—|
|Zhang et al , 2020|
|Halake and Ogoncho , 2017||—||—|
|Choi et al , 2018||—||—|
|Houghton et al , 2019|
|Plackett et al , 2020|
|Musa et al , 2017||—||—|
|Duffy et al , 2017||—||—|
|Lott et al , 2020||—||—|
|Déglise et al , 2012||—||—|
|Peiris et al , 2014||—||—|
aNumber of studies that reported a positive outcome out of the total number of studies that included the particular outcome.
bPercentage of change or odds ratios are included if available.
cNot available (ie, not reported).
dOR: odds ratio.
fBSE: breast self-examination.
Types of mHealth Interventions
SMS text messages were the most commonly used mHealth technology and were used in 46% (31/67) of the interventions. They were mainly delivered as reminders of cancer screening appointments, alone or in combination with telephone reminders, physical invitation letters, and educational pamphlets. Educational SMS text messages, sent as a one-off or in a series over days or weeks, were also widely used. Their contents included information about cancer risk factors, benefits of screening, location and operating hours of screening clinics, spiritually based health messages, and facts about cancer (eg, incidence, mortality, and screening rates). Educational SMS text messages were used alone or in combination with an e-voucher (to subsidize the cost of transportation to and from the screening facility) .
Text messages were most commonly sent as SMS text messages. In later studies, they were also sent through IP-based messaging services such as Telegram and Snapchat and mobile apps specifically designed for the interventions. In almost all (10/12, 83%) reviews, the delivery of SMS text messages was one-way, 8% (1/12) of the reviews reported an intervention that included a specifically designed mobile app (mMammogram) that featured personally tailored messages , and 8% (1/12) used social media for communication [ ].
Telephone calls were used in 40% (27/67) of the interventions mostly as cancer screening invitations and reminders and to arrange screening appointments. Telephone reminders, automated or live, were used alone or with SMS text message reminders, screening invitation letters, and pamphlets. Participants were contacted through telephone to confirm the receipt of a screening invitation letter. Motivational interviews were conducted over the telephone to increase participants’ readiness to attend screening . Knowledge about cancer was provided and barriers to screening addressed through telephone counseling [ , , ].
A few breast cancer mobile apps were specifically designed for interventions. Mammopad, for example, is a decision aid, a tool that helps women to decide to participate in mammogram screening, that ran on the iPad Mini . Another app was designed to assist community health workers (CHWs) in interviewing participants, reporting data, showing a motivational video, and offering a mammogram appointment for women with an abnormal clinical breast examination (CBE). A BSE-facilitating smartphone app included BSE date reminders and a reminder to encourage mother and daughter to practice BSE together [ ].
Other mHealth platforms that were less frequently used were emails and social media. Emails were used to deliver screening invitations, reminders, web-based educational flyers, and cancer- and health-related information. Social media platforms such as Facebook and Snapchat were used as intervention modes to provide information about breast and cervical cancers and screening, promote mammogram screening, and schedule breast screening appointments, as well as a platform for discussions about cervical cancer after a lecture .
Almost all (11/12, 92%) reviews described mHealth interventions that included 1 or 2 mHealth technologies. There was only 1 intervention that used a combination of >2 types of mHealth technologies: a training in cervical cancer through SMS text message, electronic posters, infographics, podcasts, and video tutorials .
Key Stakeholders in mHealth Interventions
Of the 12 reviews, 5 (42%) included telephone call interventions that were delivered by a broad range of personnel [, , - ]. Telephone reminders or telephone calls to make or confirm screening appointments were delivered by bilingual advocates from a community organization, local women recruited from a community charity, research assistants, general practitioner receptionist, volunteers, research nurses, midwives at antenatal health clinics, clinical secretaries, and telemarketers.
Among the important personnel in mHealth interventions were telephone counselors who called the participants to inquire about their screening intention and ascertain whether they had received the invitation letters, provided information about screening, addressed current or potential barriers to screening uptake through motivational interviews and applied a counseling approach to increase motivation for behavior change, or assisted with appointment scheduling. Telephone counseling was delivered by nurses or hospital-based health counselors.
Health navigator services were mentioned in 8% (1/12) of the reviews . Health navigators used mobile apps to facilitate interviews, report data, show motivational videos, and offer screening appointments. Health navigators or CHWs guided participants in navigating cancer screening information, provided transportation and interpretation services, addressed technical problems related to mobile app use, and reminded participants to complete cancer screening.
Cancer Screening Uptake
All (12/12, 100%) reviews included in this review reported mainly improved cancer screening uptake or self-examination practice (for breast or skin cancer;). The increase in screening between the intervention and control groups (from relevant studies) ranged from 1.2% to 50.9%.
Overall, the reviews concluded that interventions that included >1 communication mode seemed more effective than those that included a single telephone call or SMS text message reminder. A 3-step sequential approach (an automated reminder telephone call and SMS text message, followed by manual telephone calls and face-to-face interviews) conducted at Portuguese primary health care units resulted in 51% of the women in the intervention group attending cervical cancer screening compared with 34% of the women in the control group who received only written invitation letters [, ]. In another study, women in northern Tanzania who received transportation e-vouchers to cover return transportation to the nearest screening facility as well as a series of 15 behavior change messages delivered through SMS text message were more likely to attend cervical cancer screening (uptake: 18%; OR 4.7, 95% CI 2.9-7.4) compared with those who received only the same SMS text message (uptake: 12.9%; OR 3.0, 95% CI 1.5-6.2) and those who received 3 SMS text messages with the location and hours of the nearest screening clinic (uptake: 4.3%) [ , , ]. Participants from Iran who received a Health Belief Model–based training in cervical cancer through SMS text messages, electronic posters, infographics, podcasts, and a video tutorial were more likely to complete a Papanicolaou (Pap) test (47.9%) than the participants in the control group (5.8%) [ , ].
A once-a-month SMS text message reminder over 6 months combined with a BSE training through a lecture, video, and demonstration of the technique on a breast model led to a 32% increase in BSE practice [, , ]. An Android operating system–based smartphone app that included a BSE date alarm, a reminder to encourage mother and daughter to practice BSE together, a mother motivation function that allows the user to call her mother using a notification function to practice BSE together, and educational videos increased the percentage of Korean women practicing BSE from 62.2% to 71.1% [ ].
Of the 12 reviews, 1 (8%) included interventions that incorporated navigation to health services , which was found to be effective in increasing screening uptake. All (3/3, 100%) of the interventions that included health navigation services were effective in increasing screening uptake. Korean American immigrant women who received a series of 8 to 21 SMS text messages about breast cancer through a specially designed mobile app (mMammogram) and were provided with health navigation services had a significantly higher percentage of completed mammograms after 6 months than women who received printed brochures only (75% vs 30%; P<.001) [ , ]. CHWs in Bangladesh who used mobile apps to facilitate CBE, such as showing a motivational video and offering an appointment, detected 3 times more women with abnormal CBEs than CHWs without smartphone support (3.1% without navigation training and 3.2% with navigation training vs 1% without smartphone) [ , ]. CHWs who used mobile apps and were trained in navigation had the highest percentage of participants with an abnormal CBE who attended further clinical assessment compared with those who used mobile apps only or without smartphone support. In a study in the United States, participants who failed to complete a fecal occult blood test were much more likely to complete a second fecal occult blood test than those in usual care if they had been contacted through telephone call by colorectal screening navigators (82.2% vs 37.3% among those who received standard care; P<.001) [ , ].
There were a number (46/67, 69%) of studies that used only 1 mode of mHealth communication, and the findings related to screening uptake after the intervention compared with before the intervention were mixed; for example, in an email intervention study, whether an email message was loss-framed (focused on risk), gain-framed (focused on health and well-being improvement), or neutrally framed (provided only facts) had no effect on cervical cancer screening uptake [, ]. An exception was a study conducted in western Sweden where there was telephone contact through midwives to offer an appointment for a Pap test, which increased the uptake of Pap tests compared with the usual annual invitations without telephone contact (uptake at 3-month follow-up: 13% vs 3.9%; risk ratio 3.37, 95% CI 2.83-4.01) [ , ]. Another exception was the use of Facebook to share breast cancer information and schedule breast screening appointments, which increased breast cancer screening attendance by an average of 12.9% [ , ].
A brief invitation SMS text message was as effective as a detailed informative SMS text message: there was no significant difference in screening uptake between Lebanese women who received an SMS text message mammogram invitation and those who received the same SMS text message and an additional informative SMS text message about the benefits of mammogram screening [, ].
Screening Awareness, Knowledge, Intention, and Attitude
Of the 12 reviews, 4 (33%) [, , , ] included studies specifically on knowledge, awareness, intention, or attitude in relation to cervical cancer screening (2/4, 50%), breast cancer screening (1/4, 25%), or both (1/4, 25%), and almost all of the individual interventions (7/8, 88%) reported improvements in knowledge, whereas few studies reported an improvement in screening intention (1/4, 25%; ). Interventions that were successful in increasing screening uptake were also successful in increasing knowledge and awareness about screening for both cervical and breast cancer.
The CervixCheck intervention was designed for African American women and consisted of a series of 22 health-specific, spiritually based, cervical cancer–related SMS text messages (eg, on the importance of keeping the body healthy and attending screening) that were sent over 16 days. It resulted in a significant increase in knowledge about cervical cancer and the Pap test (mean difference=0.619; P=.001) [, ]. A 1-week personally tailored SMS text message intervention significantly increased Korean American women’s knowledge of cervical cancer screening guidelines (mean difference=0.31-0.71; P=.006) [ , ]. Participants who went through the Health Belief Model–based cervical cancer training scored significantly higher in perceived benefits of a Pap test and lower in barriers to obtaining a Pap test, in addition to a higher uptake of Pap tests [ , ]. Female high school students who participated in Facebook or face-to-face discussions for 2 weeks after a 50-minute classroom cervical cancer prevention education lecture that included knowledge about Pap testing increased their knowledge about cervical cancer compared with those in the control group (β=2.942; P<.001) [ , ]. Compared with a telephone reminder and invitation intervention, an educational telephone call that provided a brief explanation on cervical cancer, its risks, and colpocytological examination increased knowledge about colpocytological examination but not attitude toward it [ , ].
Korean women who used the mMammogram app and were provided with health navigation services had increased knowledge of breast cancer screening compared with the control group (group difference=mean 16.93, SD 4.77; P=.001) [, ]. Users of Mammopad, a decision aid for mammogram screening, reduced decisional conflict and increased self-efficacy in relation to mammography, although there was no significant change in screening intention [ , ]. Saudi Arabian women who received breast cancer awareness information through Snapchat had better breast cancer awareness and knowledge, including knowledge about breast cancer screening (P=.01), than those in the control group who did not receive any awareness information [ , ]. Among women who were surveyed in the tailored SMS text message mammography campaign on Facebook during Breast Cancer Awareness Month, 82% intended to get a mammography in the next year [ , ].
Implementation Outcomes and Measures
Of the 12 reviews, 4 (33%) [, , , ] included studies that examined outcomes related to the implementation of mHealth in cancer screening uptake interventions ( ). Of these 4 reviews, 3 (75%) reported a high acceptance of such interventions [ , , ]. In a 1-week personally tailored SMS text message intervention, 83% of the participants expressed satisfaction with the intervention, and 97% reported that they would recommend the program to their friends [ , ]. In the CervixCheck intervention, 83% of the participants reported being either “satisfied” or “very satisfied,” and 85% found the SMS text messages either “useful” or “very useful” [ , ]. The mMammogram intervention participants were satisfied with the intervention (P=.003) and agreed that it was effective (P<.001) [ , ]. In a tailored SMS text message mammography campaign on Facebook during Breast Cancer Awareness Month, 25% of the women surveyed agreed that they used Facebook to find breast cancer screening information, and 43% agreed with seeing more mammogram information on Facebook [ , ].
Some of the concerns of the participants regarding mHealth interventions included confidentiality of SMS text messages, loss of mobile phones, clarity of the language used, and receiving negative results through SMS text messages. Participants were interested in receiving SMS text message reminders for appointments; however, there was reluctance to receive screening results through SMS text messages in case someone else accessed their mobile phones and saw the results (OR 0.31, 95% CI 0.18-0.51), although they reported no issue with making an appointment.
The barriers to using mHealth in reaching out to people to encourage cancer screening included inconvenience for older participants, lack of texting proficiency, difficulty in texting, and apprehension that SMS text messages might not be clearly understood . Including a reminder and keeping the SMS text messages informative, short, and simple was suggested to increase screening uptake [ ].
This scoping review of reviews suggests that mHealth interventions can be effective in increasing cancer screening uptake and practice, as well as improving other screening-related outcomes such as knowledge and awareness about screening. The results are consistent across different types of reviews. The most commonly used mHealth technologies used were SMS text messages and telephone calls. Interventions that included >1 mode of communication, such as telephone calls and SMS text message reminders combined or together with invitation letters, health education, or navigation services, seemed to be more effective than interventions that included only 1 mode of communication. A few (4/12, 33.3%) of the reviews reported implementation measures, and 75% (3/4) suggested that mHealth interventions were well accepted by participants.
The effectiveness of interventions that used >1 mode of communication has been demonstrated in cancer screening uptake in LMICs ; for example, in Malaysia, mass media campaigns that used different channels of health promotion successfully increased symptom awareness of breast cancer [ ] and colorectal cancer [ ].
A very effective intervention was a combination of educational SMS text messages and e-vouchers to subsidize the transportation to attend screening , which is especially relevant in rural areas in LMICs. In many LMICs, public transport and e-hailing services are mainly available in cities, and the majority of health care facilities that offer cancer screening are located in town areas; for example, in Malaysia, travel distance to the nearest mammogram screening facility ranged between 2 km and 340 km with a median of 22 (IQR 12-42) km [ ]. Longer travel distance to cancer services is associated with lower likelihood of cancer screening uptake [ ] and presentation of more advanced stages of breast cancer [ ] and colorectal cancer [ ]. Interventions that increase knowledge might not translate into higher screening uptake if underlying structural barriers to screening, such as lack of transportation, are not addressed [ , ]. The use of e-vouchers has been described as a form of an “enablement” intervention that reduces “barriers to increase capability or opportunity” [ ].
Approximately half (31/67, 46%) of the interventions included in the reviews included SMS text messaging, which uses a cellular network and is preinstalled on every mobile phone, unlike internet-based instant messaging apps. Almost 100% of SMS text messages are read, and 90% of them are read within 30 minutes of receipt compared with emails (approximately 18% are read) , which might explain the ineffectiveness of emails in improving cancer screening uptake and related outcomes. Worldwide, IP-based chat apps are gaining popularity: WhatsApp, Facebook Messenger, and WeChat have 2 billion users, 1.3 billion users, and 1.2 billion users, respectively [ ]. Chat apps, especially those with high open rates, such as SMS text messaging [ ], enable more efficient communication by allowing users to send longer messages; share pictures, videos, or audio messages; and chat in real time. However, because SMS text messaging is operator-based, it is more useful in rural areas where there is poor mobile internet coverage. In addition, SMS text messaging is simple to use and does not require additional apps, which might be more user friendly for those who are less tech savvy; for example, older adults.
In addition to SMS text messaging and chat apps, social networking sites, with their large numbers of users, hold great potential in mHealth interventions. As of July 2021, popular social networking sites such as Facebook and Instagram had 2.85 billion users and 1.39 billion users, respectively, and the numbers are increasing rapidly . However, in the only review that examined social media solely [ ], the studies included were mostly about low-level engagement (number of impressions, reach, likes, comments, and sharing of tweets and posts), and the review highlighted the lack of studies (1/4, 25%) that examined high-level engagement with social media interventions, such as uptake of screening [ ]. This is likely because of the difficulty in linking screening uptake and social media data because social media posts are not designed for such analysis. The fast pace of social media means that social media contents could be outdated quickly or get inundated by other information, which reduces their reach to the target population and long-term sustainability. Running multiple campaigns on multiple social media platforms also means that it is difficult to pinpoint which campaign or platform has the greatest impact on behavior change. In addition, there are age differences in social media use; many individuals in the targeted age groups for cancer screening might not be reached through social media. In a survey of American adults, >80% of those aged 18 to 49 years and 73% of those aged 50 to 64 years used social media sites, whereas only 49% of those aged ≥65 years reported so [ ].
mHealth interventions will only work if there is access to mobile phones and mobile internet. Globally, although the penetration of mobile phones and mobile internet is high, there is an unequal access to mobile technology and internet between urban and rural areas and between sexes. All urban areas are covered by a mobile broadband network; however, in some LMICs, 19% of the rural population are covered by only a second generation network, and 17% of the rural population have no mobile coverage at all . The rural-urban gap is especially prominent in LMICs, where urban access to a mobile broadband network is 2.3 times as high as rural access [ ]. In LMICs, women’s mobile phone ownership and internet use is significantly lower than that of men’s, and the gap ranges from 50% in South Asia and 20% in sub-Saharan Africa to 12% in the Middle East and North Africa [ ].
The gap in mobile phone ownership and internet use has important public health implications. mHealth interventions to increase cancer screening uptake might be less effective in rural areas, where screening uptake is already low . Many (57/67, 85%) of the mHealth interventions targeted cervical and breast cancers, the 2 most common cancers among women. Thus, the rural-urban gap in mobile access means that women from rural areas are at a greater risk of inequitable access to information and interventions on cancer screening.
Given the rapid development of mHealth technologies, there is a need for researchers to incorporate them effectively into interventions. However, the speed of research does not advance at the speed of mobile technology, and researchers have little control over app development . Most smartphone apps address tertiary cancer prevention [ ], such as support for patients with cancer in health information management [ ], medication adherence [ ], weight management [ ], and mental health improvement among cancer survivors [ ], and there is a lack of smartphone apps for secondary cancer prevention. Many of the apps developed for research are not available for download and have not been widely adopted after the studies were concluded.
mHealth holds great potential to reach out to many people in low-cost settings, and it is also safe in times of the COVID-19 pandemic where social contact has to be minimized. However, it might not be acceptable to pass on personal information through certain mHealth technology; for example, there were participants who mentioned that although it was acceptable to receive SMS text message reminders about their screening appointment, they would not want to be informed about their screening results through SMS text messages. The gap could be filled by CHWs, who could act as the link between mHealth technologies and participants by informing the latter personally through telephone calls of their screening results. A recent review found that CHWs play a critical role, particularly during pandemics, in community engagement . CHWs are usually members from the same communities as the intervention participants and are knowledgeable about the resources available within the communities. They may be able to reach out to vulnerable populations and encourage uptake of cancer screening [ ] and mobile technologies [ ]. However, despite proven effectiveness of CHWs in cancer screening and early diagnosis interventions [ ], there were very few (1/12, 8%) reviews that included interventions that combined mHealth and CHWs.
Given the heterogeneity of reporting and differences in the details reported in each review, it was challenging to summarize the evidence from the reviews concisely. In addition, some reviews did not exclusively examine mHealth and cancer screening; they included other types of interventions and preventive measures. Furthermore, unlike in a systematic review, the quality of the selected articles was not assessed.
Future Research and Recommendations
Future interventions should consider combining at least two modes of mHealth communication, for example, SMS text messages and telephone calls, and screening interventions are likely to achieve better attendance when participants receive at least one reminder. In addition, future interventions should consider incorporating instant messaging apps such as WhatsApp, Facebook Messenger, and WeChat, in addition to SMS text messaging, because the number of users is increasing exponentially, and more educational information using videos, audio messages, or graphics could be shared. Social media platforms, especially Facebook, should be incorporated for health promotion, sharing of educational information, and appointment making. When social media platforms are used, there is a need to take into account their popularity and acceptability within the country where the interventions are conducted. In addition, engagement with different social media apps varies among age groups. Other incentives such as transport vouchers may be included when interventions are conducted among those with poor access to screening facilities. Facilitators to improving access to, and engagement with, mHealth among older adults have been described, including support from the government and family, addressing digital problems in deprived areas, and increasing accessibility to mobile phones or tablet computers . CHWs and navigation services may be provided along with mobile technologies to support participants’ needs, promote and facilitate the use of mHealth, and pass on information such as screening results.
mHealth interventions have the potential to increase cancer screening uptake and other cancer screening–related outcomes such as knowledge about screening and intention to screen. Combining >1 mode of communication may have a better impact on cancer screening uptake.
This work was supported by the UK Research and Innovation Medical Research Council (537084059) and the Newton Fund Impact Scheme 2020-2021 (MIGHT/CEO/NUOF/4-2020 (06) for the study “Improving early detection and diagnosis of breast cancer among multi-ethnic rural communities in Malaysia – the implementation of the community education and navigation programme (CENP).” MD and DS were also supported by the UK Research and Innovation Medical Research Council and Global Challenges Research Fund (MR/S014349/1) during the conduct and write-up of this study.
DS and MMT developed the review protocol, MMT and WMKH conducted the screening independently, DS and MMT wrote the manuscript, and TTS and MD planned the study and led in revising the manuscript. DS, WMKH, DM, and NAT revised the manuscript. All authors provided feedback and helped shape the research, analysis, and manuscript. DS and MMT contributed to the study equally and are joint first authors of the manuscript. TTS and MD contributed equally to the study and are joint last authors of this manuscript.
Conflicts of Interest
Search strategy.DOCX File , 19 KB
- Cancer. World Health Organization. URL: https://www.who.int/news-room/fact-sheets/detail/cancer [accessed 2022-02-16]
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018 Nov;68(6):394-424 [FREE Full text] [CrossRef] [Medline]
- Clegg-Lamptey JA, Vanderpuye V, Dedey F. Late presentation of breast cancer in lower- and middle-income countries. Curr Breast Cancer Rep 2019 Jun 20;11(3):143-151. [CrossRef]
- Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013 Jun 04(6):CD001877 [FREE Full text] [CrossRef] [Medline]
- Jansen EE, Zielonke N, Gini A, Anttila A, Segnan N, Vokó Z, et al. Response to the letter commenting on 'Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review'. Eur J Cancer 2020 Oct;138:232-233. [CrossRef] [Medline]
- Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, et al. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol 2010 Aug;11(8):725-732. [CrossRef]
- Navarro M, Nicolas A, Ferrandez A, Lanas A. Colorectal cancer population screening programs worldwide in 2016: an update. World J Gastroenterol 2017 May 28;23(20):3632-3642 [FREE Full text] [CrossRef] [Medline]
- Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 2010 Feb;11(2):165-173. [CrossRef]
- Freitas-Junior R, Rodrigues DC, Corrêa RD, Peixoto JE, de Oliveira HV, Rahal RM. Contribution of the Unified Health Care System to mammography screening in Brazil, 2013. Radiol Bras 2016 Oct;49(5):305-310 [FREE Full text] [CrossRef] [Medline]
- Aidalina M, Syed Mohamed AS. The uptake of Mammogram screening in Malaysia and its associated factors: a systematic review. Med J Malaysia 2018 Aug;73(4):202-211 [FREE Full text] [Medline]
- Albert US, Kalder M, Schulte H, Klusendick M, Diener J, Schulz-Zehden B, et al. [The population-based mammography screening programme in Germany: uptake and first experiences of women in 10 federal states]. Gesundheitswesen 2012 Feb;74(2):61-70. [CrossRef] [Medline]
- Carrasco-Garrido P, Hernandez-Barrera V, Lopez de Andres A, Jimenez-Trujillo I, Gallardo Pino C, Jimenez-Garcıa R. Awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests in Spain. Eur J Public Health 2014 Apr 27;24(2):264-270. [CrossRef] [Medline]
- Koo JH, Leong RW, Ching J, Yeoh K, Wu D, Murdani A, Asia Pacific Working Group in Colorectal Cancer. Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: a multicenter study. Gastrointest Endosc 2012 Jul;76(1):126-135. [CrossRef] [Medline]
- WHO Guideline Recommendations on Digital Interventions for Health System Strengthening. Geneva: World Health Organization; 2019.
- MHealth New Horizons for Health Through Mobile Technologies. Geneva: World Health Organization; 2011.
- Digital around the world. DataReportal. URL: https://datareportal.com/global-digital-overview [accessed 2022-05-05]
- Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Health Sci Pract 2013 Aug 06;1(2):160-171. [CrossRef]
- Marcolino MS, Oliveira JA, D'Agostino M, Ribeiro AL, Alkmim MB, Novillo-Ortiz D. The impact of mHealth interventions: systematic review of systematic reviews. JMIR Mhealth Uhealth 2018 Jan 17;6(1):e23 [FREE Full text] [CrossRef] [Medline]
- Buneviciene I, Mekary RA, Smith TR, Onnela J, Bunevicius A. Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis. Crit Rev Oncol Hematol 2021 Jan;157:103123 [FREE Full text] [CrossRef] [Medline]
- Jongerius C, Russo S, Mazzocco K, Pravettoni G. Research-tested mobile apps for breast cancer care: systematic review. JMIR Mhealth Uhealth 2019 Feb 11;7(2):e10930 [FREE Full text] [CrossRef] [Medline]
- Seiler A, Klaas V, Tröster G, Fagundes CP. eHealth and mHealth interventions in the treatment of fatigued cancer survivors: a systematic review and meta-analysis. Psychooncology 2017 Sep 10;26(9):1239-1253. [CrossRef] [Medline]
- Hernandez Silva E, Lawler S, Langbecker D. The effectiveness of mHealth for self-management in improving pain, psychological distress, fatigue, and sleep in cancer survivors: a systematic review. J Cancer Surviv 2019 Feb 11;13(1):97-107. [CrossRef] [Medline]
- Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005 Feb;8(1):19-32. [CrossRef]
- Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018 Oct 02;169(7):467-473 [FREE Full text] [CrossRef] [Medline]
- Bhochhibhoya S, Dobbs PD, Maness SB. Interventions using mHealth strategies to improve screening rates of cervical cancer: a scoping review. Prev Med 2021 Feb;143:106387. [CrossRef] [Medline]
- Uy C, Lopez J, Trinh-Shevrin C, Kwon SC, Sherman SE, Liang PS. Text messaging interventions on cancer screening rates: a systematic review. J Med Internet Res 2017 Aug 24;19(8):e296 [FREE Full text] [CrossRef] [Medline]
- Zhang D, Advani S, Waller J, Cupertino A, Hurtado-de-Mendoza A, Chicaiza A, et al. Mobile technologies and cervical cancer screening in low- and middle-income countries: a systematic review. JCO Glob Oncol 2020 Apr;6:617-627 [FREE Full text] [CrossRef] [Medline]
- Halake DG, Ogoncho I. The role of mobile health in supporting cancer prevention, detection, treatment and palliative care in low and middle income countries: a scoping review. Public Health Res 2017;7(6):123-135. [CrossRef]
- Choi J, Cho Y, Woo H. mHealth approaches in managing skin cancer: systematic review of evidence-based research using integrative mapping. JMIR Mhealth Uhealth 2018 Aug 02;6(8):e164 [FREE Full text] [CrossRef] [Medline]
- Houghton LC, Howland RE, McDonald JA. Mobilizing breast cancer prevention research through smartphone apps: a systematic review of the literature. Front Public Health 2019 Nov 6;7:298 [FREE Full text] [CrossRef] [Medline]
- Plackett R, Kaushal A, Kassianos AP, Cross A, Lewins D, Sheringham J, et al. Use of social media to promote cancer screening and early diagnosis: scoping review. J Med Internet Res 2020 Nov 09;22(11):e21582 [FREE Full text] [CrossRef] [Medline]
- Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L, et al. Effect of cervical cancer education and provider recommendation for screening on screening rates: a systematic review and meta-analysis. PLoS ONE 2017 Sep 5;12(9):e0183924. [CrossRef]
- Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2017 Sep 17;24(3):127-145 [FREE Full text] [CrossRef] [Medline]
- Lott BE, Trejo MJ, Baum C, McClelland DJ, Adsul P, Madhivanan P, et al. Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC Public Health 2020 May 11;20(1):654 [FREE Full text] [CrossRef] [Medline]
- Déglise C, Suggs LS, Odermatt P. Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res 2012 Jan 12;14(1):e3 [FREE Full text] [CrossRef] [Medline]
- Peiris D, Praveen D, Johnson C, Mogulluru K. Use of mHealth systems and tools for non-communicable diseases in low- and middle-income countries: a systematic review. J Cardiovasc Transl Res 2014 Nov;7(8):677-691. [CrossRef] [Medline]
- Erwin E, Aronson KJ, Day A, Ginsburg O, Macheku G, Feksi A, et al. SMS behaviour change communication and eVoucher interventions to increase uptake of cervical cancer screening in the Kilimanjaro and Arusha regions of Tanzania: a randomised, double-blind, controlled trial of effectiveness. BMJ Innov 2019 Jan 22;5(1):28-34 [FREE Full text] [CrossRef] [Medline]
- Lee H, Ghebre R, Le C, Jang YJ, Sharratt M, Yee D. Mobile phone multilevel and multimedia messaging intervention for breast cancer screening: pilot randomized controlled trial. JMIR Mhealth Uhealth 2017 Nov 07;5(11):e154 [FREE Full text] [CrossRef] [Medline]
- Heo J, Chun M, Lee KY, Oh Y, Noh OK, Park RW. Effects of a smartphone application on breast self-examination: a feasibility study. Healthc Inform Res 2013 Dec;19(4):250-260 [FREE Full text] [CrossRef] [Medline]
- Khademolhosseini F, Noroozi A, Tahmasebi R. The effect of health belief model-based education through telegram instant messaging services on pap smear performance. Asian Pac J Cancer Prev 2017 Aug 27;18(8):2221-2226 [FREE Full text] [CrossRef] [Medline]
- Firmino-Machado J, Varela S, Mendes R, Moreira A, Lunet N, SCAN-Cervical Cancer collaborators. A 3-step intervention to improve adherence to cervical cancer screening: the SCAN randomized controlled trial. Prev Med 2019 Jun;123:250-261. [CrossRef] [Medline]
- Khokhar A. Short text messages (SMS) as a reminder system for making working women from Delhi Breast Aware. Asian Pac J Cancer Prev 2009;10(2):319-322 [FREE Full text] [Medline]
- Ginsburg OM, Chowdhury M, Wu W, Chowdhury MT, Pal BC, Hasan R, et al. An mHealth model to increase clinic attendance for breast symptoms in rural Bangladesh: can bridging the digital divide help close the cancer divide? Oncologist 2014 Feb;19(2):177-185 [FREE Full text] [CrossRef] [Medline]
- Baker DW, Brown T, Buchanan DR, Weil J, Balsley K, Ranalli L, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial. JAMA Intern Med 2014 Aug 01;174(8):1235-1241. [CrossRef] [Medline]
- Adonis L, Paramanund J, Basu D, Luiz J. Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: implications for population-based communication? J Health Psychol 2017 Sep 17;22(11):1365-1375. [CrossRef] [Medline]
- Broberg G, Gyrd-Hansen D, Miao Jonasson J, Ryd M, Holtenman M, Milsom I, et al. Increasing participation in cervical cancer screening: offering a HPV self-test to long-term non-attendees as part of RACOMIP, a Swedish randomized controlled trial. Int J Cancer 2014 May 01;134(9):2223-2230 [FREE Full text] [CrossRef] [Medline]
- Using Facebook to improve attendance at screening appointments. Good Things Foundation. URL: https://static1.squarespace.com/static/5a744e79bff20048181ee226/t/5f7ec8861c77e72d9096b3c3/1602144395078/Evaluation_+Stoke+Screening+v4.pdf [accessed 2022-05-05]
- Lakkis NA, Atfeh AM, El-Zein YR, Mahmassani DM, Hamadeh GN. The effect of two types of sms-texts on the uptake of screening mammogram: a randomized controlled trial. Prev Med 2011 Oct;53(4-5):325-327. [CrossRef] [Medline]
- Le D, Holt CL. CervixCheck: a spiritually-based text messaging intervention to promote cervical cancer awareness and pap test screening intention among African-American women. J Health Commun 2018 Oct 09;23(9):842-853 [FREE Full text] [CrossRef] [Medline]
- Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: changes in knowledge and behavior pre-post intervention. J Med Internet Res 2014 Aug 27;16(8):e196 [FREE Full text] [CrossRef] [Medline]
- Lai C, Wu W, Tsai S, Cheng S, Lin K, Liang S. The effectiveness of a Facebook-assisted teaching method on knowledge and attitudes about cervical cancer prevention and HPV vaccination intention among female adolescent students in Taiwan. Health Educ Behav 2015 Jun 15;42(3):352-360. [CrossRef] [Medline]
- Lima TM, Nicolau AI, Carvalho FH, Vasconcelos CT, Aquino PD, Pinheiro AK. Telephone interventions for adherence to colpocytological examination. Rev Lat Am Enfermagem 2017 Feb 06;25:e2844 [FREE Full text] [CrossRef] [Medline]
- Eden KB, Scariati P, Klein K, Watson L, Remiker M, Hribar M, et al. Mammography decision aid reduces decisional conflict for women in their forties considering screening. J Womens Health (Larchmt) 2015 Dec;24(12):1013-1020 [FREE Full text] [CrossRef] [Medline]
- Alanzi TM, Alobrah A, Alhumaidi R, Aloraifi S. Evaluation of the SnapChat mobile social networking application for breast cancer awareness among Saudi students in the Dammam Region of the Kingdom of Saudi Arabia. Breast Cancer Target Ther 2018 Jul;Volume 10:113-119. [CrossRef]
- Klippert H, Schaper A. Using Facebook to communicate mammography messages to rural audiences. Public Health Nurs 2019 Mar 29;36(2):164-171. [CrossRef] [Medline]
- Romocki LS, Des Marais A, Cofie L, Anderson C, Curington T, Smith JS. Use of short messaging service to improve follow-up for abnormal pap test results in minority and medically underserved women in north Carolina: questionnaire on attitudes and acceptability. JMIR Form Res 2019 Aug 06;3(3):e12675 [FREE Full text] [CrossRef] [Medline]
- Soto M, Martinez-Gutierrez J, Momany M, Capurro D, Ciampi Spode F, Cea E, et al. Preferences of underserved Chilean women on a mobile technology intervention for cervical cancer screening: qualitative study. JMIR Mhealth Uhealth 2018 Nov 20;6(11):e196 [FREE Full text] [CrossRef] [Medline]
- Schliemann D, Ramanathan K, Matovu N, O'Neill C, Kee F, Su TT, et al. The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review. BMC Cancer 2021 Oct 19;21(1):1125 [FREE Full text] [CrossRef] [Medline]
- Schliemann D, Htay MN, Dahlui M, Paramasivam D, Cardwell CR, Ibrahim Tamin NS, et al. Impact of a mass media campaign on breast cancer symptoms awareness and screening uptake in Malaysia: findings from a quasi-experimental study. BMJ Open 2020 Aug 20;10(8):e036503 [FREE Full text] [CrossRef] [Medline]
- Schliemann D, Paramasivam D, Dahlui M, Cardwell CR, Somasundaram S, Ibrahim Tamin NS, et al. Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia. BMC Cancer 2020 Mar 25;20(1):252 [FREE Full text] [CrossRef] [Medline]
- Mahmud A, Aljunid SM. Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: a preliminary study using travel impedance approach. PLoS One 2018;13(2):e0191764 [FREE Full text] [CrossRef] [Medline]
- Brustrom JE, Hunter D. Going the distance: how far will women travel to undergo free mammography? Mil Med 2001 Apr;166(4):347-349. [Medline]
- Huang B, Dignan M, Han D, Johnson O. Does distance matter? Distance to mammography facilities and stage at diagnosis of breast cancer in Kentucky. J Rural Health 2009;25(4):366-371. [CrossRef] [Medline]
- Massarweh NN, Chiang Y, Xing Y, Chang GJ, Haynes AB, You YN, et al. Association between travel distance and metastatic disease at diagnosis among patients with colon cancer. J Clin Oncol 2014 Mar 20;32(9):942-948. [CrossRef]
- Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011 Apr 23;6:42 [FREE Full text] [CrossRef] [Medline]
- 2019 Mobile usage report: how consumers are really texting. EZTexting. URL: https://cdn.brandfolder.io/YAYWC2JN/at/5j668ngq5jk54hg425jm769f/2019_Mobile_Usage_Report.pdf [accessed 2022-06-05]
- Most popular messaging apps. Statista. URL: https://www.statista.com/statistics/258749/most-popular-global-mobile-messenger-apps/ [accessed 2022-04-04]
- Church K, Oliveira RD. What's up with whatsapp?: comparing mobile instant messaging behaviors with traditional SMS. In: Proceedings of the 15th international conference on Human-computer interaction with mobile devices and services. 2013 Presented at: MobileHCI '13: 15th International Conference on Human-Computer Interaction with Mobile Devices and Services; Aug 27 - 30, 2013; Munich Germany. [CrossRef]
- Social media use in 2021. Pew Research Center. 2021 Apr 7. URL: https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ [accessed 2022-04-15]
- Measuring digital development: facts and figures 2020. ITU. URL: https://www.itu.int/en/ITU-D/Statistics/Pages/facts/default.aspx [accessed 2022-04-15]
- Mariscal J, Mayne G, Aneja U. Bridging the gender digital gap. Economics 2019;13. [CrossRef]
- Walji LT, Murchie P, Lip G, Speirs V, Iversen L. Exploring the influence of rural residence on uptake of organized cancer screening - a systematic review of international literature. Cancer Epidemiol 2021 Oct;74:101995. [CrossRef] [Medline]
- Klasnja P, Hartzler A, Powell C, Pratt W. Supporting cancer patients' unanchored health information management with mobile technology. AMIA Annu Symp Proc 2011;2011:732-741 [FREE Full text] [Medline]
- Chalela P, Munoz E, Inupakutika D, Kaghyan S, Akopian D, Kaklamani V, et al. Corrigendum to "Improving adherence to endocrine hormonal therapy among breast cancer patients: study protocol for a randomized controlled trial" [Contemp. Clin. Trials Commun. 12 (2018) 109-115]. Contemp Clin Trials Commun 2019 Jun;14:100349 [FREE Full text] [CrossRef] [Medline]
- Stubbins R, He T, Yu X, Puppala M, Ezeana CF, Chen S, et al. A behavior-modification, clinical-grade mobile application to improve breast cancer survivors' accountability and health outcomes. JCO Clin Cancer Inform 2018 Dec(2):1-11. [CrossRef]
- Zhu J, Ebert L, Liu X, Wei D, Chan SW. Mobile breast cancer e-support program for Chinese women with breast cancer undergoing chemotherapy (part 2): multicenter randomized controlled trial. JMIR Mhealth Uhealth 2018 Apr 30;6(4):e104 [FREE Full text] [CrossRef] [Medline]
- Bhaumik S, Moola S, Tyagi J, Nambiar D, Kakoti M. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health 2020 Jun 10;5(6):e002769 [FREE Full text] [CrossRef] [Medline]
- Morère JF, Eisinger F, Touboul C, Lhomel C, Couraud S, Viguier J. Decline in cancer screening in vulnerable populations? Results of the EDIFICE surveys. Curr Oncol Rep 2018 Mar 05;20(Suppl 1):17. [CrossRef] [Medline]
- Liu P, Astudillo K, Velez D, Kelley L, Cobbs-Lomax D, Spatz ES. Use of mobile health applications in low-income populations. Circ Cardiovasc Qual Outcomes 2020 Sep;13(9):e007031. [CrossRef]
- O'Donovan J, Newcomb A, MacRae MC, Vieira D, Onyilofor C, Ginsburg O. Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2020 May 13;5(5):e002466 [FREE Full text] [CrossRef] [Medline]
- Abbaspur-Behbahani S, Monaghesh E, Hajizadeh A, Fehresti S. Application of mobile health to support the elderly during the COVID-19 outbreak: a systematic review. Health Policy Technol 2022 Mar;11(1):100595 [FREE Full text] [CrossRef] [Medline]
|BSE: breast self-examination|
|CBE: clinical breast examination|
|CHW: community health worker|
|LMICs: low- and middle-income countries|
|mHealth: mobile health|
|PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses|
|PRISMA-ScR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews|
Edited by A Mavragani; submitted 13.01.22; peer-reviewed by A Spini, HL Tam; comments to author 07.03.22; revised version received 14.06.22; accepted 16.06.22; published 15.08.22Copyright
©Désirée Schliemann, Min Min Tan, Wilfred Mok Kok Hoe, Devi Mohan, Nur Aishah Taib, Michael Donnelly, Tin Tin Su. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.08.2022.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.