Text messages to increase attendance to follow-up cervical cancer screening appointments among HPV-positive Tanzanian women (Connected2Care): study protocol for a randomised controlled trial

Ditte S Linde, Marianne S Andersen, Julius D Mwaiselage, Rachel Manongi, Susanne K Kjaer, Vibeke Rasch

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Background: Cervical cancer is a major health concern in Tanzania, caused by poor attendance for cervical cancer screening and follow-up of women at risk. Mobile telephone health interventions are proven effective tools to improve health behaviour in African countries. So far, no knowledge exists on how such interventions may perform in relation to cervical cancer screening in low-income settings. This study aims to assess the degree to which a Short Message Service (SMS) intervention can increase attendance at appointments among women who have tested positive for High-Risk (HR) Human Papiloma Virus (HPV) during cervical cancer screening.

Methods: Connected2Care is a non-blinded, multicentre, parallel-group, randomised controlled trial. Tanzanian Women testing positive to HR HPV at inclusion are randomly assigned in an allocation ratio of 1:1 to the SMS intervention or the control group (standard care). In a period of 10 months, the intervention group will receive 15 one-directional health educative text messages and SMS-reminders for their appointment. The total sample size will be 700 with 350 women in each study arm. Primary outcome is attendance rate for follow-up. Secondary objectives are cost-effectiveness measured through incremental ratios and knowledge of cervical cancer by a 16-item true/false scale questionnaire at baseline and follow-up. Barriers against implementing the intervention will be assessed in a mixed methods sub-population study.

Discussion: This study may provide information on the potential effects, costs and barriers in implementing an SMS intervention targeting a group of women who are followed-up after testing positive for HR HPV and therefore at increased risk of developing cervical cancer. This can guide decision-makers on the effective use of mobile technology in a low-income setting. Trial status: Recruiting.

Trial registration: NCT02509702 (ClinicalTrials.gov). Registration date: 15 June 2015.

Keywords: mHealth, SMS intervention, mobile phone, HPV, cervical cancer, screening, RCT, Tanzania
Translated title of the contributionSammenhæng mellem SMS-beskeder og øget fremmøde til en opfølgende livmoderhalskræft screening blandt tanzaniske kvinder, som er testet positive for HPV (Connected2Care): Studieprotokol for et randomiseret klinisk forsøg
Original languageEnglish
Article number555
Number of pages10
Publication statusPublished - 21. Nov 2017


  • Cervical cancer
  • HPV
  • MHealth
  • Mobile phone
  • RCT
  • Screening
  • SMS intervention
  • Tanzania

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