Storytelling Intervention to Promote Cervical Cancer Screening Uptakes Among Malawian Women Living With Human Immunodeficiency Virus
Storytelling Intervention to Promote Cervical Cancer Screening Uptakes Among Malawian Women Living With Human Immunodeficiency Virus
To develop a theory-based culturally-grounded storytelling-based intervention to increase
 cervical cancer screening among Malawian women living with HIV infection. Secondary
 objectives: To conduct a pilot randomized clinical trial (RCT) to examine the acceptability,
 feasibility and preliminary effectiveness of narrative intervention on cervical cancer
 screening prevention behavior.
Design

 This two year project will employ a holistic community-based approach for recruitment. The
 project will involve two phases: Phase 1: The investigators will produce culturally-grounded
 and human-centered storytelling narrative intervention videos to address sociocultural and
 individual factors which influence cervical cancer prevention behaviors. Phase 2: The
 investigator will conduct a pilot RCT using the storytelling-based intervention delivered by
 mHealth (tablets) with 120 women residing in a rural community in Malawi. The intervention
 groups (Arm 1: storytelling narrative video on tablets [n=60] & Arm 2: a video with a voice
 over presenting didactic materials on tablets [n=60]) will watch approximately 30 minutes of
 video intervention and the comparison group (Arm 3 [n=60]) will be read non-narrative
 educational materials. Study measures of attitudes, knowledge, and cervical cancer screening
 intention will be assessed by pre-test and immediate post-test interviews, then again at 2
 and 6-months following the intervention.

 Selection and Enrollment

 Inclusion criteria are: 1) being confirmed HIV positive based on medical records, 2) women
 living with HIV infection (WLHIV) support group members, 3) ages 20-50 years, 4) no prior
 cervical cancer screening, 5) no history of invasive cervical cancer, and 6) willingness to
 participate in the study. The age range to 20-50 years for cervical cancer screening because
 there is limited evidence that this is the optimal upper age for cervical cancer screening of
 HIV-infected women (World Health Organization [WHO] 2013).

 This study will use a sequential-stratified sampling method. Of the eligible support groups
 and among those expressing interest, the investigators will select 15 support groups from
 rural areas within the Lilongwe district and then randomly assign the selected groups into
 intervention and comparison arms. The computer-generated assignments will be stratified by
 support group size and the distance between intervention and control arms (at least 4 miles).
 Within each selected support group, 12 women who are eligible will be invited to participate
 in the study. The investigators have satisfactorily used these methods for recruitment of
 WLHIV by working with HIV support group leaders in our previous studies.
Inclusion Criteria:

 Women who:

 1. are confirmed HIV positive based on medical records

 2. are women living with HIV infection support group members

 3. are ages 20-50 years

 4. are no prior cervical cancer screening

 5. are no history of invasive cervical cancer

 6. are willingness to participate in the study

 Exclusion Criteria:

 1. are not able to speak Chichewa or English

 2. self-report currently receiving treatment of a serious mental illness (e.g.,
 schizophrenia and bipolar disorder)