Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a pragmatic trial design.
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a hybrid (type III) and pragmatic Sequential Multiple Assignment Randomized Trial (SMART) design. The adaptive strategies are designed to target patient- and system-level determinants identified in preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics. The strategies draw upon key principles in behavioral economics and are supported by systematic evidence of the effectiveness of nudge strategies in preventive, HIV, and cancer care. The overarching rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach and nudge strategies will increase timely treatment adoption and be scalable and sustainable in the long-term.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
680
A member of the pathology team will contact the referring clinic to communicate the readiness of results.
A member of the pathology team will contact both the referring clinic and the patient directly to communicate the readiness of results.
Patient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging.
University of Pennsylvania
Philadelphia, Pennsylvania, United States
ACTIVE_NOT_RECRUITINGNyangabgwe Referral Hospital
Francistown, North-East District, Botswana
RECRUITINGPrincess Marina Hospital
Gaborone, Botswana
RECRUITINGAdoption
Defined as the initiation of cervical cancer treatment within 90 days of randomization.
Time frame: Within 90 days of randomization
Fidelity
Defined as completion of evidence-based cancer treatment according to international guidelines and measured using medical record data.
Time frame: 12 months after randomization
Reach: First Appointment
Defined by the proportion of patients who complete an initial treatment visit divided by those randomized
Time frame: 12 months after randomization
Reach: First Stage
Defined by the proportion of patients who complete an enhanced outreach phone call divided by those contacted.
Time frame: 12 months after randomization
Reach: Second Stage
Defined by the proportion of patients who complete a patient navigation phone call (high touch strategy) divided by those contacted.
Time frame: 12 months after randomization
Reach: Results
Defined by the proportion of patients with confirmation of results received divided by those randomized.
Time frame: 12 months after randomization
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Patient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging in combination with synchronous telephone-based patient navigation.