# mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

> **NIH NIH R21** · UNIVERSITY OF MASSACHUSETTS BOSTON · 2021 · $167,919

## Abstract

Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV)
in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in
the prevention of CC but the availability of CC screening does not automatically translate into their utilization
among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of
resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the
population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence-
based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular
promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including
cancer screening. In addition, narrative interventions such as storytelling made available through social media
holds the promise of engaging WLWHIV in more active participation in health prevention/self-management.
This study addresses the following specific aims:
Phase I: Developmental Phase: Develop intervention
Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from
Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted
health messages that are consistent with the situation-specific theory and the desired behavior (CC screening).
Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT)
Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2:
mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary
effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15
established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign
the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV
who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning
gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention.
Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV
support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting
prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that
it attempts to integrate CC screening into the HIV support group system already in place in Malawi and
develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed
study is significant because of its potential to improve CC prevention by equipping Malawian WL...

## Key facts

- **NIH application ID:** 10149416
- **Project number:** 5R21NR018734-02
- **Recipient organization:** UNIVERSITY OF MASSACHUSETTS BOSTON
- **Principal Investigator:** Haeok Lee
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $167,919
- **Award type:** 5
- **Project period:** 2020-04-23 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10149416

## Citation

> US National Institutes of Health, RePORTER application 10149416, mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV (5R21NR018734-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10149416. Licensed CC0.

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