Randomized Trial for a Mobile Health Approach to Increase Uptake of Cervical Cancer Screening in Tanzania

Background: Largely due to low availability and uptake of screening in low- and middle-income countries, cervical cancer is the second ranked cancer among women in these countries. This is a tragedy because cervical cancer is one of the most preventable carcinomas. This thesis will investigate behaviour change methods, which capitalize on the recent exponential increase in ownership of mobile phones in Tanzania, to increase uptake of cervical cancer screening (CCS) in the Kilimanjaro region of Tanzania. Objectives: 1) To evaluate the effectiveness of behaviour change messages delivered via short message service (SMS) on the uptake of CCS in the Kilimanjaro region; 2) to evaluate the effectiveness of a transportation eVoucher on the uptake of CCS in the Kilimanjaro region; 3) to explore characteristics associated with CCS uptake in the Kilimanjaro region; and 4) to determine the attitudes towards and perceived benefit of behaviour change SMS messages and eVouchers intended to increase uptake of CCS. Methods: In the Kilimanjaro Region, 853 women participated in a randomized controlled trial. Baseline data was collected through self-report through systematic stratified random sampling. Participants were randomized to one of three groups: a control group, a group receiving behaviour change messages delivered via SMS, or a group receiving a travel eVoucher and identical SMS as the SMS group. A fieldworker recorded participants attending screening at the CCS clinics and administered a post-screening survey. The follow-up period was two months from the time of the participant’s enrolment. Logistic regression (both for the combined and stratified data sets) was used to determine associations between the behaviour change interventions, baseline characteristics and cervical cancer screening uptake. Results: All participants receiving SMS messages (SMS or eVoucher group) were more likely to attend cervical cancer screening in comparison with the control group. 83% of participants who attended screening shared the information contained in the messages with others. Conclusions: Behaviour change messages delivered via SMS and transportation eVouchers have the potential to increase uptake of cervical cancer screening in the Kilimanjaro region of Tanzania. Harnessing this potential will require implementing these interventions alongside other methods to achieve maximum impact.

Healthcare and the Common Good: Restructuring the Economy of Medical Knowledge through Communitarian Political Theory

The pharmaceutical industry wields disproportionate power and control within the medical economy of knowledge where the desire for profit considerably outweighs health for its own sake. Utilizing the theoretical tools of political philosophy, this project restructures the economy of medical knowledge in order to lessen the oligarchical control possessed by the pharmaceutical industry. Ultimately, this project argues that an economy of medical knowledge structured around communitarian political theory lessens the current power dynamic without taking an anti-capitalist stance. Arising from the core commitments of communitarian-liberalism, the production, distribution, and consumption of medical knowledge all become guided processes seeking to realize the common good of quality healthcare. This project also considers two other theoretical approaches: liberalism and egalitarianism. A Medical knowledge economy structured around liberal political theory is ultimately rejected as it empowers the oligarchical status quo. Egalitarian political theory is able to significantly reduce the power imbalance problem but simultaneously renders inconsequential medical knowledge; therefore, it is also rejected.