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.

Amorous Ex/Incursions: Love in Writings of Badiou, Weil, Fromm, and Barthes

My dissertation explores the enabling contributions of love to the practice of ethico-political and cultural critique. Engaging with the work of Alain Badiou, Simone Weil, Erich Fromm, and Roland Barthes, I examine love in terms of the following modalities: waiting, giving, and looking. I place the aforementioned thinkers in dialogue with selected literary and cinematic texts to explicate and interrogate the meaningful possibilities of their discourse on love. In my chapter on Alain Badiou, I discuss his ontology, which I draw upon heavily to set the theoretical parameters of my study. I also discuss the logic of love that he develops in his philosophy. Speaking to the problem of pre-Evental agency that critics of his work identify, I suggest that waiting as attention, as theorized by Simone Weil, might be the closest form of agency that a pre-Evental (amorous) being can experience. In my discussion of Erich Fromm, I reevaluate his “art of loving” within the constellation of late capitalism. Reading his work through a Lacanian lens, I explore the utility of his prescriptions by examining Chuck Palahniuk’s controversial novel Fight Club. In my chapter on Roland Barthes, I theorize the possibility of cinematic looking that does not depend on the antagonism inherent in the binaries masculine/ feminine and (Gazing) spectator/ (to-be-looked-at) image. Towards this objective, I propose the “amorous look,” a mode of viewing occasioned by cinematic punctual encounters, that I contend is beyond the domain of desire and perversion. I deploy the “amorous look” as I reflect on Aureus Solito’s film Ang Pagdadalaga ni Maximo Olivares (The Blossoming of Maximo Olivares) and its representations of love and waiting.