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.

Season-Long Examination of the Intervention Tone of Coach-Athlete Interactions and Athlete Development in Youth Sport

Objectives: Coaches are a primary influence on athletes' development in youth sport (Horn, 2008). However, the intervention tone of coaches' behaviour has not been directly observed. The purpose of this study was to examine associations between the intervention tone exhibited by youth sport coaches and athletes' individual developmental trajectories over the course of a season. Design: Short-term longitudinal study with behavioural observation. Method: Fifty-five athletes and their coaches from five youth volleyball teams were observed at three time points, and the intervention tone of interactive behaviour was systematically coded and organized by coach-athlete dyad. Athletes completed measures of the 4C's of athlete development (competence, confidence, connection, character) at each time point, which were used to create individualized developmental trajectories. Person-centred analyses were used to examine associations between athletes' developmental trajectories and their unique interactive experiences with their coach. Results: Cluster analysis revealed the presence of three distinct clusters based on athletes' developmental trajectories: 1) high and increasing, 2) low and decreasing, and 3) moderate and maintaining, with athletes from each team distributed across clusters. Analysis of dyadic interaction profiles revealed significant differences in interactive behaviour between clusters. Conclusions: Results suggest that differences in coach-athlete interactive experiences are associated with different developmental trajectories over the course of a season, even for athletes working with the same coach, highlighting the individualized nature of coaches' influence on young athletes. Practical implications for coaches include a critical awareness of their unique interactive relationship with each athlete independently, as well as the importance of fostering these relationships with regard to young people as more than just athletes.

"Can you ask her to help?" An examination of the factors that promote and discourage prosocial intervention in preschool children

Previous research has examined young children’s ability to detect who would be most likely to provide help to others in a given situation, but little is known about their ability to intervene based on this knowledge in a real-life setting. In the current study, 48 three-year-old children chose between two actors to retrieve an out-of-reach object for the Experimenter; one actor was physically incapable of providing the object (blocked by a tall barrier), and one was capable. Participants’ looking behaviour between the two actors during the study was also recorded and analyzed as an additional, nonverbal measure of their prediction about who would help. Approximately half of the participants in the sample actively intervened on behalf of the Experimenter, but only after a direct request for help was made. Though the other participants did not engage in this helping behaviour, they chose the unblocked actor to help the Experimenter in a subsequent interview. Children also spent more time looking at the unblocked actor. Secondary analyses indicated that shyness prevented many children in the study from asking for help on behalf of the Experimenter from one of the actors. Finally, an unexpected side bias for looking behaviour toward the actors was found that has implications for how the study design could be improved for future research.