Evaluation of an mHealth Intervention Using an Automated Text Message (SMS) Invitation System to Increase Participation in Mammography Screening Among Women Aged 50-69 Years in the Province of Santa Fe, Argentina

Breast cancer is the most common cause of death from cancer in women worldwide. In the Latin America and Caribbean region, each year 210,000 new cases are diagnosed, and 58,000 women die due this cancer (1). Access to early detection and appropriate treatment is needed for reducing the burden of this disease. According to the World Health Organization guidelines (2), in countries with well-established health systems, organized screening program with one mammography every two years has been proven effective to reduce mortality in women aged 50-74. Argentina is one of the Latin American countries with highest incidence and mortality rates in the region with 22,000 new cases and 6,800 deaths annually.(1) Breast cancer screening is opportunistic and despite several efforts to promote mammography, screening coverage remains low, around 40% in women with public health insurance (3). Therefore, the development of innovative and low-cost strategies for increasing access to breast cancer screening are needed.

The aim of the study was to evaluate effectiveness and implementation of an mHealth intervention based on SMS messages (the ATICA strategy) to promote participation in breast cancer screening among women aged 50 to 69 in Santa Fe, Argentina.

We carried out with a mixed-method study including a pragmatic randomized controlled trial to evaluate effectiveness of an mHealth intervention and quantitative and qualitative evaluation of the implementation guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework (4), specifically developed to assess interventions beyond efficacy across multiple public health criteria. RE-AIM framework was integrated in all stages of the research process, including conceptualization (e.g., selecting implementation processes that would be evaluated), data collection and analysis. Following Proctor´s Taxonomy of Implementation Outcomes (5), we also measured acceptability and appropriateness, which are essential to understand the success (or failure) of the implementation of an intervention from users' perspective. This approach is the same as we used to evaluate implementation in our previous study (The ATICA study (6-8)

Setting The study was conducted in the city of Santa Fe, the capital city of the province of Santa Fe, Argentina. The province of Santa Fe is located in the central region of Argentina. It is the third most populated province in the country, with 3,556,000 inhabitants of which 30% are women aged 50 and over and among them around 20% had public health insurance (9). Around 90% of the households had a cell phone (10).

Sample size The recruitment was conducted across ten selected healthcare centers (five in the north and 5 in the south of Santa Fe region) over a span of six months. Through this strategy, a total of 248 eligible women were successfully recruited between December 4, 2021, and July 7, 2022.