Acceptability and Feasibility of Callascope Self-Imaging of the Cervix among Women in Ventanilla, Peru: A Mixed Methods Pilot Study.

Abstract

Background: Barriers that prevent adherence to cervical cancer screening programs in low-income communities include, among others, fear of and discomfort associated with the speculum during pelvic exams and difficulties in accessing health facilities. To address these barriers, a low-cost medical device, the Callascope was developed for self-imaging of the cervix. The device has a 2 MP camera connected to a smartphone and a disposable inserter with an asymmetrical tip to replace the speculum. A pilot study was performed to 1) evaluate the feasibility, acceptability, and comfort of women imaging their own cervix with the Callascope, 2) collect information to improve the design of the Callascope prototype, and 3) identify factors related with the ease of use, discomfort of the self-exam technique and quality of images.

Methods: The pilot study included women (n=15) who were either current or former community-health volunteers from Ventanilla, Peru with the HOPE program. Participants completed a pre-exam survey to assess demographics and establish reproductive medical history. Each participant was provided with a self-exam kit. They were asked to perform a self-exam and take pictures of their cervix with the Callascope at home at their convenience. They submitted an audio reflection immediately post-examination via WhatsApp. A post-insertion survey to assess user experience and a focus group discussion were performed 72 hours post-insertion.

Conclusions: The Callascope self-imaging of the cervix was reported to be more acceptable and comfortable than the traditional speculum-based gynecologic exam. All participants indicated that they would use the device again and recommend to a friend. Recommendations to improve the prototype design were identified: lengthen handle, overlay asymmetrical tip with softer silicon, and optimize manual focus mechanism. The Body Mass Index (BMI) was found to be a factor associated to the ease of device use and comfort.