Mobile Health Patient Navigation for the Improvement of Screening and the Early Detection of Breast Cancer in Women Accessing Primary Care Clinics in Kenya

PRIMARY OBJECTIVES: I. To design and evaluate a multi-component, multi-level, evidence-informed, m-Health-supported package of interventions and delivery strategies to promote uptake and access to resource stratified and guideline-informed breast cancer screening and early detection services in Kenya. II. To identify and select candidate interventions that are effective in promoting uptake and access to breast cancer screening and early detection. III. To implement a package and strategies of m-Health supported evidence-based interventions for screening and early detection of breast cancer. IV. To evaluate feasibility (recruitment, retention, implementation) of each strategy, and identify the most effective strategy (or combination of strategies), for the lowest cost. OUTLINE: AIM 1: Participants complete a focus group over 60-90 minutes in support of the identification and selection of evidence-based interventions (EBIs) on study. AIM 2: Participants are assigned to 1 of 2 groups. GROUP I: Participants complete a stakeholder interview and complete surveys to further inform EBI adaptation and implementation on study. GROUP II: Participants complete a key informant interview and complete surveys to further inform EBI adaptation and implementation on study. AIM 3: Patients are randomized to 1 of 8 arms. ARM 1: Patients receive enhanced usual care (EUC) which may consist of viewing a motivational and educational peer testimonial video, motivational interviewing regarding breast health and cancer screening, and/or being offered clinical breast examination (CBE) access followed by standardized follow-up counseling about screening MMG or guideline-based recommendations on the need for further diagnostic testing on study. ARM 2: Patients receive EUC as in arm I and adapted m-Health PN strategy C components on study. ARM 3: Patients receive EUC as in arm I and adapted m-Health PN strategy B components on study. ARM 4: Patients receive EUC as in arm I and adapted m-Health PN strategy B and C components on study. ARM 5: Patients receive EUC as in arm I and adapted m-Health PN strategy A components on study. ARM 6: Patients receive EUC as in arm I and adapted m-Health PN strategy A and C components on study. ARM 7: Patients receive EUC as in arm I and adapted m-Health PN strategy A and B components on study. ARM 8: Patients receive EUC as in arm I and adapted m-Health PN strategy A, B, and C components on study. After completion of study intervention, patients are followed up at 3 and 6 months and at study completion.