Magali Jonnalagedda-Cattin’s research while affiliated with Swiss Federal Institute of Technology in Lausanne and other places

Background Cervical cancer is the fourth most frequent cancer among women, with 90% of cervical cancer-related deaths occurring in low- and middle-income countries like Cameroon. Visual inspection with acetic acid is often used in low-resource settings to screen for cervical cancer; however, its accuracy can be limited. To address this issue, the Swiss Federal Institute of Technology Lausanne and the University Hospitals of Geneva are collaborating to develop an automated smartphone-based image classifier that serves as a computer aided diagnosis tool for cancerous lesions. The primary objective of this study is to explore the acceptability and perspectives of women in Dschang regarding the usage of a screening tool for cervical cancer relying on artificial intelligence. A secondary objective is to understand the preferred form and type of information women would like to receive regarding this artificial intelligence-based screening tool. Methods A qualitative methodology was employed to gain better insight into the women’s perspectives. Participants, aged between 30 and 49 were invited from both rural and urban regions and semi-structured interviews using a pre-tested interview guide were conducted. The focus groups were divided on the basis of level of education, as well as HPV status. The interviews were audio-recorded, transcribed, and coded using the ATLAS.ti software. Results A total of 32 participants took part in the six focus groups, and 38% of participants had a primary level of education. The perspectives identified were classified using an adapted version of the Technology Acceptance Model. Key factors influencing the acceptability of artificial intelligence include privacy concerns, perceived usefulness, and trust in the competence of providers, accuracy of the tool as well as the potential negative impact of smartphones. Conclusion The results suggest that an artificial intelligence-based screening tool for cervical cancer is mostly acceptable to the women in Dschang. By ensuring patient confidentiality and by providing clear explanations, acceptance can be fostered in the community and uptake of cervical cancer screening can be improved. Trial registration Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017–0110 and CER-amendment n°4) and Cameroonian National Ethics Committee for Human Health Research (N°2022/12/1518/CE/CNERSH/SP). NCT: 03757299.

BACKGROUND Digital medicine shows high potential to improve patient care management around the world. Even though a digital solution is technologically well implemented, its sustained use can be hindered by numerous factors. Consequently, the technology may fail to progress beyond the pilot stage and may never reach end-users nor patients. In the field of cervical cancer, many computer-aided diagnosis (CAD) algorithms have been developed for the assessment of cervical lesions but require further investigation in terms of feasibility and effectiveness in real clinical conditions. OBJECTIVE The current study focuses on challenges perceived by healthcare providers (HCPs) for the sustained use of a cervical cancer CAD tool for visual inspection with acetic acid (VIA) in West Cameroon. It aims to identify common barriers and facilitators to ensure a smooth adoption of the technology, in that specific context of use, but also in wider settings. METHODS A qualitative methodology was used to identify the main barriers to adoption of the technology and potential solutions to those challenges. Participants of this study include 8 HCPs (6 midwives and 2 gynaecologists), all working in the district of Dschang in Cameroon. While focus groups were conducted to discuss with the midwives, individual interviews explored the perspectives of the medical doctors. All interviews were audio-recorded, transcribed and then coded independently by two researchers using the ATLAS.ti software. The Technology Acceptance Lifecycle was used as a framework to analyse the results. RESULTS The identified key elements influencing a sustained use of CAD tools for VIA by HCPs were perceived as part of a pre-adoption phase. Barriers include ease-of-use of the system, confidentiality concerns, limited infrastructure and resources as well as change in the workflow. Facilitators mainly encompass validation of the technology in terms of performance, usability and integration in the patient care, and provision of services complementary to the technology such as tailored training of the HCPs. This approach would enhance the HCPs trust in the technology, without which, a sustained use cannot be achieved. Most importantly, the users need to be involved early and regularly provide feedback about the ease-of-use, usefulness and efficiency of the system. CONCLUSIONS Focusing on the HCPs perspectives in West Cameroon, the current study provides practical insights regarding the use of CADs for VIA in clinical settings. In addition to the technology readiness and ease of use, numerous elements should be considered at an early stage of the development of the solution to ensure a proper adoption and to reach the end-users. Those elements include a deep understanding of the context of use, of its end user, training, assistance for proper use and maintenance as well as robust clinical evidence.

Background Computer-aided detection and diagnosis (CAD) systems can enhance the objectivity of visual inspection with acetic acid (VIA), which is widely used in low- and middle-income countries (LMICs) for cervical cancer detection. VIA’s reliance on subjective health care provider (HCP) interpretation introduces variability in diagnostic accuracy. CAD tools can address some limitations; nonetheless, understanding the contextual factors affecting CAD integration is essential for effective adoption and sustained use, particularly in resource-constrained settings. Objective This study investigated the barriers and facilitators perceived by HCPs in Western Cameroon regarding sustained CAD tool use for cervical cancer detection using VIA. The aim was to guide smooth technology adoption in similar settings by identifying specific barriers and facilitators and optimizing CAD’s potential benefits while minimizing obstacles. Methods The perspectives of HCPs on adopting CAD for VIA were explored using a qualitative methodology. The study participants included 8 HCPs (6 midwives and 2 gynecologists) working in the Dschang district, Cameroon. Focus group discussions were conducted with midwives, while individual interviews were conducted with gynecologists to comprehend unique perspectives. Each interview was audio-recorded, transcribed, and independently coded by 2 researchers using the ATLAS.ti (Lumivero, LLC) software. The technology acceptance lifecycle framework guided the content analysis, focusing on the preadoption phases to examine the perceived acceptability and initial acceptance of the CAD tool in clinical workflows. The study findings were reported adhering to the COREQ (Consolidated Criteria for Reporting Qualitative Research) and SRQR (Standards for Reporting Qualitative Research) checklists. Results Key elements influencing the sustained use of CAD tools for VIA by HCPs were identified, primarily within the technology acceptance lifecycle’s preadoption framework. Barriers included the system’s ease of use, particularly challenges associated with image acquisition, concerns over confidentiality and data security, limited infrastructure and resources such as the internet and device quality, and potential workflow changes. Facilitators encompassed the perceived improved patient care, the potential for enhanced diagnostic accuracy, and the integration of CAD tools into routine clinical practices, provided that infrastructure and training were adequate. The HCPs emphasized the importance of clinical validation, usability testing, and iterative feedback mechanisms to build trust in the CAD tool’s accuracy and utility. Conclusions This study provides practical insights from HCPs in Western Cameroon regarding the adoption of CAD tools for VIA in clinical settings. CAD technology can aid diagnostic objectivity; however, data management, workflow adaptation, and infrastructure limitations must be addressed to avoid “pilotitis”—the failure of digital health tools to progress beyond the pilot phase. Effective implementation requires comprehensive technology management, including regulatory compliance, infrastructure support, and user-focused training. Involving end users can ensure that CAD tools are fully integrated and embraced in LMICs to aid cervical cancer screening.