Evaluating the Impact of a Novel Educational Intervention to Improve Timely Colposcopy Follow-Up and Treatment Among High-Risk Populations

Cervical cancer mortality is preventable when detected by screening and treated at an early or precursor stage. Despite similar rates of cervical cancer screening, women with limited financial means or education, or low health literacy suffer from disproportionately higher rates of cervical cancer incidence and mortality compared to average women. A major influence on these outcomes is lack of understanding of the importance of follow-up after abnormal screening. Effective and scalable educational interventions are currently not widely implemented. An intervention emphasizing the importance of colposcopy and follow-up after abnormal cervical cancer screening that is easily understood by women in high-risk groups is a critical strategy to reduce cancer- related mortality. We propose a hybrid type 1a implementation-effectiveness trial to test the hypothesis that a pilot tested educational video intervention called COLPO (Clear communication, Optimize Follow up, Leverage Education, Promote prevention, Outreach to increase awareness) reduces loss to follow-up after colposcopy in high-risk women. COLPO uses a novel approach to education called the Patient Activated Learning System (PALS), which has been proven to increase knowledge uptake and receptivity to medical advice in low-income populations. On detection of an abnormal cervical cancer screening, women are sent SMS text messages with links to PALS videos explaining information about the human papilloma virus and the importance of follow-up. In Aim 1 we will engage stakeholders to refine the intervention protocol guided by the CFIR framework and our Community Advisory Board (CAB). We will refine the videos based on feedback of participants in our pilot study. In Aim 2, we will conduct the trial by engaging 700 women with abnormal Pap screening results who will be randomly assigned to receive either the COLPO educational intervention or standard follow-up care. The women will be patients at one of our 4 clinics in New York City. The primary effectiveness outcome is timely colposcopy follow-up appointments within 3 months. An exploratory effectiveness outcome is guideline concordant care within 1 year, measured via EMR surveillance. In Aim 3 we will assess implementation of the intervention guided by the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework by collecting survey data on patient satisfaction, anxiety, confidence, and knowledge, as well as qualitative data related to implementation. We will also embed the COLPO intervention into our EMR as a model for scalability. We will work with the CAB to disseminate the findings in the community. Our multidisciplinary team includes experts in Gyn/Oncology, the PALS, qualitative research, implementation trials, and EMR implementation, enhancing the likelihood of success of this project. If COLPO proves effective, the intervention will be scaled across our 11-hospital health system to increase colposcopy and follow-up among the Meyer Cancer Center catchment area serving more than 6 million patients, with the goal of reducing cervical cancer incidence and mortality for all populations. Project Number: 1R01CA300794-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Eloise Chapman-Davis | Institution: WEILL MEDICAL COLL OF CORNELL UNIV, NEW YORK, NY | Award Amount: $702,461 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-D (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11366182