# Formative research and design for a mobile health platform for oral cancer screening and detection (OC-DETECT)—a mixed methods study

## TL;DR

This study developed a mobile health platform for oral cancer screening in India, focusing on user-centered design and addressing barriers like awareness and privacy concerns.

## Contribution

The novel contribution is a user-centered mobile health platform (OC-DETECT) designed to improve oral cancer screening in India through mixed methods formative research.

## Key findings

- Young people and healthcare providers showed willingness to use mobile health for oral cancer screening.
- Lack of awareness and access to reliable educational materials were major barriers to seeking care.
- Privacy concerns and trust in digital health tools were identified as key considerations in the platform design.

## Abstract

Oral cancer (OC) in India accounts for one-third of the global burden of OC cases and mortality and is the third most frequent cancer in India. This study details formative research conducted to inform the design of a prototype mobile health platform that would consist of a participant-side mHealth screening app and a clinician side (a desktop-facing interface). The initial design included a risk assessment for general health as well as alcohol and tobacco habits, followed by a tool to upload digital images of the oral cavity taken with a mobile phone. The physician could then review the images remotely and make a provisional diagnosis.

E-Surveys were distributed to healthcare providers associated with the Indian Cancer Society in New Delhi (n = 11) and young people (n = 56) attending colleges in New Delhi. Questions were asked about oral health awareness, oral cancer awareness and possible barriers to seeking medical care when oral lesions were detected. Initial focus groups with young people (n = 17 individuals) and in-depth interviews with providers (n = 6) explored the resistance to visiting a clinic, issues related to trusted communications and educational materials, and willingness to use a mobile health application to collect personal health information and digital images. Second and third round of interviews and focus groups focused on reviews of low- and high-resolution wireframes of the initial designs before completing a final prototype design.

By utilizing a user-centered design approach, we concluded that young people and providers welcomed the opportunity use mobile phones to detect potential oral lesions in smokeless tobacco users and to seek care for family members, but had some concerns about issues related to privacy and personal health information. Lack of awareness of oral health issues was identified as a major barrier to seeking care, and a lack of access to reliable and trustworthy educational materials contributed to this problem.

As a result of this formative research, a final prototype is presented to produce a mobile health platform for the detection of oral cancer (OC-DETECT) which will then be tested at dental camps in New Delhi administered by the Indian Cancer Society.