Abstract A051: Mobile-based cognitive behavioral therapy intervention to reduce psychological burden among HPV-positive women in underserved rural populations of China: A multi-center randomized controlled trial

Abstract

Abstract Background: Cervical cancer is a leading cause of cancer death among women in low-resource regions of China, where primary HPV screening is expanding rapidly. Women receiving HPV-positive results often experience acute anxiety, self-stigma, and distress, yet psychosocial support is virtually absent from county-level screening programs. This gap disproportionately affects women in rural, mountainous, and ethnic-minority regions, where mental health resources are scarce and cervical cancer stigma is amplified. Digital cognitive behavioral therapy (CBT) delivered via smartphone may reduce these disparities, but evidence in underserved Chinese populations is limited. Methods: We conducted a two-arm randomized controlled trial across four counties representing diverse underserved populations in China: Xiangyuan and Yangcheng (Shanxi, rural), Mangshi (Yunnan, ethnic-minority border), and Shimian (Sichuan, mountainous rural). Women aged 35–64 with a HPV-positive result in the past month who owned a smartphone were randomized 1:1 to intervention or usual care, stratified by site. The intervention was a one-week mobile CBT program (5–10 min/day, three video modules per session) covering psychoeducation, cognitive restructuring, emotion regulation, coping, and self-acceptance. Content was reviewed by local providers to ensure cultural appropriateness across ethnic-minority contexts. Outcomes at baseline, 2, and 6 months: anxiety (STAI-6, primary), distress (GHQ-12), self-stigma (SSS-S), social support, and illness perception. Effects were estimated using generalized estimating equations under intention-to-treat, with multiple imputation for missing data. Results: Of 602 randomized (301 intervention, 301 control), baseline characteristics were comparable. Mean age was 46.8 years; 58.7% had completed high school or below; and 22.3% self-identified as ethnic minorities (primarily at Mangshi). Retention was 88.2% at 2 months (n=531) and 72.1% at 6 months (n=434), with no differential attrition. Median adherence was 4.8 of 7 sessions. At 2 months, intervention significantly reduced anxiety (β=−2.58, 95% CI −3.20 to −1.96, p<0.001) and self-stigma (β=−0.48, −0.64 to −0.32, p<0.001), with no effect on distress (β=−0.55, −1.17 to 0.07, p=0.083). At 6 months, the anxiety benefit was attenuated but remained significant (β=−1.42, −2.34 to −0.50, p=0.003), while self-stigma reduction consolidated further (β=−0.76, −1.05 to −0.47, p<0.001). No long-term distress effect emerged. Illness perception improved modestly at both time points; social support did not differ. Multiple imputation sensitivity analyses were consistent. Conclusions: A brief mobile-based CBT intervention reduced short- and long-term anxiety and self-stigma among HPV-positive women in underserved rural and ethnic-minority regions of China, with stigma benefits consolidating over time. Digital CBT represents a scalable, equity-oriented intervention that could be integrated into national HPV screening pathways to narrow disparities in psychosocial support access. Citation Format: Yijin Wu, Yitong Zhu, Rongjing Sun, Yao Yang, Youlin Qiao. Mobile-based cognitive behavioral therapy intervention to reduce psychological burden among HPV-positive women in underserved rural populations of China: A multi-center randomized controlled trial [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A051.