Abstract:

As many as 3,900 women may die this year in the United States from cervical cancer, in spite of the widespread availability and use of screening tools such as the pap smear, which can aid in significantly increasing survival. Up to 80% of women, especially those who are of both low-income and minority status, do not return for treatment when they receive an abnormal or precancerous result.

This study identified factors that differentiate between women who did and did not return for follow-up medical care after receiving an abnormal pap smear. Fifty-two low-income Caucasians, African-Americans, Hispanics, and Asian women who did not return for follow-up care after an abnormal pap smear result returned the Pap Smear Follow-Up Questionnaire, and 52 low-income women of similar age, ethnicity, and educational level who did return for further care also completed the same survey prior to receiving follow-up services. By measuring a range of logistical, informational, emotional, and contextual problems in obtaining follow-up care, and including women of different ethnicities, this investigation is one of the most comprehensive studies to date on this important problem. Stepwise Discriminant Analysis conducted for the total sample showed that problems with understanding/medical literacy (e.g., not perceiving the need to seek further treatment due to a lack of visible symptoms) differentiated the women who did not return for follow-up care from the women who did. Stepwise Discriminant Analysis for each ethnicity revealed: (1)?practical problems (e.g., inconvenient hours or location of the clinic) first distinguished Caucasian women who did not return for treatment following an abnormal pap smear from their counterparts who did; also, negative emotions (e.g., being so sad and depressed about things in general that they didn't care about getting more medical care, or being anxious and upset about the abnormal pap smear); and worry about treatment and its potential personal and social implications (e.g., concern that any treatments needed would be embarrassing) distinguished among Caucasians. (2)?Problems with understanding/medical literacy and difficulties with medical care (e.g., where participants felt health care professionals did not care about them or their feelings) differentiated African-Americans who did not return for treatment from those who did. (3)?For Hispanics, negative emotions, such as depression and anxiety following the news of an abnormal pap result, was the only significant factor distinguishing Latinas who did not return for further treatment from those who did. (4)?For Asians, three factors significantly distinguished those who did not return versus those who did: problems with understanding/medical literacy, practical problems, and other inhibiting emotions (shame, guilt, and anger about an abnormal pap smear).

In this way, this study identified a key informational component that can help practitioners better understand and better address what drives lack of follow-up behavior-after an abnormal pap smear, as well as what issues can be acted upon to influence greater return for recommended treatment among women of different ethnicities.