Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center.
OBJECTIVE
To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population.


METHODS
Telephone survey.


METHODS
An urban community health center.


METHODS
Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid.


METHODS
Completion of colposcopy.


RESULTS
Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P = .001). Younger women, especially teenagers, were less likely to return (P = .02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up.


CONCLUSIONS
Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.
McKee
M D
MD
Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. mckee@aecom.yu.edu
Lurio
J
J
Marantz
P
P
Burton
W
W
Mulvihill
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D003142:Communication; D003151:Community Health Centers; D005260:Female; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D009519:New York City; D065006:Papanicolaou Test; D010349:Patient Compliance; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology