title: Effect of health beliefs on delays in care for abnormal cervical cytology in a multi-ethnic population.
abstract: BACKGROUND
  Women from racial and ethnic minorities in the United States have higher rates of cervical cancer and present with later stage disease compared to whites. Delays in care for abnormal Papanicolaou (Pap) smears can lead to missed cases of cervical cancer or late-stage presentation and may be one explanation for these differences.
  
  
  OBJECTIVE
  To determine if race and ethnicity, health beliefs, and cancer knowledge are associated with delays in care for abnormal Pap smears.
  
  
  METHODS
  We conducted a mailed survey with telephone follow-up of all women with an abnormal Pap smear who received care at Kaiser Permanente Los Angeles Medical Center between October 1998 and October 1999 (n = 1,049).
  
  
  RESULTS
  A delay in care was defined as not attending the first scheduled clinic visit to follow up on an abnormal Pap smear, or requiring multiple contact attempts, including a certified letter, to schedule a follow-up visit. Our response rate was 70% (n = 733) and the sample was 51% Latina. Spanish-speaking Latinas and women of Asian descent were more likely to endorse fatalistic beliefs and misconceptions about cancer. Thirteen percent of the sample delayed follow-up on their abnormal Pap smear. Women who delayed care were more fatalistic and endorsed more misconceptions about cervical cancer. Delays in care were not independently associated with race and ethnicity.
  
  
  CONCLUSIONS
  Health beliefs and cancer knowledge differed by race and ethnicity among women in a large managed care organization. Fatalistic health beliefs and misconceptions about cancer, but not race and ethnicity, were independently associated with delays in care.
authors.affiliation: Primary and Specialty Medical Care Service, VA Puget Sound Health Care System and the Department of Medicine, University of Washington, Seattle, 98108-1597, USA. karin.nelson@med.va.goc
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D003625:Data Collection / Q000379:methods; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015141:Los Angeles; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000208:ethnology*; D017060:Patient Satisfaction / Q000208:ethnology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears