Abnormal cervical screen follow-up among low-income Latinas: Project SAFe.
BACKGROUND
Cervical cancer incidence and mortality rates are dramatically higher among low-income women than in the general population, in part due to poor adherence to recommended diagnostic follow-up after an index Pap test. This report describes a pilot study of the Screening Adherence Follow-Up Program (SAFe), an individualized, structured case management program designed to assess for and intervene in response to a variety of potential personal and systems barriers to follow-up adherence. Interventions included health education, counseling, and systems navigation.


METHODS
A clinical decision-making algorithm was used to determine service intensity and level of intervention. Services were provided to 196 low-income women, predominantly Latinas, who had either a low-grade or high-grade squamous intraepithelial lesion (LGSIL or HGSIL) abnormal Pap result. Adherence rates to at least one follow-up appointment after enrollment and baseline intervention were 83% following LGSIL and 93% for HGSIL.


RESULTS
Over 1 year post-enrollment, 41% of women with LGSIL were fully adherent, with 42% partially adherent; 61% of women with HGSIL were fully adherent, with 32% partially adherent. In a comparison group of 369 nonenrollees (women who refused participation or could not be located for consent), adherence rates were 58% for LGSIL and 67% for HGSIL. A survey among a random sample of women served indicated that 93% were "mostly" or "very" satisfied, overall, with SAFe services.


CONCLUSIONS
The intervention team--a peer counselor and a master's degreed social worker--addressed multiple psychosocial and systems navigation problems to reduce potential barriers to adherence, including knowledge, attitudinal, psychosocial, psychological distress, systems communication, and resource access problems. SAFe appears highly acceptable to women and may significantly enhance medical care management following an abnormal cervical screen for a carefully targeted group of women at risk for suboptimal follow-up adherence.
Ell
Kathleen
K
School of Social Work, University of Southern California, MRF 214 (MC 0411), Los Angeles, CA 90089-0411, USA.
Vourlekis
Betsy
B
Muderspach
Laila
L
Nissly
Jan
J
Padgett
Deborah
D
Pineda
Diana
D
Sarabia
Olga
O
Lee
Pey-Jiuan
PJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D015141:Los Angeles; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011203:Poverty / Q000208:ethnology / Q000523:psychology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000208:ethnology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health