Psychological and sociocultural perspectives on follow-up of abnormal Papanicolaou results.
OBJECTIVE
To understand women's motivation to attend follow-up of an abnormal Papanicolaou (Pap) test by applying a general theoretical framework for voluntary behavior.


METHODS
Semistructured, face-to-face interviews were conducted among 120 low-income, African-American, Caucasian, or Hispanic outpatients, aged 25-50 years, who presented for routine gynecologic care. Interview questions assessed social, cognitive, environmental, and emotional factors surrounding follow-up for an abnormal Pap test. Content analysis was performed.


RESULTS
The majority of women (74%) described their attitude toward returning for a follow-up visit as favorable. Overall, knowledge regarding the significance of an abnormal result was poor, and misconceptions were common. Perceived barriers, consequences, and social influences associated with attending follow-up were qualitatively different across the 3 racial/ethnic groups. For example, African-American and Hispanic women expressed embarrassment more frequently than Caucasian women and were less likely to anticipate obstacles to attending follow-up. Furthermore, African-American women were the least likely to be influenced by others' opinions and to perceive difficulty in adhering to follow-up recommendations. For nearly all women, adequate communication with their provider was a key component of anticipated adherence.


CONCLUSIONS
Clinicians may exert a positive influence on adherence among patients who experience an abnormal Pap test by engaging patients in a dialogue that accommodates the patient's sociocultural environment, explores concerns regarding the partner's reaction, emphasizes the importance of follow-up, provides a clear understanding of the process and timeline surrounding follow-up recommendations, and encourages the patient to anticipate obstacles to adherence and assists with solutions.
Breitkopf
Carmen Radecki
CR
Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, Texas, USA. cmradeck@utmb.edu
Catero
Jennifer
J
Jaccard
James
J
Berenson
Abbey B
AB
D000328:Adult; D001741:Black or African American; D003266:Continuity of Patient Care; D003469:Culture; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D012959:Socioeconomic Factors; D014626:Vaginal Smears; D044465:White People