The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer.
BACKGROUND
A disproportionate number of women diagnosed with cervical cancer are from low-income and/or ethnically diverse groups. This study was designed to evaluate the effectiveness of an outreach and counseling intervention at improving the rate of follow-up of abnormal Pap smears among women at Alameda County Medical Center, Oakland, CA.


METHODS
Between September 1, 1999 and August 31, 2001, 348 women with abnormal Pap test results were randomly assigned to intervention or usual care. The main outcome was rate of follow-up.


RESULTS
The intervention produced a significant increase in the rate of follow-up visits within 6 months. Women in the intervention group were much more likely to obtain timely follow-up at Highland Hospital than were those in the control group (61% vs. 32%, P = 0.001). The intervention was equally effective when delivered to women in the control group who had no follow-up by 6 months. Overall, we were able to contact 90% of women in the intervention group.


CONCLUSIONS
An outreach intervention is highly effective at increasing follow-up of abnormal Pap smears in a public hospital setting. Institutions offering cervical cancer screening to low-income, high-risk women should consider the use of outreach workers to reduce loss to follow-up.
Engelstad
Linda P
LP
Alameda County Medical Center, 1411 East 31st Street, Oakland, CA 94602, USA. lengelstad@acmedctr.org
Stewart
Susan
S
Otero-Sabogal
Regina
R
Leung
May S
MS
Davis
Patricia I
PI
Pasick
Rena J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003159:Community-Institutional Relations; D003376:Counseling; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008875:Middle Aged; D065006:Papanicolaou Test; D010349:Patient Compliance; D011203:Poverty; D015397:Program Evaluation; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data