Life stressors are an important reason for women discontinuing follow-up care for cervical neoplasia.
Although studies have addressed psychosocial factors associated with obtaining follow-up care for an abnormal Pap test, none have explored the effect of stressful life events in predicting the receipt of follow-up care for an abnormal Pap test. Data from a program (1995-2001) that provided free follow-up care for women with low-grade cervical lesions (n = 601) was used to determine whether life stressors increased risk of study discontinuation. Women were interviewed at baseline and offered follow-up at 4- to 6-month intervals for up to 24 months. Of the 556 women recruited and interviewed (92% response rate), 53 were referred out because they had high-grade cervical lesions and 33 had a health condition precluding follow-up. Among 470 women who began follow-up, 175 (37.2%) discontinued before completing three visits. Women who discontinued were significantly more likely to report more stressful life events in the past year [age-adjusted relative risk (aRR), 1.19; 95% confidence interval (95% CI), 1.08-1.30; 17-item scale]. Events most strongly associated with discontinuation included having a problem with a boss (aRR, 1.9; 95% CI, 1.5-2.4), severe physical partner violence (aRR, 1.7; 95% CI, 1.3-2.2), being homeless (aRR, 2.1; 95% CI, 1.6-2.8), and having an unplanned pregnancy (aRR, 1.5, 95% CI, 1.2-2.1). Life stressors may be important predictors of discontinuation of free follow-up care among women in need of immediate follow-up care to prevent lesion progression.
School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler, PO Box 20186, Houston, Texas 77225, USA. ann.l.coker@uth.tmc.edu
Ann L
AL
Coker
Sharon M
SM
Bond
Lucia A
LA
Pirisi
D000223:Adaptation, Psychological; D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts / Q000523:psychology*; D011446:Prospective Studies; D013315:Stress, Psychological; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000523:psychology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000523:psychology*