title: Barriers to follow-up of an abnormal Pap smear in Latina women referred for colposcopy.
abstract: BACKGROUND
  Lower rates of follow-up after an abnormal Pap smear in racial and ethnic minorities may contribute to the higher incidence and mortality rates of cervical cancer seen in these groups.
  
  
  OBJECTIVE
  To identify patient-perceived barriers to follow-up after an abnormal Pap smear result among Latina women. DESIGN, PARTICIPANTS AND APPROACH: Qualitative, semi-structured, one-on-one interviews were conducted with patients from an academic hospital-affiliated urban community health center. Three groups of women were interviewed: new colposcopy clinic patients, patients who had previous colposcopies and patients enrolled in the health center's patient navigator program. Open-ended questions explored their knowledge, beliefs and experiences with colposcopy. Content analysis of transcripts was performed using established qualitative techinques.
  
  
  RESULTS
  Of 40 Latina women recruited, 75% spoke only Spanish. The average age was 31.5 (range 18-55). Personal and system barriers identified were categorized into four themes: (1) anxiety/fear of procedure and diagnosis; (2) scheduling/availability of appointments interfering with work and/or child care; (3) inadequate communication about appointments, including lack of explanation regarding diagnosis, procedure and results; and (4) pain. New patients more commonly reported problems with scheduling and communication. Follow-up patients were more concerned about pain, and navigated women most often reported fear of results but had fewer concerns about inadequate communication.
  
  
  CONCLUSIONS
  Anxiety/fear was the most common personal barrier, while difficulty scheduling appointments and inadequate communication were the major systems barriers identified in these Latina women. Interventions to lower these barriers to colposcopy among Latina women may increase adherence to follow-up of abnormal Pap smears.
authors.affiliation: Chelsea HealthCare Center, Massachusetts General Hospital, 151 Everett Avenue, Chelsea, MA 02150, USA. spercaclima@partners.org
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Aldrich
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Gamba
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Bearse
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001294:Attitude to Health; D003127:Colposcopy / Q000523:psychology*; D003144:Communication Barriers; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D065006:Papanicolaou Test; D010465:Perception; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears; D055815:Young Adult