title: Perspectives on Pap test follow-up care among rural Appalachian women.
abstract: Approximately one- to three-quarters of women notified of abnormal Pap test results do not receive appropriate follow-up care, dramatically elevating their risk for invasive cervical cancer. We explored barriers to and facilitators of follow-up care for women in two counties in Appalachian Kentucky, where invasive cervical cancer incidence and mortality are significantly higher than the national average. In-depth interviews were conducted among 27 Appalachian women and seven local health department personnel. Those who had been told of an atypical Pap test result tended to have one of three reactions: (1) not alarmed and generally did not obtain follow-up care; (2) alarmed and obtained follow-up care; or (3) alarmed, but did not obtain care. Each of these typologies appeared to be shaped by a differing set of three categories of influences: personal factors; procedure/provider/system factors; and ecological/community factors. Recommendations to increase appropriate follow-up care included pursuing research on explanations for these typologies and developing tailored interventions specific to women in each of the response types.
authors.affiliation: University of Kentucky, Lexington, Kentucky 40536, USA. nesch@uky.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
authors.forename: Julie
authors.initials: J
authors.lastname: Baltisberger
authors.forename: Shoshana
authors.initials: S
authors.lastname: Bardach
authors.forename: Mark
authors.initials: M
authors.lastname: Dignan
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007629:Kentucky / Q000453:epidemiology; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014626:Vaginal Smears; D055815:Young Adult