Correlating knowledge of cervical cancer prevention and human papillomavirus with compliance after colposcopy referral.
OBJECTIVE
This study aimed to assess the impact of knowledge of cervical cancer biology and prevention as well as noncognitive measures on compliance with colposcopy referral in a high-risk population.


METHODS
Participants in a US cohort of women with human immunodeficiency virus (HIV) infection and at-risk comparison women completed behavior questionnaires and instruments measuring knowledge of cervical cancer prevention, depressive symptoms, trust in physicians, and perceived stress. Examinations including Pap tests also were conducted. Associations with compliance with resulting indicated colposcopy were assessed in multivariable models.


RESULTS
Of 326 women with indicated colposcopy, 222 (68%) were compliant with colposcopy referral and 104 (32%) were noncompliant. In multivariable analysis, better colposcopy compliance was associated with less education (odds ratio [OR] for compliance = 2.24, 95% confidence interval = 1.12-4.51 vs more than high school), previous abnormal Pap result (OR per previous abnormal Pap result = 1.08, 95% CI = 1.01-1.15), study site (OR for site with best vs worst compliance = 16.1, 95% CI = 2.91-88.6), and higher stress (OR for perceived stress scale 10 score >16 vs lower 3.25, 95% CI = 1.45-7.26).


CONCLUSIONS
Noncognitive factors and how sites manage abnormal Pap testing affect colposcopy compliance. Educational interventions alone are unlikely to improve colposcopy compliance in similar high-risk populations.
Washington University School of Medicine, St. Louis, MO, USA. massadl@wudosis.wustl.edu
L Stewart
LS
Massad
Kathleen M
KM
Weber
Tracey E
TE
Wilson
Johanna L
JL
Goderre
Nancy A
NA
Hessol
Donna
D
Henry
Christine
C
Colie
Howard D
HD
Strickler
Alexandra M
AM
Levine
D Heather
DH
Watts
Charlesnika T
CT
Evans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D015658:HIV Infections / Q000150:complications; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*