title: Intervention to improve follow-up for abnormal Papanicolaou tests: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effect of a theory-based, culturally targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test.
  
  
  METHODS
  5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to one of three groups to receive their results: Intervention (I): culturally targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): nontargeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7-14 days later with the CDDQ and CES-D.
  
  
  RESULTS
  299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p = .73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p = .77. Delay in care (in days) was (M ± SD): 58 ± 75 (I), 69 ± 72 (AC), and 54 ± 75 (SCO), p = .75. Adherence was associated with higher anxiety at notification, p < .01 and delay < 90 days (vs. 90+) was associated with greater perceived personal responsibility, p < .05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p < .05.
  
  
  CONCLUSIONS
  A theory-based, culturally targeted message was not more effective than a nontargeted message or standard care in improving behavior.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic.
authors.forename: Carmen Radecki
authors.initials: CR
authors.lastname: Breitkopf
authors.affiliation: Department of Obstetrics & Gynecology, University of Texas Medical Branch.
authors.forename: Lauren
authors.initials: L
authors.lastname: Dawson
authors.affiliation: Department of Biostatistics, University of Connecticut Health Center.
authors.forename: James J
authors.initials: JJ
authors.lastname: Grady
authors.affiliation: Department of Obstetrics & Gynecology, Mayo Clinic.
authors.forename: Daniel M
authors.identifier: 0000-0002-9161-0829
authors.initials: DM
authors.lastname: Breitkopf
authors.affiliation: Department of Obstetrics & Gynecology, University of Texas Medical Branch.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Nelson-Becker
authors.affiliation: Department of Obstetrics & Gynecology, University of Texas Medical Branch.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D054521:Cultural Competency; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000208:ethnology* / Q000706:statistics & numerical data; D011203:Poverty; D011582:Psychological Theory; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult