Psychosocial barriers to follow-up adherence after an abnormal cervical cytology test result among low-income, inner-city women.
OBJECTIVE
Low-income, inner-city women bear a disproportionate burden of cervical cancer in both incidence and mortality rates in the United States, largely because of low adherence to follow-up recommendations after an abnormal cervical cytology result in the primary care setting. The goals of the present study were to delineate the theory-based psychosocial barriers underlying these persistent low follow-up rates and their sociodemographic correlates.


METHODS
Guided by a well-validated psychosocial theory of health behaviors, this cross-sectional, correlational study assessed the barriers to follow-up adherence among underserved women (N = 210) who received an abnormal cervical cytology result. Participants were recruited through an inner-city hospital colposcopy clinic, and were assessed by telephone prior to the colposcopy appointment.


RESULTS
Participants were largely of African American race (82.2%), lower than high school completion education (58.7%), single, never married (67.3%), and without full-time employment (64.1%). Knowledge barriers were most often endorsed (68%, M = 3.22), followed by distress barriers (64%, M = 3.09), and coping barriers (36%, M = 2.36). Forty-six percent reported more than one barrier category. Less education and being unemployed were correlated with higher knowledge barriers (P < .0001 and P < .01, respectively) and more coping barriers (P < .05 and P < .05, respectively). Women who were younger than 30 years displayed greater distress barriers (P < .05).


CONCLUSIONS
In the primary care setting, assessing and addressing knowledge and distress barriers after feedback of an abnormal cervical cytology result may improve adherence to follow-up recommendations. The use of structured counseling protocols and referral to navigational and other resources may facilitate this process and thereby reduce disparities in cervical cancer.
Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA.
Siu-Kuen Azor
SK
Hui
Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA suzanne.miller-halegoua@fccc.edu.
Suzanne M
SM
Miller
Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA.
Kuang-Yi
KY
Wen
Everest Clinical Research Services, Little Falls, NJ, USA.
Zhu
Z
Fang
Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA.
Tianyu
T
Li
Research and Training Institute of Cancer Support Community, Philadelphia, PA, USA.
Joanne
J
Buzaglo
Temple University School of Medicine, Philadelphia, PA, USA.
Enrique
E
Hernandez
D000223:Adaptation, Psychological; D000328:Adult; D003127:Colposcopy / Q000523:psychology; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010414:Pennsylvania; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology; D014505:Urban Population / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000523:psychology; D014626:Vaginal Smears; D055815:Young Adult
adherence; cervical risk; low-income women; psychosocial barriers