title: Evaluating the stage of change model to a cervical cancer screening intervention among Ohio Appalachian women.
abstract: Cervical cancer incidence and mortality rates are disproportionally high among women living in Appalachia Ohio. This study used the Transtheoretical Model to examine screening barriers before and after a lay health advisor (LHA) intervention (2005-2009) to increase cervical cancer screening rates. Ohio Appalachian women (n = 90) who were in need of a Pap test, based on risk-appropriate guidelines, were randomized to a 10-month LHA intervention and received two in-person visits, two phone calls, and four mailed postcards targeted to the participant's stage of change. Findings revealed that 63% had forward stage movement 10 months after the intervention. The most frequently reported screening barriers were time constraints, forgetting to make an appointment, and cost. Women who reported the following barriers-doctor not recommending the test; being unable to afford the test; and being embarrassed, nervous, or afraid of getting a Pap test-were less likely to be in the action stage. Understanding the stages of change related to Pap testing and reported barriers among this underserved population may help inform researchers and clinicians of this population's readiness for change and how to set realistic intervention goals.
authors.affiliation: a Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Krok-Schoen
authors.affiliation: a Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Oliveri
authors.affiliation: b Center for Biostatistics , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Young
authors.affiliation: a Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA.|c Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.|d Division of Health Behavior and Health Promotion, College of Public Health , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
authors.affiliation: a Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Tatum
authors.affiliation: a Comprehensive Cancer Center , The Ohio State University , Columbus , Ohio , USA.|c Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine , The Ohio State University , Columbus , Ohio , USA.|e Division of Epidemiology, College of Public Health , The Ohio State University , Columbus , Ohio , USA.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
mesh_terms: D000328:Adult; D001061:Appalachian Region; D003150:Community Health Workers / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000523:psychology*; D008875:Middle Aged; D008962:Models, Theoretical; D009820:Ohio; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D012424:Rural Population; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D014932:Women's Health Services / Q000458:organization & administration
keywords: Appalachia; Pap testing; cervical cancer; lay health advisor; stage of change