Psychological and Sociocultural Perspectives on Follow-up of Abnormal Papanicolaou Results

Abstract

OBJECTIVE:To understand women's motivation to attend follow-up of an abnormal Papanicolaou (Pap) test by applying a general theoretical framework for voluntary behavior.METHODS: Semistructured, face-to-face interviews were conducted among 120 low-income, African-American, Caucasian, or Hispanic outpatients, aged 25-50 years, who presented for routine gynecologic care. Interview questions assessed social, cognitive, environmental, and emotional factors surrounding follow-up for an abnormal Pap test. Content analysis was performed. RESULTS:The majority of women (74%) described their attitude toward returning for a follow-up visit as favorable. Overall, knowledge regarding the significance of an abnormal result was poor, and misconceptions were common. Perceived barriers, consequences, and social influences associated with attending follow-up were qualitatively different across the 3 racial/ethnic groups. For example, AfricanAmerican and Hispanic women expressed embarrassment more frequently than Caucasian women and were less likely to anticipate obstacles to attending follow-up. Furthermore, African-American women were the least likely to be influenced by others' opinions and to perceive difficulty in adhering to follow-up recommendations. For nearly all women, adequate communication with their provider was a key component of anticipated adherence.

Life Stressors Are an Important Reason for Women Discontinuing Follow-up Care for Cervical Neoplasia

“…These competing events may indirectly affect study continuation by diverting a woman's ability to prioritize her own health. Our finding that severe physical partner violence was associated with study discontinuation was consistent with findings from qualitative studies indicating that partners may influence the likelihood of receiving follow-up care by discouraging follow-up care or threatening physical violence (12,13). Severe physical partner violence may also be correlated with study discontinuation if women experiencing abuse have physical signs, such as bruises or cuts, which they wish to hide from health care providers and therefore discontinue care.…”

“…The unified theory of behavior proposed by Jaccard et al (27) and adapted by Breitkopf et al (13) suggests that individual constructs of attitude, normative influences, expectancies, self-concept, affective responses, and self-efficacy influence the intermediate constructs of knowledge, motivation, environmental constraints, and salience. These intermediate constructs directly influence adherence behavior that can be measured as continuing to receive followup care.…”

“…Qualitative research suggests that stressful life events (SLE) may pose additional challenges for women coping with an abnormal Pap test (12,13). Breitkopf et al (13) reported that a partner may influence the likelihood of receiving follow-up care by discouraging follow-up care or threatening physical violence.…”

“…Breitkopf et al (13) reported that a partner may influence the likelihood of receiving follow-up care by discouraging follow-up care or threatening physical violence. Effective coping strategies to reduce psychological distress from an abnormal Pap test result have been noted (14,15).…”

Association of Intimate Partner Violence and Childhood Sexual Abuse with Cancer-Related Well-Being in Women

“…Limits to screening may cause delays in cancer detection and result in presentation at a later cancer stage, thus limiting cancer treatment options. Avoiding partner conflict was noted as an important reason for not receiving follow-up care among women with abnormal Pap test results, 4 and recent severe physical partner violence was associated with not receiving free follow-up care among women with preinvasive cervical lesions. 5 Authors of a case report indicate that IPV may lead to delays in cancer detection and treatment.…”