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Psychosocial barriers to follow-up adherence after an abnormal cervical cytology test result among low-income, inner-city women
J Prim Care Community Health. 2014 Oct;5(4) :234-41
PMID: 24718518 PMCID: PMC4169747
AbstractOBJECTIVES: 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). CONCLUSION: 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.
NotesHui, Siu-Kuen Azor Miller, Suzanne M Wen, Kuang-Yi Fang, Zhu Li, Tianyu Buzaglo, Joanne Hernandez, Enrique P30 CA006927/CA/NCI NIH HHS/United States R01 CA076644/CA/NCI NIH HHS/United States R01 CA104979/CA/NCI NIH HHS/United States R01 HG01766/HG/NHGRI NIH HHS/United States RC1 CA145063/CA/NCI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. United States J Prim Care Community Health. 2014 Oct;5(4):234-41. doi: 10.1177/2150131914529307. Epub 2014 Apr 9.