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 1 of 3 groups to receive their results: Intervention (I): culturally-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): non-targeted 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=0.73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p=0.77. Delay in care (in days) was (M ±SD): 58 ±75 (I), 69 ±72 (AC), and 54 ±75 (SCO), p=0.75. Adherence was associated with higher anxiety at notification, p<0.01 while delay <90 days (vs. 90+) was associated with greater perceived personal responsibility, p<0.05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p<0.05. Conclusions A theory-based, culturally-targeted message was not more effective than a non-targeted message or standard care in improving behavior.

A community‐based trial of educational interventions with fecal immunochemical tests for colorectal cancer screening uptake among blacks in community settings

“…18 Prior literature about culturally-targeted studies have suggested that targeting may be more effective with certain subgroups (based upon personal factors such as acculturation), 19 whereas other culturally-targeted studies have found no significant differences between groups. 21,22 …”

Predictors of adherence to follow-up recommendations after an abnormal Pap smear among underserved inner-city women

“…Initial adherence to abnormal Pap smear follow-up is inconsistently defined among published studies. Adherence has been defined as diagnostic colposcopy 3 months post-notification of an abnormal Pap smear test result [28,29], consistent with existing follow-up guidelines [30]. However, many studies do not differentiate timely versus delayed adherence [5,31] and define adherence broadly within a time frame ranging from 4 weeks to 18 months after receipt of an abnormal Pap smear test result [4].…”

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening

“…[1][2][3] Women from groups of racial/ethnic minorities and low education and income have limited access to healthcare and are less likely to seek care after an abnormal result. [4][5][6][7][8] In 1990, Freeman introduced the model of patient navigation as a way to support screening for, timely diagnosis of, and then treatment of cancer among vulnerable women. 9 The primary function of patient navigators is to reduce barriers to care by assisting participants in navigating the healthcare system.…”