The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68405

Irene Prabhu Das, MPH¹, Ann L. Coker, PhD², Kathryn J. Luchok, PhD³, Jill M. Abbott, MPH³, Conrad Otterness, MPH¹, and Jaya Bajaj, MBBS⁴. (1) Division of Cancer Prevention & Control, SC Department of Health and Environmental Control, PO Box 101106, Columbia, SC 29211, 803-545-4103, prabhudi@dhec.sc.gov, (2) School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225, (3) Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 800 Sumter Street HESC 216, Columbia, SC 29208, (4) Arnold School of Public Health, University of South Carolina, Epidemiology/Biostatistics, 800 Sumter Street, Columbia, SC 29208

Background: Poor adherence to recommended follow-up for abnormal Pap results remains a challenge to reducing avoidable cervical cancer diagnoses and deaths. A comprehensive literature review was conducted to construct a theoretical model for assessing factors associated with untimely follow-up among low income South Carolina women.

Methods: On-line literature searches in Medline and Cancerlit, were supplemented with a manual review of bibliographic references. Keyword combinations included “abnormal Pap”, “follow-up + adherence”, “non-adherence + abnormal Pap”, “colposcopy”, and “cervical cancer”.

Results: The 33 articles selected comprised randomized controlled trials, retrospective data audits, surveys, previous literature reviews describing barriers and predictors related to follow-up adherence, and interventions. Studies used varying definitions and classification systems for abnormal results and “non-adherence”. Consistent barriers to adherence were low SES and limited knowledge, limited understanding or lack of effective communication about the Pap test, about colposcopy, and about the implications of abnormal results. Minority race and increasing age were not consistently associated with non-adherence across the studies reviewed. Interventions included telephone counseling, tracking systems, educational brochures, and financial incentives. Intensive strategies and personalized approaches demonstrated significant increases in adherence to follow-up care.

Conclusion: Intervention research in controlled settings suggests directions for improving adherence to abnormal Pap follow-up, but these findings need to be replicated in real-world environments. Additional qualitative studies are needed to better characterize women’s understanding of the meaning and consequences of having an abnormal Pap test result. It is also crucial to better understand the interrelationship among client, provider and system/environmental factors affecting timely follow-up.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to: (
• Identify factors cited in the literature that affect adherence to abnormal Pap test follow-up; (
• Describe the state of the research and identify gaps in the current literature about adherence to abnormal Pap test follow-up, (
• Discuss possible priorities for future adherence research to promote follow-up of abnormal Pap tests among low-income women.

Keywords: Adherence, Cervical Cancer

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.