 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Kathryn J. Luchok, PhD1, Heather M. Brandt, MSPH, CHES2, Ann L. Coker, PhD3, Jill M. Abbott, MPH1, and Irene Prabhu Das, MPH4. (1) Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 800 Sumter Street HESC 216, Columbia, SC 29208, 803-777-8519, kluchok@sc.edu, (2) Prevention Research Center, University of South Carolina, Arnold School of Public Health, 730 Devine Street, Columbia, SC 29208, (3) School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225, (4) Division of Chronic Disease Prevention, SC Department of Health and Environmental Control, 1800 Julian Place, Rm 2100, Columbia, SC 29206
Background: South Carolina ranks 8th nationally in cervical cancer mortality. Lack of timely follow-up care for abnormal Pap results is a factor in these often unnecessary deaths. Since clinicians influence timely follow-up, we examined their perspectives on barriers faced by low-income clients in SC.
Methods: Telephone interviews were conducted with 30 clinicians who provide cervical cancer screening services to income-eligible women. The interviews addressed on-site services, counseling practices, and perceptions of why some women do not return for follow-up care. Following verbatim transcription, narrative data were analyzed for themes surrounding clinician views about follow-up care.
Results: Interviewees were mostly white, female, family nurse practitioners in rural settings. The most-often cited barriers to timely follow-up were client/personal factors--fear of clinical procedures, outcomes, and “the unknown;” competing life priorities, e.g., taking care of family members, self-care for co-morbid conditions; financial and transportation difficulties, and lack of understanding that Pap tests reduce the risk of cervical cancer mortality. Fewer cited provider factors--lack of time, difficulty in balancing fear messages with reassurances that early stage problems can be treated successfully, and frustration with how to convey the importance of follow-up care, or system/environmental factors--problems with continuity of care and availability of and communication with referral services for follow-up. Few gave suggestions for addressing these barriers.
Conclusion: Clinicians focused largely on client/personal factors and had little insight into how their service delivery may contribute to the problem, or how they could help reduce client barriers to increase timely follow-up care.
Learning Objectives:
Keywords: Cervical Cancer, Adherence
Presenting author's disclosure statement:
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.