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Understanding Lack of Pap Follow-up: Women Clients’ Perspectives. Jill M. Abbott, DrPH 1 , Kathryn J. Luchok, PhD 2 , Ann L. Coker, PhD 3 , and Irene Prabhu Das, MSPH 4. 1 Ohio State University, Comprehensive Cancer Center

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understanding lack of pap follow up women clients perspectives

Understanding Lack of Pap Follow-up:Women Clients’ Perspectives

Jill M. Abbott, DrPH1,

Kathryn J. Luchok, PhD2,

Ann L. Coker, PhD3, and

Irene Prabhu Das, MSPH4

1 Ohio State University, Comprehensive Cancer Center

2 University of South Carolina, Department of Health Promotion, Education, and Behavior

3 University of Texas at Houston Health Science Center, School of Public Health

4 South Carolina Department of Health and Environmental Control

study objective
Study Objective
  • To better understand women’s perspectives concerning adherence to abnormal Pap test follow-up
    • Identify facilitating and hindering factors
    • Describe primary coping strategies
    • Explain how these factors affect women’s adherence to follow-up recommendations
  • Pap test screening has increased dramatically in recent decades
  • Understanding multiple factors that affect adherence can increase program effectiveness

Working Conceptual Model

Nature of Provider – Client Communication

Practice support





Intention to

Adhere to









Competing priorities

Fear of cancer


cervical cancer in south carolina
Cervical Cancer in South Carolina

*8th in USA in cervical cancer mortality

*10.25 per 100,000 cervical cancer incidence

study population
Study Population
  • SC Breast and Cervical Cancer Early Detection Program clients
    • Had an abnormal Pap test between 1999 and 2000
    • African American and Caucasian women
    • Acknowledge receipt of abnormal Pap test results
    • Both adherent and non-adherent women
  • Semi-structured Interview Guide
    • 40 items
    • Expert reviewed, pilot-tested and revised
    • Content:
      • Facilitating and hindering factors
      • Coping strategies
      • Sociodemographic variables
  • Data Collection
    • 19 in-depth, in-person interviews
    • Approximately 60 minutes each
    • Audiotaped with consent
    • $20 incentive
  • Data Management
    • Interviews transcribed verbatim
    • Reviewed for quality control
  • Data Analysis
    • Constant comparison method
    • “Paper and pen” note-based analysis
    • Qualitative data managed using NVivo 2.0 (QSR Inc.)
    • Descriptive statistics analyzed in Excel
participant characteristics
Participant Characteristics
  • N=19 Women
    • Mean age = 59.47 years
    • 53% African American (n=10)
    • 68% had GED, high school diploma or higher (n=13)
    • 37% married (n=7)
    • 53% adherent (n=10)
  • Barriers to obtaining complete and timely follow-up care
    • Client/personal factors
      • Living on restricted income
      • Meeting the competing needs of significant others
      • Living with co-morbid conditions
    • Environmental factors
      • Transportation

“Well, I desire to have medical insurance, but I can’t afford it…and I want the care. I want to take care of myself.”

  • “Well, my husband, he had to go to the doctor on Monday and wanted me to go with him…So, that made me cancel mine and go with him…”
  • “My father was really sick in Oklahoma, and he passed away during that time, and I put this off until I could get that took care of.”
  • “Oh, transportation because, where I had to go, it’s about 60/65 miles one way. Sometimes I had to borrow the money to get there, you know, for gas.”
  • Factors facilitating adherence to follow-up recommendations
    • Provider factors
      • Clinicians’ sensitivity and concern
      • Clinic staff’s friendliness
      • Assistance with scheduling follow-up appointments
      • Reminders about needed follow-up or previously scheduled follow-up appointments

“Just to know that somebody is concerned about my health is good…and they made me feel comfortable.”

  • “He was really great about that. He saw that I did not want to have the surgery, so he came up with these other things.”
  • “Other than be nice and friendly…They shouldn’t just scoot you in there and scoot you out, you know, like you don’t have it.”
  • Most women (n=17) identified concern for their own health as a facilitating factor
  • “Just knowing that I was going to get the results…get help for myself and just thinking about the good that it is going to be for me.”
  • Predominant coping strategies
    • Problem management
    • Emotional regulation

“At first, I asked, ‘Why?’ Secondly, I got at home by myself , cried, and I got upset, and you have to relieve this built in tension. And then I prayed and asked God to help me and guide and give me strength to go through this. That was it.”

  • Few differences between adherent and non-adherent women
    • More non-adherent women identified transportation as a barrier
    • Only non-adherent women used planning
    • More adherent women used prayer and

active coping

  • Low-income women in SC face numerous challenges in their daily lives
  • Support of family and friends may not be an important consideration
  • Interactions with clinicians and clinic staff play a major role in women’s experiences
  • Develop clinical and community interventions to increase adherence that are tailored for higher-risk populations
    • Incorporate components that acknowledge and mediate their daily struggles
  • Develop clinical and community interventions to include aspects of the coping process
    • Use of adaptive coping responses may improve adherence rates

Thanks to the women who gave freely of their time to recount their experiences.

This project was supported by a grant from the Centers for Disease Control and Prevention (CDC). Grant Number U48/CCU409664-09. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC.