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PubMed2004

Social and cultural barriers to Papanicolaou test screening in an urban population.

OBJECTIVE: To define screening behaviors, attitudes, and beliefs regarding cancer and its treatment among women with cervical cancer. METHODS: Between August 2000 and July 2002, 148 consecutive women with invasive cervical cancer were queried about barriers to screening. Women presented to outpatient clinics, emergency departments, or inpatient units of 3 urban hospitals. Two groups of women were identified: those who denied having had a Papanicolaou (Pap) test and those who had recalled having Pap test in the past. Responses were compared using t tests, chi(2) tests, and binary logistic regression. RESULTS: The 146 (99%) respondents were predominantly African Americans (50%) or Hispanic (27%). Thirty-six (25%) women reported no prior screening. Women never screened were significantly more likely to be Hispanic (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.4-6.7), recent immigrants (OR 5.7, 95% CI 2.0-16), less educated (OR 3.6, 95% CI 1.6-8.0), and uninsured (OR 3.9, 95% CI 1.6-9.7). They were more likely to lack family support (adjusted OR 3.5, 95% CI 1.1-11) and lack knowledge about their risk for cervical cancer (adjusted OR 2.6, 95% CI 1.1-6.4). Unscreened women displayed fatalistic attitudes, believing cancer is bad luck (adjusted OR 2.6, 95% CI 1.0-6.9) and not wanting to know they had cancer (adjusted OR 3.0, 95% CI 1.0-9.4).. CONCLUSION: We have identified factors and beliefs that are barriers to Pap test screening in urban cervical cancer patients. Further studies should evaluate effects of addressing cultural, cognitive, and financial barriers on Pap test compliance.

Aged↗
PubMed1999

Screening for breast and cervical cancers: the importance of knowledge and perceived cancer survivability.

INTRODUCTION: This study examines the association between recent screening for breast and cervical cancers, knowledge of cancer risk factors, and perceptions of surviving cancer. METHODS: Data were from the Cancer Control Supplement to the 1992 National Health Interview Survey (NHIS-CCS). The dependent variable combined breast and cervical cancer screening practices into a single composite index. Two independent variables combined women's knowledge about breast and cervical cancers into single indicators--one representing risk factor knowledge, the other representing perceived likelihood of surviving breast and cervical cancers following early detection. RESULTS: Multivariate analysis showed that recency of screening for both breast and cervical cancers was associated with knowledge of cancer risk factors and perceptions of surviving cancer. Education, household income, and smoking status also were correlates of comprehensive screening. Significant interactions between income and perceived survivability, and between education and perceived survivability suggested that the effects of income and education on comprehensive screening varied with perceptions about surviving cancer. CONCLUSION: The study suggests that knowledge and attitudinal questions can be combined for two diseases to enhance understanding of who is most likely to be screened comprehensively for breast and cervical cancers. Although national trends show that large percentages of women over age 50 are having mammograms and Pap tests, this progress is not likely to be sustained unless existing barriers are eliminated. Limited knowledge about breast and cervical cancer risk factors and misperceptions about survival from cancer represent two of these barriers.

Aged↗
PubMed1989

Barriers to screening for cancer of the cervix.

Despite the widespread availability and demonstrated efficacy of screening with the Papanicolaou smear, many women are screened irregularly or not at all. This study was designed to identify the barriers that prevent those women at risk for cervical cancer from being screened. Complete cervical cytology screening histories were taken during a population-based case-control study of invasive squamous cell carcinoma of the cervix involving 200 patients and their matched neighborhood controls. Smears taken during the previous 5 years were verified whenever possible. Ordinal logistic regression analysis was used to identify seven factors that significantly (P less than 0.05) and independently predicted regular recent screening among both cases and controls [failure to understand the importance and screening nature of cervical smears (-), expressed fears of embarrassment (-), having had a urogenital infection (+), number of pregnancies during the last 5 years (+), the number of pregnancies for which no prenatal care was sought (-), and knowledge of the recommended screening interval (+)], two variables that predicted screening among cases but not controls [age (-) and number of years of oral contraceptives use (+)], and one that predicted screening only among controls [years of living in the United States (+)]. Education, income, Latin heritage, being married, having a regular physician for one's medical care, and all other methods of birth control were significant predictors of screening in the univariate analyses, but were explained by the other more powerful predictors in the multivariate analysis.

Adult↗
PubMedDate not supplied

Papanicolaou test status among inner-city adolescent girls.

BACKGROUND: The English medical literature for the past decade lacks any reports on Papanicolaou (Pap) test status among inner-city adolescent girls. Our objectives were (1) to assess the pattern of Pap test status among inner-city adolescent girls and (2) to ascertain the association of the Pap test status with their knowledge, beliefs, and behaviors. METHODS: All 3,980 inner-city senior high school adolescent female students in two cities in New Jersey were included in the survey. Response rate was 84%; 89% of respondents were minority adolescents. RESULTS: The factors that significantly increased the probability of obtaining a Pap smear were physician recommendation for Pap test, being knowledgeable of Pap test, awareness that other family members had obtained Pap tests, family income and parents' education levels. The age of initiation of first Pap test almost always was before 18 years of age; 13% of sexually active girls were smokers. The major barriers for never having had a Pap test were lack of physician's recommendation, ignorance about the Pap test, cost of the test, lack of information on how and where to obtain it, belief that they were not at risk for cancer, and embarrassment over requesting the test. CONCLUSION: Inner-city predominantly minority adolescent girls who have considerable sexual activity, multiple sex partners, initiation of intercourse at an early age, and smoking are at high risk for cervical cancer. It makes sense to initiate Pap screening for such high-risk adolescents. Individualized Pap test educational intervention programs adopted to the adolescents' barriers to undergoing Pap testing and physicians' recommendations for this preventive care are needed to encourage high-risk adolescent girls to undergo regular Pap tests and appropriate follow-up.

Adolescent↗
PubMed1999

Barriers to Pacific women's use of cervical screening services.

OBJECTIVE: The present study explored barriers to the use of cervical screening information and services from the perspective of Pacific women. METHOD: Qualitative, face-to-face interviews based on a snowball sampling approach were used in Palmerston North, New Zealand, in 1997, to assess attitudes among 20 Pacific women. RESULTS: The study found a high level of awareness of a local cervical screening program. Specific barriers determined were: a resistance to being defined as socially problematic, embarrassment, belief in the sacred nature of human sexuality, an anxiety about lack of confidentiality within small community groups, and a perceived relationship between cervical smears and sexual activity. CONCLUSIONS: Participants strongly preferred that information on cervical screening should be transmitted by interpersonal means, though pamphlets on screening services were also sought. The women agreed that the preferable role of a Pacific Island health professional would be in disseminating information, rather than actually serving as a smear-taker. IMPLICATIONS: The need for smear-taking should not be stereotyped as a 'Pacific problem'. Multi-racial images of women should be used in advertising to demonstrate that cervical smears are necessary regardless of ethnicity. Information providers need to show great sensitivity when providing information relevant to human reproduction or sexuality.

Adult↗
PubMed1995

Beliefs and attitudes as determinants of cervical cancer screening: a community-based study in Singapore.

BACKGROUND: The investigation of cervical cancer screening acceptance in relation to health beliefs and attitudes presents a challenge in a multiethnic population such as Singapore's, where the uptake is currently suboptimal in high-risk groups. This study attempts to identify cognitive barriers to screening activity in order to suggest possible directions for cervical cancer prevention efforts. METHODS: A cross-sectional survey consisting of a household interview of 640 randomly selected women ages 21-65 years was performed. The screening history and future intention to have a Pap smear were elicited, and attitudes toward cancer and the Pap smear as expressed in 14 statements were measured on a five-point scale. RESULTS: Of the respondents, 73.1% were aware of the Pap smear, and about half (49.7%) had obtained the information from a doctor or nurse. Overall, the belief in personal susceptibility to cancer was low (58.9%) and a substantial proportion (48.7%) of women were of the attitude that cancer could not be prevented. The effect on a future intention to have a smear varied between women who had had and women who had not had a smear. Among the former, perceived barriers such as discomfort and embarrassment had a significant influence, while a belief in personal susceptibility was an important determinant for the latter group. CONCLUSIONS: The means of increasing the acceptance of the Pap smear, both for the first time and subsequently, are culture-specific and must address the appropriate health beliefs and attitudes. In Singapore, such efforts should include not only influencing awareness and perceptions through public education but also reducing barriers by creating an appropriate environment for the delivery of this important health service.

Adult↗
PubMed2005

Sub-urethral tape treatment of female urinary incontinence--morbidity assessment of the trans-obturator route and a new tape (I-STOP): a multi-centre experiment involving 604 cases.

PURPOSE: To make an assessment of the morbidity related to using the trans-obturator route (TOT); findings after one year for the 140 first cases and preliminary results of short term morbidity after 604 implants. PATIENTS AND METHOD: This retrospective, multi-centre study involves the 604 first procedures with a 1-3 month follow-up. The mean patient age was 57 years. 92% of the patients underwent an isolated urinary incontinence cure and 8% had associated surgery. 47.3% of the cases had pure stress urinary incontinence and 52.7% had mixed incontinence. A 12-month minimum follow-up period was applied to the first 140 cases operated between September 2002 and January 2003. Patient assessment was made by a clinical examination in the first three months and their satisfaction rate expressed after 1 year. RESULTS: Operative complications were very few: 0.5% vesical perforations, 0.3% vaginal perforations, no urethral wounds, 0.8% 200-300 ml haemorrhages, two perineal haematomas (0.33%). The post-operative period was marked by: 1.5% transient retentions, 2.3% transient pain, 2.5% urinary infections, 1.3% transient dysuria. The 1-3 month follow-up of 572 patients shows a 5.2% rate of de novo symptoms. Patient assessment of 131 subjects after one year revealed an encouraging satisfaction rate of 85.5% with a 1.5% rate of de novo dysuria and urgency. To date there have been no serious or specific complications attributable to the surgical route adopted. The morbidity is not affected by associated surgery. CONCLUSION: The trans-obturator route combines low morbidity with a low rate of de novo symptoms on a large series. These results will have to be corroborated by further studies.

Female↗
PubMed1998

Women's knowledge of and attitude towards organized cervical smear screening.

OBJECTIVE: To describe women's barriers to cervical screening by asking about their experience with and knowledge of smear tests and by examining the women's contact and relationship with their GP. SETTING: Questionnaires sent to women in Aarhus County, Denmark. METHODS: A case control study in a cohort. The cohort, 133,500 women, represents women aged 23-60 years who were invited to the organized cervical screening program between 1.10.90 and 1.4.94. A case group, non-attenders (n=694), who had not had a smear within the previous 42 months, and a control group, attenders (n=1131), who had at least one smear test within the previous 42 months, were compared with each other. Predictor variables in the two groups were analyzed by univariate and multivariate (logistic regression) analysis. RESULTS: Non-attenders more often had insufficient contact with the GP (having a bad relationship, feeling of not receiving sufficient information) and associated a gynecological examination with more psychological unpleasantness. Most non-attenders (65.5%) and attenders (88.5%) intended to attend next time they were invited for cervical screening, and resistance to mass screening on principle did not seem to have great influence on the number of non-attenders. Both non-attenders and attenders had poor knowledge of the smear test. No significant difference was found concerning the characteristics of the general practice used by non-attenders and attenders. CONCLUSIONS: The main barriers to regular cervical screening are insufficient contact with the GP and psychological unpleasantness associated with the gynecological examination. Resistance to cervical screening on principle does not seem to have a great influence on attendance.

Adult↗
PubMed1998

Cervical cancer risk and Papanicolaou screening in a sample of lesbian and bisexual women.

BACKGROUND: Previous studies of lesbian and bisexual women have suggested that negative experiences with health care practitioners, combined with misinformation about the health needs of this diverse population, have led to an underutilization of medical services. METHODS: This study combined focus group data (N = 44) with a self-administered questionnaire (N = 57) to explore the health concerns of lesbian women, including the prevalence of risk factors for cervical cancer, the frequency of Papanicolaou (Pap) test screening, and the barriers to obtaining care. We examined the influence of women's perceptions regarding the knowledge and sensitivity of their clinicians to lesbian issues and their experiences of discrimination in the medical setting of Pap test utilization. RESULTS: Respondents reported risk factors for cervical cancer, including multiple past or current sexual partners (both male and female), early age at first coitus, history of sexually transmitted diseases, and cigarette smoking. One forth of respondents had not had a Pap test within the last 3 years, including 39 (7.6%) who had never had a Pap test. Women who reported that their health care providers were more knowledgeable and sensitive to lesbians issues were significantly more likely to have had a Pap test within the last year, even when controlling for age, education, income, and insurance status. CONCLUSIONS: Lesbian women are at risk for cervical cancer and should receive routine cytologic screening according to individual risk assessment. The quality of clinician-patient interactions strongly influences care-seeking within the population sampled.

Adolescent↗
PubMed2002

Breast and cervical cancer screening practices among Hispanic women in the United States and Puerto Rico, 1998-1999.

BACKGROUND: Results from recent studies suggest that Hispanic women in the United States may underuse cancer screening tests and face important barriers to screening. METHODS: We examined the breast and cervical cancer screening practices of Hispanic women in 50 states, the District of Columbia, and Puerto Rico from 1998 through 1999 by using data from the Behavioral Risk Factor Surveillance System. RESULTS: About 68.2% (95% confidence interval [CI] = 66.3 to 70.1%) of 7,253 women in this sample aged 40 years or older had received a mammogram in the past 2 years. About 81.4% (95% CI = 80.3 to 82.5%) of 12,350 women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Women with lower incomes and those with less education were less likely to be screened. Women who had seen a physician in the past year and those with health insurance coverage were much more likely to have been screened. For example, among those Hispanic women aged 40 years or older who had any health insurance coverage (n = 6,063), 72.7% (95% CI 70.7-74.6%) had had a mammogram in the past 2 years compared with only 54.8% (95% CI 48.7-61.0%) of women without health insurance coverage (n = 1,184). CONCLUSIONS: These results underscore the need for continued efforts to ensure that Hispanic women who are medically underserved have access to cancer screening services.

Adolescent↗
PubMed1993

Prostitution and risk of HIV: female prostitutes in London.

OBJECTIVE: To measure the prevalence of HIV and to describe established risk factors in female prostitutes. DESIGN: A cross sectional survey. SETTING: A genitourinary medicine clinic, streets, and magistrates' courts in London. SUBJECTS: 280 female prostitutes recruited between April 1989 and August 1991. MAIN OUTCOME MEASURES: Infection with HIV-1, reported risk behaviours, and prevalence of sexually transmitted infections. RESULTS: 228 of the women had HIV tests, and two (0.9% (95% confidence interval 0% to 2.1%)) were infected with HIV-1. Reported use of condoms was high for commercial clients and low for non-paying partners: 98% (251/255) of women used condoms with all clients and 12% (25/207) with non-paying partners for vaginal intercourse. Twenty two women were current or past injecting drug users. Of the 193 women examined for sexually transmitted infections, 27 had an acute infection (gonorrhoea, chlamydia, trichomonas, or primary genital herpes) at the time of interview. Infection was associated with younger age and increasing numbers of non-paying sexual partners, but not with duration of prostitution, numbers of clients, or reports of condom failures. When age and numbers of non-paying partners were analysed by logistic regression they remained significantly associated with sexually transmitted infections. CONCLUSIONS: A large and diverse sample of prostitutes had a low prevalence of infection with HIV and high levels of use of condoms in commercial sex. There was a significant risk of other sexually transmitted infections associated with prostitutes' non-commercial sexual relationships, in which unprotected sex is common. Interventions to reduce the risk of sexually transmitted infections in prostitutes should address both commercial and non-commercial sexual partnerships.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups in Northwestern Ontario.

PURPOSE/OBJECTIVES: To examine the knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups (i.e., Italian, Ukranian, Finnish, and the native population) in Northwestern Ontario, Canada. DESIGN: Descriptive, exploratory. SETTING: Rural and urban settings in Northwestern Ontario. SAMPLE: 105 women aged 40 and older who were residents of Northwestern Ontario and members of selected ethnic groups, including Italian, Ukranian, Finnish, Ojibwa, and Oji-Cree. METHODS: An interview guide was designed specifically for this study to gather information regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), mammography, and cervical cancer screening procedures. Data were obtained through face-to-face interviews (two or three hours) in English or the language spoken. Interviews in other languages were transcribed into English. FINDINGS: Ojibwa and Oji-Cree women were more likely than any other group to not have practiced BSE, to have refused CBE or mammogram, to not have been told how to perform BSE, to not have received written information about breast examination, and to be uncomfortable and fearful about cervical cancer screening procedures (33% refused internal examination as compared to 0-8% in the other ethnic groups). Four issues emerged from the findings: (a) using multimedia sources to inform women about screening programs, (b) educating women regarding breast and cervical cancer screening, (c) reminding women when they are due for screening, and (d) identifying that Pap tests are uncomfortable and frightening. CONCLUSIONS: Cultural beliefs, attitudes, and practices of marginal populations (e.g., native women) are important to consider when developing strategies to address barriers to effective breast and cervical screening. IMPLICATIONS FOR NURSING: Educational programs that are culturally sensitive to participants are imperative.

Adult↗
PubMed2006

Breast and cervical cancer screening in obese minority women.

PURPOSE: Studies using survey data from mostly white women showed that obese women are less likely than nonobese women to undergo breast and cervical cancer screening. It is unclear if these findings are true in nonwhite women. Using chart audit data, we examined the relationship between obesity and mammography and Pap smear screening among minority women. METHODS: Data from retrospective chart review of women in three urban New Jersey academic family medicine practices were analyzed (n = 1809) using hierarchical logistic regression models. Outcome measures were being up-to-date in mammography and Pap smears among obese and nonobese women. RESULTS: There was no difference in mammography rates among obese and nonobese women. Independent risk factors for not being up-to-date in mammography included age 40-49, smoking, and comorbidity. Obese women were less likely than nonobese women to be upto- date in Pap smears (69% vs. 77%, p = 0.001). In multivariate analysis, obesity was associated with 25% decreased odds of being up-to-date on Pap smears (OR, 0.75, 95% CI, 0.58-0.99, p = 0.041). Age >or=65 years was also associated with decreased odds of being up-to-date in Pap smears. Hispanic women had increased odds of being up-to-date in mammography (OR 2.43, 95% CI 1.63-3.63) and Pap smears (OR 1.94, 95% CI 1.24-3.03) compared with white women. CONCLUSIONS: Obesity was associated with decreased Pap smear screening but not with decreased mammography. Further studies are needed to determine barriers and effective interventions to improve screening in obese minority women.

Adult↗
PubMedDate not supplied

Facilitators and barriers to cervical cancer screening among Chinese Canadian women.

BACKGROUND: Chinese Canadian women have higher cervical cancer incidence, and lower Pap testing, rates than the general Canadian population. Predisposing, enabling and reinforcing factors associated with ever having a Pap test, and having a recent Pap test within the last 2 years, were assessed in Chinese women in British Columbia using the PRECEDE-PROCEED model. METHOD: Chinese women (n=512) between the ages of 20 and 79 years and residing in Greater Vancouver were interviewed about Pap testing, health care, traditional health beliefs, acculturation and sociodemographic characteristics. Two analyses were done, comparing women who had ever and never had a Pap test, and comparing women who had and had not received a recent Pap test. Focus groups and qualitative interviews ensured cultural sensitivity in the survey questionnaire. RESULTS: Seventy-six percent reported ever having a Pap test and 57% reported having a Pap test within the last 2 years. Traditional health beliefs were not associated with ever or recent Pap testing. However, belief that Pap testing prevented cancer and general knowledge about the Pap test were associated with screening. Concern about pain/discomfort with the test, availability of time, culturally sensitive health care services and recommendation for Pap testing by a physician were also associated with screening. Factors differed for ever, and recently, having a Pap test. INTERPRETATION: Pap testing is less common among Chinese Canadian women. Continuing education about Pap testing is recommended for physicians serving underscreened Chinese women. Culturally and linguistically appropriate educational materials are needed for the Chinese community.

Adult↗
PubMed2004

Cervical cancer screening in Korean American women: findings from focus group interviews.

PURPOSE: Korean American women have twice the rate of cervical cancer than white women and demonstrate low rates in participation in cervical cancer screening. This study was to describe the perceptions about cervical cancer and factors related to cervical cancer screening among Korean American women. METHOD: Focus group methods. RESULT: Five themes emerged. First, knowledge about cervical cancer; misconceptions about cervical cancer, its causes, reproductive anatomy and the treatment. Second, perceived meanings of having cervical cancer; most of the women felt that cervical cancer represented a loss of femininity and existential value of womanhood. Third, knowledge about cervical cancer screening ; regular medical check-ups were necessary for early detection and prevention of cervical cancer. Fourth, experiences and perceived meanings of cervical cancer screening; the participants expressed their feelings; embarrassment, fear, shame and shyness. Fifth, practices of cervical cancer screening; various intervals in participating in cervical cancer screening. But they mentioned several deterrents, language, insurance, time constraint, embarrassment, fear of the screening results, misbelief about susceptibility, lack of health prevention behavior, and lack of information written in Korean. CONCLUSION: Results emphasize the critical need for culturally appropriate health education to encourage participation of Korean American women in cervical cancer screening.

Adult↗
PubMed2001

Time costs associated with cervical cancer screening.

OBJECTIVES: Time costs borne by women when undergoing cervical cancer screening have rarely been elucidated, although such costs may pose substantial barriers to care. The purpose of this project was to quantify the opportunity costs associated with cervical cancer screening in young women attending Planned Parenthood Clinics. METHODS: We conducted a self-report survey of 105 women from six clinics to measure travel, waiting, and exam times associated with cervical cancer screening. Respondents recorded their time of arrival and departure, length of time in the waiting room, age, income level, and hours per week they worked outside of the home. Time costs were valued three ways: through self-reported hourly wage, age- and gender-adjusted minimum earnings, and national age- and gender-adjusted hourly wages. RESULTS: Respondents were on average 24 years old, worked 29 hours per week outside the home, and earned less than $20,000 per year. Mean time for one-way travel was 18.7 minutes; waiting room time was 16.9 minutes; and exam time was 50.8 minutes. Time costs were estimated to be $14.08 per visit based upon the self-reported hourly wage; $16.46 per visit based upon age- and gender-adjusted minimum earnings; and $19.63 per visit based upon age- and gender-adjusted national wage rates. CONCLUSIONS: Time costs associated with cervical cancer screening represent an important opportunity cost and should be considered in studies attempting to identify barriers to screening adherence. Our results indicate that time costs accounted for up to 25% of cervical cancer screening costs. Time costs should be identified, measured, valued, and included in cost-effectiveness analyses of cervical cancer screening.

Adult↗
PubMed2006

English proficiency and physicians' recommendation of Pap smears among Hispanics.

BACKGROUND: Hispanics have one of the highest incidence rates of cervical cancer. Physician recommendation is one of the most important cues to cancer screening; however, low English proficiency among Hispanics may hinder health providers' recommendation of Pap smears. METHODS: Analysis of data from the 2000 National Health Interview Survey. All Hispanic women, age > or =18, without a Pap smear in the past 3 years or ever and who visited a health care provider in the past year were included. The main outcome was receipt of Pap smear recommendation by a health care provider. RESULTS: A total of 314 Hispanic women were included in the analysis, 44.9% were highly English proficient. Only 7.7% of low English proficient Hispanics not up-to-date in cancer screening reported a recommendation for a Pap smear as compared to 14.3% of highly proficient Hispanics. After adjusting for sociodemographics and health access and utilization factors, highly English proficient Hispanics were more than two times as likely to report receiving a recommendation for a Pap smear as compared to the less proficient (aOR 2.2, 95% CI 1.1-4.5). CONCLUSIONS: Low English language proficiency is a barrier to receive a recommendation for Pap smear among Hispanic women not up-to-date with cervical cancer screening. Further research is needed to explore specific mechanisms responsible for the low recommendation rates and to assess the impact of interpreters or Spanish-speaking providers on Pap smear recommendation rates.

Adult↗
PubMed2002

Abnormal cervical screen follow-up among low-income Latinas: Project SAFe.

BACKGROUND: Cervical cancer incidence and mortality rates are dramatically higher among low-income women than in the general population, in part due to poor adherence to recommended diagnostic follow-up after an index Pap test. This report describes a pilot study of the Screening Adherence Follow-Up Program (SAFe), an individualized, structured case management program designed to assess for and intervene in response to a variety of potential personal and systems barriers to follow-up adherence. Interventions included health education, counseling, and systems navigation. METHODS: A clinical decision-making algorithm was used to determine service intensity and level of intervention. Services were provided to 196 low-income women, predominantly Latinas, who had either a low-grade or high-grade squamous intraepithelial lesion (LGSIL or HGSIL) abnormal Pap result. Adherence rates to at least one follow-up appointment after enrollment and baseline intervention were 83% following LGSIL and 93% for HGSIL. RESULTS: Over 1 year post-enrollment, 41% of women with LGSIL were fully adherent, with 42% partially adherent; 61% of women with HGSIL were fully adherent, with 32% partially adherent. In a comparison group of 369 nonenrollees (women who refused participation or could not be located for consent), adherence rates were 58% for LGSIL and 67% for HGSIL. A survey among a random sample of women served indicated that 93% were "mostly" or "very" satisfied, overall, with SAFe services. CONCLUSIONS: The intervention team--a peer counselor and a master's degreed social worker--addressed multiple psychosocial and systems navigation problems to reduce potential barriers to adherence, including knowledge, attitudinal, psychosocial, psychological distress, systems communication, and resource access problems. SAFe appears highly acceptable to women and may significantly enhance medical care management following an abnormal cervical screen for a carefully targeted group of women at risk for suboptimal follow-up adherence.

Adult↗