Psychosocial Barriers to Follow-up Adherence After an Abnormal Cervical Cytology Test Result Among Low-Income, Inner-City Women

• Published in: Journal of primary care & community health 2014-10, Vol.5 (4), p.234-241
• Main Authors: Hui, Siu-kuen Azor, Miller, Suzanne M., Wen, Kuang-Yi, Fang, Zhu, Li, Tianyu, Buzaglo, Joanne, Hernandez, Enrique
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adherence; Adult; African Americans; Barriers; Cellular biology; Cervical cancer; Colposcopy; Colposcopy - psychology; Coping; Counseling; Cross-Sectional Studies; Employment; Female; Goal setting; Health behavior; Health Knowledge, Attitudes, Practice; Humans; Income - statistics & numerical data; Inner city; Low income groups; Mortality rates; Papanicolaou Test; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Pennsylvania; Primary care; Psychological distress; Psychosocial factors; Race; Secondary schools; Sociodemographics; Socioeconomic Factors; Stress, Psychological - etiology; Underserved populations; Unemployed people; Urban Population - statistics & numerical data; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - psychology; Vaginal Smears; Young Adult; Young women
• ISSN: 2150-1319; 2150-1327
• DOI: 10.1177/2150131914529307

Objectives: Low-income, inner-city women bear a disproportionate burden of cervical cancer in both incidence and mortality rates in the United States, largely because of low adherence to follow-up recommendations after an abnormal cervical cytology result in the primary care setting. The goals of the present study were to delineate the theory-based psychosocial barriers underlying these persistent low follow-up rates and their sociodemographic correlates. Methods: Guided by a well-validated psychosocial theory of health behaviors, this cross-sectional, correlational study assessed the barriers to follow-up adherence among underserved women (N = 210) who received an abnormal cervical cytology result. Participants were recruited through an inner-city hospital colposcopy clinic, and were assessed by telephone prior to the colposcopy appointment. Results: Participants were largely of African American race (82.2%), lower than high school completion education (58.7%), single, never married (67.3%), and without full-time employment (64.1%). Knowledge barriers were most often endorsed (68%, M = 3.22), followed by distress barriers (64%, M = 3.09), and coping barriers (36%, M = 2.36). Forty-six percent reported more than one barrier category. Less education and being unemployed were correlated with higher knowledge barriers (P < .0001 and P < .01, respectively) and more coping barriers (P < .05 and P < .05, respectively). Women who were younger than 30 years displayed greater distress barriers (P < .05). Conclusion: In the primary care setting, assessing and addressing knowledge and distress barriers after feedback of an abnormal cervical cytology result may improve adherence to follow-up recommendations. The use of structured counseling protocols and referral to navigational and other resources may facilitate this process and thereby reduce disparities in cervical cancer.