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Barriers to Follow-Up of an Abnormal Pap Smear in Latina Women Referred for Colposcopy

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Abstract

BACKGROUND

Lower rates of follow-up after an abnormal Pap smear in racial and ethnic minorities may contribute to the higher incidence and mortality rates of cervical cancer seen in these groups.

OBJECTIVE

To identify patient-perceived barriers to follow-up after an abnormal Pap smear result among Latina women.

DESIGN, PARTICIPANTS AND APPROACH

Qualitative, semi-structured, one-on-one interviews were conducted with patients from an academic hospital-affiliated urban community health center. Three groups of women were interviewed: new colposcopy clinic patients, patients who had previous colposcopies and patients enrolled in the health center's patient navigator program. Open-ended questions explored their knowledge, beliefs and experiences with colposcopy. Content analysis of transcripts was performed using established qualitative techinques.

RESULTS

Of 40 Latina women recruited, 75% spoke only Spanish. The average age was 31.5 (range 18–55). Personal and system barriers identified were categorized into four themes: (1) anxiety/fear of procedure and diagnosis; (2) scheduling/availability of appointments interfering with work and/or child care; (3) inadequate communication about appointments, including lack of explanation regarding diagnosis, procedure and results; and (4) pain. New patients more commonly reported problems with scheduling and communication. Follow-up patients were more concerned about pain, and navigated women most often reported fear of results but had fewer concerns about inadequate communication.

CONCLUSION

Anxiety/fear was the most common personal barrier, while difficulty scheduling appointments and inadequate communication were the major systems barriers identified in these Latina women. Interventions to lower these barriers to colposcopy among Latina women may increase adherence to follow-up of abnormal Pap smears.

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Acknowledgements

The authors would like to thank Sarah Abernathy-Oo, Joan Quinlan and Diana Maldonado for assisting in the early conceptualization of the study and for their ongoing support. The authors are very thankful to Elyse Park, Ph.D, MPH, for review of the manuscript and help with the qualitative methodology. This paper was presented at the 32nd Annual Meeting of the Society of General Medicine in Miami, May 2009.

The study was funded by a grant from Gillette Corporation to the MGH Chelsea Cervical Outreach Program and the MGH Center for Community Health Improvement. Drs. Percac-Lima and Atlas were supported in part by a grant from the Agency for Healthcare Research and Quality (1R18 HS019161-01).

Conflict of interest

None disclosed.

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Authors and Affiliations

  1. Chelsea HealthCare Center, Massachusetts General Hospital, 151 Everett Avenue, Chelsea, MA, 02150, USA

    Sanja Percac-Lima MD, PhD & Gloria B. Gamba MA

  2. Center for Community Health Improvement, Massachusetts General Hospital, Boston, MA, USA

    Sanja Percac-Lima MD, PhD, Leslie S. Aldrich MPH, Gloria B. Gamba MA & Adriana M. Bearse BA

  3. General Medicine Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA

    Sanja Percac-Lima MD, PhD & Steven J. Atlas MD, MPH

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  1. Sanja Percac-Lima MD, PhD
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  2. Leslie S. Aldrich MPH
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Correspondence to Sanja Percac-Lima MD, PhD.

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Percac-Lima, S., Aldrich, L.S., Gamba, G.B. et al. Barriers to Follow-Up of an Abnormal Pap Smear in Latina Women Referred for Colposcopy. J GEN INTERN MED 25, 1198–1204 (2010). https://doi.org/10.1007/s11606-010-1450-6

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  • DOI: https://doi.org/10.1007/s11606-010-1450-6

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