CLINICAL STUDIES
Can Precolposcopy Education Increase Knowledge and Decrease Anxiety?

https://doi.org/10.1111/j.1552-6909.1998.tb02633.xGet rights and content

Objective:

To investigate the impact of an educational intervention on knowledge and anxiety level of women scheduled for colposcopy after an abnormal Papanicolaou (Pap) test.

Design:

Experimental, randomized controlled study.

Setting:

An inner-city medical school.

Participants:

The final sample consisted of 58 women in the intervention group and 55 women in the control group. Exclusion criteria included any previous colposcopy.

Interventions:

The women in the intervention group received in the mail, approximately 1 week before their appointment, a one-page handout about colposcopy. The control group received no mailed handout. After arriving for the visit, women were asked to participate in the study and then were interviewed.

Main Outcome Measures:

Knowledge of reason for visit and knowledge of colposcopy as measured by content analysis of interview; and anxiety as measured by the Spielberger State/Trait Anxiety Inventory.

Results:

Women in the intervention group demonstrated significantly more knowledge about the reason for their visit and about colposcopy than did the other women. No significant difference in mean anxiety score was found between the groups.

Conclusions:

The intervention increased knowledge about colposcopy for this population. Because patient education is an essential nursing function, these results are encouraging. This intervention can be replicated by nurses in other settings. Further research is necessary to understand how nurses can best help women alleviate anxiety before colposcopy.

Section snippets

Cervical Cancer

In 1996, approximately 15,700 women were diagnosed with cervical cancer, and 4,900 women died from this disease (Parker, Tong, Bolden, & Wingo, 1996). Of the women diagnosed, approximately 2,300 were African American, and of the women who died, 1,100 were African American (Wingo et al., 1996). Although cervical cancer incidence and mortality rates are significantly higher for African Americans than for whites (American Cancer Society, 1996), Hispanics appear to be at the highest risk for

Colposcopy

Colposcopy is a procedure whereby the health care provider examines the lower genital tract with a binocular microscope on a stand (colposcope) after the application of acetic acid to the cervix. Thus, this area is visualized under magnification, enabling directed biopsies of lesions suggestive of preinvasive or invasive disease. Colposcopy is the standard clinical procedure for evaluating women who have lesions or abnormal cytology of the lower genital tract (Benedet, 1989).

The literature

Self-Regulation Theory

Self-Regulation Theory is a guiding principle for providing patient education and was the theoretical framework for the current study (Leventhal & Johnson, 1983). Complex knowledge of material is based on sensory and procedural aspects of previous life experiences. When such life experiences are missing (such as previous experience with colposcopy), there is no foundation of concrete, objective understanding. Women such as those in the current study, therefore, have a deficiency in

Design

In this randomized controlled study, a systematic randomization scheme based on week of scheduled appointment was used to define the intervention and control groups. This scheme was chosen to avoid the contamination bias that could occur if women who had received and women who had not received the mailed educational intervention discussed such information in the waiting room. For 6 months, every other week was an intervention week, and the other weeks were control weeks. Every woman scheduled

Analysis

Demographic data were analyzed through frequency distributions, and the groups were compared via chi-square analysis. The interview data were analyzed with frequency distributions for each knowledge question, demonstrating how many women answered “I don’t know” to the four knowledge questions, and compared between groups using chi-square analysis. Commonly mentioned misconceptions were noted. The Spielberger forms were tabulated for mean scores and compared between groups using the Student’s t

Results

See Table 1 for the demographic characteristics of the groups. No statistically significant differences were found in the groups for any of the demographic characteristics. The mean age for the intervention group was 34.0 years; mean age for the control group was 35.4 years. Most women in both groups had at least 13 years of education, were African American or Hispanic, multiparous, and single.

Table 2 shows the frequency of “I don’t know” responses to the questions, representing the women’s

Discussion

It has been our experience that women in our population have little knowledge about why they are scheduled for colposcopy or what will happen to them during their appointment. In the Tomaino-Brunner et al. (1998) study, only 38% of the women knew what a colposcopy was when they arrived for their appointment. This lack of knowledge resulted in the nurse practitioner’s spending much time with women on these basic discussions before the colposcopy could be performed. Because of time and staff

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      It appears that women are concerned about the colposcopy procedure itself, and the results from the wider psychological literature have found patient preparation to improve post-operative outcomes [22]. However, pre-colposcopy information-based interventions appear ineffective in reducing anxiety levels [16,23–26]. Therefore, the present study wished to ascertain patients’ perceptions of possible coping interventions for use during the colposcopic examination.

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      Within the literature a variety of strategies has been tried to reduce women's anxiety, including video sessions, pre-colposcopy counselling and booklets, and these have been shown to increase knowledge without a reduction in anxiety level [9,17]. There is evidence that anxiety may not be reduced by increasing women's knowledge about cervical abnormality and colposcopy, as a randomised controlled study on provision of detailed mailed information to the intervention group resulted in increased knowledge prior to their colposcopy but no reduction in level of anxiety as compared to the control group who did not receive any mailed information [18]. Moreover, another study involving pre- and post-colposcopy questionnaires to evaluate anxiety, fear, knowledge and adherence to colposcopy (122 women) found that greater pre-colposcopy knowledge was associated with higher anxiety and fear [19].

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