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Psychological and Sociocultural Perspectives on Follow-up of Abnormal Papanicolaou Results

Carmen Radecki Breitkopf, PhD^*, Jennifer Catero^*, James Jaccard, PhD and Abbey B. Berenson, MD^*

From the *Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, Texas; and Department of Psychology and School of Social Welfare, University at Albany, State University of New York, Albany.

Address reprint requests to: Carmen Radecki Breitkopf, PhD, University of Texas Medical Branch, Department of Obstetrics and Gynecology RTE 0587, 301 University Boulevard, Galveston, TX 77555–0587; e-mail: cmradeck{at}utmb.edu.

OBJECTIVE: To understand women's motivation to attend follow-up of an abnormal Papanicolaou (Pap) test by applying a general theoretical framework for voluntary behavior.

METHODS: Semistructured, face-to-face interviews were conducted among 120 low-income, African-American, Caucasian, or Hispanic outpatients, aged 25–50 years, who presented for routine gynecologic care. Interview questions assessed social, cognitive, environmental, and emotional factors surrounding follow-up for an abnormal Pap test. Content analysis was performed.

RESULTS: The majority of women (74%) described their attitude toward returning for a follow-up visit as favorable. Overall, knowledge regarding the significance of an abnormal result was poor, and misconceptions were common. Perceived barriers, consequences, and social influences associated with attending follow-up were qualitatively different across the 3 racial/ethnic groups. For example, African-American and Hispanic women expressed embarrassment more frequently than Caucasian women and were less likely to anticipate obstacles to attending follow-up. Furthermore, African-American women were the least likely to be influenced by others' opinions and to perceive difficulty in adhering to follow-up recommendations. For nearly all women, adequate communication with their provider was a key component of anticipated adherence.

CONCLUSION: Clinicians may exert a positive influence on adherence among patients who experience an abnormal Pap test by engaging patients in a dialogue that accommodates the patient's sociocultural environment, explores concerns regarding the partner's reaction, emphasizes the importance of follow-up, provides a clear understanding of the process and timeline surrounding follow-up recommendations, and encourages the patient to anticipate obstacles to adherence and assists with solutions.

LEVEL OF EVIDENCE: III

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