Delays in Care for Abnormal Pap Smears Among Hispanics

Nelson, Karin

Abstract

Hispanic women have lower rates of follow-up for abnormalities found on routine Pap smear screening than their white counterparts. Health beliefs may influence adherence behavior for follow-up of abnormal cervical cytology but to date no studies have addressed this question among Hispanic women.
SPECIFIC AIMS : 1.) To determine if health beliefs and cancer knowledge differ between Hispanic and white women. 2.) To determine if culturally defined beliefs about illness and cancer influence delays in follow up for abnormalities on Pap smear among Hispanic women. METHOD: We will perform a retrospective cohort study drawn from patients followed by the Dysplasia Registry at Kaiser Sunset. At Kaiser, very few patients are lost to follow-up, but there is a significant failure rate for clinic appointments. All women with abnormal Pap smears during the study period will be mailed a brief questionnaire. In addition to demographic characteristics, survey questions will ascertain beliefs about health, risk of disease, and cancer knowledge. MAIN OUTCOME MEASURE: Delays in care, defined as failing the first scheduled clinic visit to follow up on an abnormal Pap smear. SIGNIFICANCE: This study will provide information about how health beliefs and cancer knowledge impact patient adherence among white and Hispanic women. This information will be utilized to design and test an intervention to decrease failure rates for clinic visits, in addition to increasing knowledge about how health beliefs may impact care. In the Kaiser system, failed clinic appointments create service delivery problems and require additional labor by the Registry staff to reschedule follow-up. In many less organized health care settings such as public facilities where a substantial number of Hispanic women receive care, a failed appointment for management of an abnormal Pap smear may lead to missed cases of cervical cancer and a greater likelihood of presenting with advanced disease.