The objective of the proposed project is to identify gaps in utilization behavior of providers of care and consumers of care with respect to cervical cancer screening and follow through and to mount an intervention focused on changing provider behavior regarding their role in cervical cancer screening as well as on developing a cancer control outreach program at the community level to encourage especially high risk women to seek a Pap test. A quasi-experimental design has been selected in which two large communities in the City of Baltimore have been chosen for intensive observation because of their high population density of high risk women, their demonstrated high cervical cancer mortality rate, and the relative insularity of patterns of medical care utilization.
The specific aims of the study are to (1) determine provider perspectives on the role of the primary care provider in cervical cancer screening to detect where specific targeted provider-based intervention can best be placed; (2) the development of physician peer-taught interventions for improving participation, provision and referral of women for Pap tests using a standard protocol of care to be determined in this study; (3) to develop a monitoring system of cervical cancer screening in each community by enrolling laboratories who will monitor successive Pap test and aggregate them by area and by provider; this information will be routinely fed back to providers as a method of reinforcing their behavior in the intervention community; (4) the development of an outreach community-based network of women, using community organizations, churches and American Cancer Society volunteers who will enroll high risk women and monitor their cervical cancer screening behavior through the use of existing Baltimore City Health Department clinics; (5) the development and operation of physician-based logs for cervical cancer in the practice setting to monitor and reinforce adherence to the Pap test protocol; and (6) to determine the overall effectiveness of this multiple intervention on the rates of Pap testing in each community and ultimately the stage of cervical cancer at diagnosis as determined by information from the Maryland Cancer Registry.
| Mamon, J A; Shediac, M C; Crosby, C B et al. (1990) Inner-city women at risk for cervical cancer: behavioral and utilization factors related to inadequate screening. Prev Med 19:363-76 |
