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Congruence between clinician and client perspectives on factors affecting follow-up of abnormal pap test results

Kathryn J. Luchok, PhD, Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 800 Sumter Street HESC 216, Columbia, SC 29208, 803-777-8519, kluchok@sc.edu, Mary Modayil, MSPH, PhDc, Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, 800 Sumter Street, Columbia, SC 29208, Jill M. Abbott, MPH, DrPH, Comprehensive Cancer Center, Ohio State University, A350B Starling-Loving Hall, 320 W. 10th Avenue, Columbus, OH 43210, Heather M. Brandt, PhD, CHES, Prevention Research Center, University of South Carolina, Arnold School of Public Health, 730 Devine Street, Columbia, SC 29208, Irene Prabhu Das, MPH, Division of Cancer Prevention & Control, SC Department of Health and Environmental Control, PO Box 101106, Columbia, SC 29211, and Ann L. Coker, PhD, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler, PO Box 20186, Houston, TX 77225.

Background: Pap tests have reduced the toll of cervical cancer, but lack of follow-up for abnormal results reduces this screening tool’s effectiveness in saving women’s lives. Clinicians must accurately understand factors affecting women clients in order to deliver services that best meet women’s needs. We examined how closely the factors identified by women relate to the factors clinicians believe affect their clients.

Methods: Thirty South Carolina clinicians who provide cervical cancer screening services to income-eligible women and 23 clients having abnormal results completed tape-recorded interviews about what they believed promoted or hindered follow-up care. Following verbatim transcription, narrative data were analyzed in NVivo® for recurrent themes across all interviews.

Results: Clinicians were mostly white, female, rural family nurse practitioners. Approximately equal numbers of African-American and Caucasian clients with a mean age of 59 participated. Both women and clinicians noted competing life priorities, financial and transportation difficulties, and co-morbid conditions interfered with follow-up care. Clinicians thought fear and lack of understanding were major barriers, while women indicated that neither interfered with care-seeking. Few clinicians noted clinic/provider factors influenced follow-up, but women reported clinicians’ sensitivity and concern, staffs’ friendliness, assistance with scheduling and reminders about follow-up appointments were key facilitators.

Conclusion: Clinicians and women agreed on some of the barriers facing women, but diverged in both the nature of factors and how important certain factors were. Recognition of women’s perceptions of both the barriers and facilitators to follow-up care would help providers more effectively provide services that meet the needs of women.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

Keywords: Cervical Cancer, Health Care Delivery

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Women and Cancer Poster Session

The 132nd Annual Meeting (November 6-10, 2004) of APHA