Promoting maternal Pap testing during a child visit

Background

Some groups of women in New York City lag 10-20% behind citywide Pap testing rates.

Objective

In 2008, a NYC Department of Health and Mental Hygiene pilot focused on cervical cancer screening disparities. Focus groups in 2007 with unscreened women suggested using child HPV vaccination as an opportunity to promote Pap testing with female guardians.

Methods

An online recruitment survey, completed by 184 of 3000 providers, gauged attitudes about female guardian intervention. Sixty-eight recruited primary care providers intercepted 565 female guardians during office visits of girls aged 9-17, completing cards with provider feedback and baseline female guardian Pap testing status. Providers registered, consented, and read a motivational paragraph to unscreened women. A 3-month follow-up phone survey reassessed Pap testing status among registered women.

Results

Forty percent of the providers planned to adopt the intervention. Of 565 female guardians, 489 women (87%) were current with Pap testing. Of 76 women unscreened in the prior 3 years, 35 (46%) were reached 3 months after provider intercept. Among women who recalled the conversation, all were open to Pap test recommendation by the child's provider. Twenty women (26%) scheduled or obtained a Pap test following the provider's recommendation.

Conclusions

This strategy is acceptable to both providers and female guardians, and holds promise as a potentially effective way of moving unscreened women towards Pap testing. Study limitations include provider selection bias and lack of randomization to a control group, so external validity is uncertain.