Cross-sectional predictors of Pap test among underserved women with physical disabilities

Women with physical disabilities (WPD) are a group of women at even greater risk than the general population of not obtaining clinical preventive screenings. Health behavior models provide theoretical frameworks for understanding variables that relate to likelihood of obtaining clinical preventive services. The purpose of this study was to investigate the relationship of key theoretical constructs from the Health Belief Model (HBM) and Social Cognitive Theory to the intention and the receipt of Pap tests among WPD. The participants were recruited through the enrollee rosters of a Medicaid provider and durable medical equipment vendor in Oregon during 2008 and 2009. Eligibility criteria included 35≤ age ≤ 64; having health insurance; no recent experience of cervical cancer screening, mammogram screening and/or being weighed at clinics. The PATH analyses on the M-plus was utilized to examine the mediational relationship of specific constructs (e.g., perceived risk, perceived benefits, self-efficacy, perceived barriers, cue to action) and demographic characteristics (e.g., income, education, chronic conditions) to the self-reported Pap test behavior. Most of the 230 participants were Caucasian (71%), with low education levels (21% less than high school), divorced or separated (49%) and not employed (90%). In the HBM framework, self-efficacy (β = .12, p<.05) and provider's communications (β =.74, p<.05) predicted increased Pap test history. The interactions of other theoretical constructs and demographic variables were not significant. The importance of the intervention programs targeting clinics about communication with clients will be discussed.