Barriers and motivators for the follow-up of abnormal Pap smears in low income women in Medellín, Colombia

BACKGROUND: In Colombia, cervical cancer is the second most common cancer among women with age-standardized incidence (21.5/100,000) and mortality rates (10/100,000), which are much higher than for other Latin American countries. Lack of appropriate follow-up has been associated with this problem. The purpose of this study was to examine barriers and motivators associated with the follow-up of abnormal Pap smears among women who use the subsidized regime (public health insurance) in Medellín, Colombia. METHOD:We conducted eight focus groups segmented by age groups (25-45 and 46-69). The analysis was conducted by two investigators who independently identified, then discussed and agreed upon emerging themes and categories. FINDINGS: The sample consisted of 62 women, of whom most (79%) had not finished high school. The most important barrier to follow-up was the out-of-pocket expense due in part to the fragmentation of the system (contracting of services with different providers) which was the second most common barrier. Problems and delays with appointments and authorizations were also common. Participants also mentioned long lines that start very early (4:00 am) and tense relationships with clinics' staff. Women mentioned as possible motivators: to avoid fragmentation, a patientxs navigator program, social support from their personal networks as well as health education for women and their partners. CONCLUSIONS: The most common barriers were related to the structure of the health care system and its administration by insurers. Some of these barriers could be avoided if some changes were made to the way in which the insurers and providers offer services.