Factors influencing follow -up care of abnormal Pap smears

Abstract

The current study is part of a larger retrospective study evaluating National Cancer Institute Clinical Practice Guidelines for the management of atypical squamous cells of undetermined significance (ASCUS) among participants who represent a population in the Bronx at high-risk for cervical cancer. The current study uses the Self-Regulatory Model of Illness Behavior designed by Leventhal (Leventhal, 1983) to assess psychological factors that may influence follow-up care for abnormal Pap smears. 171 participants were interviewed by phone. Interviews were conducted in Spanish and English. Only 114 respondents (approximately 66%) knew they had an abnormal Pap smear and answered relevant questions about their experience. From the instrument, scales were designed to assess participant beliefs, levels of psychological distress, perceived vulnerability, emotional response to the news of an abnormal Pap smear, and coping. Results of the study provided support for some components of the model; levels of psychological distress, perceived vulnerabililty, and emotional response to the news of an abnormal Pap smear were associated with levels of coping (F (3,102) = 19.27, p < .001, R2 of .34). These components were not predictive of follow-up group membership. Beliefs were also not associated with coping or follow-up group. Post-hoc analyses did uncover differences by ethnic background and primary language usage. Findings indicated that Non-Hispanic respondents were more likely to attribute the cause of abnormal Pap smears to sexual transmission when compared to primarily English-speaking Hispanics (Chi-square = 4.34; 1df, p < .05). Those who were primarily Spanish-speakers were more likely to endorse erroneous beliefs about the cause of abnormal Pap smears compared to English-speakers (Chi-square = 10.18; 1df, p < .01). Results of this study provide some support for previous research in this area and emphasize the need to conduct further research on psychological factors influencing follow-up care among high-risk populations.