Understanding Perceived Barriers to Colposcopy Follow-Up Among Underserved Women at an Urban Teaching Hospital: A Qualitative Study. Issue 1 (6th January 2023)

• Record Type: Journal Article
• Authors: Kulkarni, Amita; Glynn, Shannon; Gamble, Charlotte R.; Shen, Megan Johnson; Cantillo, Evelyn; Frey, Melissa K.; Holcomb, Kevin M.; Safford, Monika M.; Chapman-Davis, Eloise
• Is Part Of: Journal of lower genital tract disease. Volume 27:Issue 1(2023)
• Page Start: 87
• Page End: 92
• Publication Date: 2023-01-06
• Subjects: colposcopy -- health disparities -- cervical cancer screening -- patient education -- human papillomavirus -- abnormal Pap smear; Generative organs, Female -- Diseases -- Periodicals; Cervix uteri -- Diseases -- Periodicals; Generative organs -- Diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 618.1
• DOI: 10.1097/LGT.0000000000000700
• Languages: English
• ISSNs: 1089-2591

Abstract

Abstract : Inadequate knowledge was the most commonly identified barrier to colposcopy follow-up during qualitative interviews of 18 women despite positive perceptions of physician communication and education. Abstract : Objective: Loss to follow-up after abnormal cervical cancer screening disproportionately impacts underserved populations. Our objective was to identify perceived barriers to follow-up after abnormal Pap smear among underserved women. Methods: Women with abnormal Pap smear presenting for colposcopy at an urban teaching hospital were asked to participate in qualitative interviews. A topic guide was developed to assess knowledge about cervical cancer screening and perceived barriers to follow-up. A demographic survey was completed and interviews were recorded and transcribed. Responses were coded and placed into a framework: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified. Demographic data were reported descriptively. Results: Of 24 women enrolled, 18 (75%) completed full interviews. Median age was 38 years (range = 21–64). Participants were racially diverse: 10 (56%) Hispanic, 7 (39%) non-Hispanic White, 1 (5.5%) non-Hispanic Black, and 1 (5.5%) Asian, and all had public insurance. Seven (39%) presented for their 1st colposcopy visit and 11 (61%) had previous visits. Seventeen (94%) had a positive human papillomavirus test and 7 (39%) had atypical squamous cells of undetermined significance. The most common themes identified were related to knowledge gaps, including lack of understanding of Pap smears/human papillomavirus and cervical cancer risk factors. Most participants were satisfied with provider communication but dissatisfied with communication with the office, like scheduling appointments. Conclusions: Despite positive patient perception of physician communication, knowledge was most commonly identified as a barrier to colposcopy follow-up. Implementing a web-based intervention addressing knowledge gaps may improve abnormal cervical cancer screening follow-up among this population.