Intervention to Improve Follow-Up for Abnormal Papanicolaou Tests: A Randomized Clinical Trial
Intervention to Improve Follow-Up for Abnormal Papanicolaou Tests: A Randomized Clinical Trial
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DOI：
10.1037/a0032722
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发表时间：
2014-04-01
影响因子：
4.2
通讯作者：
Snyder, Russell R.
中科院分区：
文献类型：
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作者：
Breitkopf, Carmen Radecki;Dawson, Lauren;Snyder, Russell R.
目的：评估以理论为基础的、有文化针对性的干预措施对低收入和少数民族妇女巴氏试验异常患者坚持随访的影响。方法：5，049名妇女参加并接受了巴氏试验。其中，378人有异常结果，341人（90%）被随机分为三组：干预组（I）：文化目标行为和规范信念+知识/技能+显著性+环境约束/障碍咨询;主动控制组（AC）：非目标行为和规范信念+知识/技能+显著性+环境约束/障碍咨询;标准护理（SCO）主要结局是初次随访预约的出席率。次要结局包括护理延迟、18个月时完成护理、状态焦虑（STAI Y-6）、抑郁症状（CES-D）和苦恼（CDDQ）。在入组、通知结果时以及7-14天后使用CDDQ和CES-D评估焦虑。结果：299名妇女被纳入意向治疗分析。依从率分别为60%（I）、54%（AC）和58%（SCO），p = 0.73。AC组和SCO组的完成率分别为39%（I）和35%，p = 0.77。护理延迟（天）为（M +/- SD）：58 +/- 75（I）、69 +/- 72（AC）和54 +/- 75（SCO），p = 0.75。依从性与通知时较高的焦虑相关，p <0.01，延迟< 90天（与90+）与较高的个人责任感相关，p <0.05。未完成护理的女性（与完成护理的女性相比）在入组时的CES-D评分较高，p <0.05。结论：在改善行为方面，基于理论的文化目标信息并不比非目标信息或标准护理更有效。
Objective: To evaluate the effect of a theory-based, culturally targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test. Method: 5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to one of three groups to receive their results: Intervention (I): culturally targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): nontargeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7-14 days later with the CDDQ and CES-D. Results: 299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p = .73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p = .77. Delay in care (in days) was (M +/- SD): 58 +/- 75 (I), 69 +/- 72 (AC), and 54 +/- 75 (SCO), p = .75. Adherence was associated with higher anxiety at notification, p < .01 and delay < 90 days (vs. 90+) was associated with greater perceived personal responsibility, p < .05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p < .05. Conclusions: A theory-based, culturally targeted message was not more effective than a nontargeted message or standard care in improving behavior.