Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening.
Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening.
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DOI：
10.1097/lgt.0000000000000593
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发表时间：
2021-04-01
影响因子：
3.7
通讯作者：
Kreuter M
中科院分区：
文献类型：
--
作者：
Kuroki L;Massad LS;Martin A;Liu J;Brown D;Leon A;Groesch K;Wilson T;Zeino Y;Diaz-Sylvester P;Delfino K;Hyon K;Kreuter M
在接受阴道镜检查的妇女中确定未满足的基本需求(BN)，评估患者在导航员帮助下的可接受性/满意度以解决未满足的BN，并评估对阴道镜的依从性。2017年9月至2019年1月，从两个学术阴道镜中心招募了女性，一个服务于农村地区，另一个服务于城市地区。BN在阴道镜检查预约之前通过电话进行了评估，如果不太可能在一个月内解决，就被认为没有得到满足。从管理记录中提取研究前和研究后4-6个月的阴道镜检查依从性。在每个部位的25名患者进入导入期后，向患有≥1未满足BN的新参与者提供BN导航器(S)。主要结果是坚持最初的任命。在100名妇女中，59%的人患有≥1未满足BN，在城市和农村之间的患病率相似。接受初次阴道镜检查的总比例为83%，乡村诊所为72%，城市诊所为94%(p=0.006)。这些依从率比研究开始前的4个月有所提高[30/59(51%)乡村诊所；68/137(50%)城市诊所]。尽管BN导航的可接受性为96%，女性认为它有助于她们进行阴道镜检查，但拥有导航器与坚持无关。报告没有未满足的BN的女性与患有≥1未满足的BN的女性相比，无论导航辅助如何，依从性最低(p=0.03)。需要阴道镜检查的弱势妇女有未满足的BN，并重视初始预约的导航帮助。然而，当预约日程安排包括电话提醒和查询BN时，导航员可能不会增加价值。需要阴道镜检查的低收入妇女在阴道镜检查之前可能有未得到满足的基本需求，并重视导航仪的帮助。
To identify unmet basic needs (BN) amongst women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BN, and to estimate adherence to colposcopy. Women were recruited between 9/2017–1/2019 from two academic colposcopy centers, one serving a rural and one an urban area. BN were assessed by phone prior to colposcopy appointments and considered unmet if unlikely to resolve in one month. Colposcopy adherence pre- and post-study implementation were abstracted over 4–6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN-navigator was offered to new participants with ≥1 unmet BN(s). Primary outcome was adherence to initial appointment. Among 100 women, 59% had ≥1 unmet BN, with similar prevalence between urban vs. rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic and 94% at the urban clinic (p=0.006). These adherence rates were improved from four months prior to study launch [30/59 (51%) rural clinic; and 68/137 (50%) urban clinic]. Although acceptability of BN navigation was >96% and women felt it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BN had the lowest adherence compared to women with ≥1 unmet BN regardless of navigator assistance (p=0.03). Disadvantaged women who need colposcopy have unmet BN and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BN, a navigator may not add value. Low-income women who need colposcopy may have unmet basic needs and value navigator assistance prior to their colposcopy visit.