DELAYS IN CARE FOR ABNORMAL PAP SMEARS AMONG HISPANICS

西班牙裔妇女在常规子宫颈抹片检查中发现异常的随访率低于白人妇女。健康信念可能会影响异常宫颈细胞学随访的依从性行为，但迄今为止还没有研究解决西班牙裔妇女的这个问题。具体目标：1)；确定西班牙裔和白人女性的健康信念和癌症知识是否不同。2)。确定西班牙裔妇女对疾病和癌症的文化观念是否影响子宫颈抹片检查异常随访的延迟。方法：我们将进行一项回顾性队列研究，从Kaiser Sunset的异常增生登记处的患者中提取。在凯撒医院，很少有病人错过随访，但门诊预约失败率很高。在研究期间，所有宫颈抹片检查异常的女性都将被邮寄一份简短的问卷。除了人口统计特征外，调查问题还将确定人们对健康、疾病风险和癌症知识的看法。主要结局测量：延误护理，定义为未能第一次预定的诊所访问，随访异常子宫颈抹片检查。意义：本研究将提供有关健康信念和癌症知识如何影响白人和西班牙裔女性患者依从性的信息。这些信息将用于设计和测试干预措施，以减少诊所就诊的失败率，以及增加有关健康信念如何影响护理的知识。在Kaiser系统中，失败的诊所预约会造成服务交付问题，并且需要登记处工作人员额外的劳动力来重新安排后续工作。在许多组织较差的卫生保健机构，如大量西班牙裔妇女接受护理的公共设施中，未能预约进行异常子宫颈抹片检查可能导致宫颈癌漏诊，并更有可能出现晚期疾病。

Hispanic women have lower rates of follow-up for abnormalities found on routine Pap smear screening than their white counterparts. Health beliefs may influence adherence behavior for follow-up of abnormal cervical cytology but to date no studies have addressed this question among Hispanic women. SPECIFIC AIMS: 1.) To determine if health beliefs and cancer knowledge differ between Hispanic and white women. 2.) To determine if culturally defined beliefs about illness and cancer influence delays in follow up for abnormalities on Pap smear among Hispanic women. METHOD: We will perform a retrospective cohort study drawn from patients followed by the Dysplasia Registry at Kaiser Sunset. At Kaiser, very few patients are lost to follow-up, but there is a significant failure rate for clinic appointments. All women with abnormal Pap smears during the study period will be mailed a brief questionnaire. In addition to demographic characteristics, survey questions will ascertain beliefs about health, risk of disease, and cancer knowledge. MAIN OUTCOME MEASURE: Delays in care, defined as failing the first scheduled clinic visit to follow up on an abnormal Pap smear. SIGNIFICANCE: This study will provide information about how health beliefs and cancer knowledge impact patient adherence among white and Hispanic women. This information will be utilized to design and test an intervention to decrease failure rates for clinic visits, in addition to increasing knowledge about how health beliefs may impact care. In the Kaiser system, failed clinic appointments create service delivery problems and require additional labor by the Registry staff to reschedule follow-up. In many less organized health care settings such as public facilities where a substantial number of Hispanic women receive care, a failed appointment for management of an abnormal Pap smear may lead to missed cases of cervical cancer and a greater likelihood of presenting with advanced disease.