Predicting Adherence to Follow up of Abnormal Pap Smears

摘要：定期通过巴氏涂片进行宫颈癌筛查，并在需要时进行适当治疗，可预防90%以上的宫颈癌死亡率。然而，许多妇女没有定期进行巴氏涂片检查，而在那些进行了检查的妇女中，有很大比例的妇女在发现异常后未能返回随访。因此，子宫颈癌仍然是当今美国最常见的恶性肿瘤之一，每年有4000多人死亡。在非洲裔和西班牙裔妇女中，宫颈癌的发病率和死亡率是白人妇女的2至7倍。为了降低这种疾病的死亡率，临床医生必须能够识别有不依从风险的妇女，并影响患者的行为。很少有数据可以指导临床医生如何评估患者的可靠性，也很少有人了解决定妇女坚持随访动机的因素。拟议的研究旨在确定心理和行为决定因素的动机，妇女坚持后续建议的异常子宫颈抹片检查。我们运用行为的统一理论来识别认知、规范、情感、环境和社会机制的后续依从性。此外，本研究旨在通过使用定性和定量评估方法来了解基于社会文化的动机差异。我们拟对585名25-50岁的非裔、西班牙裔和白人女性进行三个阶段的研究。采用访谈调查方法，提出的研究将产生丰富的关于巴氏涂片随访的社会心理动态的定性信息。第一阶段是启发式研究，我们通过经验推导出理论构造的性质和结构。在第二阶段，我们将开发心理测量健全的调查工具，用于随访依从性的前瞻性检查。在第三阶段，我们将进行随访依从性的前瞻性试点调查，以收集大规模研究的初步数据，我们将使用第一阶段和第二阶段开发的方法和措施。这项研究将通过识别有不依从风险的妇女来改善临床结果，这样临床医生就可以相应地计划异常子宫颈抹片检查的管理。此外，它将有助于设计量身定制的干预措施，以提高依从性。通过告知参与宫颈癌预防的临床医生和研究人员，这项研究将最终降低该病的发病率和死亡率。

ABSTRACT=Regular screening for cervical cancer via the Papanicolaou (Pap) smear and appropriate treatment when indicated can prevent over 90% of cervical cancer mortality. However, many women do not obtain regular Pap smears, and among those who do, a large percentage fail to return for follow-up when notified of abnormality. Consequently, cervical cancer remains one of the most common malignancies in the US today accounts for over 4,000 deaths per year. Among African-American and Hispanic women rate of morbidity and mortality due to cervical cancer are 2 to 7 times that observed among Caucasian women. To decrease mortality due to this disease, clinicians must be able to identify women who are at risk of nonadherence and influence patient behavior. Few data are available to direct clinicians on how to assess patient reliability and little understood about factors that determine women's motivation to adhere to follow-up. The proposed research designed to identify psychological and behavioral determinants of women's motivation to adhere to follow-up recommendations for an abnormal Pap smear. We apply the unified theory of behavior to identify cognitive, normative, affective, environmental and social mechanisms underlying adherence to follow-up. Furthermore, this research is designed to understand sociocultural-based differences in motivation through the use of qualitative and quantitative methods of assessment. We propose to study 585 African-American, Hispanic and white women between 25-50 yeas of age over the course of three phases of research. Using interview survey methodology, the proposed research will yield a rich corpus of qualitative information about the social psychological dynamics of Pap smear follow-up. Phase one is an elicitation study in which we empirically derive the nature and structure of the theory constructs. In phase two, we will develop psychometrically-sound survey instruments for use in a prospective examination of adherence to follow-up. In phase three, we will conduct a prospective pilot investigation of adherence to follow-up to collect preliminary data for a large-scale study in which we use the methodology and measures developed during phases one and two. This research will improve clinical outcomes by identifying women at risk of nonadherence so that clinicians can plan management of the abnormal Pap smear accordingly. Additionally, it will assist in the design of tailored interventions to improve adherence. By informing both clinicians and researchers who are involved with cervical cancer prevention, this research will ultimately reduce the morbidity and mortality due to this disease.