Intervention to Improve Follow-up of Abnormal Pap Test

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Over 90 percent of deaths due to cervical cancer could be prevented with appropriate screening and treatment of precursor lesions. However, 20 percent to 70 percent of women in the United States who are told that their Papanicolaou (Pap) test was abnormal do not adhere to recommendations for follow-up care. This is a problem especially among minorities and women of lower socioeconomic status. The proposed study will address this problem by investigating an intervention based in the unified theory of behavior that has been designed to improve follow-up rates after notification of an abnormal Pap test. A total of 600 women of white, black, or Hispanic race/ethnicity between 18 and 55 years of age who experience an abnormal Pap test will be randomized to one of three groups: (1) matched belief + knowledge + importance (intervention), (2) mismatched belief + knowledge + importance (active control), or (3) standard care (passive control). All groups will be notified by telephone of their abnormal results and provided instructions for follow-up. Women assigned to the intervention will receive a semi-structured message addressing three core determinants of behavior identified in our previous work. Specifically, the message will target beliefs about the consequences of follow-up that were isolated for each racial/ethnic group (matched beliefs). In addition, the message will provide detailed information regarding the procedures and timeline associated with follow-up care. Finally, the importance of follow-up, particularly for "low-grade" abnormalities, will be emphasized. Women assigned to the active control group will receive the same knowledge and importance message; however, the belief component will have been designed for a race/ethnicity different from their own (mismatched). Multiple behavioral and psychological outcomes including adherence to initial follow-up, anxiety, and patient satisfaction will be evaluated between groups. In addition, delay in care and completeness of care will be assessed over an 18- month interval. Finally, we will examine the grade of Pap abnormality (low versus high) as an effect modifier. If the proposed intervention is supported by the data, it will significantly increase adherence to follow-up recommendations and consequently decrease the number of women who develop invasive cervical cancer.