Predicting Adherence to Follow up of Abnormal Pap Smears

摘要=通过巴氏涂片定期筛查宫颈癌，并在有指征时进行适当治疗，可预防90%以上的宫颈癌死亡率。然而，许多妇女没有定期接受巴氏涂片检查，在接受检查的妇女中，很大一部分在被告知异常情况后没有返回接受后续检查。因此，宫颈癌仍然是当今美国最常见的恶性肿瘤之一，每年造成4，000多人死亡。在非洲裔美国人和西班牙裔妇女中，宫颈癌的发病率和死亡率是高加索妇女的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出有不依从风险的女性，并影响患者的行为。很少有数据可用于指导临床医生如何评估患者的可靠性，也很少了解决定女性坚持随访的动机的因素。拟议的研究旨在确定妇女的动机，坚持后续建议的异常巴氏涂片的心理和行为决定因素。我们应用行为的统一理论，以确定认知，规范，情感，环境和社会机制的基础上坚持跟进。此外，本研究旨在通过使用定性和定量的评估方法来了解基于社会文化的动机差异。我们建议在三个阶段的研究过程中，对585名年龄在25-50岁之间的非洲裔美国人、西班牙裔和白色女性进行研究。 使用访谈调查方法，拟议的研究将产生丰富的语料库的定性信息的社会心理动态的巴氏涂片随访。第一阶段是一个启发式研究，我们从经验上推导出理论结构的性质和结构。在第二阶段，我们将开发心理测量的声音调查工具，用于前瞻性检查坚持后续行动。在第三阶段，我们将进行一项前瞻性的试点调查，以遵守后续行动，以收集初步数据的大规模研究中，我们使用的方法和措施，在第一和第二阶段。 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，以便临床医生可以相应地计划异常巴氏涂片的管理。此外，它还将协助设计有针对性的干预措施，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这种疾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.