Intervention to Improve Follow-up of Abnormal Pap Test

描述（由申请人提供）：通过适当的筛查和治疗前驱病变，可以预防90%以上的宫颈癌死亡。然而，在美国，20%到70%的妇女被告知她们的巴氏涂片（Pap）测试异常，但她们没有遵守后续护理的建议。这在少数民族和社会经济地位较低的妇女中尤其是一个问题。这项拟议的研究将通过调查基于行为统一理论的干预措施来解决这个问题，以提高巴氏试验异常通知后的随访率。共600名年龄在18 - 55岁之间的白色、黑人或西班牙裔种族/民族的女性，其经历异常巴氏试验，将被随机分配到三组之一：（1）文化目标信念+知识+重要性（干预），（2）非目标信念+知识+重要性（主动对照），或（3）标准护理（被动对照）。将通过电话通知所有组其异常结果，并提供随访说明（标准治疗）。被随机分配到干预组的女性将在电话中收到一条半结构化的信息，该信息涉及我们先前工作中确定的行为核心决定因素。具体而言，该信息将针对每个种族/族裔群体孤立的关于随访后果的文化目标信念（目标信念）。该信息还将包括传递给主动控制组的信念，以便这些组之间只有目标信念的呈现不同。此外，该消息还将提供与随访护理相关的程序和时间轴的详细信息。最后，将强调随访的重要性，特别是对“低度”异常。分配到活性对照组的女性将收到相同的知识和重要性信息;然而，信念部分将仅包含先前在人种/种族中确定的信念（非目标）。将在两组之间评价行为和心理结局，包括对初始随访的依从性、焦虑和患者满意度。此外，将在18个月的时间间隔内评估护理延迟和护理完整性。最后，我们将检查Pap异常的等级（低与高）作为影响因素。该干预策略具有普遍性，最终可能会减少低收入和少数民族妇女患浸润性宫颈癌的人数。

DESCRIPTION (provided by applicant): 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 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) culturally targeted belief + knowledge + importance (intervention), (2) non-targeted 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 (standard care). Women randomized to the intervention will receive a semi-structured message during the phone call addressing core determinants of behavior identified in our previous work. Specifically, the message will address culturally targeted beliefs about the consequences of follow-up that were isolated for each racial/ethnic group (targeted beliefs). The message also will include beliefs delivered to the active control group so that only the presentation of targeted beliefs differs between these groups. 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 contain only those beliefs previously identified across race/ethnicity (non-targeted). 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 grade of Pap abnormality (low versus high) as an effect modifier. The intervention strategy is generalizable and may ultimately decrease the number of low income and minority women who develop invasive cervical cancer.