Intervention to Improve Follow-up of Abnormal Pap Test

通过适当筛查和治疗前驱病变，90%以上的宫颈癌死亡是可以预防的。然而，在美国，20%到70%的女性在被告知她们的巴氏涂片检查异常后，并没有坚持进行后续护理。这在少数民族和社会经济地位较低的妇女中尤其成问题。提出的研究将通过调查一种基于行为统一理论的干预措施来解决这个问题，该干预措施旨在提高Pap检查异常通知后的随访率。共有600名年龄在18至55岁之间的白人、黑人或西班牙裔女性经历了异常的巴氏试验，将被随机分为三组：(1)匹配信念+知识+重要性（干预），(2)不匹配信念+知识+重要性（主动控制），或(3)标准治疗（被动控制）。所有小组的异常结果将以电话通知，并提供跟进指示。分配到干预的妇女将收到半结构化的信息，解决我们之前工作中确定的三个核心行为决定因素。具体来说，该信息将针对对每个种族/民族群体孤立的后续结果的信念（匹配的信念）。此外，该信息还将提供与后续护理相关的程序和时间表的详细信息。最后，将强调随访的重要性，特别是对于“低级别”异常。被分配到积极控制组的妇女将收到相同的知识和重要性信息；然而，信仰部分将被设计为与自己不同的种族/民族（不匹配）。多种行为和心理结果，包括对初始随访的依从性、焦虑和患者满意度将在组间进行评估。此外，护理的延迟和护理的完整性将在18个月的间隔内进行评估。最后，我们将检查Pap异常的等级（低与高）作为效果调节剂。如果建议的干预措施得到数据的支持，它将显著提高对随访建议的依从性，从而减少患浸润性宫颈癌的妇女人数。

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.