Intervention to Improve Follow-up of Abnormal Pap Test

超过90%的宫颈癌死亡可以通过适当的筛查和治疗前病变来预防。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）匹配的信念+知识+重要性（干预），（2）不匹配的信念+知识+重要性（主动对照），或（3）标准治疗（被动对照）。将通过电话通知所有组的异常结果，并提供随访说明。分配到干预的妇女将收到一个半结构化的信息，解决我们以前的工作中确定的行为的三个核心决定因素。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结果的信念（匹配信念）。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;但是，信念部分将针对与其自身不同的人种/种族（不匹配）设计。将在两组之间评估多种行为和心理结局，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。如果拟议的干预措施得到数据的支持，它将大大增加对后续建议的遵守，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.