Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center

Arch Fam Med. 1999 Mar-Apr;8(2):129-34. doi: 10.1001/archfami.8.2.129.


Objective: To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population.

Design: Telephone survey.

Setting: An urban community health center.

Participants: Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1994. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid.

Main outcome measure: Completion of colposcopy.

Results: Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the results of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P = .001). Younger women, especially teenagers, were less likely to return (P = .02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up.

Conclusions: Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cervix Uteri / pathology*
  • Colposcopy
  • Communication
  • Community Health Centers
  • Female
  • Humans
  • Middle Aged
  • Minority Groups
  • New York City
  • Papanicolaou Test*
  • Patient Compliance*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Urban Health
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / psychology
  • Vaginal Smears* / psychology