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Development of a text message-based intervention for follow-up colposcopy among predominately underserved Black and Hispanic/Latinx women. Cancer Causes Control 2022; 33:861-873. [PMID: 35334016 PMCID: PMC9516784 DOI: 10.1007/s10552-022-01573-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Underserved Black and Hispanic/Latinx women show low rates of follow-up care after an abnormal Pap test, despite the fact that cervical cancer is one of the few preventable cancers if detected early. However, extant literature falls short on efficacious interventions to increase follow-up for this population. A concurrent mixed methods study was completed to evaluate the acceptability of a text message-based intervention and identify perceived barriers and facilitators to follow-up after an abnormal Pap test among underserved predominantly Black and Hispanic/Latinx women. METHODS Patients who completed follow-up for an abnormal Pap test were recruited to complete a cross-sectional survey, qualitative interview assessing barriers and facilitators to follow-up, and text message content evaluation (N = 28). Descriptive statistics were performed to describe background variables and to evaluate the acceptability of text messages. A directed content analysis was completed for the qualitative interviews. RESULTS Participants expressed interest in a text message-based intervention to increase abnormal Pap test follow-up. In the qualitative interviews, low knowledge about cervical risk and negative affect toward colposcopy/test results were identified as barriers to follow-up. Facilitators of follow-up included feeling relieved after the colposcopy and adequate social support. Participants rated the text messages as understandable, personally relevant, and culturally appropriate. CONCLUSION The findings suggest that underserved Black and Hispanic/Latinx women experience cognitive and emotional barriers that undermine their ability to obtain follow-up care and a text message-based intervention may help women overcome these barriers. Future research should develop and evaluate text message-based interventions to enhance follow-up after an abnormal Pap test.
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Buick C, Murphy KJ, Howell D, Metcalfe K. Understanding the role of oncogenic human papillomavirus (HPV) status on adherence behaviors among women with abnormal cervical cytology. BMC WOMENS HEALTH 2021; 21:29. [PMID: 33461543 PMCID: PMC7812645 DOI: 10.1186/s12905-020-01168-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND With the introduction of oncogenic Human Papillomavirus (HPV) testing into cervical screening there is a renewed focus on primary prevention among high-risk groups. To date, little is known about the effectiveness of this program, and the extent to which individual-level factors, such as psychosocial health and agency, may play a role. In particular, it is unclear if knowledge of one's oncogenic HPV status impacts on adherence behaviors amongst women with screening abnormalities. The purpose of this study was to identify if clinical, demographic or psychosocial factors predict non-adherence with recommended colposcopy follow-up. METHODS This prospective pilot study included 145 women referred to a large Toronto colposcopy clinic between December, 2013 and September, 2014. Demographic, clinical and psychosocial characteristics were collected at three points in time: (1) at initial colposcopy consultation; (2) 4-6 weeks following initial consultation, and; (3) at time of follow-up appointment (within 12 months of initial consultation). RESULTS Overall, 13% (n = 145) of the women were classified as non-adherent. Older women (OR = 0.73, p < 0.01) and those with higher-grade lesions (OR = 0.10, p < 0.01) were less likely to be non-adherent, whereas current smokers (OR = 22.46, p < 0.01) were more likely to be non-adherent. While not statistically significant, variation in rates of non-adherence amongst the various HPV status groups (untested; 15.3%, HPV positive; 5.3%, HPV negative; 6.7%) warrants further study. CONCLUSION Findings of this study indicate that younger women, those with higher-grade lesions and current smokers were more likely to be non-adherent to recommended colposcopy follow-up. While HPV status did not reach statistical significance, the direction of this finding suggests that testing for HPV may have a positive reinforcing role on adherence to follow-up. The direction of this finding warrants further study, and potentially a practical clinical goal as HPV testing for women becomes standard of care.
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Affiliation(s)
- Catriona Buick
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - K Joan Murphy
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Doris Howell
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Kelly Metcalfe
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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Should We Always Look Before We LEEP? A Discussion of the Pros and Cons of Colposcopic Biopsy Prior to Treatment. J Low Genit Tract Dis 2019; 23:147-150. [PMID: 30817690 DOI: 10.1097/lgt.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ketelaars PJW, Buskes MHM, Bosgraaf RP, van Hamont D, Prins JB, Massuger LFAG, Melchers WJG, Bekkers RLM. The effect of video information on anxiety levels in women attending colposcopy: a randomized controlled trial. Acta Oncol 2017; 56:1728-1733. [PMID: 28760058 DOI: 10.1080/0284186x.2017.1355108] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim was to investigate whether additional information, in video form, reduces anxiety, depression and pain levels in women referred for colposcopy. MATERIAL AND METHODS Between September 2012 and March 2015, 136 patients referred for colposcopy were randomized into two study arms. Group A received video information in addition to the regular information leaflet, and group B (control group) received only the regular information leaflet. The patients were requested to complete standardized online questionnaires. The first online questionnaire (T1) was pre-randomization, and was completed at home, 5 days prior to the appointment. The second online questionnaire (T2) was completed directly before the colposcopy appointment, and the last online questionnaire (T3) was completed directly following colposcopy at the out-patient clinic. The questionnaires included the Spielberger State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), and the Numeric Rating Scale (NRS) to assess pain. RESULTS The STAI state anxiety score was high (44.6), but there was no significant difference in STAI, HADS and NRS between the two groups at the three measuring points. A post hoc analysis showed that women with a generally higher baseline anxiety trait had significantly lower HADS anxiety levels following video information. CONCLUSIONS Additional information (video) before colposcopy did not significantly reduce anxiety, depression, and expected or experienced pain, as measured by the STAI, HADS and NRS in patients attending their first colposcopy appointment. However, most patients positively appreciated the video information, which may reduce the anxiety of extremely anxious patients.
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Affiliation(s)
- Pleun J. W. Ketelaars
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M. H. M. Buskes
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R. P. Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D. van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Judith B. Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L. F. A. G. Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Aharon D, Calderon M, Solari V, Alarcon P, Zunt J. Barriers to Follow-Up for Abnormal Papanicolaou Smears among Female Sex Workers in Lima, Peru. PLoS One 2017; 12:e0169327. [PMID: 28060937 PMCID: PMC5217960 DOI: 10.1371/journal.pone.0169327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cervical cancer is the most prevalent cancer among Peruvian women. Female sex workers (FSW) in Peru are at elevated risk for HPV infection, and receive annual Papanicolaou screening. The objective of this study was to identify barriers to follow-up for abnormal Pap smears among FSW in Peru. METHODS 97 FSW attending the Alberto Barton Health Center in Lima were surveyed regarding their STI screening history. 17 women with a history of an abnormal Pap smear were interviewed about their experiences regarding follow-up care. RESULTS Of the 27 HPV-positive women, only 8 (30%) received follow-up treatment. Of the 19 women who did not receive follow-up, 7 (37%) had not been informed of their abnormal result. Qualitative interviews revealed that the major barrier to follow-up was lack of knowledge about HPV and potential health consequences of an abnormal Pap smear. CONCLUSION HPV infection is highly prevalent in Peruvian FSW, yet only 30% of FSW with abnormal Pap smears receive follow-up care. The predominant barriers to follow-up were lack of standardization in recording and communicating results and insufficient FSW knowledge regarding health consequences of HPV infection. Standardization of record-keeping and distribution of educational pamphlets have been implemented to improve follow-up for HPV.
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Affiliation(s)
- Devora Aharon
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- * E-mail:
| | - Martha Calderon
- Centro de Salud Alberto Barton del Callao, Callao, Lima, Peru
| | - Vicky Solari
- Centro de Salud Alberto Barton del Callao, Callao, Lima, Peru
| | | | - Joseph Zunt
- University of Washington, Seattle, WA, United States
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Patient compliance with cervical smear surveillance in a shared-care setting. Int J Gynaecol Obstet 2016; 135:177-181. [DOI: 10.1016/j.ijgo.2016.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/26/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022]
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Multidimensional associations of pain and anxiety before and after colposcopy. Int J Gynaecol Obstet 2015; 131:297-300. [PMID: 26386494 DOI: 10.1016/j.ijgo.2015.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/16/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effect of pre-procedural variables on post-procedural outcomes following colposcopy. METHODS A prospective study was conducted at Concord Women's Health Center in Israel between March 1, 2013, and March 31, 2014. Women waiting for colposcopy were approached and asked to complete questionnaires about anxiety, information-seeking patterns, fear associated with the examination, and demographics. After the procedure, participants answered questions about pain and state anxiety. The physician performing the procedure assessed the participant's levels of distress. A path analysis model was constructed. RESULTS Path analysis showed direct and indirect effects of both demographic and psychological variables on the main outcome measures. Physician's appraisal was related to fear, information seeking, state anxiety, and pain. Post-procedural state anxiety was related to fear, trait anxiety, pre-procedural state anxiety, past experience, pain, and information seeking. Pain was related to information seeking and age. Information seeking, pre-procedural state anxiety, and subjective pain served as mediators for some of these relationships. CONCLUSION The effect of various psychological and demographic variables on psychological outcome variables following colposcopy should not be measured independently but rather as inter-related variables.
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Montella JM, Pelegano JF. Improving the Rate of Colposcopy in an Urban Population of Patients With Known Abnormal Pap Smears. Am J Med Qual 2015; 31:233-9. [PMID: 25614512 DOI: 10.1177/1062860614568648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project was designed to improve the colposcopy rate in an urban patient population with known abnormal Pap smears within 75 days of the test to rapidly identify and treat premalignant lesions. Using Plan-Do-Study-Act cycles, Lean techniques, and the electronic health record, the authors created a protocol to verify all Pap smears, then created a process whereby a phone-triage team contacted patients with abnormal Pap smears to educate them and schedule colposcopy. As a result, 100% of Pap smears were verified, compared with 95% prior to plan implementation. The mean time from Pap to colposcopy was 38.5 days, with 85% of patients having colposcopy performed after plan implementation, compared with 50% prior-a 70% improvement. If patients with medical contraindications were excluded, the percentage rose to 91%-an 82% improvement. Patient and provider satisfaction improved, staff and provider workload did not increase, and there was the potential for substantial economic savings.
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Affiliation(s)
- Joseph M Montella
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - James F Pelegano
- Jefferson School of Population Health of Thomas Jefferson University, Philadelphia, PA
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Kola-Palmer S, Walsh JC. Correlates of psychological distress immediately following colposcopy. Psychooncology 2015; 24:819-24. [DOI: 10.1002/pon.3738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Susanna Kola-Palmer
- Department of Behavioural and Social Sciences; University of Huddersfield; UK
| | - Jane C. Walsh
- School of Psychology; National University of Ireland; Galway Ireland
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Pritham UA, Brigdon A, Jones M. Understanding factors related to women's adherence to colposcopy. Nurs Womens Health 2014; 18:402-12. [PMID: 25316540 DOI: 10.1111/1751-486x.12148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early detection can prevent death from cervical cancer, but success is dependent on women with abnormal cytology attending follow-up procedures, including colposcopy. Factors that influence adherence to colposcopy include age, race, education, socioeconomic status, smoking, chemical dependence, intimate partner violence and anxiety. Comprehension of abnormal Pap smear results and knowledge of current treatment guidelines and follow-up is important in the prevention of cervical cancer. Understanding factors that could inhibit adherence to colposcopy will allow for tailored communication and individualized treatment to prevent colposcopy default. Implementation of colposcopy clinics with designated nurses to track and monitor adherence could help.
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Factors affecting compliance in the first year of postcolposcopy surveillance among women with a high incidence of cervical cancer. Int J Gynaecol Obstet 2013; 124:160-3. [DOI: 10.1016/j.ijgo.2013.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/18/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022]
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