IMPROVING ADHERENCE TO SCREENING FOLLOW-UP AMONG WOMEN WITH ABNORMAL PAP SMEARS - RESULTS FROM A LARGE CLINIC-BASED TRIAL OF 3 INTERVENTION STRATEGIES

被引:145
作者
MARCUS, AC
CRANE, LA
KAPLAN, CP
READING, AE
SAVAGE, E
GUNNING, J
BERNSTEIN, G
BEREK, JS
机构
[1] UNIV CALIF LOS ANGELES,JONSSON COMPREHENS CANC CTR,DIV CANC CONTROL,LOS ANGELES,CA 90024
[2] KING DREW MED CTR,DEPT OBSTET & GYNECOL,LOS ANGELES,CA
[3] DREW MEHARRY MOORHOUSE,CONSORTIUM CANC CTR,LOS ANGELES,CA
[4] CEDARS SINAI MED CTR,DEPT OBSTET & GYNECOL,LOS ANGELES,CA 90048
[5] UNIV CALIF LOS ANGELES,DEPT PSYCHIAT,LOS ANGELES,CA 90024
[6] UNIV CALIF LOS ANGELES,LOS ANGELES CTY HARBOR MED CTR,DEPT OBSTET & GYNECOL,TORRANCE,CA 90509
[7] UNIV SO CALIF,LOS ANGELES CTY MED CTR,DEPT OBSTET & GYNECOL,LOS ANGELES,CA 90033
[8] UNIV CALIF LOS ANGELES,SCH MED,DEPT OBSTET & GYNECOL,DIV GYNECOL ONCOL,LOS ANGELES,CA 90024
关键词
FOLLOW-UP; PAP SMEARS; ADHERENCE;
D O I
10.1097/00005650-199203000-00004
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P < .05); patients without health insurance (OR = 1.77; P < .01); and patients with more severe pap smear results (OR = 1.71; P < .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P < .05) and patients with less severe pap smear results (OR = 5.16; P < .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.
引用
收藏
页码:216 / 230
页数:15
相关论文
共 29 条
  • [1] Ajzen I, 1985, ACTION CONTROL COGNI, V2, P11, DOI [DOI 10.1007/978-3-642-69746-3_2, 10.1007/978-3-642-69746-3_2]
  • [2] *AM CANC SOC, 1990, 1990 CANC FACTS FIG
  • [3] BEREK JS, 1989, PRACTICAL GYNECOLOGI
  • [4] THE EARLY DETECTION OF CANCER IN THE PRIMARY-CARE SETTING - FACTORS ASSOCIATED WITH THE ACCEPTANCE AND COMPLETION OF RECOMMENDED PROCEDURES
    BURACK, RC
    LIANG, J
    [J]. PREVENTIVE MEDICINE, 1987, 16 (06) : 739 - 751
  • [5] CARTWRIGHT PS, 1990, M J GYN HLTH, V4, P181
  • [6] ATTENDANCE FOR CERVICAL SCREENING - WHOSE PROBLEM
    EARDLEY, A
    ELKIND, AK
    SPENCER, B
    HOBBS, P
    PENDLETON, LL
    HARAN, D
    [J]. SOCIAL SCIENCE & MEDICINE, 1985, 20 (09) : 955 - 962
  • [7] UNDERSTANDING AND IMPROVING PATIENT COMPLIANCE
    ERAKER, SA
    KIRSCHT, JP
    BECKER, MH
    [J]. ANNALS OF INTERNAL MEDICINE, 1984, 100 (02) : 258 - 268
  • [8] FRISCH L E, 1986, Journal of American College Health, V35, P112
  • [9] Green LW, 1984, BEHAV HLTH HDB HLTH, P181
  • [10] Greenwald P, 1986, NATL CANCER I MONOGR, V2, P1