ASPO Abstracts
Improving adherence to colposcopy referral: Results from interviews with colposcopy adherers and non-adherers
Category: Early Detection & Risk Prediction, Behavioral Science & Health Communication
Conference Year: 2018
Abstract Body:
Purpose Researchers partnered with Planned Parenthood-Wisconsin and a family medicine clinic to conduct interviews to explore barriers to, and facilitators of, colposcopy referral adherence. Methods We recruited clinic patients who had been referred for colposcopy. Interviews were conducted in clinic sites and were audio-recorded, transcribed, and analyzed using open coding to generate grounded theory. Themes were mapped to Bronfenbrenner’s (1977) socioecological framework for health at individual, interpersonal, organizational, community, and policy levels. Results We interviewed 40 women, 33 had had a colposcopy, 7 had not. Themes emerged at all levels of the socioecological model. At the individual level, women expressed that fear of cancer/the procedure, lack of understanding of clinical recommendations, lack of understanding of effectiveness of cervical cancer screening and internal motivations contributed to adherence. At the interpersonal level, key themes included: importance of supportive relationships; desire to stay healthy for one’s children; trust for clinician. Procedural factors leading to comfort (privacy during procedure) or discomfort (presence of multiple clinicians and/or clinical learners) were identified as organizational themes. Community level themes included: desire for increased understanding of prevalence of — and elimination of stigma related to — HPV; insurance/transportation barriers. And, policy/systems level themes include the importance of Planned Parenthood and other organizations that improve access to care for un-/underinsured populations. Conclusions By mapping interview themes to the socioecological model, we demonstrate the complexity of patients' decision-making processes related to adherence to colposcopy referral. Based on these findings, adherence might be improved in the following ways: 1) advocacy for support and funding for organizations that improve access to care for the un-/underinsured; 2) messaging to improve patient knowledge of HPV (and HPV vaccine), and to highlight the effectiveness of cervical cancer screening; 3) improved clinical practices (improved information about HPV, cervical cancer, and colposcopy; procedures that ensure patient comfort during colposcopy).
Keywords: colposcopy, cervical cancer, screening, qualitative research