A Qualitative, theory-based study of adolescent girls’ knowledge and attitudes about pap smears and compliance with follow-up

Abstract

Background Little is known about predictors of compliance with recommended follow-up for normal or abnonnal Pap smears among adolescents. The objectives of this study were to explore qualitatively adolescent knowledge and attitudes about Pap smears, and to identify which constructs of three behavioraJ theories - the Health Belief Model. Social Cognitive Theory, and the Transtheoretical Model of Change - may be relevant to understanding attitudes about Pap smears and predicting adolescent compliance with Pap smear follow-up. Methods A focus group of nine adolescents with a history of abnormal Pap smears was used to develop a behavioral theory-based interview guide. The guide was then used to conduct in-depth individual interviews with 15 adolescents. Of the 15,5 had a normal Pap smear, 5 had an abnormal Pap smear and had complied with a colposcopy referral, and 5 had an abnormal Pap smear but had not complied with a colposcopy referral. The interviews were audiotaped, transcribed, and analyzed for relevant themes by three investigators. Consensus on themes was reached after independent coding. Results Mean age of the interview participants was 18.7 years (SD 1.9). 53% were black, nonhispanic and 13% hispanic. Overall knowledge about Pap smears was poor: 73% could not derine any aspect of a Pap smear, and 80% could not distinguish between a pelvic examination and a Pap smear. 60% thought that most of their peers received regular Pap smears. Major themes that emerged in terms of perceived benefits of Pap smears were prevention and early diagnosis, mentioned 17 times in 15 interviews. Other themes included trealment of STDs. peace of mind, and validation of the initial result. 53% of participants perceived high susceptibility to cancer after an abnormal Pap smear. 73% of participants reponed that they would seek intormation from their primary physician after an abnormal Pap smear; other information sources included clinics, gynecologists, school nurses, libraries and relatives. Major barriers to obtaining Pap smears included pain/discomfon (87%) and embarrassment (67%). Other barriers included fear of finding a problem. denial, prior negative experiences, lack of knowledge, fear of the unknown problematic relationship with doctor and peers’ advice. Teengenerated strategies to overcome barriers included in-depth, understandable education (by provider or through written materials), a trusting, personal, consistent relationship with a provider, and a gentle examination. Reponed strategies to enhance appointment-making and appointment-keep109 included phone and written reminders and expanded hours. Conclusions In this population of primarily minority adolescents. knowledge about Pap smears was poor. Selected constructs of three behavioral theories were useful in classifying themes and identifying novel themes related to adolescent attitudes about Pap smears and compliance with follow-up. Adolescents repon physicians as the primary source of information about Pap smears. Major perceived benefits to Pap smears were prevention and early diagnosis. Half of adolescents perceived themselves to be at high risk for cervical cancer after an abnormal Pap smear. Major barriers to obtaining Pap smears were pain and embarrnssment. Strategies to overcome barriers and enhance appointment keeping included education. a trusting. consistent relationship with a provider, and phone or written reminders.