Distress after an abnormal Pap smear result: scale development and psychometric validation

Abstract

Background. Psychological distress is severe in women who receive a report of abnormal findings on Pap smear, and may be one reason 10–61% of such women fail to undergo follow-up testing. Methods. Using the 14-question Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q) as a basis, we developed the 23-question Cervical Dysplasia Distress Questionnaire (CDDQ), testing its internal consistency and validity with 661 women undergoing colposcopy after an abnormal Pap smear finding in a three-phase analysis. Results. Items were divided into two sets and factor analyzed separately: one addressed distress during medical procedures, and the other concerned perceived consequences of an abnormal Pap smear. The medical procedures items yielded two factors: embarrassment regarding the procedures and discomfort/tension with the procedures. Factor analysis of the second set also resulted in two factors: concern about sexual and reproductive issues and concern about health consequences. Subscales created from items loading highly on each factor had high internal consistency ( α ranged from 0.76 to 0.90) and demonstrated good concurrent validity with other psychometrically validated measures of distress. Conclusions. The CDDQ is a reliable and valid questionnaire for measuring multiple domains of distress unique to women who test positive on a cervical cancer screening test.