Understanding knowledge gaps and perceived barriers to follow up after abnormal Pap smear among low-income women in NYC: a qualitative study

Abstract

Objectives: Cervical cancer is a preventable disease with disproportionate morbidity and mortality among low-income, minority populations. Non-adherence to follow up and treatment after abnormal cervical cancer screening is a major contributor to these disparities and is an ideal time to intervene. The purpose of this study was to identify knowledge gaps and perceived barriers to follow up after abnormal pap smear among low-income women to inform development of a web-based intervention. Methods: Women with a history of abnormal pap smear were approached at a New York City (NYC) colposcopy clinic serving low-income patients (determined by government subsidized insurance) to participate in structured interviews. A topic guide was developed to assess knowledge about cervical cancer screening, treatment of abnormal pap smears, and perceived barriers surrounding appropriate follow up. Interviews were recorded and transcribed, consisting of an initial demographic survey followed by open-ended and probing questions. Responses were coded by 3 independent investigators and placed into a single framework with 3 overarching categories: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified under this framework. After initial independent coding, all discrepancies were discussed, and coders reached perfect agreement. Results: 24 women were enrolled and 15 (62.5%) completed full interviews. The mean age of those who completed interviews was 38.3 years (range: 21-64). Self-identified race was Hispanic (66.7%), White (36.7%), and Black (6.7%), and 46.7% of patients had an annual income of Download : Download high-res image (295KB) Download : Download full-size image Conclusions: Despite positive patient perception of physician communication and education around abnormal pap smears, knowledge was the most common theme identified as a barrier to follow up. Consideration for alternative web-based interventions addressing health literacy and knowledge gaps focused on HPV, cervical cancer risk factors, and treatments may improve follow up among this patient population.