Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center

Objective: To determine factors predictive of failure to return for colposcopy among women with significant abnormalities on Papanicolaou smears in a high-risk clinical population. Design: Telephone survey. Setting: An urban community health center. Participants: Two hundred seventy-nine women randomly selected from all women seen at the health center with abnormal Papanicolaou smears requiring colposcopy during 1993 to 1944. Six (2%) refused participation, and 19% could not be reached for inclusion. Subjects were mostly minority women receiving Medicaid. Main Outcome Measure: Completion of colposcopy. Results: Of the 279 selected women, 79% were interviewed. The rate of adherence with colposcopy was 75% for the respondents. Women who did not know the re suits of their smear or who incorrectly understood their results were significantly less likely to return for colposcopy (P=.001). Younger women, especially teenagers, were less likely to return (P=.02). Socioeconomic status, education, primary language, health beliefs, fear of cancer, and clinician's gender or discipline were not associated with rate of follow-up. Barriers involving transportation, child care, and insurance also did not predict follow-up. Conclusions: Effective communication of results is the most important factor related to follow-up after abnormal Papanicolaou smear in this setting. In other settings, other factors may be of greater importance.