ABSTRACT=Regular screening for cervical cancer via the Papanicolaou (Pap) smear and appropriate treatment when indicated can prevent over 90% of cervical cancer mortality. However, many women do not obtain regular Pap smears, and among those who do, a large percentage fail to return for follow-up when notified of abnormality. Consequently, cervical cancer remains one of the most common malignancies in the US today accounts for over 4,000 deaths per year. Among African-American and Hispanic women rate of morbidity and mortality due to cervical cancer are 2 to 7 times that observed among Caucasian women. To decrease mortality due to this disease, clinicians must be able to identify women who are at risk of nonadherence and influence patient behavior. Few data are available to direct clinicians on how to assess patient reliability and little understood about factors that determine women's motivation to adhere to follow-up. The proposed research designed to identify psychological and behavioral determinants of women's motivation to adhere to follow-up recommendations for an abnormal Pap smear. We apply the unified theory of behavior to identify cognitive, normative, affective, environmental and social mechanisms underlying adherence to follow-up. Furthermore, this research is designed to understand sociocultural-based differences in motivation through the use of qualitative and quantitative methods of assessment. We propose to study 585 African-American, Hispanic and white women between 25-50 yeas of age over the course of three phases of research. Using interview survey methodology, the proposed research will yield a rich corpus of qualitative information about the social psychological dynamics of Pap smear follow-up. Phase one is an elicitation study in which we empirically derive the nature and structure of the theory constructs. In phase two, we will develop psychometrically-sound survey instruments for use in a prospective examination of adherence to follow-up. In phase three, we will conduct a prospective pilot investigation of adherence to follow-up to collect preliminary data for a large-scale study in which we use the methodology and measures developed during phases one and two. This research will improve clinical outcomes by identifying women at risk of nonadherence so that clinicians can plan management of the abnormal Pap smear accordingly. Additionally, it will assist in the design of tailored interventions to improve adherence. By informing both clinicians and researchers who are involved with cervical cancer prevention, this research will ultimately reduce the morbidity and mortality due to this disease.
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