Sanders G, Craddock C, Wagstaff I
Newcastle Health Authority, Newcastle upon Tyne.
Qual Health Care. 1992 Dec;1(4):236-40. doi: 10.1136/qshc.1.4.236.
To identify factors reducing compliance at diagnosis, treatment, and review stages among women referred with abnormal cervical smears to a hospital colposcopy clinic.
Retrospective analysis of sociodemographic data from hospital notes of the attenders and defaulters during one year (1989-90) and prospective collection of information by structured interviews of a sample of defaulters and attenders during five months (May-September 1990).
One hospital colposcopy clinic.
238 women defaulting on two consecutive occasions and 188 attending regularly (retrospective analysis) and a subset of 40 defaulters and 24 attenders (interview sample).
Sociodemographic data and interview responses about attitudes, behaviour, choice, accessibility cultural understanding, communications, and emotional response.
22 (12%) women defaulted at diagnosis, 24(13%) at treatment, 39(21%) at the first check up after treatment, and 84(45%) at the review stage; 19(10%) defaulted from the first check up after diagnostic examination revealed no need for treatment. Age and social class differed between the two groups. 181(76%) defaulters were under 30 compared with 91(48%) attenders; 14(6%) compared with 41(23%) were over 40(p < 0.001). The proportion of women in social classes 4 and 5 was 33%(20/60) for defaulters and 21%(25/120) for attenders (p < 0.05) and unemployed was 66%(158/238) and 36%(68/188) respectively. 63(28%) defaulters were pregnant compared with 11(6%) attenders (p < 0.001). More defaulters came from gynaecology or antenatal clinics. Most defaulters (93%) had child care responsibilities and they knew and understood less about colposcopy. Their explicit reasons for defaulting included child care commitments and fear and their implicit reasons lack of understanding, inaccessibility of information, and staff attitudes.
Compliance may be improved by promoting women's understanding of treatment and encouraging health professionals to develop a service more sensitive to the various needs of women in different socioeconomic groups.
确定在一家医院阴道镜门诊，转诊来的宫颈涂片异常女性在诊断、治疗及复查阶段依从性降低的因素。
回顾性分析1989 - 1990年一年间就诊者和未就诊者医院记录中的社会人口统计学数据，并于1990年5月至9月的五个月期间，通过对部分未就诊者和就诊者进行结构化访谈，前瞻性收集信息。
一家医院阴道镜门诊。
238名连续两次未就诊的女性和188名定期就诊的女性（回顾性分析），以及40名未就诊者和24名就诊者的一个子集（访谈样本）。
社会人口统计学数据以及关于态度、行为、选择、可及性、文化理解、沟通和情绪反应的访谈回答。
22名（12%）女性在诊断阶段未就诊，24名（13%）在治疗阶段未就诊，39名（21%）在治疗后的首次检查时未就诊，84名（45%）在复查阶段未就诊；19名（10%）在诊断性检查显示无需治疗后的首次检查时未就诊。两组在年龄和社会阶层方面存在差异。181名（76%）未就诊者年龄在30岁以下，而就诊者为91名（48%）；14名（6%）年龄超过40岁，就诊者为41名（23%）（p<0.001）。社会阶层4和5中的女性比例，未就诊者为33%（20/60），就诊者为21%（25/120）（p<0.05），未就业比例分别为66%（158/238）和36%（68/188）。63名（28%）未就诊者怀孕，而就诊者为11名（6%）（p<0.001）。更多未就诊者来自妇科或产前门诊。大多数未就诊者（93%）有育儿责任，她们对阴道镜检查了解和认识较少。她们未就诊的明确原因包括育儿责任、恐惧，隐含原因包括缺乏理解、信息不可及以及工作人员态度。
通过增进女性对治疗的理解，并鼓励卫生专业人员开发一种对不同社会经济群体女性的各种需求更敏感的服务，可能会提高依从性。
