Department of Health Sciences Research, Mayo Clinic.
Department of Obstetrics & Gynecology, University of Texas Medical Branch.
Health Psychol. 2014 Apr;33(4):307-316. doi: 10.1037/a0032722. Epub 2013 Jun 3.
To evaluate the effect of a theory-based, culturally targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test.
5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to one of three groups to receive their results: Intervention (I): culturally targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): nontargeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7-14 days later with the CDDQ and CES-D.
299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p = .73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p = .77. Delay in care (in days) was (M ± SD): 58 ± 75 (I), 69 ± 72 (AC), and 54 ± 75 (SCO), p = .75. Adherence was associated with higher anxiety at notification, p < .01 and delay < 90 days (vs. 90+) was associated with greater perceived personal responsibility, p < .05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p < .05.
A theory-based, culturally targeted message was not more effective than a nontargeted message or standard care in improving behavior.
评估基于理论、针对文化的干预措施对接受异常巴氏试验的低收入和少数族裔女性随访依从性的影响。
共有 5049 名女性接受了巴氏试验。其中 378 名结果异常，341 名（90%）被随机分为三组接受结果：干预组（I）：针对文化的行为和规范信念+知识/技能+凸显+环境限制/障碍咨询；积极对照组（AC）：非针对性行为和规范信念+知识/技能+凸显+环境限制/障碍咨询；或仅标准护理（SCO）。主要结局是参加初始随访预约。次要结局包括延迟护理、18 个月时完成护理、状态焦虑（STAI Y-6）、抑郁症状（CES-D）和痛苦（CDDQ）。焦虑在入组时、通知结果时和 7-14 天后用 CDDQ 和 CES-D 进行评估。
299 名女性纳入意向治疗分析。依从率分别为 60%（I）、54%（AC）和 58%（SCO），p=.73。完成率分别为 39%（I）和 AC 和 SCO 组的 35%，p=.77。延迟护理天数（M±SD）：58±75（I）、69±72（AC）和 54±75（SCO），p=.75。通知时的焦虑程度与依从性相关，p<.01，90 天以内（vs. 90+天）的延迟与更大的感知个人责任相关，p<.05。未完成护理的女性（与完成护理的女性相比）在入组时的 CES-D 评分更高，p<.05。
基于理论、针对文化的信息与非针对性信息或标准护理相比，在改善行为方面没有更有效。
