Abnormal Pap screening among Mexican-American women: impediments to receiving and reporting follow-up care.

PURPOSE/OBJECTIVES: To understand impediments to receiving and reporting timely follow-up care for abnormal Pap tests among Hispanic women.

DESIGN

Descriptive, qualitative.

SETTING

A federally funded cancer screening clinic in urban South Texas.

SAMPLE

11 Mexican/Mexican-American women over 40 years old who appear in clinic records as "lapsed" in follow-up and 5 clinic staff members.

METHODS

Semistructured, qualitative interviews regarding staff and patient concepts about cancer, cancer screening, and follow-up. Abstraction of patients' clinic charts.

MAIN RESEARCH VARIABLES

Factors associated with women being classified as "lapsed" in follow-up care for abnormal Pap tests.

FINDINGS

Only two patients had no follow-up, while nine eventually had follow-up, either elsewhere or after several missed appointments. Contrary to expectations, poor knowledge, lack of social support, and lack of availability of care were not factors impeding follow-up. Reluctance to be examined by a male practitioner, lack of flexibility in scheduling clinic appointments, and poor staff communication regarding appointments and the seriousness of the condition were all influences negatively affecting follow-up behavior. Nevertheless, these women went to significant lengths to comply with follow-up recommendations.

CONCLUSIONS

The classification of patients' follow-up behavior as "lapsed" was not attributable to culturally based beliefs and attitudes, nor lack of knowledge and motivation, but was primarily the result of institutional features such as scheduling and record-keeping practices and policies.

IMPLICATIONS FOR NURSING PRACTICE

More thorough evaluation of actual behaviors would ensure more accurate assessment of follow-up behavior in this group. More female practitioners, better communication of appointments and of the seriousness of the condition, and more flexible scheduling options would reduce the difficulty these Hispanic patients encountered in having timely follow-up care.