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Effect of health beliefs on delays in care for abnormal cervical cytology in a multiethnic population

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Abstract

CONTEXT: Women from racial and ethnic minorities in the United States have higher rates of cervical cancer and present with later stage disease compared to whites. Delays in care for abnormal Papanicolaou (Pap) smears can lead to missed cases of cervical cancer or late-stage presentation and may be one explanation for these differences.

OBJECTIVE: To determine if race and ethnicity, health beliefs, and cancer knowledge are associated with delays in care for abnormal Pap smears.

DESIGN, PARTICIPANTS, AND SETTING: We conducted a mailed survey with telephone follow-up of all women with an abnormal Pap smear who received care at Kaiser Permanente Los Angeles Medical Center between October 1998 and October 1999 (n=1,049).

MEASUREMENTS AND MAIN RESULTS: A delay in care was defined as not attending the first scheduled clinic visit to follow up on an abnormal Pap smear, or requiring multiple contact attempts, including a certified letter, to schedule a follow-up visit. Our response rate was 70% (n=733) and the sample was 51% Latina. Spanish-speaking Latinas and women of Asian descent were more likely to endorse fatalistic beliefs and misconceptions about cancer. Thirteen percent of the sample delayed follow-up on their abnormal Pap smear. Women who delayed care were more fatalistic and endorsed more misconceptions about cervical cancer. Delays in care were not independently associated with race and ethnicity.

CONCLUSIONS: Health beliefs and cancer knowledge differed by race and ethnicity among women in a large managed care organization. Fatalistic health beliefs and misconceptions about cancer, but not race and ethnicity, were independently associated with delays in care.

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Author information

Authors and Affiliations

  1. Received from the Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, USA

    Karin Nelson MD, MSHS

  2. the Department of Medicine, University of Washington, Seattle, Wash

    Karin Nelson MD, MSHS

  3. the Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, Calif

    Ann M. Geiger PhD

  4. the Division of General Internal Medicine and Health Services Research, UCLA School of Medicine, Los Angeles, Calif

    Carol M. Mangione MD, MSPH

Authors
  1. Karin Nelson MD, MSHS
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  2. Ann M. Geiger PhD
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  3. Carol M. Mangione MD, MSPH
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Corresponding author

Correspondence to Karin Nelson MD, MSHS.

Additional information

Dr. Nelson completed this study while she was a NRSA research fellow in the Division of General Internal Medicine and Health Services Research at UCLA and received additional funding from the National Cancer Institute (1F32 CA 88495-01).

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Nelson, K., Geiger, A.M. & Mangione, C.M. Effect of health beliefs on delays in care for abnormal cervical cytology in a multiethnic population. J GEN INTERN MED 17, 709–716 (2002). https://doi.org/10.1046/j.1525-1497.2002.11231.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.11231.x

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