African American Women's Personal Influencing Factors Associated with Pap Smear Testing and Cervical Cancer.

Abstract

Pap smears are well established as a screening test that detects precursor lesions to cancer. African American (AA) women’s mortality rates from cervical cancer are highest compared to all other groups of women in part due to their screening practices. The purpose of this study was to explore personal factors that influence AA women’s use of Pap smear screening services. The Interaction Model of Client Health Behavior (IMCHB) (Cox, 1984) was used as a guiding framework to qualitatively explore the influence of women’s social influence and previous health care experience and their influence on women’s cognitive appraisal associated with Pap smears and cervical cancer. Face-to-face interviews with 24 low income AA women (19 to 60 years of age) were conducted, 11 of whom obtained Pap smears routinely (every 1-3 years) and 13 were identified as non-routine (greater than every 3 years). Data were analyzed using two approaches: 1) constant comparison to collect and evaluate data inductively and arrive at an understanding of major themes and comparisons across groups; and 2) a content analysis where the interview data were considered in relation to the elements of the IMCHB. Findings revealed that social influence in regards to valuing preventative health care was different between the routine and non-routine groups. Previous health care experience with having a Pap smear and pelvic exam was primarily positive for the routine-use group and negative for the non-routine-use group. Cognitively, Pap smears were believed to test for cancer and sexually transmitted diseases by both groups. Both routine-use and non-routine-use groups believed vulnerability to cervical cancer was thought to run in families, that they were either safe from risk or hoped that the odds were in their favor. An unexpected finding was a history of trauma (n=9) among the non-routine-use group that elicited negative perceptions towards their previous health care experience contributing to avoidance of the screening test. The insights from these interviews with AA women provide new information on personal influences that affect routine screening behavior. Specifically, traumatic histories were found to negatively affect behavior in routine preventative health care.