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Correlating Knowledge of Cervical Cancer Prevention and Human Papillomavirus With Compliance After Colposcopy Referral

Massad, L. Stewart MD1; Weber, Kathleen M. RN, BSN2; Wilson, Tracey E. PhD3; Goderre, Johanna L. BA4; Hessol, Nancy A. MSPH5; Henry, Donna MD, MPH6; Colie, Christine MD7; Strickler, Howard D. MD, MPH8; Levine, Alexandra M. MD9,10; Watts, D. Heather MD11; Evans, Charlesnika T. MPH, PhD12

Journal of Lower Genital Tract Disease: April 2012 - Volume 16 - Issue 2 - p 98–105
doi: 10.1097/LGT.0b013e318238e83d
Original Articles

Objective This study aimed to assess the impact of knowledge of cervical cancer biology and prevention as well as noncognitive measures on compliance with colposcopy referral in a high-risk population.

Methods Participants in a US cohort of women with human immunodeficiency virus (HIV) infection and at-risk comparison women completed behavior questionnaires and instruments measuring knowledge of cervical cancer prevention, depressive symptoms, trust in physicians, and perceived stress. Examinations including Pap tests also were conducted. Associations with compliance with resulting indicated colposcopy were assessed in multivariable models.

Results Of 326 women with indicated colposcopy, 222 (68%) were compliant with colposcopy referral and 104 (32%) were noncompliant. In multivariable analysis, better colposcopy compliance was associated with less education (odds ratio [OR] for compliance = 2.24, 95% confidence interval = 1.12–4.51 vs more than high school), previous abnormal Pap result (OR per previous abnormal Pap result = 1.08, 95% CI = 1.01–1.15), study site (OR for site with best vs worst compliance = 16.1, 95% CI = 2.91–88.6), and higher stress (OR for perceived stress scale 10 score >16 vs lower 3.25, 95% CI = 1.45–7.26).

Conclusions Noncognitive factors and how sites manage abnormal Pap testing affect colposcopy compliance. Educational interventions alone are unlikely to improve colposcopy compliance in similar high-risk populations.

Perceived stress and site-specific factors rather than knowledge of cervical cancer prevention impact women’s compliance with recommended colposcopy.

1Washington University School of Medicine, St. Louis, MO; 2Hektoen Institute of Medicine and the CORE Center at John H. Stroger Hospital of Cook County, Chicago, IL; 3Downstate Medical Center, Brooklyn, NY; 4The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 5University of California, San Francisco, CA; 6Montefiore Medical Center, Bronx, NY; 7Georgetown University School of Medicine, Washington, DC; 8Albert Einstein College of Medicine, Bronx, NY; 9City of Hope National Medical Center, Duarte, CA; 10Keck School of Medicine, University of Southern California, Los Angeles, CA; 11Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, MD; and 12Department of Veterans Affairs Hines Veterans Administration Medical Center and Northwestern University Feinberg School of Medicine, Chicago, IL

Reprint requests to: L. Stewart Massad, MD, Division of Gyn Oncology, 4911 Barnes-Jewish Hospital Plaza, St Louis, MO 63110. E-mail:

The authors declare that there are no conflicts of interest.

The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). The study is cofunded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

©2012The American Society for Colposcopy and Cervical Pathology