Pap smear screening at an urban Aboriginal health service: report of a practice audit and an evaluation of recruitment strategies

A culturally appropriate women's health service was established at an Abori ginal community-controlled health service in Darwin in 1994. An initial fil e audit found that 48% of included women had ever been screened with a Pap smear and 37% of women were considered to have been adequately screened. Th e enhancement of opportunistic screening by file tagging had a modest effec t on screening coverage over a 12-month period for women who attended the h ealth service. The proportion of these women who were adequately screened i ncreased from 43% to 48% and of those ever screened increased from 54% to 6 2%. A randomised trial of recruitment interventions including personal appr oach, letter and control groups was subsequently performed for women for wh om Pap smears were overdue or not recorded. The impact of both intervention s on the number of Pap smears performed was low, with 7% of women in the pe rsonal approach group, 2% of women in the letter group and no women in the control group having Pap smears during the three-month follow-up period. Lo w rates of abnormalities were observed for women having Pap smears over a t wo-year period. The minimal effect of a formal reminder system and letters at this urban Aboriginal health service has resulted in a re-orientation of activities towards strengthening opportunistic screening and the continued promotion of Pap smears in a range of clinic and community settings. It is important to place Pap smear screening in the context of other social, eco nomic and health priorities for Aboriginal women and health workers.