Beliefs about Papanicolaou smears and compliance with Papanicolaou smear follow-up in adolescents

Objective: To explore qualitatively adolescent girls' understanding of Papa nicolaou smears and barriers to compliance with Papanicolaou smear follow-u p appointments. Design: Qualitative analysis, using 3 focus groups and 15 in-depth, semistr uctured individual interviews. Setting: Adolescent Clinic and Young Parents' Program at Children's Hospita l, Boston, Mass. Main Outcome Measures: Beliefs and attitudes about Papanicolaou smears and barriers to compliance with Papanicolaou smear follow-up. Results: The mean (+/-SD) age of the 15 interview participants was 18.7 (+/ -1.9) years. Knowledge about Papanicolaou smears and pelvic examinations wa s poor. Most participants believed that their peers receive Papanicolaou sm ear screening and perceived teenagers to be susceptible to cervical cancer. Perceived benefits to getting Papanicolaou smears were prevention and earl y detection or diagnosis, and reported barriers included pain or discomfort , embarrassment, fear of finding a problem, fear of the unknown, denial, po or communication or rapport with the provider, not wanting to look for trou ble, lack of knowledge, and peers' advice. Participant-generated strategies for how providers could overcome barriers to Papanicolaou smear screening included education and the development of trusting, consistent relationship s with providers. Participant-generated strategies for how providers could enhance appointment-keeping among adolescents included telephone and writte n reminders. Conclusions: These data support a behavioral theory-based model of adolesce nt compliance with Papanicolaou smear follow-up, which may help to develop strategies to enhance compliance with Papanicolaou smear follow-up appointm ents. These strategies include providing in-depth education about Papanicol aou smears, addressing barriers to Papanicolaou smear follow-up, focusing o n appropriate provider behaviors, and instituting an appointment reminder s ystem.