Effectiveness of interventions to improve follow-up after abnormal cervical cancer screening

Objective. The purpose of this study was to determine the effectiveness of interventions designed to improve follow-up after an abnormal Pap smear. Methods. We performed a qualitative meta-analysis of interventions designed to improve follow-up after an abnormal Pap smear and included studies that met the following criteria: randomized or concurrently controlled study de sign, defined outcomes, and data available for abstraction. Interventions w ere classified as behavioral, cognitive, sociologic, or combined strategies (e.g,, behavioral and cognitive). Abnormal Pap smears were defined as any test result requiring additional follow-up. Effectiveness was measured by t he rate of compliance with recommended follow-up. Results, Twenty-two interventions in 10 studies met the inclusion criteria. Cognitive interventions utilizing interactive telephone counseling were th e most effective, improving compliance by 24 to 31%, Behavioral interventio ns, such as patient reminders, were also effective, increasing follow-up by up to 18%, Not all of these results achieved statistical significance. The single sociologic intervention we identified used videotaped peer discussi ons to provide a message about abnormal Pap smears and appropriate follow-u p. This intervention was not associated with increased followup after an ab normal test. The effectiveness of interventions using multiple types of str ategies to improve follow-up was inconsistent. Conclusions, Cognitive strategies led to the greatest improvement in compli ance with follow-up of abnormal Pap smear screening tests. Extension of sim ilar interventions to follow-up of abnormal breast and colon cancer screeni ng, development of physician- and system-targeted interventions, and evalua tion of the cost-effectiveness of these strategies are important priorities for future research. (C) 2000 American Health Foundation and Academic Pres s.