Cp. Kaplan et al., Improving follow-up after an abnormal Pap smear: Results from a quasi-experimental intervention study, J WOMEN H G, 9(7), 2000, pp. 779-790
Citations number
43
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
The success of cervical cancer control programs depends on regular screenin
g with the Pap smear test and prompt and appropriate treatment of early neo
plastic lesions. Recognizing the potentially grave consequences of lack of
follow-up for abnormal Pap smears, numerous intervention studies have teste
d the impact of a variety of strategies to increase return for follow-up. T
he majority of these studies were evaluated under controlled experimental c
onditions. Despite the encouraging findings of these trials, the next step
in the research continuum requires that the effectiveness of these interven
tions be demonstrated in real world settings before full implementation is
initiated. We report the results of an evaluation study assessing the combi
ned effectiveness of three intervention modalities found effective in prior
randomized studies: a tracking follow-up protocol, transportation incentiv
es, and financial incentives. This study used a before-after, nonequivalent
control group design to assess the impact of a multifaceted intervention t
hat included a computerized tracking protocol with transportation and finan
cial incentives. The study was implemented at two major hospitals, two comp
rehensive health centers (CHC), and nine public health centers (PHC) under
the jurisdiction of the Los Angeles County Department of Health Services. O
ne hospital, one CHC, and the four PHC located in the catchment area of the
CHC were selected as experimental sites. The control sites-one hospital, o
ne CHC, and five PHC-provided usual care. All women with an abnormal Pap sm
ear at the intervention and control sites were included in the study. The s
tudy consisted of a 1-year period of baseline data collection (September 19
89-August 1990), followed by a 21/2-year intervention period (September 199
0-February 1993). During the intervention period, the intervention protocol
was implemented at the experimental sites, and the control sites provided
usual care. Overall, we found that the rates of receipt of follow-up care w
ere consistent with those found in similar studies. In contrast to results
obtained in these prior randomized trials, we did not find strong and consi
stent evidence for intervention effects. Significant findings emerged only
at the CHC and hospital levels and only for selected years. Results undersc
ore the importance of testing interventions in real world conditions before
large-scale implementation is initiated. In addition, this study highlight
s the challenge of detecting intervention effects in large-scale studies be
cause of the greater measurement difficulties in field studies as compared
with controlled experiments.