Abstract
Purpose: Invasive cervical cancer and its
precursor lesions are the most important gynecologic manifestations
of human immunodeficiency virus (HIV) infection. Regular
Papanicuolaou (Pap) testing is accepted as a critical strategy for
early detection and timely treatment. A significant gap in
adherence to cervical cancer screening exists among HIV positive
women enrolled in Georgia's West Central Health District (WCHD)
Ryan White Program (RWP). A clinical quality improvement strategy
was implemented and its effect on cervical cancer screening was
observed. The primary questions addressed were (1) What impact will
implementation of a telephone care management system have on client
completion of annual cervical cancer screening, and (2) What
barriers prevent clients from maintaining up-to-date Pap
smears? Methods: Women identified as
overdue for Pap testing received a series of telephone support
calls from a trained Prevention Care Manager (PCM) from September
2012 through December 2012. Inclusion and exclusion criteria were
determined by the HIV/AIDS Bureau's (HAB) cervical cancer screening
performance measure. Patient follow-up continued from January 2013
through December 2013. Data Analysis: Statistical
analysis was performed by Minitab 17. The p control chart, or p
chart, was used to allow visualization and analysis of process
performance during the baseline, intervention, and
post-intervention time periods. Patient barriers to Pap testing
were assessed by the PCMs during the telephone support calls.
Results: The proportion of women with due or overdue
cervical cancer screenings decreased from 49% to 23% during the
intervention. During the post-intervention period a steady increase
in the proportion of women without documented up-to-date screening
occurred, reaching a high of 54%. The most common barriers to
maintaining up-to-date Pap status were concerns about cost, (lack
of) transportation, and competing priorities. Summary:
Intensive recruitment techniques and a combination of tailored
strategies have the potential to promote adherence to cervical
cancer screening. Patient barriers may be overcome with the
implementation of well-designed interventions that are based on the
characteristics of the particular patient and provider populations.
Further research may be needed to understand the effect of time on
persistence of an intervention's impact.
Table of Contents
Table of Contents
Chapter I - Introduction
Introduction and
rational.................................................1
Problem
Statement........................................................
1
Theoretical
Framework....................................................3
Purpose
Statement.........................................................4
Research
Questions........................................................4
Significance
Statement...................................................4
Chapter II - Review of the Literature
Introduction..................................................................5
Body of Review of
Literature.............................................5
Summary of Current Problem and Study
Relevance..............21
Chapter III - Methodology
Introduction.................................................................23
Population and
Sample...................................................24
Research
Design...........................................................24
Procedures..................................................................25
Instruments.................................................................29
Plans for Data
Analysis...................................................32
Limitations and
Delimitations............................................33
Chapter IV - Results
Introduction.................................................................35
Findings.......................................................................35
Other
Findings...............................................................40
Summary......................................................................43
Chapter V - Conclusions, Implications, and
Recommendations
Introduction..................................................................44
Summary of
Study..........................................................44
Conclusion....................................................................46
Implications and
Recommendations....................................49
Tables..........................................................................51
Figures.........................................................................60
References....................................................................67
Appendix.......................................................................72
About this Master's Thesis
Rights statement
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