Follow-Up Behavior after Abnormal Pap test Results in Ohio Appalachia

Background: Women who do not receive appropriate follow-up after an abnormal Pap test are at risk for cervical cancer. This study aims to examine predictors of follow-up for abnormal Pap results among Appalachian women.
Methods: Women (n=283) with an abnormal Pap test at participating clinics in Appalachia were selected for participation. Medical records were abstracted to determine follow-up. Multivariable logistic regression models were utilized to determine correlates of any follow-up, guideline follow-up and timely guideline follow-up.
Results: Following an abnormal result, 201 (71.0%) women received any follow-up, 171 (60.4%) received follow-up within guidelines, and 122 (43.1%) received timely guideline follow-up. Multivariable logistic regression models revealed that no recent alcohol use was associated with higher odds of any follow-up (aOR= 2.15, 95% CI [1.10-4.20]) or guideline follow-up (aOR=2.15, CI [1.19-3.90]). Women who attended private clinics had higher odds of any follow-up compared to women who attended other clinics (aOR= 2.82, 95% CI [1.43-5.56]). Women who reported ever smoking had higher odds of any follow-up (aOR= 2.61, CI [1.37- 4.99]) compared to never smokers, and women with less than a high school education had higher odds of timely guideline follow-up (aOR=2.32, CI [1.07-5.06]).
Conclusions: Many Appalachian women with an abnormal Pap test fail to receive timely follow-up. Individual level factors, such as education, alcohol use, smoking status, as well as clinic type may be associated with obtaining follow-up among Appalachian women. These results may aid in designing interventions to target those at risk for failure to follow-up after an abnormal Pap test.