Assessing multi-level predictors of diagnostic follow-up attendance after an abnormal cervical cancer screen

About This Grant

Project Summary Due to effective primary (human papillomavirus (HPV) vaccination) and secondary (screening) prevention methods, cervical cancer (CC) is a preventable disease. A strategy for CC elimination has been globally adopted and includes three pillars for success: (1) 90% of girls receiving the HPV vaccine; (2) 90% of women screened with an HPV test; and (3) 90% of cervical disease detected and treated. The threshold for elimination was set at an incidence rate of 4 per 100,000 women, however the incidence rate in the US is nearly double the elimination threshold. This results in approximately 14,000 new cases and 4,500 preventable deathseach year. CC is most commonly diagnosed among women aged 35-45 who may be raising families or embedded in their careers; thus, a CC diagnoses significantly impacts not only the cancer survivor, but her family and community. While the US is making progress towards the vaccination and screening goals, there have been insufficient efforts towards the detection/treatment goal, which is likely a significant driver for the persisting high rates of disease. Studies suggest that receiving an abnormal CC screen, only 25-80% of women attend diagnostic follow-up (DFU), significantly below the 90% elimination goal. A critical gap exists in our understanding of barriers and facilitators to DFU completion, without which CC prevention may be unachievable. This study aims to identify multi-level predictors of DFU completion to allow for the future development of interventions to improve the CC screening process. Specifically, this project will 1) investigate associations between individual-level reportedscreening barriers and DFU completion after an abnormal screen; 1a) model associations between clinic-level facilitators and DFU, as well as the effect moderation of these factors on associations between barriers and DFU completion; and 2) qualitatively contextualize multilevel barriers and facilitators by exploring the lived experiences of women who have received an abnormal cervical screen and staff who work at screening clinics. This study will employ a multi-level, sequentially explanatory mixed- methods design.Enrollment survey datafromunder- and uninsured women who receive free screeningthrough the tri-county Breast and Cervical Cancer Control Program (BCCCP), which serves the tri-county area of Metropolitan Detroit, will linked to electronic medical records to investigate the association between individual- level factors and DFU completion. The BCCCP enrollment survey collects data on demographics, socioeconomics, health history, and screening barriers. A survey will be con ducted with BCCCP clinics to identify clinic-level services available for participants. Data fromthis survey will be used to model a multilevel relationship between individual-level barriers and clinic-level facilitators with DFU completion. Finally, qualitative interviews will be conducted with BCCCP participants who have had an abnormal cervical screen and clinic staff to generate an in-depth understanding of multilevel barriers and facilitators along the screening process. The findings from this project will inform future interventions aimed at improving CC prevention strategies.