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According to Colorado Behavioral Risk Factor Surveillance System (BRFSS) data, there appears to be slight declining trend in the number of women 18 and older reporting having had a Pap test in the past 3 years. In 2004, nearly 90% of women surveyed reported having a Pap in the past 3 years; in 2008 the number is 85%.
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According to the National Healthcare Disparities Report, 2008 (), patient and provider interactions encompass various aspects of care, including whether patients can get appointments in a timely manner, whether they feel respected and listened to, and whether they understand their care. One interaction is communication. Poor provider-patient communication can result from a number of complex factors, including a provider's lack of familiarity with cultural norms, language barriers, a patient's low health literacy, a chaotic work environment, and a lack of time during a visit. Minorities are more likely to experience poor provider-patient communication and are more likely to receive care in clinics where providers face workplace challenges and have a more complex patient mix. To improve cervical cancer screening rates and reduce mortality in ethnic/minority populations, addressing these health care disparities will require special attention to cultural attitudes and perceptions that affect health behaviors and patterns of health care access and utilization.
Women with a history of sexually transmitted diseases (STDs) might be at increased risk for cervical cancer, and women attending STD clinics might have other risk factors that place them at even greater risk. Prevalence studies indicate that precursor lesions for cervical cancer occur approximately five times more frequently among women attending STD clinics than among women attending family planning clinics (Kamb ML. Cervical cancer screening of women attending sexually transmitted disease clinics. Clin Infect Dis 1995;20 (Suppl 1):S98–S103).
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According to findings of the CDC Guide to Community Preventive Services (), the following proven interventions are being recommended for increasing screening rates:
- Client Reminders: Reminders include letters, postcards, or phone calls to alert clients that it is time for their cancer screening. Some may be a note only that the test is due, while others include facts about the screening or offer to help set up an appointment.
- Small Media: Small media include videos and printed materials such as letters, brochures, and newsletters. These materials can be used to inform and motivate people to be screened for cancer. They can provide information tailored to specific individuals or targeted to general audiences.
- One-on-One Education: One-on-one education is provided in person or by telephone to encourage individuals to be screened for cancer. Healthcare providers can deliver one-on-one education in clinical settings, at home, or in local gathering places. Brochures, informational letters, or reminders may also be used. The information can be general or tailored to the needs of each person.
- Physicians and other providers can play an important role in encouraging patients to be screened for cervical cancer. Recommended strategies include:
- Provider Assessment and Feedback: These interventions assess how often providers offer or deliver screening services to clients (assessment) and then give providers information about their performance (feedback). The feedback may describe the performance of an individual provider or of a group of providers (e.g., mean performance for a practice). The performance may be compared with a goal or standard.
- Provider Reminders and Recall: Reminders inform health care providers it is time for a client’s cancer screening test (called a “reminder”) or that the client is overdue for screening (called a “recall”). The reminders can be provided in different ways, such as in client charts or by e-mail.
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The National Immunization Survey (NIS) is sponsored by the National Center for Immunizations and Respiratory Diseases (NCIRD) and conducted jointly by the NCIRD and the National Center for Health Statistics (NCHS). In 2007, NIS HPV vaccination coverage was reported for the first time and showed that 25.1% of U.S. females 13-17 years of age had received at least one HPV vaccination. In 2008, the NIS assessed state-level vaccination coverage and reported Colorado’s HPV vaccination (>1 HPV vaccine dose) coverage level for females 13-17 years of age is 34% compared to the national rate of 37%.
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There are several emerging studies that demonstrate differences in populations that receive the vaccine, those that need and are receptive to education about the vaccine, and persistent myths about HPV vaccine.
- Vaccine awareness differs by race, education and income. Interventions to increase awareness of HPV could benefit from tailoring information to prescreening age, screening age, and postscreening-age women. (The Impact of Human Papillomavirus Information on Perceived Risk of Cervical Cancer. Hughes, et al. Cancer Epidemiol Biomarkers Prev. Feb 3, 2009.)
- Barriers to vaccination are cost and access to vaccine and concern that immunization with the vaccine may promote adolescent sexual behavior. HPV vaccine programs should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination. (Predictors of HPV vaccine acceptability: a theory-informed, systematic review. , . Preventive Med. 2007 Aug-Sep;45(2-3):107-14. Epub 2007 Jun 2.)
- Given information, mothers of teens in Mexico had high acceptance rates of vaccinating their adolescent children against HPV. (Parental Attitudes About Sexually Transmitted Infection Vaccination for Their Adolescent Children. Arch Pediatr Adolesc Med. 2005;159:132-137.)
- Teenage girls surveyed indicated no increased interest in risky sexual behavior if they were to be vaccinated. (Attitudes about human papillomavirus vaccine in young women. (, et al. Int J STD AIDS. 2003 May;14(5):300-6.)
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According to findings of the CDC Guide to Community Preventive Services (), there are no specific evidence-based interventions for increasing HPV vaccination at this time. Therefore, the following proven interventions are being recommended for increasing HPV vaccination coverage:
- Provider Reminder Systems: Provider reminders let providers or other appropriate staff knows when individual clients are due for vaccinations, through notations, stickers, or other prompts in clients’ charts, or through computer databases or registries. Reminders can be directed to the primary healthcare provider or clinic staff.
- Interventions that should be implemented in combination:
- Expanded access in healthcare settings;
- Reducing patient out-of-pocket costs;
- Patient or family incentives;
- Patient reminder/recall systems;
- Clinic-based patient education;
- Community-wide education;
- Vaccination requirements;
- Provider assessment and feedback;
- Provider education; and
- Standing orders.
For detail on individual strategies, please go to The Community Guide, Vaccinations for Preventable Diseases: Targeted Coverage at ().