Noncompliant behavior for colposcopy examination in women with abnormal pap smears

Abstract

The purpose of this study was to describe, through a qualitative approach, the emotional, physical, and psychosocial barriers experienced by women who are noncompliant with their scheduled colposcopy exams. The objectives were to describe from the women's own perspective what they experienced when receiving abnormal Pap smear results, to explore the barriers experienced to colposcopy by non-compliant women, and to conceptualize without the bias of race, age, or socioeconomic status, common causes of non-compliance in women. It is hoped that programs can be developed and tested that would address barriers to colposcopy and result in successful increases in compliance. The sample consisted of six women noncompliant for colposcopy after receiving abnormal Pap smears. Three participants received their gynecological health care from private physicians, one from a non-profit private organization, and two from a local health department. Data were collected prior to the participant's rescheduled colposcopy exam using an open-ended questionnaire similarly structured for all interviews. Data analysis was done through transcriptions of the interviews and coding of common concepts. Five categories describing the emotional, physical and psychosocial barriers emerged from 20 codes. Validation of the codes and categories was accomplished through confirmation interviews with two of the six participants, the thesis chair and input from an experienced ethnographic researcher. Five categories emerged from the data: fear, denial, social and self influence, lack of knowledge and physical obstacles. They comprised the experience of having an abnormal Pap smear and noncompliance for colposcopy for the six participants. The categories of fear and denial contained the emotional response to the abnormal Pap smear and the colposcopy procedure. The category, social and self influence and lack of knowledge, elicited psychosocial influences for colposcopy compliance. The category, physical obstacles, consisted of physical and psychosocial barriers to compliance for colposcopy examination. It is important for nurses to consider the individual impact of having an abnormal Pap smear and be aware of the multitude of emotional, physical and psychosocial influences for compliance to colposcopy and to tailor his or her counseling to meet not only the woman's informational needs but her emotional needs as well.