Introduction: In 2016, it is estimated that approximately 12,500 American women will be diagnosed with cervical cancer and about 4,100 women will die from the disease (American Cancer Society, 2015). A recent study showed that there has been a 5.5% decrease in Pap test screening over the period of 2008-2013 (84.5% to 80.7%) (Sabatino, White, Thompson, & Klabunde, 2015). This is a troublesome statistic, since the Healthy People 2020 target of 93% has yet to be met (Healthy People 2020, 2014a). This urgent public health issue needs to be addressed. Although some studies have looked at predictors of Pap test screening (Eaker, Adami, & Sparen, 2001; Gu, 2010; Kahn, Goodman, Slap, Huang, & Emans, 2001) there is a gap in health behavior research examining the psychosocial factors that predict American women’s failure to meet Pap test screening national recommendations (Chan, Yang, Gu, Wang, & Tao, 2015).
This dissertation consisted of two studies: 1) Racial/Ethnic Disparities, Body Weight, and Other Psychosocial Antecedents that Predict Women’s Failure to Meet Pap Test Screening National Recommendations and 2) Using the Modified Integrated Behavioral Model to Validate a Path Model of Women’s Failure to Meet Pap Test Screening National Recommendations. The aim of both studies was to identify psychosocial variables explaining and predicting adult women’s failure to meet Pap test screening national recommendations.
Methods: The first study was a secondary data analysis of the 2014 National Cancer Institute’s nationally representative HINTS 4 Cycle 4 data. The second study was an original, cross-sectional web survey using a modified Integrated Behavioral Model (IBM) to explain and predict failure to meet Pap test screening national recommendations.
The outcome variable for both studies was failure to meet Pap test screening national recommendations. For the first study, the explanatory variables were identified based off the psychosocial and demographic correlates of HINTS 4 Cycle 4. Regarding the original study, an extensive literature review informed the explanatory variables used to examine women’s failure to meet Pap test screening national recommendations.
For both studies, statistical analyses were conducted using IBM Statistical Package for the Social Sciences (SPSS), version 21.0. The original study’s path model analysis was conducted using EQS 6.1. Demographic characteristics of respondents for both studies were summarized via descriptive statistics. Bivariate analyses for both studies were performed to evaluate the relationships between failure to meet Pap test screening national recommendations and the explanatory variables. For both studies, stepwise multiple binary logistic regression was conducted to identify the significant predictors of failure to meet Pap test screening national recommendations among women aged 21-65. Path analysis was conducted in the second study to identify the best-fit model.
Results: The first study showed that women with the following characteristics tend to fail to meet the Pap test screening national recommendations with statistical significance: 1) being Asian, White, or African American (vs. Hispanic); 2) being underweight or normal weight 3) fail to meet USPSTF mammography recommendation (vs. met); 4) having more symptoms of depression and anxiety within the past two years; 5) having last routine check-up by a doctor more than 2 years (vs. within 2 years); 6) being older than 35 (vs. aged 21-35); 7) being single, divorced/separated, or widowed (vs. married/living as married); and 8) having less education (vs. college graduate or more).
For the second study, bivariate analysis indicated that failure to meet Pap test screening national recommendations was significantly associated with the following demographic characteristics: 1) having lower income (vs. higher income level); 2) having less education (vs. college graduate or more); and 3) being older than 35 (vs. aged 21-35). The path analyses revealed that Self-efficacy was the strongest predictor of Pap test screening Intentions (ß=0.24, p<.05). Also, other constructs of the modified IBM were significant in predicting Pap test screening Intentions, including, Instrumental Attitude (ß=0.19, p<.05), Experiential Attitude (ß=0.15, p<.05), Injunctive Norm (ß=0.16, p<.05), Perceived Risk (ß=0.13, p<.05), and Perceived Barriers (ß= -0.10, p<.05). Furthermore, these constructs account for 32% (R2) of variance in Pap test screening Intentions.
Findings from this original study also showed that Instrumental Attitude (ß=-0.12, p<.05), and Intentions (ß=-0.43, p<.05), directly influenced failure to meet Pap test screening national recommendations. The aforementioned constructs accounted for 24% variance (R2) in failure to meet Pap test screening national recommendations.
Conclusion: Both studies significantly contribute to the understanding of why women fail to meet the Pap test screening national recommendations. The psychosocial factors that have been identified through this dissertation should be used to create programs geared towards increasing Pap test screening in women aged 21-65.