Cervical Cancer Screening: Exploring Appalachian Patients' Barriers to Follow up Care

Introduction: This poster describes a community-based Patient Navigation (PN) project developed in partnership with local Appalachian Kentucky public health departments, designed to identify Appalachian patient barriers to seeking follow-up cervical cancer care. Methods: County public health departments serving rural populations in southeastern Kentucky were recruited to participate in the project. Local residents were hired by the health departments and then trained by the investigators to serve as patient navigators (PNs) in health departments’ cervical cancer screening programs. These PNs then surveyed participants to gain information about their experiences in seeking care after receiving positive Pap test results. Results: PNs contacted and offered enrollment to 656 women ages 18 and older from 13 public health departments; 519 (79%) agreed to participate.  PNs met with patients and asked them to identify any potential barriers to seeking follow-up care after a positive Pap test result. PNs also documented any barriers they observed. Study participants identified a variety of factors as potential barriers to obtaining follow-up care after an abnormal Pap test at three levels: the individual/personal level, the health care system level and the community/environmental level.  One identified barrier that was unique to the study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Conclusion: PNs were effective at recruiting patients and identifying and documenting barriers to follow-up care. However, the capacity of the PNs to address some of the identified barriers was outside their scope of practice. One solution to this problem could be pairing PNs with a social worker who is more specially trained to engage patients in the areas of counseling and developing referrals. Public health social workers could be recruited to serve as the PNs in order to expand the scope of practice of the PNs and provide both PN services and social work services at the same time. Given that this area of Appalachia is medically underserved, social workers who also serve as PNs could begin to bridge the gap between the population and their barriers to care.