A Longitudinal Analysis of Factors Associated with Adherence to Preventive Pap Test Among Chinese American Women

Background: In the US, Chinese women (66%) have a lower rate of obtaining Pap tests within the past 3 years than non-Hispanic white women (83%), Filipino women (83%), and Asian Indians (70%)v (Katki et al., 2011). Predictors of adherence to repeated Pap tests among Chinese women are complex and not well understood in the current literature. The purpose of this longitudinal study is to analyze factors associated with adherence to preventive Pap tests among middle-aged Chinese American women.

Method: The Study of Women's Health across the Nation (SWAN) Series (1996-2008) provides the data from Chinese females for this secondary analysis. In total, this longitudinal study will analyze data from 1,326 person-time-waves (498 individuals). By using the Systems Model of Clinical Preventive Care, Generalized Estimating Equation (GEE) was applied to explore associations between the likelihood of having a pap test and predisposing factors (e.g., demographic characteristics), enabling factors (e.g., socioeconomic status, health insurance status), reinforcing factors (e.g., social support), and situational factors (e.g., risky behaviors).

Result: in 61% of the person-waves (n=824), a Chinese American woman reported had a Pap test. Across the person-waves, the average age was 52 years old (Std.D= 3.2).  The likelihood of adhering to Pap test among Chinese American women was significantly associated positively with having a primary healthcare provider = 1.27, p=.06), having a physician for female health care (PFH)= 1.21, p=.00), time spent by the PFH = 0.21, p=.00), had cancer(s) = 1.80, p=.00), and participants who have fibroids = 0.51, p=.04). However, patients who were too busy to visit healthcare providers = -1.16, p=.06) were less likely to adhere to Pap test among participants. In addition, participants in the last wave (7^th wave) were less likely to have a Pap test comparing to prior waves.

Conclusion and implication: the findings suggested that availability of healthcare resource is critical for Chinese American women to have preventive Pap tests. Especially, having a PFH can significantly promote Chinese American women to adhere to preventive Pap testing. In addition, longer time spent by the PFH predicts increasing likelihood of adherence to Pap testing. Furthermore, busy is a critical barrier of having Pap tests among Chinese women. Therefore, it is important for health care providers and social workers in health care settings to educate the benefit of using preventive Pap tests for Chinese American women, which may improve Chinese women’s knowledge and awareness of preventive cervical cancer care. Culturally sensitive cervical cancer care services for Chinese women may promote their awareness, understanding, and adherence to preventive Pap test use in the U.S.

Reference

Katki, H. A., Kinney, W. K., Fetterman, B., Lorey, T., Poitras, N. E., Cheung, L., … Castle, P. E. (2011). Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. The Lancet. Oncology, 12(7), 663–72.