Barriers to Routine Gynecological Care in Young Adult Females in the United States

Well-woman exams (WWEs) are important preventive health care; however, many do not regularly receive these exams. Understanding barriers to timely care is important in improving health care delivery and health outcomes.

We conducted a panel survey of 1000 U.S. females 18-30 years of age. Barriers to gynecological care were assessed in four domains: financial, practical, procedural, and health care provider related. Differences between groups were assessed using t-test and analysis of variance, and logistic regression was used to examine the association between barriers and delayed care.

Respondents were on an average 24.5 years old and the majority were White, non-Hispanic (63%). Respondents were categorized by WWE screening status: never screened (24%), delayed screening (>1 year) (30%), and on-time screening (46%). Those who had delayed WWE expressed higher practical, procedural, and provider barriers compared with those with on-time exams. After adjusting for other barrier types and sociodemographic characteristics, lack of insurance was associated with more than twice the odds of delayed WWE (odds ratio [OR]: 2.61 95% confidence interval [CI]: 1.41-4.92) and a one-point increase in the provider barriers mean scale was associated with nearly 60% increased odds (OR: 1.59; 95% CI: 1.16-2.17) of having delayed WWE.

The patient experience with the health care provider, along with insurance coverage, is significantly associated with delayed WWE. These results indicate that in the presence of insurance coverage, providers have a significant role in creating an environment that supports the timeliness of WWE in young adult patients.