Barriers and Facilitators to Colposcopy Follow-up After Abnormal Cervical Cancer Screening: Qualitative Insights From...

Delays to colposcopy increase the risk for cervical cancer development. Our study sought to understand the barriers and facilitators to follow-up after an abnormal cervical cancer screening test result.

English-speaking adult patients who did not attend at least one of their scheduled appointments at an urban academic colposcopy clinic between June 2021 and June 2023 were eligible. Semistructured interviews were conducted, and thematic analyses using inductive and deductive coding were completed.

Twenty women were interviewed. The mean (SD) age was 34 (10) years, and participants mainly identified as non-Hispanic Black (60%). The mean (SD) time to colposcopy was 12.5 (11.9) months. Seven participants did not have a follow-up colposcopy at the time of the interview. Five categories of themes emerged at the individual, interpersonal, clinic, and system level, including (1) fear of pain and/or pelvic examinations, (2) patient-provider communication (including result communication), (3) clinic interactions (including presence of trainees and lack of continuity), (4) scheduling difficulties, and (5) system-level barriers such as loss of insurance coverage.

Barriers to follow-up care exist across multiple levels. A one-size-fits-all approach may be ineffective for facilitating follow-up; rather, a multipronged approach may be needed to improve adherence and reduce delays to follow-up care after an abnormal cervical cancer screening test result.