A longitudinal analysis of factors associated with adherence to preventive Pap test recommendations among middle-age Chinese American women
Background: Pap tests can prevent cervical cancers by allowing for the early detection and removal of precancerous lesions. In the US, Chinese American women (66%) have a lower rate of obtaining Pap tests within the past three years than non-Hispanic white women (83%), Filipino women (83%), and Asian Indians (70%). Predictors of adherence to repeated Pap tests among Chinese American women are not well understood in the current literature. Purpose: The purpose of this longitudinal study is to analyze factors associated with adherence to preventive Pap tests among middle-aged Chinese American women. This longitudinal study will: (a) estimate annual uptake of Pap testing and examine changes over a seven-year period among middle-aged Chinese American women and (b) determine which factors are associated with middle-aged Chinese American women’s adherence to Pap testing for cervical cancer prevention in the U.S. health care system. Method: The Study of Women's Health across the Nation (SWAN) Series provides the data from Chinese females for this secondary analysis. In total, the present study analyzed data from 498 individuals (1,326 person-time-waves). 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 explanatory factors. Result: Of the 1,326 person-time-waves, 61% (n= 824) had a Pap test in seven waves. The likelihood of adhering to Pap test among Chinese American women was significantly and positively associated with having a physician for female health care (PFH), time spent by the PFH, having cancer(s), and having fibroids. However, patients who were too busy to visit healthcare providers and patients who did not have a primary health care provider were less likely to adhere to a Pap test. Discussion and Implications: The findings highlighted the importance of the availability of healthcare resources and education about Pap testing for Chinese American women to encourage them to have preventive Pap tests. It is important for health care providers and social workers to emphasize the benefits of using preventive Pap tests for Chinese American women. Implications for practice are discussed.