American Indians; Delivery of Health Care; North America; Pap Test


Community-Based Research | Gender and Sexuality | Maternal and Child Health | Medicine and Health | Public Health | Race and Ethnicity


Objective: To quantify the loss to follow-up rate after abnormal Pap test results at the Phoenix Indian Medical Center, an Indian Health Service regional facility, and identify barriers to follow-up from the patients’ point of view.

Materials and Methods: Patient records were used to identify women who had abnormal Pap tests in 2002 and to document the status of their follow-up care. Women who had no clinical record of follow-up were contacted by telephone to arrange a follow-up appointment and to request participation in a structured qualitative interview to identify barriers to follow-up at the individual, family, community, and health care system levels. Structured qualitative interviews were conducted with 15 women.

Results: Of the 930 women with abnormal Pap test results in 2002, 11.1% received follow-up care at PIMC in accordance with the recommended time frame stipulated inclinical protocols; 74.6% received follow-up care at PIMC, but not in accordance with protocols; 2.6% were followed-up at another facility, 1% had moved out of the area, 3.5% were never treated, and we were unable to contact 6.6%. Most of the barriers to follow-up were related to communicating the need for follow-up and providing access to care within a time frame appropriate for clinical care.

Conclusion: While these findings place an important additional responsibility and burden on the health care system serving American Indian women, our research outreach efforts suggest that given the availability of appropriate resources, these barriers can be overcome.