A Study to Determine Factors That Inhibit Compliance With Engaging In Recommended Papanicolaou Smear Screenings In African American Women

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Anna Brock

Advisor Department



Papanicolaou (Pap) smear screenings help to detect abnormal cervical cells in the cervix. African American women are usually diagnosed in the later stages of cervical cancer. The purpose of this study was to determine factors that inhibit compliance with Pap smear screening in African American women. Ninety-three African American women ages 18 or older, attending an urban health clinic participated in this descriptive design study to answer three research questions: (1) What factors inhibit compliance with recommended Pap smear screening in African American women age 18 or older? (2) Is there a difference between participants who attended the mobile clinic and the land based clinic on the four identified subscales of cost, convenience, negative emotions, and misinformation or knowledge? (3) Is there a significant relationship between Pap smear screening compliance and age, income, number of births, number of children, or distance? Participants received care at either the land-based clinic or the mobile site clinic. Participants completed the Pap Smear Attitudinal Barriers Questionnaire (PSABQ) and a brief demographics questionnaire. The Health Belief Model (HBM) was the theoretical framework for this study. Descriptive statistics for frequencies and percentages, t-tests and Chi square analysis were utilized in this study. This study identified cost as the most frequent barrier and knowledge as the second most frequent barrier. There was a significant difference in the identification of cost and knowledge as a barrier by land-based versus mobile clinic site participants. A Chi square analysis showed a significant association between Pap smear screening compliance and age and distance from the clinic. A statistically significant relationship was found between land-based participants' Pap smear screening compliance and number of children given birth to, and mobile participants' Pap smear screening compliance and age, number of children given birth to and number of children living in the home. This study supports recommendations for teaching patients about Pap smear screenings and the accessibility of affordable Pap smear screenings, increased marketing of the availability of low or no cost Pap smear screenings, as well as the need to obtain demographic information that adversely effects Pap smear screening compliance in African American women.