Abstract
This work in writing conducts a literature review in the form of a synthesis of several studies published in journals that are peer-reviewed publications that focus on Latina/Hispanic women who have received a report of an abnormal Pap smear and who fail to return to six-month follow-up appointments. This study concludes by stating that the literature reviewed in this study demonstrates that reasons that Latina women fail to follow-up after receiving abnormal results on Pap smear testing due to fear and anxiety that is associated with the procedure or the diagnosis they will receive as well as problems with scheduling and a lack of clear communication about appointments as well as pain they experience with the procedure. However, the studies reviewed in this literature review clearly show that interventions are successful in Latina women adhering to six-month follow-up. Interventions included various methods of gaining adherence for six-month follow-up including patient navigation and other interventions.

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Literature Review Outline

Models for Increasing Follow-up
Interventions
Cultural Considerations
Summary

Literature Review Synthesis
The objective of this literature review is to conduct a synthesis of previous studies on the Latina/Hispanic female population in regards to health care and specifically to their compliance with follow-up screening after having received an abnormal Pap smear.

Models for Increasing Follow-up
One model that was identified for increasing follow-up of abnormal Pap smear results among Latina and Hispanic women was that of Maslow’s Hierarchy of Needs which was reported in the work of Benson and Dundis (2003) which identified Maslow’s model as being one that contains critical elements in the health care setting with the reason stated that motivation of employees can be assured through providing employees with the security and appreciation they need (Benson and Dundis, 2003). Therefore, it is important to motivate employees in the health care setting to ensure that patients are following orders after having received a report of an abnormal Pap smear. Another model found to be effective was that reported in the work of Breifkopf and Pearson (2009) in the work entitled “A Theory-based Approach to Understanding Follow-up of Abnormal Pap Tests” published in the Journal of Health Psychology and is a theory based upon the intentions of women who receive results that their Pap smear is abnormal. In this particular study, intentions were determined as being critical in a group of 338 female patients with abnormal Pap smear results and specifically “was negatively associated with believing the problem could be avoided by not returning for follow-up” (Breitkopf and Pearson, 2009, p..1). Follow-up attendance was reported to be linked to self-concept and attitude (Breitkopf and Pearson). Another model was identified in the work of Duggan, Coronado, Martinez, Byrd, Carosso, Lopez, Benavides and Thompson (2012) entitled “Cervical Cancer Screening and Adherence to Follow-up among Hispanic Women Study Protocol: A Randomized Controlled Trial to Increase the Uptake of Cervical Cancer Screening in Hispanic Women” in what was a study of 600 women who were Hispanic ages 21 to 63. The study reported having the possibility of the identification of mechanisms that will serve to bring about reductions in cervical cancer disparities in health through an increase in screening for cancer which will serve to increase cancer detection for women. This study focused on the behavioral intention of the women and their normative beliefs concerning this area of healthcare, and it is reported that the understanding gained in this model is that the behavioral intentions of women along with the normative beliefs of those women determined follow-up care after an abnormal Pap smear result.

Interventions
The work of Percac-Lima, Benner, Lui Aldrich, Oo, Regan and Cahbner (2013) entitled “The Impact of a Culturally Tailored Patient Navigator Program on Cervical Cancer Prevention in Latina Women” published in the Journal of Women’s Health informed this literature review synthesis that navigation of patients for prevention of cervical cancer was an intervention found to be successful in ensuring that women with abnormal Pap smears kept their follow-up appointment. The work of Percac-Lima, Aldrich, Gamba, Bearse, and Atlas (2010) entitled “Barriers to Follow-up of an Abnormal Pap smear in Latina Women Referred for Colposcopy” published in the Journal of General Internal Medicine reports a study with the aim of the identification of barriers perceived by patients for follow-up following a Pap smear that was abnormal and specifically in a group of Latina women. Removal of barriers was cited as an intervention that is successful in assisting patients in keeping follow-up appointments following an abnormal Pap smear result and specifically cited barriers as following (1) fear of procedure/diagnosis and anxiety about procedure/diagnosis; (2) availability of appointment scheduling and interference with care for children or work; (3) breakdowns in communication concerning appointments as well as failure to relay information about the diagnosis as well as the procedure and the results; (4) pain associated with the procedure (Percac-Lima, Aldrich, Gamba, Bearse, and Atlas, 2010). Another successful intervention is reported in the work of Engelstad, Stewart, Nguyen, Bedeian, Rubin, Pasick and Hiatt (2001) entitled “Abnormal Pap smear Follow-up in a High-risk Population” published in the Journal of Cancer Epidemiological Biomarkers Prev, illustrating that groups that are on the receiving end of an “aggressive follow-up strategy” are more likely to keep follow-up appointments than are those who are not in receipt of this intervention (Engelstad, Stewart, Nguyen, Bedeian, Rubin, Pasick and Hiatt, 2001, p.1).

Yet another successful intervention is reported in the work of Ell, Vourlekis, Muderspach, Nissly, Padgett, Pineda, Sarabia and Lee (2002) entitled “Abnormal Cervical Screen Follow-up Among Low-Income Latinas: Project SAFe” published in the Journal of Womens Health Gender Based Medicine. The intervention identified was one that was the algorithm used for clinical decision-making was successful in gaining adherence from a high percentage of women in seeking follow-up following an abnormal Pap smear result. The work of Soares and de Silva entitled “Interventions that Facilitate adherence to Pap smear Exam: Integrative Review” states findings that successful interventions include: (1) case manager use; (2) calls on the telephone; (3) letters of invitation; (4) activities of education; (5) outreach via media; (6) health agents in the community; (7) partnerships; (8) screening of database in the population; and (9) interventions that are multiple in nature and that these are effective among females who are other than American.

Cultural Considerations
There are cultural considerations that must be taken into account when working with the Latina/Hispanic population and this is highlighted in the work of Kingsley and Bandolin (2011) entitled ‘Cultural and Socioeconomic Factors Affecting Cancer Screening, Early Detection and Care in the Latino Population’. The specific cultural considerations for this population is reported to be those including: (1) low socioeconomic status; (2) culture; (3) health literacy; and (4) fear and barriers relating to lack of knowledge (Kingsley and Bandolin, 2011). Cultural considerations are confirmed in the work of Torres, Erwin, Trevino and Jandorf (2011) who report that factors contributing to the failure of Latina women to adhere to health screening follow-up includes: (1) limitations in knowledge about the risks of cancer; (2) possessing information that is not accurate about the risks of cancer; (3) insurance costs; (4) problems with transportation and appointment scheduling; (5) barriers relating to language; and (5) communication with health care providers due to feeling intimidated.

Summary of the Literature Reviewed
The literature reviewed in this study demonstrates that reasons that Latina women fail to follow-up after receiving abnormal results on Pap smear testing due to fear associated with the procedure, anxiety that is associated with the procedure or the diagnosis they will receive as well as problems with scheduling and a lack of clear communication about appointments as well as pain they experience with the procedure. However, the studies reviewed in this literature review clearly show that interventions are successful in Latina women adhering to six-month follow-up. This study provided a synthesis of ten studies and specifically in the areas of models that are successful in gaining adherence of Latina/Hispanic women to follow-up appointment following receiving an abnormal Pap smear result as well as interventions that previous studies have found to be successful in gaining adherence of Latina/Hispanic women following receipt of an abnormal Pap smear result and finally the cultural considerations that come into play when attempting to ensure Latina/Hispanic women are in compliance with follow-up screening after receiving an abnormal Pap smear result.

    References
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