An in-depth and updated perspective on determinants of cervical cancer screening among central Appalachian women

Nancy E. Schoenberg, Claudia Hopenhayn, Amy Christian, Evelyn A. Knight, Angel Rubio

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appalachian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and maintaining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker; inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests.

Original languageEnglish
Pages (from-to)89-105
Number of pages17
JournalWomen and Health
Issue number2
StatePublished - 2006

Bibliographical note

Funding Information:
Nancy E. Schoenberg is affiliated with the Department of Behavioral Science, 125 College of Medicine Office Building, University of Kentucky, Lexington, KY 40536-0086 (E-mail: [email protected]). Claudia Hopenhayn is affiliated with the Department of Epidemiology, College of Public Health, University of Kentucky. Amy Christian and Angel Rubio are affiliated with the Markey Cancer Control Program, University of Kentucky. Evelyn A. Knight is affiliated with the Appalachian Center, University of Kentucky. This research was supported by the Appalachian Regional Commission (ARC) and the Centers for Disease Control and Prevention (CDC).


  • Appalachia
  • Attitudes/perceptions
  • Cervical cancer
  • Rural women
  • Screening

ASJC Scopus subject areas

  • General Medicine


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