Original article
Measurement of young women’s attitudes about communication with providers regarding papanicolaou smears

https://doi.org/10.1016/S1054-139X(01)00254-3Get rights and content

Abstract

Purpose: To describe the psychometric properties of a scale created to measure communication with the provider regarding Papanicolaou (Pap) smears.

Methods: A scale based on expectancy-value theory was developed and administered to 490 young women aged 12 to 24 years in an urban adolescent clinic. Psychometric properties were assessed using factor analysis to evaluate latent variables, intraclass correlation coefficient to evaluate test-retest reliability, and Cronbach coefficient α to evaluate internal consistency reliability. Content validity was assessed by qualitative interviews, feedback on a pilot survey, and expert review. Construct validity was evaluated by examining whether relevant health care characteristics, knowledge, and attitudes were significantly associated with perceived communication.

Results: Mean respondent age was 18.2 ± 2.1 years; 50% were black and 22% Hispanic. The scale items loaded on one factor. The intraclass correlation coefficient was 0.83 and Cronbach α 0.95. Report of a consistent provider, report that a provider recommended a Pap smear, knowledge of Pap smears and Human Papillomavirus (HPV), intention to return for follow-up Pap smears, and positive attitudes about Pap follow-up were significantly associated with good communication.

Conclusions: The scale appears to be reliable and valid as a measure of young women’s communication with providers regarding Pap smears. Future research should focus on whether this newly developed scale is useful in the design and evaluation of cervical cancer prevention programs for young women.

Section snippets

Scale development

Expectancy-value theory provided the theoretical framework for scale development 28, 29. The central concept of this theory is that attitudes are determined by beliefs concerning the attributes of an object or action and by evaluations of those attributes. Expectancy-value theory has been applied extensively in areas as diverse as learning theory, attitude theory, and decision-making. It is also the basis for the Theory of Reasoned Action and the Theory of Planned Behavior, which have been used

Respondents

The mean age of respondents was 18.2 ± 2.1 years. Twenty-four percent reported race as white, 50% as black, and 26% as “other”; 22% reported ethnicity as Hispanic. Fifty-two percent reported Medicaid insurance, 31% private insurance, 7% no insurance, and 10% unknown insurance status. Sixty-three percent of patients reported having a consistent provider in the clinic. Twenty-six percent of respondents (n = 128) had a history of an abnormal cytology report: 63 (12.8%) atypical cells of

Discussion

We used an expectancy-value theory framework to create and test the psychometric properties of a scale specific to communication between providers and young women regarding Pap smears. The scale that we developed appears to be a reliable and valid measure of attitudes and beliefs about communication. Previous research in the area of communication between adolescents and providers has focused on adolescent preferences and attitudes about provider behaviors and communication 12, 13, 16, 17, 18

Acknowledgements

The authors would like to acknowledge Victoria Chiou, B.S. and Rebekah Kaplowitz, M.D. for assistance with data collection and management, and Jonathan Ellen, M.D. M.P.H. and Lorraine Freed, M.D. M.P.H. for their contribution to the development of the scale.

This study was supported by the Deborah Munroe Noonan Memorial Fund, and by Projects No. MCJ-MA259195 and MCJ-000964 from the Maternal-Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human

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    Copyright © 2001 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.