| The morbidity and mortality burden of uterine cervical dysplasia (5 million) and uterine cervical cancer (65,000 in situ, and 13,000 invasive) among U.S. women annually is disproportionately experienced by sheltered women due to a combination of late diagnosis due to low rates of Pap smear participation, less access to health care, increased risk for cervical disease, competing health issues, and cultural barriers. This dissertation study's aims were met: (a) develop culturally relevant scales to measure the Transtheoretical Model-based concepts of Self-efficacy (SE), Decisional Balance (DB), Knowledge (K), Contextual Factors (CF), and Stage of Change (SOC) applicable to Pap smear screening; (b) test and revise the newly developed, conceptually based scales, using psychometrically sound reliability and validity criteria, (c) test the Pap Smear Screening Participation Model's predictive ability, and (d) describe the study sample regarding these concepts. Methodology. The study was conducted through a series of pilot studies and a final sample of inner city, sheltered women (n = 161) in the Omaha metropolitan area. Results. The study resulted in five new, culturally relevant, reliable and valid scales to measure SE, DB, K, CF, and SOC concepts. Internal consistency measures, alpha and theta, ranged from 0.79 to 0.95, and content and construct validity were supported. The best predictive model (p = 0.05) with SOC as the outcome included SE, DB, and the CF of age and illicit drug addiction, (R2 = 0.28). For actual Pap smear screening performance, the best predictors (p = 0.05) were the DB Pro subscale ‘Professional recommendation for Pap smear screening’ (OR = 1.6) and education (OR = 1.6) with pseudo-R 2 = 0.20 (full model 0.32). Culturally relevant components were identified. Conclusions. Low annual Pap smear screening (46.0%) in this sample indicates considerable risk for late diagnosis of cervical abnormalities. Five new psychometrically sound scales were developed and tested for use with sheltered women to measure SE, DB, K, and CF, as applicable to Pap smear screening. The scales distinguish among stages of change. |
