Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Eric Benotsch

Second Advisor

Linda Zyzniewski

Third Advisor

Susan Bodnar-Deren

Fourth Advisor

Andrew Barnes

Fifth Advisor

Kristina Hood


Background: Cervical cancer among Black women is a major individual and public health concern. Despite advancements in medical technology and policy, disparities in cervical cancer diagnosis and mortality still exist between White and Black women, with Black women having higher rates of diagnosis (10.0 vs 7.1 per 100,000) and mortality (4.1 vs 2.0 per 100,000). Previous studies have focused heavily on barriers to obtaining cervical cancer screening among Black women and efforts to improve screening rates. Despite speculation by researchers that gaps in receipt of quality follow-up care may contribute to disparities, its role in disparate mortality rates between Black and White women has yet to be formally studied.

Purpose: The goals of the present research were to (1) assess differences in Pap screening rates and (2) rates of adherence to recommended follow-up care after abnormal Pap results between Black and White women, (3) evaluate how specific factors of the Health Belief Model (HBM) influence the decision-making process for obtaining Pap screening and (4) receiving recommended follow-up Pap care, and (5) evaluate the role of ethnic centrality as a factor in health decision-making.

Results: Results indicated that HBM facets functioned similarly in predicting engagement in Pap screening and follow-up care, although there were differences in the influence of different facets by race. Ethnic centrality showed little applicable influence on adherence to follow-up care among Black women. An exploratory analysis revealed that doctor recommendation was the most influential factor predicting follow-up care use for both racial groups.

Conclusion: The present study offers support for increased education and training on provider recommendation of appropriate follow-up care, as well as effective provider communication of results and services using messaging that appeals to the values and concerns of patients.


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VCU Theses and Dissertations

Date of Submission