Results Summary

What was the research about?

Pap tests screen for cervical cancer in women. Current guidelines recommend that women ages 21–29 get a Pap test once every three years because they are at low risk for cervical cancer. But many women get Pap tests more often. Having more tests can cause anxiety and lead to unneeded procedures.

In this study, the research team tested two ways to help clinics make sure women get Pap tests as recommended but not more often:

  • Clinician app. Clinicians, such as doctors and nurses, received an app for their phones. The app helped clinicians figure out how often patients should get Pap tests based on guidelines and patient traits such as age.
  • Clinician app and patient website. Clinicians received the app. Their clinics also received tablet computers with a website that had information for patients about when women should get Pap tests. Clinic staff asked patients to view the website in the waiting room.

The research team compared the rate of Pap tests per woman receiving care for clinics that used the app, the app plus the website, or neither.

What were the results?

During the study, the rate of Pap tests per woman didn’t differ based on whether women received care at a clinic that had the app, the app and the website, or neither.

When the research team compared the rate of Pap tests before and after the study started, the clinics that got both the app and the website had more of a decrease than clinics with the app only or clinics with neither.

Who was in the study?

The study included claims for 84,823 women who received care at 1 of 42 women’s health clinics in Southern California. Of these women, 81 percent were Latina; 8 percent were white, 5 percent were Asian or Pacific Islander, 4 percent were black, and 2 percent were other races. Spanish was the primary language for 61 percent of women; English was the primary language for 34 percent; and 6 percent spoke another language. The average age was 26.

What did the research team do?

The research team assigned 14 clinics by chance to use either the app or the app plus the website for 18 months. Then the team compared these 14 clinics with 28 clinics that didn’t have the app or website.

The research team looked at how many Pap tests women received in the 18 months before and the 18 months during the study.

Members of advocacy organizations helped create the patient education website and recruit clinics.

What were the limits of the study?

The research team followed patients for only 18 months. Results may have differed if the study tracked patients for longer. The team also couldn’t track which clinics used the app or website. Some clinics may not have used the app or website as much as others.

Future studies could track Pap test rates for longer and look at app and website use by clinic.

How can people use the results?

Clinics can use the results when considering ways to help women get Pap tests as recommended.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked why the 18-month follow-up period was broken into three 6-month segments and questioned the validity of extrapolating from the 18-month period to 3 years. The researchers explained that they used 6-month intervals to see if an observed change was consistent over time or if there was a lag period before an effect was seen. The researchers said they extrapolated from 18 months because their study had to be completed in a restricted time frame. The reviewers continued to express concern about this extrapolation to 3-year outcomes, and the researchers removed reference to 3 years from the report.
  • The reviewers questioned the exclusion of women from the study who had screening at intervals averaging more than 30 months, many of whom were likely not having screening enough and suggested conducting statistical analyses including these women. The researchers agreed that many of the women at such sites were likely underscreened but observed that the purpose of their study was to examine overscreening, not underscreening. The researchers said they excluded clinics that were already screening at the recommended 3-year intervals. Since they excluded those clinics from the beginning of the study, the researchers had no access to data from the sites and could not perform any additional analyses of these patients.
  • The reviewers noted that control participants were not assigned within clinics or practices where the researchers conducted interventions and suggested that the non-random assembly of control groups from outside practices might have introduced bias. The researchers said they designed the study in this way because practices would not participate unless they received some kind of intervention, so the researchers assigned the practices they recruited to one or the other of their two interventions. They then randomly sampled clinics that matched the intervention sites on a set of specific characteristics.
  • The reviewers expressed concern that the study gave little consideration to subgroups within the study population and suggested conducting additional exploratory, after-the-fact analyses. The reviewers said they did do subgroup analysis based on patients’ primary language and race, but they did not find other patient characteristics in their dataset that they could analyze for heterogeneity.
  • The reviewers wondered about providers’ familiarity with current guidelines regarding cervical screening and asked if there was any information regarding providers’ attitudes and practices before the intervention. The researchers pointed out that they were not able to conduct a formal assessment of providers’ knowledge prior to them receiving the intervention, because the assessment may have comprised an intervention itself. Instead, the study included formal group-based provider orientations, so that all providers received the same information regarding the provider tool.

Conflict of Interest Disclosures

Project Information

Anna-Barbara Moscicki, MD
University of California, Los Angeles^
$1,598,000 *
10.25302/08.2020.CDR.071501IC
Randomized Trial to Increase Adherence to Cervical Cancer Screening Guidelines for Young Women

Key Dates

September 2013
March 2020
2013
2019

Study Registration Information

^Anna-Barbara Moscicki was affiliated with University of California, San Francisco when this project was funded.

Final Research Report

View this project's final research report.

Journal Articles

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Last updated: October 18, 2023