How primary care providers recommend and complete cervical cancer screening in women with intellectual and developmental disabilities

Lee, Michele Sky (2023) How primary care providers recommend and complete cervical cancer screening in women with intellectual and developmental disabilities. Doctoral thesis, Northern Arizona University.

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Abstract

Cervical cancer screening (CCS) is one of the most effective forms of cancer screening. However, women with intellectual and developmental disabilities (I/DD) are less likely to be screened for cervical cancer compared to women without disabilities. A scoping review was conducted to identify the barriers and facilitators to CCS for women with I/DD, which revealed that type of health care provider was associated with women with I/DD participating in CCS. Results of the scoping review informed the subsequent phase of research. An exploratory sequential mixed method study was designed with the overall research objective of identifying how primary care providers (PCPs) recommend and perform CCS in women with I/DD. This study also implemented a community engaged approach, where a community advisory board of PCPs assisted in developing research materials. In the first study, interviews were conducted with 13 PCPs to identify how they recommended and performed CCS in women with I/DD. All PCPs recommended CCS to women with I/DD while they acknowledged the challenges in performing CCS in this population. Interview results were used to develop clinical vignettes for a questionnaire. In the second study, ninety-eight PCPs participated in an online questionnaire. PCPs were presented with three clinical vignettes, each clinical vignette had two conditions, PCPs were randomly presented with one of the two conditions. Based on the clinical vignette, PCPs were asked if they would continue to perform CCS. The clinical vignettes described a woman with I/DD with the following conditions: participating or not participating in sexual activity, comfort or discomfort prior to CCS, and low or high support needs. Questionnaire results were consistent with the qualitative study, the majority of PCPs reported performing CCS. Clinical vignette scenario conditions that elicited fewer PCPs reporting performing CCS included the conditions where a woman with I/DD was not participating in sexual activity and patient discomfort prior to CCS. Both studies demonstrated that PCPs consider several factors prior to performing CCS in women with I/DD.

Item Type:	Thesis (Doctoral)
Publisher’s Statement:	© Copyright is held by the author. Digital access to this material is made possible by the Cline Library, Northern Arizona University. Further transmission, reproduction or presentation of protected items is prohibited except with permission of the author.
Keywords:	Cervical cancer screening; Intellecual and developmental disabilities; Primary care; Primary care providers; Women with disabilities
Subjects:	R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
MeSH Subjects:	C Diseases > C04 Neoplasms
NAU Depositing Author Academic Status:	Student
Department/Unit:	Graduate College > Theses and Dissertations College of Social and Behavioral Science > Institute for Human Development
Date Deposited:	23 Mar 2026 18:35
Last Modified:	23 Jul 2026 23:31
URI:	https://openknowledge.nau.edu/id/eprint/6307

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