Term of Award

Spring 2017

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy & Management (COPH)

Committee Chair

Gulzar Shah

Committee Member 1

Bettye Apenteng

Committee Member 2

William Mase


Background: According to the Centers for Disease Control and Prevention (2016), HPV-related cervical cancer is considered one of the most common cancers among women and was once the leading cause of death for women in the United States. With the implementation of prevention and screening techniques, cervical cancer rates decreased heavily over the years in the United States. However, even with the availability of health screening options and the HPV vaccine, nearly a third will not survive. Purpose: The primary aim of this study was to analyze the influence of ethnicity, age, marital status, geographic location, insurance status, year diagnosed, disease stage, and treatment options on follow-up care adherence among women with cervical cancer. Methods: Through the use of the Andersen Healthcare Utilization Model, this research study analyzed socio-demographic factors that may influence gaps in cervical cancer mortality rates. This study used cervical cancer data extracted from the Surveillance, Epidemiology, and End Results program for the state of Georgia between the years 2007 - 2013. Using the Andersen Healthcare Utilization Model, this research study examined predisposing, enabling, and need factors that may affect follow-up care to promote health equity through the use of a binomial logistic regression. Results: The full model containing all predictors was statistically significant, χ2 (17, N = 1970) = 41.584, p < .001, indicating that the model was able to distinguish between respondents who adhered to their recommended cervical cancer treatment and those who did not. The model as a whole explained 18.8% (Nagelkerke R2) of the variance in adherence to treatment and recommendations, and correctly classified 98.9% of cases. Conclusions: This study found that the stage of the cancer is the greatest indicator of the likelihood of engaging in follow-up care. The strongest predictor of adherence to provider-recommendations was Stage I which was 16 times more likely to adhere to treatment recommendations than those in Stage IV. Stages II and III were over 11 and over eight times more likely to follow recommendations than patients in Stage IV, respectively.

Research Data and Supplementary Material