Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Education Sciences

First Advisor

Dr. Kristen P. Mark


Regular gynecological screenings are critical for women in promotion of health and preventing diseases like cervical cancer. Despite the importance of such examinations, many women fail to adhere to recommended screening protocols. As a result, women experience an increased disease risk. The current study examined the relationship between patient-provider communication quality, skill, and empathy on pelvic exam seeking behavior and exam-related anxiety and satisfaction. Additionally, negative self-concept, perceived poor genital self-image, and various elements of the socio-physical clinic environment were explored to better understand their impact on a women’s care seeking behavior.

A total of 350 women 19 through 80 years of age completed a one time, 15-minute online survey regarding their gynecological care seeking behavior. Ordered logistic regression analysis revealed that when controlling for demographic variables and self-concept scores satisfaction was significantly impacted by the quality of provider communication. Specifically, higher quality of communication likely increases satisfaction by 12% (coef = .77; odds ratio= 1.19 at a p< .01). Avoidance was significantly associated with greater provider empathy indicating a 9% decrease in avoidance is likely as empathy scores go up (coef = -.19; odds ratio= 0.96 at a p< .01). When controlling for various demographic factors, self-concept scores and provider communication were not shown to be significantly associated with patient anxiety. These findings suggest that enhancing provider communication quality and empathy may improve satisfaction and lessen patient avoidance. Results also indicate that women who have a more positive evaluation of their genital self-image were more likely to feel greater satisfaction concerning gynecological care. Thematic analysis of open-ended essay questions revealed several themes among 3 main areas: 1). Clinician Communication (active listening, explanation, empathic communication, & pace), 2). Social Environment (hospitality& being relational), and 3). Physical Environment (Privacy, Aesthetics, & Sensate Variables).

Detailed explanation, empathetic communication, and not rushing patients through procedures all emerged as important components that may guard against patient anxiety. Results suggest that distress related to gynecological care could be mitigated by easily modifiable improvements to the environment like increasing the temperature of the exam rooms, opting for less harsh lighting, providing a place to hang or set clothing, and more thoughtful placement of baby pictures. Results also suggest that improvements to modesty concerns within the exam room, like larger cloth draping and gowns, may significantly improve the patient experience.

Digital Object Identifier (DOI)