Jailed women are four-five times more likely to have had cervical cancer compared to women without criminal justice histories. Previous research has shown that an important contributor to cervical cancer risk, and perhaps lack of follow-up, is incarcerated women's low health literacy about broader reproductive health issues. Little work has been done to address this disparity. Thus, the objective of this study was to test the effectiveness of an intervention to improve incarcerated women's cervical health literacy and ultimately address cervical cancer disparities. Using a waitlist control design, we compared changes in cervical health literacy (knowledge, beliefs, self-efficacy, and confidence for screening and follow-up) among 188 incarcerated women who completed a 10-hour intervention between 2014 and 2016 in three Kansas City jails. We used bivariate tests and multivariate analyses that controlled for baseline cervical health literacy level and key covariates. Women in the intervention group showed significant gains in seven out of eight cervical health literacy domains (all p < 0.01), whereas the control group only improved in one domain (p < 0.01). When controlling for covariates, the intervention group had less barriers, perceptions of seriousness, susceptibility to disease, and increased self-efficacy for cervical health screening and follow-up, compared to the control group (all p < 0.05). A brief intervention is an effective way to improve jailed women's cervical health literacy, but should be provided alongside systemic efforts that expand access to correctional preventive health services, including the human papillomavirus vaccine, community-based cancer screenings, and health insurance after women leave jails and transition back to communities.

Moral distress in nursing has been linked to a relative lack of power in the workplace. We designed and piloted a Freirean-based conscientization intervention to raise awareness and address disempowerment with 13 critical care nurses in the US Midwest who recently experienced moral distress. A transformative, mixed-methods, pre/post design was used with convergence of qualitative and quantitative data. Results showed improved moral distress and mixed results in perceived personal and group empowerment. Further study is warranted to test conscientization-based interventions that give nurses opportunity collectively to develop empowered responses to situations that lead to moral distress.

We report on data we collected from a 2018 survey examining jails’ human papillomavirus virus vaccine delivery capacity and on a secondary analysis we conducted to describe factors similarly associated with delivery planning for the COVID-19 vaccine. We provide recommendations for delivering the COVID-19 vaccine in jails, based on evidence from Kansas, Iowa, Nebraska, and Missouri. Our key finding is that jails have limited staff to implement vaccination and will require collaboration between jail administrators, jail medical staff, and local health departments.

Purpose: To assess effectiveness, 1-year post-intervention, of a program delivered in jails with women to improve cervical health literacy (CHL) and up-to-date Papanicolaou (Pap) screening. Design: Pre-post design to evaluate Pap screening and CHL effects 1 year after our original randomized wait-list control study. Setting: Surveys conducted in Kansas City, 2015 to 2017 (baseline in 2014). Participants: Adult women (n = 133). Intervention: One-week (10-contact-hour), small-group, CHL program. Measures: Surveys to assess CHL components and up-to-date Pap screening. Analysis: χ2 and t tests, followed by best-subsets logistic regression using sociodemographic and CHL components to fit an optimal model for up-to-date screening 1-year post-intervention. Results: 73% (133/182) women retained at 1-year. From pre-intervention, 6 of 8 CHL components improved (.01 > P > .001). Up-to-date Pap screenings increased over pre-intervention (72%−82%, P < .05). Best-subset model to predict up-to-date screening included age; public benefits; medical insurance; 5 CHL components (knowledge, benefits, barriers, seriousness, susceptibility). Conclusion: A brief intervention to promote cervical health literacy, delivered with women during a jail detention, can lead to sustained improvements in CHL and prevention practices.

Nurses who provide care in the community to women with a history of repeated incarceration may struggle to understand the full extent of the barriers faced by this population and as a result risk giving suboptimal care to an already underserved group. This narrative inquiry study of stories told by 10 women with histories of repeated incarceration fulfilled 2 purposes: to demonstrate how women's shelter-seeking stories exposed uniquely complex patterns of health opportunity and risk and to demonstrate how storytelling might serve as an informative mode of nursing health assessment for this population.

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Objective: To model condom usage by jail-incarcerated women incarcerated in U.S. local jails and understand results in terms of fundamental cause theory. Design, Sample, Measurements: We surveyed 102 women in an urban jail in the Midwest U.S. Chi-square tests and generalized linear modeling were used to identify factors of significance for women who used condoms during last-sex compared with women who did not. Stepwise multiple logistic regression was conducted to estimate the relation between the outcome variable and variables linked to condom use in the literature. Results: Logistic regression showed that for women who completed high school odds of reporting condom use during last sex were 2.78 times higher (p =.043) than the odds for women with less than a high school education. Among women who responded no to ever having had a sexually transmitted infection, odds of using a condom during last sex were 2.597 times (p = .03) higher than odds for women who responded that they had had a sexually transmitted infection. Conclusions: Education is a fundamental cause of reproductive health risk among incarcerated women. We recommend interventions that creatively target distal over proximal factors.

Research-based findings with vulnerable populations are strengthened by strong retention rates at the time of postintervention data collection. Women in the criminal justice system face a variety of gender-specific challenges including histories of childhood and adult sexual and physical abuse, substance abuse, untreated mental health problems, and chronic housing insecurity that can hinder follow-up of a research sample. The authors highlight a variety of retention strategies that they successfully used in their work with women following incarceration in local county jails.