Abnormal Pap Follow-Up among Criminal-Legal Involved Women in Three U.S. Cities

Abstract

Criminal-legal involved women experience significant barriers to preventive cervical care, and consequently there is a higher incidence of cervical cancer in this population. The purpose of this study is to identify variables that may facilitate abnormal Pap follow-up among criminal-legal involved women living in community settings. The study included n = 510 women with criminal-legal histories, from three U.S. cities—Birmingham, AL; Kansas City, KS/MO; Oakland, CA. Participants completed a 288-item survey, with questions related to demographics, social advantages, provider communication, and reasons for missing follow-up care. There were n = 58 women who reported abnormal Pap testing, and n = 40 (69%) received follow-up care. Most women received either repeat Pap/HPV testing (n = 15, 38%), or colposcopy and/or biopsy (n = 14, 35%). Women who did not follow-up (n = 15, 26%) cited that they forgot (n = 8, 53%), were uninsured (n = 3, 20%), or were reincarcerated (n = 3, 20%). In a multivariate analysis, both having a primary care provider (OR 4.6, 95% CI 1.3–16.0) and receiving specific provider communication about follow-up (OR 3.8, 95% CI 1.1–13.2) were independent predictors for abnormal Pap follow-up. Interventions that offer linkages to providers in the community or ensure abnormal Pap care plans are communicated effectively may mitigate the disparate incidence of cervical cancer among criminal-legal involved women.

Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care: a systematic review

“…The results of the secondary analysis are reported together with the primary study as most study characteristics were the same. Using the JBI risk of bias checklists, we assessed 12 studies as low risk of bias, [ 22 – 24 , 30 , 33 , 34 , 38 , 40 , 41 , 43 , 44 , 46 ] 10 with a moderate risk [ 21 , 25 , 26 , 28 , 29 , 32 , 35 , 37 , 42 , 45 ] and four studies with a high risk of bias [ 27 , 31 , 36 , 39 ]. The detailed quality assessment can be found in Appendix 2 .…”

“…The included studies comprised seven RCTs [ 22 , 23 , 26 , 29 , 35 , 39 , 43 ] and seven cohort studies [ 21 , 24 , 31 , 34 , 37 , 41 , 44 ]. The remaining were cross-sectional [ 4 ], [ 27 , 32 , 36 , 42 ] non-randomised experimental [ 2 ], [ 25 , 40 ] case–control [ 2 ], [ 28 , 45 ] qualitative [ 2 ], [ 30 , 33 ] case series [ 1 ] [ 46 ] and diagnostic accuracy studies[ 1 ] [ 38 ]. Half of the studies were conducted in the USA [ 21 , 22 , 24 , 26 – 28 , 32 , 33 , 36 , 37 , 40 – 42 , 46 ].…”

“…The remaining were cross-sectional [ 4 ], [ 27 , 32 , 36 , 42 ] non-randomised experimental [ 2 ], [ 25 , 40 ] case–control [ 2 ], [ 28 , 45 ] qualitative [ 2 ], [ 30 , 33 ] case series [ 1 ] [ 46 ] and diagnostic accuracy studies[ 1 ] [ 38 ]. Half of the studies were conducted in the USA [ 21 , 22 , 24 , 26 – 28 , 32 , 33 , 36 , 37 , 40 – 42 , 46 ]. The remaining were conducted in Canada [ 3 ], [ 25 , 36 , 43 ] the UK [ 3 ], [ 30 , 39 , 45 ] Denmark [ 2 ], [ 34 , 35 ] the Netherlands [ 2 ], [ 29 , 38 ] New Zealand [ 1 ], [ 23 ] Hong Kong [ 1 ] [ 44 ] and Türkiye.…”

“…The remining 19 were clinic-based. 7 studies included exclusively women from underserved populations (Latinas, low income, Maori and Criminal-legal involved) [ 22 , 23 , 26 , 32 , 33 , 40 , 42 , 47 ] and 4 studies included only non-adherent women [ 23 , 29 , 33 , 45 ].…”

“…The majority (87.5%) of the included studies had a clear definition for inadequate follow up of an abnormal test result [ 21 – 29 , 33 – 45 , 47 ]. Of these, 70% defined it as a failure to attend the following appointment either with their clinician or for a follow up test [ 22 – 25 , 27 – 29 , 33 , 37 , 39 , 40 , 42 – 45 ] and the remaining 30% defined it as no evidence of further testing in the electronic medical record (EMR) [ 21 , 26 , 34 – 36 , 38 , 41 ].…”