Challenges to Pap Smear Follow-up among Women in the Criminal Justice System

Kelly, Patricia J.; Hunter, Jennifer L.; Daily, Elizabeth Brett; Ramaswamy, Megha

doi:10.1007/s10900-016-0225-3

Cited by 19 publications

(13 citation statements)

References 19 publications

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“…Incarcerated women have uniquely complicated barriers when it comes to cervical health literacy – specifically, complex risk histories and environments that may affect their ability to act on knowledge about cervical health. For example, one barrier to knowledge stems from frequent STI checks, which inadvertently cause confusion over pelvic and Pap screening ( Kelly et al, 2017 ). Furthermore, these women's long trauma histories tend to impact on their beliefs about Pap screening – that is, an expectation of fear, discomfort, and questionable safety during gynecological exams ( Ramaswamy & Kelly, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women

Ramaswamy

Lee

Wickliffe

et al. 2017

Preventive Medicine Reports

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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.

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Section: Introductionmentioning

confidence: 99%

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women

Ramaswamy

Lee

Wickliffe

et al. 2017

Preventive Medicine Reports

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“…The findings of this study are consistent with another study of incarcerated women in the Kansas City area that found Pap tests were often thought of as an all-inclusive screening for gynecological and pelvic health issues. Pelvic exam findings such as abnormal bleeding, STIs, bacterial vaginosis, yeast infections, and ovarian cysts were considered “abnormal Pap test results” by many of the women in interviews [8].…”

Section: Discussionmentioning

confidence: 99%

“…Limited cervical health literacy may lead women to mistakenly report a pelvic exam as a Pap test [7]. Cervical cancer screening awareness among justice-involved women is low, with studies showing that incarcerated women consider any range of women’s health problems as “abnormal Pap test results,” and confusion about the etiology of cervical cancer, screening recommendations, and need for screening [8,9].…”

Section: Introductionmentioning

confidence: 99%

Validating self-reported cervical cancer screening among women leaving jails

et al. 2019

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Background Despite women with criminal justice involvement reporting routine Papanicolaou (Pap) testing, significant disparities in cervical cancer outcomes exist when compared to women without criminal justice involvement. A possible reason for the discrepancy is that this group of women may be misreporting Pap testing. The objective of this study was to validate self-reported cervical cancer screening among women leaving jails. Methods We used three methods to validate self-reported cervical cancer screening for women recently released from jail: 1) Medical record review; 2) Semi-structured interview; 3) Pap test knowledge survey. After validating women’s self-reported Pap tests with a review of their medical records, we scored interviews for Pap test recall, and used Pap test knowledge survey scores to compare scores between women who accurately reported Pap tests vs. those who did not. Results Sixty-one percent (N = 14/23) self-reported cervical cancer screenings were accurate per medical record review. Comparing participants who did and did not accurately self-report a Pap test, we found a significant difference in Pap test recall scores (1.90 vs. 0.00, t = 3.87, p < .01) and Pap test knowledge scores (13.50 vs. 12.13, t = 2.42, p < .05). Conclusion Self-report of cervical cancer screening was more likely to be accurate if a woman’s Pap test knowledge was high. Clinicians might take extra care in describing screening and distinguishing between Pap tests and pelvic exams to support the cervical health of women with lower knowledge.

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“…Following release from jail or prison, criminal-legal involved women encounter significant barriers to cervical care-they must obtain health insurance and find a primary care provider, while also securing income, housing, food, and other basic needs [8,14,15]. Barriers that limit access to preventive cervical care have been well studied, but there are less data on factors that will facilitate abnormal Pap follow-up.…”

Section: Introductionmentioning

confidence: 99%

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

Salyer

Lipnicky

Bagwell-Gray

et al. 2021

IJERPH

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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.

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Challenges to Pap Smear Follow-up among Women in the Criminal Justice System

Cited by 19 publications

References 19 publications

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women

Validating self-reported cervical cancer screening among women leaving jails

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

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