Managing Technology, Content, and User Experience: An mHealth Intervention to Improve Women's Health Literacy after Incarceration

Abstract

E very year, more than 3.2 million women come into contact with the criminal legal system in the United States. 1 Representing the fastest-growing incarcerated group, women with criminal legal histories are more likely to report chronic conditions, such as cancer, hypertension, heart disease, and diabetes. 2 Around 67% of females in jails reported ever having a chronic condition. 3 On top of these health issues, many women are affected by sexual trauma, poverty, drug addition, mental illness, and limited access to medical care. 4 The majority of incarcerated women are between the ages of 18 and 44. 1 Women with incarceration histories bear a greater burden of sexual and reproductive health problems such as abnormal Pap test histories, cervical cancer, unintended pregnancies, and sexually transmitted infections (STIs). 1,5,6 In addition, there is a growing number of women in jails and prisons who are 55 and older, a group of women who have lower rates of up-to-date mammograms compared with the general population. 7,8 When released from jail, women must face these and other health and social problems as they reorient themselves back into the community. 9,10 Community reentry presents an opportune moment for health intervention in that it gets women to think about changing circumstances at a high-risk time 11 and may provide women with resources to see those changes through. Researchers have found that women with past criminal legal histories are often savvy health care users, though woefully underinsured in some regions of the U.S. 12 Although most incarcerated women are knowledgeable about behavioral health issues to some extent, many have beliefs about women's health that are outdated, often affected by family, medical, or social beliefs about screening regimens, or in some cases their own trauma histories. 13 These

Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners

“…Digital health literacy initiatives should address the potential for exacerbating existing health inequities. Vulnerable populations, including those with lower health literacy, limited digital skills or language barriers, may face additional challenges in navigating and utilising digital health resources ( 61 , 72 , 73 ). Ensuring inclusivity and tailoring digital health interventions to diverse populations can help mitigate disparities.…”

Special Section on Inclusive Digital Health: Notable Papers on Addressing Bias, Equity, and Literacy to Strengthen Health Systems

“…In addition to these efforts, there is considerable work on gender inclusivity and equity in healthcare. Bright et al, proposed a plan to improve the representation of women in biomedical and health informatics [15], and Geana et al, described informatics interventions to improve the health literacy of incarcerated women [16].…”

“…Our search resulted in the retrieval of five excellent examples of where informatics fits into this enterprise. Geana focused on improving health literacy of women in prison, particularly to prepare them for life after release [16]. The paper further described a new intervention, SHE WOMEN, which is an mHealth application designed to provide a "…rich, comprehensive, engaging, and scalable online training solution tailored for women leaving jail, while concomitantly being able to collect usability data for evaluation and feedback".…”

Effect of a board game on imprisoned women’s knowledge about sexually transmitted infections: a quasi-experimental study

“…A systematic review evidences that board games exert positive impacts on knowledge about STIs and health-related behaviors [ 6 ], with the need to evaluate the effect of these games on knowledge in the female prison population [ 7 ]. This population has a history of problems related to sexuality and health [ 7 ], such as STIs, cervical cancer and unwanted pregnancies [ 8 – 10 ]. This assessment aims at contributing to preventing dissemination of STIs and their consequences.…”