Using a feminist standpoint epistemological framework, this article reports the findings from 26 interviews with drug-offending incarcerated mothers in Kentucky regarding the effects of incarceration on their relationships with their children. The participants related personal histories characterized by poverty, victimization, chronic substance addiction, and repeated failed attempts at sobriety. Many felt betrayed by the courts and child protective services, and those who had lost custody of their children felt they had no remaining reason to rehabilitate themselves. The mothers expressed profound feelings of guilt and remorse for the impact that their behaviors had on their children and expressed hope that their children would experience better lives than they have.

Yet unknown is how they avoid obstetrical 17 interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric 18 interventions as well as the underpinning factors that influence aversion to obstetrical interventions by 19 Somali refugee women. 20 Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited 21 via snowball technique in Franklin County, Ohio, United States. Data was collected through audio-22 recordings of individual interviews and focus groups conducted in English and Somali languages. The 23 collected data were transcribed and analyzed using thematic analyses. 24 Results: Forty Somali refugee women aged 18 to 42 years were recruited. Participants reported engaging 25 in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: 26 1) intentionally not seeking or misleading prenatal care, 2) changing hospitals and/or providers, 3) delayed 27 hospital arrival during labor, and 4) refusal of care. Underpinning all four avoidance mechanisms were their 28 significant fear of obstetrical interventions, and perceived lack of choice in their care processes as 29 influenced by: cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a 30 lack of privacy provided to them while receiving care. 31 Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention 32 is to improve access to and experiences with care for this population, building trust, addressing their fears 33 and concerns, and respecting their culture is a critical first step. This should be well established prior to the 34 need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel 35 compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers 36 is key to advancing health equity for this vulnerable population.

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The purpose of this study was to examine the effectiveness of a community health worker (CHW)-delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p = .013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.