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

Abstract

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.

Breast Cancer Risk Among Women in Jail

“…In SHE, we found that only 67% of these women were up-to-date on cervical cancer screening. 16 With older literature showing low rates of up-to-date breast cancer screening in incarcerated women and our recent study finding less than ideal rates of up-to-date cervical cancer screening, it would not be unexpected that women in jail would continue to have low rates of up-to-date breast cancer screening. The objective of our study was to analyze data from the SHE project to determine what proportion of incarcerated women have up-to-date breast cancer mammography since the change in USPSTF recommendations for biennial screening mammograms starting at the age of 50 years.…”

“…SHE was informed by social and feminist theory, designed to increase cervical health knowledge, reduce barriers encountered by personal beliefs of breast cancer, and improve self-efficacy and confidence navigating the healthcare system. 16 , 17 …”

“…The women completed a 158-question survey focused mainly on cervical cancer risks, prevention, and treatment. 16 Two questions from the survey focused solely on breast health and were used for this analysis: “Have you ever had a mammogram” and “How long has it been since you had your last mammogram?” Women were considered “up-to-date” if they reported having had a mammogram within the past 2 years. 9…”

“…IPV was included as a variable because it is such a pervasive experience among this group of women and because of its association with other women's health variables in previous studies. 16 , 18 …”

Incarceration Exposure and Barriers to Prenatal Care in the United States: Findings from the Pregnancy Risk Assessment Monitoring System

“…Finally, incarceration exposed women were less likely to receive prenatal care because of not knowing they were pregnant. To the extent that incarceration exposed women have lower levels of gestational and health literacy [ 57 , 58 , 59 , 60 ], these women may be more prone to not receiving adequate prenatal care (particularly during the first trimester) because of lacking knowledge about the early signs of pregnancy. Furthermore, these barriers (keeping pregnancy a secret and not knowing they were pregnant) could be linked to an unintended pregnancy or ambivalence about being pregnant [ 61 ].…”