Over the last 35 years, there has been a 700% increase in the number of women in prisons and jails. These women, mostly women of color, have pervasive trauma histories, mental health problems, and drug use, all of which compromise their ability to engage in preventive health behaviors. For the last eight years, our research team has studied women leaving jail and why they are 4-5 times more likely to develop cervical cancer, a disparity that has remained unchanged for over 50 years. The original objective of the Sexual Health Empowerment (SHE) for Cervical Health Literacy and Prevention program (R01 CA181047) was to assess the effectiveness of a jail-based intervention to increase cervical health literacy and screening. SHE increased jailed women?s cervical health literacy and rates of cancer screening after the women left jail. While delivering SHE, we observed: 1) the cross-cutting nature of women?s health risk factors, i.e. the risks that jailed women faced for cervical cancer also could lead to other women?s health problems; and 2) opportunity for taking an evidence-based intervention, with a rich theoretical framing, to expand to other women?s health issues faced by this group, around, not only cervical cancer prevention, but also breast cancer, unintended pregnancy, and STI prevention. While following women after release from jail (85% follow-up rate after 3 years), we also identified strategies for reaching this high-risk population through electronic communication. SHE participants were high users of mobile phones (88%), text (76%), Web (79%), and Facebook (70%). This renewal application presents an opportunity to holistically address health disparities experienced by women leaving jail and test new modalities for intervention delivery given their use of electronic communication and social media. In our first aim, we will assess the feasibility and pilot effectiveness of ?SHE-Women?, an electronic women?s health literacy intervention, with women leaving jail.
The second aim uses an RCT to test the effectiveness of SHE-Women with women leaving jail on increasing women?s health literacy, screening, and risk reduction practices (for cervical, breast cancer, unintended pregnancy, and STIs) against a standard of care.
Our third aim will be to understand the role and impact of human interaction in electronic interventions by tracking participants and interviewing key stakeholders. Knowledge gained from this study will lead to an understanding of: 1) how a comprehensive women?s health literacy intervention can narrow health disparities among justice-involved women and 2) the role of human interaction in successful electronic interventions, thereby creating a sustainable model for dissemination of health promotion interventions.
The key contributions of this study are to determine whether a comprehensive women?s health literacy intervention is effective at changing intersecting behaviors among women leaving jail; whether an electronic women?s health literacy intervention is feasible and effective; and how much human ?touch? is ideal in an electronic intervention. Knowledge gained from this study will help develop a new paradigm for mitigating health disparities among vulnerable women.
| Kelly, Patricia J; Emerson, Amanda; Fair, Chelsea et al. (2018) Assessing fidelity: balancing methodology and reality in jail interventions. BMC Womens Health 18:127 |
| Emerson, Amanda Marie (2018) Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications. ANS Adv Nurs Sci 41:260-274 |
| Pickett, Michelle L; Allison, Molly; Twist, Katelyn et al. (2018) Breast Cancer Risk Among Women in Jail. Biores Open Access 7:139-144 |
| Kelly, Patricia J; Allison, Molly; Ramaswamy, Megha (2018) Cervical cancer screening among incarcerated women. PLoS One 13:e0199220 |
| Emerson, Amanda M (2018) Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women. Qual Health Res 28:873-887 |
| Kelly, Patricia J; Ramaswamy, Megha (2017) Closing the cervical cancer disparity gap. Public Health Nurs 34:195-196 |
| Ramaswamy, Megha; Lee, Jaehoon; Wickliffe, Joi et al. (2017) Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women. Prev Med Rep 6:314-321 |
| Kelly, Patricia J; Hunter, Jennifer; Daily, Elizabeth Brett et al. (2017) Challenges to Pap Smear Follow-up among Women in the Criminal Justice System. J Community Health 42:15-20 |
| Ramaswamy, Megha; Kelly, Patricia J (2015) ""The Vagina is a Very Tricky Little Thing Down There"": Cervical Health Literacy among Incarcerated Women. J Health Care Poor Underserved 26:1265-85 |
