The Affordable Care Act (ACA) has created an unprecedented opportunity for women with criminal justice involvement (CJI) to obtain health insurance coverage, primarily through Medicaid expansion in 32 states and the District of Columbia. The vast majority (77%) of women with CJI are on probation. The proposed study will investigate healthcare utilization among women on probation who have Medicaid, focusing on health literacy and other factors that influence type (e.g., urgent, routine) and venue (e.g., emergency department, community clinic) of care. Women with CJI are disproportionately low-income women of color who are strongly affected by health disparities, with much higher burdens of preventable and chronic health conditions than women without CJI. In addition to practical, social, and economic factors, the Institute of Medicine recognizes that poor health literacy is a major barrier to the use of preventive and routine care among disadvantaged populations. Poor health literacy is associated with lower likelihood of receiving preventive care and poorer outcomes for chronic health conditions. It also contributes to overuse of urgent and emergency care. Guided by the Health Literacy Skills Framework and the Behavioral Model for Vulnerable Populations, our research aims are as follows:
Aim 1 : To identify health literacy and other enabling, impeding, and need factors that influence type (e.g., urgent, routine) and venue (e.g., emergency department, community clinic) of healthcare utilization in a cohort (n=360) of women on probation who have Medicaid.
Aim 2 : To explore how criminal justice involvement, health literacy, and prior experiences navigating healthcare settings contextualize type and venue of healthcare utilization among a qualitative subsample (n=80) of women on probation who have Medicaid.
Aim 3 : To use findings from Aims 1 and 2 to adapt an existing health literacy intervention designed for women with CJI, pilot the intervention with women on probation who have Medicaid (n=40), and assess its feasibility and acceptability for a larger efficacy study. The ultimate goal of the intervention would be to shift patterns of Medicaid utilization toward routine and preventive healthcare in community settings. The proposed study is responsive to PAR-10-133 in its investigation of the influence of health literacy on a behavioral outcome (healthcare utilization) and the development of an intervention to address the specific health literacy needs of a vulnerable population. For women on probation, Medicaid utilization for preventive and routine health care may require specific, focused health literacy education and support. Knowledge from the proposed study will contribute to scholarship on the underlying causes of health disparities among women with CJI, the impact of Medicaid expansion under the ACA, and strategies to improve women?s health by increasing routine and preventive healthcare utilization.
The proposed mixed-methods study will investigate health literacy and other factors that influence type and venue of healthcare utilization among women on probation who have Medicaid. Knowledge gained will contribute to scholarship on the underlying causes of health disparities among women with criminal justice involvement. Findings also will be used to inform the adaptation of an intervention addressing health literacy, thereby advancing the applied research agenda to reduce health disparities.
| Conroy, Amy A; McKenna, Stacey A; Comfort, Megan L et al. (2018) Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy. Soc Sci Med 214:110-117 |
