Improving Cervical Cancer Prevention in the Community Health Delivery System for Post-Incarcerated Women

描述（由申请人提供）：刑事司法系统中的女性患宫颈癌的可能性是非监禁女性的4 - 5倍。在我们之前的研究中，我们发现宫颈癌风险的最重要因素，也许是缺乏随访，是监禁妇女对更广泛的生殖健康问题的低健康素养。除非我们有效地解决监禁妇女独特的生殖健康知识普及需求，否则监禁妇女和非监禁妇女之间的宫颈癌健康差距将继续存在。本研究的目的是评估性健康赋权（SHE Project）干预的有效性，以提高宫颈癌健康知识，减少与宫颈癌信念相关的筛查障碍，提高导航提供者和医疗保健系统的自我效能，并最终致力于预防宫颈癌。这一目标是对PAR-10-133的响应，因为它制定了一项干预战略，以解决弱势群体的卫生知识普及和更广泛的健康成果问题。为了实现本研究的目标，我们建议评估性健康赋权干预（SHE项目）对子宫颈健康知识的影响；筛查障碍与对宫颈癌的信念有关，以及出狱妇女对筛查和随访的自我效能。更具体地说，我们将使用等候名单对照设计，从基线到为期一周的干预结束进行干预前和干预后评估。接下来，我们将采用一项为期三年的观察性研究设计，采用调查和民族志方法进行随访，了解知识、信念、自我效能感等因素如何随时间改变释放后的宫颈健康预防行为。这种方法将使我们能够观察女性在临床接触中将增加的知识、减少的障碍和提高的自我效能转化为实践的程度，或者其他因素是否可以解释长期的健康行为。这项研究对公共卫生的影响在于，它有可能降低这一高危和弱势妇女群体的宫颈癌发病率和死亡率。我们开发了一种有效且易于传播的健康素养干预措施，可适用于许多健康状况，并在制度化人群（监狱、监狱、社区惩戒、军事机构）中开展了更广泛的癌症预防工作，这将对公共卫生产生影响，也将对制定有效的健康素养干预措施的科学产生影响。

DESCRIPTION (provided by applicant): Women in the criminal justice system are four-five times as likely to have cervical cancer compared to non- incarcerated women. In our previous research, we found that the most important contributor to cervical cancer risk, and perhaps lack of follow-up, is incarcerated women's low health literacy about broader reproductive health issues. Until we effectively address incarcerated women's unique reproductive health literacy needs, the cervical cancer health disparity between incarcerated and non-incarcerated women will persist. The objective of this study is to assess the effectiveness of a sexual health empowerment (SHE Project) intervention to improve cervical health knowledge, reduce barriers to screening that are related to beliefs about cervical cancer, improve self-efficacy for navigatin providers and health care systems, and ultimately work towards preventing cervical cancer. This objective is responsive to PAR-10-133 in that it develops an intervention strategy to address health literacy and broader health outcomes in a vulnerable population. To meet the objectives of this study, we propose to assess the impact of a sexual health empowerment intervention (SHE Project) on cervical health knowledge; barriers to screening that are related to beliefs about cervical cancer, and self-efficacy for screening and follow-up among women leaving jail. More specifically, we will conduct a pre- and post-intervention assessment from baseline to the end of a weeklong intervention using a wait-list control design. Next, we will use a three-year observational study design employing both survey and ethnographic methods for follow-up, to understand how knowledge, beliefs, self-efficacy, and other factors change post-release cervical health prevention behaviors over time. This approach will allow us to observe the extent to which women translate, if at all, increased knowledge, reduced barriers, and increased self-efficacy into practice during clinical encounters, or if other factors explain health behaviors ove time. The public health impact of this study is its potential to reduce cervical cancer morbidity and mortality for this high risk and vulnerable group of women. Our development of an effective and easily disseminated health literacy intervention that can be adapted to many health conditions and broader cancer prevention efforts in institutionalized populations (jails, prisons, community corrections, military institutions) will have an impact on public health, and also on the science of developing effective health literacy interventions.