Understanding the Cervical Cancer Health Gap for Women in Jail

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四五倍。一些人将这种差异归因于对异常产程追踪的困难，但对于参与刑事司法系统的女性为何异常产程追踪调查的比率较低，从经验上了解甚少。这项申请的目的有两个：从被监禁妇女的角度理解对异常巴氏事件的解释及其后续的后续行动；第二，根据对她们的医疗记录的审查来解释妇女的异常巴氏事件及其后续行动。通过病历审查确认妇女对异常子宫颈病变随访(或缺乏)的描述，将有助于理解为什么有些妇女得不到后续护理。因此，我们将能够有针对性地进行干预，以解决妇女对异常子宫颈病变事件与实际事件的理解方面的这一有据可查的差距。为了实现这一目标，首先，我们将对堪萨斯城一所县监狱的40名妇女进行焦点小组和深入访谈，讨论异常巴氏筛查和后续事件。研究妇女患有异常子宫颈病变的经历和后续行动可能会提供线索，了解她们的宫颈癌筛查知识，以及妇女在进出监狱的情况下实际寻求宫颈癌预防服务的过程。其次，我们将要求之前采访的40名妇女允许查阅她们的医疗记录，以调查被监禁妇女对异常产程和后续事件的自我报告是否与这些事件的实际医疗记录相匹配。这一目标将使我们能够衡量妇女对帕金森病事件的了解，验证妇女在试图获得后续护理方面面临的医疗障碍，并证明通过审查病历来评估这一高危人群获得卫生保健的可能性。该项目通过深入了解如何解决参与刑事司法系统的妇女的宫颈癌负担，对公共卫生影响具有重要意义。该项目具有创新性，其目标是评估被监禁妇女对异常巴氏综合症事件的理解，并通过病历审查验证她们的理解。研究结果将有助于开发一种干预措施，试图缩小参与刑事司法系统的妇女与她们在“自由”世界中的姐妹之间的宫颈癌健康差距。 公共卫生相关性：这项研究对公共卫生的影响是，它将为减少已经处于不利地位的群体--参与刑事司法系统的妇女--的宫颈健康发病率和死亡率的干预措施提供信息。这项研究不仅将告诉我们妇女对Pap事件的理解与实际医疗接触之间的鸿沟，而且还将更全面地讲述这些人口在进入和离开刑事司法系统时获得医疗保健的经历。

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. Some have attributed this disparity to difficulty in follow-up of abnormal Paps, but little is known empirically about why women involved in the criminal justice system have low abnormal Pap follow-up rates. The objective of this application is two-fold: to understand the interpretation of abnormal Pap events and their subsequent follow-up from the perspective of incarcerated women; second, to interpret women's abnormal Pap events and follow-ups based on a review of their medical records. The validation of women's accounts of abnormal Pap follow-up (or lack thereof) with medical chart review will provide an understanding as to why some women do not gain access to follow-up care. Thus, we will be able target interventions to address this documented gap in women's understanding of abnormal Pap events versus actual events. To meet this objective, first we will conduct focus groups and in-depth interviews with 40 women in a Kansas City county jail about abnormal Pap screening and subsequent follow-up events. Studying women's experiences with abnormal Paps and follow-up may provide clues as to their cervical cancer screening knowledge and the processes by which women actually seek out cervical cancer prevention services given their movement in and out of jails. Second, we will ask the 40 women previously interviewed for permission to access their medical records, in order to investigate whether incarcerated women's self-report of abnormal Pap and follow-up events matched actual medical records of these events. This aim will allow us to gauge women's understanding of Pap events, validate the medical barriers that women faced in trying to gain access to follow- up care, and demonstrate the feasibility of assessing health care access through medical chart review for this high-risk population. This project has significance for public health impact by providing insight into how to address the cervical cancer burden for women involved in the criminal justice system. This project is innovative in its goal of assessing incarcerated women's understanding of abnormal Pap events and validating their understanding with medical record review. Study findings will contribute to the development of an intervention that attempts to close the cervical cancer health gap between women involved in the criminal justice system and their sisters in the "free" world. PUBLIC HEALTH RELEVANCE: The public health impact of this study is that it will inform interventions that reduce cervical health morbidity and mortality for an already disadvantaged group, women involved in the criminal justice system. This study will tell us not only about the chasm between women's understanding of Pap events and actual medical encounters, but will also speak more generally to this population's experience with health care access, given their movement in and out of the criminal justice system.