Sexual Health Empowerment for Jail-Involved Women's Health Literacy and Prevention

摘要 在过去的35年里，监狱和监狱中的妇女人数增加了700%。 这些女性大多是有色人种，有普遍的创伤病史、精神健康问题和吸毒， 所有这些都损害了他们从事预防性健康行为的能力。在过去的八年里，我们 研究小组研究了出狱的女性以及她们患宫颈癌的可能性是女性的4-5倍的原因 癌症，一种50多年来一直没有改变的差异。性健康的初衷 宫颈健康知识和预防计划赋权(SHE)(R01 CA181047)是为了评估 以监狱为基础的干预措施在增加宫颈健康知识和筛查方面的有效性。她增加了 被监禁妇女的宫颈健康素养和出狱后的癌症筛查率。 在分娩SHE时，我们观察到：1)妇女健康风险因素的交叉性，即风险 因宫颈癌而入狱的女性也可能导致其他女性的健康问题； 采取循证干预的机会，具有丰富的理论框架，以扩展到其他 这个群体面临的女性健康问题，围绕着，不仅是宫颈癌预防，还有乳腺癌， 意外怀孕和性传播感染预防。出狱后跟踪妇女(85%的随访率 三年后)，我们还确定了通过电子方式接触到这一高危人群的策略 沟通。她的参与者是手机(88%)、短信(76%)、网络(79%)和 Facebook(70%)。这一续签申请提供了一个全面解决健康差距的机会 出狱妇女的经历，并测试新的干预交付方式，因为她们使用电子产品 通信和社交媒体。 在我们的第一个目标，我们将评估的可行性和试点效果的妇女，一个电子产品 妇女健康素养干预，妇女出狱。第二个目标使用RCT来测试 SHE--妇女出狱对提高妇女的健康素养、筛查和 降低风险的做法(针对子宫颈癌、乳腺癌、意外怀孕和性传播感染) 关心。我们的第三个目标将是了解人类交互在电子干预中的作用和影响 跟踪参与者并采访关键的利益相关者。从这项研究中获得的知识将导致 了解：1)全面的妇女健康素养干预如何缩小健康差距 2)人与人的互动在成功的电子干预中的作用， 从而创建了传播健康促进干预措施的可持续模式。

ABSTRACT 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.