title: Challenges to Pap Smear Follow-up among Women in the Criminal Justice System.
abstract: Women involved in the United States criminal justice system face a variety of challenges in maintaining their health. Histories of sexual abuse, early initiation of sex, and substance abuse are reflected in more negative reproductive health outcomes, including cervical cancer, than those found among non-incarcerated women. Little is known about how to close this health gap. The present study assessed what incarcerated women perceived to be facilitators and inhibitors of obtaining recommended follow-up for abnormal Pap tests. In-depth individual interviews were conducted with 44 women in an urban county jail about experiences with Pap tests and how they followed-up on abnormal results. We analyzed data using the process of thematic content analysis. Four themes were found, Pap test abnormality as an all-inclusive phrase for women's health problems, unstable lives, the structural challenges of money, and competing demands. Women with criminal justice histories have numerous and complex challenges in following-up abnormal Pap test results, as well as other health problems. Understanding the context around the follow-up for abnormal Pap tests in this population may increase providers' ability to help women effectively obtain cancer prevention care that can be life-saving, as well as to more effectively provide care for other health problems.
authors.affiliation: School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA. kellypj@umkc.edu.
authors.forename: Patricia J
authors.identifier: http://orcid.org/0000-0002-8143-7153
authors.initials: PJ
authors.lastname: Kelly
authors.affiliation: School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hunter
authors.affiliation: Department of Family Medicine, Banner University Medical Center, Phoenix, AZ, USA.
authors.forename: Elizabeth Brett
authors.initials: EB
authors.lastname: Daily
authors.affiliation: Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Megha
authors.initials: M
authors.lastname: Ramaswamy
mesh_terms: D000328:Adult; D003416:Criminal Law; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D065006:Papanicolaou Test / Q000523:psychology; D011329:Prisoners / Q000523:psychology; D036301:Qualitative Research; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D055815:Young Adult
keywords: Cervical cancer prevention; Incarcerated populations; Qualitative research; Women’s health