Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women

Megha Ramaswamy, Jaehoon Lee, Joi Wickliffe, Molly Allison, Amanda Emerson, Patricia J Kelly, Megha Ramaswamy, Jaehoon Lee, Joi Wickliffe, Molly Allison, Amanda Emerson, Patricia J Kelly

Abstract

Jailed women are four-five times more likely to have had cervical cancer compared to women without criminal justice histories. Previous research has shown that an important contributor to cervical cancer risk, and perhaps lack of follow-up, is incarcerated women's low health literacy about broader reproductive health issues. Little work has been done to address this disparity. Thus, the objective of this study was to test the effectiveness of an intervention to improve incarcerated women's cervical health literacy and ultimately address cervical cancer disparities. Using a waitlist control design, we compared changes in cervical health literacy (knowledge, beliefs, self-efficacy, and confidence for screening and follow-up) among 188 incarcerated women who completed a 10-hour intervention between 2014 and 2016 in three Kansas City jails. We used bivariate tests and multivariate analyses that controlled for baseline cervical health literacy level and key covariates. Women in the intervention group showed significant gains in seven out of eight cervical health literacy domains (all p < 0.01), whereas the control group only improved in one domain (p < 0.01). When controlling for covariates, the intervention group had less barriers, perceptions of seriousness, susceptibility to disease, and increased self-efficacy for cervical health screening and follow-up, compared to the control group (all p < 0.05). A brief intervention is an effective way to improve jailed women's cervical health literacy, but should be provided alongside systemic efforts that expand access to correctional preventive health services, including the human papillomavirus vaccine, community-based cancer screenings, and health insurance after women leave jails and transition back to communities.

Keywords: Cervical cancer; Cervical health literacy; Health literacy; Jails; Women's health.

Figures

Fig. 1
Fig. 1
Intervention participation flowchart. Notes. aFrom September 2014 to March 2016, we recruited participants in 26 cohorts. During each recruitment cohort, the average daily census at the jail was 38.9; an average of 10.9 participants were interested; and an average of 10.0 participants were recruited. Within each cohort, participants were randomly assigned to the intervention (average of 5.5 participants) or waitlist control group (average of 4.6 participants). bIf ≤ 5 participants were recruited during a cohort, then all participants were assigned to the intervention group.
Fig. 2
Fig. 2
Sexual Health Empowerment (SHE) Project intervention topics, delivery, outcomes. Note. More information about intervention development and content can be found in Ramaswamy et al. (2015). The intervention manual and training in delivery can also be requested at www.kumc.edu/she.
Fig. 3
Fig. 3
Cervical health literacy scores at pre-test (baseline) and post-test (post-intervention for intervention cases, pre-intervention for waitlist control cases). Legend. Black circles and lines represent the intervention group, and gray circles and lines represents the control group. Note. The intent-to-treat analysis on the primary outcomes includes 112 participants in the intervention group (participants who completed baseline and post-intervention survey) and 76 participants in the waitlist control group (participants who completed baseline and pre-intervention survey).

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