Sociodemographic predictors of cervical cancer screening in women with a medical disability

Factors Associated with Lack of Health Screening among People with Disabilities Using Andersen's Behavioral Model

People with disabilities often have poorer health than the general population, and many do not participate in preventive care. This study aimed to identify the health screening participation rates of such individuals and investigate why they did not receive preventive medical services based on Andersen's behavioral model, using data from the Survey on Handicapped Persons with Disabilities. The non-participation health screening rate for people with disabilities was 69.1%. Many did not in health screening because they showed no symptoms and were considered healthy, in addition to poor transportation service and economic limitations. The binary logistic regression result indicates that younger age, lower level education, and unmarried as predisposing characteristics; non-economic activity as the enabling resources; and no chronic diseases, severe disability grade, and suicidal ideation as need factor variables were the strongest determinants of non-participation health screening. This indicates that health screening of people with disabilities should be promoted while takings into account the large individual differences in socioeconomic status and disability characteristics. It is particularly necessary to prioritize ways to adjust need factors such as chronic disease and mental health management, rather than focusing on uncontrollable predisposing characteristics and enabling resources among barriers to participation in health screening for people with disabilities.

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

OBJECTIVE

The objective was to determine population-based estimates of use of contraception among women 15-44 years of age in the United States by disability status.

STUDY DESIGN

We examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011-2015 National Survey of Family Growth.

RESULTS

After examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12-2.12) and physical disabilities (aOR=1.59, CI=1.08-2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40-0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36-2.66).

CONCLUSIONS

Self-reported cognitive disabilities ("serious difficulty concentrating, remembering or making decisions"), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use.

IMPLICATIONS

The patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals.