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Orji AF, Roess AA. Assessing Disparities in Cervical Cancer Screening with Pap Test by Disability Types. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:39-49. [PMID: 37782432 DOI: 10.1007/s13187-023-02373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
Prior research has found that women with disabilities have often experienced disparities in receipt of cervical cancer screening. However, there is a research gap regarding receipt of cervical cancer screening by types of disability. This study examined the differences in receiving cervical cancer screening through self-reported Pap testing among women by disability type. This cross-sectional study analyzed data from the 2016, 2018, and 2020 Behavioral Risk Factor and Surveillance System (BRFSS). The relative risk of cervical cancer screening through self-reported Pap tests received within the past three years among women aged 21-65 by disability type was compared using modified Poisson regression with robust error variance. A total of 307,142 women from across the USA were sampled. In every disability group, older women were significantly less likely to receive Pap tests than their counterparts without disabilities. Women with multiple disabilities (aRR=0.91; 95% CI, 0.89-0.94) and those with ambulatory disabilities (aRR=0.93; 95% CI, 0.91-0.97) reported being less likely to receive Pap tests than women with no disability. Ambulatory disability and multiple disabilities are associated with a lower likelihood of cervical cancer screening with Pap test, increasing the need to eliminate disability-specific disparities in Pap testing. Future efforts should focus on improving cancer education programs tailored to the needs of women with disabilities, addressing barriers related to mobility and access to healthcare services, and ensuring equitable access to preventive screenings.
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Affiliation(s)
- Amarachukwu F Orji
- Department of Global and Community Health, George Mason University, 4400 University Drive, Peterson Hall, Fairfax, VA, Fairfax, VA, 22030, USA.
| | - Amira Albert Roess
- Department of Global and Community Health, George Mason University, 4400 University Drive, Peterson Hall, Fairfax, VA, Fairfax, VA, 22030, USA
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Goldstein J, Robinson JL, Hart MH, Nallamothu N, Ohl SV, Wiener JS, Streur CS. Codevelopment of an illustration representative of people living with spina bifida for health educational materials. Disabil Health J 2023; 16:101475. [PMID: 37142458 PMCID: PMC10335040 DOI: 10.1016/j.dhjo.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The lack of health education resources specific to people with disabilities contributes to disparities in outcomes. Developing user-centered materials with representative images tailored to people with disabilities could help improve knowledge and outcomes. OBJECTIVE As a first step in developing an online sexual health resource for adolescents with physical disabilities, we sought end-user feedback to create illustrated characters for use in educational materials. METHODS Two styles of characters were developed by the research team, which included a professional disability artist. Verbal and online survey feedback was obtained at the Spina Bifida Association's Clinical Care Conference. A new image was created incorporating initial feedback. The new image and favored image from the first round were then tested through an online survey advertised on the Spina Bifida Association's Instagram story feed. Open-ended comments were organized by categories and overlapping themes. RESULTS Feedback was obtained from 139 audience members and 25 survey respondents from the conference and 156 Instagram survey respondents. Themes included depiction of disability, nondisability diversity, other physical appearance, emotional response, and design style. Most frequently, participants suggested the inclusion of characters with a range of accurately depicted mobility aids and of characters without mobility aids. Participants also wanted a larger, more diverse group of happy, strong people of all ages. CONCLUSIONS This work culminated in the codevelopment of an illustration that represents how people impacted by spina bifida view themselves and their community. We anticipate that using these images in educational materials will improve their acceptance and effectiveness.
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Affiliation(s)
- Jenna Goldstein
- University of Michigan Medical School, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | | | - Mieke H Hart
- University of Michigan, Ann Arbor, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | - Neela Nallamothu
- University of Michigan, Ann Arbor, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | - Sydney V Ohl
- Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - John S Wiener
- Department of Urology, Duke University, 2301 Erwin Rd. Durham, North Carolina 27710, USA; Department of Surgery, Duke University, 2301 Erwin Rd. Durham, North Carolina 27710, USA
| | - Courtney S Streur
- Department of Urology, University of Michigan, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA.
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Chen CY, Kung PT, Chiu LT, Tsai WC. Comparison of Cervical Cancer Screening Used between Individuals with Disabilities and Individuals without Disabilities. Healthcare (Basel) 2023; 11:healthcare11101363. [PMID: 37239649 DOI: 10.3390/healthcare11101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Cervical cancer is the fourth most prevalent cancer in women worldwide. It is vital to achieve a high cervical cancer screening rate among women. We compared the Pap smear test (PST) used between individuals with disabilities and those without disabilities in Taiwan. METHODS Individuals registered in the Taiwan Disability Registration File and the National Health Insurance Research Database (NHIRD) were screened for this nationally representative retrospective cohort study. Women aged 30 and above in 2016 and who were still alive in 2016 were matched in a 1:1 ratio via propensity score matching (PSM); 186,717 individuals with disabilities and 186,717 individuals without disabilities were included. Controlling for relevant variables, the odds of receiving PST were compared using conditional logistic regression analysis. RESULTS A lower percentage of individuals with disabilities (16.93%) received PST than those without disabilities (21.82%). The odds of individuals with disabilities receiving PST were 0.74 times that of individuals without disabilities (OR = 0.74, 95% CI = 0.73-0.76). Compared to individuals without disabilities, individuals with intellectual and developmental disabilities had the lower odds of receiving PST (OR = 0.38, 95% CI = 0.36-0.40), followed by individuals with dementia (OR = 0.40, 95% CI = 0.33-0.48) or multiple disabilities (OR = 0.52, 95% CI = 0.49-0.54). CONCLUSIONS We highly recommend that healthcare practitioners recognize the unique needs of individuals with different types of disabilities, especially those with cognitive impairments.
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Affiliation(s)
- Chia-Yu Chen
- Graduate Institute of Public Health, China Medical University, Taichung 406040, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
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Experiences, Barriers, and Facilitators to Sexual and Reproductive Health Care Access of People with Sensory Impairments: A Scoping Review. SEXUALITY AND DISABILITY 2023. [DOI: 10.1007/s11195-023-09778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Zanwar PP, Davis MM, Horner-Johnson W. Assessing Intersectional Disparities in Cervical Cancer Screening by Disability Status, Race, and Ethnicity. AJPM FOCUS 2022; 1:100019. [PMID: 37791247 PMCID: PMC10546533 DOI: 10.1016/j.focus.2022.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Separate bodies of research have studied disparities by disability status and by race or ethnicity in receipt of cervical cancer screening. Much less is known about how these disparities intersect. The purpose of this study was to evaluate disparities in compliance with the U.S. Preventive Services Task Force guidelines for Pap testing in age-eligible women at the intersection of disability and race or ethnicity. Methods We conducted cross-sectional analyses of the Medical Expenditure Panel Survey Household Component deidentified public data files pooled for years 2007-2016, using a modified Poisson regression analysis to compute prevalence ratios for being up to date with Pap testing by disability status and race or ethnicity. We also calculated predicted marginal proportions adjusting for demographic and socioeconomic covariates. Results The analytic sample included 68,507 women with nonmissing covariates; 15.6% had a disability. Overall, the proportion current with Pap testing was significantly lower among women with disabilities than among those without disabilities (82.1% vs 88.6%, p<0.0001). Furthermore, within each racial and ethnic group, women with disabilities were less likely than those without disabilities to be current with Pap testing. In adjusted analyses, prevalence ratios for White women with disabilities (adjusted prevalence ratio=0.94; 95% CI=0.92, 0.96) and other race women with and without disabilities (adjusted prevalence ratio=0.91; 95% CI=0.86, 0.95 and adjusted prevalence ratio=0.91; 95% CI=0.89, 0.95, respectively) were significantly below those for the reference group of White women without disabilities. Hispanic women with disabilities did not differ significantly from White women without disabilities, and Black women with disabilities had significantly higher adjusted prevalence ratios than White women without disabilities (adjusted prevalence ratio=1.07; 95% CI=1.05, 1.09). When taking covariates into account, the proportion of Black women with disabilities current with screening was only slightly lower than the estimated proportion for Black women without disabilities (92% vs 93%). The gap in screening between White women with and without disabilities narrowed somewhat (from 9 percentage points to 4 percentage points) but remained significant. Conclusions Our results extend previous research focused separately on disability or race and ethnicity. Women with disabilities in all racial and ethnic groups fell short of Healthy People 2020 goals for cervical cancer screening.
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Affiliation(s)
- Preeti Pushpalata Zanwar
- Applied Health Economics & Outcomes Research & Health Policy, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
- NIA Funded Network on Life Course Health Dynamics & Disparities, University of Southern California, Los Angeles, California
| | - Melinda M. Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon
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Baruch L, Bilitzky-Kopit A, Rosen K, Adler L. Cervical Cancer Screening Among Patients with Physical Disability. J Womens Health (Larchmt) 2022; 31:1173-1178. [PMID: 35072543 PMCID: PMC9419959 DOI: 10.1089/jwh.2021.0447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Pap smear has a central role in cervical cancer screening. Previous studies have found that female patients with disabilities are less likely to receive a Pap smear as recommended by guidelines. The aim of our study was to examine the association between physical disability and Pap smear receipt in Israel. Methods: This cross-sectional study was conducted using the electronic medical records of the second largest health care maintenance organization in Israel. All female patients during 2012–2017 aged 25–65 were identified. The exposure variable was physical disability, and the outcome variable was Pap smear receipt. We used logistic regression to control for covariates. Results: A total of 391,259 patients were eligible for this study, 6,720 (1.7%) with physical disability. 56.7% of patients with disabilities had received Pap smear compared to 63.3% of patients without disabilities, odds ratio (OR) 0.76, 95% confidence interval [CI] 0.72–0.80. When adjusting to sociodemographic and clinical covariates, patients with disabilities were less likely to receive Pap smear, adjusted OR 0.83, 95% CI 0.79–0.88. For all patients, older age, lower socioeconomic status, religious minorities, cardiovascular disease, type-2 diabetes mellitus, hypertension, smoking, and obesity were associated with lower odds of receipt of Pap smear. A history of nongynecologic oncologic disease was associated with increased odds of Pap smear receipt. Conclusion: Our study highlights the disparities between patients with and without physical disability with regard to screening for cervical cancer by receipt of Pap smear. Creating an appropriate practice with adequate access to patients with disability should be a focus for health care providers and policy makers.
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Affiliation(s)
- Lior Baruch
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Lior Baruch, MD, Founder of HealthyHer-Feminist Medicine, integrating intersectional feminism in medical practice. A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in women's and LGBTQI+ health and in reducing health disparities
| | - Avital Bilitzky-Kopit
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Avital Bilitzky-Kopit, MD, MPH, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in nutrition interventions and public health
| | - Keren Rosen
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Keren Rosen, MD, A resident in the department of family medicine in Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel. Interested in immunology, preventive medicine, and women's health
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel.,Limor Adler, MD, A specialist in Family Medicine in the Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Works as a family physician in Maccabi Health care Services. Interested in community health research, addiction medicine, and women's health
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Bouza B, Hammig B, Schaefer Whitby P. Physicians’ Experiences of Recommending the HPV Vaccine to Females with an Intellectual Disability. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Iezzoni LI, Rao SR, Agaronnik ND, El-Jawahri A. Associations Between Disability and Breast or Cervical Cancers, Accounting for Screening Disparities. Med Care 2021; 59:139-147. [PMID: 33201087 PMCID: PMC7855335 DOI: 10.1097/mlr.0000000000001449] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Studies suggest that women with disability experience disparities in routine, high-value screening services, including mammograms and Papanicolaou (Pap) tests. However, few studies have explored whether women with disability have higher risks than other women of developing breast or cervical cancers. METHODS The authors analyzed 2010, 2013, 2015, and 2018 National Health Interview Surveys, which involved civilian, noninstitutionalized US residents, and included supplemental surveys on cancer screening. The authors used self-reported functional status limitations to identify women without disability and women with movement difficulties (MDs) or complex activity limitations (CAL) predating breast or cervical cancer diagnoses. Multivariable models evaluated associations of disability status to cancer diagnosis, adjusting for other variables. Analyses used sampling weights, producing national estimates. RESULTS The sample included 66,641 women; 24.4% reported MD and 14.5% reported CAL. Compared with women without disability, women with pre-existing MD or CAL had significantly higher rates of breast cancer (2.2% vs. 3.5% and 3.6%, respectively) and cervical cancer (0.6% vs. 0.8% and 1.0%, respectively). Women with disability had significantly lower recent mammography and Pap test rates than women without disability. After adjusting for all covariates, the values for odds ratio (95% confidence interval) of pre-existing CAL for cancer diagnoses were 1.21 (1.01-1.46; P=0.04) for breast cancer and 1.43 (1.04-1.99; P=0.03) for cervical cancer. CONCLUSIONS Pre-existing disability is associated with a higher likelihood of breast and cervical cancer diagnoses, raising the urgency of eliminating disability disparities in mammography and Pap testing. Further research will need to explore the causes of these higher cancer rates.
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Affiliation(s)
- Lisa I Iezzoni
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
| | - Sowmya R Rao
- Massachusetts General Hospital Biostatistics Center
- Boston University School of Public Health
| | - Nicole D Agaronnik
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School
- Division of Hematology/Oncology and Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
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Lee MS, Peart JR, Armin JS, Williamson HJ. A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2021; 14:25-56. [PMID: 38550304 PMCID: PMC10978025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Background Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. Aim The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. Method A scoping review was conducted where the research team searched United States academic literature from 1990 through February 2020 in PubMed, Medline, and CINAHL using general subject headings for disability, mental illness, and Pap testing. Results Thirty-two articles met inclusion criteria. More barriers than facilitators were mentioned in articles. Barriers and facilitators are organized into three groups according to social ecological model and include individual (e.g., socioeconomic status, anxiety, education), interpersonal (e.g., family, living environment), and organizational factors (health care provider training, health care system). Participant's race/ethnicity were often reported but minoritized populations were often not the focus of articles. Conclusions More articles discussed the difficulties that women with disabilities and women with serious mental illnesses face with receiving a Pap test than facilitators to Pap testing. Additional research should focus on the intersectionality race/ethnicity and women with disabilities and women with serious mental illnesses in relation to Pap testing.
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Affiliation(s)
- Michele Sky Lee
- The Institute for Human Development, Northern Arizona University
| | | | - Julie S Armin
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona
| | - Heather J Williamson
- Center for Health Equity Research and Department of Occupational Therapy, Northern Arizona University
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Horner-Johnson W, Akobirshoev I, Amutah-Onukagha NN, Slaughter-Acey JC, Mitra M. Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity. Womens Health Issues 2021; 31:65-74. [PMID: 33234388 PMCID: PMC7775679 DOI: 10.1016/j.whi.2020.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity. METHODS We analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18-44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS In every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57-2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19-1.41) and Black race alone (PR, 1.47; 95% CI, 1.36-1.58). CONCLUSIONS Women at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.
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Affiliation(s)
- Willi Horner-Johnson
- Department of Pediatrics, Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon; Oregon Health & Science University-Portland State University Collaborative School of Public Health, Portland, Oregon.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | | | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Pearson J, Payne D, Yoshida K, Garrett N. Access to and engagement with cervical and breast screening services for women with disabilities in Aotearoa New Zealand. Disabil Rehabil 2020; 44:1984-1995. [PMID: 32931340 DOI: 10.1080/09638288.2020.1817158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ). METHOD We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening. RESULTS Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information. CONCLUSIONS This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening.Implications for rehabilitationRehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening.Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients.Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results.For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities.
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Affiliation(s)
- Janet Pearson
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Payne
- Department of Nursing, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Karen Yoshida
- Department of Physical Therapy, Social & Behavioural Health Sciences Division, Rehabilitation Sciences Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nicholas Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Gender and Sex Considerations in Traumatic Brain Injury. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Socio-demographic Characteristics and Use of Pap Smear for Cervical Cancer Screening Among Women of Eastern Part of India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kilic A, Tastan S, Guvenc G, Akyuz A. Breast and cervical cancer screening for women with physical disabilities: A qualitative study of experiences and barriers. J Adv Nurs 2019; 75:1976-1986. [PMID: 31087581 DOI: 10.1111/jan.14048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/20/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Abstract
AIM To determine the experiences of women with physical disabilities regarding the barriers to their participation in breast and cervical cancer screening. DESIGN Qualitative descriptive study. METHOD Sixteen women who use wheelchairs were recruited. Data were collected via semi-structured face-to-face interviews between January - March 2017. Interviews were transcribed and data were analysed thematically. RESULTS Three main themes were uncovered: (a) Personal factors; such as lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others; (b) Environmental and structural factors; and (c) expectations and suggestions of women with disabilities to enable their participation in screening. CONCLUSION The participation rate of women with physical disabilities in screening is low. The participation of women with disabilities in breast and cervical cancer screening may increase if physical barriers to accessing healthcare services are removed, appropriate and less time-consuming examination conditions are met, and healthcare personnel are informed about the needs of persons with disabilities. IMPACT Knowing the barriers for women with physical disabilities to participate in cancer screening can help health professionals develop new procedures to increase their participation to cancer screening. Women with physical disabilities encountered various barriers such as; lack of knowledge, fear and embarrassment, feeling anxious about the examination process and dependency on others, access to the healthcare services, environmental, physical limitations, and inadequate knowledge of healthcare professional about their disability. This study will guide healthcare professionals in developing strategies to increase the participation of women with physical disabilities in screening.
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Affiliation(s)
- Ayse Kilic
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Sevinc Tastan
- Health Sciences Faculty, Nursing Department, Eastern Meditarrenean University, Fagamusta, Turkey
| | - Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Aygul Akyuz
- Florance Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Thakral M, Lacroix AZ, Molton IR. Sex/gender disparities in health outcomes of individuals with long-term disabling conditions. Rehabil Psychol 2019; 64:221-228. [PMID: 30299140 PMCID: PMC6453755 DOI: 10.1037/rep0000248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Women with disabling conditions experience health disparities relative to nondisabled women, but few studies have compared women and men with disabling conditions. OBJECTIVES To investigate gender differences in physical functioning and emotional health among individuals with long-term disabling conditions, that is, neuromuscular disease, multiple sclerosis, postpolio syndrome, or spinal cord injury. METHOD From a mailed survey of 1,862 adults with long-term disabling conditions, we used the 12-item Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning to assess physical limitations in activities and Patient Health Questionnaire-9 (PHQ-9) for emotional health and severity of secondary conditions (rated 0-10). Least square means models were used to estimate marginal mean PHQ-9 scores and severity of secondary conditions by age and sex adjusted for diagnosis. Generalized linear models were performed to determine the association between sex/gender and PROMIS physical function t score, controlling for age and diagnostic group with potential Age × Sex interaction. RESULTS Women reported more fatigue than men (5.48 ± .08 vs. 5.13 ± .11, p = .01) and more pain (3.99 ± .08 vs. 3.67 ± .11, p = .03). Women aged 45-54 had higher average PHQ-9 scores than men aged 45-54 (M = 8.05, SE = .33 vs. M = 6.35, SE = .42, p < .007) adjusted for diagnosis. Younger women had higher physical functioning than younger men while older women had lower physical functioning than older men adjusted for diagnostic group (p = .0003 for the interaction term). CONCLUSION Middle-aged and older women with long-term disabling conditions experience considerable health disparities in physical functioning and emotional health compared with middle-aged and older men with similar conditions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Manu Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle WA
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA
| | - Andrea Z. Lacroix
- Kaiser Permanente Washington Health Research Institute, Seattle WA
- Divisions of Epidemiology and Family Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ivan R. Molton
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
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Abstract
Women with disabilities are underscreened for cervical cancer compared with the general population, likely because, in part, of both emotional and physical challenges associated with Pap testing. Women with certain disabilities often require an examination under anesthesia to undergo a speculum examination. However, anesthesia is not without risks and the perioperative experience can be burdensome to patients and caregivers. Either self-collected or provider-collected samples for human papillomavirus (HPV) testing might be better tolerated by patients, and recent evidence suggests that it is a suitable primary screening strategy. The Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology published an Interim Guidance Report outlining using primary HPV testing as an option for women 25 years and older. More recently, the US Preventive Services Task Force released a recommendation statement that included the option to use oncogenic HPV testing alone for women aged 30 to 65 years. We encourage clinical researchers and professional organizations to evaluate primary HPV screening among women with disabilities to advise providers about how to best perform cervical cancer screening without the need for a speculum examination. We cannot ignore the screening disparity experienced by this population, and advocating for screening approaches that reduce patient and caregiver burden would be a step in the right direction.
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Tilley L, Yarger J, Brindis CD. Young Adults Changing Insurance Status: Gaps in Health Insurance Literacy. J Community Health 2018; 43:680-687. [DOI: 10.1007/s10900-018-0469-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Obstacles to preventive care for individuals with disability. J Am Assoc Nurse Pract 2017; 29:282-293. [DOI: 10.1002/2327-6924.12449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/11/2017] [Indexed: 11/07/2022]
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Steele CB, Townsend JS, Courtney-Long EA, Young M. Prevalence of Cancer Screening Among Adults With Disabilities, United States, 2013. Prev Chronic Dis 2017; 14:E09. [PMID: 28125399 PMCID: PMC5268742 DOI: 10.5888/pcd14.160312] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Many studies on cancer screening among adults with disabilities examined disability status only, which masks subgroup differences. We examined prevalence of receipt of cancer screening tests by disability status and type. Methods We used 2013 National Health Interview Survey data to assess prevalence of 1) guideline-concordant mammography, Papanicolaou (Pap) tests, and endoscopy and stool tests; 2) physicians’ recommendations for these tests; and 3) barriers to health-care access among adults with and without disabilities (defined as difficulty with cognition, hearing, vision, or mobility). Results Reported Pap test use ranged from 66.1% (95% confidence interval [CI], 60.3%–71.4%) to 80.2% (95% CI, 72.4%–86.2%) among women with different types of disabilities compared with 81.4% (95% CI, 80.0%–82.7%) among women without disabilities. Prevalence of mammography among women with disabilities was also lower (range, 61.2% [95% CI, 50.5%–71.0%] to 67.5% [95% CI, 62.8%–71.9%]) compared with women without disabilities (72.8% [95% CI, 70.7%–74.9%]). Screening for colorectal cancer was 57.0% among persons without disabilities, and ranged from 48.6% (95% CI, 40.3%–57.0%) among those with vision limitations to 64.6% (95% CI, 58.5%–70.2%) among those with hearing limitations. Receiving recommendations for Pap tests and mammography increased all respondents’ likelihood of receiving these tests. The most frequently reported barrier to accessing health care reported by adults with disabilities was difficulty scheduling an appointment. Conclusion We observed disparities in receipt of cancer screening among adults with disabilities; however, disparities varied by disability type. Our findings may be used to refine interventions to close gaps in cancer screening among persons with disabilities.
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Affiliation(s)
- C Brooke Steele
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F76, Atlanta, GA 30341. E-mail:
| | - Julie S Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth A Courtney-Long
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monique Young
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Xu X, Mann JR, Hardin JW, Gustafson E, McDermott SW, Deroche CB. Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury. J Spinal Cord Med 2017; 40:76-84. [PMID: 27077580 PMCID: PMC5376149 DOI: 10.1080/10790268.2016.1153293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
CONTEXT Women with spinal cord injury (SCI) may face barriers that result in disparities in receipt of recommended mammography and Papanicolaou testing. SETTING South Carolina. PARTICIPANTS South Carolina women with SCI were identified using International Classification of Diseases codes in 2000-2010 Medicaid and Medicare billing data. OUTCOME MEASURES Receipt of mammography and Pap testing was determined using procedure billing codes. Partial proportional odds models were estimated to examine the association between SCI and adherence with screening recommendations from the United States Preventive Services Task Force. Each individual's screening experience was classified as full adherence, partial adherence, or no screening. RESULTS The cohort for mammography consisted of 3,173 women with SCI and 6,433 comparison women without SCI. The cohort for Pap testing consisted 5,025 women with SCI and 9,538 comparison women. Women with SCI were less likely to have full adherence with mammography recommendations (aOR = 0.69, 95% CI 0.64, 0.76) and Pap test recommendations (aOR = 0.53, 95% CI 0.49, 0.57). They were more likely to have no mammography screening (aOR = 1.44, 95% CI 1.33, 1.57) and no Pap testing (aOR = 1.89, 95% CI 1.77, 2.03) than women without SCI. CONCLUSION Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.
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Affiliation(s)
- Xinling Xu
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Joshua R. Mann
- Department of Preventive Medicine. University of Mississippi Medical Center, Jackson, MS, USA
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Erin Gustafson
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Suzanne W. McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA,Correspondence to: Suzanne W. McDermott, Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Chelsea B. Deroche
- Biostatistics and Research Design Unit, University of Missouri Columbia School of Medicine, Columbia, MO, USA
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Horner-Johnson W, Darney BG, Kulkarni-Rajasekhara S, Quigley B, Caughey AB. Pregnancy among US women: differences by presence, type, and complexity of disability. Am J Obstet Gynecol 2016; 214:529.e1-529.e9. [PMID: 26546851 DOI: 10.1016/j.ajog.2015.10.929] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Approximately 12% of women of reproductive age have some type of disability. Very little is known about sexual and reproductive health issues among women with disabilities, including what proportion of women with disabilities experience pregnancy. Data on pregnancy are important to inform needs for preconception and pregnancy care for women with disabilities. OBJECTIVE The purpose of this study was to describe the occurrence of pregnancy among women with various types of disability and with differing levels of disability complexity, compared with women without disabilities, in a nationally representative sample. STUDY DESIGN We conducted cross-sectional analyses of 2008-2012 Medical Expenditure Panel Survey annualized data to estimate the proportion of women aged 18-44 years with and without disabilities who reported a pregnancy during 1 year of participation on the survey panel. We used a multivariable logistic regression to test the association of pregnancy with presence, type, and complexity of disability, controlling for other factors associated with pregnancy. RESULTS Similar proportions of women with and without disabilities reported a pregnancy (10.8% vs 12.3%, with 95% confidence intervals overlapping). Women with the most complex disabilities (those that impact activities such as self-care and work) were less likely to have been pregnant (adjusted odds ratio, 0.69, 95% confidence interval, 0.52-0.93), but women whose disabilities affected only basic actions (seeing, hearing, movement, cognition) did not differ significantly from women with no disabilities. CONCLUSION Women with a variety of types of disabilities experience pregnancy. Greater attention is needed to the reproductive health care needs of this population to ensure appropriate contraceptive, preconception, and perinatal care.
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Iezzoni LI, Kurtz SG, Rao SR. Trends in Pap Testing Over Time for Women With and Without Chronic Disability. Am J Prev Med 2016; 50:210-9. [PMID: 26372417 DOI: 10.1016/j.amepre.2015.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Data from 20 years ago--shortly after passage of the Americans with Disabilities Act--showed that women with significant mobility disability had 40% lower Pap test rates than other women. METHODS To examine whether disability disparities in Pap test rates have diminished over time, this study analyzed National Health Interview Survey responses from selected years between 1998 and 2010 from women aged 21-65 years without histories of cervical cancer or hysterectomy. Seven chronic disability types were identified using self-reported functional impairments or participation limitations. Self-reported Pap testing within the previous 3 years was studied. Bivariable analyses and multivariable logistic regression analyses controlling for sociodemographic variables were conducted in 2014. RESULTS Rates of all chronic disability types increased over time. Pap test rates remained relatively constant over time for all women, holding around 84%-87%. Bivariable analyses found statistically significantly lower rates of Pap testing for women with disability compared with nondisabled women. Multivariable analyses failed to find consistent evidence of lower Pap test rates among women across disability types compared with nondisabled women. In 2010, the AOR for reporting Pap testing for women noting the most severe movement difficulty compared with nondisabled women was 0.35 (95% CI=0.15, 0.79). However, the AOR for this disability type varied over time. CONCLUSIONS Little has changed over time in Pap test rates for all women. Women with certain disabilities continue to experience disparities compared with nondisabled women in receipt of this important screening test.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Stephen G Kurtz
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sowmya R Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
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McColl MA, Aiken A, Schaub M. Do people with disabilities have difficulty finding a family physician? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4638-51. [PMID: 25927477 PMCID: PMC4454931 DOI: 10.3390/ijerph120504638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC) is a government-funded agency in Ontario Canada, designed to "help Ontarians who are without a family health care provider to find one". Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients.
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Affiliation(s)
- Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L-3N6, Canada.
- Centre for Health Services & Policy Research, Queen's University, Kingston, ON K7L-3N6, Canada.
| | - Alice Aiken
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L-3N6, Canada.
| | - Michael Schaub
- Centre for Health Services & Policy Research, Queen's University, Kingston, ON K7L-3N6, Canada.
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Hamilton JG, Breen N, Klabunde CN, Moser RP, Leyva B, Breslau ES, Kobrin SC. Opportunities and challenges for the use of large-scale surveys in public health research: a comparison of the assessment of cancer screening behaviors. Cancer Epidemiol Biomarkers Prev 2015; 24:3-14. [PMID: 25300474 PMCID: PMC4294943 DOI: 10.1158/1055-9965.epi-14-0568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Large-scale surveys that assess cancer prevention and control behaviors are a readily available, rich resource for public health researchers. Although these data are used by a subset of researchers who are familiar with them, their potential is not fully realized by the research community for reasons including lack of awareness of the data and limited understanding of their content, methodology, and utility. Until now, no comprehensive resource existed to describe and facilitate use of these data. To address this gap and maximize use of these data, we catalogued the characteristics and content of four surveys that assessed cancer screening behaviors in 2005, the most recent year with concurrent periods of data collection: the National Health Interview Survey, Health Information National Trends Survey, Behavioral Risk Factor Surveillance System, and California Health Interview Survey. We documented each survey's characteristics, measures of cancer screening, and relevant correlates; examined how published studies (n = 78) have used the surveys' cancer screening data; and reviewed new cancer screening constructs measured in recent years. This information can guide researchers in deciding how to capitalize on the opportunities presented by these data resources.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Nancy Breen
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Carrie N Klabunde
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Richard P Moser
- Science of Research and Technology Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Bryan Leyva
- Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Erica S Breslau
- Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Sarah C Kobrin
- Process of Care Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
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Yen SM, Kung PT, Tsai WC. Sociodemographic characteristics and health-related factors affecting the use of Pap smear screening among women with mental disabilities in Taiwan. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:491-497. [PMID: 25462509 DOI: 10.1016/j.ridd.2014.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
This study examined the use of the Pap cervical cancer screening test among women with mental disabilities in Taiwan and analyzed factors related thereto. Data were obtained from three national databases in Taiwan: the 2008 database of physically and mentally disabled persons from the Ministry of the Interior, 2007-2008 Pap smear test data from the Health Promotion Administration, and claims data from the National Health Insurance Research Database. The study subjects included 49,642 Taiwanese women aged ≥30 years with mental disabilities. Besides descriptive and bivariate analyses, logistic regression analysis was also performed to examine factors affecting Pap smear use. In 2007-2008, Taiwanese women with mental disabilities had a Pap screening rate of 11.05%. Age, income, education, marital status, catastrophic illness/injury, relevant chronic illnesses, and severity of disability were identified as factors affecting their Pap smear use. Age and severity of disability were negatively correlated with Pap screening, with the odds of screening being 0.37 times as high in ≥70-year-olds as in 30-39-year-olds and 0.49 times as high for very severe disability as for mild disability. Income was positively correlated with Pap screening. Being married (OR=2.55) or divorced or widowed (OR=2.40) relative to being unmarried, and having a catastrophic illness/injury (OR=1.13), cancer (OR=1.47), or diabetes (OR=1.25), were associated with greater odds of screening. In Taiwan, women with mental disabilities receive Pap smears at a far lower rate than women in general.
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Affiliation(s)
- Suh-May Yen
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Chinese Medicine, Nantou Hospital, Nantou, Taiwan, ROC.
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC.
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Shandra CL, Hogan DP, Short SE. Planning for motherhood: fertility attitudes, desires and intentions among women with disabilities. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:203-10. [PMID: 25209449 PMCID: PMC4268070 DOI: 10.1363/46e2514] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 05/23/2023]
Abstract
CONTEXT An estimated 10% of U.S. women of reproductive age report a current disability; however, the relationship between disability, motherhood attitudes and fertility intentions among these women is largely unknown. METHODS Data from the 2006-2010 National Survey of Family Growth were used to examine attitudes toward motherhood and fertility intentions among 10,782 U.S. women aged 15-44. A series of regression models assessed, separately for mothers and childless women, associations between disability status and women's attitudes and intentions. RESULTS Women with and without disabilities held similar attitudes toward motherhood. Among women without children, women with and without disabilities were equally likely to want a child and equally likely to intend to have one. However, childless women with disabilities who wanted and intended to have a child were more likely to report uncertainty about those intentions than were childless women without disabilities (odds ratio, 1.7). Mothers with disabilities were more likely to want another child (1.5), but less likely to intend to have a child (0.5), than were mothers without disabilities. CONCLUSIONS Deepening understanding of the reproductive health desires, needs and challenges of women with disabilities is essential if the highest quality reproductive health services are to be provided for all.
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Affiliation(s)
- Carrie L Shandra
- Department of Sociology, Core Faculty, Program in Public Health, State University of New York, Stony Brook.
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Carvalho CFDS, Brito RSD, Medeiros SMD. Contextual analysis of gynaecological care provided to women with physical disability. Rev Gaucha Enferm 2014; 35:114-7. [DOI: 10.1590/1983-1447.2014.04.45335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This is a theoretical-reflective study that aimed to analyze the contexts associated with gynaecological care for women with physical disabilities. Discussion consisted of contextual analysis according to Hinds, Chaves and Cypress, leading to four interconnected layers: immediate, specific, general and metacontext. Analysis showed that gynaecological assistance to clients with physical disabilities is influenced by attitudinal, structural, financial and informational barriers. Other influential issues are social beliefs and stigmas and the persistence of a biomedical model, which is hegemonic in this type of assistance. Therefore, gynaecological care must be valued based on the holistic paradigm offered by a transdisciplinary team in order to provide quality care to women with physical disabilities.
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Peterson-Besse JJ, O'Brien MS, Walsh ES, Monroe-Gulick A, White G, Drum CE. Clinical preventive service use disparities among subgroups of people with disabilities: A scoping review. Disabil Health J 2014; 7:373-93. [DOI: 10.1016/j.dhjo.2014.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/14/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Yen SM, Kung PT, Tsai WC. The characteristics and relevant factors of Pap smear test use for women with intellectual disabilities in Taiwan. BMC Health Serv Res 2014; 14:240. [PMID: 24890828 PMCID: PMC4048461 DOI: 10.1186/1472-6963-14-240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines the Pap smear usage conditions and relevant influential factors for 18,204 women aged 30 years and above with intellectual disabilities, using nationwide data from 2008. METHODS The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of Pap smear testing by women with intellectual disabilities. Chi-square test was used to assess the correlation between Pap smear test usage and several variables. Logistic regression analysis was employed to explore the factors that influence Pap smear test usage. RESULTS The results show that 4.83% (n =880) of women with intellectual disabilities underwent Pap smear tests. Pap smear test usage rates exhibit a declining trend with increases in age. Factors that significantly influence Pap smear test use include age, urbanization level of resident area, monthly salary, aboriginal status, marital status, existence of DM, severity of disability. CONCLUSIONS The women with intellectual disabilities had a low use rate of Pap smear test, which is significantly less than the 28.8% usage rate for the general population of women aged 30 years and above.
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Affiliation(s)
| | | | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No, 91 Hsueh-Shih Road, Taichung, Taiwan 40402, Republic of China.
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HPV vaccination in female children with special health care needs. J Pediatr Adolesc Gynecol 2013; 26:219-23. [PMID: 23726139 DOI: 10.1016/j.jpag.2013.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 02/26/2013] [Accepted: 03/14/2013] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE Potential barriers between parents of children with special health needs (CSHCN) and their health care providers in regards to the patient receiving a full course of the human papillomavirus (HPV) immunization are explored in this study. STUDY DESIGN Parents of female CSHCN between ages of 9-26 years completed a questionnaire asking about personal receptivity of vaccines and potential barriers to vaccinating their child against HPV. A separate survey was completed by members of the Wisconsin and Illinois chapters of the American Academy of Pediatrics about HPV vaccination practices provided to patients with special health care needs. SETTING Outpatient urban health clinic and the Children's Hospital of Wisconsin's Adolescent Medicine and Neurology clinics from January 2009-2010. RESULTS Seventeen parents completed the survey. Forty-seven percent of parents answered that their child's pediatrician had offered the HPV vaccine; 17% reported that their child was vaccinated against HPV. Most parents knew that HPV is a sexually transmitted infection, causes genital warts, and can cause abnormal pap smears. For the provider survey, 77 out of 130 respondents offer HPV vaccine as part of their practice and see CSHCN. Ninety percent have vaccinated CSHCN against HPV. CONCLUSIONS This study suggests that acceptability of the HPV vaccine is high for health care providers, but acceptability in parents of CSHCN is lower than in the general population. This study raises awareness that health care providers need to be aware of the possibility that parents of CSHCN may not perceive their child as needing or being offered the HPV vaccine.
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Preventive Health Care Among Community-Dwelling Persons with Spinal Cord Injury. PM R 2013; 5:496-502. [DOI: 10.1016/j.pmrj.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 10/12/2012] [Accepted: 11/02/2012] [Indexed: 11/20/2022]
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