Using participatory methods to examine policy and women prisoners' health.

This article describes how community-based participatory research (CBPR) led to the discovery of the unintended consequences of jail and prison copayment policy on women prisoners' health. The article addresses (a) a working definition of participatory research; (b) the importance of research with women prisoners; (c) the origins and development of our work and its grounding in CBPR; (d) issues related to research with prisoners; and (e) recommendations for using participatory methods to bring women prisoners into the discourse about the practices and policies that impact their lives. These methods have the potential to minimize the invisibility of prisoners and their health disparities.

How clinical trials really work rethinking research ethics.

Despite prevalent concerns about the ethical conduct of clinical trials, little is known about the day-to-day work of trials and the ethical challenges arising in them. This paper reports on a study designed to fill this gap and demonstrates a need to refine the oversight system for trials to reflect an understanding of this day-to-day work. It also illuminates ethical challenges that cannot be addressed by the oversight system and so necessitate a rethinking of the ethics of clinical trials.

A study of women prisoners' use of co-payments for health care: issues of access.

OBJECTIVES: We sought to analyze women prisoners' use of co-payments for health care; how co-payments affect their access to health care; and how they view the impact of co-payments on their health. METHODS: Using a community-based participatory research approach, we conducted six focus groups with 31 previously incarcerated women. Data were analyzed using qualitative field research methods, grounded theory, and consensual qualitative research strategies to construct a shared understanding of the data. RESULTS: Co-payments hindered women prisoners' access to health care. Women reported inequitable implementation of the policy and foregoing care because of the financial burden of the co-payment. Co-payments contributed to delays in treatment, avoidance of health care professionals, unnecessary suffering, and poor health outcomes. In response, women used self-advocacy skills to manage their health care needs and deal with the prison health care system. CONCLUSION: Co-payments place an unfair burden on prisoners who are poor, limit access to health care, and contribute to needless suffering and potentially to preventable deaths.

Women prisoners: health issues and nursing implications.

The purpose of this article is to describe health issues of women prisoners, analyze the implications of these issues for nursing practice, and consider strategies to improve the health of this vulnerable population. The article focuses primarily on women prisoners in the United States and includes a brief contextual background to explain the rapid increase in their numbers. Although the incarceration of women is increasingly a global problem, the authors focus primarily on the situation in the United States.

Prisoners' perspectives of health problems and healthcare in a US women's jail.

In the last decade, the number of women in US jails has increased at an annual average of 7.0%. These women typically suffer from untreated, serious health problems. This participatory research project explored health problems and healthcare from the perspective of women incarcerated in a county detention facility located in the western US. A convenience sample of 78 inmates and former inmates participated in 10 focus groups. Using the constant comparative method, the data analysis revealed that they suffered from physical, mental, and iatrogenic health problems. Barriers to care included concerns about privacy and dignity as well as waiting time for treatment, co-payments, and concealing problems in order to obtain work opportunities. Women in the project identified solutions for these problems and analyzed why incarceration made them aware of previously ignored health concerns. The findings suggest the importance of further research with this vulnerable, hidden population.

Outcomes of managing disability benefits among patients with substance dependence and severe mental illness.

To evaluate the feasibility and efficacy of a program to manage Social Security disability benefits in a clinical sample of patients with severe mental illness and co-occurring substance dependence, 41 patients were randomly assigned to have their benefits either contingently or noncontingently managed through their mental health center. Contingent management involved adjustments to the type or frequency (not amount) of disability benefits and payments for study participation based on ratings of substance use, money management, and treatment follow-through. The patients with contingent management used significantly less alcohol and drugs and showed much better money management than those with noncontingent management. Patients and case managers who participated in the study reported that they found the management strategy to be acceptable and useful.