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.

Michele Sky Lee, Jillian R Peart, Julie S Armin, Heather J Williamson
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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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残疾妇女和患有严重精神疾病的妇女接受子宫颈抹片检查的障碍和促进因素范围综述》(A Scoping Review of Barriers and Facilators to Pap Testing in Women with Disabilities and Serious Mental Illnesses:美国残疾人法案》颁布三十年后。
背景:美国残疾人法案》(Americans with Disabilities Act,ADA)的通过承诺了残疾人和患有严重精神疾病的人可以平等地获得医疗服务,而在该法案通过 30 年之后,有关子宫颈抹片检查的研究仍在继续揭示残疾妇女和患有严重精神疾病的妇女(包括那些被认定为少数种族/少数族裔的妇女)之间的健康差异。我们还研究了这些文章在多大程度上纳入了少数种族/族裔妇女:研究小组使用残疾、精神疾病和子宫颈抹片检查等一般主题词,在 PubMed、Medline 和 CINAHL 中检索了 1990 年至 2020 年 2 月期间的美国学术文献,并进行了范围审查:有 32 篇文章符合纳入标准。文章中提到的障碍多于促进因素。根据社会生态模型,障碍和促进因素分为三组,包括个人因素(如社会经济地位、焦虑、教育)、人际因素(如家庭、生活环境)和组织因素(医疗服务提供者培训、医疗保健系统)。文章经常报道参与者的种族/民族,但少数群体往往不是文章的重点:更多的文章讨论了残疾妇女和患有严重精神疾病的妇女在接受子宫颈抹片检查时所面临的困难,而不是促进子宫颈抹片检查的因素。更多的研究应关注种族/民族、残疾妇女和患有严重精神疾病的妇女在接受子宫颈抹片检查时的交叉性。
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