{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:43:49Z","timestamp":1793040229822,"version":"4.5.0"},"reference-count":48,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA06516"],"award-info":[{"award-number":["P30CA06516"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R25CA057711"],"award-info":[{"award-number":["R25CA057711"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Women experiencing homelessness are at increased risk of cervical cancer and have disproportionately low Pap screening behaviors compared to the general population. Prevalence of Pap refusals and multiple kinds of trauma, specifically sexual trauma, are high among homeless women. This qualitative study explored how trauma affects Pap screening experiences, behaviors, and provider practices in the context of homelessness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted 29 in-depth interviews with patients and providers from multiple sites of a Federally Qualified Health Center as part of a study on barriers and facilitators to cervical cancer screening among urban women experiencing homelessness. The Health Belief Model and trauma-informed frameworks guided the analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Trauma histories were common among the 18 patients we interviewed. Many women also had strong physical and psychological reactions to screening, which influenced current behaviors and future intentions. Although most women had screened at least once in their lifetime, many patients experienced anticipated anxiety and retraumatization which pushed them to delay or refuse Paps. We recruited 11 providers who identified strategies they used to encourage screening, including emphasizing safety and shared decision-making before and during the exam, building strong patient\u2013provider trust and communication, and individually tailoring education and counseling to patients\u2019 needs. We outlined suggestions and implications from these findings as trauma-informed cervical cancer screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Discomfort with Pap screening was common among women experiencing homelessness, especially those with histories of sexual trauma. Applying a trauma-informed approach to cervical cancer screening may help address complex barriers among women experiencing homelessness, with histories of sexual trauma, or others who avoid, delay, or refuse the exam.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455065211029238","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T01:26:52Z","timestamp":1625534812000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Trauma and cervical cancer screening among women experiencing homelessness: A call for trauma-informed care"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1017-3832","authenticated-orcid":false,"given":"Racquel E","family":"Kohler","sequence":"first","affiliation":[{"name":"Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA"},{"name":"Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Boston Health Care for the Homeless Program, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill S","family":"Roncarati","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Boston Health Care for the Homeless Program, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pritha","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Dana-Farber Cancer Institute, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie","family":"Gaeta","sequence":"additional","affiliation":[{"name":"Boston Health Care for the Homeless Program, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasisomayajula","family":"Viswanath","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Boston Health Care for the Homeless Program, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassis","family":"Henry","sequence":"additional","affiliation":[{"name":"Boston Health Care for the Homeless Program, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,7,5]]},"reference":[{"key":"bibr1-17455065211029238","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"bibr2-17455065211029238","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6608a1"},{"key":"bibr3-17455065211029238","unstructured":"National Health Center Data. Administration HRS, 2017, https:\/\/data.hrsa.gov\/tools\/data-reporting\/program-data\/national"},{"key":"bibr4-17455065211029238","doi-asserted-by":"crossref","unstructured":"Asgary RJTLO. Cancer screening in the homeless population 2018; 19: e344\u2013e350.","DOI":"10.1016\/S1470-2045(18)30200-6"},{"key":"bibr5-17455065211029238","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.03.038"},{"key":"bibr6-17455065211029238","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2008.1111"},{"key":"bibr7-17455065211029238","doi-asserted-by":"publisher","DOI":"10.2174\/1874924001003020080"},{"key":"bibr8-17455065211029238","doi-asserted-by":"crossref","unstructured":"Jasinski JL, Wesely J, Mustaine E, et al. 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