Facilitators of Routine Cervical Screening Receipt for Women With Intellectual and Developmental Disabilities in Nebraska

Author

Anne Woodruff Jameson, University of Nebraska Medical CenterFollow

ORCID ID

0000-0003-4611-679X

Graduation Date

Fall 12-20-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Sandra Willett

Second Advisor

Kerry Miller

Third Advisor

Leeza Struwe

Fourth Advisor

Sofia Jawed-Wessel

Abstract

Women with intellectual and developmental disabilities (I/DD) experience disproportionately low rates of cervical screening relative to women without I/DD, despite its clear role in cancer prevention. This disparity is especially stark in Nebraska, where in 2023, only 56% of women with I/DD had cervical screen receipt, compared to 78.4% of their non-disabled peers.. Previous literature has explored barriers to cervical screening for women with I/DD using the socioecological model (SEM) as a framework. This dissertation used three methodologies: a case study, a scoping review, and survey research, to examine facilitators to cervical screening for women with I/DD using the SEM framework, with a specific emphasis on interventions.

First, a case report documents a Nebraska woman with I/DD and a history of trauma from her failed cervical screening attempt through a pelvic floor physical therapy plan of care to a successful cervical screen. The outcomes suggest that pelvic floor physical therapy may serve as a trauma-informed facilitator to prepare women with I/DD for successful cervical screening.

Next, a scoping review of the literature revealed that few interventions have been developed to improve cervical screening receipt rates for women with I/DD. The interventions that have been studied report modest success in increasing knowledge or receipt of cervical screening and focus primarily on the individual, interpersonal, and organizational levels of the SEM. No interventions target the SEM community or public policy levels, despite previously documented barriers and facilitators at those levels.

Finally, survey data identified facilitators of cervical screening for women with I/DD in Nebraska, including recent sexual activity, a knowledge of cervical screening, and help from a provider. However, court-appointed medical guardianship emerged as a significant barrier, raising concerns about autonomy in preventative care.

Together, these findings highlight the potential of interventions at multiple levels of the SEM to improve cervical screening receipt rates for women with I/DD. It moves the field beyond identifying barriers to applying and studying interventions that facilitate screening. This holistic view will assist in the design of interventions that increase autonomy and ensure equitable and accessible cervical screening for women with I/DD.

Recommended Citation

Woodruff Jameson, Anne, "Facilitators of Routine Cervical Screening Receipt for Women With Intellectual and Developmental Disabilities in Nebraska" (2025). Theses & Dissertations. 995.
https://digitalcommons.unmc.edu/etd/995