LAWRENCE — Women who have experienced intimate partner violence are at a higher risk of negative health outcomes such as cervical cancer, sexually transmitted infections, HPV and HIV/AIDS. A University of Kansas researcher is building a body of work through publications and grants to better understand these risks and to build an intervention to improve health outcomes.
Meredith Bagwell-Gray, assistant professor of social welfare at KU, has written a study on sexual health for women who experienced intimate partner violence, and she is leading two grant projects to help survivors.
Intimate partner violence and sexual health
As an undergraduate, Bagwell-Gray heard an activist's story about contracting HIV as a result of intimate partner violence. Shortly after, Bagwell-Gray began volunteering at a domestic violence shelter and knew from the experience that she wanted to have a career in helping women overcome abuse. These early exposures and her subsequent social work practice as a domestic violence advocate and therapist helped lead to her dissertation in which she interviewed 28 women about their sexual health and sexual safety strategies during and after experiencing physical, sexual and psychological abuse in their relationships.
The dissertation has led to a series of publications, including a study forthcoming in a special issue of the journal Social Work, focusing on the importance of mainstreaming gender and gender-based violence in the American Academy of Social Work’s “Grand Challenges,” co-written by Sarah Jen, assistant professor, and Nikolaus Schuetz, doctoral candidate, both at KU. Previous research has focused largely on risk factors for women and intimate partner violence but very little on what can be done for those who experience it. Bagwell-Gray’s qualitative study examined the importance of using an intersectional lens to understand both sexual risks and resilience when helping women recover.
Research has shown minority women are more likely to experience negative consequences of such violence, and socioeconomic status is closely related to health outcomes as well. Study respondents spoke at length about their experiences as women, their personal backgrounds, sexual messages they’ve received throughout life, sexual health care available to them, their recovery and more. Bagwell-Gray's findings have helped show that considering a woman’s gendered experience, together with other intersecting identities such as age, socioeconomic status, race and ethnicity, can much better help form responses and interventions to help women heal, connect them with sexual health services and better connect services such as abuse services and sexual health. They have also been turned into strategies to help serve intimate partner violence survivors.
“These women are often caught between sexual pressure on all sides. They face sexual assault and coercion from partners and non-partners alike, unwanted sexual attention and harassment. At the same time, cultural gender norms tell them it’s not OK to have sex or that having sex means they’re promiscuous,” Bagwell-Gray said. “It’s not always comfortable for them to talk about, so we ask about the type of sexual messages they’ve received throughout life and whether they’re helpful or harmful, and then about the types of sexual messages they want to choose for themselves and share back with the world.”
American Cancer Society sexual health grant
That body of research helped lead to an American Cancer Society grant awarded through the University of Kansas Medical Center to help test an intervention to improve this population’s sexual health outcomes by increasing their cervical health literacy and promoting cervical cancer prevention and screening. A mentored project, Bagwell-Gray is working with Megha Ramaswamy of the KU Medical Center, who has researched cervical cancer and women who have been incarcerated; Ann Coker of the University of Kentucky, who researches connections between domestic abuse and cervical cancer; and Jody Brook, associate professor and director of KU’s Center for Children and Families. In addition, Madison Noyes and Haley Cooper, both spring 2020 KU graduates, contributed as research assistants.
“It is really important to acknowledge my team and their contribution to the research,” Bagwell-Gray said. “My mentors have this wealth of knowledge and experience I can draw from, and my student researchers provided exciting new insights.”
Bagwell-Gray designed an intervention based on her research to help improve health literacy about cervical cancer and improve access to preventive services. She and partners recruited 30 women in Kansas and Missouri to take the intervention and see if their cervical health literacy improves and what preventive actions they take, such as getting an HPV vaccine.
In addition to evaluating the intervention’s effectiveness, the project is also assessing barriers to recruitment and feasibility of its strategies. While the grant has been delayed by the COVID-19 pandemic, data gathering is ongoing, and the goal is to test it on a larger scale.
Funding a technological approach to prevention
Bagwell-Gray also recently received a new faculty grant from the KU Office of Research to broaden the focus of her intervention and deliver it beyond small-group, in-person settings. Women involved in the first intervention said they wished they had learned the information at a younger age. Thus, the new project is focusing on reaching women age 18-26 and will also address some of the main barriers to accessing the intervention: time and distance.
Several women were unable to take part in the intervention because they could not attend group sessions due to family responsibilities or travel distance. The newer grant will help transition the intervention to a virtual form that can be delivered via an app. Bagwell-Gray will work with a community advisory board made up of domestic violence survivors, advocates, health providers and tech intervention experts to develop a tech-based platform for the intervention.
“The timing is perfect,” Bagwell-Gray said of the grant. “The purpose of this project is to transition the intervention to an online, app-based platform that people can use on their own time from wherever they are. While the previous project has been put on hold, we can gather data for this virtually.”
Together, the two grant projects will help inform the effectiveness of the intervention, and the ultimate goal is to develop an intervention that can be tested on a broader scale and eventually be made available to shelters and agencies nationwide that help women suffering from intimate partner violence improve their sexual health and reduce rates of cervical cancer and other negative health outcomes that result from violence.
“Much of my work grew from working in shelters and seeing that women’s sexual health needs were often unmet,” Bagwell-Gray said. “By the time I was doing my Ph.D., I knew I wanted to form an intervention to help women beyond small groups, and I’m grateful I get to do that.”
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