Fairness First Blog

Researchers’ voices in health equity

The Fairness First blog represents a space where researchers share with the broader community why health equity research matters to them, how do they connect to health equity, and what is the value of community engagement in the research process.

April 26, 2024

Improving Women’s Health During and After Incarceration

A Conversation with Interdisciplinary Health PhD Candidate Rebecca Annorbah

April is Second Chance Month. This yearly observance draws attention to opportunities, programs, and services from state, tribally-based, and community-based organizations that support people as they return to their communities after incarceration. In this post we feature Interdisciplinary Health PhD candidate Rebecca Annorbah, who uses community-engaged approaches to evaluate a reentry program. One of the project’s goals is to identify areas for improving health outcomes for women.

About the Researchers

Rebecca Annorbah is a student and researcher in NAU’s Interdisciplinary Health PhD (IH PhD) program. After completing a bachelor’s degree in social work at the University of Ghana, Rebecca worked in Ghana’s capital city, Accra, as a social worker for a few years. Rebecca relocated to the US to pursue a master’s degree in criminology and criminal justice and then began the Interdisciplinary Health PhD program at NAU. Her current research focuses on the intersecting relationships between incarceration and health, specifically among women and mothers.

About the Research

Rebecca is a NARBHA Institute Fellow. This program connects recipients to community programs and partners.

I am currently reviewing a reentry program* in a Southwestern jail in the US. The program provides behavioral health services for individuals who are released from jail. Research shows that a lot of people going into jail struggle with substance use and mental health issues. This program offers opportunities to get connected to behavioral health services and to ultimately reduce recidivism**. I am evaluating this program to see its impacts on health outcomes and recidivism, particularly for women and mothers.

To do this, I will be conducting a series of analyses using program data and engaging women at the jail and in the reentry program in focus group interviews. The focus groups will be used to gather information on the women’s experiences and perspectives on the program and how it can be improved to better meet their specific needs. When women – specifically mothers – are involved in the criminal justice system, the effects are far reaching. Children often depend on their mother as their primary caregiver. The absence of a mother can lead to adverse effects in the children they leave behind, including academic underachievement and emotional stress. These children may also be more susceptible to negative influences in their social circles. Drawing from this evaluation, the jail will be able to expand the reentry program to include gender responsive strategies that can better serve the needs of women and mothers returning into their communities.

Identifying gender differences in the health consequences of incarceration can inform policies aimed at reducing health disparities among justice-involved populations. It’s truly a privilege to contribute to our community and have the opportunity to make a positive impact on the health outcomes of women and mothers.

Additionally, I am currently working on parental incarceration and its impact on C-reactive protein (CRP) levels. CRP is a biomarker*** for a lot of chronic diseases. Collaborating with two researchers, we are leveraging national quantitative secondary data to explore potential associations between parental incarceration and CRP levels in male and female offspring. Additionally, our study aims to investigate any gender differences in these associations, shedding light on the nuanced effects of parental incarceration on the health outcomes of offspring.

*Reentry programs provide resources for people who have been incarcerated as they reintegrate into life outside of prison.

**Recidivism: The tendency for a person to commit another crime, usually after having been convicted of a crime.

***Biomarkers: Different molecules found in the body that can suggest a person has a condition or disease.

Why this research is important: Gender specific healthcare during reentry

Once a person becomes involved in the criminal justice system, a lot of the factors that are considered social determinants of health* are immediately interrupted. For example, individuals with histories of incarceration experience challenges securing housing, employment, and higher education. They may also have challenges accessing healthcare while in jail and post-release. My research is addressing this gap by evaluating behavioral health services for individuals in jail and identifying areas for program improvements. I am passionate about this research because results from this study will go a long way in improving healthcare access, particularly for women involved in the criminal justice system.

*Social determinants of health: Non-medical factors – such as socioeconomic status, education access, living location – in a person’s environment that influence health.

Equal Partnership: A community-informed approach to research

I am employing a community-based approach in my research, collaborating closely with health service providers, a woman with lived experience*, and community members. Everyone on the community advisory board is considered equal partners in this project. I strongly believe in community engagement and the importance of involving the communities in research, as ultimately, the research is intended to benefit them. I am directly working with program administrators, and the combined recommendations gathered from study participants will be shared to inform program changes, ensuring that the voices and perspectives of the community are central to the research outcomes. As an advocate for women’s health, I find it truly humbling to engage with women who have lived experience in the re-entry program, seeking their narratives and perspectives on the program. Their insights and stories are invaluable in shaping our understanding and approach to supporting women’s health and well-being.

*Lived experience: Knowledge based on a person’s identities and history.

An international perspective on health equity and healthcare access

Health equity priorities exist everywhere and Ghana, as a country, has been particularly upfront in acknowledging disparities in healthcare access. To bridge gaps in healthcare access, Ghana established the National Health Insurance Scheme (NHIS), a publicly funded healthcare system,  in 2003. NHIS provides health coverage for basic health care services in Ghana. Although there are challenges with NHIS coverage, the insurance goes a long way to subsidize healthcare costs. Ghana also uses community engagement strategies to improve healthcare access. For example, most rural communities have community-based healthcare centers that provide primary healthcare services including vaccinations, routine check ups, and treatment for non-life-threatening diseases.

Staying Connected with Home

Self-care is a vital part of our collective work towards health equity. Rebecca discusses spirituality and how she stays connected with her home in Ghana.

For self-care, I listen to podcast shows from Ghana to stay connected to my home country. I also enjoy taking walks outside – especially now that the weather is getting nicer – and often listen to a Christian radio show called Family Life Radio. To care for myself spiritually, I attend Northern Christian Assembly. I have an amazing church family in Flagstaff that I’m able to lean on. Church is my safe place and helps me stay spiritually healthy.

Plans for the future and feeling thankful

After finishing the IH PhD program, I intend to pursue a career in academia. I enjoy working with students and providing mentorship. Ideally, I aim to focus my research on marginalized populations, particularly individuals who have been incarcerated, as well as maternal and child health.

I am grateful for the opportunities afforded to me during my time at NAU and for the support I have received. I would like to express my heartfelt appreciation to my advisor, Dr. Samantha Sabo, who has been a constant source of support and guidance. Working with her has been an incredible learning experience, and I am truly thankful for her mentorship. I also want to extend my gratitude to everyone at CHER for their unwavering support throughout my journey. Additionally, I am thankful for the collaborative research projects I have had the privilege to work on with Beya Thayer*, who is the executive director of the Yavapai Justice & Mental Health Coalition.

*Beya Thayer is also a member of SHERC’s Community Expert Board where she provides perspective and insights to inform SHERC research and programs.

Want to connect?
Rebecca at ra854@nau.edu

Interested in learning more about health equity research at NAU and in the community?

Visit CHER’s social media for short stories that highlight SHERC researchers, students, lab spaces, and more! Look for “Fit it in a Minute” posts.