• Narissa J Nonzee, Daiva M Ragas, Ha LuuThanhT3 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois., Ava M Phisuthikul, Laura Tom, XinQi Dong, and Melissa A Simon.
• 1 Institute for Public Health and Medicine, Northwestern University , Chicago, Illinois.
• J Womens Health (Larchmt). 2015 Jun 1; 24 (6): 506-14.

IntroductionNarrowing the racial/ethnic and socioeconomic disparities in breast and cervical cancer requires an in-depth understanding of motivation for adherence to cancer screening and follow-up care. To inform patient-centered interventions, this study aimed to identify reasons why low-income women adhered to or delayed breast or cervical cancer screening, follow-up and treatment despite access to cancer care-related services.MethodsSemistructured qualitative interviews were conducted among women with access to cancer care-related services receiving care at an academic cancer center, federally qualified health centers, or free clinics in the Chicago metropolitan area. Transcripts were coded and analyzed for themes related to rationales for adherence.ResultsAmong 138 participants, most were African American (46%) or Hispanic (36%), English speaking (70%), and between ages 41 and 65 years (64%). Primary drivers of nonadherence included lack of knowledge of resources, denial or fear, competing obligations, and embarrassment. Facilitators included abnormality identification, patient activation, provider-initiated actions, and motivation from family or friends.ConclusionsInterventions targeting increased adherence to care among low-income and ethnic minority women should direct efforts to proactive, culturally and patient-informed education that enables patients to access resources and use the health care system, address misconceptions about cancer, ensure health care providers' communication of screening guidelines, and leverage the patient's social support network.

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