Barriers to Obtaining Cancer Screenings for Underserved Women with Mobility Impairments: Process Evaluation

Background. Promoting Access to Health Services (PATHS) is a theory-based intervention program designed to increase receipt of clinical preventive services by women with mobility impairments. The results of a previous randomized control trial to examine the efficacy of PATHS indicated that the intervention group was more likely to have received a Pap test, with no significant group effect observed for mammography. Objectives. To improve the 90 minute PATHS workshop, the present study identified the barriers and concerns expressed narratively by women in regards to obtaining mammogram screening and cervical cancer screening. Targeted population. Eligibility criteria included: being a woman between 35 and 64 years old; having a mobility limitation; having health insurance; no recent experience of either cervical cancer screening or mammography. Workshop participants were recruited via a Medicaid managed care organization and a durable medical equipment vendor in Oregon. Of the 197 workshop participants, 75 completed phone interviews to discuss barriers. Analysis. Phone transcripts were reviewed and the most frequent barriers and concerns to obtain cancer screenings were organized by the Transtheoretical Model (TTM). Results. Qualitative results indicated that physical secondary conditions and affordability were the most frequent barriers and concerns related to obtaining cancer screenings across TTM stages. Of note, women who were in the action stage indicated a lack of knowledge about the cancer screenings as their barrier to maintain their performance. Implication. Efforts to improve clinical preventive screening rates among women with disabilities need to address the barriers and concerns that they encounter.