title: Patient barriers to follow-up care for breast and cervical cancer abnormalities.
abstract: BACKGROUND
  Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care.
  
  
  METHODS
  Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers.
  
  
  RESULTS
  The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier.
  
  
  CONCLUSIONS
  In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.
authors.affiliation: Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois 60608, USA. stejeda@uic.edu
authors.forename: Silvia
authors.initials: S
authors.lastname: Tejeda
authors.forename: Julie S
authors.initials: JS
authors.lastname: Darnell
authors.forename: Young I
authors.initials: YI
authors.lastname: Cho
authors.forename: Melinda R
authors.initials: MR
authors.lastname: Stolley
authors.forename: Talar W
authors.initials: TW
authors.lastname: Markossian
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D001741:Black or African American; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D057210:Delayed Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D062526:Patient Navigation; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D055815:Young Adult