title: Facilitators and barriers to cervical cancer screening, diagnosis, and enrollment in Medicaid: experiences of Georgia's Women's Health Medicaid Program enrollees.
abstract: Although cervical cancer incidence and mortality rates have declined in the USA, African American women have a higher incidence rate of cervical cancer and a higher percentage of late-stage diagnosis than white women. Previous analyses by the authors showed that, even after adjusting for age, provider location, and availability, African American women were almost half as likely as white women to be diagnosed or enter Medicaid while at an early stage of their cervical cancer. To understand why these differences exist, we undertook a qualitative examination of the cervical cancer experiences of women enrolled in Georgia's Women's Health Medicaid Program (WHMP). Life history interviews were conducted with 24 WHMP enrollees to understand what factors shaped their cervical cancer experiences, from screening through enrollment in Medicaid. We also examined whether these factors differed by race in order to identify opportunities for increasing awareness of cervical cancer screening among underserved women. Results suggest that many women, especially African Americans, lacked understanding and recognition of early symptoms of cervical cancer, which prevented them from receiving a timely diagnosis. Additionally, participants responded positively to provider support and good communication but wished that their doctors explained their diagnosis more clearly. Finally, women were able to enroll in Medicaid without difficulty due largely to the assistance of clinical staff. These findings support the need to strengthen provider education and public health efforts to reach low-income and minority communities for screening and early detection of cervical cancer.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA, scblake@emory.edu.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Blake
authors.forename: Karen
authors.initials: K
authors.lastname: Andes
authors.forename: Laura
authors.initials: L
authors.lastname: Hilb
authors.forename: Karie
authors.initials: K
authors.lastname: Gaska
authors.forename: Linien
authors.initials: L
authors.lastname: Chien
authors.forename: Lisa
authors.initials: L
authors.lastname: Flowers
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
mesh_terms: D000328:Adult; D001741:Black or African American; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008484:Medicaid; D008875:Middle Aged; D009367:Neoplasm Staging; D010358:Patient Participation; D011379:Prognosis; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology*; D044465:White People; D016387:Women's Health