title: Delays in Cancer Care Among Low-Income Minorities Despite Access.
abstract: BACKGROUND
  Narrowing 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.
  
  
  METHODS
  Semistructured 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  Interventions 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.
authors.affiliation: 1 Institute for Public Health and Medicine, Northwestern University , Chicago, Illinois.|2 Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, Illinois.
authors.forename: Narissa J
authors.initials: NJ
authors.lastname: Nonzee
authors.affiliation: 3 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois.
authors.forename: Daiva M
authors.initials: DM
authors.lastname: Ragas
authors.affiliation: 3 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois.
authors.forename: Thanh
authors.initials: T
authors.lastname: Ha Luu
authors.affiliation: 3 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois.
authors.forename: Ava M
authors.initials: AM
authors.lastname: Phisuthikul
authors.affiliation: 1 Institute for Public Health and Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Laura
authors.initials: L
authors.lastname: Tom
authors.affiliation: 4 Rush Institute for Healthy Aging, Rush University Medical Center , Chicago, Illinois.
authors.forename: XinQi
authors.initials: X
authors.lastname: Dong
authors.affiliation: 1 Institute for Public Health and Medicine, Northwestern University , Chicago, Illinois.|2 Robert H. Lurie Comprehensive Cancer Center, Northwestern University , Chicago, Illinois.|3 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois.|5 Department of Preventive Medicine, Northwestern University , Chicago, Illinois.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D002641:Chicago; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008403:Mass Screening / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D011203:Poverty / Q000208:ethnology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012944:Social Support; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data