Beyond Free Screening: Structural Barriers to Follow-Up Cervical Cancer Care Among Uninsured Hispanic Women in Minnesota, 2020-2021

Objectives: Uninsured or underinsured Hispanic women in Minnesota use the state’s free cervical cancer screening program, Sage. Although the rate of screening program use is high, incidence of and mortality from cervical cancer persist in this group. We examined systemic barriers to follow-up cervical cancer care despite access to the free program. Methods: From fall 2020 through spring 2021, we conducted virtual focus groups with 23 Hispanic women in Minnesota who previously received Sage services. We interviewed 7 key informants, including service providers, clinic administrators, and Sage team members. Three bilingual researchers independently used inductive approaches to identify themes from transcripts, refined categories, and finalized analysis through feedback sessions. We used the social-ecological model framework to reveal barriers to follow-up care after an abnormal cervical cancer screening result. Results: Exploratory inductive analyses of data from focus groups and key informants identified 4 interconnected barriers: (1) reliance on community clinics and patient navigators, often causing navigator burnout; (2) scheduling and attending follow-up appointments at clinics outside of familiar community clinics, particularly in rural areas; (3) negative health care experiences and interpreter misuse that discouraged further care; and (4) confusion and anxiety from unexpected billing, despite Sage being a free program. Conclusions: To address the identified barriers, we recommend expanding and compensating patient navigator roles, strengthening interpreter use, and training hospital staff to reduce billing errors. Even with free screening available through Sage, structural failures (billing confusion, rural access gaps, navigator workload) undermined equitable care. Addressing these systemic issues is essential if programs like Sage are to realize their potential in reducing disparities in incidence of cervical cancer among Hispanic women.