{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:34:48Z","timestamp":1793014488399,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100011539","name":"Masonic Cancer Center, University of Minnesota","doi-asserted-by":"publisher","award":["#NIH P30 CA077598"],"award-info":[{"award-number":["#NIH P30 CA077598"]}],"id":[{"id":"10.13039\/100011539","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011539","name":"Masonic Cancer Center, University of Minnesota","doi-asserted-by":"publisher","award":["HD20MCC02"],"award-info":[{"award-number":["HD20MCC02"]}],"id":[{"id":"10.13039\/100011539","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007316","name":"Division of Cancer Prevention, National Cancer Institute","doi-asserted-by":"publisher","award":["100007316"],"award-info":[{"award-number":["100007316"]}],"id":[{"id":"10.13039\/100007316","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Uninsured or underinsured Hispanic women in Minnesota use the state\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549261442167","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T18:25:02Z","timestamp":1778351102000},"page":"844-853","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond Free Screening: Structural Barriers to Follow-Up Cervical Cancer Care Among Uninsured Hispanic Women in Minnesota, 2020-2021"],"prefix":"10.1177","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2050-2488","authenticated-orcid":false,"given":"Jessica","family":"Pakonen","sequence":"first","affiliation":[{"name":"Hispanic Advocacy and Community Empowerment through Research (HACER), Saint Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Jensen","sequence":"additional","affiliation":[{"name":"Hispanic Advocacy and Community Empowerment through Research (HACER), Saint Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Cruz Zorrilla","sequence":"additional","affiliation":[{"name":"Hispanic Advocacy and Community Empowerment through Research (HACER), Saint Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Hispanic Advocacy and Community Empowerment through Research (HACER), Saint Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2227-7209","authenticated-orcid":false,"given":"Gabriela","family":"Bustamante","sequence":"additional","affiliation":[{"name":"Program in Health Disparities Research, School of Public Health and School of Medicine, University of Minnesota, Minneapolis, MN, USA"},{"name":"School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"American Association for Cancer Research. 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About the National Breast and Cervical Cancer Early Detection Program. September 9 2025. Accessed January 25 2026. https:\/\/www.cdc.gov\/breast-cervical-cancer-screening\/about\/index.html"},{"key":"e_1_3_3_11_2","unstructured":"Minnesota Department of Health. About Sage Screening Program. January 7 2025. Accessed January 25 2026. https:\/\/www.health.state.mn.us\/diseases\/cancer\/sage\/about\/index.html"},{"key":"e_1_3_3_12_2","unstructured":"Minnesota Department of Health. Sage eligibility 2022. Accessed March 16 2026. https:\/\/www.health.state.mn.us\/diseases\/cancer\/sage\/documents\/eligibility.pdf"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-024-01947-4"},{"key":"e_1_3_3_14_2","unstructured":"Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program. Minnesota five-year summary: January 2017 to December 2021. 2023. 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