. 2023 Jun 6;34(10):855–871. doi: 10.1007/s10552-023-01721-y

Table 2.

Community Member and Provider Perspectives Associated with the MHOF Constructs

Construct	Community member quotes	Provider quotes
Knowledge	C1 “We do need to know [more] about cervical cancer because…I myself am guilty of not going to the hospital to get regular pap smears…” (Women 21–49) C2 “People know about breast cancer, but these other two [cervical and colorectal cancers], you know, we don’t really know about.” (Women 50–75) C3 “I don't know how it is. Is it a germ? I don't know what cancer is.” (Women 50–75) C4 “Down here they said it [cancer] comes from our food, with that posole, our bread, lot of grease, and all those. That’s how they said it comes we get sick with that right away like diabetic, cancer, whatever, kidney failure. Yeah that’s what they said causes that, cause were eating too much of that.” (Women 50–75) C5 “See that’s why I’m asking. Is it in the air? Is it in our water? Is it the food? Is it where we live? What is it? Where is it? That was my first question.” (Men 50–75) C6 “It’s heredity. If you’re great grandparents had it, cancer, […] it’s not passed down to the first one it’s passed down to the second or third, cause […] my mon and brother had cancer. My mother had cancer of the pancreas and my uncle had stomach cancer or colon cancer and none of us received it […] and then my daughter had […] cancer of the uterus…” [Women 50–75] C7 “As soon as I heard about it [HPV vaccination] and when my daughter started going into her teen years and once the hospital started doing that I already had her go and you know get her shots for that…” (Women 21–49)	P1 “… now a lot of people can come in and are like, ‘Do I have cancer? […] Check me out,’ […] [they] don’t think of it as colon cancer, breast cancer, cervical [cancer] […] these are all different things. I don’t think that’s […] the way people think of it […] there’s a way that we should be able to figure out if someone has cancer…” P2 “I think for me, my patients, if they have a family member who have had something and have had to help them deal with it they are more incline[d] to get checked. I have a patient who just recently died from rectal cancer and her younger sister who is less than 50 asked for a colonoscopy, so I think… and that’s just one but, but, yeah I think […] when they see what happens to them.”
Barriers & supports (community member, provider, system, societal)	C8 “Frustration for me because every time I go up there [to the community clinic] they say…there’s nothing wrong me, but I come back. So I don’t know if it’s like they only pick and choose who they want to help. I don’t know, I’m not sure.” (Women 50–75) C9 “It’s kind of scary…to find out.” (Men 50–75) C10 “[It’s] probably [because of] embarrassment. I mean, who wants to go drop their pants…who wants to put their stool on a piece of paper and…send it to the doctor?” (Men 50–75) C11 “I would recommend you […] make sure that you’re informed and of course family’s always involved […] my family, everybody […] we’re open to […] anything cause […] that’s part of being a family […] to care for another […] I first inform[ed] my spouse and […] when I was through my procedure […] I had to tell them [so they] knew what’s going on with the procedure […] with family it’s always good cause they care and […] everybody wants to be healthy …” (Men 50–75) C12 “My brothers and uncles we’ve all got tested and they always keep telling me or asking me if I got tested and I always tell them not yet and they say get your butt in gear and get yourself tested it’s nothing to be embarrassed about” (Men 50–75)	P3 “…a lot of women…don’t show up following…an abnormal Pap or repeat Pap, and I think that it’s a lot of being scared for mammograms…people are scared and they don’t want to know the results and they think the worst…] P4 “[It’s] fear, maybe jinxing, like you’re fulfilling it if you go looking for it, whereas if you didn’t look for it, it wouldn’t happen…” P5 “I honestly feel like the test to my patients and the community members I’ve talked to, seem irrelevant, unfortunately. It seems beside the point…I think there’s a certain fatalism, this isn’t by any means a 100 percent or 80 percent, but I do hear that sometimes, when people feel like, ‘what’s going to happen [is] what’s going to happen.’” P6 “…colonoscopy is really important but is an abstract idea when you are having issues with financial insecurity, you’re having issues with the child care, you’re having this stress at home, you know, whether it’s intimate partner violence or kind of like everything, colonoscopy is the least important, Pap smear is the least important, all that, it’s like, you know it’s important, they articulate that, but there’s just so much other stuff.” P7 “… in [Facility Name] for whatever reason them not showing up to appointments […] I think appointments are difficult […] especially […] for a colonoscopy […] there’s a lot of systematic problems […] waitlist, wait times, and contract health referring delays, and transportation […] gas money is always […] the reason.” P8 “I wish that we could give mammograms […] on demand…” P9 “Transportation is the issue for patients, because usually when you go for a screening colonoscopy you have to take someone […] so just to have transportation to get there, to the place, you’re going to have someone to go with you. So if somebody else […] maybe takes a day off from work […], taking care of kids to be able to do this, I mean, I’m always getting issues about transportation.” P10 “That’s also a tricky thing, of finding a good way to document [family history of cancer] in the EHR [electronic health record] so it carries forward […] so other people can find that information […]” P11 “[…] I think that the colon cancer screening […] I think we really struggle there […] it’s like we give kits to people but ‘you didn’t return your kit.’ ‘Oh, I still have it at home. I’ll bring in that’.”
Communication	C13 “Yes, I would talk to my spouse about it [colonoscopy]…she went through it and told me what to expect […] I’m willing to go through it […] I’m willing to tell other people about it. Certainly some of my friends that I went to school, some of them are already long gone […] so I don’t want to be like them. I want to be informative on the situation when this type of disease comes up.” (Men 50–75) C14 “…we all share laughter, we all share humor so it would maybe put women more at ease […] so I, I would say you know just keep it light hearted […] at least laugh about it but then at the same time you know be serious about it [and if get] yourself checked it would definitely help” (Women 21–49 C15 “Whatever my doctor tells me I’m […] very confident that he’s going to help me […] with my health issues. So, yes, I would take tests [recommended by my provider]” (Men 50–75) C16 “I like going to my appointment cause I’m comfortable with my female doctor and just do whatever she tells me to do” (Woman 50–75) C17 “Always ask for a female. If not, schedule it another day where the female is working.” (Women 21–49) C18 “It’s very scary. In our traditional ways we don’t talk about death. It’s taboo, so we tend to just keep things to ourselves. We don’t think about getting life insurance because its taboo. We have…relatives that are on the verge of death; we don’t want to talk about it because what you say is what you get and maybe somebody will point the finger at you saying, ‘Why did you say that?’” (Women 50–75) C19 “It’s probably not something that people really want to talk about…I mean, cervical cancer, that’s pretty…that’s almost as private and personal as a person can get, you know, cause it’s inside of us and…it affects…your womanhood…if it’s cervical cancer then…it can hurt your chances of…[having] kids or…just being a being a mother…” (Women 21–49) C20 “This conversation [about cancer and cancer testing] don't come up…we don't talk about it, you know…cause we're guys, you know.” (Men 50–75) C21 “Now a days these doctors, my doctor now, just wants to see [me] for a quick minute. They’ll let you wait for a long time and then he comes in for like maybe two minutes and that’s it. [Laughs].” (Men 50–75) C22 “To me [talking to the doctor about cancer screening] is hard. It’s hard because the long terminology words; whatever they’re using. I mean, they don’t have the time to explain it to you in the terms that you would understand and it’s kind of difficult to say, ‘okay.’ Or, if I say no, what am I gonna put myself through or what am I gonna end up having later. So it’s kind of difficult…” (Women 50–75)	P12 “We talk about it [cancer] all the time and every time she’s able to articulate why she needs a colonoscopy but […] her work […] it’s just more important right now […]” P13 “When I first came here I think I put more effort, energy in trying to talk people into screening colonoscopy […] but maybe because it’s a better test and a lot of people would like sort of sit and be like we explained it and then they’ll be like, ‘No, no, no, I just want to do the FOB card’, and then maybe we can try it, maybe not, and then among people that I did talk to […] they would often cancel or no show” P14 “‘I don’t [know] what type.’ ‘Can you like ask your mom like what surgery she had,’ ‘Like no, no we don’t talk about it.’ I hear that a lot, like, ‘We don’t ask those private questions.’ P15 “It’s just good to talk in the third person…when I first started working here…I don’t know who told me that it’s better if you suggest [to patients] without saying… ‘this is to make sure you don’t have colon cancer’ [instead say]… ‘this is to make sure everything’s healthy inside,’ …so try [to] use more gentle phrases. Try to avoid the word [cancer] when talking about cancer if it feels like too personal…” P16 “In the last year the women who had Pap smear, [I would ask them], like, ‘hey why are you having a Pap? […] Do you know what a Pap smear is for?’ and twenty percent know that it’s for cancer; most people are just like ‘to make sure everything’s okay down there.’” P17 “For the stool test [I] joke with my patients. You know, I say, ‘Oh look, we gave you a little gift today.’ And I…say, ‘You know, look, I know nobody really wants to do these but this is why, you know, this is why we do [this].’”

Construct

Community member quotes

Provider quotes

Knowledge

C1 “We do need to know [more] about cervical cancer because…I myself am guilty of not going to the hospital to get regular pap smears…” (Women 21–49)

C2 “People know about breast cancer, but these other two [cervical and colorectal cancers], you know, we don’t really know about.” (Women 50–75)

C3 “I don't know how it is. Is it a germ? I don't know what cancer is.” (Women 50–75)

C4 “Down here they said it [cancer] comes from our food, with that posole, our bread, lot of grease, and all those. That’s how they said it comes we get sick with that right away like diabetic, cancer, whatever, kidney failure. Yeah that’s what they said causes that, cause were eating too much of that.” (Women 50–75)

C5 “See that’s why I’m asking. Is it in the air? Is it in our water? Is it the food? Is it where we live? What is it? Where is it? That was my first question.” (Men 50–75)

C6 “It’s heredity. If you’re great grandparents had it, cancer, […] it’s not passed down to the first one it’s passed down to the second or third, cause […] my mon and brother had cancer. My mother had cancer of the pancreas and my uncle had stomach cancer or colon cancer and none of us received it […] and then my daughter had […] cancer of the uterus…” [Women 50–75]

C7 “As soon as I heard about it [HPV vaccination] and when my daughter started going into her teen years and once the hospital started doing that I already had her go and you know get her shots for that…” (Women 21–49)

P1 “… now a lot of people can come in and are like, ‘Do I have cancer? […] Check me out,’ […] [they] don’t think of it as colon cancer, breast cancer, cervical [cancer] […] these are all different things. I don’t think that’s […] the way people think of it […] there’s a way that we should be able to figure out if someone has cancer…”

P2 “I think for me, my patients, if they have a family member who have had something and have had to help them deal with it they are more incline[d] to get checked. I have a patient who just recently died from rectal cancer and her younger sister who is less than 50 asked for a colonoscopy, so I think… and that’s just one but, but, yeah I think […] when they see what happens to them.”

Barriers & supports (community member, provider, system, societal)

C8 “Frustration for me because every time I go up there [to the community clinic] they say…there’s nothing wrong me, but I come back. So I don’t know if it’s like they only pick and choose who they want to help. I don’t know, I’m not sure.” (Women 50–75)

C9 “It’s kind of scary…to find out.” (Men 50–75)

C10 “[It’s] probably [because of] embarrassment. I mean, who wants to go drop their pants…who wants to put their stool on a piece of paper and…send it to the doctor?” (Men 50–75)

C11 “I would recommend you […] make sure that you’re informed and of course family’s always involved […] my family, everybody […] we’re open to […] anything cause […] that’s part of being a family […] to care for another […] I first inform[ed] my spouse and […] when I was through my procedure […] I had to tell them [so they] knew what’s going on with the procedure […] with family it’s always good cause they care and […] everybody wants to be healthy …” (Men 50–75)

C12 “My brothers and uncles we’ve all got tested and they always keep telling me or asking me if I got tested and I always tell them not yet and they say get your butt in gear and get yourself tested it’s nothing to be embarrassed about” (Men 50–75)

P3 “…a lot of women…don’t show up following…an abnormal Pap or repeat Pap, and I think that it’s a lot of being scared for mammograms…people are scared and they don’t want to know the results and they think the worst…]

P4 “[It’s] fear, maybe jinxing, like you’re fulfilling it if you go looking for it, whereas if you didn’t look for it, it wouldn’t happen…”

P5 “I honestly feel like the test to my patients and the community members I’ve talked to, seem irrelevant, unfortunately. It seems beside the point…I think there’s a certain fatalism, this isn’t by any means a 100 percent or 80 percent, but I do hear that sometimes, when people feel like, ‘what’s going to happen [is] what’s going to happen.’”

P6 “…colonoscopy is really important but is an abstract idea when you are having issues with financial insecurity, you’re having issues with the child care, you’re having this stress at home, you know, whether it’s intimate partner violence or kind of like everything, colonoscopy is the least important, Pap smear is the least important, all that, it’s like, you know it’s important, they articulate that, but there’s just so much other stuff.”

P7 “… in [Facility Name] for whatever reason them not showing up to appointments […] I think appointments are difficult […] especially […] for a colonoscopy […] there’s a lot of systematic problems […] waitlist, wait times, and contract health referring delays, and transportation […] gas money is always […] the reason.”

P8 “I wish that we could give mammograms […] on demand…”

P9 “Transportation is the issue for patients, because usually when you go for a screening colonoscopy you have to take someone […] so just to have transportation to get there, to the place, you’re going to have someone to go with you. So if somebody else […] maybe takes a day off from work […], taking care of kids to be able to do this, I mean, I’m always getting issues about transportation.”

P10 “That’s also a tricky thing, of finding a good way to document [family history of cancer] in the EHR [electronic health record] so it carries forward […] so other people can find that information […]”

P11 “[…] I think that the colon cancer screening […] I think we really struggle there […] it’s like we give kits to people but ‘you didn’t return your kit.’ ‘Oh, I still have it at home. I’ll bring in that’.”

Communication

C13 “Yes, I would talk to my spouse about it [colonoscopy]…she went through it and told me what to expect […] I’m willing to go through it […] I’m willing to tell other people about it. Certainly some of my friends that I went to school, some of them are already long gone […] so I don’t want to be like them. I want to be informative on the situation when this type of disease comes up.” (Men 50–75)

C14 “…we all share laughter, we all share humor so it would maybe put women more at ease […] so I, I would say you know just keep it light hearted […] at least laugh about it but then at the same time you know be serious about it [and if get] yourself checked it would definitely help” (Women 21–49

C15 “Whatever my doctor tells me I’m […] very confident that he’s going to help me […] with my health issues. So, yes, I would take tests [recommended by my provider]” (Men 50–75)

C16 “I like going to my appointment cause I’m comfortable with my female doctor and just do whatever she tells me to do” (Woman 50–75)

C17 “Always ask for a female. If not, schedule it another day where the female is working.” (Women 21–49)

C18 “It’s very scary. In our traditional ways we don’t talk about death. It’s taboo, so we tend to just keep things to ourselves. We don’t think about getting life insurance because its taboo. We have…relatives that are on the verge of death; we don’t want to talk about it because what you say is what you get and maybe somebody will point the finger at you saying, ‘Why did you say that?’” (Women 50–75)

C19 “It’s probably not something that people really want to talk about…I mean, cervical cancer, that’s pretty…that’s almost as private and personal as a person can get, you know, cause it’s inside of us and…it affects…your womanhood…if it’s cervical cancer then…it can hurt your chances of…[having] kids or…just being a being a mother…” (Women 21–49)

C20 “This conversation [about cancer and cancer testing] don't come up…we don't talk about it, you know…cause we're guys, you know.” (Men 50–75)

C21 “Now a days these doctors, my doctor now, just wants to see [me] for a quick minute. They’ll let you wait for a long time and then he comes in for like maybe two minutes and that’s it. [Laughs].” (Men 50–75)

C22 “To me [talking to the doctor about cancer screening] is hard. It’s hard because the long terminology words; whatever they’re using. I mean, they don’t have the time to explain it to you in the terms that you would understand and it’s kind of difficult to say, ‘okay.’ Or, if I say no, what am I gonna put myself through or what am I gonna end up having later. So it’s kind of difficult…” (Women 50–75)

P12 “We talk about it [cancer] all the time and every time she’s able to articulate why she needs a colonoscopy but […] her work […] it’s just more important right now […]”

P13 “When I first came here I think I put more effort, energy in trying to talk people into screening colonoscopy […] but maybe because it’s a better test and a lot of people would like sort of sit and be like we explained it and then they’ll be like, ‘No, no, no, I just want to do the FOB card’, and then maybe we can try it, maybe not, and then among people that I did talk to […] they would often cancel or no show”

P14 “‘I don’t [know] what type.’ ‘Can you like ask your mom like what surgery she had,’ ‘Like no, no we don’t talk about it.’ I hear that a lot, like, ‘We don’t ask those private questions.’

P15 “It’s just good to talk in the third person…when I first started working here…I don’t know who told me that it’s better if you suggest [to patients] without saying… ‘this is to make sure you don’t have colon cancer’ [instead say]… ‘this is to make sure everything’s healthy inside,’ …so try [to] use more gentle phrases. Try to avoid the word [cancer] when talking about cancer if it feels like too personal…”

P16 “In the last year the women who had Pap smear, [I would ask them], like, ‘hey why are you having a Pap? […] Do you know what a Pap smear is for?’ and twenty percent know that it’s for cancer; most people are just like ‘to make sure everything’s okay down there.’”

P17 “For the stool test [I] joke with my patients. You know, I say, ‘Oh look, we gave you a little gift today.’ And I…say, ‘You know, look, I know nobody really wants to do these but this is why, you know, this is why we do [this].’”