Table 3.

Illustrative quotes from interview participants, including administrators, staff and providers, collected in Minneapolis, Minnesota between February–August 2022.

Main Theme	Illustrative Quotes
Views on HPV Self-Collect	Yeah, we've done patient collected samples for STI screening, and I'm like, for, you know, for initial evaluation of like yeast infections if people want to avoid a vaginal exam. But primarily for STI screening. I would say we've done self collected samples for many, many years. So not just vaginal but rectal, oral---we've done a lot of self samples and self swabbing for that, and we just teach people how to do that, and then they can do it themselves. And I'll allow that for, you know, an initial vaginitis work up to for somebody who's super, super nervous about vaginal exams. (Clinic 2, Provider)
Perceived Patient Response/Reaction	I think that there's subsets of the population that would be all in favor. I anticipate that there will be people that are “no way, no how.” And then with a large bucket in the middle, so representative, your typical bell shape curve don't have any experience at other clinics or other organizations with this, and so I can only speak in generalities. (Clinic 1, Leadership) I do think that a potential worry is, will there be the perception that this is sub-optimal care right? “So why are you asking us this question? Aren't you supposed to do it the other way? Isn't that the right way the better way and now you're doing it differently and you're doing it with us? Is that the cheaper way or this faster way or something that isn't quite as good as the standard way?” So I would anticipate we will have thoughtful questions that span the whole gamut. (Clinic 2, Provider) Well, I mean I think both my Somali patients and my trans-men both probably I would guess that they would be in favor of it. I think both groups have been leery to have pap tests done in clinic, particularly by male providers, so my guess is that they will appreciate the option. I think one of it questions people have is, you know can you explain this well to me like, how I do this technique so that I get it a good test and so I think that would be something. I think that both groups would want to make sure that they knew how to do it, that they could kind of be guided through the process of how to self-sample. (Clinic 2, Provider)
Patient and Provider Education	We know that our Somali community has, you know, unfortunately, there's a lot of misunderstanding, miseducation, miss of whatever in there, you know, out there within that community, and I know, we are struggling, we struggle, and we want to make sure that we are, you know, educating them correctly. So I think that, if this is one, one thing that we can help, do, I think we need to really, I think we should do it, I think that there will be there's going to have to be a lot of that education piece and how to break that ice within that community. To say that this, you know, this is so important, and this is, you know, hopefully the fact that you know, you get to do it yourself will help, help with that. (Clinic 2, Staff) Everything has to be in Somali language. Yeah, not English. I know that's just common and, you know, you'd think that it would be a no brainer. But there's so many things that we give patients that are in English and, you know, they just take it and stuff in their bag, and that's it. But I think every, all the materials have to be very clearly explained in Somali at a, you know, at an appropriate level of understanding. (Clinic 1, Provider) I do think though anytime you roll something out you absolutely have to have very strong why’s, right? There's generally a mistrust in the healthcare system that it's doing things so that it costs less or we make more money and so being very clear that we're doing this because we believe our patients aren't adequately screened for cervical cancer. (Clinic 2, Provider) I think to be able to implement it at clinic, I think just making providers like nursing staff and patients just aware that it's an option and having good like, guidance, and how to do the swab and good education about that. It's just as high quality as doing a pap smear, I think are important, otherwise, I don't think there's a lot of barriers to implementing it. You know, we have all of the like, equipment and swabs already in the lab capability. Like I don't see that being a factor at all. I think it's more just education piece for staff and patients. (Clinic 2, Provider)
Integration into Routine Primary Care	We have to have the ability to just have it in the room. Like saying, it's like you know I’m imagining the way this will happen is I’ll be seeing a woman for headaches or something I'll look in their chart and they'll say hey you're due for a pap smear so you know I’ll come back next year for that. Oh, you know, there's a really easy way, to do it now. All you have to do is, is this, and just put it in here just this like, and but if I have to go and get it somewhere else, if I have to order it, and then go find this special thing and all kinds of extra things versus right now pap smears are in the rooms, you know. And I can just reach and grab it, you know. So if I can grab it put a label on and say here it is. I'm just going to step out you do it and you just leave it right here, and I put a little thing, you know, so they're just making it super easy, even to the extent that I can leave and not come back again because I’m not going to interpret the test right away. (Clinic 2, Leadership) MAs do a lot. A lot a lot a lot around here. I think there's you know they can they may possibly have to know how to do it too, when nurses aren't available. There may be someone else who comes in or during a visit that that the provider may say, this needs to be done, and nurse may be busy already, so I don't know. You know the MAs may also have to know how to educate the patient to get it done. (Clinic 1, Leadership) So this you know, I think to explain the why. You know, whatever, whatever the process is to explain, the why this is important is going to be really important in terms of the process. There are several key meetings that would be important to have someone like yourself to come and describe what it is, and how this is going to impact patients or the clinical flow. (Clinic 1, Leadership) I think that we are motivated to provide cancer screening. And also we want, we know that our Somali women have lower rates of cancer screening and higher rates of cervical cancer. And are motivated to other, you know, reach out to patients in other ways. So I think absolutely can be implemented. (Clinic 2, Leadership)