| Risk reduction |
“There’s a lot of folks that don’t live in the downtown area or a walkable part of our town that will never make it 5 miles to the [University of Kentucky Cooperative] Extension Office [or] don’t know that the Extension Offices have fabulous nutritional programming.” [White woman from a rural county; aged 31 y] “My husband still smokes heavily, and he knows all the risk and he still does it because he’s addicted to it. I think that preventing it from happening [in the first place] is definitely a concern. I know in my area, my dad and mama did, their uncle did, their grandpa did. [When I] ask, they say, ‘Well, I started smoking at seven when I got a cigarette from my grandpa,’ and it's just old family mentality circles.” [Asian woman from a rural county; aged 31 y] “We could definitely have a bigger presence [of environmental pollutant awareness] in my specific area, especially with how much agriculture we have...the runoff can cause a lot more issues than I think most of our residents are aware of.” [White woman from a rural county; aged 32 y] “It’s about people feeling attacked, so I think it just really goes back to messaging, and I think...people always want to know why, like what’s your motivation for doing it, so I think the better you can communicate that.” [White woman from an urban county; aged 36 y]
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| Screening |
“Well, you know the colon [screening], it’s not so much that the procedure’s horrible but the process of getting ready for the procedure is not pleasant, and I know that I’m aware of that. And even though my best friend has gone through the process, she shared it, so I’m trying to hold off.” [Black woman from an urban county; aged 45 y] “I can remember when they cut back on pap smears I was shocked. I don’t see the benefit, and, okay, now I only need one every 3 years, and I’m like, that doesn't seem to make sense to me.” [White woman from an urban county; aged 36 y] “Another issue is that even people that have insurance and then all the things [she] said, like people that work all the time that are working two jobs or they don’t have someone to watch their kids. They don’t have transportation. That’s a big problem here, we don’t have public transit.” [White woman from an urban county; aged 44 y; LGBTQ+a identity] “I think it was mammogram screening...the mobile clinic, so I think that’s a really good idea that they came up with, and you know, it’s able to go around and meet the people where they are.” [Black woman from an urban county; aged 48 y] “Well, I think even people that have insurance, the deductibles are so high on a lot of them that there are people that will not [get screened]. I mean there’s a few things on this list that are now because of the ACA [Affordable Care Act] you can get screened once a year, and you don't have to pay for it [if you know about it].” [White woman from a rural county; aged 45 y]
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| Diagnosis and treatment |
“These [radiation and chemotherapy] are available in my community, but most people that have means don’t want to receive them here...A lot of people that have means would go elsewhere. They would go to [hospital in nearby city] or somewhere else. Or, I know people that may go there [locally] the first time, and then when they get diagnosed, if they have the means they go to [hospitals in larger nearby cities].” [White woman from a rural county; aged 44 y; LGBTQ+ identity] “The ease of medical information being shared...would help with treatment, knowing all your doctors are on the same page...knowing what each person, what the right hand is doing and what the left hand is doing at the same time.” [White woman from an urban county; aged 45 y] “The way that the health care system is set up right now takes too long. So, if you go in and find a lump or whatever, its 2 weeks or a month before you go to the next step and then it’s even more time after that, before you know what stage it is, and then a treatment plan. That is a lot of heavy mental load for somebody to have to carry for that long.” [Black woman from an urban county; aged 48 y] “I think a lot of times, you have to recognize when you need a proxy or for the health care staff to recognize when someone needs a proxy because you’re saying something to somebody and saying, ‘do you understand?’ They're going to say ‘yes’ because they don’t want to appear that they don’t know, but just being able to understand and to ask the type of questions they need to.” [Black woman from an urban county; aged 28 y]
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| Follow-up and survivorship |
“I think they gave her family false hope and did things that work for some people because they’re younger...but probably lowered her quality of life at the end when it was inevitable that she was going to pass away.” [White woman from an urban county; aged 73 y; LGBTQ+ identity] “They found that she had Medicaid it’s like ‘oh we’re sorry, this is an experimental treatment, and this isn’t covered by Medicaid.’ So, [we asked] how much does this cost. It will cost you about $100,000, and it might as well have been a million dollars. I have followed the research and it has been phenomenal, and it’s so sad that we live in a world that $100,000 is worth more than an extra 10 to 15 years of my mother’s life.” [White man from an urban county; aged 41 y; LGBTQ+ identity] “And the other person I met with...was like ‘well, I don’t understand why a young, pretty women like you wouldn’t...want to have that surgery done.’ So, I think that there is sort of pressure to meet traditional gender stereotypes in reconstruction, and you know, like how you deal with that that sort of thing, and also with like fertility issues.” [White woman from a rural county; aged 45 y] “We probably need more mental health professionals down here. When I first got a cancer diagnosis, the insurance company sent me a letter in the mail that I could talk to an oncology nurse, and I talked with her and that was really helpful to have like a third-party person not involved in like my achieving my plan and not family or friend who has any emotional investment but also not my doctor to talk to. That was a really great support.” [White woman from an urban county; aged 74 y]
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