TABLE 1.

Themes, Categories, and Codes Obtained from Narratives of Clinic Personnel and Latina Patients

Theme: Barriers to Adoption of New Guidelines

Category: Clinical Personnel Reluctance to Adopt Changes to Guidelines

Guidelines given low scientific merit

Insufficient evidence to recommend

Clinical experience contradicts guidelines

Ever-changing guidelines

Absence of structural barriers

The BCCHP* pays for screening mammography beginning at age 40

Perceived beneficence to patients

Women want it earlier / more often; providing it improves patient-provider relationship

Desire to avoid confusing patients with mixed messages

Category: Patients’ Misunderstanding/Mistrust

Mistrust in reasons guidelines were changed and in who informed the changes

Government is saving money on health care (e.g. rationing)

Government takes too little care of us

Guidelines issued by men not women

Earlier is better, especially if symptoms (pain, lumps) are present

Theme: Facilitators to Adoption of New Guidelines

Category: Clinical Personnel’s Willingness

Organizational standards of practice and guidelines

Consensus on guidelines within clinic system

Consensus across referral sites

Responsibility toward minimizing patient harms

Desire to avoid patient costs (time from work to attend clinic visits) and morbidity associated with screening and follow-up care

Responsibility toward use of public funds

Category: Patients’ Willingness

Trust

Trust in providers’ recommendations/opinions

^*The Centers for Disease Control’s Breast, Cervical and Colon Health Program