Table 4.

Barriers and Facilitators to Cancer Screening

Themes	Subthemes	Representative Statements
		Women With Breast Cancer Diagnosis	Women With No Breast Cancer History
Barriers	Language	“I cannot speak English, I even cannot read Chinese. My children take me to the hospital. If they are not available, one of my friends will help me. My husband works in a restaurant. He cannot take me to the hospital. My friend will help me if I feel sick.” “I have communication problems, it would be better if I have an interpreter.”	“I haven’t gone for a screening in nearly 10 years. Firstly, I am lazy. Second, I cannot speak English, so I have to ask help to people who can speak English. So if I don’t have to, I will not do screening. I know it’s important, but I am old, so I let it go.”
	Time	“Last time I had a backache, I made an appointment, but I still waited for 9 hours, from 7 am to the evening.” “The appointment is too long, sometimes 2 weeks, sometimes 3 weeks. And you cannot be late even for half an hour.” “In the U.S., the doctors and nurses are very good. I said I have no money, they still treat me well. But you have to make an appointment and wait for a long time. Sometimes you just have a cold, and when it’s your turn to see the doctor, you have already recovered.”	“It is ok if no reservation is needed. We waste a lot of time on making reservations.” “You have to wait everywhere.”
	Insurance	“I do screening all the time, I have insurance.”	“I don’t have an insurance card, so I cannot do screening.” “I don’t have money.”
	Lack of doctor recommendation		“(Does doctor ask you to get screened?) No.”
	Stigma/embarrassment		“(Why some people don’t like screening?) Some people feel it’s embarrassing. Some people think they are old. Sometimes the doctor is male and it’s very embarrassing.”
	Family assistance constraints	“In Chinatown, everyone speaks Chinese, so there is no problem. But if you do go to the hospital to get a screening, you need someone to help you. My son in-law takes me to the hospital. He was born here. My daughter does this too. But sometimes they don’t have time, so it’s very troublesome.”	“[Elderly people] don’t want to trouble their children every time they feel sick. If there is small problem, they won’t trouble their children.”
Facilitators	Community participation/convenience	“I rarely get screenings. After I moved into this building, they (the building manager) will notify us when it is the time to receive the screening.”	“I hope community centers could navigate us to receive regular screenings. It would also be great if we can have more discussions or workshops that help us gain a better understanding of breast cancer.”
	Advertisements	“Elderly people have time and will attend. But young people have to work. Like what she said, medical newspapers work, people can read at work.”
	Reach out to physicians		“You should talk to the doctor, ask him do breast examination for everyone. They won’t be happy if you ask for screening initiatively.” “You should talk to the doctor, express that you need every patient’s breast screening result, then the doctor will agree. Otherwise doctors will feel tired if everyone requests breast screening. They don’t only have one patient.”