Table 2.

Subthemes and exemplar quotes corresponding to the regional services and needs theme

Subtheme: lack of proximal services
Speaker	Quote
Leader	I think most helpful would be bringing the screening options closer to them, in their own communities, so they don’t have to reach out and do some of those. I know some of them you can do kits and mail it off.
Leader	I think people need—know that they need to go get screened, but if it’s not close by, obviously, I think there—that’s their—the correlation with the high numbers in our area is because people aren’t accessing it. Even though there may be free screenings out there. It may be that’s an easy thing to go do, and maybe it’s not expensive, but just because it’s not nearby, I think that a lot of people aren’t getting screened.
Leader	I know it’s very difficult to get in, and sometimes it incorporates an overnight stay because of how long they’re receiving treatment and then having to come back the next day.
Leader	She has to ride that bus for five hours after a treatment. She’s stuck on this bus, going, stopping, going, dropping all these other people off.
Resident	Most people traveled to St. Louis, which is a two-and-a-half—two—two-and-a-half or three hours, depending where in St. Louis.
Resident	And I shouldn’t have to go 40 minutes to the doctor.
Subtheme: perceptions on the quality of regional services
Leader	I try to get them to go to St. Louis—a larger area—because of the conditions here. We’ve lost a couple people to cancer through bad treatment.
Resident	I’m constantly asked what my needs are, and that’s—I feel really strongly about that and, also, the fact that, um, I am taken, you know, as a priority, and that makes a big difference.
Resident	When I was goin’ down to Cairo, it took a little while for them to get around to gettin’ me to somewhere to get worked on. So like they maybe they need a little faster movement.
Resident	He had went to all these doctors around in southern Illinois, and none of ‘em told him he had cancer.
Resident	There’s this perception that if you stay local that it’s not a good choice. So there’s—there’s a stigma out there that you can’t get good treatment locally.
Resident	The people with the best resources are getting the best treatment, and that’s not how- that’s not how you equalize things. that’s not how you get things better.
Subtheme: systemic factors influencing access to regional services
Provider	If we’re thinking about healthy lifestyles and diet, one thing—we are a nutrition desert in Cairo. We have no grocery store. We have three liquor stores, but we have [laughter] no groceries.
Provider	Some patients actually had to switch from one plan to the other just in order to get a referral because with only Medicaid a lot of specialist doctors, they don’t even take it.
Resident	You know, when you go out to—when they go out to door, you can’t go nowhere but the Dollar Store and to post office and-and to the bank. You can’t go nowhere. There’s nowhere to go, you know. Now we don’t have no gas station. We don’t have no drugstores, don’t have the grocery stores.