Building capacity for equitable cervical cancer screening and follow-up in an FQHC–NCI cancer center partnership: a mixed-methods study of multilevel implementation determinants

INTRODUCTION: Multilevel barriers to cervical cancer screening and follow-up contribute to persistent inequities in cancer burden in communities that face social and structural disadvantage. Partnerships between NCI-designated cancer centers and Federally Qualified Health Centers (FQHCs) can strengthen primary care capacity to improve cervical cancer screening uptake, timely follow-up care, and regional cancer control. METHODS: Through the HRSA Accelerating Cancer Screening program, the USC Norris Comprehensive Cancer Center partnered with Chinatown Service Center, a multi-site FQHC serving Chinese and Hispanic patients in Los Angeles, to improve access to cervical cancer screening, follow-up and referral to treatment. Guided by the Consolidated Framework for Implementation Research, we conducted a mixed-methods assessment that combined surveys and semi-structured interviews with clinic team members to identify multilevel determinants of care processes and implementation priorities and a medical chart review to assess screening follow-up patterns among patients screened between January 2020 and March 2023. RESULTS: Surveys (n = 24) showed providers had higher knowledge of screening guidelines (67% vs. 49%; p < 0.05) and greater confidence discussing cervical cancer with patients (94% vs. 36%; p < 0.05) than clinic staff, indicating opportunities for staff training. Qualitative interviews (n = 23) identified inner setting barriers such as provider variation screening guidelines adherence and lack of tracking tools for screening follow-up. Outer setting barriers included wait times for referrals, transportation barriers, and difficulty accessing specialists through managed care networks. Inner setting factors included FQHC strengths in community partnerships that can contribute to addressing cultural barriers and patients' social needs. Building capacity for tracking cervical cancer screening results was needed. At the individual level, many patients requested gender and language-concordant providers for screening. Older patients and those not sexually active often declined screening. Medical chart reviews (n = 50) identified opportunities to improve closed-loop communication with specialists and to systematically document screening results and risk-based follow-up. DISCUSSION: We found that cervical cancer screening and follow-up strategies should prioritize strengthening workforce capacity, building infrastructure for tracking screening and follow-up, and improving referral coordination. Strengthening partnerships between FQHCs and comprehensive cancer centers offers a scalable approach to disseminating and sustaining innovations in cancer screening, with potential to improve access, adherence, and early detection across populations.