Cervical cancer is a disease of socioeconomic and racial/ethnic disparities; under- and un-insured women face increased risk of cancer and dying from the disease. Under and un-insured populations rely on the Emergency Department (ED) as a safety net and are less likely to have a medical home. Thus, the ED is a novel setting for engaging patients with preventive services like cancer screening.

We surveyed women presenting to the ED with non-critical conditions to assess their cervical cancer screening behaviors, barriers, and knowledge, to inform an ED-based prevention intervention. We recruited 118 women eligible for screening and descriptively analyzed responses. Participants were 44 years on average (SD=10); 9% identified as Asian, 31% as Black, 35% as Hispanic. 42% had high school diploma or less education. 55% had private insurance, 23% had Medicaid, and 18% were un-insured. 28% did not have a primary care provider (PCP).

5% of the sample had never screened. Overall, 14% were overdue for cervical screening (i.e., last Pap >3 years or Pap/HPV co-test >5 years). Women overdue for screening were more likely to be Hispanic, have less education, have Medicaid or no insurance, and not have a PCP compared to women who had screened recently. 31% history of abnormal results. The most common barriers to screening or follow-up were forgetting to schedule the exam (44%), being able to make an appointment (34%), fear of cancer (34%), and anxiety (33%). Women who were overdue reported additional screening barriers: cost (50%), not knowing when to screen (44%), other health issues (38%), male physician (38%), transportation (31%), and embarrassment (31%). Among all participants, knowledge of sexual behavior risk factors was low with less than half correctly identifying early sexual debut, multiple sex partners, and unprotected sex as risk factors. Women who were overdue were less knowledgeable about sexual behavior risk factors and less likely to know that HPV vaccination and routine Pap/HPV screening can prevent cancer. Women were interested in education and screening opportunities in the ED.

Despite high cervical screening adherence, our survey shows women in the ED endorsed logistical and psychosocial barriers to care. Additional structural barriers and low knowledge were more common among women who were overdue. Future interventions addressing knowledge, logistical, structural, and psychosocial barriers are needed to promote screening and support follow-up.