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Table 3 CFIR Constructions in relation to themes presented

From: Clinicians’ perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study


CFIR domain

Sub codes associated with domain

Example Quotes

CFIR Construct: Characteristics Of Individuals

  BH conditions related barriers

Other Personal Attributes

•A history of trauma

“Some women have – with behavioral health have maybe had traumatic experiences in the past, whether it’s physical or sexual abuse. And so that is a very difficult topic for them to sort of broach and be comfortable with.”(PC_FG_01)


•Uncontrolled comorbid conditions

“If they are in a situation where they are experiencing severe depression or severe anxiety, they don't have the ability to literally leave the house to get any services or—that's [cervical cancer screening] not their even primary concern.” (BH_FG_01)

CFIR Construct: Inner Setting

  BH conditions related barriers


•Stigma and perceived discrimination

“There's absolutely a stigma that's associated with the clients—our clients, our residents seeking outside medical care, and then being open and honest about their history, the fear that maybe a provider will deny to treat them because of that history and the risks associated with it. It's hard. It's most certainly hard.” (BH_FG_01)

  System level barriers related to BH care

Structural Characteristics

•Lack of integration between behavioral health and primary care services

“Still have trouble at {our primary care site} communicating between that group (BH providers) given some of the firewalls that exist.”(PC_FG_01)

  Similar barriers to the general population


•No process to send out reminders

“One thing that’s not automatic is letting them (patients) know when the next one (screening) is due.” (PC_FG_01)

CFIR Construct: Outer Setting

  Similar barriers to the general population

Patient Needs and Resources

•Lack of health insurance

“Well, one definite barrier we see here a lot is the lack of health insurance.” (BH_FG_03)


•Communication Challenges

“Either we cannot get them on the phone or their phone’s been disconnected, or stuff like that.” (PC_FG_01)