Table 3 CFIR Constructions in relation to themes presented

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

Culture

•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)