Journal of General Internal Medicine

, Volume 29, Issue 1, pp 169–175 | Cite as

Social Service Barriers Delay Care Among Women with Abnormal Cancer Screening

  • Sarah W. Primeau
  • Karen M. Freund
  • Ambili Ramachandran
  • Sharon M. Bak
  • Timothy Heeren
  • Clara A. Chen
  • Samantha Morton
  • Tracy A. Battaglia
Original Research



Inequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life’s most basic needs, like housing and income, which are often supported by public policy, regulation and services.


To examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality.


Secondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007–2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution.


Women ≥ 18 years of age with a breast or cervical cancer screening abnormality.


Social service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service).


1,481 navigated women; 31 % Hispanic, 27 % Black, 32 % White; 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days = 0.27, ≥ 60 days = 0.37).


Vulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed.


access to care cancer disparities vulnerable populations 



Our sincere appreciation to the Boston Patient Navigation Research Program (The National Cancer Institute NCI U01CA116892) for providing the data necessary to complete these analyses, and to MLP|Boston for their collaboration on this research. This research was supported by a training grant from Susan G. Komen for the Cure (KG101421). Preliminary findings from this study were previously presented at the American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (October 2012), and at the American Public Health Association Annual Meeting (October 2012).

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Sarah W. Primeau
    • 1
  • Karen M. Freund
    • 2
  • Ambili Ramachandran
    • 1
  • Sharon M. Bak
    • 1
  • Timothy Heeren
    • 3
  • Clara A. Chen
    • 4
  • Samantha Morton
    • 5
  • Tracy A. Battaglia
    • 1
  1. 1.Women’s Health Unit, Section of General Internal Medicine, Boston Medical Center and Women’s Health Interdisciplinary Research CenterBoston University School of MedicineBostonUSA
  2. 2.Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonUSA
  3. 3.Biostatistics DepartmentBoston University School of Public HealthBostonUSA
  4. 4.Data Coordinating CenterBoston University School of Public HealthBostonUSA
  5. 5.Medical-Legal PartnershipBostonUSA

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