OBJECTIVES: Early diagnosis of breast cancer can significantly reduce morbidity, mortality and improve life expectancy. Among those eligible, non-white women are underrepresented in mammography screening rates: both nationally, and in Vermont. The objective of our study was to explore non-white women's beliefs about access to mammography screening in Vermont. The impact of the COVID-19 outbreak on access to mammography was also examined.

METHODS: A mixed methods approach was employed through advanced qualitative and quantitative subgroup analyses to determine why individuals respond differently to public health campaigns. In-depth interviews were conducted to explore perceptions related to access to mammography screening at a Community Health center and a control site to compare motivations of women who get screened and those who do not.

RESULTS: Sociodemographic disparities populations may influence mammography screening choices. Knowledge of mammography, and subsequent utilization, were far lower among the Nepali women interviewed, aligning with documented disparities in the Vermont Mammography Registry. The COVID-19 pandemic resulted in cancelled or rescheduled mammogram screening appointments, contributing to long wait times in accessing mammography. Primary care physicians emerged as a critical link in addressing this disparity: trust was found to be high among Nepali women with their established PCP, and those who had not had a conversation with their physician regarding breast cancer screening had no awareness of it. Language and translation supports were a large barrier to effective health communication for the Nepali population, with informational packets and scheduling reminders often mailed in English.

CONCLUSIONS: The experiences contrasted highly with those of the "control" women seeking mammography care at UVMMC, who reported thorough knowledge of screening practices and risk factors, positive experiences obtaining care, and easy access to care. These findings suggest that there is strong variation in mammography screening access along sociodemographic lines, with clear opportunities for amelioration.