Study setting and participants

KPSC is an integrated delivery system serving over 4.4 million members. Members are racially, ethnically, and socioeconomically diverse and broadly representative of the underlying Southern California population [33]. We conducted interviews with clinicians and administrators between April and November 2019 and with patients from July 2019 to November 2019. The following types of clinical and administrative stakeholder participants were invited to participate: (1) Family Medicine, Internal Medicine, and Obstetrician-Gynecology physicians; (2) department administrators (DAs) and assistant department administrators (ADAs); and (3) nurses including medical assistants (MAs) and licensed vocational nurses (LVNs). For patients, we invited individuals who were female, aged 30–65 years, who received cervical cancer screening within the last 3 months and were English speakers. We obtained verbal consent from all participants, which was approved by the KPSC Institutional Review Board [IRB #12015], and a written informed consent from the patients for audiotaping and transcribing.