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Keywords: Health education, Homelessness, Cancer screenings

Background: In Skid Row, Los Angeles there are approximately 900 women experiencing homelessness. Unhoused women face significant barriers to accessing preventative healthcare, resulting in lower rates of breast and cervical cancer screening and higher rates of late-stage diagnoses compared to their housed counterparts. Limited health literacy, competing survival priorities, and mistrust of healthcare systems significantly influence engagement in preventative care. Prior studies suggest that health education and direct provider engagement are key predictors of screening uptake, supporting the integration of education into service delivery. To address these challenges, the Women’s Health Initiative was developed in collaboration with Union Rescue Mission (URM) and City of Hope to deliver education and onsite cancer screening services in a trusted shelter setting.

Objectives: 

1.  Provide accessible, interactive, and community-informed women’s health education sessions
2.  Increase engagement with breast cancer screening by providing mobile mammography services within the shelter setting
3. Establish sustainable partnerships with community partners to ensure continuity of care

Design: This initiative consists of three core components: (1) interactive women’s health education sessions, (2) onsite/mobile mammography services and (3) coordinated personalized patient navigation. Educational content was tailored to resident-identified interests from preliminary survey data and focused on screening guidelines, prevention, and the mammography experience. Sessions were discussion-based, with 20–30 participants in attendance and included engagement strategies such as hygiene kit distribution.

In partnership with City of Hope, our first mobile mammography event was organized at URM in February 2026. Pre-event outreach included tabling to assist residents with scheduling appointments. Post-screening follow-up planning included individualized sessions with each patient to discuss their results and next steps. We also assisted patients with scheduling follow up imaging with their PCPs or identified nearby clinics that accept uninsured patients.  

Impact/Effectiveness: Education sessions revealed common misconceptions, including concerns about radiation exposure and breast tissue damage during mammography. This open discussion allowed us to provide accurate information and education, hopefully reducing the distrust of healthcare systems. A total of 18 mammogram appointments were scheduled, with 13 completed screenings during our first mammography event. Participants reported that education sessions improved their understanding of screening and increased comfort with engaging in care and receiving a mammogram. 

Lessons Learned: Integrating education with onsite services improves patient engagement but requires substantial coordination with community partners. Additionally, flexible educational approaches and non-judgmental physician attitudes are critical in addressing mistrust of healthcare systems. Maintaining continuity of care and establishing follow up remain challenging in this highly transient population. Successful strategies included leveraging existing community services and aligning educational programming with participant interests.

Summary: The Women’s Health Initiative demonstrates the feasibility of developing community-engaged and education-centered mobile cancer screening programs within shelters to improve cancer screening uptake among unhoused women. Future efforts include expanding screening services to provide Pap smears and HPV testing, strengthening follow-up coordination, and refining our educational content to align with approximately a sixth grade reading level. Our goal is to continue refining and adapting our programming in real time based on participant feedback, ensuring that interventions remain community-informed and responsive.