This qualitative study consisted of semi-structured interviews in English and Spanish with Latinos to understand the perceived benefits, barriers, and cues to action for lung cancer screening. Study procedures were approved and monitored by the University of Rochester Medical Center Institutional Review Board (protocol number STUDY00007787). Participants were compensated with a $30 gift card for their time and effort.

In qualitative studies, the researcher is considered a research instrument given their ability to observe details, conduct in-depth interviews, and reflect on the meaning of interview data (22). The first author, who conducted the semi-structured interviews, is a Latino medical student interested in promoting Latino health. The second and third authors, who conducted the qualitative theoretical analysis, are medical students also interested in promoting Latino health. The last author, who supervised the qualitative theoretical analysis, is a Latino researcher trained in community-based participatory research (including qualitative studies) to address disparities among Latinos (23–28).

This study used the health belief model (HBM) as a theoretical model. The HBM posits that individuals act to change their health behaviors (e.g., getting screened for lung cancer) based on their perceived benefits, barriers, and cues to action (29). Perceived benefits refer to an individual’s opinion of the value or usefulness of a new behavior in lowering the risk of a disease and/or condition (29). Perceived barriers refer to an individual’s view of the obstacles to behavior change (29). Cues to action refer to events, people, or things that trigger people to change behavior (29).

Recruitment was conducted by a team of culturally diverse, bilingual (English and Spanish) trained recruiters between January and April 2023. Recruitment strategies included study presentations in venues with a high concentration of Latinos (e.g., community-based organizations, festivals, malls), referrals from the Wilmot Tobacco Cessation Center at the University of Rochester Medical Center, and word of mouth from community partners.

Individuals were eligible if they (1) self-identify as Hispanic/Latino; (2) speak English and/or Spanish; (3) were between 50 and 80 years old; (4) had not completed their annual screening for lung cancer with LDCT; (5) had a 20 pack-year smoking history; (6) currently smoked cigarettes or had quit within the past 15 years; (7) were interested in participating in a 90-minute interview; and (8) were comfortable with communicating over Zoom^® or a phone call for the interview. Eligibility criteria 3, 4, 5, and 6 were consistent with the 2021 USA Preventive Services Task Force eligibility for lung cancer screening (10). Study staff conducted an eligibility assessment over the phone in the participant’s language of preference, either English or Spanish.

Individuals eligible to participate in the study received an informational letter with detailed information about the study (e.g., procedures, confidentiality, contact information of the study team). The informational letter was available in English and Spanish. The first author reviewed the informative letter with participants. Verbal consent was obtained from the participants before enrollment in the study.

Before the interview, the first author conducted a sociodemographic survey to collect information on age, gender, sexual orientation, education level, language of preference, and country of birth. Moreover, smoking-related variables were collected, including current smoking status, number of cigarettes smoked per day (CPD), age that the participant started smoking, time to their first cigarette, use of menthol cigarettes, quit attempt in the past year, and ever use of pharmacotherapy and electronic cigarettes for cessation. Lastly, participants were asked if they were aware of lung cancer screening (i.e., Before this study, have you ever heard about lung cancer screening with low-dose CT scan? Yes/No) and if they knew they were eligible (i.e., Before this study, did you know you were eligible to screen for lung cancer with low-dose CT scan? Yes/No). The survey was completed in the participants’ language of preference, either English or Spanish.

Immediately after the sociodemographic survey, the first author conducted a semi-structured interview. An interview guide with open-ended questions was used to facilitate the interviews. The interview was completed in the participants’ language of preference, either English or Spanish. The HBM was used to develop the interview guide (30). Table 1 shows examples of the interview questions by the HBM factor.

The first author conducted the interviews. All interviews were audio-taped and subsequently transcribed verbatim in the language they were conducted. Interviews in Spanish were translated to English. The interviewer verified the translations and resolved any discrepancies using a consensus approach (31).

For the sociodemographic and smoking-related questions, means and frequencies were calculated. Interview data were analyzed manually after all data were collected. Qualitative theoretical analysis was used to identify, analyze, and report themes within the interview data (32). The second and third authors independently coded the first five transcripts through line-by-line coding. An iterative process was employed to achieve consensus between the two sets of codes, create a coding scheme, and develop a codebook that included details about agreed-upon code definitions. New codes were added to the coding scheme as needed until no new themes emerged with successive interviews (33). The last author supervised the qualitative theoretical analysis and provided in-depth feedback on the codebook development. All authors agreed on the final themes and sub-themes.

Based on principles of data saturation, the study estimated a sample size of twenty participants to collect enough data to draw necessary conclusions (34, 35).

As shown in Table 2 , the participants’ mean age was 58.3 years old (SD 5.84), 50% of the participants were female, 85% self-identified as heterosexual or straight, 55% had an education of high school or less, and 55% indicated “more Spanish than English” as their language of preference. Twelve participants (60%) were born in Puerto Rico. All participants (100%) were currently smoking, 55% smoked 1-10 cigarettes daily, 20% smoked their first cigarette within five minutes after waking up, and 70% used menthol cigarettes. Twelve participants (60%) had made a quit attempt in the past year, and 90% had used pharmacotherapy for cessation. Fourteen participants (70%) were unaware of lung cancer screening and 90% were unaware they were eligible for lung cancer screening. Half of the participants (50%) were insured by Medicaid. Table 3 describes each participant’s age, gender, and language of preference.

As shown in Figure 1 , participants identified five benefits of lung cancer screening: 1) Smoking cessation, 2) early detection of lung cancer, 3) increased survivorship, 4) self-care, and 5) peace of mind. Select quotes from participants are shown below.

As shown in Figure 1 , participants identified seven barriers to lung cancer screening: 1) Fear of outcomes, 2) cost, 3) lung cancer screening not being recommended by their clinician, 4) lack of knowledge about the procedure, 5) self-blame, 6) transportation, and 7) lack of time. Select quotes from participants are shown below.

As shown in Figure 1 , participants identified four cues to action for lung cancer screening: 1) Family, 2) recommendation by healthcare professionals, 3) printed and online educational materials, and 4) having symptoms. Select quotes from participants are shown below.

Our study had multiple strengths. First, this research builds upon an established history of smoking cessation research with the Latino community (23–28). Second, this work is grounded in principles of community-based participatory research (CPBR). CBPR is a partnership approach to research that involves community members, organizational representatives, and researchers across all phases of research (51). This approach ensures that the research is relevant, meaningful, and appropriate to the population for which it is planned. Third, this study benefited from an adequate sample size that gave us sufficient information to understand the perspectives of Latinos on lung cancer screening (35). Fourth, the use of the HBM framework is another strength. This model provided a conceptual framework to successfully understand identified barriers, benefits, and cues to action. Lastly, the inclusion of Spanish speaking participants is another study strength.

The study has several limitations. First, there is a possibility that participants felt compelled to offer socially desirable responses. To reduce response bias, the first author assured participants that there were no right or wrong answers before starting the interview. Second, we employed a non-probability sampling method, which limits the generalizability of the findings. Lastly, all participants were currently smoking and had medical insurance. Future studies should purposely include Latinos who have quit smoking and have no medical insurance to understand their perspectives on lung cancer screening.