{"doi":"10.1016/j.ssmph.2025.101873","title":"Unpacking rural Heterogeneity: A proof-of-concept study of how varying rural contexts shape breast cancer screening behaviors","abstract":"Purpose: Rural women in the U.S. experience persistent inequities in breast cancer (BrCa) screening access, yet rural populations are often treated as a monolith in research and practice. This study serves as a proof of concept by examining how contextual heterogeneity across rural settings in South-Central Washington shapes screening behaviors and access, emphasizing the intersection of structural, cultural, and environmental factors through a community-informed lens. Methods: Guided by the Community Capitals Framework, we conducted focus groups with women in two demographically and economically distinct rural communities in South-Central Washington. Participants discussed how barriers to BrCa screening manifest across seven domains of community capital-natural, cultural, human, social, political, financial, and built-offering a multidimensional understanding of health access in context. Findings: Participants across both rural settings identified overlapping community barriers, but also revealed unique, context-specific barriers. Four emergent themes captured these dynamics: (1) seasonality and competing resource demands; (2) distance as a resource-dependent constraint; (3) gendered expectations shaping care access; and (4) race and place influencing resource distribution. These findings illustrate how overlapping systems of power and community assets interact to shape health behavior and access. Conclusions: Addressing rural BrCa screening inequities requires more than generic rural interventions; this study demonstrates that inequities may manifest differently across rural types, with distinct underlying dynamics shaping barriers. By showing how contextual variation influences health behaviors, this proof-of-concept study underscores the importance of disaggregating rural populations in health research and tailoring interventions to the specific mechanisms and resources operating within each context.","journal":"SSM - Population Health","year":2025,"id":536891,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9509,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1116846,"name":"Destiny A. Jackson","orcid":null,"position":1,"is_corresponding":false},{"id":1422722,"name":"Sarah L Johns","orcid":null,"position":2,"is_corresponding":false},{"id":370885,"name":"Shoba Ramanadhan","orcid":"0000-0003-0650-9433","position":3,"is_corresponding":false},{"id":562116,"name":"Douglas A. Luke","orcid":"0000-0003-1332-8569","position":4,"is_corresponding":false},{"id":332605,"name":"Karen M. Emmons","orcid":"0000-0002-0685-6446","position":5,"is_corresponding":false},{"id":749909,"name":"Rachel M. Ceballos","orcid":"0000-0003-3697-0140","position":6,"is_corresponding":false},{"id":797938,"name":"Jennifer L. Cruz","orcid":"0000-0002-4035-743X","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-19T02:52:09.056872Z","pmid":"41216225","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}