Sustainability of Rideshare Programs to Promote Engagement of Underrepresented Populations in Breast Cancer Screening Trials.

Background: Transportation barriers significantly limit participation in breast cancer screening trials among Hispanic women, exacerbating disparities in breast cancer outcomes and underrepresentation in clinical research. Rideshare programs have emerged as a potential solution, but their long-term sustainability remains underexplored. Understanding sustainability capacity is critical to ensuring these programs can address structural barriers, promote health equity, and improve outcomes for underserved populations. The aim of this study is to evaluate sustainability capacity of a no-cost rideshare program and to identify potential strategies to support sustainability.

Methods: This explanatory, sequential, mixed-methods study evaluated the sustainability capacity of a no-cost rideshare program aimed at increasing Hispanic women's participation in the Tomosynthesis Mammographic Imaging Screening Trial (TMIST). Analyses and data integration were guided by the Capacity for Sustainability Framework. Average domain scores on the Program Sustainability Assessment Tool (PSAT) survey were calculated ranging from 1 to 7 with higher scores indicating higher levels for each domain, and structured interviews were analyzed using a rapid qualitative approach. PSAT and interview findings were integrated using a joint display.

Results: Survey responses (N=37) indicated strengths in environmental support (mean score: 5.4) and partnerships (6.0), but challenges in funding stability (4.2) and strategic planning (4.5). Interview findings emphasized the importance of program champions and collaborative partnerships, while highlighting gaps in securing diverse funding sources and engaging institutional leadership in strategic planning. Participants identified opportunities to strengthen communication, evaluate program impact, and adapt processes to meet evolving needs.

Discussion: Strong partnerships and champions supported the program's initial success, but funding instability and insufficient strategic planning threaten sustainability. Future efforts should prioritize securing diverse funding, engaging leadership, and fostering collaboration to scale rideshare programs, thereby reducing disparities and advancing equity in breast cancer screening and research participation.