This exploratory mixed-methods study aims to examine receipt of treatment and decision-making among rural cancer patients in Utah. Guided by Conceptual Model of Healthcare Access, the study will integrate, survey and cancer registry data with patient interviews to better understand how travel burden, socioeconomic conditions, health literacy, and other contextual factors shape treatment location and access to care . While the setting of this research is specific to Utah, a state with vast rural regions and only one National Cancer Institute (NCI)-designated cancer center, the findings may inform policy and practice improvements in other states with similar geographic and healthcare infrastructure. Thus, the study has potential relevance for advancing rural cancer equity nationwide.

Understanding how rural cancer patients make treatment decisions is essential to addressing persistent disparities in cancer care access and outcomes. While geographic barriers and structural inequities are well-documented, less is known about the individual and contextual factors that shape patients' choices about where and how to receive treatment. This mixed-methods study will examine receipt of treatment, decision-making, and patient experience among rural cancer patients in Utah, with attention to travel burden, referral pathways, health literacy, and perceived barriers to care.

Inclusion Criteria:

• Eligible participants include cancer survivors who are currently ages 18-26 years and who were diagnosed with childhood cancer (ages 0-26 at diagnosis) in the past ten years.
• Currently use Facebook or willing to create a Facebook account to use for the duration of the study.
• At the time of enrollment, have not completed all recommended doses of the HPV vaccine.

Exclusion Criteria:

• Unable to speak and understand English.
• Participants who take part in the Aim 1 focus groups will be ineligible for the Aim 2 social media group.
• Participants who are fully vaccinated for HPV will be ineligible as the goal of Aim 2 is to evaluate the feasibility of the social media campaign for improving vaccine intention among HPV unvaccinated individuals.