The patient's perspective on the acceptability of technological innovation must be taken into account during the development of new technologies. Because patients are involved in their own care, medical devices that address their needs can produce better treatment outcomes. In this program project, we take a global approach to developing and assessing technologies to detect cervical cancer, considering factors at all levels that affect cervical screening and diagnosis: from the molecular to the patients and their communities. In Project 4, we will consider the effects of emerging technologies on patient outcomes in both developed and developing worlds. In developed countries, the multiple delays in the diagnosis and treatment trajectory after Papanicolaou smear and biopsy can reduce adherence and increase psychological distress for women receiving unfavorable results. In developing countries and underserved areas of the developed world, standard-of-care procedures require resources that are not available. In addition, cultural beliefs about screening for cervical cancer often exist that pose barriers to widespread screening programs. In this program project, we are developing technologies to address limitations in current technologies for both developed and developing countries. Emerging technologies under development with support from this grant aim to improve screening outcomes through (1) improved accuracy in less time, which can support diagnosis and treatment in a single visit; (2) more automation, facilitating wider use of the technology by non-expert providers; and (3) less invasive testing, which results in increased comfort and less distress for patients. To achieve the goals of Project 4, we take surveys of patient attitudes, distress, anxiety, pain, and priorities from 805 participants in the two clinical trials proposed in Project 3, which will be conducted at six clinical sites in Vancouver and Houston. We will also assess specific barriers to health care delivery in Appalachia, the Texas-Mexico border, and in Ibadan, Nigeria.