Background
Cervical cancer remains the second most common cancer among women in Mexico, despite national vaccination and screening policies. At the Mexican Institute of Social Security (IMSS), which serves approximately 31 million women, screening is opportunistic, with limited coverage and reliance on low-performance cytology. In response, IMSS launched Maquilas, a workplace-based, multi-component HPV self-sampling pilot program implemented in factories along the U.S.–Mexico border. As IMSS considers integrating HPV testing as standard care within the largest healthcare system in Latin America, a detailed understanding of the program’s design, mechanisms of action, and implementation strategies is needed to inform adaptation and expansion.
Objective
To describe the Maquilas cervical cancer screening program, focusing on its mechanism of action and implementation strategies to inform its scale-up.
Methods
We followed Evidence-Based Intervention Mapping (EBI Mapping), a systematic process to map intervention components and mechanisms, to understand the Maquilas program, link it to outcomes, and identify potential modifications to improve implementation and effectiveness. EBI Mapping tasks include: (1) document program components, audiences, and goals; (2) identify outcomes, required tasks, and determinants that influence task completion; (3) identify methods/techniques used to change behavior; (4) describe design features and delivery channels; and (5) characterize implementers, their tasks, and implementation strategies. Data sources included program materials (brochures and posters for female workers; operations manuals and training slides for clinicians delivering the program), and interviews with female workers (n = 19), clinicians (n = 30), program coordinators, and program developers (n = 6). 
Results
The primary behavioral outcome of the Maquilas program was increased cervical cancer screening uptake among female factory workers. The environmental outcomes were provider recommendations and improved access to screening. Health education materials aimed to raise awareness, knowledge, expectations, and beliefs related to screening and HPV infection. Materials applied behavior change methods to explain cervical cancer risk, presented screening as a preventive alternative, addressed beliefs about HPV infection, stigma, and partner infidelity, and structured self-sampling into a few steps.
Provider training targeted awareness, beliefs, and attitudes related to counseling and program delivery. Behavior change methods invited to reflect on personal beliefs and reinforcement of providers’ perceived positive impact. To increase access, the program distributed and collected HPV self-sampling kits directly at workplaces with a high proportion of female employees and communicated test results via email.
All materials incorporated a multicolored design with cultural elements, IMSS branding, and a text-focused layout. Implementation involved factory-based providers enrolling participants, distributing kits, and shipping completed samples, while IMSS clinic providers conducted triage, referrals, and treatment. Implementation strategies included training, an implementation guide, and audit and feedback. Implementation strategy content aimed to increase knowledge of program processes, shape attitudes toward implementation tasks, and provide performance-based reinforcement.
Conclusion
This study used a systematic process (EBI Mapping) to describe the Maquilas cervical cancer screening program, including its theoretical foundations and linking program components, content, and implementation strategies. This structured understanding supports decisions about which elements should be retained, adapted, or discontinued to facilitate dissemination and scale-up within IMSS and similar health systems