Investigator
Calvin University
Reconstructing trust in preventive care: Black women’s perspectives on equity-centered, cervical cancer interventions
Black women in the United States face disproportionately high rates of cervical cancer incidence and mortality, driven in part by structural racism, medical mistrust, and barriers to culturally responsive care. Existing interventions often overlook the lived experiences of Black women and fail to address the systemic roots of healthcare inequities. To explore how Black women conceptualize healthcare mistrust and identify multilevel changes needed to improve cervical cancer screening and equity-centered preventive care. Seventeen in-depth, semi-structured interviews were conducted with self-identified Black women aged 21-65 years between February and April 2023. Guided by an integrated theoretical framework including Ecological Systems Theory, Ecosocial Theory of Embodiment, Intersectionality, and Black Feminist Thought. Interviews were thematically analyzed to surface key barriers and recommendations. Participants were recruited through purposive sampling, and thematic saturation was achieved. Four major themes emerged: (1) increasing access to affordable, community-centered healthcare; (2) expanding reproductive health knowledge and addressing informational gaps; (3) enhancing provider training in diversity, equity, and culturally responsive care; and (4) implementing systemic reforms to rebuild trust and deliver holistic, justice-driven healthcare. Participants underscored the importance of long-term community engagement, generational knowledge transfer, and trauma-informed care. Trust was framed as a central determinant, shaped by intersecting histories of discrimination and institutional exclusion. This study highlights the urgent need for systemic transformation in preventive care delivery. Improving cervical cancer outcomes among Black women requires multilevel strategies that prioritize trust, equity, and the leadership of communities most affected. These insights inform policy, provider training, and structural reforms aimed at advancing justice in healthcare.
Beyond Knowledge: Trust and the Engagement of Newly Arrived Refugee Women in Cervical Cancer Prevention
Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. Emerging research suggests that trust in healthcare systems and providers plays a pivotal role in shaping engagement with these services, yet little is known about how trust is built or broken in the early resettlement period. This study explores how trust and medical mistrust shape cervical cancer prevention behaviors among newly arrived refugee women in the United States, with attention to the multilevel relational and contextual factors that influence screening and vaccination. We conducted in-depth, semi-structured interviews with 17 refugee women resettled within the past two years in a Mid-western City, recruited through a community-based organization. Interviews were conducted in participants' preferred languages and lasted approximately 60 min. Data were thematically analyzed using Braun and Clarke's six-step framework, supported by Dedoose software. A codebook was developed through double coding and refined via consensus meetings. Themes were reviewed collaboratively and verified through member checking to enhance analytical rigor. Participants (n = 17) ranged in age from 21 to 56 and represented five countries, with the majority from Rwanda and Congo. Most had less than a high school education, and nearly all reported limited or no prior knowledge of cervical cancer, Pap smears, or HPV vaccination. Some confused HPV with other illnesses, while others attributed cervical cancer to unrelated factors such as stress or diet. Four themes emerged: trust as a precondition for engagement; provider trust shaped by cultural concordance, communication, and respect; systemic mistrust shaped by health literacy, practical/access issues and social influences; and the importance of community-based relationships in rebuilding trust and supporting preventive care engagement. Refugee women's engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.
