Reconstructing trust in preventive care: Black women's perspectives on equity-centered, cervical cancer interventions.

Abstract

Background: 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.

Objective: To explore how Black women conceptualize healthcare mistrust and identify multilevel changes needed to improve cervical cancer screening and equity-centered preventive care.

Methods: 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.

Results: 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.

Conclusions: 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.