Determinants of cervical cancer screening among African and African American women: a qualitative systematic review.

Abstract

Objectives: To examine the individual- and systemic-level barriers and facilitators that influence cervical cancer screening behaviors among African and African American women, and to highlight both shared and unique factors through the lens of the Social Determinants of Health (SDH) framework.

Design: A qualitative systematic review was conducted in accordance with PRISMA 2020 standards. Twelve peer-reviewed qualitative studies published between January 2020 and May 2025 were included. Data were analyzed thematically to classify barriers and facilitators at both individual and systemic levels, using the SDH framework.

Results: Across both populations, common barriers included limited awareness, cultural and religious stigma, and financial concerns. African women frequently reported infrastructural and logistical barriers such as distance and shortages of trained providers, while African American women emphasized institutional mistrust, racial discrimination, and inconsistent communication with providers. However, factors such as community-based education, peer and partner support, and personal motivation facilitated screening uptake in both groups.

Conclusion: The study shows that even though African women and African American women share similar barriers and facilitators to cervical cancer screening, the underlying causes differ. Among African women, poor screening uptake is largely due to inadequate health infrastructure, whereas African American women's barriers are rooted in historical medical mistrust. These findings highlight the need for culturally tailored interventions, such as community-driven awareness and culturally trained providers, that respond to the lived experiences of each population rather than adopting a monolithic approach.