Trust at the intersections: black women's strategies for navigating bias, identity, and self-advocacy in health care.

Abstract

Background: Black women in the United States continue to experience inequitable preventive health care shaped by racism, gender discrimination, and medical mistrust. While prior research has examined historical foundations of mistrust or individual attitudes, less attention has focused on how Black women interpret and navigate bias as it unfolds in everyday clinical encounters.

Objective: To examine how Black women understand their health care interactions, how they experience bias in preventive care, and the strategies they use to protect their well-being and sustain engagement in care.

Methods: Seventeen self-identified Black women, including both U.S. born and immigrant participants aged 21-65 years, completed in-depth semi structured interviews between February and April 2023. Interviews explored participants' interpretations of clinical interactions, perceptions of being unheard or dismissed, and the responses they enacted to preserve their dignity and health. A thematic analytic approach guided the interpretation of the data.

Results: Three major themes emerged: (1) participants described biased encounters ranging from subtle dismissive cues to overt discrimination connected to race, gender, class, immigration, and religion; (2) these experiences carried emotional and psychological demands, contributing to constant self-monitoring during care; and (3) women employed strategies such as modifying their behavior, selectively choosing providers, and self-advocacy, while acknowledging the personal limits and emotional toll of continually having to protect themselves in clinical spaces. These findings illustrate how mistrust is not only historically rooted but continually reinforced through routine interactions that communicate who is valued within health care systems.

Conclusions: Black women's accounts demonstrate that mistrust emerges from lived experiences within health care, not only historical memory. Improving preventive care requires meaningful change in provider communication, institutional responsiveness to bias, and system level commitments that demonstrate trustworthiness. Strengthening trust will depend on whether health systems can consistently honor Black women's dignity, voice, and safety in care.