Experiences of Racism in Health Care and Medical Mistrust Shape Cancer Prevention and Control Behaviors Among Black Residents of Black Hawk County, Iowa: A Qualitative Study.
Ashley N T Williams, Angela VanArsdale, Rachel Hirschey, Natoshia Askelson, Sarah H Nash
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Abstract
Background: Non-Hispanic Black Iowans have substantially higher incidence of and mortality from cancer than their non-Hispanic White (NHW) counterparts in all but the oldest age groups; rates are particularly high in Black Hawk County, which contains the city of Waterloo, a highly segregated city with a documented history of redlining and distinct racial differences in the social drivers of health.
Objective: To gather perspectives on race, racism, healthcare, and engagement with cancer prevention and control behaviors, among Black individuals living in Black Hawk County, Iowa.
Methods: We conducted semi-structured interviews with 20 individuals (10 male, 10 female), questions included experiences in healthcare and feelings towards the healthcare system, trust of the healthcare system, experiences of racism or other perceived biases within healthcare, and how experiences of racism/bias and/or feelings towards the healthcare system impact desire or ability to participate in cancer prevention and control activities.
Results: Almost all interviewees reported both positive and negative experiences in healthcare. Nine themes emerged from analysis of the interviews: everyday racism and racism in healthcare, medical mistrust, need for more Black healthcare professionals, communication with healthcare professionals, need to break down cultural stigma around cancer, need and desire for community education around health and cancer, ability to choose, self-advocacy, and social support.
Conclusions: There are substantial barriers for Black individuals engaging with cancer prevention and control behaviors in Iowa. Multi-level interventions are needed to address structural, healthcare facility, and individual-level barriers to care; interventions may build on existing resiliencies within the community.
期刊介绍：
Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.
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