“I Have My Reasons”: How Epistemic Injustice Shapes Black Patients’ Engagement with Preventive Care.

Racial disparities in healthcare remain a persistent issue in the United States, shaping the experiences and outcomes of Black patients across a variety of medical settings. Patient-provider interactions, and more specifically how knowledge is perceived, have not been fully examined within the context of preventative care engagement among Black adults. Through seven semi-structured, in-depth interviews with Black adults who accessed healthcare services over the last two years, this study examines how Black patients experience and navigate medical encounters and how these encounters influence their engagement with preventative care. I found that medical encounters often function as spaces where patients' credibility, knowledge, and experiences are evaluated alongside medical authority. Participants described frequent communication gaps, credibility challenges, and rigid clinical practices that sometimes left their concerns feeling minimized or misunderstood. In response to these experiences, many participants developed strategies to navigate medical encounters more effectively, including preparing extensively for appointments, engaging in independent research, and selectively advocating for themselves during interactions with providers. While participants generally remained engaged with healthcare, these interactions often required significant emotional and cognitive labor. Participants described feeling anxiety, frustration, and higher levels of precaution when approaching medical encounters, as well as intentional efforts to seek providers who they believed would better understand their unique experiences. These findings highlight how healthcare interactions can shape not only patients' immediate experiences but also their long-term relationships with medical systems as a whole. Rather than disengaging entirely from care, participants adapted their behaviors and expectations in order to navigate perceived credibility gaps and communication barriers. This study underscores the importance of patient-provider communication, cultural awareness, and collaborative engagement in fostering more equitable healthcare experiences. By examining how Black patients interpret and respond to their medical encounters, this research contributes to a deeper understanding of how everyday clinical encounters shape trust, engagement, and experiences within healthcare systems.