“You guys don’t listen to us”: a mixed methods study of barriers to breast and cervical cancer screening among black women

Breast and cervical cancers are highly treatable when detected early, yet they remain leading causes of cancer-related morbidity and mortality among U.S. women, with persistent racial and ethnic disparities. Prior research on screening barriers has largely focused on individual-level and structural determinants, with less attention to the interpersonal level of influence. We assess how experiences within healthcare delivery, including interactions with providers and staff, influence breast and cervical cancer screening behaviors among Black women in Illinois, with the goal of informing health services interventions. We conducted an exploratory sequential mixed-methods study in partnership with a statewide safety-net screening program. In-depth interviews ( n = 35) were conducted with Black Illinoisan women ages 21–64 years who had experienced challenges accessing breast and/or cervical cancer screening. Interview data were analyzed thematically. Findings informed a structured survey administered to Black women ( n = 233) across the state. Survey data were analyzed descriptively and stratified by age, geography, and insurance status to examine the prevalence and distribution of reported screening barriers. Triangulation of findings provided a comprehensive understanding of screening experiences. Participants represented 22 Illinois counties. IDI participants described negative healthcare experiences characterized by poor communication, dismissive treatment, and limited explanation during screenings. Providers and staff were often described as rushed, disrespectful, and discriminatory, eroding trust in the healthcare sytem. In this context, structural issues, such as long wait times for care, were frequently interpreted as manifestations of racism and discrimination. Survey findings indicated that these experiences were widespread: 56.8% of respondents reported feeling dismissed by providers or staff, 64.4% experienced discrimination, and 62.2% reported avoiding medical care due to fear of unfair treatment. Across all age groups, prior negative healthcare experiences were the most commonly reported reason for delaying or avoiding screening (64.8%). Findings suggest that negative and discriminatory healthcare encounters are important correlates of breast and cervical cancer screening behaviors among Black women. Thus, efforts to improve screening uptake must address both patient-provider communication and structural aspects of care delivery. Multilevel interventions are needed to improve care quality, rebuild trust, and ultimately reduce racial inequities in screening, early detection, and cancer-related mortality. Not applicable.