Examining Barriers to Cancer Care: A Needs Assessment of African American and Black African Immigrants in Iowa

Gawain J Williams; Hannah Huang; Megan Schmidt; Kelly Wells Sittig; Natoshia Askelson; Sarah H Nash

doi:10.1007/s40615-026-03040-9

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Examining Barriers to Cancer Care: A Needs Assessment of African American and Black African Immigrants in Iowa

Journal article

Open access

Peer reviewed

Examining Barriers to Cancer Care: A Needs Assessment of African American and Black African Immigrants in Iowa

Gawain J Williams, Hannah Huang, Megan Schmidt, Kelly Wells Sittig, Natoshia Askelson and Sarah H Nash

Journal of racial and ethnic health disparities

06/11/2026

DOI: 10.1007/s40615-026-03040-9

PMID: 42274944

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Abstract

Non-Hispanic Black (NHB) Iowans experience significantly higher cancer incidence and mortality rates compared to their non-Hispanic White (NHW) counterparts. Yet, their unique barriers to cancer-related care remain understudied, particularly in the context of a geographically rural state with limited racial and ethnic diversity like Iowa. A deeper understanding of the nuanced challenges faced by this population is essential to the creation of equitable, community-based solutions to cancer care across the continuum. We conducted key informant interviews with 20 Black Iowans: 14 African Americans and 6 Black African immigrants. Using descriptive thematic analysis, we organized themes according to the Health Equity Framework. Six dominant themes emerged: health literacy and cultural understanding; structural barriers to care; interpersonal dynamics and communication; trust; strengths and resiliencies; and, community identified solutions. These themes revealed distinct experiences across subpopulations, highlighting both similarities and differences in barriers to care. Differences between groups primarily occurred within health literacy, and trust. For example, African Americans often understood the health system but reported distrust shaped by historical and cultural trauma, whereas Black African immigrants' mistrust frequently co-occurred with limited health literacy and unfamiliarity with the local health system. Black Iowans face multifaceted barriers to accessing cancer care, underscored by heterogeneity in cultural and social norms, resource limitations, and variations in cancer-related health literacy. Given differences between African Americans and Black African immigrants, our findings highlight the necessity for tailored interventions for specific subpopulations to effectively address inequities and improve cancer-related care outcomes.

Health Disparities

Iowa

African Immigrant

Non-Hispanic Black

Disparities

Health Equity

Cancer Disparities

Cancer

Details

Title: Subtitle: Examining Barriers to Cancer Care: A Needs Assessment of African American and Black African Immigrants in Iowa
Creators: Gawain J Williams - University of Iowa
Hannah Huang - University of Iowa Health Care
Megan Schmidt - University of Iowa
Kelly Wells Sittig - University of Iowa
Natoshia Askelson - University of Iowa
Sarah H Nash - University of Iowa
Resource Type: Journal article
Publication Details: Journal of racial and ethnic health disparities
DOI: 10.1007/s40615-026-03040-9
PMID: 42274944
NLM abbreviation: J Racial Ethn Health Disparities
ISSN: 2196-8837
eISSN: 2196-8837
Publisher: Springer Nature
Grant note: P30CA086862 / NCI NIH HHS
Language: English
Electronic publication date: 06/11/2026
Academic Unit: Epidemiology; Injury Prevention Research Center; Community and Behavioral Health; Holden Comprehensive Cancer Center
Record Identifier: 9985174494502771

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