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

doi:10.1007/s40615-024-02199-3

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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

Journal article

Peer reviewed

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 and Sarah H Nash

Journal of racial and ethnic health disparities, Vol.12(6), pp.4043-4052

12/2025

DOI: 10.1007/s40615-024-02199-3

PMCID: PMC11975716

PMID: 39379789

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https://pmc.ncbi.nlm.nih.gov/articles/PMC11975716/pdf/nihms-2034633.pdfView

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Abstract

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. To gather perspectives on race, racism, healthcare, and engagement with cancer prevention and control behaviors, among Black individuals living in Black Hawk County, Iowa. 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. 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. 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.

Midwest

Racism

Cultural stigma

Cancer screening

Details

Title: Subtitle: 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
Creators: Ashley N T Williams - University of Iowa
Angela VanArsdale - Black Hawk College
Rachel Hirschey - University of North Carolina at Chapel Hill
Natoshia Askelson - University of Iowa
Sarah H Nash - University of Iowa
Resource Type: Journal article
Publication Details: Journal of racial and ethnic health disparities, Vol.12(6), pp.4043-4052
DOI: 10.1007/s40615-024-02199-3
PMID: 39379789
PMCID: PMC11975716
NLM abbreviation: J Racial Ethn Health Disparities
ISSN: 2197-3792
eISSN: 2196-8837
Publisher: SPRINGER INT PUBL AG
Grant note: 3P30CA086862 / NCI NIH HHS K23MD015719 / NIMHD NIH HHS
Language: English
Electronic publication date: 10/08/2024
Date published: 12/2025
Academic Unit: Psychiatry; Epidemiology; Center for Social Science Innovation; Injury Prevention Research Center; Community and Behavioral Health
Record Identifier: 9984722575402771

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