Examining Preventive Healthcare Utilization in Black College Women Through a Black Feminist-Womanist Lens

Abstract

Despite higher rates of disease and mortality compared to White women, Black women often experience low rates of preventive health care including recommended screenings and vaccinations that may have a protective effect. An increase in preventive healthcare utilization, has been posited as a way to offset health disparities. However, little is known about how different cultural aspects including lived experiences in the healthcare system, generational knowledge, and intersecting experience with oppression affect the ways that Black women engage with recommended preventive healthcare screenings and vaccinations broadly. Further, even less is known about how preventive healthcare habits are established while in college at a time when Black women are learning to establish a variety of lifelong habits. Thus, the current mixed methods study utilized a cross-sectional online survey to examine how Black college women define and learn about overall health and preventive health and whether applying a Black Feminist-Womanist lens to Andersen's Behavioral Model of Health Services Utilization would predict preventive healthcare utilization in Black college women. Applying a Black Feminist-Womanist lens included prioritizing qualitative data to learn about how Black college women defined their experiences and to contextualize quantitative data. Qualitative questions assessed how Black college women defined health, how they engaged in preventive health for both acute and chronic conditions, their experiences with healthcare thus far, expectations for or messages received about the healthcare system, and the sources of this information. Quantitative questions assessed rates of preventive healthcare utilization while examining the ways that culturally relevant factors including medical mistrust, health literacy, social influence, religious salience, provider respect, and affirming provider behaviors predicted preventive healthcare utilization. Qualitative responses highlighted participant's holistic views of health that included both physical and mental health. However, when it came to acute and chronic illness prevention, few participants conceptualized preventive health screenings, vaccinations, or appointments as important parts of preventive healthcare. However, themes of health literacy, self-advocacy, and holistic preventive healthcare behaviors, were voiced across participants as ways to live healthier lives and get their needs met within the healthcare system. Quantitative responses indicated low rates of preventive healthcare utilization with only 30% of the same receiving 60% or more of the recommended preventive screenings and vaccinations for their individual demographics. Results indicated that some culturally relevant predisposing factors predicted healthcare utilization. Taken together, qualitative and quantitative results highlighted the importance of health literacy and evaluated need in relationship to utilization of preventive healthcare. Future studies should examine ways to incorporate screenings and vaccinations into Black college women's conceptualization of preventive healthcare, continue to examine facilitators to preventive healthcare utilization, and leverage the existing strengths of communities of Black women to continue to move towards health equity.