“This is some mess right here”: Exploring interactions between Black sexual minority women and health care providers for breast cancer screening and care

Background: Few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). Issues within patient-provider relationships, including bias, contribute to health disparities for minority groups. The authors used constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW. Methods: Participants were sampled nationally through social media, targeted emails, and referrals. Qualitative, in-depth interviews were conducted with 15 Black cisgender SMW, ages 38 to 64 years, who had a breast cancer diagnosis or recent abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT. Results: Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation. Conclusions: When interacting with health care providers for breast cancer screening and care, Black SMW face specific challenges related to their multiply marginalized social position. Reducing health care provider bias toward Black SMW may improve patients' desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.