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Empowering Black women: Navigating breast cancer care and survivorship

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Empowering Black women: Navigating breast cancer care and survivorship

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Content Empowering Black Women: Navigating Breast Cancer Care and Survivorship
Fredrick Dwane Lee II
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
August 2024

© Copyright by Fredrick Dwane Lee II 2024
All Rights Reserved

The Committee for Fredrick D. Lee II certifies the approval of this Dissertation
Erika Page
Briana Hinga
Patricia Tobey, Committee Chair
Rossier School of Education
University of Southern California
2024

iv
Abstract
This study examined the multifaceted experiences of Black women as they navigated breast
cancer treatment and survivorship. The study was grounded in the theoretical frameworks of
social cognitive theory (SCT) and Black feminist thought (BFT), which provided a foundation
for comprehending the complexities of this journey. The research aimed to elucidate how Black
women perceived their self-efficacy and its influence on their health behaviors, recognizing the
role of self-efficacy in shaping health outcomes. Additionally, it explored the impact of race,
gender, and socioeconomic class identities on healthcare experiences and how these factors
contributed to variations in the quality of care, communication with healthcare providers, access
to resources, and overall satisfaction with the treatment journey. A mixed-methods approach
combined a quantitative survey and qualitative semi-structured interviews to achieve these
objectives. The survey used standardized instruments to quantify the influence of self-efficacy on
health behaviors. At the same time, the interviews presented Black women’s narratives,
capturing the depth and richness of their experiences. The study’s significance rests in its ability
to inform culturally inclusive and patient-centric healthcare models that empower Black women
facing breast cancer. This research sought to contribute meaningful insights, bridge gaps in
healthcare practices, and confront the challenges this demographic faces. It aspired to catalyze
positive changes that resonate on individual and societal levels, fostering equitable and
compassionate healthcare for all.
Keywords: Black women, breast cancer, healthcare disparities, intersectionality, selfefficacy, survivorship

v
Dedication
To God, whose unwavering support and guidance carried me through every challenge. Your
strength and love made this achievement possible.
To my grandparents, Vernice Caffey, Jesse Caffey, Margie Lee, and Nathaniel Lee, Sr., thank
you for your spiritual guidance, unconditional love, and invaluable life lessons. Your
demonstration of Seventh-Day Adventist Christian values has shaped my character.
To my parents, Faith Skelton, Fredrick Lee, and Cookie Lee, your teachings on discipline, hard
work, and resilience have been the foundation of my success. Mom, your unwavering support
from my first day of school to completing this degree has been invaluable. Dad, your lessons on
being a man of substance and respect have guided me. Cookie, your flexibility, and positive
outlook have taught me how to navigate life’s challenges.
To my siblings, who have been my first and best friends. Your perseverance, big sister Kisha
Armstead, taught me to pick myself up. Eugene Armstead, my nephew, showed me the
importance of choosing my path. Older sister, La Cresha Lee, your fighting spirit inspired me
never to give up. Qui’Niah Lee, my niece, reminded me of empathy’s value. Kacere Lee, my
nephew, showed me there are many ways to finish a race. Little brother, Brandon Hughes, your
resilience was inspiring. Baby sister, Janae Lee, your structured approach was a model for
handling challenges. Adrian Booker, my nephew, reignited my curiosity. Baby brother, Mikhail
Lee, your determination motivated me.
To my friends, who have been the cheerleaders of my life, thank you for understanding the real
me and for your unwavering support.

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Acknowledgments
I am profoundly grateful to everyone who has supported and encouraged me throughout
the journey of completing this dissertation. This accomplishment would not have been possible
without your guidance, love, and support.
First, I acknowledge the life and the memory of my grandmother, Vernice Caffey. Your
passing from triple-negative breast cancer on January 7, 2022, just three days before I began this
program, was a tremendous loss. You are the inspiration behind this study. A devoted Seventhday Adventist Christian, you provided me with invaluable spiritual guidance. It was the spiritual
guidance that I leaned on to get through this program. I cherish the memory of you singing
“Happy Birthday” to me every year for 40 years. Your love and wisdom continue to inspire me
daily. I look forward to telling your story and sharing my memories of you with others as I
continue my post-doctorate journey.
I would like to extend my heartfelt thanks to my mentors, who have encouraged and
inspired me. Dr. Cynthia Payne, your dedication to the profession and lifelong learning and your
unwavering encouragement have been instrumental in my journey. As a former colleague and
forever friend, your support has been invaluable. Although our time working together ended
sooner than expected, I look forward to future collaborations highlighting our growth and
knowledge. Dr. Terri Dyer, your passion for caregiving and your guidance have been a beacon of
light. I remember the days we worked together, focusing on educating our clinical staff. I look
forward to future endeavors that bring us together in a similar capacity. Your encouragement and
the example you set as a former colleague and a lifelong inspiration have profoundly impacted
my path.

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My deepest gratitude goes to my dissertation committee for their unwavering support,
guidance, and mentorship. Dr. Patricia Tobey, your support and mentorship have been critical in
navigating this complex process. I would not have gotten through this process without you. I am
eternally grateful for having you as my dissertation chair. Dr. Briana Hinga, your inspiration,
knowledge, and guidance have enriched my understanding and shaped my research. You were
the first professor I was introduced to while in this program. This was not a coincidence. You
offered challenging questions that made me uncomfortable while also providing the cathartic
release I needed by presenting the truth unfiltered yet compassionate. Dr. Erika Page, your
guidance, knowledge, and support have been cornerstones of my academic journey. Your
perspectives during our course were profound. You kept challenging the status quo by making us
think critically more deeply. I am blessed to have encountered you on this journey.
I thank the USC Rossier Organizational Change and Leadership (OCL) Faculty and
Professors. Your support, availability, and guidance have been indispensable in my academic
development. Each of you has contributed significantly to my growth and success. Finally, to my
fellow Cohort 22 doctoral students, sharing this journey with you has been an honor, and I am
grateful for our lifelong bonds.
This dissertation was completed through the ethical use of AI tools, including Grammarly
and ChatGPT. Grammarly is a cloud-based writing assistant that enhanced the written
communication of this work by providing real-time grammar, spelling, punctuation, and style
feedback. It uses advanced AI and natural language processing, which helped me create clear,
compelling, and error-free text. Additionally, I used ChatGPT to refine my writing style, create a
succinct flow, ensure proper APA formatting, and simplify technical jargon, enhancing my

viii
original ideas based on the research and analysis conducted into a polished and accessible
document.
Finally, I am deeply grateful to the participants of my study surveys and interviews. Your
willingness to share your vulnerability and lived experiences has contributed to the body of
knowledge in this field. I acknowledge the difficult journey you have been on. I am forever
thankful to all of you for taking the time to open yourselves up to revisiting your breast cancer
journey. Your participation and insights have been invaluable contributions to this research. To
everyone who has walked this path with me, your support has been integral to my journey.
Thank you for your unwavering support and belief in me.

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Table of Contents
Abstract.......................................................................................................................................... iv
Dedication ........................................................................................................................................v
Acknowledgments.......................................................................................................................... vi
List of Tables ............................................................................................................................... xiii
List of Figures.............................................................................................................................. xiv
Chapter One: Introduction to the Study ...........................................................................................1
Context and Background of the Problem.............................................................................2
Purpose of the Project and Research Questions...................................................................3
Importance of the Study.......................................................................................................4
Overview of Theoretical Framework and Methodology .....................................................5
Definition of Terms..............................................................................................................6
Organization of the Study ..................................................................................................10
Conclusion .........................................................................................................................11
Chapter Two: Review of the Literature .........................................................................................12
Historical Context ..............................................................................................................13
Earlier Research Using BFT and SCT...............................................................................15
Current Successful Practices..............................................................................................17
Current Challenges and Barriers........................................................................................22
Characteristics of the Population and Key Stakeholders...................................................30
Reasons Underlying the Problem.......................................................................................32
Current Strategies for Solving the Problem.......................................................................37
Approaches to Measurement of the Problem.....................................................................42
Conceptual Framework......................................................................................................44
Conclusion .........................................................................................................................52

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Chapter Three: Methodology.........................................................................................................53
Research Questions............................................................................................................53
Dissertation Research Questions and Hypotheses.............................................................54
Overview of Design ...........................................................................................................54
Research Setting.................................................................................................................57
The Researcher...................................................................................................................58
Instrumentation ..................................................................................................................60
Participants.........................................................................................................................60
Data Collection Methods ...................................................................................................64
Data Analysis.....................................................................................................................66
Validity and Reliability......................................................................................................68
Credibility and Trustworthiness.........................................................................................76
Ethics..................................................................................................................................76
Limitations and Delimitations............................................................................................77
Conclusion .........................................................................................................................78
Chapter Four: Quantitative Results and Qualitative Findings.......................................................80
Participant Demographics..................................................................................................81
Descriptive Statistics..........................................................................................................86
Reliability and Factor Analyses.........................................................................................87
Quantitative Survey Results Hypothesis 1.........................................................................88
Open-Ended Survey Response Findings (RQ1) ................................................................90
Qualitative Interview Findings (RQ1) .............................................................................100
Summary of RQ 1 ............................................................................................................109
Quantitative Survey Results: Hypothesis 2......................................................................110
Open-Ended Survey Responses (RQ2)............................................................................121

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Qualitative Interview Findings for RQ2 ..........................................................................133
Summary of RQ2 Findings..............................................................................................145
Summary of RQ 3 Findings.............................................................................................165
Conclusion .......................................................................................................................166
Chapter Five: Discussion and Recommendations for Practice ....................................................168
Summary of Findings and Results...................................................................................169
Recommendations for Practice ........................................................................................173
Implementation of Recommendations.............................................................................175
Recommendations for Future Research ...........................................................................183
Conclusion .......................................................................................................................186
References....................................................................................................................................187
Appendix A: Survey Protocol......................................................................................................218
Qualtrics Survey Link ......................................................................................................218
Target Population.............................................................................................................218
Introduction......................................................................................................................218
Purpose of the Study ........................................................................................................218
Procedures........................................................................................................................218
Risks and Benefits............................................................................................................219
Confidentiality and Data Handling ..................................................................................219
Voluntary Participation and Withdrawal .........................................................................219
Contact Information .........................................................................................................219
Consent ............................................................................................................................220
Appendix B: Interview Protocol ..................................................................................................227
Introduction to the Interview ...........................................................................................227
Respondent Type .............................................................................................................227

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Introduction......................................................................................................................227
Study Procedures .............................................................................................................227
Recording Consent...........................................................................................................228
Risks and Benefits............................................................................................................228
Confidentiality .................................................................................................................228
Voluntary Participation and Right to Withdraw ..............................................................228
Questions and Concerns...................................................................................................228
Consent ............................................................................................................................229
Conclusion to the Interview.............................................................................................231

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List of Tables
Table 1: Conceptual Framework Elements 48
Table 2: Data Sources 56
Table 3: Quantitative Survey Participant Demographics 82
Table 4: Qualitative Interview Participant Demographics 85
Table 5: Descriptive Statistics 87
Table 6: Linear Regression Analysis: Positive Health Behaviors on Self-Efficacy 89
Table 7: Descriptive Statistics: Independent Variables 111
Table 8: Linear Regression Analysis: Quality on Self-Efficacy and Demographic Measures 112
Table 9: Descriptive Statistics 114
Table 10: Linear Regression Analysis: Q 26 on Self-Efficacy, Main Effects, and Interactions 115
Table 11: Linear Regression Analysis: Q27 on Self-Efficacy, Main Effects, and Interactions 116
Table 12: Linear Regression Analysis: Q28 on Self-Efficacy, Main Effects, and Interactions 118
Table 13: Linear Regression Analysis: Q29 on Self-Efficacy, Main Effects, and Interactions 119
Table 14: Linear Regression Analysis: Q30 on Self-Efficacy, Main Effects, and Interactions 121
Table A1: Survey Protocol 220
Table B1: Interview Protocol 229

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List of Figures
Figure 1: Conceptual Framework Illustration 46
Figure 2: ADKAR Change Model 177

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Chapter One: Introduction to the Study
Breast cancer is the leading cause of cancer-related deaths among women worldwide and
is a significant global health concern (Azamjah et al., 2019). In 2020, breast cancer was the most
prevalent cancer among women globally. It comprised 24.5% of all diagnosed cancer cases (Lei
et al., 2021) and was the leading cause of cancer-related deaths in women, representing 15.5% of
all cancer-related fatalities (Lei et al., 2021). This dominance in incidence and mortality rates
was observed in many countries (Azamjah et al., 2019; Lei et al., 2021). In the United States, in
2020, the overall breast cancer mortality rate was 24.8% (Haque et al., 2023). A 2020 study by
Giaquinto et al. indicated that Black women in the United States are approximately 40% more
likely to die from breast cancer than White women. The study also stated the breast cancer
mortality rate was 27.4 deaths per 100,000 people for White women aged 20 and above, while
for Black women in the same age group, the mortality rate was 38.7 deaths per 100,000
(Giaquinto, Miller, et al., 2022).
The reported difference in breast cancer mortality rates underscores the presence of
disparities in health outcomes between Black and White women (Haque et al., 2023). The
contrast suggests a complex interplay of biological, social, and healthcare system factors as
contributors to Black women’s unnecessary deaths (Reeder-Hayes et al., 2015; Williams et al.,
2010). The racial disparity in mortality rates between Black and White women is unjust and has
significant implications for the lived experiences of Black women and their families (Braveman,
2022; Secules et al., 2021). Particularly relevant are Black women’s lived experiences navigating
the U.S. healthcare system for breast cancer treatment (Sacks, 2018; Secules et al., 2021). The
impact of these experiences on Black women’s self-efficacy and health outcomes and the

2
manifestation of stereotypes arising from the intersectionality of their identities within these
experiences remain insufficiently understood and warrant further academic investigation.
This dissertation examined these influences, focusing on the intersectionality of Black
women’s identities and their self-efficacy in navigating breast cancer treatment. Guided by Black
feminist thought (BFT) and social cognitive theory (SCT), this study aimed to illuminate the
factors that shape Black women’s health outcomes and influence their experiences with the
healthcare system. By examining these components, the study revealed nuanced dynamics and
developed an enriched understanding that can inform policy and practice toward achieving
healthy outcomes in breast cancer treatment.
Context and Background of the Problem
Breast cancer is a significant global health issue and a leading cause of cancer death
among women worldwide, including in the United States (Azamjah et al., 2019; Lei et al., 2021).
Research from 2020 conducted by Gianquinto et al. noted a distinctive racial disparity in breast
cancer outcomes, where Black women have 40% higher mortality rates than their White
counterparts. These disparities have been acknowledged for decades and persist despite
advancements in detection and treatment modalities (Gerend & Pai, 2008; Reeder-Hayes et al.,
2015). Several factors contribute to the discrepancies, including differential access to quality
healthcare, differences in tumor biology, health behaviors, and the impact of social determinants
of health (Gerend & Pai, 2008; Reeder-Hayes et al., 2015).
In this context, the healthcare industry has made numerous attempts to address these
disparities, with approaches ranging from policy interventions to community outreach initiatives,
increased access to screening and care services, and targeted research on biological differences
(Makurumidze et al., 2022; Williams et al., 2016). However, there is still a significant gap in

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addressing Black women’s experiences navigating the healthcare system for breast cancer
treatment (Rankin-Wright et al., 2020; Sacks, 2018). Prior research has often overlooked the
sociocultural context within which Black women interact with the healthcare system and how
their identities and perceived self-efficacy influence their experiences and health outcomes
(Sacks, 2018). The necessity to focus on these aspects formed the central premise of this study.
Purpose of the Project and Research Questions
This mixed-methods study aimed to analyze the lived experiences of Black women with
an earlier breast cancer diagnosis in the United States and to explore the influences they
perceived as shaping their health outcomes. Furthermore, the study sought to understand how
Black women perceived their self-efficacy concerning their environment and how their
intersectionality manifested in their healthcare experiences. The research was predicated on the
assumption that understanding these nuances would help address the persisting disparities in
breast cancer outcomes for Black women. Guided by the theoretical frameworks of BFT and
SCT, this study aimed to address the following research questions and hypotheses:
1. How do Black women with breast cancer perceive their self-efficacy and its influence
on their health behaviors? Hypothesis 1: Higher self-efficacy levels are associated
with increased engagement in positive health behaviors.
2. In what ways do Black women diagnosed with breast cancer perceive that their race,
gender, and socioeconomic class identities influence their healthcare experiences?
Hypothesis 2: The interaction of self-efficacy and stereotypes formed from race,
gender, and socioeconomic elements influences the quality of healthcare experiences.

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3. How might the insights from these lived experiences contribute to designing
healthcare models incorporating self-agency aimed at breast cancer survivorship for
Black women?
Importance of the Study
The persistence of racial disparities in breast cancer outcomes among Black women in
the United States is a pressing problem that merits investigation (Goel et al., 2023; Reeder-Hayes
et al., 2015). The literature revealed a 40% higher mortality rate among Black women than their
White counterparts, demanding attention and transformative interventions (Giaquinto, Miller, et
al., 2022; Haque et al., 2023). This implies systematic and interrelated cultural, socioeconomic,
and healthcare delivery issues that could significantly affect outcomes for this demographic
(Soulé, 2014; Williams et al., 2010). Failure to address this problem has perpetuated a lack of
efficacious strategies to mitigate these disparities and invariably prolongs the status quo of
suboptimal health outcomes for Black women (Reeder-Hayes et al., 2015).
Leaving this problem unexplored could have far-reaching implications, including the
continued erosion of trust in healthcare systems among Black communities, exacerbation of
health disparities, and, crucially, the loss of more human lives that could be preventable with
prompt and proper interventions (Makurumidze et al., 2022; Reeder-Hayes et al., 2015). The
moral and ethical imperatives of healthcare, coupled with its fundamental principles of equity,
justice, and inclusivity, demand an examination of this issue (Braveman, 2022; Sacks, 2018). By
thoroughly investigating and understanding the lived experiences of Black women navigating
breast cancer treatment, the healthcare field can develop interventions that are culturally
competent, patient-centered, and, thus, more likely to result in improved health outcomes (Crown
& Joseph, 2022; Schneider et al., 1996). Confronting this issue head-on is imperative, for

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looking the other way would only perpetuate the enduring inequity in healthcare, casting a
shadow on the tapestry of progress in modern medicine.
Overview of Theoretical Framework and Methodology
The theoretical underpinnings of this dissertation are grounded in two primary
frameworks: BFT and SCT. Black feminist thought offers a lens to understand Black women’s
experiences and challenges, emphasizing the intersectionality of race, gender, and class (Collins,
2009). The theory posits that Black women have distinct ways of knowing and understanding the
world, shaped by their historical and contemporary social, political, and economic realities
(Collins, 2009). It allows an understanding of the multifaceted influences on Black women’s
breast cancer treatment navigation (Collins, 2009; Sacks, 2018).
Social cognitive theory (Bandura & Cervone, 2023) posits that learning occurs in a
social context and that individuals learn by observing others. Key elements of this theory,
including self-efficacy, outcome expectations, and observational learning, are instrumental in
understanding health behaviors (Bandura, 2000; Bandura & Cervone, 2023). Thus, SCT can
provide insights into how Black women perceive their ability to influence their health outcomes
and how these perceptions shape their health behaviors (Bandura, 2000; Bandura & Cervone,
2023).
The appropriateness of these theories lies in their capability to provide a nuanced
understanding of the lived experiences of Black women navigating breast cancer treatment.
Black feminist thought acknowledges Black women’s intersectional influences and experiences,
while SCT enables understanding the cognitive processes that underpin health behaviors
(Hemingway et al., 2015; Kelly‐Brown et al., 2022). Together, they offer a comprehensive
framework for understanding the problem.

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A mixed-methods research approach was used for this study due to the complexity of the
breast cancer health issue. The emerging field of mixed-methods research, which combines
qualitative and quantitative approaches, has gained prominence (Feilzer, 2010; Sadan, 2014). By
concurrently collecting, analyzing, and integrating both types of data in a single research
framework, this method offers a holistic and pragmatic approach that can aptly tackle
multifaceted health challenges (Sadan, 2014). The quantitative data provides a comprehensive
understanding of demographic trends, prevalence, treatment patterns, and outcomes among the
sample population, offering an objective lens through statistical visualizations to identify
correlations or trends (Ma et al., 2013; Sadan, 2014). Conversely, the qualitative data explores
rich narratives, perceptions, and individual lived experiences (Cypress, 2015; Soulé, 2014). This
combination helps to provide a robust perspective on the experiences of Black women with
breast cancer, informing interventions and healthcare models that are more culturally inclusive
and patient centric (Soulé, 2014).
Definition of Terms
The following operational definitions ensure a consistent and clear understanding of the
concepts and terms used throughout this study. These definitions, organized alphabetically,
elucidate the specific meaning attributed to each term in the context of this dissertation.
Black feminist thought (BFT) is a theoretical framework that posits Black women have
unique ways of understanding the world, influenced by the intersectionality of race, gender, and
class, emphasizing Black women’s distinctive experiences and challenges (Collins, 1989).
Breast cancer is a type of cancer originating in the breast cells, with disproportionate
incidence and mortality rates among Black women (Waks & Winer, 2019).

7
Breast cancer treatment navigation is a process through which an individual diagnosed
with breast cancer progresses from the initial diagnosis to various stages of treatment involves
interactions with healthcare professionals, decision-making about treatment options, and
managing physical and psychological effects (Daly & Olopade, 2015; Waks & Winer, 2019).
Culturally competent care is the aptitude of healthcare providers to meet patients’ diverse
cultural, social, and linguistic needs through understanding and respecting their varying values,
beliefs, and behaviors during care provision, which aims to enhance health outcomes and patient
satisfaction and to address health disparities present among specific populations (Betancourt et
al., 2003).
Health behavior is any action undertaken by individuals is influenced by their
knowledge, attitudes, and beliefs about a disease or health condition that affects their health or
illness (Knecht & Kenning, 2016). Health behaviors, such as adhering to treatment protocols,
regular medical check-ups, and lifestyle modifications, are influenced by social, cultural, and
physical environments that are pivotal in health outcomes and disease prevention (Knecht &
Kenning, 2016).
Health disparities involve the unequal distribution of health outcomes and healthcare
access among different racial, ethnic, and socioeconomic groups, specifically focusing on the
poorer survival rates of breast cancer among Black women in the United States (Reeder-Hayes et
al., 2015).
Health literacy is the degree to which individuals can obtain, process, and understand
basic health information and services needed to make appropriate health decisions (Kamimura et
al., 2016; Nielsen-Bohlman et al., 2004). This dissertation relates to the organization’s efforts to
assist Black women with navigating the healthcare system, understanding their breast cancer

8
diagnoses and treatment options, and making informed decisions about their care (Kamimura et
al., 2016; Nielsen-Bohlman et al., 2004).
Health outcomes include factors like health behaviors, health care services, and health
literacy influence the measurable changes in the health status of Black women undergoing breast
cancer treatment (Kindig et al., 2008; Nielsen-Bohlman et al., 2004). Such outcomes include
survival rates, disease recurrence, recovery time, treatment side effects, psychological wellbeing, and overall quality of life during and after treatment (Kindig et al., 2008; NielsenBohlman et al., 2004).
Healthcare delivery refers to the administration of health services. Pertaining to breast
cancer treatment, healthcare delivery involves various elements such as diagnostic procedures,
treatment options like surgery and chemotherapy, follow-up care, and patient education (Waks &
Winer, 2019).
Holistic refers to a comprehensive, multi-dimensional approach to patient care that
acknowledges and treats a person’s physical, mental, emotional, and social health (D. W. Bailey,
2006). This approach considers the entire person and how different health dimensions interact,
not just the disease or ailment (D. W. Bailey, 2006).
Intersectionality is a comprehensive framework that recognizes how multiple aspects of
an individual’s identity, such as race, class, gender, sexual orientation, and religion, interrelate
and can collectively contribute to experiences of oppression or privilege (Kelly‐Brown et al.,
2022).
Lived experiences are the first-hand accounts and interpretations of an individual’s
experiences within their social and cultural context are personal and subjective, reflecting their
emotions, thoughts, and perceptions of the world (Miller et al., 2018).

9
Patient-centric care is a healthcare approach that emphasizes designing care around the
needs and preferences of patients, with a focus on active patient and family engagement in
decision-making and respect for patient values (Mitchell et al., 2020). This model is known to
improve patient satisfaction and healthcare outcomes and potentially reduce costs by avoiding
unnecessary interventions (Mitchell et al., 2020).
Pragmatic refers to the strategic blending of qualitative and quantitative methods in a
manner that provides the most meaningful and actionable insights into the lived experiences and
health outcomes of Black women undergoing breast cancer treatment in the United States
(Feilzer, 2010). Pragmatism in this study entails adopting a mixed-methods approach to collect
rich, complex data that effectively addresses the study’s diverse research questions and
objectives contextually and comprehensively (Feilzer, 2010).
Remission is when cancer signs and symptoms decrease or disappear, with complete
remission indicating no evident signs and partial remission showing some remaining signs
(Runowicz et al., 2016). This term refers to evaluating treatment effectiveness and subsequent
patient health outcomes (Runowicz et al., 2016).
Self-agency in this dissertation means Black women with breast cancer can actively
participate in healthcare decisions, advocate for their needs, and assert control over their
treatment journey (Budhwani et al., 2019; Kennedy & Rollins, 2016). It explores how their
identities’ intersections impact their sense of empowerment and autonomy in the healthcare
system (Budhwani et al., 2019; Kennedy & Rollins, 2016).
Self-efficacy pertains to a person’s confidence in their ability to navigate and cope with
breast cancer treatment and related challenges while influencing their decision-making,
engagement in healthcare, and overall health outcomes (Bandura, 2000).

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Social cognitive theory (SCT) is a psychological framework developed by Albert Bandura
emphasizes observational learning, cognitive processes, and personal agency in shaping human
behavior through the influence of self-efficacy (Bandura & Cervone, 2023).
Socioeconomic is the social and economic factors that influence an individual’s or a
community’s position and status in society include income, education, occupation, and social
class (Williams et al., 2010). In the context of this dissertation, socioeconomic factors may play a
significant role in shaping the experiences and health outcomes of Black women navigating
breast cancer treatment (Williams et al., 2010).
Survivorship refers to after cancer treatment, individuals coping with cancer’s physical,
emotional, and psychosocial impacts (C. M. Davis et al., 2016). In the context of this
dissertation, survivorship among Black women with breast cancer involves understanding their
experiences, challenges, and quality of life as they navigate life post-treatment (C. M. Davis et
al., 2016).
Organization of the Study
This dissertation unfolds over five comprehensive chapters. Chapter One introduced the
study, contextualized the problem in the field of healthcare for Black women navigating breast
cancer treatment, and established the purpose of the research. Chapter Two presents a detailed
literature review that elucidates the current knowledge about the problem, provides a foundation
for the theoretical framework, and justifies the study’s significance. Chapter Three details the
research method, explaining the rationale for a mixed-methods approach, participant selection,
data collection, and analysis procedures. Chapter Four offers an in-depth discussion of the
study’s findings, detailing the themes and patterns from the collected data. The last chapter,
Chapter Five, interprets these findings within the theoretical framework, discusses the

11
implications for practice and policy, offers recommendations for future research, and concludes
with reflective remarks about the study’s contribution to the field.
Conclusion
This chapter has established a framework for an exploration of the experiences of Black
women in the context of breast cancer treatment and survivorship in the United States. This
chapter has also provided a comprehensive overview of the research problem’s significance,
highlighting its relevance in the broader landscape of healthcare disparities. Additionally, it has
emphasized the limited representation of Black women’s voices in the literature about breast
cancer.
The research questions and hypotheses have been articulated, setting the stage for a
systematic inquiry into this complex phenomenon. Drawing on pertinent literature, the study was
situated within the current state of knowledge, exposing the gaps and constraints in the research.
Incorporating SCT and BFT as the underpinning theoretical frameworks fortified the foundation
for comprehending the intricate interplay of self-efficacy, identity, and healthcare experiences.
Furthermore, the rationale behind adopting a mixed-methods approach, which
encompasses both quantitative surveys and qualitative interviews, has been elucidated. This
methodological choice aimed to triangulate data, augment the depth of comprehension, and yield
more robust and nuanced findings. The subsequent chapters carry forward the commitment to
illuminate Black women’s experiences, challenges, and strengths confronting breast cancer.
Their narratives constitute the heart of this study, proffering invaluable insights for advancing
healthcare models and policies to ensure equitable and patient-centric care.

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Chapter Two: Review of the Literature
This literature review delves into Black women’s multifaceted experiences of navigating
breast cancer treatment in the United States, highlighting the urgency of understanding the
challenges and inequities they face in the healthcare system. Prior research on this population’s
health outcomes, perceived influences, and healthcare navigation underpins the significance of
exploring this subject matter comprehensively (Dillon et al., 2021; Wells, 2021). Examining
studies on self-efficacy among this population yields insight into their sense of autonomy and
empowerment in managing their health within the healthcare system and developing effective
interventions and support strategies (Bandura, 2000; Wells, 2021).
Furthermore, intersectionality emerges as a central theme in the literature review,
illuminating stereotypes formed from the complex interplay of race, gender, and socioeconomic
status shaping Black women’s healthcare experiences (Kelly‐Brown et al., 2022; Mwangi &
Constance-Huggins, 2019). Through the lenses of SCT and BFT, we can interpret and
contextualize these experiences, providing a deeper understanding of how individual beliefs and
societal structures influence the health outcomes of Black women (Mwangi & ConstanceHuggins, 2019; Rogers & Kelly, 2011). Integrating these theoretical frameworks helps to
examine the multilayered nature of Black women’s breast cancer experiences and formulate
more nuanced and inclusive healthcare practices.
Moreover, a critical aspect explored in the literature review pertained to recognizing and
examining institutional and systemic factors that significantly impacted the health behaviors and
outcomes of Black women facing breast cancer. These factors encompassed a wide range of
structural elements, such as healthcare policies, socioeconomic disparities, and systemic biases,
which intersect to shape healthcare experiences (Haji-Jama et al., 2016; Rogers & Kelly, 2011).

13
Understanding and addressing these intricacies are paramount in fostering the development of
culturally specific and patient-centric healthcare models (Betancourt et al., 2003; Mitchell et al.,
2020; Soulé, 2014). These models, grounded in health literacy, empowerment, and equitable
access to care, hold promise in ameliorating disparities and advancing a more comprehensive and
compassionate approach to breast cancer care for Black women in the United States (Betancourt
et al., 2003; Mitchell et al., 2020; Soulé, 2014). This review laid a foundation for the research by
weaving together insights from diverse scholarly sources, igniting a transformative journey
toward a more equitable and holistic breast cancer care landscape for this vulnerable population.
Historical Context
The historical context of Black women’s challenges in navigating the landscape of breast
cancer treatment in the United States is a complex tapestry of socioeconomic, cultural, and
institutional factors. During racial segregation, American society embedded inequities in access
to quality healthcare for Black Americans (Allen, 1915; Diogo et al., 2023). Even with the
advent of the Civil Rights Act of 1964 and subsequent health equity reforms, these disparities
persisted, influencing the present-day experiences of Black women with breast cancer (Allen,
1915; Z. D. Bailey et al., 2021; Diogo et al., 2023).
The legacy of historical inequities resulted in Black women persistently experiencing
higher breast cancer mortality rates than their White counterparts (Giaquinto, Miller, et al., 2022;
Haque et al., 2023; Reeder-Hayes et al., 2015). This troubling disparity underscores the urgency
for comprehensive research and effective interventions to address the underlying factors
contributing to these disparities and to advance health equity in breast cancer care. This stark
contrast has its roots in a myriad of factors: delayed diagnosis due to limited access to preventive
screenings, socioeconomic barriers to quality care, and lower use of innovative treatment

14
modalities (Reeder-Hayes et al., 2015; Teysir et al., 2019; Yearby, 2018). These factors, coupled
with institutional biases and a lack of cultural sensitivity in healthcare delivery, contribute to a
distressing narrative of health disparity (Reeder-Hayes et al., 2015; Yearby, 2018).
Simultaneously, the literature indicates that the intersectionality of Black women’s
identities—as Black individuals and as women—shapes their experiences, further complicating
their healthcare journey (Kelly‐Brown et al., 2022; Mwangi & Constance-Huggins, 2019). The
intertwining forces of racism and sexism have affected their self-efficacy, a critical element in
health behavior and outcomes (Kelly‐Brown et al., 2022; Mwangi & Constance-Huggins, 2019).
The stereotypes attached to Black women are embedded in a historical context, influencing their
breast cancer treatment (Sacks, 2018; Wailoo, 2018). These ingrained perceptions, often
emanating from centuries of systemic racism and gender biases, have given rise to narratives of
unwavering strength and resilience in the face of adversity (Sacks, 2018; Wailoo, 2018).
However, this singular narrative can overshadow the multifaceted realities that Black women
navigate when confronting breast cancer.
The stereotypes attached to Black women catalyze disparities in healthcare access,
treatment options, and interactions with healthcare providers (Devine et al., 2012; Sim et al.,
2021). For instance, the research indicates the stereotype of Black women as strong can
inadvertently lead to a lack of emotional support or inadequate pain management in their
treatment (Melissa et al., 2018; Sacks, 2018). Additionally, the stereotype of the angry Black
woman may result in their concerns being dismissed, undermining effective communication with
medical professionals (Gopal et al., 2021; Melissa et al., 2018; Sacks, 2018). These entrenched
stereotypes thus obstruct tailored treatment strategies, fostering potential misdiagnoses and
suboptimal care (Gopal et al., 2021; Melissa et al., 2018; Sacks, 2018). It is imperative to

15
comprehend and disentangle these historical stereotypes to ensure culturally sensitive, holistic,
and equitable breast cancer care for Black women (Craig, 2022; Sukhera & Watling, 2018).
Thus, the current body of knowledge on the historical context of Black women’s
challenges in navigating breast cancer treatment in the United States reveals long-standing
disparities and systemic inequities that underline the urgency and necessity of the present study
(Z. D. Bailey et al., 2021; Rodríguez et al., 2021). It emphasizes the need for a comprehensive,
culturally sensitive, and patient-centered approach to improving Black women’s breast cancer
treatment experience, contributing to a more equitable healthcare landscape (Braveman, 2022;
Masi & Gehlert, 2009; Mitchell et al., 2020).
Earlier Research Using BFT and SCT
Earlier research utilizing BFT and SCT has significantly contributed to understanding the
intricate interplay of social, psychological, and institutional factors that impact health outcomes
for Black women navigating breast cancer treatment (Copeland et al., 2018; Crown & Joseph,
2022; Patterson et al., 2016). Through the lens of BFT, scholars have exposed Black women’s
systemic and intersectional challenges in the healthcare system, revealing the dual axes of racial
and gender biases that often lead to discriminatory practices and subpar care (Patterson et al.,
2016; Rankin-Wright et al., 2020). Black women’s experiences are shaped by the
intersectionality of their identities, influencing their perceptions of self-efficacy and their
navigation of the healthcare journey (Bandura, 2000; Rogers & Kelly, 2011). Empowering Black
women to articulate their experiences and challenges has emerged as beneficial in transforming
institutional practices and enhancing patient outcomes (Heiney et al., 2017; Knecht & Kenning,
2016).

16
In parallel, research grounded in SCT has shed light on the role of individual perceptions
and behaviors in shaping health outcomes (Cho et al., 2023; Copeland et al., 2018). The theory
underscores the significance of self-efficacy in determining an individual’s health behaviors, as
higher self-efficacy levels are associated with better adherence to treatment regimens and more
positive health outcomes (Cho et al., 2023; Copeland et al., 2018; Marcu et al., 2017). However,
experiences with healthcare providers and the healthcare system can significantly influence
Black women’s perceptions of self-efficacy (Bandura, 2000; Mkuu et al., 2022; Thompson et al.,
2022). Encounters marked by discrimination or cultural insensitivity can undermine selfefficacy, emphasizing the necessity for a more culturally attuned and patient-centric approach
(Bandura, 2000; Mkuu et al., 2022; Thompson et al., 2022).
Together, the body of research informed by BFT and SCT aids in analyzing Black
women’s experiences in breast cancer treatment (Anburaj & Mangayarkarasi, 2021; Cho et al.,
2023). By delving into the social, psychological, and institutional factors, the earlier research
underscores the need to address systemic inequities and individual behavioral factors to improve
health outcomes for Black women (Gerend & Pai, 2008; McIntosh, 2023). Through a
comprehensive exploration of Black women’s experiences and challenges while navigating
breast cancer treatment, the literature highlights the urgency of implementing culturally specific,
patient-centric healthcare models (C. M. Davis et al., 2016; Wells, 2021). Inclusive approaches
considering the interplay of individual agency, institutional practices, and sociocultural context
are pivotal to fostering equitable and compassionate breast cancer care for Black women in the
United States (Ashing-Giwa et al., 2013; Williams et al., 2010).

17
Current Successful Practices
According to the literature, current successful practices for addressing disparities in
breast cancer treatment for Black women are guided by the principle of health equity,
acknowledging the systemic and intersectional challenges this population faces and tailoring
interventions to address them (Burg et al., 2009; Butler, 2021; Hook et al., 2012). The following
sections present six of these practices.
Patient Navigation
According to the research, patient navigation is a healthcare program designed to guide
patients through the complex healthcare system, reducing barriers to care and improving the
continuity of care (Hook et al., 2012; Wells, 2021; Worland et al., 2022). The research indicates
patient navigators, often culturally sensitive to their populations, are necessary to help patients
manage their treatment journey, from scheduling appointments to understanding their diagnosis
and treatment options (Hook et al., 2012; Wells, 2021; Worland et al., 2022). For Black women,
who often face barriers such as limited access to healthcare, cultural disparities, and historical
mistrust, patient navigation serves as a bridge to improved outcomes (Hook et al., 2012;
Markossian & Calhoun, 2011; Wells, 2021). The literature indicates patient navigators ensure
timely diagnosis and treatment, better adherence to recommended interventions, and a deeper
understanding of the complexities of the patient’s condition (Hook et al., 2012; Wells, 2021;
Worland et al., 2022). By alleviating logistical and communication hurdles, patient navigation
empowers Black women to engage in care decisions actively, fostering a sense of agency and
ownership over their health (Hook et al., 2012; Wells, 2021; Worland et al., 2022). Patient
navigation transforms the breast cancer journey for Black women by providing personalized
support that addresses their needs and challenges, leading to enhanced treatment adherence,

18
improved health outcomes, and a higher quality of life (Hook et al., 2012; Wells, 2021; Worland
et al., 2022).
Culturally Competent Care
According to Betancourt et al. (2003), culturally competent care provides healthcare
services that meet patients’ cultural, social, and linguistic needs. This practice includes using
culturally appropriate health communication and educational materials, fostering a diverse
healthcare workforce, and implementing institutional policies that acknowledge and address
health disparities (Ahmad, 2019; Betancourt et al., 2003; C. M. Davis et al., 2016). The literature
indicates healthcare providers can build trust and rapport with Black women by valuing cultural
context, leading to improved treatment outcomes (Betancourt et al., 2003; Mitchell et al., 2020;
Soulé, 2014). Additionally, the research found that this strategy helps mitigate disparities in
access to care by recognizing and addressing barriers specific to Black women, such as mistrust
of healthcare institutions due to historical injustices (Ahmad, 2019; Betancourt et al., 2003; C.
M. Davis et al., 2016). Culturally competent care improves patient-provider relationships and
ensures that medical decisions are made collaboratively, leading to more informed choices,
increased treatment adherence, and better breast cancer outcomes for Black women (Betancourt
et al., 2003; Mitchell et al., 2020; Soulé, 2014).
Shared Decision-Making
A 2010 study by Sheppard et al. concluded that encouraging patients to participate in
their healthcare decisions can lead to better adherence to treatment and more positive health
outcomes. This process of shared decision-making respects and utilizes patients’ values,
preferences, and expressed needs in making health decisions (Sheppard et al., 2010). Research
shows that empowering Black women with breast cancer to take an active role in their care

19
fosters a sense of autonomy and control over their health journey (Heiney et al., 2017; Howard et
al., 2014; Sheppard et al., 2010). The literature indicates that shared decision-making ensures
treatment plans are tailored to individual needs (Heiney et al., 2017; Howard et al., 2014). For
Black women, this approach addresses historical mistrust of healthcare systems and disparities in
access (Heiney et al., 2017; Howard et al., 2014). Through open communication and joint
decision-making, healthcare providers can address concerns, explain treatment options clearly,
and establish realistic expectations (Heiney et al., 2017; Howard et al., 2014). This fosters a
sense of agency, trust, and engagement, leading to better treatment adherence, improved
psychological well-being, and enhanced breast cancer outcomes (Heiney et al., 2017; Howard et
al., 2014).
Health Literacy Interventions
As the literature indicates, ensuring patients understand their health conditions and
treatment options is essential for adequate healthcare (Gregg, 2009; Kamimura et al., 2016;
Livaudais et al., 2013). Research has found that tools and interventions to improve health literacy
can improve patient engagement and outcomes (Gregg, 2009; Kamimura et al., 2016; Livaudais
et al., 2013). By providing accessible and understandable health information, healthcare
providers can empower Black women with knowledge, enhancing their ability to make informed
decisions about their treatment (Gregg, 2009; Kamimura et al., 2016; Livaudais et al., 2013). The
literature mentions health literacy interventions as practical communication tools between
patients and healthcare providers, reducing misunderstandings and increasing treatment
adherence (Gregg, 2009; Kamimura et al., 2016; Livaudais et al., 2013). This comprehensive
approach empowers Black women to advocate for themselves, make informed choices, and seek

20
timely medical attention, improving breast cancer outcomes and overall well-being (Gregg,
2009; Kamimura et al., 2016; Livaudais et al., 2013).
Community Engagement
Recent research reveals partnering with community-based organizations as a
transformative approach that empowers Black women and addresses their specific needs in the
context of breast cancer (Haapanen & Christens, 2021; Tan et al., 2023). The literature notes that
engaging with local communities, including religious institutions, adds invaluable insights into
the intricate tapestry of Black women’s experiences, fortifying the foundation for more impactful
and culturally relevant interventions (Adksion-Bradley et al., 2005; Betancourt et al., 2003;
Mitchell et al., 2020). Through collaborative efforts, we can bridge the gap between healthcare
providers and Black women, fostering a compassionate and supportive environment where Black
women can flourish, heal, and thrive (Adksion-Bradley et al., 2005; Tan et al., 2023).
The literature states that community engagement initiatives foster awareness about breast
cancer risks, early detection methods, and treatment options (Adegboyega et al., 2019; AdksionBradley et al., 2005; Haapanen & Christens, 2021). Additionally, these efforts provide access to
resources such as screening services, transportation assistance, and emotional support, which are
necessary to overcome barriers (Adegboyega et al., 2019; Adksion-Bradley et al., 2005;
Haapanen & Christens, 2021). The strong bonds within these communities foster a sense of
solidarity, reducing the stigma and fear associated with breast cancer (Adegboyega et al., 2019;
Adksion-Bradley et al., 2005; Haapanen & Christens, 2021). The research shows through
community engagement, religious institutions empower Black women to make informed health
choices, seek timely medical care, and navigate the healthcare system effectively, leading to

21
improved breast cancer outcomes (Adegboyega et al., 2019; Adksion-Bradley et al., 2005;
Haapanen & Christens, 2021).
Emphasizing Preventive Care
The literature states that early detection strategies, such as regular mammograms, reduce
breast cancer mortality (Masi et al., 2007; Pullen et al., 2014; Wells, 2021). Fostering awareness
about the paramount significance of early detection and diligently removing barriers to
accessible and affordable mammography services help to empower Black women to secure
timely diagnosis, potentially enhancing outcomes and prolonged survival (Masi et al., 2007;
Pullen et al., 2014; Wells, 2021). A focus on preventive care, embedded in healthcare systems
and communities, can increase breast cancer survival rates among Black women and signify a
commitment to their well-being and health equity (Braveman, 2022; Masi et al., 2007; Pullen et
al., 2014; Wells, 2021).
Preventive treatment options in the literature review include embracing a healthy lifestyle
with balanced nutrition and regular physical activity, reducing the risk of developing breast
cancer (Masi et al., 2007; Pullen et al., 2014). Genetic counseling and testing for high-risk
individuals, especially those with a family history of the disease, enable proactive measures like
preventive surgeries or enhanced surveillance. Moreover, breast self-exams empower women to
promptly identify any changes (Knecht & Kenning, 2016; Masi et al., 2007; Pullen et al., 2014).
These preventive treatment options in the literature collectively contribute to a comprehensive
strategy for reducing breast cancer incidence and improving overall outcomes among Black
women (Knecht & Kenning, 2016; Masi et al., 2007; Pullen et al., 2014).
Research focusing on the intersection of BFT and SCT offers insights into the interplay
of individual experiences and systemic structures shaping healthcare outcomes for Black women

22
(Crown & Joseph, 2022; Terman et al., 2023). Each practice is rooted in the principles of these
theoretical frameworks, illuminating the need for comprehensive, multi-dimensional strategies to
combat health disparities Black women face in breast cancer treatment (Crown & Joseph, 2022;
Terman et al., 2023). Integrating these successful practices into the healthcare system yields a
transformative and empathetic approach, enabling a more equitable and compassionate care
environment where Black women receive the unwavering support and tailored interventions they
deserve, empowering them to triumph over the challenges of breast cancer and realize positive
health outcomes (Hemingway et al., 2015; Terman et al., 2023). This holistic endeavor aligns
with the overarching pursuit of justice and health equity, reshaping the landscape of breast
cancer care and fostering a future where Black women’s well-being is prioritized and celebrated
(Braveman, 2022; Kooken et al., 2007).
Current Challenges and Barriers
The challenges and barriers found in the literature review of breast cancer treatment for
Black women in the United States are deeply rooted in systemic healthcare disparities,
socioeconomic factors, cultural and linguistic disconnects, health literacy limitations, medical
mistrust, and psychosocial burdens (Kamimura et al., 2016; Kooken et al., 2007; Sutton et al.,
2019; Williams et al., 2010). These multifaceted challenges intertwine with broader
sociopolitical structures, exacerbating the urgency of addressing the disparity in breast cancer
mortality rates between Black and White women (Babatunde et al., 2021; Williams et al., 2010).
Healthcare System Challenges
Research indicates Black women encounter structural inequalities in the healthcare
system, marked by disparities in insurance coverage and limited access to quality care (Aleshire
et al., 2021; Haji-Jama et al., 2016). This results in delayed screenings and treatments, leaving

23
them disadvantaged in their breast cancer journey (Aleshire et al., 2021; Haji-Jama et al., 2016).
The delays contribute to longer intervals between screenings and follow-ups and inadequate
support systems for post-treatment recovery (Aleshire et al., 2021; Haji-Jama et al., 2016).
According to researchers, the disparity in care quality exposes Black women to less advanced
therapies and less experienced physicians, compromising their treatment outcomes (Aleshire et
al., 2021; Haji-Jama et al., 2016; Ponce-Chazarri et al., 2023). These challenges lead to laterstage diagnoses that require more aggressive interventions and often result in poorer prognoses
(Aleshire et al., 2021; Haji-Jama et al., 2016; Ponce-Chazarri et al., 2023). Additionally, these
challenges perpetuate a cycle of unequal health outcomes; addressing them is pivotal to
improving breast cancer outcomes for Black women (Aleshire et al., 2021; Haji-Jama et al.,
2016; Ponce-Chazarri et al., 2023).
Socioeconomic Barriers
Research indicates that the barriers Black women face in accessing regular screenings
and prompt treatment are multifaceted and directly affect their breast cancer outcomes
(Babatunde et al., 2021; McIntosh, 2023). In a study by Babatunde et al. (2021), economic
barriers weighed heavily on Black women, hindering their ability to prioritize preventive
healthcare. With issues like lack of transportation, financial burden, and the inability to take time
off work for medical appointments, Black women are impeded from accessing regular screenings
and prompt treatment, further widening the gap in breast cancer outcomes (Aleshire et al., 2021;
Haji-Jama et al., 2016; Wells, 2021). The lack of reliable transportation poses a substantial
barrier for those residing in underserved communities with limited access to healthcare facilities
(Aleshire et al., 2021; Haji-Jama et al., 2016; Wells, 2021). This difficulty in reaching medical
appointments can lead to missed screenings, delayed diagnoses, and, consequently, more

24
advanced-stage cancers at the time of detection (Aleshire et al., 2021; Haji-Jama et al., 2016;
Wells, 2021).
Researchers found that financial barriers exacerbate the situation, as costs associated with
medical appointments, screenings, diagnostics, treatments, and follow-ups can be overwhelming
(Haji-Jama et al., 2016; Williams et al., 2010). These financial constraints can deter Black
women from seeking timely medical attention, hampering the effectiveness of interventions and
treatment plans (Haji-Jama et al., 2016; Williams et al., 2010). Moreover, the inability to take
time off work for medical appointments due to job insecurity or a lack of paid leave creates a
significant barrier (Aleshire et al., 2021; Haji-Jama et al., 2016; Williams et al., 2010).
According to researchers, this results in Black women postponing or entirely forgoing essential
medical visits, exacerbating their risk for undiagnosed or late-stage breast cancer (Aleshire et al.,
2021; Haji-Jama et al., 2016; Williams et al., 2010). These barriers contribute to a widening gap
in breast cancer outcomes for Black women, emphasizing the need for equitable access to
healthcare services and support mechanisms to address these challenges (Aleshire et al., 2021;
Haji-Jama et al., 2016; Williams et al., 2010).
Cultural and Linguistic Challenges
Cultural insensitivity in communication creates a chasm between healthcare providers
and Black women, leading to potential misunderstandings and non-compliance with treatment
recommendations (Aburizik et al., 2023; Anderson et al., 2021). Researchers indicate linguistic
challenges exacerbate the issue, making it difficult for Black women to comprehend healthcare
information, compromising their treatment (Aburizik et al., 2023; Anderson et al., 2021). The
research shows that an inability to communicate essential information about treatment options,
procedures, and potential side effects can lead to a lack of informed decision-making and non-

25
compliance with recommended treatments (Delphin-Rittmon et al., 2021; Koh et al., 2014). For
instance, cultural insensitivity might result in medical jargon that is unfamiliar to patients or
overlooking cultural beliefs that impact healthcare decisions (Delphin-Rittmon et al., 2021; Koh
et al., 2014).
Current literature indicates linguistic challenges amplify this issue, particularly when the
healthcare information is presented in a language Black woman do not understand (Anderson et
al., 2021; Koh et al., 2014). This can hinder their ability to comprehend essential healthcare
details, including treatment plans, medications, and potential risks (Anderson et al., 2021; Koh et
al., 2014). As a result, they may not fully grasp the implications of their diagnosis or the reasons
for adhering to treatment regimens (Anderson et al., 2021; Koh et al., 2014). This linguistic
challenge can impede their engagement in shared decision-making and limit their ability to
participate actively in their care (Anderson et al., 2021; Koh et al., 2014).
Research shows that cultural insensitivity and linguistic challenges underscore the
significance of culturally competent communication in healthcare settings (Betancourt et al.,
2003; Koh et al., 2014; Soulé, 2014). To bridge this gap, the research states that healthcare
providers should receive cultural competence training that helps them understand their patients’
diverse backgrounds and values (Betancourt et al., 2003; Koh et al., 2014; Soulé, 2014).
Tailoring communication styles, using plain language, and employing interpreters when
necessary ensure that Black women receive accurate and understandable information about their
breast cancer diagnosis and treatment (Betancourt et al., 2003; Koh et al., 2014; Soulé, 2014).
This approach enhances patient-provider relationships, encourages informed decision-making,
and improves breast cancer outcomes for Black women (Betancourt et al., 2003; Koh et al.,
2014; Soulé, 2014).

26
Health Literacy Challenges
According to the literature, health systems’ limited health literacy actions pose another
significant challenge obstructing Black women’s understanding of the importance of preventive
screenings and adherence to treatment protocols (Kamimura et al., 2016; Livaudais et al., 2013).
The literature notes health literacy encompasses an individual’s capacity to understand and
utilize healthcare information to make informed decisions about their health (Kamimura et al.,
2016; Nielsen-Bohlman et al., 2004). When Black women face organizational barriers in health
literacy initiatives, existing literature suggests they might find it challenging to understand the
significance of preventive screenings fully, the reasoning behind adhering to treatment plans, and
the potential repercussions of non-compliance (Kamimura et al., 2016; Nielsen-Bohlman et al.,
2004). These health literacy challenges can lead to delays in seeking care or non-compliance
with prescribed treatment plans, affecting the effectiveness of interventions (Adegboyega et al.,
2019; Kamimura et al., 2016; Nielsen-Bohlman et al., 2004).
For instance, the literature shows a Black woman with limited access to health literacy
information might lack an accurate understanding of screening mammograms and their role in
detecting early signs of breast cancer (Adegboyega et al., 2019; Gregg, 2009). Consequently,
having limited access to health literacy information, Black women might underestimate the
benefits of regular screenings, leading to delays in seeking medical attention (Adegboyega et al.,
2019; Gregg, 2009). Similarly, misconceptions about treatment procedures and potential side
effects due to low organizational health literacy efforts can cause a Black woman to hesitate to
follow prescribed treatment plans (Kamimura et al., 2016; Nielsen-Bohlman et al., 2004). The
literature shows this hesitancy can result in the discontinuation of treatments or inconsistent

27
adherence, jeopardizing the effectiveness of interventions (Kamimura et al., 2016; NielsenBohlman et al., 2004).
Research has found that misinformation and lack of understanding can perpetuate a cycle
where the absence of preventive measures or incomplete adherence to treatment plans diminishes
the likelihood of favorable health outcomes (Kamimura et al., 2016; Mwanri et al., 2020;
Nielsen-Bohlman et al., 2004). This can lead to late-stage diagnoses, more aggressive
interventions, and a poorer prognosis (Kamimura et al., 2016; Mwanri et al., 2020; NielsenBohlman et al., 2004). Research also notes that addressing limited health literacy initiatives
requires multifaceted approaches, such as utilizing plain language in healthcare communication,
providing visual aids, and employing patient education materials that are culturally sensitive and
easily comprehensible (Burg et al., 2009; Mwanri et al., 2020). By enhancing health literacy
efforts targeting Black women, healthcare providers can empower them to make informed
decisions, engage in shared decision-making, and take proactive steps toward better breast cancer
outcomes, according to researchers (Burg et al., 2009; Mwanri et al., 2020).
Medical Mistrust Challenges
The historical and ongoing experiences of racism and discrimination in healthcare have
led to Black women’s mistrust, lowering their willingness to engage with healthcare services, as
evidenced throughout the current body of knowledge (Ho et al., 2022; Molina et al., 2015; Sutton
et al., 2019). The literature revealed that mistrust planted by historical mistreatment and
contemporary racial bias fostered skepticism about healthcare providers’ intentions, medical
recommendations, and the healthcare system (Ho et al., 2022; Molina et al., 2015; Sutton et al.,
2019). The literature states that this mistrust prevents seeking preventive screenings and adhering

28
to treatment regimens, leading to suboptimal health outcomes (Ho et al., 2022; Molina et al.,
2015; Sutton et al., 2019).
For instance, the literature indicates that a Black woman with a family history of breast
cancer might doubt the necessity of a screening mammogram, fearing that she will receive
unequal treatment or unnecessary interventions (Ho et al., 2022; Kooken et al., 2007). This
hesitation can result in delayed screenings or missed opportunities for early detection (Ho et al.,
2022; Kooken et al., 2007). Furthermore, the research shows mistrust may lead to skepticism
about the efficacy and intentions of prescribed treatments, potentially leading to non-compliance
with recommended regimens (Ho et al., 2022; Kooken et al., 2007).
The far-reaching impact of this challenge becomes evident in its contribution to health
disparities and inequities among Black women, according to researchers (Masi & Gehlert, 2009;
McIntosh, 2023). Delayed diagnoses and underutilization of healthcare services can lead to
advanced-stage cancer diagnoses and poorer treatment outcomes (Masi & Gehlert, 2009;
McIntosh, 2023). The cycle of mistrust can perpetuate a self-fulfilling prophecy where the lack
of engagement with the healthcare system hampers the chances of timely interventions and
positive health outcomes (Masi & Gehlert, 2009; McIntosh, 2023).
Addressing this challenge requires a multifaceted approach that acknowledges the
historical injustices and systemic biases that have fueled mistrust. The research indicates that
establishing culturally sensitive communication, nurturing patient-provider relationships based
on empathy and respect and promoting equitable healthcare access rebuild Black women’s trust
to engage effectively with the healthcare system (Adams & Craddock, 2023; Kooken et al.,
2007). Recognizing the experiences of racism and discrimination and actively working to
eliminate them can pave the way for a healthcare environment where Black women feel valued,

29
heard, and empowered to make informed decisions about their breast cancer journey (Adams &
Craddock, 2023; Kooken et al., 2007).
Psychosocial Barriers
A breast cancer diagnosis can accompany fear, stigma, and emotional distress for Black
women (Gregg, 2009; Patel‐Kerai et al., 2017). The literature states the lack of emotional support
during the treatment journey compounds the psychosocial burdens, influencing Black women’s
approach to treatment and potentially hindering their treatment adherence (Gregg, 2009; Patel‐
Kerai et al., 2017; Pillai et al., 2022). The emotional responses are rooted in the personal
challenges of facing a severe illness and are influenced by cultural and societal factors that can
exacerbate the emotional burden (Gregg, 2009; Patel‐Kerai et al., 2017). For example, the
literature says the historical stigma attached to illness within the Black community and the
enduring societal misconceptions about breast cancer can lead to heightened levels of fear and
anxiety (Gregg, 2009; Patel‐Kerai et al., 2017). Black women might worry about the
implications of their diagnosis on their roles as caregivers, breadwinners, or active community
members (Gregg, 2009; Patel‐Kerai et al., 2017). The fear of being perceived as weak or
vulnerable due to the illness can intensify the emotional distress associated with the diagnosis
(Gregg, 2009; Patel‐Kerai et al., 2017).
Furthermore, the literature reveals that insufficient emotional support during the breast
cancer treatment journey can exacerbate these psychosocial burdens and have tangible effects on
treatment approaches and adherence (Adegboyega et al., 2019; Gregg, 2009; Patel‐Kerai et al.,
2017). The literature shows that the absence of empathetic and culturally sensitive support
networks can lead to feelings of isolation and amplify emotional distress (Adegboyega et al.,
2019; Gregg, 2009; Patel‐Kerai et al., 2017). Thus, Black women may feel unheard or

30
misunderstood by their healthcare providers, compounding their emotional challenges and
potentially causing them to withdraw from seeking treatment or sharing their concerns (Mkuu et
al., 2022; Patel‐Kerai et al., 2017). For instance, the literature found that a Black woman facing a
breast cancer diagnosis might experience feelings of shame or embarrassment due to the
prevailing societal narratives surrounding cancer (Mkuu et al., 2022; Patel‐Kerai et al., 2017). If
her healthcare environment lacks avenues for open discussions about these emotions, she might
suppress her fears and anxieties, hindering her from making informed decisions about her
treatment options (Mkuu et al., 2022; Patel‐Kerai et al., 2017).
Addressing these multifaceted challenges and barriers requires a comprehensive,
intersectional approach considering Black women’s experiences. By aligning with the principles
of BFT and SCT, interventions can be tailored to be culturally specific and sensitive,
emphasizing self-efficacy and dismantling systemic racism to create a more equitable and
empowering healthcare environment for Black women facing breast cancer (C. M. Davis et al.,
2016; Hemingway et al., 2015). The challenges Black women face in the context of breast cancer
demand a holistic and intersectional approach that recognizes and respects their unique
experiences. By tailoring interventions to align with BFT’s emphasis on cultural sensitivity and
SCT’s focus on self-efficacy, we can create targeted solutions addressing Black women’s
multifaceted barriers (Hemingway et al., 2015).
Characteristics of the Population and Key Stakeholders
The cohort under investigation comprises Black women with a prior diagnosis of breast
cancer who have achieved remission for 1 or more years. Beyond mere survival, these women
bear the weight of multifaceted experiences shaped by intricate sociocultural and systemic
factors, providing a rich tapestry of insights into their healthcare experiences and survivorship.

31
The urgency to address barriers faced during treatment and the ongoing challenges in posttreatment survivorship among Black women underscores the impact of these experiences
(Geronimus et al., 2006; Haji-Jama et al., 2016). For instance, including women from various
age groups will help elucidate the impact of generational differences on their breast cancer
journey (Geronimus et al., 2006; Haji-Jama et al., 2016). Similarly, the diverse socioeconomic
backgrounds will shed light on how financial disparities influence access to care and treatment
decisions (Geronimus et al., 2006; Haji-Jama et al., 2016).
Characteristics
The population of Black women with a prior diagnosis of breast cancer who have
achieved remission for 1 or more years is characterized by their shared experience of breast
cancer and remission, making them uniquely positioned to reflect on their journey, encompassing
diagnosis, treatment, and recovery. Their experiences provide valuable insights into the
challenges they encountered and the strategies they employed to navigate the healthcare system.
By including women who have been in remission for at least 1 year, the study aims to capture
their long-term reflections, offering a comprehensive understanding of the lasting effects of their
treatment journey.
Considering the intersection of identities, this population’s diverse backgrounds
encompass education, occupation, and cultural influences. Research has found that
intersectionality enables a deeper exploration of how various aspects of identity impact their
perceptions, experiences, and decisions related to breast cancer (Kelly‐Brown et al., 2022;
Mwangi & Constance-Huggins, 2019). For instance, the research indicates that educational
background may influence their health literacy, while cultural factors could affect their
preferences for treatment options (Kelly‐Brown et al., 2022; Mwangi & Constance-Huggins,

32
2019). Overall, this population’s diversity in age, socioeconomic status, geographical location,
and shared experience of breast cancer and remission will provide insights into the complexities
of Black women’s breast cancer experiences.
The experiences of Black women with breast cancer shine a powerful light on the
complex interplay of individual and systemic factors impacting healthcare outcomes and
survivorship. The urgency to address disparities and provide equitable care is evident. Black
women’s strength and determination deserve a healthcare system that meets their diverse needs
and empowers them on their survivorship journey (Kooken et al., 2007; Mkuu et al., 2022). By
heeding the insights from their experiences and fostering collaboration among all stakeholders,
we can build a more compassionate and equitable healthcare landscape for Black women facing
breast cancer (Kooken et al., 2007; Mkuu et al., 2022).
Reasons Underlying the Problem
Research indicates that Black women in the United States are 40% more likely to die
from breast cancer than White women due to historical, sociocultural, and systemic factors that
affect their treatment experiences and health outcomes (Giaquinto, Sung, et al., 2022; Haque et
al., 2023). Systemic and structural challenges have historically marred Black women’s healthcare
experiences (Allen, 1915; Diogo et al., 2023). Research shows disparities in access to healthcare,
delayed diagnosis, and differential treatment outcomes have all contributed to higher breast
cancer mortality rates among Black women compared to their White counterparts (Gerend & Pai,
2008; Giaquinto, Sung, et al., 2022; Poteat et al., 2021).
Historical Reasons
The pages of history reveal a disconcerting narrative of ethical transgressions and
systemic injustices that have influenced the problem at the heart of this dissertation. Three

33
distinct yet interconnected stories in this narrative bear particular significance: the stories of
Henrietta Lacks, Dr. J. Marion Sims, and the Tuskegee Syphilis Experiment. These historical
injustices serve as a backdrop to the contemporary challenges faced by Black women navigating
breast cancer treatment, highlighting the urgent need for equitable and compassionate healthcare
models.
Henrietta Lacks
According to literature, the deep-rooted mistrust of medical institutions, stemming from
historical episodes of systemic racial discrimination and unethical treatment, has impacted Black
women’s perceptions of and interactions with the healthcare system (Ho et al., 2022; Sutton et
al., 2019). The literature indicates that one source of the mistrust stems from the treatment of a
Black woman named Henrietta Lacks. Researchers harvested Henrietta Lacks’ cancer cells in
1951 without her informed consent, establishing the first immortal human cell line known as
HeLa cells (Baptiste et al., 2022; Skloot, 2011). These cells have revolutionized medical
research, contributing to significant advancements such as the polio vaccine development and the
study of human genetics (Baptiste et al., 2022; Skloot, 2011). According to the literature, HeLa
cells’ unauthorized extraction and commercialization epitomize systemic racial discrimination
and unethical treatment in medical institutions (Baptiste et al., 2022; Rowe, 2018; Skloot, 2011).
This historical episode has further entrenched deep-rooted mistrust among Black women toward
healthcare systems, influencing their perceptions of and interactions with medical treatment
protocols and outcomes (Baptiste et al., 2022; Masi & Gehlert, 2009; Skloot, 2011).
Additionally, the legacy of this unethical practice reinforces the need for ethical considerations
and culturally competent care to bridge the gap and rebuild trust between healthcare providers
and Black patients today (Baptiste et al., 2022; Rowe, 2018).

34
Dr. J. Marion Sims
The historical mistreatment by Dr. J. Marion Sims, who conducted painful obstetric
procedures on enslaved women without anesthesia or consent, further deepens Black women’s
mistrust of the medical establishment (Rowe, 2018; Wailoo, 2018; Warren et al., 2020). This
egregious violation of bodily autonomy and the systematic exploitation of Black women’s bodies
for medical advancement continue to have enduring consequences on contemporary healthcare
experiences (Sutton et al., 2019; Wolinetz & Collins, 2020). The trauma inflicted by such
historical atrocities reverberates through generations, influencing Black women’s perceptions of
the healthcare system and their willingness to engage in preventive care and seek medical
attention when needed (McIntosh, 2023; Warren et al., 2020). Addressing this historical trauma
and acknowledging past injustices are essential to fostering a more equitable and compassionate
healthcare system that respects and supports Black women’s health needs and choices
(McIntosh, 2023; Wailoo, 2018; Warren et al., 2020).
The Tuskegee Syphilis Experiment
The Tuskegee Syphilis Experiment, officially known as the Tuskegee Study of Untreated
Syphilis in the Negro Male, was a notorious clinical study conducted by the United States Public
Health Service from 1932 to 1972 (Alsan & Wanamaker, 2018). The study involved 600 African
American men, 399 of whom had syphilis and 201 who did not and aimed to observe the natural
progression of the disease when left untreated (Alsan & Wanamaker, 2018). Participants were
not informed of their diagnosis or offered treatment, even after penicillin became the standard
cure for syphilis in the 1940s (Alsan & Wanamaker, 2018). Although the study focused on men,
the implications had a broader impact on Black women (Scharff et al., 2010).

35
First, since the men were neither informed that they had syphilis nor treated for it, they
could have unknowingly transmitted the disease to their sexual partners, many of whom would
have been Black women (Alsan & Wanamaker, 2018; Scharff et al., 2010). This exposed these
women to the risk of infection, various health complications, and potentially passing congenital
syphilis onto their children (Alsan & Wanamaker, 2018; Scharff et al., 2010). Second, the
unethical nature of the Tuskegee experiment has had a long-lasting impact on the Black
community’s trust in healthcare systems and medical research (Gamble, 1997; Scharff et al.,
2010). As integral community members, Black women share the collective memory and mistrust
engendered by such medical atrocities (Gamble, 1997; Scharff et al., 2010). This pervasive
distrust can affect their willingness to seek medical care, participate in medical research, or
undergo screening procedures, exacerbating existing health disparities, including higher
mortality rates from conditions like breast cancer (Scharff et al., 2010; Wolinetz & Collins,
2020). The Tuskegee experiment, therefore, placed Black women at immediate risk through
potential exposure to syphilis and contributed to a legacy of mistrust that continues to
compromise their interactions with and perceptions of the healthcare system (Gamble, 1997;
Scharff et al., 2010).
Sociocultural Reasons
Transitioning to the sociocultural dimension underlying the problem found in the
literature, the intersectionality of Black women’s identities significantly shapes their healthcare
experiences (Mwangi & Constance-Huggins, 2019; Rogers & Kelly, 2011). The interlocking
systems of race, gender, and class influence how Black women perceive their agency and
navigate their healthcare journeys (Kelly‐Brown et al., 2022; Mwangi & Constance-Huggins,
2019; Rogers & Kelly, 2011). The compounded effects of racism and sexism lead to alienation

36
and mistrust in healthcare settings, affecting health behaviors and perceptions of care (Kelly‐
Brown et al., 2022; Mwangi & Constance-Huggins, 2019; Rogers & Kelly, 2011). The historical
legacies of these intersecting identities, documented in the literature, intertwine with present-day
experiences, creating a complex interplay of factors needing careful consideration in the pursuit
of equitable breast cancer care (Kelly‐Brown et al., 2022; Mwangi & Constance-Huggins, 2019;
Rogers & Kelly, 2011).
System-Related Reasons
In healthcare, the experiences of individuals navigating breast cancer treatment are
shaped by many factors, two of which emerge as critical facets of concern: effective health
literacy initiatives and post-cancer treatment support. These elements are intrinsically linked to
the more prominent system-related reasons that underscore the problem. This dissertation
embarks on an in-depth exploration of these crucial aspects, seeking to unravel their complex
interplay within the healthcare system. By shedding light on the systemic challenges related to
effective health literacy initiatives and post-cancer treatment support, the study aims to develop
more equitable and patient-centered healthcare models, fostering improved breast cancer
outcomes, particularly for Black women.
Health Literacy
The literature notes health literacy is critical to breast cancer treatment and survivorship
outcomes (Kamimura et al., 2016; Nielsen-Bohlman et al., 2004). Informed decision-making,
treatment adherence, and initiative-taking engagement in post-treatment care hinge on adequate
health literacy initiatives (Kamimura et al., 2016; Livaudais et al., 2013; Nielsen-Bohlman et al.,
2004). However, concerns about the sufficiency of health literacy healthcare organizations
provide to marginalized populations, including Black women, raise questions about its impact on

37
their treatment journey (Kamimura et al., 2016; Livaudais et al., 2013; Nielsen-Bohlman et al.,
2004). Understanding and addressing system-related health literacy barriers fosters a healthcare
environment that empowers Black women to make well-informed choices about their health
(Gregg, 2009; Livaudais et al., 2013; Nielsen-Bohlman et al., 2004).
Post-treatment Support
Lastly, while Black women are surviving breast cancer, the literature indicates their
journey to survivorship is far from devoid of challenges (Ashing-Giwa et al., 2013; C. M. Davis
et al., 2016). Post-treatment survivorship care, encompassing recurrence surveillance, side
effects management, and psychological support, is pivotal for long-term well-being (AshingGiwa et al., 2013; Rosedale, 2009). Yet, the literature indicates disparities in access to and
quality of survivorship care, potentially affecting the long-term health outcomes of Black women
in remission (Ashing-Giwa et al., 2013; C. M. Davis et al., 2016; Rosedale, 2009). Closing these
gaps in survivorship care is imperative to ensure Black women thrive in their post-treatment
journey (Ashing-Giwa et al., 2013; C. M. Davis et al., 2016).
Current Strategies for Solving the Problem
According to the literature, addressing the problem of racial disparities in breast cancer
mortality rates for Black women requires multifaceted strategies designed to help them navigate
their unique healthcare journeys (Butler, 2021; Crown & Joseph, 2022; Schneider et al., 1996).
The most promising approaches in the literature include survivorship care planning, communitybased participatory research (CBPR), mobile clinics and telehealth services, peer support groups,
and cultural competency training for healthcare professionals.

38
Survivorship Care Planning
Survivorship care planning (SCP) is a systematic approach to address the multifaceted
needs of individuals transitioning from active cancer treatment to the post-treatment survivorship
phase (Boekhout et al., 2015; Lewis-Thames et al., 2020). This comprehensive strategy involves
creating personalized care plans that encapsulate the patient’s medical history, treatment details,
and tailored recommendations for ongoing health management (Boekhout et al., 2015; LewisThames et al., 2020). By providing survivors with a structured roadmap for their post-treatment
journey, SCP seeks to bridge the gap between treatment and survivorship, fostering improved
communication, collaboration, and continuity of care (Boekhout et al., 2015; Lewis-Thames et
al., 2020).
For instance, the literature indicates that in the context of breast cancer, SCP could entail
outlining the specifics of a patient’s surgery, chemotherapy, and radiation treatments and
detailing potential long-term side effects or complications to be aware of (Ashing-Giwa et al.,
2013; Boekhout et al., 2015). It might also encompass guidelines for regular check-ups,
recommended screenings, lifestyle modifications, and psychological support resources (AshingGiwa et al., 2013; Boekhout et al., 2015). These plans empower patients by providing selfagency over their health and facilitating informed conversations between patients and healthcare
providers, ensuring that survivorship needs are thoroughly addressed (Ashing-Giwa et al., 2013;
Boekhout et al., 2015).
According to the literature, implementing SCP has demonstrated promising outcomes in
various cancer care settings (Boekhout et al., 2015; Lewis-Thames et al., 2020). Patients with
personalized SCPs report feeling more informed, engaged, and proactive in managing their
health (Boekhout et al., 2015; Lewis-Thames et al., 2020). Healthcare professionals, armed with

39
a clear understanding of each patient’s journey, can offer more targeted guidance and
interventions (Boekhout et al., 2015; Lewis-Thames et al., 2020). Furthermore, the literature
shows SCPs reduce anxiety and uncertainty often accompanying the transition from active
treatment, enhancing psychological well-being (Boekhout et al., 2015; Lewis-Thames et al.,
2020). While SCP has proven benefits, challenges remain in ensuring that underserved
populations, such as Black women facing breast cancer, have equal access to this essential
strategy (Ashing-Giwa et al., 2013). Providing SCPs is a logistical solution and a means of
empowering patients and fostering a patient-centric approach to healthcare, contributing to
improved breast cancer outcomes and survivorship experiences (Boekhout et al., 2015; LewisThames et al., 2020).
Community-Based Participatory Research
The literature indicates that CBPR represents an impactful strategy to address the
problem of improving breast cancer outcomes among Black women by enlisting the
community’s active involvement in research (Gehlert & Coleman, 2010; McFarlane et al., 2022).
CBPR fundamentally shifts the traditional researcher-participant dynamic by creating a
collaborative partnership between researchers and community members (Gehlert & Coleman,
2010; McFarlane et al., 2022). The literature indicates this approach recognizes that the
community possesses invaluable experiential knowledge, cultural insights, and contextual
awareness that can inform the development and implementation of interventions (Gehlert &
Coleman, 2010; McFarlane et al., 2022).
Overall, CBPR’s collaborative nature fosters a sense of ownership and investment in the
research process among community members, ensuring that interventions are relevant and
tailored to the specific needs and challenges Black women face in breast cancer care (D. Davis et

40
al., 2017; Regnante et al., 2023). The literature shows that ongoing engagement empowers
community members to contribute to the design of research questions, methodologies, and the
interpretation of findings (D. Davis et al., 2017; Gehlert & Coleman, 2010). This ensures that the
research outcomes are aligned with the community’s lived experiences, enhancing the potential
for effective implementation and sustainability of interventions (D. Davis et al., 2017; Gehlert &
Coleman, 2010).
Moreover, CBPR’s incorporation of religious aspects is particularly significant in the
context of Black women’s lives (Ashing-Giwa et al., 2013; Beck et al., 2007). Religious
institutions play a vital role in many Black women’s lives, serving as hubs of social interaction,
support, and community engagement (Ashing-Giwa et al., 2013; Beck et al., 2007). Integrating
religious institutions into the CBPR process makes the research more inclusive and respectful of
the cultural context, enhancing the community’s willingness to participate and contribute their
perspectives (Ashing-Giwa et al., 2013; Beck et al., 2007). Thus, CBPR offers a transformative
strategy that transcends the boundaries of traditional research methods (Gehlert & Coleman,
2010; McFarlane et al., 2022). By actively involving the community, fostering collaboration, and
embracing the cultural and religious dimensions of the target population, CBPR ensures that
interventions are practical, culturally sensitive, and more likely to lead to sustainable
improvements in breast cancer outcomes for Black women (Beck et al., 2007; Gehlert &
Coleman, 2010; McFarlane et al., 2022).
Mobile Clinics and Telehealth Services
The literature documents setting up mobile clinics in underserved communities or
offering telehealth services are innovative strategies to overcome geographic barriers and
increase access to breast cancer screenings and consultations for Black women (Cox et al., 2017;

41
Trivedi et al., 2022). Mobile clinics can bring medical services directly to communities lacking
healthcare facilities, making it easier for women to receive timely check-ups (Cox et al., 2017;
Trivedi et al., 2022). Telehealth services allow patients to consult with healthcare providers
remotely, eliminating the need for travel and reducing the burden of transportation (Bayard et al.,
2022; Cox et al., 2017). These approaches found in the literature are particularly valuable for
individuals with limited mobility or those living in rural areas, ensuring they receive healthcare
services without undue hardship (Bayard et al., 2022; Cox et al., 2017).
Peer Support Groups
Establishing peer support groups tailored to Black women’s experiences in the literature
offers an emotional and practical assistance platform (Haynes et al., 2023; Nicks et al., 2019).
The literature states that these groups create safe spaces where women can share their breast
cancer journeys, express concerns, and receive advice from others who have navigated similar
challenges (Haynes et al., 2023; Nicks et al., 2019). Peer support offers emotional solace, helps
to alleviate feelings of isolation, and imparts practical insights into navigating the healthcare
system (Ashing-Giwa et al., 2012; Haynes et al., 2023). By sharing their stories and solutions,
the literature shows participants can equip each other with information on accessing care,
understanding treatment options, and managing the psychosocial impact of breast cancer
(Ashing-Giwa et al., 2012; Haynes et al., 2023).
Cultural Competency Training for Healthcare Professionals
Providing cultural competency training to healthcare professionals is a step toward
addressing racial biases and improving the healthcare experiences of Black women (Khanna et
al., 2009; Vella et al., 2022). The literature shows this training equips healthcare providers with a
deeper understanding of cultural nuances, historical contexts, and potential biases that can impact

42
patient care (Khanna et al., 2009; Vella et al., 2022). By enhancing cultural awareness,
healthcare professionals can communicate more effectively, provide patient-centered care, and
build trust with Black women (Khanna et al., 2009; Lai et al., 2023). The literature revealed that
addressing cultural gaps can lead to better patient-provider relationships, increased patient
satisfaction, and improved treatment adherence (Khanna et al., 2009; Lai et al., 2023). Cultural
competency training creates a more inclusive and equitable healthcare environment for Black
women, fostering a collaborative approach to breast cancer care (Lai et al., 2023; Vella et al.,
2022).
Thoughtfully implementing these strategies found in the literature presents an opportunity
to unlock potential benefits, aligning with Black women’s needs and contexts with breast cancer
(Ashing-Giwa et al., 2013; Butler, 2021). Nevertheless, continued research is imperative to
ascertain the most effective integration of these strategies into the healthcare system, thereby
maximizing their impact in addressing health disparities and improving the overall breast cancer
care landscape for Black women (Ashing-Giwa et al., 2013; Butler, 2021).
Approaches to Measurement of the Problem
I chose a mixed-methods approach for this study. According to current literature, mixedmethods research can provide a comprehensive and nuanced understanding of the experiences of
Black women navigating breast cancer treatment and survivorship (Bolarinwa & Holt, 2023;
Mundy et al., 2022). The literature review found that combining quantitative and qualitative data
collection methods allows for a holistic exploration of the intricate interplay between individual
and systemic factors that impact health outcomes (Feilzer, 2010; Sadan, 2014). The literature
indicates that the quantitative survey will provide numerical insights, while the qualitative
interviews and thematic analysis will offer rich narratives, capturing Black women’s lived

43
experiences and complexities (Bolarinwa & Holt, 2023; Mundy et al., 2022). The literature
shows this combination of data collection methods enhances the validity and robustness of the
findings, leading to more informed and impactful interventions (Feilzer, 2010; Grant & Osanloo,
2014; Sadan, 2014).
Quantitative Surveys
The utilization of a quantitative survey in this study is substantiated by the literature,
which shows its capacity to generate structured and quantifiable data, enabling a rigorous
statistical analysis that deepens our comprehension of the research problem (Ma et al., 2013;
Vadaparampil et al., 2017). This approach aligns with recent studies that have leveraged
quantitative surveys to investigate the intricate interplay between variables (Ma et al., 2013;
Vadaparampil et al., 2017). With a focus on the perceptions of self-efficacy and health behaviors
among Black women diagnosed with breast cancer, this survey follows a trajectory like recent
research endeavors that examined health-related behaviors in response to specific contextual
factors (Vadaparampil et al., 2017; Wilkerson et al., 2023). In synthesis, employing a
quantitative survey aligns with recent research that has utilized similar methodologies to examine
health behaviors and psychological constructs (Ma et al., 2013; Vadaparampil et al., 2017;
Wilkerson et al., 2023). This survey’s alignment with recent research frameworks enhances its
relevancy and reinforces its potential to provide insights that resonate with contemporary
empirical findings.
Qualitative Interviews
The inclusion of qualitative semi-structured interviews in this study derives its relevance
from research on the value of this approach in exploring nuanced and contextually rich
experiences (Cypress, 2015; Paladino et al., 2019). Healthcare research akin to this study has

44
recognized the significance of qualitative interviews in providing an in-depth understanding of
individuals’ perspectives (Cypress, 2015; Paladino et al., 2019). The semi-structured interviews
will facilitate the exploration of participants’ narratives, capturing their voice and agency in
shaping their breast cancer journey (Cypress, 2015; Rose et al., 2022). Furthermore, the thematic
analysis that will be applied to these interview responses draws from recent studies that have
utilized this analytical technique to identify and extract key themes from qualitative data, thereby
adding rigor to the research findings (Cypress, 2015; Nowell et al., 2017).
Adopting a mixed-methods approach in this study is firmly grounded in the literature,
which has increasingly recognized its value in addressing complex and multifaceted research
questions (Dixit et al., 2021; Sadan, 2014). The amalgamation of quantitative and qualitative
methodologies aligns with recent scholarly trends that emphasize the complementary nature of
these methods in providing a holistic understanding of intricate phenomena (Dixit et al., 2021;
Sadan, 2014). Contemporary studies have consistently noted the power of mixed methods in
enriching research findings by offering a more comprehensive view of participants’ experiences,
perspectives, and behaviors (Dixit et al., 2021; Sadan, 2014).
Conceptual Framework
Social cognitive theory (SCT) and Black feminist thought (BFT) are two theoretical
lenses that form the foundation of this study’s investigation into the experiences of Black women
navigating breast cancer treatment in the United States. The literature notes that SCT allows for
developing a deep understanding of self-efficacy and its impact on health behaviors (Bandura &
Cervone, 2023). At the same time, BFT sheds light on the intersectionality of identities and their
implications on experiences and outcomes (Collins, 2015). The conceptual framework
underpinning this study combines the components of SCT and BFT, providing a comprehensive

45
understanding of Black women’s experiences in breast cancer treatment based on the literature
(Bandura & Cervone, 2023; Collins, 2015). Figure 1 illustrates the interconnectedness between
SCT and BFT in shaping Black women’s self-agency over their breast cancer treatment journey.

46
Figure 1
Conceptual Framework Illustration
Note. *Agency refers to an individual’s capacity to take intentional actions, make choices, and
exert control over their life circumstances and decisions (Budhwani et al., 2019). **Social
cognitive theory is a psychological framework highlighting the reciprocal interactions between
individual behaviors, environmental factors, and cognitive processes, shaping how individuals
learn, make decisions, and modify their behaviors (Bandura & Cervone, 2023). ***Black
feminist thought is a theoretical framework that focuses on Black women’s experiences and
perspectives, particularly addressing the intersecting issues of race, gender, and class and their
impacts on social and cultural dynamics (Collins, 2015).
Black feminist thought’s components of race, gender, and class intertwine, creating
stereotypes of Black women. As part of SCT’s environment, these stereotypes shape the
***BFT **SCT *Agency
Self-Agency
Environment
Healthcare
system
Stereotypes
Individual
Experiences
Gender
Race
Class
Behavior
Self-Efficacy
Gender
Race
Class

47
healthcare system, impacting Black women’s treatment decisions and interactions with
healthcare providers (Anburaj & Mangayarkarasi, 2021; Patterson et al., 2016; Sukhera &
Watling, 2018). At the same time, SCT’s cognitive element influences their self-perception and
beliefs about their ability to navigate their healthcare journey (Bandura, 2000; Hemingway et al.,
2015). This interconnected model reveals how BFT empowers Black women, influencing their
self-efficacy and health behaviors within the healthcare system and fostering self-agency in
navigating their breast cancer journey (Garza et al., 2022; Hemingway et al., 2015). Through the
complex interplay of BFT and SCT, Black women emerge as active agents in their healthcare
experiences, advocating for their needs and shaping their paths to survivorship (Garza et al.,
2022; Hemingway et al., 2015).
Table 1 presents a comprehensive overview of the key elements integral to this study.
The table encapsulates the definitions in the context of this research, effectively exploring Black
women’s experiences with breast cancer treatment.

48
Table 1
Conceptual Framework Elements
Key elements Descriptions Theoretical
foundations
Lived experiences Black women’s lived
experiences
The unique experiences,
perspectives, and challenges of
Black women navigating breast
cancer treatment
BFT
Healthcare
experiences
Black women meet diverse
interactions, processes, and
outcomes within the healthcare
system.
BFT
Intersectionality of
identities
The interconnected nature of
social categorizations, such as
race, class, and gender, creates
overlapping systems of
disadvantage or privilege.
BFT
Self-efficacy Health outcomes Changes in the health status of
individuals attributable to
interventions and measures
employed during their treatment
process
SCT
Self-efficacy People’s confidence in navigating
and coping with health
challenges influences their
decision-making and health
behaviors.
SCT
Systemic barriers Institutional processes, societal
structures, and biases impede
adequate breast cancer treatment
access.
SCT
Social Cognitive Theory
Social cognitive theory (SCT) provides a framework through which to examine the
interplay between personal, behavioral, and environmental elements in shaping human behavior,
learning, and adaptation (Bandura & Cervone, 2023). It is a comprehensive model for
comprehending how individuals acquire new behaviors, sustain current ones, and adjust their

49
actions based on changing circumstances (Bandura & Cervone, 2023). Bandura (as cited in
Bandura & Cervone, 2023) introduced SCT in the mid-20th century as an evolution of
behavioral and cognitive theories. It emphasizes that individuals are not passive recipients of
external stimuli but active agents capable of influencing and shaping their behavior (Bandura &
Cervone, 2023). At the heart of SCT lies self-regulation, highlighting individuals’ capacity to set
goals, self-monitor their progress, and modify their actions accordingly (Bandura & Cervone,
2023).
Central to SCT is reciprocal determinism, which elucidates the dynamic interaction
between individual factors, behavior, and the environment (Short et al., 2013; Stacey et al.,
2015). This interaction occurs in three keyways:
1. Individual factors encompass an individual’s cognitive processes, beliefs, emotions,
and biological predispositions (Bandura & Cervone, 2023). For instance, a Black
woman’s perception of her self-efficacy or confidence in navigating breast cancer
treatment and survivorship can significantly influence her decisions and actions
(Short et al., 2013; Vilardaga et al., 2022).
2. Behavioral factors encompass individuals’ actions, responses, and habits (Bandura &
Cervone, 2023). For example, a Black woman’s decision to adhere to a prescribed
treatment regimen or to engage in self-care behaviors is influenced by her selfefficacy beliefs, previous experiences, and the immediate environment (Bandura,
2000; Hemingway et al., 2015).
3. Environmental factors include external influences such as societal norms, peers,
family, media, and physical surroundings (Bandura & Cervone, 2023). A supportive
network of family and friends, access to culturally sensitive healthcare information,

50
and availability of support groups can significantly impact a Black woman’s health
behaviors and decisions throughout her breast cancer journey (Hemingway et al.,
2015; Nicks et al., 2019).
The implications of SCT for Black women navigating breast cancer treatment and
survivorship are profound. Self-efficacy, the core concept of SCT, plays a pivotal role. A Black
woman’s belief in her ability to overcome challenges and navigate the complexities of breast
cancer treatment influences her choices, perseverance, and overall well-being (Thompson et al.,
2022; Vilardaga et al., 2022). Moreover, the reciprocal determinism concept underscores that her
factors do not solely shape her behavior but are influenced by her interactions with the healthcare
system, her cultural context, and the support she receives (Short et al., 2013; Stacey et al., 2015).
SCT provides a holistic lens through which we can understand the factors driving health
behaviors and decisions of Black women facing breast cancer (Bandura & Cervone, 2023; Cho et
al., 2023). By considering the interplay of personal, behavioral, and environmental factors, SCT
highlights self-efficacy, empowerment, and a supportive environment in fostering positive health
outcomes in this context (Bandura & Cervone, 2023; Cho et al., 2023).
Black Feminist Thought
Black feminist thought (BFT) emerged from the voices and experiences of Black women
who sought to challenge the limitations of mainstream feminism by highlighting the
intersectionality of their identities and challenges (Collins, 2009, 2015). Regarding this study’s
topic, BFT offers a comprehensive lens for understanding the complex intersections of race,
gender, class, and other factors that shape Black women’s lived experiences (Collins, 2009,
2015). At its core, BFT aims to center Black women’s experiences, voices, and agency,

51
historically marginalized and silenced within broader feminist and civil rights movements
(Collins, 2009, 2015).
Collins (1989) highlighted that BFT emerged as a distinct framework that centers the
experiences of Black women in the context of race and gender. This perspective recognizes that
BFT is deeply rooted in Black communities and their struggles (Collins, 1989). Collins’s
contribution marked a departure from earlier studies that merely hinted at a resistant stream in
the thoughts and actions of Black women (Collins, 1989, 2015). Instead, Collins explicitly
identified this stream as a feminist consciousness, providing a foundation for understanding the
distinct and intersecting challenges Black women face, which resonates profoundly in the
context of this study’s exploration of Black women’s experiences in breast cancer treatment and
survivorship (Anburaj & Mangayarkarasi, 2021; Patterson et al., 2016).
Within BFT, “interconnected positionalities” refers to recognizing that individuals
embody multiple identities and social positions that interact and intersect to create unique
experiences (Collins, 1989, 2015). In the context of Black women navigating breast cancer
treatment and survivorship, this means understanding how their identities as Black women
intersect with other factors such as socioeconomic status, age, sexual orientation, and more
(Anburaj & Mangayarkarasi, 2021; Garza et al., 2022). These interconnected positionalities
influence their access to healthcare, treatment decisions, communication with medical
professionals, and overall well-being (Anburaj & Mangayarkarasi, 2021; Garza et al., 2022).
The implications of BFT for Black women facing breast cancer treatment and
survivorship are profound. By acknowledging the interconnectedness of their identities and
experiences, BFT underscores the importance of considering the holistic context in which health
disparities arise (Cooper, 2015; Patterson et al., 2016). It recognizes that addressing health

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outcomes requires addressing physical health and confronting systemic racism, gender biases,
and socioeconomic inequalities (Cooper, 2015; Patterson et al., 2016).
Furthermore, BFT encourages the empowerment of Black women as active agents in
their healthcare journey (Armour-Burton & Etland, 2020; Collins, 2009). It prompts reevaluating
healthcare systems to ensure they are culturally sensitive and responsive and provide space for
Black women’s voices (Armour-Burton, 2017; Armour-Burton & Etland, 2020). This
empowerment aligns with the principles of self-efficacy from SCT, as Black women are not
passive recipients of care but active participants in their health decisions (Anburaj &
Mangayarkarasi, 2021; Bandura, 2000). By considering the interconnected positionalities of
Black women, BFT highlights the need for holistic, patient-centered, and culturally sensitive
approaches to breast cancer treatment (Armour-Burton & Etland, 2020; Garza et al., 2022).
Conclusion
In culmination, this literature review has navigated the diverse realms of research
surrounding Black women’s experiences in breast cancer treatment and survivorship. With the
illumination provided by SCT and BFT, this review underscored the complexity of Black
women’s challenges in the healthcare system. Drawing from a comprehensive array of studies,
theories, and methodologies, this synthesis laid the foundation for the forthcoming empirical
investigation. As this chapter concludes, it sets the stage for a meticulously designed research
methodology amalgamating quantitative and qualitative methods. It offers an innovative lens to
understand and address Black women’s breast cancer journeys.

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Chapter Three: Methodology
Chapter Three unpacks the methodology used to examine the intricacies of Black
women’s lived experiences during breast cancer treatment in the United States and the influential
factors impacting their health outcomes. This chapter outlines the research design and rationale,
establishing a solid foundation for addressing the higher mortality rate disparity Black women
face compared to White women in the United States. My role as the researcher was to ensure
transparency and integrity in the research. By employing a mixed-methods approach, this study
combined the strengths of quantitative and qualitative methods, facilitating an exploration of the
target population’s experiences. Scrutinizing participant selection logic ensured a representative
and meaningful sample, while data collection procedures were designed to capture these resilient
women’s nuanced narratives. The data analysis emphasized the richness of the data and the
insights it yields. This chapter’s ethical considerations underscored my commitment to
respecting participants and safeguarding their privacy and well-being. Combining these elements
created a framework that ensured the research was purposeful and contributed to advancing
knowledge and promoting equitable breast cancer care for Black women in the United States.
Research Questions
This study explored the lived experiences of Black women navigating breast cancer
treatment and the influence of BFT and SCT elements on their perceptions and decision-making.
The research questions focused on understanding how BFT elements impacted their experiences,
how SCT elements influenced their self-efficacy, and how insights from these experiences
informed culturally inclusive and patient-centric healthcare models. By delving into the
intersectionality of race, class, and gender, this study sought to unveil the complex influences

54
shaping Black women’s healthcare journeys and contribute to equitable and compassionate
breast cancer care by exploring the research questions below.
Dissertation Research Questions and Hypotheses
1. How do Black women with breast cancer perceive their self-efficacy and its influence
on their health behaviors? Hypothesis 1: Higher self-efficacy levels are associated
with increased engagement in positive health behaviors.
2. In what ways do Black women diagnosed with breast cancer perceive that their race,
gender, and socioeconomic class identities influence their healthcare experiences?
Hypothesis 2: The interaction of self-efficacy and stereotypes formed from race,
gender, and socioeconomic elements influences the quality of healthcare experiences.
3. How might the insights from these lived experiences contribute to designing
healthcare models incorporating self-agency aimed at breast cancer survivorship for
Black women?
Overview of Design
This study adopted a mixed-methods research design strategically chosen to explore the
experiences of Black women navigating breast cancer treatment in the United States. The
research questions sought an understanding of the impact of BFT and SCT elements on these
experiences and how they influenced health outcomes. The qualitative component of the study
aimed to capture the rich, nuanced narratives of Black women through in-depth, semi-structured
interviews. The interviewees were Black women with a prior diagnosis of breast cancer who had
been in remission for 1 or more years. Through these interviews, participants shared their
personal stories, perceptions, and challenges faced during their breast cancer treatment journey.

55
Additionally, as Nowell et al. (2017) outlined, a thematic analysis was employed to
interpret and analyze the interview data. This analytical approach identified recurring patterns
and themes, which enabled a deeper understanding of the intersectionality of identities, selfefficacy, and perceived influences on health outcomes among Black women. The qualitative data
was coded and analyzed, contributing to the generation of a comprehensive and nuanced
portrayal of their lived experiences and perspectives.
The initial stage of the research design involved survey administration, wherein survey
responses encompassed quantitative, closed-ended, and qualitative, open-ended narratives. The
relevant descriptive statistical elements contained the participants’ demographic characteristics,
such as age, race, geographic location, and socioeconomic status. Additionally, descriptive
statistics summarized participants’ health histories, including their breast cancer diagnosis
details, treatment modalities, and remission duration. Moreover, capturing frequencies and
percentages illuminated the prevalence of specific participant experiences or perceptions.
Examples are the frequency of encountering challenges during their breast cancer journey and
the percentage of participants who reported feeling adequately supported by their healthcare
providers. Descriptive statistics also summarized self-efficacy scores, reflecting participants’
perceived ability to influence their health outcomes. These statistical elements presented and
analyzed an overview of the study’s participants, experiences, and perceptions.
Qualitative and quantitative data were integrated through a mixed-methods analysis. This
approach aligned with the research’s overarching aim: to provide a clear and replicable pathway
to understanding the complexities and challenges Black women face in their breast cancer
treatment journeys, informing the development of culturally inclusive and patient-centric
healthcare models to improve breast cancer outcomes for this population.

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Table 2 presents the active mapping of the research questions that guided this study to the
specific methods of data collection employed. This approach ensured the exploration of each
research question. Surveys were administered to gather quantitative data and qualitative
information to understand better the factors influencing health outcomes. In-depth, semistructured interviews were conducted to capture the participants’ lived experiences and
perceptions. By integrating these two data collection methods, the study created a holistic and
multifaceted understanding of the phenomena under investigation, providing insights into the
experiences of Black women navigating breast cancer treatment.
Table 2
Data Sources
Research questions Surveys Semi-structured interviews
How do Black women with
breast cancer perceive their
self-efficacy and its
influence on their health
behaviors?
X X
In what ways do Black
women diagnosed with
breast cancer perceive that
their race, gender, and
socioeconomic class
identities influence their
healthcare experiences?
X X
How might the insights from
these lived experiences
contribute to designing
healthcare models
incorporating self-agency
aimed at breast cancer
survivorship for Black
women?
X X

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Research Setting
This research encompassed Black women from various cities in the United States. The
study focused on Black women previously diagnosed with breast cancer and who have achieved
remission. These participants offered valuable insights into their lived experiences navigating
breast cancer treatment and their perceptions of factors influencing their health outcomes. The
participants represented diverse backgrounds, including age, socioeconomic status, and cultural
perspectives, which provided a comprehensive understanding of breast cancer experiences and
survivorship among Black women nationwide.
The research setting was adapted to the contemporary demands of convenience and
safety, leveraging technology to facilitate participation. The primary data collection mode was
through online surveys, allowing participants to complete the questionnaires at their chosen
location. This flexible setting aimed to maximize participation rates and mitigate logistical or
health-related constraints that may have discouraged involvement. A link to the survey was
distributed by the primary investigator, who served as the sole point of contact and the custodian
of the study’s integrity. To augment the survey data, semi-structured interviews were conducted
via secure video conferencing, Zoom, ensuring participant anonymity and data privacy were
rigorously maintained. This approach permitted a broader geographical reach, enhancing the
study’s generalizability. Though remote, this research setting was designed to adhere to the
highest standards of academic rigor, ethical conduct, and data security. The primary investigator
oversaw all research activities, including data collection, storage, and subsequent analysis,
ensuring the research objectives were met while upholding ethical considerations.

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The Researcher
Understanding my positionality extended beyond merely cataloging my identifiers; it
involved recognizing the dynamic crossroads of my multiple identities. As a Black gay man, my
intersectional positionality includes my race, gender, and sexuality, which shaped my unique
perspective and experiences. This positionality was essential for my research on Black women’s
health outcomes and healthcare experiences navigating breast cancer treatment. It provided an
apt lens to explore their lived realities and allowed me to acknowledge and address potential
biases that may have arisen.
In this research, understanding my positionality aided in acknowledging and addressing
personal biases that could have influenced the study. Unique positionality insights brought
valuable perspectives, but I remained vigilant in not generalizing my experiences to those of
Black women. Furthermore, my gender and sexual orientation might have introduced biases, and
I ensured that I did not overemphasize sexual orientation-related health issues in contexts where
they did not apply.
As a healthcare administrator specializing in diagnostic imaging and mammography
services, my professional experience significantly enriched my comprehension of breast cancer
and its multifaceted dimensions. Directly engaging with the operational intricacies, patient
interactions, and technical aspects inherent in these services afforded me a comprehensive
understanding of the intricacies surrounding breast cancer detection and management. Over the
years, my role has given me a unique vantage point beyond technical proficiency. It enabled me
to intimately connect with patients, cultivating a profound appreciation for their breast cancer
journeys’ emotional and psychological facets. This empathetic insight equipped me to
contextualize the participants’ experiences within a broader spectrum of breast cancer care.

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Furthermore, my administrative position necessitates close collaboration with various
medical professionals, including radiologists, oncologists, and support staff. This
interdisciplinary engagement deepened my comprehension of the collaborative nature of breast
cancer treatment, fostering an enriched understanding of the collective efforts involved. This
holistic perspective facilitated the integration of clinical, operational, and patient-centered
insights, thereby fortifying the study’s depth and applicability. My role as a healthcare
administrator uniquely positioned me to navigate both the technical intricacies of breast cancer
diagnosis and the intricate tapestry of patient experiences. The amalgamation of administrative
oversight, technical proficiency, and patient engagement imbued my study with a comprehensive
lens through which I examined the nuanced narratives of breast cancer care.
To address these biases and assumptions, I practiced reflexivity throughout the research.
Reflexivity involves continuous reflection on how my positionality may impact the study’s
methodology and outcomes (Bukamal, 2022; Olukotun et al., 2021). Maintaining an open
dialogue with participants and seeking their insights challenged my preconceptions and ensured a
more accurate representation of Black women’s experiences. Triangulation of data from multiple
sources limited the influence of personal biases and increased the study’s validity.
While it was impossible to eliminate my positionality, acknowledging it openly and using
it as a tool for deeper understanding and critical analysis enhanced the research and contributed
to a comprehensive exploration of the experiences of Black women navigating breast cancer
treatment. By embracing reflexivity and striving for unbiased research, I aimed to approach this
study with sensitivity and empathy, respecting the participants’ perspectives and challenges.

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Instrumentation
In this study, a survey was the primary data source. The survey consisted of closed and
open-ended questions, carefully crafted to capture detailed responses on the respondents’ lived
experiences. These questions were formulated on the research questions, conceptual framework,
and related literature. The survey questions were designed to explore the participants’
perceptions about their treatment journey, self-efficacy, and the intersectionality of their
identities and how these factors influenced their healthcare experiences. Appendix A provides
the survey protocol. These questions were strategically designed to tap into the participants’
lived experiences and self-perceptions, aligned with the study’s conceptual framework focused
on the experiences of Black women with breast cancer.
In addition to the survey protocol, this study employed a semi-structured interview
protocol as a secondary data collection method found in Appendix B. The semi-structured
interviews explored the participants’ experiences, perspectives, and narratives about breast
cancer treatment. This qualitative data collection instrument enabled the gathering of rich and
nuanced insights into the participants’ experiences and perceptions, complementing the
quantitative survey data. The study aimed to comprehensively explore the lived experiences of
Black women navigating breast cancer treatment in the United States and guided the
instruments’ selection and design of these instruments.
Participants
This study recruited Black women with a prior breast cancer diagnosis who have been in
remission for at least 1 year. For the quantitative component, surveys were administered to a
large sample of Black women. This larger survey sample allowed quantitative capture of
essential factors and trends related to the participants’ health outcomes and healthcare

61
experiences (Livingston & Cassidy, 2005; Pan et al., 2018). Relevant to the participants were the
inclusion and exclusion criteria that followed.
Semi-structured Interview Inclusion Criteria
The survey inclusion criteria for this study were carefully designed to ensure that
participants met specific characteristics that aligned with the research objectives. To be eligible
for participation, individuals were to be Black women who had previously received a breast
cancer diagnosis and are currently in remission for at least 1 year. The rationale behind this
criterion was to capture a group of participants who had navigated the various stages of breast
cancer treatment and could provide insights into their experiences over an extended period.
Additionally, participants were 18 years or older, as this ensured legal consent for participation.
Moreover, participants were willing to share their experiences and perceptions about their breast
cancer journey. This criterion ensured that participants were actively engaged and forthcoming in
responding to the survey questions, facilitating the acquisition of comprehensive data. Overall,
the survey inclusion criteria were crafted to recruit participants with the background and
willingness to contribute effectively to the study’s objectives.
A multifaceted inclusion criteria protocol established a sound foundation for the semistructured interviews. The initial volunteer pool comprised participants who completed the
preliminary survey and expressed an explicit willingness to engage in qualitative interviews. A
computer-generated randomization process was deployed to select interviewees from this
volunteer pool to mitigate selection bias and uphold the ethical principle of equitable
opportunity. Before finalizing this selection, each potential participant thoroughly reviewed the
study’s inclusion criteria to validate their eligibility for participation.

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The participants were contacted via email upon securing this selection and provided
comprehensive details about the forthcoming interviews. This communication encompassed the
overarching purpose and format of the interview and the meticulous measures in place to
guarantee confidentiality. Recognizing the importance of participant convenience, the study
offered various scheduling options, including virtual interviews, to accommodate any logistical
or health-related constraints the participants may have had.
Before the interviews, participants were provided informed consent, confirming their
ethical compliance and commitment to the research endeavor. This consent covered the audio
recording of interviews, which were transcribed verbatim to facilitate in-depth, subsequent
analysis. By adhering to this structured yet comprehensive set of inclusion criteria and
procedural steps, the study aimed to ensure that the data were both high in quality and ethically
unimpeachable.
Semi-structured Interview Exclusion Criteria
The survey exclusion criteria for this study was established to maintain the integrity and
relevance of the data. Individuals who did not meet the specific criteria outlined for inclusion
were excluded from participating in the survey. Firstly, individuals who did not identify as Black
women were not eligible for participation, as the study focused exclusively on the experiences of
this demographic. Furthermore, individuals who had not been diagnosed with breast cancer or
who were not in remission were excluded. This ensured that participants had direct experience
with breast cancer treatment and its effects over an extended period, aligned with the study’s
aims.
Additionally, individuals under eighteen were not eligible to participate due to legal and
ethical considerations regarding informed consent and participation in research. Lastly,

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individuals unwilling to share their experiences or perceptions of their breast cancer journey
were excluded. This criterion ensured that participants were actively engaged and contributed
meaningfully to the study’s objectives. The survey exclusion criteria had been thoughtfully
designed to maintain the homogeneity and relevance of the participant group, thus enhancing the
validity and applicability of the study’s findings.
A robust set of exclusion criteria was implemented to ensure the relevance and integrity
of the interview data. First, participants who had yet to provide complete or consistent responses
during the initial survey phase were excluded from consideration for the interviews. This
stipulation ensured that participants had engaged with the research process thoughtfully and
would offer meaningful contributions during the qualitative phase.
Secondly, individuals who indicated any time constraints or unavailability for the
scheduled interview sessions were excluded. This criterion guaranteed that participants were
fully committed to the study and could provide comprehensive insights. Additionally, any
participant reluctant to share in-depth individual experiences or perceptions of their breast cancer
journey was not considered for the interviews. This ensured the qualitative data was rich,
detailed, and informative.
Moreover, in an active effort to encapsulate diverse experiences and viewpoints,
individuals whose backgrounds, treatment paths, or experiences closely mirrored those of other
participants were excluded. This strategy was employed to preclude data redundancy and to
enrich the dataset with varied perspectives. Finally, an essential ethical criterion for exclusion
was the unwillingness to provide informed consent for participation in the interviews. Upholding
this criterion ensured the study maintained ethical rigor and transparency. By adhering to these

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carefully crafted exclusion criteria, the study aimed to curate a participant cohort conducive to
achieving the specified research objectives.
Data Collection Methods
Data collection for this mixed-methods study spanned approximately 3 months, with
surveys serving as the primary mode of data collection. Semi-structured interviews followed to
comprehensively explore the lived experiences of Black women who had navigated breast cancer
treatment.
Method 1: Survey Administration
According to research, surveys offered a practical and efficient method to gather a broad
range of data from a large sample of participants (Daley et al., 2003; Knekta et al., 2019). The
surveys included closed and open-ended questions, allowing participants many opportunities to
provide comprehensive responses. The survey was conducted online, adhering to patient privacy
and data confidentiality regulations. Carefully reviewing the survey responses ensured an
organized and systematic recording of relevant data. Through surveys, this study quantified
specific factors and identified correlations that may influence health outcomes among Black
women with breast cancer. This quantitative approach provided a broad overview of the
participants’ experiences and perceptions, allowing the study to identify common themes and
areas of interest.
The sample size for the survey administration was 100 participants. There were 40
questions on the survey, which covered various aspects of the participants’ treatment journey,
providing data on experiences with healthcare providers, treatment adherence, access to
resources, and perceived influences on health outcomes. This data collection complemented the
qualitative insights obtained from semi-structured interviews, which offered a comprehensive

65
understanding of the challenges and factors influencing the healthcare experiences of Black
women.
Method 2: Semi-structured Interviews
Following the survey administration, semi-structured interviews occurred in a virtual
setting. Each interview lasted less than 60 minutes. To ensure accuracy and completeness, the
interviews were audio-recorded with participants’ consent and transcribed verbatim by Otter AI
transcription services. According to the literature, these methods are known for reliably capturing
detailed qualitative data and maintaining data integrity (Creswell & Hirose, 2019).
The adaptable nature of semi-structured interviews proved especially fitting for this
research, as it allowed for exploring complex and sensitive topics while respecting participants’
pace, ensuring their comfort, and affirming their consent (Lewis et al., 2015; Paladino et al.,
2019). Through these interviews, Black women, whose experiences with breast cancer are
frequently ignored and marginalized, were empowered to share their stories. This process
promoted a greater comprehension of their struggles, resilience, and hopes for fair and
empathetic treatment.
For this study, twelve semi-structured interviews were completed to unravel the
experiences of Black women who had navigated breast cancer treatment. The participants
indicated on the survey if they were open to being interviewed. The participants were contacted
by email to schedule the interviews. The first twelve survey respondents willing to participate in
the interviews were contacted. Each participant was asked the same set of questions during the
interview.
By integrating insights from quantitative and qualitative data sources, this study aimed to
inform the development of patient-centric healthcare models that address the needs of Black

66
women with breast cancer centered on self-agency. All data was stored confidentially and
securely. To protect participant privacy, pseudonyms were used for any sensitive or potentially
identifiable information in strict adherence to ethical research standards.
The selection of these data collection methods was guided by the need for credibility and
trustworthiness in mixed-methods research, aligning with the nature of the research questions
and considering the comfort and privacy of the participants. Combining surveys and semistructured interviews provided a comprehensive and in-depth exploration of Black women’s
experiences navigating breast cancer treatment, ensuring a robust analysis of the study’s
objectives.
Data Analysis
Quantitative Data
Analyzing the closed-ended survey data involved a comprehensive quantitative
examination driven by statistical methodologies. Central to this approach were descriptive
statistics, which, according to the literature, serve as the bedrock for unraveling the nuances of
the survey responses (Kaur et al., 2018). For example, summarizing self-efficacy scores through
mean, median, and standard deviation offered insights into how Black women with breast cancer
perceived their ability to influence their health outcomes. Likewise, descriptive statistics for
health behavior scores, including their mean, median, and standard deviation, established a
baseline for understanding the prevalence and extent of positive health behaviors in this
population.
To evaluate the first hypothesis (H1), Pearson’s correlation analysis between self-efficacy
scores and health behavior scores validated the assertion that higher levels of self-efficacy relate
to more frequent engagement in positive health behaviors. For the second hypothesis (H2), a

67
multiple regression analysis elucidated the interplay between self-efficacy and socioeconomic
factors as predictors of healthcare experience quality. This quantitative approach helped to
quantify the significant influence these factors exert on healthcare experiences among Black
women with breast cancer.
Within this analytical framework, the study extracted multifaceted information.
Demographic characteristics such as age, marital status, income, and educational level were
scrutinized to identify potential associations with distinct health behaviors or outcomes.
Moreover, this analytical journey illuminated trends and patterns that might affect health
outcomes, providing a deeper understanding of how these factors interplay in the context of
breast cancer experiences. By applying these quantitative techniques, the study distilled precise
insights from the closed-ended survey responses. Through this analytical process, the study
aimed to uncover dynamics in the data and contribute to the larger discourse on the interplay
between factors and their impact on health-related perceptions and behaviors in breast cancer
experiences.
Qualitative Data
The data analysis for the survey’s open-ended questions adopted a qualitative thematic
approach. The responses were transcribed and read multiple times to familiarize the participants’
narratives. Themes were generated through systematic coding, using ChatGPT to identify key
concepts and explore emerging patterns and connections in the responses. The iterative coding
process ensured that themes accurately captured the essence of the participants’ experiences.
Thematic Analysis
Byrne (2022) describes Braun and Clarke’s six-phase approach as “one of the most
thoroughly delineated methods of conducting thematic analysis” (p. 1391). Firstly, in this

68
approach, the verbatim transcripts of each interview were generated to provide a written account
of participants’ responses. The data was familiarized through repeated readings, noting initial
ideas and observations.
Next, initial codes were generated across the entire dataset, systematically identifying key
concepts, ideas, and potential patterns in the participants’ responses through detailed line-by-line
coding. The third phase involved collating codes into themes and exploring how different codes
combined to form overarching themes. These themes were then reviewed and refined, ensuring
they aligned with the coded extracts and the entire dataset.
In the fifth phase, each theme was named and defined, developing a straightforward
narrative that explained what each piece represented and the specific aspect of the data it
captured. Finally, in the sixth phase, the final analysis was produced by selecting compelling
examples to illustrate the themes and conducting a comprehensive analysis of the selected
extracts.
The thematic analysis approach allowed for a comprehensive and organized
representation of participants’ experiences, capturing their stories in detail. Throughout the
analysis, ChatGPT software assisted in data management and coding, ensuring systematic
organization and easy retrieval of data, thus enhancing the efficiency of the analysis. ChatGPT
provided a helpful tool for managing a large volume of data and supporting rigorous exploration
of the themes and patterns that emerged from the interviews.
Validity and Reliability
Ensuring the validity and reliability of a mixed-methods study enhanced the findings’
credibility and trustworthiness. In this study, multiple strategies were implemented to achieve
these goals. Using Cronbach’s alpha, the application of internal consistency reliability emerged

69
as pivotal in this study, especially for survey questions designed to gauge analogous constructs.
The survey questions about self-efficacy encompassed inquiries about confidence in managing
various facets of breast cancer treatment, such as recovery, exercise frequency, stress-reduction
techniques, diet, adherence to medication and treatment regimens, engagement in medical
follow-up exams, and rigorous reliability testing. This ensured these items cohesively measured
the underlying construct of self-efficacy consistently. Additionally, survey items probing into the
participants’ lived experiences, including those that sought to understand the multifaceted impact
of race, gender, and income on healthcare experiences, were examined for their collective
reliability in authentically capturing the nuanced intricacies of these experiential narratives.
Furthermore, survey questions tailored to explore the realm of self-agency encompassed aspects
related to how individual experiences informed healthcare models, the enactment of active
decision-making, and the adaptive strategies employed in navigating healthcare models were
subjected to internal consistency reliability testing. This ensured that responses to these questions
cohesively and reliably reflected the construct of self-agency, thereby bolstering the empirical
robustness and validity of the findings derived from these response sets.
Triangulation
Triangulation was employed in this study to enhance the validity of the findings. It
integrated qualitative and quantitative data sources, diverse data collection methods, and
theoretical perspectives. This approach explored Black women’s experiences in breast cancer
treatment. Integrating different data types and perspectives strengthened the credibility and
trustworthiness of the study’s outcomes, providing a multi-dimensional understanding of selfefficacy, experiences, and health outcomes. Triangulation enhanced the robustness of findings,

70
contributing to a comprehensive and impactful analysis of Black women’s breast cancer
journeys.
Data Collection Protocols
In this study, the data collection protocols included a combination of established survey
instruments to ensure comprehensive and accurate data collection. These instruments were
selected based on their relevance to the research objectives and their established psychometric
properties. Each survey was administered using a web link to Qualtrics. This provided a secure
online platform for survey completion. Before survey administration, a comprehensive
introduction was provided to the participants to clarify the study’s purpose, reinforce participant
anonymity, and emphasize the voluntary nature of participation.
Likert Scales
The survey protocol encompassed a blend of closed-ended queries employing Likert
scales, categorical response options, and open-ended questions, facilitating a nuanced
exploration of participants’ experiential and perceptual domains. The literature tells us Likert
scales are commonly used in surveys to measure participants’ attitudes, opinions, perceptions, or
beliefs on a particular topic (Emerson, 2017; Norman, 2010). Likert scales typically consist of
statements or items to which respondents indicate agreement or disagreement using a
predetermined range of response options (Emerson, 2017; Norman, 2010). These response
options are often labeled, ranging from strongly disagree to strongly agree, and sometimes
include a neutral option (Emerson, 2017; Norman, 2010).
This study used a 5-point Likert scale to measure the complex constructs of self-efficacy,
lived experiences, and self-agency. Utilizing a scale ranging from strongly disagree to strongly
agree, the self-efficacy measure included items that gauged confidence in managing breast

71
cancer symptoms, adherence to treatment protocols, and the perceived ability to positively
impact health outcomes. High cumulative scores on this scale were interpreted as indicative of
strong self-efficacy. These scores systematically correlated with data on positive health
behaviors to test the first hypothesis (H1).
Similarly, to quantify the lived experiences of Black women regarding the influence of
race, gender, and socioeconomic factors on their healthcare, another 5-point Likert scale was
employed. This scale ranged from never to always, offering items that explored the perceived
impacts of these sociocultural variables on healthcare interactions and quality. This quantitative
data augmented qualitative insights, enabling a robust, multifaceted analysis relevant to the
second hypothesis (H2).
Lastly, self-agency was measured using another 5-point Likert scale, ranging from not at
all likely to extremely likely. This scale assessed the degree to which participants engaged in
active decision-making concerning their treatments, perceived their influence throughout their
illness, and undertook additional informational pursuits. Elevated scores in this domain
suggested a heightened sense of self-agency. This factor was subsequently analyzed for its
correlation with treatment outcomes and survivorship.
Participant Recruitment
The recruitment process involved collaboration with community health nonprofit
organizations, cancer support groups on Facebook, and targeted social media campaigns on
Instagram and LinkedIn. Inclusion criteria, aligned with the study’s objectives, guided the
selection of participants. The inclusion criteria included Black women diagnosed with breast
cancer, in remission for at least 1 year, and of diverse ages.

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Survey Distribution
The survey was distributed through online platforms. This approach augmented
inclusivity and response rates. Stringent quality control mechanisms, entailing reviews of the
survey’s linguistic clarity, logical coherence, and pertinence, further contributed to the
dependability, validity, and robustness of the data amassed.
Informed Consent Process
Before survey administration, participants received comprehensive informed consent
information outlining the study’s purpose, procedures, potential risks and benefits,
confidentiality measures, and their rights as participants. This information was presented in
written and verbal formats to ensure participants understood and voluntarily participated.
Building Rapport for Qualitative Interviews
Building rapport means establishing a trusting relationship between the researcher and
the study participants (Abbe & Brandon, 2014; Risan et al., 2018). The literature tells us building
rapport involves creating a comfortable and open environment where participants feel safe to
share their experiences and perspectives (Abbe & Brandon, 2014; Risan et al., 2018). Building
rapport laid the foundation for authentic and meaningful data collection in this study. It enabled
participants to openly share their lived experiences and insights related to breast cancer
treatment, which was essential for obtaining accurate and rich qualitative data. The steps listed
next were used to build rapport with the participants.
Transparency and Preparation
I provided participants with clear and comprehensive information about the study’s
objectives and my role. This upfront transparency helped build mutual understanding and trust.

73
Warm Introduction
At the beginning of each interview, I introduced myself, shared my background, and
expressed genuine warmth and interest in their experiences. This initial connection set a friendly
tone.
Active Listening
I prioritized active listening, allowing participants to share their thoughts and emotions.
This attentive approach showed respect for their viewpoints and contributed to a sense of
validation.
Empathetic Responses
I offered compassionate responses throughout the interviews to convey that I understood
and acknowledged their feelings and experiences. This empathy helped establish a deeper
connection.
Open-Ended Questions
I used open-ended questions to encourage participants to share detailed narratives. I
signaled my interest in hearing their stories and insights by asking these questions.
Non-judgmental Attitude
I maintained a non-judgmental stance during the interviews, ensuring that participants felt
safe expressing their thoughts without fear of negative judgment.
Verbal Validation and Affirmation
Participants’ experiences were validated, and they received verbal affirmation that their
stories were valuable. This validation empowered them to share their perspectives and offered
encouragement to support an inclusive interview environment.

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Cultural Sensitivity
I was sensitive and considerate, respecting participants’ backgrounds, identities, and
viewpoints. This approach fostered mutual respect and inclusivity.
Follow-up and Gratitude
After each interview, I expressed gratitude for their time and willingness to share their
experiences. This follow-up gesture maintained a positive connection.
Through these strategies, I aimed to build rapport with interviewees, creating an
environment where they felt valued, understood, and empowered to share their breast cancer
treatment journeys openly and authentically.
Member-Checking
Member-checking, also known as participant or respondent validation, is a qualitative
research technique to enhance the validity and credibility of findings (Birt et al., 2016; Candela,
2019). In this process, study participants are presented with the interpreted results of their
responses to confirm their accuracy and relevance (Birt et al., 2016; Candela, 2019). This allows
participants to validate the researcher’s interpretation and offer additional insights or corrections
(Birt et al., 2016; Candela, 2019). In this study, member-checking ensured accuracy in capturing
and representing the interviewees’ experiences and perceptions of breast cancer treatment,
adding a layer of authenticity and trustworthiness to the research findings with the memberchecking procedure steps listed next.
Transcription and Analysis
First, the recorded interviews were transcribed, and the qualitative data was analyzed
using thematic analysis. This analysis generated themes and patterns reflecting participants’
experiences and perceptions related to breast cancer treatment. The interpreted results from the

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thematic analysis were formulated into coherent narratives that captured the essence of
participants’ stories and insights. Based on these narratives, concise summaries of the findings
were crafted, highlighting key themes and significant points from the data. Participants were
invited to review these summaries and provide feedback. Based on participants’ preferences, this
feedback was collected through email.
Open-Ended Prompts
During this process, participants were presented with open-ended prompts encouraging
them to assess the accuracy and resonance of the summarized findings. These prompts included
questions like, “Do these findings accurately reflect your experiences?” and “Are there any
important aspects you feel have been missed?” Participants’ feedback was analyzed
systematically to identify areas of assurance where their experiences aligned with the interpreted
findings. Additionally, their insights addressed any discrepancies or points of uncertainty,
ensuring a more accurate representation. The feedback received guided the advancement of the
findings. Necessary adjustments and clarifications were made to align the interpretations with
participants’ experiences.
Final Validation
Once the findings had been refined based on participants’ feedback, a final round of
member-checking was conducted. Participants were asked to validate whether the refined results
accurately resonated with their experiences.
The member-checking process ensured the credibility and trustworthiness of the study’s
qualitative findings. It established a collaborative relationship between the researcher and the
participants, validating their voices accurately captured and respected in the analysis. This

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thorough process contributed to the robustness of the study’s qualitative insights and enhanced
the overall validity of the research.
Credibility and Trustworthiness
Embarking on a journey to illuminate the experiences of Black women traversing their
breast cancer journeys, this research diligently prioritized establishing a robust framework of
credibility and trustworthiness throughout the research process. The intricate narratives of the
participants, rich with emotions and diverse perceptions, necessitated a methodologically solid
exploration that respected their experiences and adhered to stringent academic benchmarks.
Through prolonged engagement, the research deeply immersed into the participants’ contexts,
enhancing rapport and understanding of their experiences, especially in areas pertinent to selfefficacy and healthcare behaviors. Peer debriefing provided a robust framework for analytical
scrutiny. According to Altenmüller et al. (2021) and Cope (2014), peer debriefing enables
refined findings and interpretations by leveraging insights from experienced colleagues in
qualitative research. The audit trail enhanced methodological transparency by meticulously
documenting every research activity, bolstering accountability and verifiability. Ensuring
sampling adequacy, the study deliberately selected participants who offered diverse and rich
perspectives, reinforcing the comprehensiveness and representativity of the findings. Lastly,
incorporating negative case analysis allowed the research to transcend potential biases, providing
a more nuanced, comprehensive, and balanced exploration of the experiences and perceptions of
Black women with breast cancer, as mentioned by Altenmüller et al. (2021) and Cope (2014).
Ethics
Ethical considerations are paramount in protecting human participants’ rights and wellbeing according to a study by Peter, 2015. I upheld the ethical practice, which began with

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obtaining informed consent from participants. I provided detailed consent information,
explaining the study’s purpose, procedures, potential benefits, and risks. They were allowed to
ask questions and clarify concerns before giving oral consent.
Maintaining voluntary participation was of utmost importance, and participants were
informed that they could withdraw from the study at any time without penalty or reason.
Confidentiality was another essential ethical consideration. All participants’ identities and
personal details remained confidential throughout the study and will remain so in any future
publications. Survey responses were anonymized, ensuring participants’ privacy and protecting
their identities. To record the interviews, I sought explicit permission from the participants
during the informed consent process. It was made apparent the recordings were only used for
accurate transcription and analysis.
Stringent measures were implemented regarding data storage and security. All data,
including recordings, transcriptions, and consent forms, were stored securely in passwordprotected files on an encrypted computer system to prevent unauthorized access. By strictly
adhering to these ethical procedures, the study ensured the well-being and rights of the
participants were respected while upholding the academic community’s ethical standards.
Limitations and Delimitations
In a mixed-methods study, it is essential to acknowledge and address potential limitations
and delimitations to ensure the credibility and rigor of the research, according to a study by
Cypress, 2017. One limitation in the study’s qualitative phase was the interview data’s inherent
subjectivity. While the qualitative data provided rich and nuanced insights into the experiences
of Black women navigating breast cancer treatment, the findings are not readily generalizable to
a broader population due to the subjective nature of the responses—another limitation related to

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the role of the researcher in data collection and analysis. Despite efforts to minimize bias through
reflexivity and triangulation, some researcher bias will still influence the interpretation of the
qualitative data as mentioned by Dean et al., 2018 and Noble & Heale, 2019.
Regarding delimitations, the study’s focus on Black women with at least 1 year in
remission narrowed the scope. It limited the transferability of findings to women at various
stages of breast cancer treatment or from other racial/ethnic backgrounds. Additionally, specific
data collection methods, such as semi-structured interviews and surveys, excluded potential
insights that could be gained through other methods like focus groups or observations. Moreover,
using specific theoretical frameworks, such as SCT and BFT, also influenced the interpretation
of the data, limiting the exploration of alternative perspectives.
Despite these limitations and delimitations, the mixed-methods approach allowed for a
comprehensive and holistic exploration of the experiences of Black women who have been
navigating breast cancer treatment. By acknowledging and addressing these potential challenges,
the study sought to enhance the validity and reliability of its findings and contribute valuable
insights to the field of breast cancer care for Black women.
Conclusion
In conclusion, the first three chapters of this dissertation proposal laid the foundation for
the comprehensive study focused on the experiences of Black women who have navigated breast
cancer treatment. This research traversed the theoretical landscape, integrating SCT and BFT to
provide a robust framework for understanding the study’s topic, purpose, methods, and relevance
to the literature. Additionally, this research discussed the intricacies of the mixed-methods
approach, highlighting the significance of both quantitative surveys and qualitative interviews in
capturing the multifaceted nature of these experiences.

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The significance of this study sheds light on the challenges and strengths inherent in the
healthcare journeys of Black women with breast cancer. The exploration of self-efficacy, the
impact of intersecting identities, and the role of empowerment in healthcare decision-making
contributed to the broader discourse on health equity and patient-centered care. By addressing
the gaps in the current literature and incorporating the voices of those directly affected, the study
aimed to inspire positive changes in healthcare models and policies.

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Chapter Four: Quantitative Results and Qualitative Findings
This research investigated the enduring racial disparities affecting breast cancer outcomes
among Black women in the United States, adopting a dual lens of social and healthcare system
analysis. It aimed to shed light on the significance of self-efficacy among Black women
concerning their health-related behaviors and how their layered identities influenced their
encounters in the healthcare environment. The goal was to leverage these insights to forge
culturally responsive healthcare models centered around the patient, enhancing survivorship
prospects. The study analyzed demographic information—age, socioeconomic background, and
geographical settings—to better frame these experiences. Findings were articulated through
descriptive statistics, Pearson’s correlations, and multiple linear regression analyses, focusing on
data points such as sample sizes, response rates for categorical variables, and a range of
statistical measures for continuous variables. The quantitative study portion was conducted and
analyzed using a combination of tools. The survey was administered electronically using
Qualtrics, an online software tool for creating and implementing surveys. A copy of the
participant survey can be found in Appendix A. Survey response rates and raw data were taken
from Qualtrics and analyzed using IBM SPSS Statistical software. This examination probed the
correlations among distinct factors and tested specific hypotheses to deepen our comprehension
of the factors influencing breast cancer outcomes for Black women.
The participants’ narratives unearthed a layered and challenging landscape marked by
economic hardships, discrimination, and mental health struggles, all interwoven with their
complex identities. Their accounts underscored the pressing demand for encompassing and
culturally adept healthcare frameworks, especially considering documented instances of racial
bias in the healthcare domain. This qualitative research highlighted the importance of self-

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efficacy and agency, revealing that participants were confident in managing their healthcare
journeys. A manual thematic analysis was initially conducted using Microsoft Excel using the a
priori coding process. The identified themes and codes were condensed and validated using
ChatGPT generative AI software. This qualitative analysis highlighted how a supportive
healthcare infrastructure bolsters this self-assurance, aligning with SCT’s tenets. Furthermore,
the emphasis on informed decision-making, individualized care, and community-focused
strategies signaled a need for enhanced self-efficacy and proactive engagement in healthcare.
This approach aligned with Black feminist thought, advocating for integrating personal
narratives and the intricate interplay of race, gender, and socioeconomic status in healthcare
planning and delivery.
Participant Demographics
The survey respondents’ demographic information provided a foundation for
understanding this study’s context and implications. It encompasses a broad range of data points,
including ethnicity, age at diagnosis, education level, income, marital status, type and stage of
breast cancer, treatment received, and duration of remission. This information was central in the
examination of the multifaceted nature of healthcare disparities and breast cancer outcomes,
allowing for a more tailored and informed approach to addressing Black women’s needs in
healthcare settings. Table 3 details the breakdown of participant demographics, offers insight
into their specific characteristics and sheds light on the personal and medical narratives that
underpin the research findings.

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Table 3
Quantitative Survey Participant Demographics
Question Response options Sample size and percentage
Q5: Years in remission Less than 1 year 14 (17.28%)
1–4 years 50 (61.73%)
5–8 years 16 (19.75%)
17 or more years 1 (1.23%)
Q7: Age at diagnosis 18–24 years old 12 (15.19%)
25–34 years old 37 (45.57%)
35–44 years old 25 (30.38%)
45–54 years old 6 (7.59%)
55–64 years old 1 (1.27%)
Q8: Highest education
High school graduate or
equivalent 9 (11.39%)
Some college or certificate 17 (21.52%)
Associate degree 3 (2.53%)
Bachelor’s degree 44 (55.70%)
Master’s degree 7 (8.86%)
Q9: Annual income $0–$29999 7 (8.75%)
$30000–$49999 23 (26.25%)
$50000–$69999 18 (23.75%)
$70000–$89999 16 (20.00%)
$90000–$109999 9 (11.25%)
More than $110000 8 (10.00%)
Q10: Marital status Married 57 (71.25%)
Widowed 3 (3.75%)
Divorced 4 (3.75%)
Separated 4 (5.00%)
Never married 13 (16.25%)
Q11: Type of breast cancer Inflammatory 49 (62.82%)
Triple-negative 8 (10.26%)
Ductal 22 (26.92%)
Q12: Cancer stage at diagnosis Stage 0 1 (1.25%)
Stage 1 30 (37.50%)
Stage 2 40 (51.25%)
Stage 3 10 (10.00%)
Q13: Type of treatment received Unilateral mastectomy 13 (9.92%)
Bilateral mastectomy 11 (9.09%)

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Question Response options Sample size and percentage
Lumpectomy 20 (16.53%)
Radiation therapy 36 (28.93%)
Chemotherapy 38 (30.58%)
Other 6 (4.96%)
The quantitative demographic data offers insight into the participants’ characteristics.
This data is pivotal for understanding the nuances of healthcare disparities in this demographic.
The homogeneity in ethnicity is crucial for isolating race-specific factors influencing breast
cancer prognosis and treatment in Black women.
In terms of age range at diagnosis, the data shows the most sizable proportion (45.57%)
being between 25 and 34 years old, followed by those between 35 and 44. This trend indicates an
early onset of breast cancer in this demographic, which may implicate genetic, environmental, or
lifestyle factors unique to Black women. Regarding educational background, a considerable
number of participants (55.70%) held bachelor’s degrees. This level of education could be
associated with better health literacy, potentially influencing their treatment decisions and
understanding of the healthcare system.
The participants’ income levels varied, with a notable distribution across brackets,
suggesting that the impact of socioeconomic status on breast cancer outcomes could be a
complex interplay of access to healthcare, treatment options, and support systems. A married
marital status (71.25%) implies the potential influence of spousal or family support in the cancer
journey. This aspect is essential in understanding the social support dynamics that affect
treatment adherence, mental health, and overall well-being during cancer treatment.
Looking at the clinical aspects, most participants had inflammatory or ductal breast
cancer, with most being diagnosed at Stage 2. This information aids in understanding the

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progression and aggressiveness of cancer types prevalent in Black women. Furthermore, the
commonality of treatments like chemotherapy and radiation therapy underscores the medical
approaches commonplace in this group. Finally, the remission duration, with most women being
in remission for at least 1 year, offers a glimpse into the survivorship and long-term outcomes of
breast cancer treatment in this demographic.
Transitioning to the qualitative dimension, this study emphasizes the depth and personal
significance of the participants’ experiences with breast cancer. Employing pseudonyms to
ensure confidentiality, the research details demographic information such as location, age at
diagnosis, and cancer stage, as presented in Table 4. This approach honors each participant’s
individuality and enhances the understanding of how diverse contexts influence health outcomes.
By integrating these personal narratives with quantitative data, the study offers a comprehensive
view of the multifaceted impact of breast cancer across a spectrum of American urban and
suburban settings.

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Table 4
Qualitative Interview Participant Demographics
Participant Residence
Age at
diagnosis Cancer stage
Alicia Brooklyn, New York 29 Stage 2 breast cancer
Imani Las Vegas, Nevada 44 Not specified
Tasha Mobile, Alabama 42 Not specified
Nia Atlanta, Georgia 38 Stage 1 non-invasive ductal carcinoma
Tanya Seattle, Washington 35 Stage 2 triple-negative
Keisha San Antonio, Texas 38 Stage 2 inflammatory
Yolanda Los Angeles, California 48 Stage 3 invasive ductal carcinoma
Latoya Dallas, Texas 48 Stage 2 ductal carcinoma in situ
Shanice Johnson City, Tennessee 33 Stage 2 ductal
Jasmine Brooklyn, New York 55 Stage 3 invasive ductal carcinoma
Brianna Miami, Florida 40 Stage one inflammatory
Destiny Not specified 44 Stage 2
The study’s qualitative component illustrates the journeys of 12 Black women, each
narrative rooted in the principles of Black feminist thought, highlighting resilience, community,
and individuality. Alicia (29, Brooklyn, NY) confronts Stage 2 breast cancer, her youth
intensifying the emotional and urgent nuances of her experience. Imani (44, Las Vegas, NV) and
Tasha (42, Mobile, AL) offer perspectives on navigating healthcare systems in culturally
dynamic environments. Nia (38, Atlanta, GA) represents early detection success against Stage 1
non-invasive ductal carcinoma. Tanya (35, Seattle, WA) battles the aggressive Stage 2 triplenegative cancer, underscoring the need for effective treatments. Keisha (38, San Antonio, TX)
and Yolanda (48, Los Angeles, CA) share their experiences with Stage 2 and 3 cancers,
emphasizing the spectrum of care requirements. Latoya (48, Dallas, TX) sheds light on Stage 2
ductal carcinoma in situ, exploring localized treatment challenges. Shanice (33, Johnson City,

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TN) and Jasmine (55, Brooklyn, NY) contribute to the discourse on the impact of cancer across
ages and stages. Brianna (40, Miami, FL) underscores the importance of early diagnosis in her
fight against Stage 1 Inflammatory breast cancer. With her broad representation, Destiny (44,
location not specified) brings attention to the collective struggle against Stage 2 breast cancer,
embodying the shared and diverse experiences presented in this study.
Each participant’s demographic information, including age, residence, and cancer stage,
offers a lens through which to view and understand the varied experiences of breast cancer
diagnosis, treatment, and survivorship. Their collective narratives provide insights, challenges,
and triumphs, contributing to a deeper understanding of breast cancer’s impact on women from
diverse backgrounds. This demographic overview humanizes the data and sets the stage for a
deeper, more empathetic understanding of each woman’s journey through breast cancer.
Descriptive Statistics
Table 5 presents the results of the descriptive statistics conducted on the primary
categorical measures of interest included in this study. Participants were asked to rate their level
of confidence in the listed categories. The scale used on the survey was 1 (not at all confident) to
5 (extremely confident). In most cases, the modal response consisted of three and the scale’s
midpoint. Exceptions consisted of the final three items included in Table 5, the measures of
medication regimen, treatment regimen, and breast cancer exams, all of which had a modal
response of 2. Some extent of a floor effect was found among these items in the sense that only
some individuals provided a response of 4, and only a few individuals provided a response of 5
about these measures.

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Table 5
Descriptive Statistics
Response
Measure
1
Not at all
confident
2
Slightly
confident
3
Moderately
confident
4
Very
confident
5
Extremely
confident
Managing treatment 11 (13.58%) 26 (32.10%) 30 (37.04%) 11 (13.58%) 3 (3.70%)
Managing recovery 9 (1.11%) 25 (30.86%) 31 (38.27%) 11 (13.58%) 5 (6.17%)
Regular exercise 14 (17.28%) 21 (25.93%) 34 (41.98%) 11 (13.58%) 1 (1.23%)
Stress reduction 11 (13.58%) 22 (27.16%) 37 (45.68%) 10 (12.35%) 1 (1.23%)
Balanced diet 22 (27.85%) 25 (31.65%) 27 (34.18%) 5 (6.33%)
Medication regimen 26 (32.10%) 33 (40.74%) 21 (25.93%) 1 (1.23%)
Treatment regimen 25 (31.25%) 31 (38.75%) 18 (22.50%) 5 (6.25%) 1 (1.25%)
Breast cancer exams 30 (37.04%) 36 (44.44%) 14 (17.28%) 1 (1.23%)
Reliability and Factor Analyses
The first hypothesis incorporated Study Questions 16 and 17 as self-efficacy, with
positive health behaviors consisting of Questions 18 through 23. Concerning the second
hypothesis, the self-efficacy measures again consisted of Questions 16 and 17, while the quality
of healthcare experience measures consisted of Questions 26 through 30. A copy of the
participant survey can be found in Appendix A. Initially, Cronbach’s alpha was calculated and
reported for all three scales. First, self-efficacy was found to have an alpha of 0.68, with positive
health behaviors having an alpha of 0.76. The quality of the healthcare experience was 0.5192,
which needed to be revised. Additional steps were taken to remove items to maximize the
Cronbach’s alpha measure associated with this scale. Questions 29 and 30 were removed; this
produced a maximum alpha of 0.6012. This was still deemed unacceptable, with each item
analyzed instead of using this measure as a scale concerning the tests conducted for Hypothesis
2.

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Using exploratory factor analysis, factor scores were then calculated for these first two
measures. The initial eigenvalue associated with self-efficacy was 0.76944, with both factor
loadings equal 0.6203. Self-efficacy factor scores were then predicted using the regression
method, with scoring coefficients of 0.41086 found regarding both items. The Bartlett method
was also applied, which was discovered to be perfectly correlated with the predictions associated
with the regression method, r (79) = 1.000, p < .001.
The factor analysis on positive health behaviors was associated with an initial eigenvalue
of 2.32764. Factor loadings were as follows: Question 18 (0.3700), Question 19 (0.3791),
Question 20 (0.5545), Question 21 (0.7881), Question 22 (0.7934), and Question 23 (0.6993).
The method of regression was then used to predict these factor scores; this was associated with
the following scoring coefficients: Question 18 (0.12563), Question 19 (0.11180), Question 20
(0.14162), Question 21 (0.34164), Question 22 (0.31822), and Question 23 (0.19945). Bartlett’s
method was also applied, positively correlated with the regression method scores, r (76) = .9958,
p < .001.
Quantitative Survey Results Hypothesis 1
This study’s first hypothesis (H1) was that higher self-efficacy levels are associated with
increased engagement in positive health behaviors.
Initially, descriptive statistics were conducted on these measures. Self-efficacy had a
mean of zero and a median of –132. A standard deviation of .714 was found, with a minimum of
–1.345 and a maximum of 1.872. Positive health behaviors had a mean of zero, a median of –
.107, and a standard deviation of .910. A minimum of –1.546 and a maximum of 1.923 were
found.

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An initial Pearson correlation was conducted between self-efficacy and positive health
behaviors. According to Hauke and Kossowski (2011), the Pearson correlation is a fundamental
statistical tool that provides insights into the linear relationship between variables, aiding in
predictive modeling, feature selection, and hypothesis testing. This was positive, statistically
significant, and moderate in strength, r (76) = .335, p = .0028. A regression analysis was then
conducted, with positive health behaviors regressed on self-efficacy. Regression analysis is a
statistical method used to examine the relationship between a dependent variable and one or
more independent variables, allowing researchers to understand, predict, and infer causal
relationships within data (Frost, 2020). Table 6 presents these results. As shown, statistical
significance was found concerning the effect of self-efficacy on positive health behaviors. A
coefficient of .420 was indicated, indicating that a one-unit increase in self-efficacy was
associated with a .420-unit increase in positive health behaviors. Additionally, a beta of .335 was
found, suggesting that a one standard deviation increase in self-efficacy was associated with a
.335 standard deviation increase in positive health behaviors. This regression model was also
found to achieve statistical significance at the .01 alpha level, with the adjusted R-squared
indicating that 10.02% of the variance in positive health behaviors was explained based on selfefficacy.
Table 6
Linear Regression Analysis: Positive Health Behaviors on Self-Efficacy
Measure Coefficient Beta SE t p
Self-efficacy 0.42 0.335 0.136 3.09 0.003
Constant –0.004 0.098 –0.05 0.964
Note. N = 78; F(1, 76) = 9.58, p = .0028; R
2 = .1119, Adjusted R
2 = .1002.

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Open-Ended Survey Response Findings (RQ1)
The open-ended survey Questions 24 and 25 targeting RQ1 aimed to understand the
participants’ self-efficacy perceptions and their influence on health behaviors. These questions
sought individual experiences, probing how their confidence and belief in their abilities impacted
their treatment choices and engagement in post-diagnosis healthy behaviors. Major themes
emerged from the analysis. The theme of self-efficacy in decision-making relates to treatment
choices and information gathering. The impact of self-efficacy on lifestyle changes pertains to
adherence to healthy behaviors and overcoming barriers—the theme of emotional resilience and
coping focuses on managing emotional challenges and the importance of support systems. The
influence of treatment outcomes on self-perception concerns the effects of treatment feedback.
The theme of active participation in the treatment process highlights assertiveness in healthcare
settings. Lastly, perseverance and determination emphasize the ongoing commitment to
treatment and health behaviors. These themes collectively illuminate the role of self-efficacy in
these women’s healthcare journey.
Open-Ended Survey Responses Theme 1 (RQ1): Self-Efficacy in Decision-Making
The research question focused on how Black women with breast cancer perceive their
self-efficacy and its influence on their health behaviors. The theme of self-efficacy in decisionmaking emerged, encompassing two primary areas: confidence in treatment choices, including
choosing health facilities and selecting specific treatment plans, and research and information
gathering, which involves consulting with specialists, seeking second opinions, and
understanding medical information.

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Subtheme: Confidence in Treatment Choices
The subtheme of confidence in treatment choices demonstrates these women’s sense of
autonomy and capability in making critical health decisions. Choosing where to receive
treatment and selecting specific treatment plans are not just medical decisions; they are
reflections of their belief in their ability to determine the best course of action for their health. A
survey comment illustrates this point: “I was the one who chose the health facility where I would
get treatment. I have always been positive towards this breast cancer treatment and believe that I
would do it.” This comment demonstrates the participant’s proactive role and confidence in
making significant decisions.
Subtheme: Research and Information Gathering
On the other hand, research and information gathering related to these women’s proactive
approach to seeking comprehensive information to make informed decisions. They do not
passively accept medical advice; they actively seek additional opinions and educate themselves
about their condition. For instance, one participant shared, “I spent countless hours reading
medical journals, consulting with specialists, and seeking second opinions. My unwavering
belief in my ability to make informed choices gave me the courage to opt for a more aggressive
treatment plan.” This comment exemplifies the importance of being well-informed and having
the confidence to challenge and explore beyond the initial medical advice.
Another respondent reflected on this theme by saying, “It was my first time being
diagnosed with cancer. I felt the stigma, and it was hard, but I did come to accept and start the
medication after consulting with several specialists.” This statement shows the journey from
initial uncertainty to a position of empowerment, where seeking advice from various specialists
led to confident decision-making. Similarly, a different participant noted, “I once faced a

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challenging decision regarding my breast cancer treatment. My confidence and belief in
understanding my options played a significant role.” This underscores the importance of selfconfidence in understanding and evaluating various treatment options, leading to an informed
and personal decision.
Open-Ended Survey Responses Theme 2 (RQ1): Impact of Self-Efficacy on Lifestyle
Changes
The theme of the impact of self-efficacy on lifestyle changes pertains to adherence to
healthy behaviors and overcoming barriers to these behaviors. This theme connects to how these
women perceive their self-efficacy and its influence on their health behaviors.
Subtheme: Adherence to Healthy Behaviors
This aspect refers to the respondents’ commitment to maintaining a healthy diet,
exercising regularly, and making essential lifestyle modifications following their breast cancer
diagnosis. Their comments illustrate a powerful sense of self-efficacy in managing their health
proactively. For instance, one respondent expressed, “I have always been confident enough to
face it, and therefore, I took my diet and regular exercise very seriously,” indicating a deep sense
of responsibility and self-trust in managing her health. Another noted, “The positive attitude I
maintained … helped me towards making healthy changes,” showing how her confidence
translated into positive health behaviors. Additional comments further reinforce this theme, with
respondents detailing their efforts to adhere to healthy diets and regular exercise regimens,
reflecting a strong belief in their ability to influence their health outcomes positively.
Subtheme: Overcoming Barriers to Healthy Behaviors
This aspect addresses the challenges these women face in sustaining healthy behaviors
and their resilience in overcoming these obstacles. One woman’s comment underscores the

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common challenge of maintaining lifestyle changes over time: “In the past year, I have found
that the healthy habits I started have been pushed to the back burner.” However, resilience was
evident in another’s words: “When I was diagnosed, the willingness to engage in healthy
behavior in my first stages was hard, but with time, you get engaged and confident.” This
comment illustrates the journey from initial struggle to eventual empowerment. Other
respondents echoed similar sentiments, discussing battles with initial difficulties and eventual
success in embedding these healthy behaviors into daily life.
Open-Ended Survey Responses Theme 3 (RQ1): Emotional Resilience and Coping
In exploring the theme of emotional resilience and coping in the context of handling
emotional challenges, the analysis uncovered significant insights into how individuals navigate
the complexities of fear, stigma, and mental health issues. The respondents’ voices revealed the
intricate dance between vulnerability and strength.
Subtheme: Handling Emotional Challenges
One respondent shared, “Facing my diagnosis was like confronting a storm. The fear was
palpable, but learning to navigate this fear became my first step towards resilience.” This
statement encapsulates the journey from initial fear to gradually building resilience. Another
mentioned, “The stigma around my condition felt like a heavier burden than the illness itself.
Finding communities who understood made a world of difference.” This sentiment highlights the
role of the community in counteracting stigma. A third respondent noted, “My darkest days were
clouded with uncertainty, but embracing therapy opened a pathway to managing my mental
health.” This statement underscores the importance of professional support in managing mental
health challenges. “I used to see my illness as a weakness, but now I view my coping strategies
as a testament to my strength,” another respondent reflected, illustrating a shift in perspective

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toward self-compassion and resilience. Lastly, a sentiment shared by another emphasized the
normalization of emotional struggles as part of the human experience: “The constant battle with
my emotions felt isolating until I realized that it’s okay not to be okay.”
Subtheme: Support Systems As Confidence Builders
Turning to the theme of support systems as confidence builders, the narratives depict how
family, friends, and healthcare professionals provided support and confidence. “My family’s
unwavering support became the bedrock of my resilience,” one respondent expressed, noting the
foundational role of familial support. Another shared, “The moments I felt like giving up, my
friends reminded me of my strength, fueling my will to persevere.” This comment notes the
motivational boost friends can provide. A third respondent pointed to the therapeutic value of
being heard: “Engaging with a healthcare professional who truly listens made me feel seen and
validated.” “My therapist became my guide, helping me navigate through my vulnerabilities to
find my inner strength,” another noted, emphasizing the role of healthcare professionals in
fostering resilience. Finally, a comment about “the encouragement … received from my support
network transformed my fear into a drive to overcome challenges” encapsulates how emotional
support can be transformative.
The thematic analysis reveals that emotional resilience is not a solitary journey but is
linked to a supportive environment. Coping with fear and stigma requires internal mechanisms of
resilience and external support systems, highlighting the dynamic interplay between the
individual and their community. Managing mental health issues is a testament to individuals’
strength, nurtured by the compassion and understanding of those around them. The narratives
illustrate that resilience is cultivated through personal determination, community support, and
professional guidance, providing a multifaceted approach to overcoming emotional challenges.

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These findings address the research question by detailing the strategies for maintaining
emotional resilience and the role of support systems as confidence builders, underscoring the
importance of a comprehensive approach to emotional well-being.
Open-Ended Survey Responses Theme 4 (RQ1): Influence of Treatment Outcomes on SelfPerception
The thematic analysis of the influence of treatment outcomes on self-perception delves
into how individuals’ experiences with medical treatment outcomes shape their self-views,
focusing on the dichotomy of positive feedback from successful treatments and the adaptation to
treatment challenges. The research question guiding this exploration sought to understand how
Black women with breast cancer perceive their self-efficacy and its influence on their health
behaviors.
Subtheme: Positive Feedback From Successful Treatments
In the domain of positive feedback from successful treatments, respondent comments
illustrate the transformative power of treatment success on self-perception. One shared, “Seeing
my condition improve was like witnessing my strength in real-time. It made me believe in my
ability to overcome.” This comment encapsulates the reinforcement of self-efficacy through
successful treatment outcomes. Another stated, “Each small victory in my treatment journey was
a testament to my resilience.” Thus, positive outcomes serve as milestones of personal strength.
One woman reflected on the connection between treatment success and positive self-regard:
“The moment my doctor confirmed my recovery, I felt a surge of pride in what I’d endured.” A
fourth respondent remarked, “Overcoming my illness has reshaped how I view myself; I’m not
just a survivor, but a warrior.” This statement indicates a shift in self-identity post-treatment.

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Lastly, a participant highlighted the reevaluation of self-concept considering treatment success:
“My recovery journey taught me that my limitations are not my defining features.”
Subtheme: Adapting to Treatment Challenges
Conversely, adapting to treatment challenges presents a different spectrum of selfperception, underscored by resilience during adversity. One individual noted, “Handling the side
effects of my treatment was as much a mental battle as a physical one. It taught me endurance.”
This comment speaks to the comprehensive nature of resilience developed through navigating
treatment side effects. Another shared, “Each hurdle in my treatment path tested my limits but
also showed me my capacity to endure.” Her experience reveals how challenges fostered a
deeper understanding of her resilience. “The days I felt overwhelmed by side effects were the
days I learned the most about my strength,” another respondent observed, noting the paradoxical
nature of challenges as opportunities for growth. Another participant indicated the adaptive
strategies employed to manage treatment challenges: “Finding ways to cope with the difficulties
of treatment made me realize my resourcefulness.” Finally, another encapsulated the integral role
of adversity in shaping self-perception: “Despite the ups and downs of my treatment, I emerged
with a stronger sense of who I am.”
The thematic analysis thus reveals a nuanced perspective on how treatment outcomes
influence self-perception. On the one hand, positive feedback from successful treatments is a
potent enhancer of self-efficacy, pride, and a reshaped self-identity that leans toward viewing
oneself as capable and resilient. On the other hand, adapting to treatment challenges, including
managing side effects and navigating the emotional and physical highs and lows of treatment,
fosters a sense of endurance, resourcefulness, and a deeper, more resilient self-concept. These
findings illustrate that individuals’ experiences with treatment outcomes contribute to their

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perceptions of self-regarding physical health and shape their mental and emotional resilience,
underscoring the complex interplay between health experiences and self-perception.
Open-Ended Survey Responses Theme 5 (RQ1): Active Participation in the Treatment
Process
The thematic analysis concerning active participation in the treatment process sheds light
on assertiveness and empowerment through knowledge in healthcare settings. This exploration is
anchored to the research question. Respondents’ narratives revealed a multifaceted view of how
they navigated their healthcare journey, advocating for themselves and leveraging knowledge in
their treatment.
Subtheme: Assertiveness in Healthcare Settings
Assertiveness in healthcare settings is a critical factor in the treatment process, with
respondents emphasizing the importance of open communication and engagement with
healthcare providers. One respondent shared, “Asking questions didn’t just clarify my doubts; it
made me an active participant in my care.” This comment underscores the role of inquiry as a
form of assertiveness that enhances patient involvement. Another stated, “Initially, I hesitated to
voice my concerns, but I learned that my voice matters in managing my health.” This reflects the
journey from passivity to assertiveness in healthcare interactions. “The more I engaged with my
doctors, the more empowered I felt to make informed decisions,” a third respondent noted,
emphasizing the connection between engagement and empowerment. “Being assertive in my
appointments transformed the doctor-patient dynamic, making it more of a partnership,” another
remarked, indicating a shift toward a more collaborative approach to healthcare. Lastly, one
participant recalled the practical outcomes of assertiveness in healthcare settings: “I insisted on
exploring all treatment options, which opened up avenues I hadn’t considered before.”

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Subtheme: Empowerment Through Knowledge
Empowerment through knowledge emerged as another significant theme, with
respondents detailing how gaining insights about breast cancer and taking an active role in health
management contributed to their sense of control and empowerment. “Educating myself about
breast cancer was daunting, but it equipped me with the tools to navigate my treatment,” one
individual expressed, illustrating the dual nature of knowledge as both challenging and
empowering. Another shared, “The more I learned, the less helpless I felt. Knowledge became
my shield against fear,” encapsulating the protective role of information. “Being informed
allowed me to discuss my treatment options more confidently with my healthcare team,” a third
respondent highlighted, demonstrating how knowledge facilitates more effective communication.
“I took charge of my health by understanding the implications of my choices, which was
incredibly empowering,” another mentioned, reflecting on the active management of health.
Finally, one participant summed up empowerment through knowledge: “My journey taught me
that knowledge is power, especially when facing something as formidable as breast cancer.”
The analysis uncovers that active participation in the treatment process, characterized by
assertiveness in healthcare settings and empowerment through knowledge, enhances patients’
treatment experiences. Assertiveness allows individuals to voice their concerns, ask questions,
and engage meaningfully with their healthcare providers, fostering a partnership model of care.
Meanwhile, empowerment through knowledge enables patients to understand their condition
better, make informed decisions, and actively manage their health, thereby reducing feelings of
helplessness and anxiety. These findings reveal that active participation is not merely about
being present during treatment but involves a dynamic and proactive approach to managing
one’s health, underscoring the importance of patient agency in healthcare.

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Open-Ended Survey Responses Theme 6 (RQ1): Perseverance and Determination
The thematic analysis of perseverance and determination delved into continuing
treatment despite challenges and the long-term commitment to health during chronic illnesses.
This analysis is linked to the overarching research question regarding how the participants
perceive their self-efficacy and its influence on their health behaviors. The insights derived from
respondents’ experiences illuminate the impact of these qualities on navigating healthcare.
Subtheme: Continuing Treatment Despite Challenges
The theme of continuing treatment despite challenges is illustrated through respondents’
narratives regarding the role of persistence in the face of adversity. One respondent remarked,
“There were days when the side effects made me question if it was worth continuing, but my
determination to get better kept me going.” This comment underscores the inner conflict and the
resolve needed to persist with treatment. Another shared, “Facing setbacks in my treatment was
disheartening, but I learned that perseverance is part of the healing process.” This reflects an
acceptance of challenges as integral to recovery. “Each time my treatment hit a roadblock, my
resolve to fight grew stronger,” a third respondent noted, indicating how obstacles can fortify
determination. “Persistence is not just about enduring treatment; it’s about holding onto hope
even when it’s hard to see,” another mentioned, noting the emotional dimension of persistence.
Finally, one woman encapsulated the therapeutic value of steadfastness: “The journey through
my treatment taught me that perseverance is the most powerful medicine.”
Subtheme: Long-Term Commitment to Health
The commitment to long-term health through ongoing healthy behaviors is another
pivotal theme, emphasizing the importance of a sustained effort in health management.
“Adopting healthy habits wasn’t easy, but my commitment to my health has been my guiding

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light,” one individual expressed, illustrating the transformative impact of lifestyle changes.
Another stated, “My illness taught me that health isn’t a destination but a continuous journey that
requires dedication.” This sentiment reflects a holistic view of health as an ongoing commitment.
“I’ve integrated exercise and nutrition into my daily life, not just as a treatment strategy but as a
pledge to myself,” a third respondent revealed, showing the integration of healthy behaviors into
one’s identity. “Staying committed to my health goals has given me a sense of control over my
illness,” another shared, underscoring the empowering aspect of this commitment. Lastly, a
comment about “discipline to maintain healthy behaviors has been both a challenge and a
victory” highlights the dual nature of this commitment as both demanding and rewarding.
Through the lens of perseverance and determination, the thematic analysis reveals that
continuing treatment despite challenges and maintaining a long-term commitment to health are
not merely acts of survival but are expressions of self-care and resilience. Persistence through
treatment challenges embodies a resolve to overcome illness. At the same time, the dedication to
healthy behaviors signifies a broader commitment to enhancing one’s quality of life. These
themes illustrate that perseverance and determination are dynamic processes that evolve and
strengthen over time, offering insights into the interplay between mental fortitude and physical
health. Respondents’ narratives answer the research question regarding the role of these qualities
in achieving positive treatment outcomes and shed light on the transformative power of enduring
commitment to one’s health behaviors.
Qualitative Interview Findings (RQ1)
The first research question regarding how Black women with breast cancer perceive their
self-efficacy and its influence on their health behaviors delves into the critical exploration of
self-perceived abilities and the impact these perceptions have on managing health. The themes

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provide a comprehensive understanding of this interplay. These themes in the participants’
experiences and narratives underscore the significance of self-efficacy in shaping health
behaviors and outcomes.
Qualitative Interviews Theme 1 (RQ1): Self-Confidence Level
The theme of self-confidence level captures the evolving nature of individuals’ trust and
belief in their capability to manage health post-breast cancer diagnosis. This theme addresses
how individuals feel confident about making informed health decisions and coping effectively
with their illness. Evidence of this theme’s impact comes from participants who described
fluctuating confidence. This indicates that individuals’ self-confidence can evolve positively as
they acquire more information and experience managing their health. This theme sets the stage
for understanding the initial emotional and cognitive responses individuals experience upon
diagnosis.
Subtheme: Initial Reaction
The subtheme of initial reaction focuses on the immediate emotional and cognitive
responses individuals exhibit upon receiving a breast cancer diagnosis. It covers the spectrum of
initial reactions ranging from shock to determination. Participants’ accounts illustrate this
variability. Participant 4 (Nia) stated, “I was completely overwhelmed when I first heard the
news,” while Participant 7 (Yolanda) shared a contrasting attitude: “I took the news as a
challenge to overcome.” These references highlight individuals’ diverse emotional landscapes,
impacting their subsequent attitudes and behaviors toward illness management. The claim here is
that the initial reaction shapes the trajectory of self-confidence and coping strategies. The
transition from this subtheme to coping mechanisms reflects the progression from immediate
responses to longer-term strategies for managing health.

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Subtheme: Coping Mechanisms
Coping mechanisms refer to the diverse strategies and behaviors individuals employ to
manage the implications and stress associated with a breast cancer diagnosis. This subtheme
reveals individuals’ various approaches to maintain or rebuild their confidence. Participant
narratives provide concrete examples of these mechanisms. Participant 1 (Alicia) emphasized,
“Seeking support from my family has been my cornerstone,” and Participant 2 (Imani) noted,
“Educating myself about my options has empowered me.” These references underscore
individuals’ different pathways to bolster their confidence, whether through emotional support or
information acquisition. The claim is that effective coping mechanisms are instrumental in
maintaining or enhancing self-confidence during challenging times. This leads to a broader
understanding of how individuals navigate their journey with breast cancer, integrating
immediate reactions and long-term coping strategies into a cohesive narrative of resilience and
adaptation.
Qualitative Interviews Theme 2 (RQ1): Challenges Impacting Confidence
The theme of challenges impacting confidence is integral in exploring the range of
external and internal barriers that affect individuals’ confidence in managing their health after a
breast cancer diagnosis. This theme encompasses elements such as the quality of the healthcare
system, societal perceptions, and personal beliefs, each affecting confidence levels. Participants’
experiences illustrate how these factors converge to impact their confidence, underscoring the
negative impact of inadequate social support. The central claim here is that external factors like
healthcare quality and internal factors such as personal beliefs significantly influence an
individual’s confidence in managing their health. Exploring this theme leads to a more nuanced
understanding of the specific aspects of support systems and their impact on confidence.

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Subtheme: Support System Quality
The subtheme of support system quality emphasizes emotional, informational, and
practical support from personal networks and healthcare providers in influencing individuals’
confidence in managing their health. This subtheme encapsulates the importance of quality
support in the healthcare journey. For example, Participant 8 (LaToya) stated, “My doctor’s
encouragement made a huge difference,” demonstrating the positive impact of supportive
healthcare interactions. Conversely, Participant 12 (Destiny) expressed, “Feeling isolated from
my friends shook my confidence,” illustrating how a lack of support can adversely affect
confidence. The essential claim here is that the quality of the support system, whether from
healthcare providers or personal networks, is pivotal in influencing an individual’s confidence in
managing their health. This understanding segues into considering practical aspects of
healthcare, such as treatment accessibility.
Subtheme: Treatment Accessibility
The “Treatment Accessibility” subtheme addresses the practical and logistical challenges
of accessing healthcare services and their impact on individuals’ confidence in managing their
health. This subtheme pertains to the importance of accessible healthcare in influencing
confidence levels. Participant 9 (Shanice) remarked, “Struggling to get timely appointments
added to my anxiety,” pointing to the stress caused by logistical barriers. On the other hand,
Participant 11 (Brianna) observed, “Having a clinic nearby makes me feel more in control,”
indicating the positive effect of convenient healthcare access. The central claim here is that
practical aspects of healthcare accessibility, such as the proximity of clinics and the ease of
scheduling appointments, influence individuals’ confidence in managing their health. This

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perspective sheds light on the broader implications of healthcare systems and individual
experiences in the context of breast cancer management.
Qualitative Interviews Theme 3 (RQ1): Confidence in Decision-Making
Confidence in decision-making is a pivotal theme that delineates the influence of selfassurance on making significant health-related decisions, especially at crucial junctures of the
healthcare journey. This theme is vital in understanding how individuals perceive and act on
essential health decisions. For instance, as Participant 3 (Tasha) expressed, “Choosing my
treatment path was daunting, but I felt prepared,” illustrates the role of confidence in facing
challenging decisions. Similarly, Participant 4 (Nia) stated, “Deciding to participate in a trial was
a big step, backed by my confidence in the research,” demonstrating the importance of
confidence in making informed choices. These narratives underscore how individuals with
higher confidence levels tend to approach critical health decisions with more determination and
clarity. The central claim here is that confidence significantly influences decision-making,
particularly at crucial points where choices can have profound implications on health outcomes.
Qualitative Interviews Theme 4 (RQ1): Confidence Impact on Well-Being
This subtheme addresses the expansive influence of confidence on individuals’ mental,
emotional, and overall well-being. It refers to how self-perceived abilities to manage health
significantly shape psychological and physical states. The evidence for this theme’s importance
is reflected in participant statements, which indicate a direct correlation between confidence and
improved mental health outcomes. The central claim here is that confidence is pivotal in
promoting mental and emotional well-being, suggesting that feeling capable and in control can
significantly alleviate psychological distress.

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Subtheme: Mental Health Outcomes
Mental health outcomes concentrate on the psychological aspects of stress, anxiety, and
depression. This subtheme quantifies the impact of confidence on mental health, providing a
nuanced understanding of its role. Participant narratives provide straightforward evidence of this
impact. Participant 5 (Tanya) stated, “Feeling confident eases my anxiety about my health,” and
Participant 6 (Keisha) shared, “My bouts of depression are fewer when I feel in control of my
health.” These experiences demonstrate the positive influence of confidence on mental health
outcomes. The claim here is that a keen sense of confidence can significantly mitigate adverse
mental health conditions. The exploration of mental health outcomes leads to an understanding
of how confidence influences lifestyle choices and behaviors.
Subtheme: Lifestyle Changes
Lifestyle Changes explores the influence of confidence on making and maintaining
alterations in daily routines, activities, and overall lifestyle that contribute to health and wellbeing. This subtheme quantifies the transformative power of confidence in promoting positive
lifestyle changes. Participants’ experiences vividly illustrate this influence. Participant 7
(Yolanda) expressed, “I made significant lifestyle changes once I felt more confident in my
ability to get better,” and Participant 8 (LaToya) noted, “My confidence led me to join a support
group and change my daily routine.” These statements highlight the catalytic role of confidence
in initiating and sustaining lifestyle modifications for better health. The central claim is that
confidence motivates and maintains healthy lifestyle changes. This perspective enriches the
understanding of the comprehensive effects of confidence on individuals’ health journeys.

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Qualitative Interviews Theme 5 (RQ1): Confidence and Treatment Adherence
Confidence plays a pivotal role in the treatment adherence of Black women with breast
cancer, shaping their health outcomes. The theme is prominent, with many participants
indicating that their confidence directly impacts their adherence to treatment protocols. For
example, Participant 10 (Jasmine) shared, “My confidence is what keeps me grounded in my
treatment; I know I can manage the side effects,” illustrating her trust in her ability to cope with
the treatment’s demands. Brianna stated, “Staying on track with my medication is tough, but my
belief in my strength makes it possible,” emphasizing the role of self-efficacy in maintaining
treatment routines. Furthermore, Destiny reflected, “I see every completed treatment as a victory,
reinforcing my belief that I can beat this,” suggesting that treatment adherence also reinforces
confidence, creating a positive feedback loop. The theme “Confidence and Treatment
Adherence” encapsulates the considerable influence a keen sense of self-belief has on the
willingness and ability of these women to follow their treatment plans consistently. This theme
emphasizes that while confidence is integral to adherence, it is also closely related to the broader
spectrum of health behaviors, indicating a dynamic interaction between self-efficacy and overall
health management in these women’s lives.
Subtheme: Adherence Challenges
Black women with breast cancer often encounter significant obstacles that challenge their
treatment adherence, with these barriers being linked to their levels of confidence. Many
participants identified various barriers, such as side effects, financial constraints, and
misinformation, which tested their determination to follow through with their treatment plans.
For instance, Alicia disclosed, “There are days when side effects overwhelm me, but I push
through because I believe in the process.” This sentiment was echoed by another who explained

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that despite the financial burden sometimes shaking her confidence, she finds ways to remain
compliant with her treatment. Additionally, Keisha stated, “Misinformation can be distracting,
but I stay true to what my doctors say,” thus presenting her trust in the guidance of medical
professionals. These statements illustrate that the ability to surmount the challenges of adhering
to treatment often stems from a deep-seated sense of confidence. The resilience shown during
such challenges is a testament to confidence’s pivotal role in meeting treatment demands and
ensuring continued compliance. These adherence challenges, while daunting, are often mitigated
by a confidence-driven commitment to treatment, and this steadfast commitment is essential for
maintaining consistent compliance.
Confidence: Driven Compliance
Their self-confidence heavily influences compliance with treatment among Black women
with breast cancer. This relationship was evident as many respondents linked their strict
adherence to treatment to a strong belief in their efficacy. For example, Shanice stated, “I trust in
my ability to make the right choices for my health,” highlighting the connection between selfassurance and adherence to treatment. Tasha shared, “Knowing that I’m doing everything I can
gives me strength,” further echoing the importance of self-belief in managing her health regimen.
Similarly, Imani affirmed, “My confidence in the treatment plan keeps me from straying,”
underlining the role of confidence in the efficacy of medical advice in adherence. Overall,
confidence-driven compliance has emerged as a critical factor in how these women approach
their treatment plans, indicating that their self-confidence is beneficial and essential in managing
their health. While this confidence fuels treatment adherence, it also leads to necessary
behavioral adjustments, demonstrating that managing breast cancer requires medical compliance
and lifestyle adaptations.

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Qualitative Interviews Theme 6 (RQ1): Confidence and Health Behaviors
Confidence is a critical determinant in shaping the health behaviors of Black women with
breast cancer, influencing how they manage their illness and treatment. The participants
frequently stated that their self-confidence empowered them to adopt and maintain healthenhancing behaviors. For example, Tanya stated, “I take charge of my health by staying
informed and making lifestyle choices that complement my treatment.” This sense of agency
directly manifests her confidence in managing her health. Yolanda emphasized the role of selfefficacy in her daily routine: “I make time for exercise and proper nutrition because I believe in
their benefits to my recovery.” This indicates a proactive approach to health behaviors driven by
confidence in the outcomes. Furthermore, Keisha shared, “I prioritize my mental health along
with the physical, attending support groups, and practicing mindfulness.” This holistic view of
health behavior highlights a comprehensive strategy bolstered by a strong belief in self-care.
Behavioral Adjustments
Behavioral adjustments are a natural response to the challenges faced by Black women
with breast cancer, often anchored by their self-confidence. This is reflected in the experiences of
most respondents, who indicated that they had to make significant lifestyle changes to support
their health. Nia recounted her proactive steps: “I’ve changed my diet and exercise routine since
my diagnosis, believing it will make a difference.” Jasmine detailed the restructuring of her daily
life to accommodate her health needs: “I schedule my life around my treatments now, and it’s a
testament to how much I value my health.” Moreover, LaToya shared the importance of rest in
her regimen: “Sleep has become a priority for me; I’ve learned to listen to my body,”
emphasizing the adoption of health-promoting behaviors. These statements underscore the theme

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of behavioral adjustments, demonstrating the practical steps these women take, driven by their
self-confidence to maintain their health and well-being.
Self-Motivation Factors
Beyond adjusting, these women often tap into self-motivation as an intrinsic factor
propelling their health behaviors forward. Self-motivation is a critical element that propels the
health behaviors of Black women with breast cancer. Many participants recognized their selfmotivation as a catalyst for maintaining health-promoting behaviors. “I find the strength within
myself to stay active, even on the hard days,” Brianna confidently asserted, demonstrating the
power of internal drive. Echoing this sentiment, Keisha declared, “My determination to get better
is what gets me up in the morning,” displaying her inner drive to overcome the disease.
Reflecting on the impact of personal history, Destiny said, “I draw on my past successes
to fuel my current fight,” showing how past experiences shape present behaviors. These selfmotivation factors highlight the internal dialogue and personal drive that influence these
women’s actions, suggesting that their proactive engagement with health behaviors is not static
but evolves to meet the changing demands of their health journey. Self-motivation influences
current behaviors and equips Black women with breast cancer to adjust their behaviors over
time, ensuring they are aligned with their health goals and treatment plans.
Summary of RQ 1
The investigation of Hypothesis 1 and Research Question 1 focused on examining the
interplay between self-efficacy and health-promoting behaviors among Black women diagnosed
with breast cancer. The hypothesis posited that there existed a positive correlation between selfefficacy levels and the propensity to engage in behaviors beneficial to health. This was premised

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on the theoretical understanding that individuals’ confidence in their ability to execute specific
health-related actions directly influences their health behavior choices.
Further exploration through Research Question 1 sought to uncover how these women
perceived their self-efficacy in the face of their illness and the extent to which it influenced their
health management practices. It revealed nuanced themes such as confidence in making healthrelated decisions, lifestyle modifications in response to their diagnosis, resilience in coping with
the emotional toll of cancer, and proactive engagement in their treatment processes. The study
noted the centrality of self-efficacy in driving the persistence and determination necessary for
navigating the challenges of breast cancer treatment and maintaining a long-term commitment to
health-enhancing behaviors. In summary, the investigation underscored the critical role of selfefficacy in fostering health-promoting behaviors among Black women with breast cancer,
emphasizing its importance in the initial adoption of such behaviors and their sustained practice
over time.
Quantitative Survey Results: Hypothesis 2
The second hypothesis (H2) included in this study was that the interaction of selfefficacy, race, gender, and socioeconomic elements influences the quality of healthcare
experiences.
Among the initially proposed independent variables, no variation was present for race, so
this measure needed to be removed from the model. Gender was also removed from this model
as this measure was absent in the dataset. Independent variables included in the final model
consisted of respondent education and annual income as measures of socioeconomic status. In
place of respondents’ race and gender, age-range and marital status were included as additional
predictors. Additionally, the response categories of divorced, separated, and widowed were

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combined into a single category for marital status as these individual sample sizes were small,
and combining these three categories was deemed appropriate.
Table 7 presents descriptive statistics associated with these independent variables. Most
respondents were married, with smaller percentages being separated, divorced, widowed, or
never married. Regarding education, most respondents had a bachelor’s degree, while most had
annual incomes between $30,000 and $90,000.
Table 7
Descriptive Statistics: Independent Variables
Measure Sample size and percent
Marital status
Married 57 (70.37%)
Separated/divorced/widowed 11 (13.58%)
Never married 13 (16.05%)
Education
High school graduate or equivalent 9 (11.25%)
Some college or certificate 17 (21.25%)
Associate degree 3 (3.75%)
Bachelor’s degree 44 (55.00%)
Masters’s degree 7 (8.75%)
Annual income
$0–$29,999 7 (8.64%)
$30,000–$49,999 23 (28.40%)
$50,000–$69,999 18 (22.22%)
$70,000–$89,999 16 (19.75%)
$90,000–$109,999 9 (11.11%)
More than $110,000 8 (9.88%)

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Table 8 presents an initial multiple linear regression analysis conducted with the quality
of healthcare experience as a factor and with interaction effects omitted. This initial analysis
aimed to determine if any significant main effects were present. This analysis excluded the
interaction effects to increase the level of statistical power, leading to a higher likelihood of any
results achieving statistical significance. The factor measure was also used here to determine
whether any predictors were significantly associated with this outcome.
Table 8
Linear Regression Analysis: Quality on Self-Efficacy and Demographic Measures
Measure Coefficient Beta SE t p
Self-efficacy 0.477 0.377 0.137 3.48 0.001
Education 0.008 0.011 0.082 0.1 0.923
Annual income –0.122 –0.197 0.074 –1.64 0.106
Age range 0.077 0.07 0.133 0.58 0.563
MS: Sep/div/wid –0.087 –0.031 0.323 –0.27 0.788
MS: Never married –0.616 –0.258 0.309 –1.99 0.05
Constant 0.265 0.525 0.5 0.616
Note. N = 76; F(6, 69) = 3.06, p = .0103; R
2 = .2101, Adjusted R
2 = .1414.

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As shown in Table 8, significance was found in the effect of self-efficacy. Specifically, a
one-unit increase in self-efficacy was associated with a .477 unit increase in quality of healthcare
experience, with a one standard deviation increase in self-efficacy associated with a .38 standard
deviation increase in quality of healthcare experience. This means when people feel more
confident in their abilities (self-efficacy), their healthcare experience improves; specifically, a
slight increase in confidence leads to a noticeable improvement in their healthcare quality.
Additionally, about marital status, the effect that approached significance consisted of comparing
those who were never married and those who were married. Compared with married, nevermarried individuals had a predicted value on the quality of healthcare experience that was
reduced by .62 units. This regression model achieved statistical significance at the .05 alpha
level, with the adjusted R-squared indicating that this set of predictors explained 14.14% of the
variation in quality. This means the study found that people who have never been married tend to
have a slightly lower quality of healthcare experience than those who are married, with their
scores being 0.62 units lower on average. This difference is statistically significant, meaning it is
unlikely to be due to chance.
The following multiple linear regression analyses examined each item among five items
that may influence a person’s self-agency. Table 9 presents the descriptive statistics associated
with these five measures. The scale used included the following options: 1(Not likely at all) to 5
(Extremely likely). As shown, modal responses consisted of two in all cases, with some extent of
a floor effect, also indicated here, in the sense that only one or two individuals each responded
with 5 concerning these five measures.

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Table 9
Descriptive Statistics
Response
Measure 1
Not likely at
all
2
Slightly
likely
3
Moderately
likely
4
Very
likely
5
Extremely
likely
Q 26: Race
impact quality.
15 (18.75%) 47 (58.75%) 13 (16.25%) 4 (5.00%) 1 (1.25%)
Q 27: Gender
influence
16 (20.25%) 41 (51.90%) 12 (15.19%) 8 (10.13%) 2 (2.53%)
Q 28: Finances
affect access.
26 (32.50%) 43 (53.75%) 7 (8.75%) 2 (2.50%) 2 (2.50%)
Q 29: Understand
needs.
11 (13.75%) 37 (46.25%) 20 (25.00%) 10 (12.50%) 2 (2.50%)
Q 30: Satisfaction 13 (16.25%) 39 (48.75%) 15 (18.75%) 11 (13.75%) 2 (2.50%)
Table 10 presents the multiple linear regression analysis results with Question 26 on
these main effects and all associated two-way interactions. No significant findings were present
concerning this model, with this overall regression model failing to achieve statistical
significance. This indicates the study did not find any important results with this model, meaning
the overall analysis did not show a clear or reliable pattern, and the results could be due to
chance. Additionally, the adjusted R-squared, being negative, fails to indicate substantial
predictive power concerning this set of predictors on Question 26. This means the model does
not effectively predict or explain the data, suggesting it is useless in making accurate predictions.

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Table 10
Linear Regression Analysis: Q 26 on Self-Efficacy, Main Effects, and Interactions
Measure Coefficient Beta SE t p
Self-efficacy –0.142 –0.123 0.203 –0.7 0.489
Education –0.091 –0.113 0.129 –0.71 0.481
Annual income –0.137 –0.168 0.14 –0.97 0.334
Age range 0.038 0.047 0.13 0.29 0.771
MS: Sep/div/wid 0.105 0.044 0.38 0.28 0.782
MS: Never married –0.433 –0.199 0.734 –0.59 0.558
SE*Education 0.02 0.016 0.183 0.11 0.914
SE*Income range 0.244 0.247 0.177 1.38 0.174
SE*Age –0.018 –0.014 0.194 –0.09 0.926
SE*Sep/div/wid 0.762 0.253 0.72 1.06 0.295
SE*Never married 0.607 0.239 0.488 1.24 0.219
Education*income 0.062 0.078 0.139 0.45 0.657
Education*age 0.091 0.114 0.133 0.69 0.496
Education*Sep/div/wid 0.261 0.118 0.399 0.65 0.516
Education*never married 0.575 0.23 0.523 1.1 0.276
Income*age –0.039 –0.052 0.12 –0.32 0.748
Income*Sep/div/wid 0.425 0.154 0.743 0.57 0.569
Income*never married –0.621 –0.251 0.687 –0.9 0.37
Age*Sep/div/wid 0.399 0.162 0.34 1.17 0.245
Age*never married –0.014 –0.008 0.396 –0.03 0.973
Constant 12.071 0.124 97.05 0
Note. N = 78; F(20, 57) = 0.61, p = .8873; R
2 = .1768, Adjusted R
2 = –0.1121.
Next, Table 11 presents the analysis results with Question 27. In this analysis,
significance was indicated only concerning the interaction between self-efficacy and income
range. Interaction effects are commonly only discussed if the main effects also achieve statistical
significance; however, this significant interaction is noted here. This regression model failed to
reach statistical significance, with the adjusted R-squared also suggesting the need for more
substantial predictive power concerning this set of predictors on Question 27. In other words, this

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analysis did not find any meaningful results, and the low adjusted R-squared value indicates that
the model is not good at predicting outcomes for Question 27.
Table 11
Linear Regression Analysis: Q27 on Self-Efficacy, Main Effects, and Interactions
Measure Coefficient Beta SE t p
Self-efficacy –0.274 –0.198 0.248 –1.11 0.273
Education –0.042 –0.043 0.157 –0.27 0.789
Annual income 0.047 0.048 0.171 0.28 0.784
Age range 0.035 0.036 0.158 0.22 0.824
MS: Sep/div/wid –0.212 –0.073 0.458 –0.46 0.645
MS: never married –0.002 –0.001 0.886 0 0.998
SE* education 0.087 0.057 0.221 0.39 0.697
SE* income range 0.515 0.436 0.218 2.36 0.022
SE* age –0.046 –0.03 0.235 –0.2 0.845
SE* sep/div/wid 0.318 0.088 0.871 0.37 0.716
SE* never married 1.05 0.346 0.595 1.76 0.083
Education* income –0.197 –0.206 0.169 –1.17 0.247
Education*age 0.081 0.085 0.16 0.51 0.614
Education* sep/div/wid 0.279 0.105 0.481 0.58 0.565
Education* never married –0.052 –0.017 0.633 –0.08 0.934
Income* age 0.174 0.193 0.148 1.18 0.242
Income* sep/div/wid –0.824 –0.249 0.896 –0.92 0.362
Income* never married 0.107 0.036 0.832 0.13 0.898
Age* sep/div/wid 0.067 0.023 0.41 0.16 0.871
Age* never married –0.051 –0.023 0.479 –0.11 0.915
Constant 12.218 0.152 80.16 0
Note. N = 77; F(20, 56) = 0.61, p = .8914; R
2 = .1780, Adjusted R
2 = –0.1156.

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Question 28 was examined next, with these results presented in Table 12. These results
indicate a significant effect of self-efficacy and a significant interaction between self-efficacy
and income range. First, about self-efficacy, a one-unit increase in self-efficacy was associated
with a .534 unit decrease in Question 28, with a one standard deviation increase in self-efficacy
associated with a .44 standard deviation decrease in Question 28. This regression model failed to
achieve statistical significance, with the adjusted R-squared indicating that 4.13% of the variation
in Question 28 was explained based on all predictors included in this model. Meaning, this
analysis did not find any significant results, and the model could only explain 4.13% of the
differences in responses to Question 28, which means it does not do a good job of predicting the
outcomes.

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Table 12
Linear Regression Analysis: Q28 on Self-Efficacy, Main Effects, and Interactions
Measure Coefficient Beta SE t p
Self-efficacy –0.534 –0.441 0.198 –2.69 0.009
Education –0.121 –0.142 0.126 –0.96 0.34
Annual income 0.108 0.126 0.137 0.79 0.435
Age range –0.167 –0.196 0.127 –1.32 0.193
MS: sep/div/wid –0.166 –0.065 0.371 –0.45 0.657
MS: never married –0.731 –0.319 0.718 –1.02 0.313
SE* education –0.157 –0.117 0.179 –0.88 0.385
SE* income range 0.54 0.52 0.173 3.12 0.003
SE* age –0.21 –0.156 0.19 –1.11 0.273
SE* sep/div/wid 1.005 0.317 0.704 1.43 0.159
SE* never married 0.746 0.279 0.477 1.56 0.123
Education* income –0.089 –0.107 0.136 –0.66 0.514
Education* age 0.036 0.043 0.13 0.28 0.78
Education* sep/div/wid 0.167 0.072 0.39 0.43 0.67
Education* never married 0.249 0.095 0.511 0.49 0.628
Income* age 0.026 0.033 0.118 0.22 0.826
Income* sep/div/wid 0.041 0.014 0.726 0.06 0.955
Income* never married –0.264 –0.101 0.672 –0.39 0.696
Age* sep/div/wid 0.153 0.059 0.332 0.46 0.646
Age* never married –0.047 –0.024 0.387 –0.12 0.904
Constant 11.958 0.122 98.36 0
Note. N = 78; F(20, 57) = 1.17, p = .3161; R
2 = .2903, Adjusted R
2 = 0.0413.
Next, the analysis results of Question 29 are presented in Table 13. These results only
indicated statistical significance concerning the interaction between age and never-married
status. This regression model did not achieve statistical significance, with the adjusted R-squared
indicating that 13.56% of the variation in Question 29 was explained based on all predictors
included in this model. So, this analysis did not find any significant results, and the model could

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only explain 13.56% of the differences in responses to Question 29, meaning it does not
effectively predict the outcomes.
Table 13
Linear Regression Analysis: Q29 on Self-Efficacy, Main Effects, and Interactions
Measure Coefficient Beta SE t p
Self-efficacy 0.225 0.164 0.214 1.05 0.296
Education 0.029 0.03 0.136 0.21 0.831
Annual income –0.029 –0.03 0.148 –0.2 0.846
Age range 0.011 0.012 0.137 0.08 0.934
MS: sep/div/wid 0.737 0.255 0.4 1.84 0.07
MS: never married 0.425 0.164 0.773 0.55 0.585
SE* education –0.05 –0.033 0.193 –0.26 0.798
SE* income range –0.067 –0.057 0.186 –0.36 0.722
SE* age –0.215 –0.141 0.204 –1.05 0.298
SE* sep/div/wid 0.762 0.212 0.758 1 0.319
SE* never married 0.478 0.158 0.514 0.93 0.356
Education* income –0.002 –0.002 0.147 –0.01 0.99
Education* age –0.138 –0.144 0.14 –0.99 0.329
Education* sep/div/wid –0.722 –0.273 0.42 –1.72 0.091
Education* never married –0.34 –0.114 0.55 –0.62 0.54
Income* age 0.101 0.112 0.127 0.8 0.429
Income* sep/div/wid 0.5 0.151 0.782 0.64 0.525
Income* never married –0.193 –0.066 0.724 –0.27 0.79
Age* sep/div/wid –0.071 –0.024 0.358 –0.2 0.844
Age* never married 1.007 0.462 0.417 2.41 0.019
Constant 10.338 0.131 78.91 0
Note. N = 78; F(20, 57) = 1.60, p = .0838; R
2 = 0.3601, Adjusted R
2 = 0.1356.

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Finally, Table 14 presents the regression model results obtained for Question 30. In this
analysis, statistical significance was indicated concerning the effect of marital status, specifically
separated/divorced/widowed status as compared with married status, as well as the interaction
between self-efficacy and age, between self-efficacy and never married status, and between
income and age, as well as between age and never married status. Regarding marital status,
separated, divorced, or widowed respondents had predicted values on Question 30 that were
increased by 0.80 units compared to married respondents. This regression model achieved
statistical significance at the .01 alpha level, with the adjusted R-squared indicating that 24.92%
of the variation in Question 30 is explained based on this model. To put simply, this analysis
found that separated, divorced, or widowed people scored 0.80 units higher on Question 30 than
married people. The model explains 24.92% of the differences in responses and is statistically
significant at the 0.01 level.

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Table 14
Linear Regression Analysis: Q30 on Self-Efficacy, Main Effects, and Interactions
Measure Coefficient Beta SE t p
Self-efficacy 0.35 0.248 0.204 1.71 0.092
Education 0.145 0.146 0.129 1.12 0.267
Annual income –0.13 -0.13 0.141 –0.92 0.361
Age range –0.035 –0.035 0.131 –0.26 0.792
MS: sep/div/wid 0.796 0.268 0.382 2.08 0.042
MS: never married 0.247 0.093 0.739 0.33 0.739
SE* education 0.131 0.084 0.184 0.71 0.479
SE* income range 0.194 0.161 0.178 1.09 0.28
SE* age 0.522 0.334 0.195 2.68 0.01
SE* sep/div/wid 0.202 0.055 0.724 0.28 0.782
SE* never married 1.017 0.328 0.491 2.07 0.043
Education* income –0.132 –0.136 0.14 –0.94 0.349
Education* age –0.244 –0.249 0.133 –1.83 0.073
Education* sep/div/wid –0.589 –0.218 0.401 –1.47 0.147
Education* never married –0.488 –0.159 0.526 –0.93 0.357
Income* age 0.309 0.334 0.121 2.55 0.014
Income* sep/div/wid 0.401 0.119 0.747 0.54 0.593
Income* never married 0.002 0.001 0.691 0 0.998
Age* sep/div/wid 0.071 0.024 0.342 0.21 0.835
Age* never married 0.955 0.428 0.399 2.4 0.02
Constant 10.412 0.125 83.23 0
Note. N = 78; F(20, 57) = 2.28, p = .0080; R
2 = 0.4442, Adjusted R
2 = 0.2492.
Open-Ended Survey Responses (RQ2)
The responses to RQ2, precisely Questions 31 and 32, offer a deep dive into the lived
experiences of Black women dealing with breast cancer and how their race, gender, and financial
status have influenced these experiences. The thematic analysis of these responses brings to light
the most prevalent themes: healthcare access, racial disparities, economic impact, and trust and
confidence in the healthcare system. These themes reflect significant issues such as the role of

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employer coverage in accessing care, the financial barriers to treatment, the instances of
experienced racism and gender-specific challenges, and the overall trust and confidence—or lack
thereof—that patients feel toward the healthcare system. Each narrative is a testament to the need
to address these disparities to foster an equitable and trustworthy healthcare environment.
Open-Ended Survey Responses Theme 1 (RQ2): Healthcare Access
Healthcare access is crucial for breast cancer patients. Many respondents highlighted the
varying impact of employer coverage, financial barriers, and insurance limitations on their
treatment journey. For instance, one participant stated, “Employer healthcare coverage was
pivotal in accessing quality treatment,” illustrating the benefits of comprehensive employer
insurance. Another noted, “Financial barriers often made it difficult to pursue necessary
treatments,” indicating the challenges faced by those without sufficient financial means.
Regarding insurance coverage constraints, a third shared, “Insurance limitations restricted my
treatment options.” In summary, healthcare access is significantly influenced by employment,
financial status, and insurance coverage, directly affecting treatment availability and quality.
This discussion sets the stage for exploring racial disparities, where the interplay of race and
healthcare further complicates access issues.
Subtheme: Employer Coverage Impact
Employer-provided health insurance significantly influences the accessibility of breast
cancer treatment. One respondent gratefully noted, “The healthcare coverage I have through my
employer played a big part in the access to some of the best care.” Another acknowledged the
critical support from medical teams specializing in women’s breast cancer, highlighting the
intersection of gender and employer-based care benefits. Conversely, a participant mentioned,
“Financial status was not an issue,” reflecting that consistent specialist care could mitigate the

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need for expansive coverage. These reflections underscore employer coverage’s pivotal role in
navigating the healthcare system and receiving adequate care.
Subtheme: Financial Barriers
For many, the financial aspect is a formidable barrier in the healthcare journey. One
patient expressed, “I feel like I could have gotten more care and attention had I been white,”
suggesting a perceived link between financial barriers and racial disparities. Another shared the
stark reality: “Financial status hindered access to screening and early detection,” pointing to the
systemic obstacles faced when financial resources are scarce. These accounts vividly depict how
financial limitations can shape the course and quality of treatment, influencing decisions and
potential health outcomes.
Subtheme: Insurance Limitations
Insurance limitations present another layer of complexity in accessing care. A
respondent’s experience of being “treated unfairly by healthcare providers” due to their race and
financial status illustrates the compounded difficulties marginalized individuals face. The
sentiment “My financial status limits me from getting the best services” echoes the harsh
consequences of inadequate insurance. Additionally, the statement “I’ve not been able to attend
several therapies because of the cost” depicts the direct impact of insurance limitations on
treatment options. These narratives emphasize the need for comprehensive insurance coverage
that accommodates all patients’ needs, regardless of their financial standing.
These individual experiences with employer coverage, financial barriers, and insurance
limitations reveal a healthcare system where access to quality care is unevenly distributed, often
influenced by one’s employment status, financial capacity, and the scope of insurance coverage.

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Delving into the racial disparities that intertwine with these economic factors is imperative,
further challenging the pursuit of equitable healthcare.
Open-Ended Survey Responses Theme 2 (RQ2): Racial Disparities
Black women diagnosed with breast cancer frequently encounter racial disparities in their
healthcare experiences. These disparities manifest in various aspects of their care, from diagnosis
to treatment options. “I’ve felt overlooked and had to insist on tests that led to my late
diagnosis,” shared one respondent, highlighting the lack of proactive care. Another noted, “My
doctor seemed surprised I was educated about my options, as if not expecting it because of my
race.” A third respondent mentioned, “There’s a noticeable difference in the treatment and
options discussed with me compared to what I’ve seen with white patients in similar situations.”
The perception of racial disparities is a common thread in the healthcare journey of Black
women with breast cancer. While these disparities mark a significant part of their experiences,
they also make note of the nuanced ways in which experienced racism compounds their
challenges, leading to more direct instances of discrimination.
Subtheme: Experienced Racism
Experienced racism is a pervasive element of the healthcare journey for many Black
women facing breast cancer. Racism, both overt and subtle, shapes their interactions with
healthcare providers and the system. One woman recounted, “A nurse dismissed my pain levels,
suggesting I was exaggerating a stereotype of Black patients.” Another reported, “I was told my
concerns were just anxiety, hinting at the ‘strong Black woman’ trope without addressing my
symptoms seriously.” A third shared, “My request for a second opinion was met with hostility, as
if questioning the authority of a white doctor was out of place.” Racism, thus, colors their
treatment options and affects the quality of care and respect they receive. This experienced

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racism seamlessly transitions into more explicit instances of discrimination, where the bias
becomes more direct and the impact more overt.
Subtheme: Discrimination Instances
Direct instances of discrimination further exacerbate the healthcare challenges faced by
Black women with breast cancer. Discrimination takes many forms, from refusing service to
allocating inferior treatment options. “I was outright denied access to certain treatments available
to others, with no clear explanation,” one woman explained. Another stated, “My healthcare
provider made assumptions about my insurance coverage based on my race, affecting the
treatments they offered.” A third recalled, “I experienced longer wait times and appointment
delays, which felt like a subtle form of discrimination.” These instances of discrimination
highlight the systemic barriers and biases that negatively impact their healthcare experiences.
Beyond facing direct discrimination, these women also navigate inequalities in treatment, where
the bias is not just about what happens to them but also about what does not happen to them.
Subtheme: Treatment Inequality
Treatment inequality is a stark reality for Black women diagnosed with breast cancer,
affecting their prognosis and overall healthcare outcomes. The inequality manifests in the quality
of treatment, access to innovative therapies, and the attentiveness of healthcare providers. “I was
not informed about newer, less invasive options that I later learned were available,” said one
respondent. Another mentioned, “My treatment plan seemed outdated compared to what I read
was available to others, with no discussion on clinical trials.” A third shared, “There was a lack
of follow-up on my care, which I had to initiate and push for aggressively.” Such treatment
inequalities reflect the multifaceted nature of discrimination and underscore the need for
systemic change. The cumulative effect of racial disparities, experienced racism, direct

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discrimination, and treatment inequality paints a complex picture of the healthcare landscape for
Black women with breast cancer, necessitating a multifaceted and intersectional approach to
healthcare reform.
Open-Ended Survey Responses Theme 3 (RQ2): Gender Impact
The intersection of gender and race significantly shapes the healthcare experiences of
Black women with breast cancer. Many respondents expressed that being a woman adds a layer
of complexity to their healthcare journey, affecting everything from the types of support offered
to the attention received from healthcare providers. One woman shared, “My concerns were
often dismissed as overreactions, a bias I feel is tied to my gender.” Another stated, “I had to
fight harder to be heard, which I attribute to stereotypes about women, especially Black women.”
A third recounted, “The focus on my emotional well-being felt patronizing as if my gender
meant I couldn’t handle the truth about my health.” Gender, therefore, plays a critical role in the
healthcare experiences of Black women, often leading to biases that affect their care and
treatment. While gender significantly impacts their healthcare experiences, it also influences the
support systems available to these women, merging into the realm of gender-specific attention
and resources.
Subtheme: Women’s Support Systems
Gender often shapes the support systems available to Black women with breast cancer,
providing both challenges and opportunities for tailored assistance. Many respondents noted that
support systems must understand women’s challenges in the healthcare system. “Support groups
for women were my sanctuary, offering understanding and empathy not found elsewhere,” one
participant noted. Another mentioned, “I found resources aimed at women invaluable in
navigating my treatment and recovery.” A third added, “My female healthcare provider was

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more empathetic and took my concerns seriously, which made a huge difference in my
experience.” Gender-specific support systems play a vital role in the healthcare journey of Black
women with breast cancer, offering tailored resources and empathetic care. These genderinfluenced support systems provide crucial assistance and highlight the need for gender-specific
attention in healthcare practices, ensuring that women receive the nuanced care they require.
Subtheme: Gender-Specific Attention
Gender-specific attention in healthcare is a crucial aspect of the treatment and support for
Black women with breast cancer. Many respondents underscored the difference that genderaware healthcare practices can make in their treatment efficacy and overall experience. “My
doctor’s approach to discussing options was mindful of women’s health issues, which I
appreciated,” said one woman. Another stated, “Educational materials tailored for women helped
me understand my body and the impact of treatment better.” A third pointed out, “Clinics
specializing in women’s health were more attuned to my needs and provided a level of care that
felt comprehensive and respectful.” Providing gender-specific attention acknowledges women’s
healthcare needs and enhances their treatment outcomes and satisfaction with their healthcare
experience. This focus on gender-specific attention underscores the broader implications of
intersecting identities in healthcare, where race, gender, and socioeconomic status collectively
shape the experiences of Black women with breast cancer, calling for a holistic and inclusive
approach to healthcare provision.
Open-Ended Survey Responses Theme 4 (RQ2): Financial Impact
The financial impact of breast cancer treatment poses significant challenges for Black
women, influencing their access to and choices of treatment. A substantial portion of respondents
reported that treatment costs heavily influence their healthcare decisions, highlighting the

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pervasive nature of financial barriers in their treatment journey. “The cost of some treatments
was prohibitive, forcing me to choose less-effective options,” one woman revealed, emphasizing
the dire choices some patients face. Another shared, “I delayed certain treatments due to cost,
which I fear has affected my prognosis.” A third explained, “Even with insurance, the out-ofpocket costs are overwhelming, affecting my ability to follow through with recommended care.”
Summary sentence: Financial constraints, therefore, limit treatment options for Black women
with breast cancer and contribute to delays and disruptions in their care, compounding the stress
and uncertainty of their diagnosis. Beyond the immediate affordability of treatments, these
financial challenges extend to broader cost-related barriers, further complicating these women’s
healthcare experiences and underscoring the need for systemic solutions to address these
economic disparities.
Subtheme: Treatment Affordability
Treatment affordability is a pressing concern for Black women with breast cancer,
significantly affecting their access to care and choice of treatment options. A vast majority of
respondents expressed that the high cost of breast cancer treatment posed a substantial burden,
often forcing them to make difficult decisions about their care. “The cost of chemotherapy was
overwhelming, leading me to delay treatment,” one woman revealed, detailing the reality of
financial considerations in healthcare decisions. Another shared, “I had to choose between
medication and other essentials due to the high costs,” illustrating the dire financial choices
faced. A third recounted, “Insurance covered only a part of my surgery, and the out-of-pocket
expenses were devastating,” exposing the gaps in insurance coverage and the financial strain it
causes. The affordability of treatment emerges as a significant barrier for Black women, directly
impacting their ability to receive timely and effective care. While the issue of treatment

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affordability underscores the financial strain on Black women with breast cancer, it also leads
into the broader spectrum of cost-related barriers that further complicate their healthcare journey.
Subtheme: Cost-Related Barriers
Beyond the direct costs of treatment, Black women with breast cancer face numerous
cost-related barriers that hinder their access to comprehensive care. Respondents frequently cited
additional costs, such as transportation to treatment centers, lost wages from missed work, and
the need for exceptional nutrition, as significant hurdles. “Traveling for treatment meant extra
expenses that I hadn’t anticipated,” one patient explained, shedding light on the often-overlooked
costs associated with healthcare access. Another noted, “Taking time off work for treatment
without paid leave put a huge financial strain on my family,” highlighting the compound effect
of healthcare costs and income loss. A third added, “The recommended diet was more expensive,
adding to the financial burden of my treatment,” pointing out the hidden costs of following
medical advice for optimal recovery. Cost-related barriers extend far beyond the price of medical
treatment, encompassing a wide range of financial challenges that exacerbate the difficulties
faced by Black women with breast cancer. These cost-related barriers illuminate the multifaceted
budgetary impact of breast cancer treatment and underscore the interconnectedness of
socioeconomic factors with healthcare outcomes, demanding a more comprehensive approach to
support and address the needs of Black women facing this disease.
Open-Ended Survey Responses Theme 5 (RQ2): Trust and Confidence
Trust and confidence in the healthcare system vary significantly among Black women
diagnosed with breast cancer, profoundly influencing their treatment decisions and experiences.
Many respondents expressed mixed feelings of trust and confidence in their healthcare providers
and the system, pointing to a complex landscape of perception and experience. “I’ve encountered

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doctors who were dismissive, which eroded my trust in the healthcare system,” one woman
shared, illustrating the impact of negative interactions on patient trust. Another stated, “Finding a
healthcare provider who understood my concerns and took them seriously restored my
confidence in seeking treatment.” A third added, “My confidence varies depending on the
provider’s willingness to listen and address my concerns, highlighting the variability in my trust
levels.” The fluctuating levels of trust and confidence among Black women with breast cancer
underscore the importance of positive patient-provider interactions in building trust and ensuring
effective care. While distrust in the healthcare system presents a significant hurdle, the
variability in confidence among patients points to the potential for rebuilding trust through
compassionate and culturally competent care, leading into the subtheme of distrust in the system.
Subtheme: Distrust of the System
Distrust in the healthcare system is a prominent concern for many Black women with
breast cancer, stemming from historical injustices and individual experiences of bias and
discrimination. A substantial proportion of respondents cited past negative experiences and
systemic issues as key factors contributing to their distrust of the healthcare system. “Historical
medical exploitation of Black individuals makes me wary of the healthcare system,” one
respondent explained, connecting her distrust to broader systemic issues. Another noted,
“Instances where my pain was dismissed, or I felt racially profiled have deepened my distrust.”
A third described, “The lack of representation among healthcare providers makes me question
whether my best interests are truly considered.” Such deep-seated distrust in the healthcare
system among Black women with breast cancer calls for systemic changes to address the root
causes of this skepticism. Addressing this distrust requires acknowledging these valid concerns

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and working to increase confidence through consistent, respectful, and culturally sensitive care,
thus moving toward the related subtheme of confidence variability.
Subtheme: Confidence Variability
The confidence Black women with breast cancer have in their healthcare experiences
varies widely and is influenced by individual interactions, representation, and the perceived
competence of their healthcare providers. Responses indicated that confidence levels can shift
dramatically based on healthcare professionals’ quality of communication, empathy, and
understanding. “A provider who took the time to explain my diagnosis and treatment options in
detail boosted my confidence,” said one woman, emphasizing the positive impact of clear
communication. Another mentioned, “Seeing healthcare professionals who look like me and
understand my cultural background significantly affects my confidence levels.” A third
recounted, “Confidence in my care plan fluctuates with the level of active listening and personal
attention I receive from my healthcare team.” The variability in confidence levels among Black
women with breast cancer underscores the critical role of personalized, compassionate, and
culturally competent care in enhancing patient trust and satisfaction. This confidence variability,
shaped by positive and negative healthcare experiences, illustrates Black women’s nuanced
relationship with the healthcare system, emphasizing the potential for improvement in patientprovider dynamics and the overarching need for a healthcare environment that fosters trust,
respect, and equity.
Open-Ended Survey Responses Theme 6 (RQ2): Cultural Competence
Cultural competence in the healthcare system plays a crucial role in the experiences of
Black women diagnosed with breast cancer, significantly affecting their satisfaction and
outcomes. Many respondents emphasized the importance of healthcare providers being culturally

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competent, noting that a lack of such competence often leads to misunderstandings and
diminished care quality. “When my healthcare provider acknowledged my cultural background
and its implications for my treatment, I felt truly seen,” one woman stated, illustrating the
positive impact of cultural competence. Another recounted, “I’ve experienced moments where
my cultural practices were dismissed or misunderstood, affecting my comfort and trust levels.” A
third shared, “The failure to consider my dietary habits and religious beliefs in my treatment plan
was disheartening.” Therefore, cultural competence emerges as a pivotal factor in enhancing the
healthcare experience for Black women with breast cancer, underscoring the need for a more
inclusive and understanding approach to care. While cultural competence can bridge many gaps
in healthcare, specific issues such as communication gaps and cultural insensitivity still present
significant challenges, necessitating further attention and improvement.
Subtheme: Communication Gaps
Communication gaps between healthcare providers and Black women with breast cancer
often exacerbate the challenges they face, hindering their ability to receive effective and
empathetic care. Numerous respondents reported experiences where poor communication led to
confusion, fear, and alienation in the healthcare system. One respondent discussed the impact of
communication barriers: “I often left appointments feeling more confused than when I entered
due to jargon and a lack of clear explanations.” Another said, “Important details about my
treatment were glossed over, making it difficult for me to make informed decisions.” A third
described, “Language barriers were not adequately addressed, leaving me to navigate complex
medical information independently.” Addressing these communication gaps is essential for
ensuring that Black women with breast cancer are fully informed and comfortable with their
treatment plans, reinforcing the importance of clear, compassionate dialogue. Beyond the issue

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of communication gaps, cultural insensitivity further complicates the relationship between Black
women and their healthcare providers, pointing to a need for cultural understanding and respect
in healthcare interactions.
Subtheme: Cultural Insensitivity
Cultural insensitivity in healthcare settings can profoundly affect Black women with
breast cancer, leading to feelings of marginalization and disrespect. Many participants expressed
encountering cultural insensitivity, from stereotyping to outright disregard for their cultural
norms and values. “My spiritual beliefs were trivialized during consultations, making me feel
undervalued,” one woman shared, underscoring the pain of cultural dismissal. Another
explained, “Assumptions made about my family structure and support system felt rooted in
stereotypes and were far from my reality.” A third lamented, “The lack of sensitivity towards my
cultural expressions of pain and grief was alienating.” Cultural insensitivity diminishes the
quality of care, erodes trust and confidence in the healthcare system, and illustrates the need for
cultural awareness and sensitivity training for healthcare professionals. The journey toward
improved healthcare for Black women with breast cancer necessitates a commitment to
overcoming both communication gaps and cultural insensitivity, ensuring that all patients feel
respected, understood, and valued in their healthcare experiences.
Qualitative Interview Findings for RQ2
The second research question, “In what ways do Black women diagnosed with breast
cancer perceive their race, gender, and socioeconomic class identities influence their healthcare
experiences?” seeks to explore the intersectionality of identity and healthcare experiences among
Black women with breast cancer. The themes resonate with this question, revealing these
experiences’ multifaceted nature. Key themes include the impact of racial identity, where

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instances of perceived discrimination and cultural insensitivity are prominent; the influence of
gender identity, highlighted by experiences of gender bias and varied dynamics with healthcare
providers; and the role of socioeconomic class, underscored by concerns about treatment
accessibility and financial constraints. Additional themes, such as communication barriers,
difficulties in accessing resources, and varying degrees of satisfaction with the healthcare
system, further illuminate the complex interplay between race, gender, and socioeconomic class
in shaping healthcare experiences. These themes collectively offer a nuanced understanding of
how Black women with breast cancer perceive the influences of their intersecting identities on
their healthcare journeys, aligning with the core principles of BFT and emphasizing the need for
an inclusive, empathetic approach in healthcare.
Qualitative Interviews Theme 1 (RQ2): Racial Identity Impact
Racial identity impact explores the influence of participants’ racial identity on their
healthcare experiences in the context of discrimination and cultural sensitivity. This significant
theme reflects the broader concerns about racial disparities in healthcare. Evidence of these
disparities is seen in the experiences participants shared. Imani explained, “I was sometimes
skipped in line for checkups and treatments and felt ignored by specialists. … It is like they did
not understand where I was coming from.” These statements underline the theme of racial
identity impacting healthcare experiences due to perceived discrimination and lack of cultural
sensitivity.
Subtheme: Perceived Discrimination
The subtheme, Perceived Discrimination, encapsulates the experiences of participants
who articulated feelings of marginalization in the healthcare system attributed to their racial
identity. These experiences are characterized by devaluation and neglect, vividly captured in

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participant testimonies. Tasha expressed feeling “less valued than other patients,” while Tanya
recounted times when they were “outright ignored.” These statements poignantly illustrate the
individual and emotional toll of racial bias and discrimination in healthcare settings.
Subtheme: Cultural Sensitivity
In the subtheme of cultural sensitivity, participants discussed the pressing need for
healthcare providers to be culturally competent and empathetic. This subtheme underscores the
importance of understanding and respecting patients’ diverse cultural backgrounds in healthcare
interactions. Yolanda articulated a desire for medical professionals who recognize and respond to
their cultural contexts, as evidenced by her call for doctors to “understand our background and
culture” and LaToya’s need for someone who “understood my cultural needs.” These
expressions emphasize the vital role that cultural sensitivity plays in enhancing patient care and
building trust in healthcare environments.
Qualitative Interviews Theme 2 (RQ2): Gender Identity Impact
Gender identity impact examines how the healthcare experiences of participants are
influenced by their gender. This theme reflects the diverse narratives participants shared
regarding interactions with healthcare providers, which are often influenced by the gender
dynamics present. Some participants noted gender-based disparities in care, like Shanice, who
stated, “Male doctors were sometimes more dismissive of my pain,” contrasting with others who
found a more empathetic understanding from female doctors: “Female doctors understood what I
was going through,” mentioned Jasmine. These experiences underscore the varied dynamics
based on gender in healthcare settings.

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Subtheme: Gender Bias
Gender bias is a pervasive issue in healthcare. Participants expressed a sense of
differential treatment based on gender, impacting the quality of care received. This is evidenced
in Brianna’s remarks: “There is a difference in how you are treated as a woman in these spaces,”
Destiny also discussed experiences where health concerns were minimized: “My concerns were
often downplayed.” These statements reflect the widespread nature of gender bias affecting
patient-provider dynamics.
Subtheme: Patient-Provider Dynamics
The patient-provider dynamics subtheme delves into the interpersonal relationships
between patients and healthcare providers. The quality of these interactions is vital to patient
satisfaction and treatment efficacy. Participants stated that being heard and understood by their
providers was important. One noted, “I felt more comfortable with providers who took the time
to listen,” stated Alicia. Similarly, LaToya emphasized the impact of these dynamics on
treatment: “The relationship with my doctor significantly affected my treatment experience.”
These quotes illustrate the role that patient-provider dynamics play in individuals’ healthcare
experiences in the context of gender.
Qualitative Interviews Theme 3 (RQ2): Financial Status Impact
The Financial Status Impact theme delves into the influence of socioeconomic status on
healthcare experiences, focusing on aspects such as treatment accessibility and insurance
coverage. This theme captures individuals’ financial challenges and dilemmas in seeking
healthcare. For instance, Tasha’s comment starkly illustrates the severe choices some must make,
“I had to choose between food and medicine sometimes,” while Nia lamented, “The costs are

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overwhelming.” These experiences convey the substantial financial burden and the critical role
of economic factors in treatment access and decisions.
Subtheme: Treatment Accessibility
Treatment accessibility addresses the financial barriers that often restrict individuals’
access to necessary healthcare. Participants shared poignant insights into the difficulties of
reaching healthcare providers and affording the treatment prescribed. This predicament is
encapsulated in statements such as, “It is not just about getting to the doctor; it is about affording
what is prescribed,” stated Alicia, and the resulting compromises in care are reflected in the
admission by Keisha, “I had to skip certain treatments because of the cost.” These comments
underscore the dire consequences of financial constraints on treatment access.
Subtheme: Insurance Coverage
Under the subtheme of insurance coverage, the complexities and anxieties associated
with navigating health insurance systems are highlighted. Participants expressed frustration and
worry over the intricacies of insurance coverage, which affect their healthcare experiences.
Shanice’s remarks portrayed this sentiment: “Navigating insurance was a nightmare; coverage
was never guaranteed.” Imani also mentioned continuous uncertainty: “I constantly worried
about what was covered and what was not.” These statements reflect the significant impact of
insurance coverage, or the lack thereof, on accessing and affording necessary healthcare services.
Qualitative Interviews Theme 4 (RQ2): Identity and Communication
Identity plays a pivotal role in communication in the healthcare experience of Black
women with breast cancer. Many women reported that their racial and gender identities
significantly influenced how healthcare providers communicate with them, often leading to
barriers that impede understanding and care. “Because of my identity, I often feel like I’m not

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heard or taken seriously, which is frustrating and demoralizing,” Destiny expressed, revealing
the struggle for clear communication. Brianna stated, “I have to repeat myself multiple times to
be understood as if my identity makes me less credible.” Jasmine explained, “It’s as if there’s a
preconceived notion of who I am that clouds the actual conversation.” The intersection of racial
and gender identities with communication underscores the necessity for healthcare providers to
actively work on understanding and addressing the needs of Black women with breast cancer.
While identity shapes how communication unfolds, it also brings to the fore the need for
effective advocacy to ensure that these women’s voices are heard, and their concerns are
addressed.
Subtheme: Communication Barriers
Communication barriers stand as a significant obstacle for Black women with breast
cancer, often stemming from a lack of cultural competency and biases in the healthcare system.
Reports from numerous participants mentioned the prevalence of communication barriers, which
can take many forms, from language differences to misunderstanding of cultural cues. “My
healthcare providers sometimes use medical jargon I don’t understand, and they don’t always
take the time to explain,” Tanya shared, indicating a common communication barrier. Keisha
commented, “I’ve experienced a disconnect when my cultural expressions of pain are not
recognized or are misinterpreted by my healthcare team.” Shanice noted, “I feel there’s a barrier
when non-Black providers communicate with me; there’s a layer of disconnect that we can’t
seem to cross.” These communication barriers contribute to isolation and misunderstanding,
emphasizing the importance of effective communication strategies in healthcare. Overcoming
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with effective advocacy, which can empower Black women with breast cancer to navigate the
healthcare system more successfully.
Subtheme: Effective Advocacy
Effective advocacy is critical for Black women with breast cancer to overcome
communication barriers and ensure their healthcare needs are met. Many called for empowering
patients through advocacy to improve healthcare experiences and outcomes. “Having an
advocate who understands my language and culture made a huge difference in my treatment,”
Alicia reflected, emphasizing the importance of culturally aligned advocacy. Tasha mentioned,
“My patient advocate was instrumental in helping me ask the right questions and get clear
answers.” Nia asserted, “Effective advocacy has helped me to assert my needs and ensure that I
receive the proper attention and respect.” Effective advocacy thus emerges as a powerful tool for
bridging communication gaps and enhancing the agency of Black women in their healthcare
journey. As such, effective advocacy helps to mitigate the communication barriers arising from
identity and serves to amplify the voices of Black women with breast cancer, ensuring that their
experiences and needs are acknowledged and addressed in the healthcare system.
Qualitative Interviews Theme 5 (RQ2): Access Difficulties and Biases
Black women with breast cancer often face access difficulties and biases in healthcare,
impeding their ability to obtain necessary treatments and services. Reports from numerous
interviewees suggest that these difficulties and biases are not isolated incidents but are indicative
of systemic issues within the healthcare framework. “I’ve been turned away from clinics that
were supposedly at full capacity, only to see others walk in without issue,” Imani recounted,
suggesting discriminatory access practices. Keisha said, “My insurance was scrutinized more
than others, adding unnecessary hurdles to my care.” LaToya shared, “There’s a palpable

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hesitation when I request certain services as if my needs are less legitimate.” Such difficulties
and biases in access to healthcare contribute significantly to the disparities in cancer care and
outcomes for Black women. While access difficulties present a barrier to care, the issue of
resource availability becomes even more salient, as it directly affects the options and quality of
treatment these women can obtain.
Subtheme: Resource Availability
The availability of resources crucial to breast cancer treatment is another area where
Black women often encounter significant disparities. Many women described a lack of access to
essential resources such as advanced treatment technologies, supportive care, and information
critical to their healthcare journey. “Advanced treatment options seem out of reach due to limited
availability in my community,” Shanice lamented, highlighting geographic disparities. Tasha
noted, “Support services like counseling or rehabilitation are scarce, and when they are available,
they’re not well-advertised.” Destiny explained, “Accessing up-to-date and relevant information
about breast cancer is a constant challenge.” The gap in resource availability affects the
immediate treatment and the long-term recovery and quality of life for Black women with breast
cancer. Resource availability is intricately linked to the biases in service provision, which further
exacerbate the challenges Black women face in accessing equitable healthcare.
Subtheme: Bias in Service Provision
Bias in the provision of healthcare services results in Black women with breast cancer
receiving different standards of care compared to other demographic groups. Instances of bias in
service provision, as reported by numerous interviewees, indicate a troubling trend of unequal
treatment based on race and socioeconomic status. “There’s a stark contrast in the attention and
care I receive compared to non-Black patients,” Nia observed, indicating racial bias. Jasmine

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stated, “I was offered fewer pain management options and had to advocate strongly for what I
knew was available.” Keisha described, “The referral process for specialized care was fraught
with delays and dismissals, which I suspect were influenced by bias.” Biases in service provision
limit the treatment options for Black women with breast cancer and undermine their trust in the
healthcare system. These biases in service provision denote a flaw in the healthcare system,
where the ideal of impartiality is undermined by unequal treatment, necessitating a renewed
focus on equity and fairness in healthcare delivery.
Qualitative Interviews Theme 6 (RQ2): Identity-Shaped Interactions
Interactions between Black women with breast cancer and healthcare providers are often
shaped by the patients’ identities, influencing the dynamics of care and communication. A
considerable number of interviewees felt their racial and gender identities affected how
healthcare professionals interact with them, sometimes leading to a lack of understanding and
empathy. “My identity seems to precede me, setting a tone before I even speak,” Yolanda
described, signaling how stereotypes impact her healthcare experience. Tanya reported, “I sense
a different approach in how I’m treated compared to other patients, which I can’t help but
attribute to my identity.” Destiny recounted, “It often feels like there’s an invisible barrier
between my providers and me, defined by my race and gender.” These identity-shaped
interactions can lead to feelings of alienation and a diminished sense of trust in the healthcare
system among Black women with breast cancer. However, when professional empathy is
extended, it can transform these interactions, bridging gaps and fostering a more understanding
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Subtheme: Professional Empathy
Professional empathy in the healthcare setting is essential for Black women with breast
cancer, promoting a sense of care that transcends clinical treatment. Many interviewees reported
that empathy from healthcare professionals can significantly improve their healthcare
experience, making them feel seen and heard as individuals beyond their diagnosis. Regarding
the power of empathetic care, Nia said, “When my doctor showed genuine concern for my
experiences as a Black woman, it made a world of difference.” Alicia added, “Empathetic
communication from my care team helped me cope with my diagnosis and treatment journey.”
Brianna explained, “Feeling understood personally made me more comfortable discussing my
health concerns and needs.” Professional empathy is thus a key component in patient-centered
care, influencing both the psychological well-being and treatment satisfaction of Black women
with breast cancer. This empathy is closely tied to the relatability of providers, as patients often
feel more at ease with healthcare professionals whom they perceive as understanding and sharing
aspects of their identity and experiences.
Subtheme: Relatability to Providers
The relatability of healthcare providers to their patients is an essential aspect of care for
Black women with breast cancer, affecting their comfort level and willingness to engage in their
healthcare. A sense of relatability, or lack thereof, was frequently mentioned by interviewees as a
factor that influenced their interactions with and trust in healthcare providers. “Connecting with a
provider who shared a similar cultural background made me feel more understood,” Alicia noted,
suggesting that relatability enhances communication. Tasha said, “It’s reassuring when I find a
provider who can relate to my life experiences; it builds trust.” Imani expressed, “I value when
providers make an effort to relate to me, even if they don’t share my background; it shows they

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care.” Relatability to providers, whether through shared experiences, cultural understanding, or
effortful engagement, is integral to fostering a therapeutic alliance and optimizing healthcare
outcomes. The presence of professional empathy and relatability to providers significantly
impacts the healthcare experiences of Black women with breast cancer, underscoring the need
for healthcare systems to prioritize these aspects in patient care to ensure equitable and effective
treatment for all patients.
Qualitative Interviews Theme 7 (RQ2): Identity and System Satisfaction
The satisfaction that Black women with breast cancer derive from the healthcare system
is deeply intertwined with their identities. Many interviewees reported that their race and gender
identities influence their expectations and experiences with healthcare services, affecting their
overall satisfaction with the system. “I feel that the system isn’t built for people like me, which
often leaves me dissatisfied,” Tasha expressed, emphasizing the disconnect. Imani stated, “My
expectations for respectful and attentive care are often unmet, leading to dissatisfaction.” Tanya
described, “Satisfaction is hard to find when you regularly face biases that ignore your identity.”
Identity-related factors thus play a substantial role in shaping the system satisfaction levels of
Black women with breast cancer, with many feeling that the system falls short of their needs.
The alignment of expectations with the care received is critical to system satisfaction, which is
further influenced by how responsively the healthcare system meets these women’s needs.
Subtheme: Expectation Alignment
Expectation alignment is a critical determinant of healthcare satisfaction for Black
women with breast cancer. These women often enter the healthcare system with specific
expectations based on their personal and community experiences, which may only sometimes
align with the reality of the care they receive. Tanya discussed a misalignment in expectations: “I

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expected a collaborative treatment plan, but my input seems undervalued.” Nia noted, “I
anticipated more holistic care that considers my entire well-being, not just my cancer.” Alicia
explained, “The lack of alignment between my expectations of empathy and understanding and
what I experience is disheartening.” The misalignment of expectations can lead to significant
dissatisfaction among Black women with breast cancer, impacting their perception of the
healthcare system’s effectiveness. Aligning patient expectations with healthcare delivery is a
complex challenge that requires system responsiveness to patients’ specific needs and identities,
ensuring that the care provided meets their expectations and improves satisfaction.
Subtheme: System Responsiveness
System responsiveness to the needs of Black women with breast cancer is essential for
their satisfaction and trust in healthcare services. The degree to which the healthcare system is
responsive to their needs can significantly influence how these women perceive and interact with
the system. “When the system quickly adapts to my feedback, I feel more valued and satisfied,”
Tasha remarked, indicating the importance of responsiveness. Imani said, “Responsiveness to my
concerns about medication side effects was slow, which made me feel ignored.” Destiny
detailed, “The system’s responsiveness to my cultural needs has been hit or miss, affecting my
overall satisfaction with my care.” A responsive healthcare system can significantly improve
satisfaction by showing that the needs and preferences of Black women with breast cancer are
acknowledged and acted on. The responsiveness of the healthcare system enhances expectation
alignment and contributes to a more trusting and satisfactory relationship between Black women
with breast cancer and their healthcare providers, demonstrating the system’s ability to adapt and
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Summary of RQ2 Findings
Research Question 2 aimed to understand the impact of self-efficacy, socioeconomic
status, and demographic variables on the healthcare experiences of individuals, with a nuanced
focus on Black women with breast cancer. The analysis was structured into three parts, each
uncovering layers of complexity in how these factors interplay to shape healthcare outcomes.
In the first part, quantitative analyses revealed that self-efficacy significantly influences the
perception of healthcare quality. Socioeconomic indicators such as education and income and
demographic variables like age and marital status also played crucial roles, though their impacts
varied. The interaction between self-efficacy and income notably highlighted a complex
relationship with healthcare experiences, suggesting that higher self-belief and financial stability
can enhance the perceived quality of care.
The second part transitioned to qualitative insights from Black women with breast cancer,
emphasizing the intersectionality of race, gender, and socioeconomic status. Themes such as
healthcare access, racial disparities, financial impact, and the need for cultural competence
emerged, painting a detailed picture of these women’s systemic barriers and personal challenges.
Their narratives underscored a healthcare landscape riddled with inequities, necessitating a more
supportive and culturally sensitive approach. In the final part, the focus on qualitative interviews
further illuminated how racial and gender identities, alongside socioeconomic class, influence
healthcare experiences. This section reinforced the necessity for healthcare systems to adopt
inclusive practices that recognize and address the needs and challenges of Black women facing
breast cancer.
The comprehensive analysis for Research Question 2 underscores the need for an
intersectional approach in healthcare research and practice. The results showed that self-efficacy,

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socioeconomic factors, and demographic variables, compounded by race and gender, shape
healthcare experiences in complex ways. The findings advocate for policies and practices that are
equitable, culturally competent, and responsive to the varied needs of individuals at the
intersections of multiple marginalized identities.
Open-Ended Survey Response Findings for RQ3
The thematic analysis of survey Questions 38 and 39 delve into the individual
experiences and perspectives of Black women undergoing breast cancer treatment and their
recommendations for enhancing related healthcare practices. Through a meticulous examination
of open-ended survey responses, several core themes and sub-themes emerged, painting a
comprehensive picture of the patient journey and the intricacies of navigating the healthcare
system. The analysis regarding communication and support underscores the need for clear
healthcare communication, emotional support networks, and professional empathy. It also
highlights the aspects of treatment and care, emphasizing the necessity of clarifying treatment
information, personalized treatment plans, and effective care coordination. In response to
suggestions for improving healthcare approaches, themes of patient-centered improvements and
equity and access were identified, focusing on enhanced patient listening, inclusive decisionmaking, addressing healthcare disparities, and improving access to care. The significance of
creating a positive healthcare environment through fostering positive interactions and supportive
healthcare infrastructure was also recognized. Together, these themes provide insightful
guidance for healthcare professionals and policymakers aiming to optimize breast cancer care
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Open-Ended Survey Responses Theme 1 (RQ3): Communication and Support
The insights from these lived experiences underline the critical role of clear healthcare
communication in breast cancer treatment and survivorship for Black women. This theme
emphasizes healthcare providers’ need to communicate straightforwardly and empathetically,
ensuring patients fully understand their treatment options, processes, and expected outcomes.
Many respondents noted clear communication in their treatment journey: “When my doctor took
the time to explain things clearly, I felt more in control and less anxious.” Another shared, “The
clarity with which my treatment options were presented made all the difference in my decisionmaking process.” However, another emphasized, “Feeling heard and understood by my
healthcare team empowered me to participate actively in my care.” This theme suggests that
enhancing communication can significantly impact patients’ sense of self-agency and their
overall treatment experience. Based on these findings, it becomes evident that clear
communication facilitates better understanding and fosters a foundation for emotional and
professional empathy.
Emotional Support Networks
Emotional support networks play a pivotal role in the healthcare models designed for the
survivorship of Black women with breast cancer, offering essential psychological and social
backing. These networks, encompassing family, friends, and patient support groups, provide
multifaceted support during treatment. One respondent noted, “The unwavering support from my
family and friends gave me the strength I needed to face my treatment.” Another shared,
“Joining a support group introduced me to others who truly understood my experience, making
me feel less alone.” A third stated, “The encouragement from my support network helped me
maintain a positive outlook throughout my treatment.” This theme concerns the role of emotional

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support networks in enhancing self-agency and resilience among Black women undergoing
breast cancer treatment. While emotional support networks provide comfort and understanding,
the need for professional empathy further complements the holistic care model, seamlessly
connecting the emotional and professional aspects of patient care.
Professional Empathy
Professional empathy in the healthcare system significantly contributes to designing
effective healthcare models for breast cancer survivorship among Black women. This subtheme
stresses demonstrating understanding and compassion from healthcare professionals toward their
patients, which is vital for fostering a supportive and trusting healthcare environment.
Respondents’ experiences illuminate this, with one stating, “My nurse’s compassion during my
lowest moments helped me keep fighting.” Another expressed, “Feeling empathized with by my
care team made me feel seen and valued, not just as a patient but as a person.” A third recounted,
“The empathy shown by my healthcare providers reassured me that I was not just a case
number.” This evidence underscores the role of professional empathy in enhancing patient
experiences and fostering an environment where Black women feel supported and understood.
Professional empathy bridges the gap between clinical care and emotional support. It
underscores the interconnectedness of communication, support networks, and empathy in
shaping patient-centered, empowering healthcare experiences.
Open-Ended Survey Responses Theme 2 (RQ3): Treatment and Care
The central theme of treatment and care in the context of breast cancer treatment for
Black women emphasizes the paramount importance of creating a healthcare model that is both
inclusive and responsive to patients’ needs. Participants’ narratives, such as “Having clear,
understandable information made me feel empowered and part of my care team,” “My treatment

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plan was tailored to my personal needs, making my journey more manageable,” and “The
coordinated efforts of my healthcare providers ensured a smooth treatment process,” reflect the
critical impact of these elements in enhancing patient engagement, satisfaction, and outcomes.
This theme sheds light on the current gaps in treatment and care and offers a pathway toward a
more empathetic, effective, and patient-centered approach to healthcare for Black women facing
breast cancer. It also underlines the necessity of integrating these principles to foster a supportive
and empowering environment for patients.
Treatment Information Clarity
This subtheme is foundational in ensuring that patients are well-informed about their
treatment options, procedures, and what to expect, empowering them with knowledge and selfagency. Many participants underscored the value of accessible and comprehensible information,
with one stating, “Having clear information about my treatment plan made me feel empowered
and less fearful.” Another remarked, “Understanding the side effects helped me prepare mentally
and physically.” Furthermore, a respondent reflected, “Clarity in information helped me trust my
healthcare team more, knowing what was happening every step of the way.” These insights
highlight the role of clear, accessible treatment information in enhancing patient engagement and
confidence. Moving toward a more individualized approach in healthcare, personalized treatment
plans emerge as a pivotal aspect of care, further calling for aligning treatment strategies with
patient-specific needs and preferences.
Personalized Treatment Plans
Personalized treatment plans are essential in fostering self-agency and optimizing the
survivorship outcomes for Black women with breast cancer. Tailoring treatment approaches to fit
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feel valued and heard. One participant shared, “My treatment was adjusted based on my health
history and preferences, which made all the difference.” Another conveyed, “Being involved in
creating my treatment plan made me feel more in control of my health.” Additionally, a third
participant stated, “Personalized care addressed not just my cancer, but me as a whole person.”
These experiences illustrate the transformative potential of personalized treatment plans in
creating more responsive and patient-centered healthcare models. As we consider the nuances of
individualizing patient care, the significance of care coordination becomes apparent, underlining
the necessity for a cohesive and collaborative approach among healthcare professionals to
streamline patient care effectively.
Care Coordination
Care coordination is a critical component of effective treatment and care, ensuring that all
healthcare providers involved in a patient’s care are synchronized to deliver holistic and
seamless treatment experiences. This subtheme regards the importance of coordination among
specialists, which can significantly impact the quality of care and patient outcomes. One
respondent noted, “The coordinated effort between my oncologist and the rest of my care team
made my treatment journey smoother and less stressful.” Another shared, “Knowing that my
doctors were communicating effectively about my care gave me peace of mind.” Furthermore, a
participant expressed, “Efficient care coordination meant fewer complications and a more
straightforward treatment process for me.” These statements underline the vital role of care
coordination in enhancing the treatment experience, reducing patient anxiety, and improving
overall outcomes. As we transition from the importance of seamless care coordination, it
becomes evident that each subtheme in the treatment and care central theme plays an integral
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survivorship among Black women, emphasizing the constructive collaboration between
information clarity, personalized plans, and coordinated care.
Open-Ended Survey Responses Theme 3 (RQ3): Patient-Centered Improvements
The patient-centered improvements theme encapsulates a transformative approach in
healthcare for Black women navigating the complexities of breast cancer treatment. This theme
underscores the necessity of integrating patient voices and preferences into healthcare delivery.
Participants’ stories reveal the impact of being actively listened to and involved in treatment
decisions, with sentiments like “feeling truly heard by my healthcare team” and “being part of
the decision-making process.” These words recall the empowerment and agency patients
experience when their concerns and preferences are prioritized. This theme champions a shift
toward a more democratic and collaborative healthcare model, where patients’ insights and lived
experiences inform and enrich the treatment process. Such patient-centered improvements
elevate the quality of care and foster a sense of partnership between patients and providers,
leading to more tailored, effective, and satisfying healthcare experiences for Black women with
breast cancer.
Enhanced Patient Listening
Enhanced patient listening emerges as a critical subtheme, emphasizing the
transformative power of healthcare providers actively engaging with and responding to patient
concerns and feedback. Stories from participants pertained to the significance of being heard,
with reflections like “when my doctor listened, it changed the entire course of my treatment for
the better.” Attentive listening can have significant benefits for patient trust, treatment
adherence, and overall satisfaction. Additional participant responses included, “My doctor’s
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throughout my journey. It was a game-changer in how I approached my treatment and recovery.”
Another participant stated, “Feeling truly heard by my healthcare team gave me the confidence
to voice my concerns and ask questions I otherwise would not have. It made a world of
difference in my understanding and comfort level with the treatment process.” This subtheme
champions that effective communication and genuine empathy can bridge gaps between patients
and providers, leading to more personalized and effective care.
Inclusive Decision-Making
The inclusive decision-making subtheme stands out as a testament to the importance of
empowering Black women with breast cancer to take an active role in their treatment journeys.
This approach fosters a sense of ownership and control over health decisions. “The moment my
care team involved me in the decision-making process, I felt a significant shift in my treatment
experience. It was empowering to know that my voice mattered and that my preferences were
considered in shaping my treatment plan,” stated a participant. Another participant shared her
experiences and stated, “Being involved in my treatment decisions made me feel empowered and
respected,” underscoring the value of collaborative care strategies. Another participant stated,
“Being part of the decision-making process made me feel respected and more invested in my
treatment outcomes. It was reassuring to know that my treatment plan resulted from a
collaborative effort that considered my values and lifestyle.” Inclusive decision-making respects
patient autonomy. It leverages their perspectives and preferences to tailor treatment plans that
align with their life goals and values. This subtheme concerns the shift toward a more
democratized healthcare environment where patients are viewed as partners in care, leading to
outcomes more aligned with patient well-being and satisfaction. Together, these sub-themes
under the umbrella of patient-centered improvements mark a significant move toward healthcare

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that is truly reflective of and responsive to the needs and voices of Black women navigating
breast cancer treatment.
Open-Ended Survey Responses Theme 4 (RQ3): Equity and Access
The equity and access theme crucially underscores the imperative for the healthcare
system to ensure that Black women facing breast cancer are afforded equitable treatment
opportunities and unhindered access to healthcare services. This theme pertains to the systemic
inequities that can profoundly affect treatment experiences and outcomes, advocating for a
healthcare landscape where patients’ needs are met without bias or barriers. One participant
echoed this sentiment: “Equal access to care should not be a privilege but a right that every
woman, regardless of her race or background, deserves.” Another shared a powerful reflection,
“I faced hurdles in getting the care I needed because of where I live and my insurance status. It is
time for the system to change.” A third participant emphasized the broader impact of these
disparities, noting, “When we talk about fighting breast cancer, we must also fight for the equity
in care that is long overdue.” These statements underscore the need for systemic reforms to
eliminate disparities and ensure that all individuals receive comprehensive, culturally competent
care.
Addressing Healthcare Disparities
The subtheme of addressing healthcare disparities pertains to a central aspect of
enhancing healthcare models for breast cancer treatment. It focuses on the necessity of
acknowledging and actively working to mitigate the disparities in care and outcomes that
disproportionately affect Black women and other marginalized groups. Participants’ experiences
bring this issue to the forefront, with one stating, “Despite advancements in treatment, not all of
us benefit equally, revealing deep-seated disparities that need urgent attention.” Another

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participant shared, “My journey through breast cancer treatment exposed me to the systemic
biases that still pervade our healthcare system.” Moreover, a third insight underscores this
challenge’s actionable aspect: “It is critical that healthcare providers and policymakers work
together to dismantle the barriers that lead to these disparities.” This subtheme calls for a
comprehensive strategy that includes data-driven analysis, community engagement, and policy
reform to ensure equitable healthcare outcomes for all patients, regardless of their demographic
or socioeconomic status.
Improving Access to Care
This subtheme delves into the practical measures required to enhance the availability and
accessibility of healthcare services for under-resourced populations. This theme is particularly
relevant in addressing logistical, financial, and informational barriers that can prevent timely and
influential breast cancer treatment. One participant discussed the geographical challenges,
“Living in a rural area, the nearest specialist is hours away, making consistent care a challenge.”
Another pointed out the financial aspect, “The cost of treatment is a huge barrier for many,
leading to delayed or foregone care.” A compelling reflection also emphasizes the role of
information and education, “Access to care is not just about physical availability but also about
knowing your options and rights.” These insights emphasize the multifaceted nature of access to
care, calling for solutions ranging from expanding healthcare infrastructure to implementing
policies that reduce financial burdens, ensuring that all individuals have the resources and
information needed to navigate their treatment paths effectively.
Open-Ended Survey Responses Theme 5 (RQ3): Positive Healthcare Environment
The theme of a positive healthcare environment underscores the profound impact of the
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outcomes of breast cancer treatment for Black women. This theme encapsulates the notion that
the atmosphere in which care is provided significantly influences healing. This atmosphere
includes healthcare professionals’ attitudes, the care setting’s supportiveness, and the overall
approach to patient well-being. Participants’ reflections vividly illustrate this, with one sharing,
“Walking into a healthcare facility that feels welcoming and safe made a huge difference in my
treatment journey.” Another emphasized the importance of the care team’s demeanor: “The
positivity and encouragement from my healthcare providers boosted my spirits and motivated me
during my toughest days.” Furthermore, a poignant insight pertains to the broader implications,
“A positive healthcare environment goes beyond decor; it’s about creating a space where every
patient feels valued, respected, and cared for.” These perspectives underscore the need for
healthcare systems to foster environments that meet clinical needs and address patients’ holistic
well-being, contributing to a more supportive and healing atmosphere that can enhance treatment
efficacy and the overall patient experience.
Subtheme: Fostering Positive Interactions
This subtheme plays a crucial role in enhancing the patient experience for Black women
navigating breast cancer treatment. This aspect focuses on the quality of interactions between
patients and healthcare providers, emphasizing the importance of empathy, respect, and effective
communication. Participants’ accounts highlight these interactions’ transformative power, with
one stating, “Every positive conversation with my care team made me feel more understood and
less isolated.” Another shared, “The respect and kindness I received from my healthcare
providers helped me maintain hope and resilience throughout my treatment.” Furthermore, a
participant reflected on the broader impact, “Positive interactions should be a cornerstone of
care; they can significantly lift a patient’s spirits and improve treatment outcomes.” These

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insights underscore the necessity of prioritizing compassionate communication and supportive
relationships in healthcare settings and how positive interactions can significantly contribute to a
healing and empowering patient environment.
Subtheme: Supporting Healthcare Infrastructure
This subtheme addresses the foundational aspects of healthcare environments that
facilitate effective treatment and care. This includes the physical facilities and the availability of
resources and services that support patient well-being and treatment accessibility. Insights from
participants bring attention to the importance of this infrastructure, with remarks like, “A wellequipped facility with accessible services made my treatment process smoother and less
stressful.” Another participant said, “Access to comprehensive resources, from counseling to
rehabilitation services, played a key role in my recovery.” Additionally, the participants
discussed the need for innovation and inclusivity in healthcare design: “Creating healthcare
spaces that are welcoming and inclusive to all, especially marginalized communities, is crucial
for equitable treatment access.” These reflections emphasize the critical role of robust healthcare
infrastructure in supporting the complex needs of breast cancer patients, underscoring the need
for continuous investment and innovation in healthcare facilities and services to ensure they are
conducive to healing, accessible, and responsive to the diverse needs of the patient population.
Qualitative Interview Findings for RQ3
The third research question, “How might the insights from these lived experiences
contribute to designing healthcare models incorporating self-agency aimed at breast cancer
survivorship for Black women?” is deeply rooted in understanding the experiences of Black
women who are breast cancer survivors. The narratives from their interviews revealed several
critical themes. Firstly, autonomy-respecting approaches call for tailoring healthcare to

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individual needs and preferences. Secondly, inclusive healthcare models emphasize the necessity
for healthcare models to be culturally sensitive and aware of the specific socio-cultural contexts.
This ensures that care is inclusive and acknowledges their identities and experiences. Lastly,
adaptive healthcare models suggest the need for healthcare systems to adapt and be more
inclusive, integrating community support, which is crucial in the survivorship journey. These
insights, drawn from the lived experiences of Black women survivors, are essential in shaping
effective and empowering healthcare models, emphasizing the need for healthcare systems to
evolve in ways that support self-agency, cultural respect, and community involvement in their
survivorship journey.
Qualitative Interviews Theme 1 (RQ3): Autonomy-Respecting Approaches
In addressing the theme of autonomy-respecting approaches in healthcare models, the
emphasis is notably placed on honoring the individual preferences and needs of Black women
who are breast cancer survivors. The significance of this theme is quantified by the participants’
strong advocacy for enhanced control and customization in their treatment experience. For
instance, Alicia asserted the necessity of providing patients with comprehensive information
about their options, indicating a demand for increased transparency and patient education in
healthcare processes. “Patients should be provided more information about options,” stated
Alicia. Similarly, Nia’s call for “more tailored healthcare solutions” and Tanya’s plea for
“individual-focused treatment plans” underlines the need for personalized care that addresses
each patient’s distinct needs and circumstances.
Subtheme: Personalized Care
Personalized care emerged as a critical subtheme, asserting the demand for health
interventions tailored to the circumstances of Black women navigating breast cancer treatment.

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This call for tailor-made care solutions is evident in the perspectives the participants shared, with
Participant 4 advocating for “more tailored healthcare solutions.” Jasmine recommended
“individual-focused treatment plans.” These insights underscore the pressing need for healthcare
providers to prioritize personalized care that acknowledges and adapts to the distinct narratives
of each patient.
Subtheme: Shared Decision-Making
Shared decision-making is essential, capturing the participants’ desire for more
outstanding agency in their healthcare experiences. Imani’s recommendation for “more
involvement in decision-making” and Tasha’s insistence that patients should have “a voice in our
treatment” underscore the significance of engaging patients as active collaborators in their
treatment journey. This emphasis on shared decision-making aligns with the central tenets of
SCT and BFT, advocating for a healthcare paradigm that respects and empowers patients through
participatory practices.
Qualitative Interviews Theme 2 (RQ3): Inclusive Healthcare Models
The theme of inclusive healthcare models stands out as a pivotal aspect of modern
healthcare in the context of services provided to Black women survivors of breast cancer. This
theme advocates for healthcare systems that are aware of and actively responsive to patients’
cultural nuances and identities. This theme underscores the importance of healthcare
professionals’ cultural competence. This statement points to a need for a more nuanced
understanding of patient diversity—a principle supported by both SCT, which acknowledges the
role of environmental and social contexts in shaping behaviors, and BFT, which advocates for an
intersectional approach to understanding the experiences of Black women.

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Subtheme: Cultural Competency
Cultural competency is where participants voiced the need for healthcare providers to
incorporate and respect patients’ cultural backgrounds. Yolanda’s observation, “Understanding
patients’ nationality, offering culturally sensitive care,” alongside Keisha’s comment, “Providers
need to understand our cultural background,” emphasizes the significance of cultural awareness
in healthcare provision. These insights advocate for integrating cultural understanding into
patient care, which aligns with SCT’s recognition of the importance of social and environmental
contexts and BFT’s call for an intersectional approach to healthcare that acknowledges the
multifaceted experiences of Black women.
Subtheme: Identity-Sensitive Policies
Identity-sensitive policies further underscore the participants’ calls for healthcare that is
reflective of and responsive to their identities. LaToya stated, “Healthcare needs to reflect our
identities in policies,” and Brianna expressed the need for “identity-sensitive treatment options.”
These statements call for healthcare policies and treatments to be attuned to the diverse identities
of patients, which is a central tenet of BFT and resonates with SCT’s emphasis on the role of
personal and environmental factors in influencing health behaviors.
Qualitative Interviews Theme 3 (RQ3): Adaptive Healthcare Models
Adaptive healthcare models as a theme encapsulate the necessity for healthcare systems
to evolve and encompass a more encompassing view of patient care that integrates the societal
and communal support structures instrumental in patient well-being. Such adaptability is a core
component of SCT, which posits that learning and behavioral change are products of interaction
with the environment, and resonates with BFT, which emphasizes the need for systems to be
responsive to the nuanced challenges Black women face.

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Subtheme: Inclusivity Treatment
The subtheme of inclusivity treatment emphasizes tailoring medical treatments to the
patients’ diverse needs. Destiny noted this aspect of healthcare when she discussed the need for
broader inclusion: “Include more Black women in clinical trials for more inclusive treatments.”
This plea for inclusivity is not just a call for diversity but a demand for equity and representation
in healthcare, aligning with SCT’s principles of learning from and within the environment and
BFT’s insistence on recognizing and celebrating diverse identities in all societal facets.
Subtheme: Community-Oriented Solutions
The subtheme of Community-Oriented Solutions underscores the vital role of communal
support and resources in healthcare. Brianna recognized the importance of community in
healthcare, noting, “Community support groups are crucial.” At the same time, Destiny
emphasized the significance of involving community leaders by stating, “Involving community
leaders in healthcare discussions.” These insights highlight the community’s role as a source of
support and advocacy, resonating with SCT’s emphasis on environmental and social influences
and BFT’s focus on collective action and empowerment.
Qualitative Interviews Theme 4 (RQ3): Empowerment Strategies
Empowerment strategies facilitate self-agency in breast cancer survivorship among Black
women. These strategies enable women to make informed decisions about their healthcare,
leading to better outcomes and personal growth after treatment. Keisha expressed,
“I felt in control when I could ask my doctor questions and understand my choices.” Tasha
stated, “Having a support group of other survivors made me feel powerful,” underscoring the
role of peer support. Shanice shared, “Learning about my rights as a patient was empowering,”
pointing to the need for advocacy knowledge. Thus, empowerment strategies are foundational in

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fostering a sense of control and self-advocacy. While empowerment lays the groundwork for
agency, it is through educational programs that survivors acquire the knowledge to exercise this
agency effectively.
Subtheme: Educational Programs
Educational programs serve as a bridge between empowerment and applied self-agency
for Black women in breast cancer survivorship. Structured information sessions can demystify
medical jargon, explain treatment options, and provide guidance on post-treatment care. “The
workshops taught me about my treatment options in a way I could understand,” Shanice
recounted, illustrating the clarity gained through education. Nia valued lifestyle education:
“Nutrition classes helped me take charge of my health.” Imani added, “Learning how to manage
my symptoms gave me confidence,” emphasizing education’s role in self-care. Educational
programs thus translate empowerment into actionable knowledge for survivors. Empowerment
and education, while essential, are complemented by advocacy and support services, which
provide the tangible assistance and community backing that fortify a survivor’s journey.
Subtheme: Advocacy and Support Services
Advocacy and support services are the tangible pillars supporting the self-agency of
Black women navigating breast cancer survivorship. These services often manifest as legal
advice, financial assistance, and emotional counseling, directly impacting survivors’ quality of
life. “The financial aid for my treatment changed everything for me,” revealed Keisha, pointing
to the material impact of support services. “Counseling helped me through the darkest times,”
Jasmine shared, demonstrating the emotional lifeline provided. “Advocacy groups helped me
understand my healthcare rights,” Brianna described, revealing the empowerment stemming
from legal support. Advocacy and support services are therefore crucial in actualizing the self-

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agency fostered by empowerment and education. As support services anchor the present, the
ongoing journey of survivorship calls for an integrated healthcare model that continuously
nurtures self-agency, thus circling back to the overarching theme of empowerment strategies.
Qualitative Interviews Theme 5 (RQ3): Reducing Mortality Rates
Reducing mortality rates is a primary objective in enhancing breast cancer care for Black
women. Strategic health interventions focused on mortality reduction can significantly increase
survival rates and improve long-term health prospects. “I wouldn’t be here if it weren’t for the
early screening program,” Yolanda shared, emphasizing the life-saving potential of early
detection. “Access to the latest treatments made a difference in my prognosis,” Tanya noted,
shedding light on the importance of advanced care options. “Educational resources on selfexamination led me to find my lump early,” Nia mentioned, underlining the role of patient
education in mortality reduction. Initiatives to reduce mortality rates are a cornerstone of
effective breast cancer survivorship care. The foundational goal of reducing mortality rates
becomes attainable through early detection initiatives, which indicates the need to move to the
first subtheme.
Subtheme: Early Detection Initiatives
Early detection initiatives are vital in preemptively addressing breast cancer in Black
women and reducing mortality rates. These initiatives include community outreach programs,
free screening clinics, and education on self-examination, all aimed at catching cancer at its most
treatable stages. “The mobile mammogram unit in my neighborhood was how I got diagnosed,”
Shanice recounted, showing the impact of accessible screening services. “I learned how to do a
self-exam from a brochure,” Tasha explained, demonstrating the value of informational
resources. “The health talk at my church about early signs of breast cancer saved my life,”

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Destiny added, illustrating the importance of community-based health education. Early detection
initiatives, therefore, play a crucial role in the early intervention and successful management of
breast cancer. While early detection is critical to catching cancer early, the ability to survive and
thrive also hinges on access to advanced care, linking to the next subtheme.
Subtheme: Access to Advanced Care
Access to advanced care is imperative for the effective treatment and improved survival
rates of Black women with breast cancer. Advanced care includes the latest chemotherapy
regimens, targeted therapies, and surgical techniques, which can be life-altering for patients.
Yolanda accentuated the necessity of logistical support: “Innovative therapy was not available in
my area, but a program helped me travel to get it.” Keisha discussed the benefits of modern
surgical interventions: “The advanced surgical options offered to me meant less recovery time.”
Tasha pointed to the critical nature of financial aid in healthcare: “Without the financial
assistance for the new medication, I wouldn’t have been able to afford it.” Consequently, access
to advanced care is a transformative aspect of healthcare that significantly contributes to the
decrease in mortality rates among Black breast cancer survivors. Ensuring access to advanced
care aids in immediate survival and sets a precedent for continuous healthcare improvement, thus
connecting back to the overarching goal of reducing mortality rates in this population.
Qualitative Interviews Theme 5 (RQ3): Reducing Mortality Rates
Policy recommendations are crucial for shaping a healthcare landscape that supports
Black women through breast cancer survivorship. These recommendations can lead to systemic
changes that improve screening rates, treatment access, and survival outcomes. “Policy changes
that funded local screening programs made all the difference for us,” Jasmine stated,
demonstrating the impact of targeted policies. Tanya noted the importance of financial support:

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“When the government subsidized advanced treatments, more women came in for help.” Keisha
called for tailored policy action: “We need policies that address the specific needs of Black
women with breast cancer.” Practical policy recommendations can potentially transform the
healthcare experience for these women significantly. However, for policies to be truly
transformative, they must be grounded in the actual needs of patients, which brings us to the
critical subtheme of needs-based policymaking.
Subtheme: Needs-Based Policy Making
Needs-based policymaking is essential to ensure that policies directly address the
challenges faced by Black women in breast cancer survivorship. This approach analyzes
demographic data, health disparities, and survivor feedback to inform policy development. “A
survey of survivor needs can lead to a policy that provides free transportation to treatments,”
shared Shanice, indicating the responsiveness of needs-based policies. “Support groups with
survivors helped shape my emotional cancer care needs,” Yolanda revealed, showing the value
of direct input. LaToya declared, “I revised care plan based on policies to include genetic testing
coverage after learning it was included in my coverage,” pointing to policy adaptation in action.
Hence, needs-based policymaking ensures that recommendations are relevant but also equitable
and effective. While identifying needs is a pivotal first step, the actual impact of these policies is
felt in efficient and equitable resource allocation, which connects to the subsequent subtheme of
resource allocation.
Subtheme: Resource Allocation
Resource allocation is a fundamental aspect of policy that dictates the practicality and
effectiveness of healthcare services for breast cancer survivors. It involves strategically
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difference. Shanice noted, underscoring the importance of strategic funding by stating,
“Allocating funds to rural clinics would help reach underserved women.” Destiny provided a
data-driven allocation suggestion: “I think the information can be gathered to direct resources to
communities with higher mortality rates.” LaToya noted the benefits of dedicated support:
“Focusing the resources on survivorship programs, I think, would improve quality of life for
patients post-treatment.” Therefore, thoughtful resource allocation is critical in translating policy
recommendations into tangible benefits for survivors. Effective resource allocation ensures the
practical application of policies and feeds back into the cycle of policy recommendation,
continuously refining the approach to meet the evolving needs of Black women battling breast
cancer.
Summary of RQ 3 Findings
The analysis of RQ 3 embarked on an in-depth investigation into the experiences of
Black women navigating breast cancer treatment, focusing on the communication dynamics,
emotional support mechanisms, and the personalization of care plans. It highlighted the
importance of clear, empathetic communication in healthcare settings, the critical role of
emotional and professional support networks, and the need for healthcare services to tailor
treatment plans to individual patient needs. These findings underline the necessity for healthcare
practices to be inclusive, empathetic, and responsive to the challenges faced by Black women
with breast cancer.
Further analysis revealed the importance of healthcare models that respect patient
autonomy, emphasize cultural competence, and offer empowerment strategies. The research
suggests a pathway toward improving survivorship outcomes and healthcare experiences for
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emphasizes education and advocacy. The insights gained call for adaptability and responsiveness
in healthcare systems, aiming to promote patient empowerment, reduce disparities in care, and
lower mortality rates through well-informed policy changes and healthcare interventions.
Conclusion
This chapter provided a comprehensive analysis of the demographic data of Black
women participating in the study, highlighting key factors such as age, socioeconomic status,
geographical settings, education level, income, marital status, type and stage of breast cancer,
treatment received, and duration of remission. The findings from both quantitative and
qualitative dimensions underscored the complex interplay of these factors in shaping the
healthcare experiences and outcomes of Black women facing breast cancer. The quantitative data
revealed significant insights into the demographic characteristics of the participants, pointing to
the early onset of breast cancer, high educational attainment, diverse income levels, and a
predominance of married individuals. These factors, combined with the prevalence of
inflammatory and ductal breast cancer diagnosed primarily at Stage 2 and the commonality of
treatments such as chemotherapy and radiation therapy, provided a nuanced understanding of the
healthcare disparities and treatment pathways for Black women.
Qualitatively, the participants’ narratives reflected a rich tapestry of experiences
underpinned by resilience, community support, and individuality. These stories noted the role of
culturally responsive and patient-centered healthcare models in addressing Black women’s
specific needs. The qualitative insights complemented the quantitative findings, offering a
deeper, more empathetic understanding of the multifaceted impact of breast cancer. This chapter
concludes by emphasizing the importance of integrating personal narratives with demographic
data to forge healthcare models that are sensitive to the experiences of Black women and capable

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of addressing the systemic inequities that contribute to disparate breast cancer outcomes. This
approach aligns with the principles of SCT and BFT, advocating for an informed, inclusive, and
equitable healthcare system, thereby enhancing survivorship prospects for Black women.

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Chapter Five: Discussion and Recommendations for Practice
This research explored the lived experiences of Black women in the United States who
received a diagnosis of breast cancer, with a focus on understanding the influences on their
health outcomes. By examining their perceptions of self-efficacy and the manifestation of
intersectionality in their healthcare experiences, this mixed-methods study aimed to uncover the
underlying factors contributing to the persistent disparities in breast cancer outcomes for this
demographic. Anchored in the theoretical frameworks of BFT and SCT, the investigation
provided insights into the interplay of cultural, socioeconomic, and healthcare delivery systems
affecting Black women’s breast cancer experiences. The research findings aimed to inform the
development of targeted, culturally competent interventions, addressing the ethical and moral
imperatives of equity, justice, and inclusivity in healthcare. This study represents a step toward
understanding and mitigating the enduring health disparities faced by Black women in breast
cancer treatment and recovery, contributing to the broader discourse on health equity and the
advancement of patient-centered care.
This study’s findings illuminated the role of self-efficacy in promoting health behaviors,
highlighting its influence on both the adoption and sustained practice of such behaviors. Analysis
revealed that self-efficacy, socioeconomic status, and demographic variables significantly affect
healthcare experiences, with complex interplays shaping outcomes. The research underscored
systemic barriers and the need for culturally competent care, advocating for equitable healthcare
models responsive to diverse patient needs. It emphasized the importance of personalized care,
clear communication, and supportive networks in improving healthcare experiences and
outcomes for Black women navigating breast cancer treatment.

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The conceptual framework of the study was anchored in SCT and BFT, which grounded
the examination of the past experiences of Black women undergoing breast cancer treatment in
the United States. Primarily, SCT allowed for the retrospective exploration of self-efficacy and
its impact on health behaviors. At the same time, BFT illuminated the intersectionality of race,
gender, and class and their collective historical impact on healthcare experiences and outcomes.
This framework facilitated an understanding of how self-perception, influenced by societal
stereotypes and personal beliefs, shaped the participants’ interactions with the healthcare system
and their self-agency in managing their breast cancer journey historically. Following this
conceptual approach, three key research questions guided the study:
1. How did Black women with breast cancer perceive their self-efficacy and its
influence on their health behaviors?
2. In what ways did Black women diagnosed with breast cancer perceive that their race,
gender, and socioeconomic class identities influenced their healthcare experiences?
3. How might the insights from these lived experiences contribute to designing
healthcare models that incorporate self-agency aimed at improving breast cancer
survivorship for Black women?
Summary of Findings and Results
This study explored the intricate dynamics among self-efficacy, race, gender, and
socioeconomic class and their collective impact on healthcare experiences for Black women with
breast cancer. Through an analysis of qualitative and quantitative data across three research
questions, the study shed light on these women’s lived experiences, offering invaluable insights
for designing more inclusive and empowering healthcare models. The initial RQ investigated the
role of self-efficacy on health behaviors and revealed a significant correlation between higher

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levels of self-efficacy and an increased engagement in positive health behaviors. This finding
underscores the role of self-efficacy in navigating breast cancer treatment and recovery,
suggesting that interventions aimed at enhancing self-efficacy could lead to more proactive
health management and better health outcomes. The intersectionality of the participants’
identities influences their experiences and affects their self-efficacy beliefs and how they manage
their healthcare experiences (Bandura, 2000; Rogers & Kelly, 2011). Facilitating the expression
of Black women’s experiences and challenges is advantageous in reforming institutional
practices and improving patient outcomes (Heiney et al., 2017; Knecht & Kenning, 2016). In
addition, this study noted that emotional resilience, informed decision-making, and active
participation are important in the treatment process, emphasizing the need for healthcare systems
to support these aspects of patient care. Studies suggest that creating culturally sensitive
communication channels, fostering empathetic and respectful patient-provider relationships, and
ensuring equitable healthcare access are crucial to restoring Black women’s confidence in
effectively interacting with the healthcare system (Adams & Craddock, 2023; Kooken et al.,
2007).
The second research question examined the influence of race, gender, and socioeconomic
status on healthcare experiences, particularly elucidating the compounded challenges confronting
Black women with breast cancer. Quantitative analyses revealed that self-efficacy significantly
impacts perceptions of healthcare quality. At the same time, socioeconomic indicators such as
education and income, alongside demographic variables like age and marital status, also wielded
substantial influence, albeit with varying effects. Notably, the interaction between self-efficacy
and income underscored a nuanced relationship with healthcare experiences, suggesting that
heightened self-belief and financial stability can augment perceptions of quality of care.

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Qualitative exploration identified prevalent themes encompassing healthcare access, racial and
gender discrimination, financial constraints, and diminished trust in the healthcare system,
highlighting the imperative for healthcare policies and practices to rectify systemic inequities and
biases exacerbating healthcare disparities among Black women.
Scholarly literature advocates implementing cultural competency training among
healthcare professionals to mitigate racial biases and enhance healthcare experiences for Black
women (Khanna et al., 2009; Vella et al., 2022). This study underscores the necessity of a
multifaceted approach to healthcare delivery attuned to the intersectionality of race, gender, and
socioeconomic status, advocating for reforms to ensure equitable access to quality care for all
patients. Additionally, extant research underscores the efficacy of shared decision-making,
characterized by open communication and joint planning, in tailoring treatment to individual
needs and ameliorating historical mistrust and access disparities encountered by Black women,
thereby facilitating informed decision-making and establishing realistic treatment expectations
(Heiney et al., 2017; Howard et al., 2014).
The third RQ of the study focused on how the insights from the participants’ lived
experiences could inform the design of healthcare models that promote self-agency and improve
breast cancer survivorship. Key recommendations based on the qualitative findings include
adopting patient-centered care approaches that prioritize clear communication, emotional
support, personalized treatment plans, and equitable access to care. Furthermore, healthcare
models incorporating self-agency should respect patient autonomy, embrace shared decisionmaking, and foster cultural competency among healthcare professionals. Accessible and
understandable health information, coupled with health literacy interventions, empowers Black
women to make informed treatment decisions, reduces misunderstandings, and increases

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adherence, serving as practical communication tools between patients and healthcare providers
(Gregg, 2009; Kamimura et al., 2016; Livaudais et al., 2013). The literature notes that patient
navigators ensure timely diagnosis and treatment, adherence to interventions, and a
comprehensive understanding of patient conditions. They also alleviate logistical and
communication barriers, empowering Black women to participate in their care decisions actively
and transforming their breast cancer journey with personalized support, thus enhancing treatment
adherence, improving health outcomes, and elevating the quality of life (Hook et al., 2012;
Wells, 2021; Worland et al., 2022). By integrating these elements, healthcare providers can
create a more inclusive, supportive, and effective care environment that empowers Black women
to participate actively in their treatment and recovery processes.
Transitioning between the significant findings of each research question, it becomes
evident that the interplay between self-efficacy, intersectional identities, and healthcare
experiences forms a complex landscape that requires understanding and targeted interventions.
This study presents the disparities and challenges faced by Black women with breast cancer and
offers a blueprint for transformative healthcare practices. The literature suggests that practical
approaches to mitigating disparities are rooted in health equity principles and require recognizing
systemic and intersectional challenges and customizing interventions accordingly (Burg et al.,
2009; Butler, 2021; Hook et al., 2012). These practices recognize and actively address this
population’s needs and barriers, paving the way for more positive health outcomes and enhanced
quality of life.
This study’s findings advocate for a comprehensive approach to healthcare for Black
women with breast cancer, emphasizing the importance of self-efficacy, understanding the
impact of intersecting identities, and designing healthcare models that promote self-agency. By

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integrating these insights into practice, healthcare providers and policymakers can work toward a
healthcare system that is truly equitable, compassionate, and responsive to the needs of all
patients. Comprehending and tackling these complexities is crucial for creating culturally
specific, patient-centric healthcare models that, by emphasizing health literacy, empowerment,
and equitable care access, show promise in reducing disparities and fostering a more holistic and
compassionate breast cancer care approach for Black women in the United States (Betancourt et
al., 2003; Mitchell et al., 2020; Soulé, 2014). This research serves as a call to action, urging for
continued exploration, advocacy, and implementation of strategies that elevate the healthcare
experiences and outcomes for Black women with breast cancer, contributing to a more just and
inclusive healthcare landscape.
Recommendations for Practice
This data analysis revealed the multifaceted challenges encountered by Black women
with breast cancer, culminating in targeted recommendations for enhancing healthcare
experiences and outcomes. These recommendations, rooted in the study’s findings and
substantiated by the literature, aim to bridge gaps and elevate patient care standards.
Strengthening healthcare experiences for Black women with breast cancer entails tailoring
interventions to foster self-efficacy and self-agency, empowering patients to actively engage in
their healthcare journey. These recommendations are grounded in empirical evidence and serve
as a strategic framework for healthcare systems to facilitate care and outcomes for this
demographic, emphasizing bias mitigation, standardized care practices, patient empowerment,
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Build Comprehensive Implicit Bias Training
Comprehensive implicit bias training programs are essential for addressing healthcare
professionals’ implicit biases, as they equip them with the skills to recognize and mitigate biases.
These programs focus on increasing awareness and providing strategies to reduce biases,
supported by Devine et al. (2012) and Kawakami et al. (2007). The study’s findings on the
impact of provider biases on patient care quality underscore the importance of such training.
Moreover, these programs can create a more supportive environment that fosters patient selfefficacy. Training emphasizing empathy and understanding can improve communication, making
patients feel more comfortable and confident in expressing their needs and preferences and
enhancing their sense of control over their healthcare decisions.
Design Standardized Clinical Guidelines and Decision Support Systems
Standardized clinical guidelines and decision support systems can counteract the
variability in treatment decisions influenced by individual biases. As Tutun et al. (2023)
suggested, standardized guidelines ensure equitable care by promoting objective and consistent
care practices. Implementing these tools helps patients understand their treatment options,
facilitating informed decision-making. When patients receive clear, unbiased information, they
are more likely to feel capable of making choices that align with their values and health goals,
thereby increasing their self-efficacy.
Develop Shared Decision-Making Models
Elwyn et al. (2012) and Joosten et al. (2008) advocated for shared decision-making
models, emphasizing patient engagement in treatment decisions. These models ensure treatments
are aligned with patient preferences, addressing this study’s findings on the need for
collaborative healthcare experiences. By directly involving patients in their care plans, these

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models bolster self-agency. Fostering a collaborative environment where patients’ voices are
heard and valued enhances their confidence in managing their health, leading to increased
treatment adherence and satisfaction.
Model Integrated Health Coaching With Patient Navigation
Integrating health coaches as patient navigators, as Aalsma and Schwartz (2019)
recommended, proposes that health coaches guide patients through their healthcare journey,
offering personalized support. This recommendation builds on this study’s insights into the need
for emotional support for Black women with breast cancer. Health coaches support patients
through education, motivation, and self-management skills. This personalized support helps them
navigate the healthcare system, understand their treatment options, and take proactive steps
toward their health goals, building their self-efficacy and supporting self-agency.
Implementation of Recommendations
When implementing recommendations, a change model serves as a structured framework
to guide the process effectively (Nancy, 2007; Phillips & Klein, 2023). Change models help
identify key steps, stakeholders, and resources for successful implementation (Nancy, 2007;
Phillips & Klein, 2023). Change models exist, including Lewin’s change management model,
Kotter’s 8-step change model, and Prosci’s ADKAR model. Each model offers unique strategies
and steps for managing change, such as creating a sense of urgency, empowering stakeholders,
and reinforcing new behaviors (Nancy, 2007; Phillips & Klein, 2023). ADKAR is particularly
suitable for implementing the recommendations discussed because ADKAR focuses on
individual readiness and capability development, aligning well with the research’s emphasis on
addressing healthcare disparities and improving patient outcomes (Kaminski, 2022). ADKAR
can effectively guide interventions promoting cultural competency training and shared decision-

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making among healthcare professionals (Kaminski, 2022). This approach ensures that healthcare
providers are adequately prepared and motivated to implement the recommendations, leading to
more equitable access to quality care for Black women with breast cancer (Kaminski, 2022).
The ADKAR model refines the concept of change into five sequential stages, integrating
insights from Van Gennep (1909/1960), Lewin (1948), and Bridges (1980) into a cohesive
framework (Kaminski, 2022). Figure 2 shows the ADKAR change model starts with the current
stage, focusing on building awareness and desire for change, progresses through the transition
stage, where knowledge and ability are developed, and culminates in the future stage, with
reinforcement to solidify the change (Kaminski, 2022). Esteemed for its structured approach to
facilitating organizational change, the ADKAR model emphasizes addressing individual
transitions that collectively lead to successful change initiatives (Kaminski, 2022). It centers on
the role of management and support in ensuring a smooth transition (Kaminski, 2022). It offers
leaders and change agents a clear, purpose-driven roadmap from the current state to the desired
outcomes, thereby simplifying the complexities involved in organizational transformation
(Kaminski, 2022).

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Figure 2
ADKAR Change Model
Each element of the ADKAR model is crucial for the success of change initiatives. By
addressing these elements sequentially, organizations can effectively support their employees
through the change process, ensuring a smoother transition and better outcomes (Kaminski,
2022; Phillips & Klein, 2023). Leveraging the ADKAR model to implement recommendations to
reduce implicit bias and enhance patient-centered care offers a strategic approach to fostering
meaningful transformation in healthcare organizations (Kaminski, 2022; Seufert, 2019). This sets
the stage for employing ADKAR to guide the implementation of this study’s recommendations,
ensuring alignment with organizational goals and maximizing the likelihood of sustainable
change, as shown in the following implementation recommendations.
Building Comprehensive Implicit Bias Training Programs
Awareness (A): Begin by raising awareness among healthcare staff about the existence
and impact of implicit biases on patient care outcomes. Conduct workshops, presentations, and
discussions on recognizing and addressing biases. Provide current information indicating the
disparities in health outcomes associated with implicit biases.

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Desire (D): Foster a desire for change by emphasizing the benefits of mitigating biases in
healthcare, such as improved patient satisfaction, better health outcomes, and a more inclusive
work environment. Encourage staff to reflect on personal motivations for embracing bias
reduction. Use internal data to be transparent, showing how the organization has contributed to
the problem.
Knowledge (K): Provide comprehensive training programs on identifying and mitigating
biases in clinical settings. Utilize interactive methods such as case studies, role-playing, and
simulations to enhance understanding and retention of key concepts.
Ability (A): Ensure healthcare providers have the necessary skills and resources to
implement bias reduction strategies effectively. Offer ongoing support, mentoring, and access to
decision-making tools to bolster their ability to apply learned techniques in real-world scenarios.
Reinforcement (R): Reinforce bias reduction through continuous feedback, performance
evaluations, and recognition of achievements. Integrate bias mitigation goals into organizational
values, policies, and practices to sustain long-term change.
Designing Standardized Clinical Guidelines and Decision Support Systems
Awareness (A): To implement standardized clinical guidelines and decision support
systems effectively, healthcare staff must first understand their advantages in promoting
evidence-based practice and reducing variability in care delivery. Educating staff on these
benefits fosters a deeper appreciation for adhering to established protocols and leveraging
technological tools to enhance patient care. By emphasizing the role of standardized guidelines
in improving clinical outcomes and patient safety, staff become more receptive to adopting these
practices into their workflow.

179
Desire (D): Generating a willingness to change involves creating a persuasive argument
for how standardized guidelines and decision support systems streamline decision-making
processes, enhance patient safety, and improve outcomes. Engaging staff in discussions about the
potential impact on workload, efficiency, and job satisfaction helps them envision the benefits of
embracing these tools. By articulating a compelling case for change, healthcare professionals
become motivated to actively participate in the implementation process and contribute to
improving overall patient care.
Knowledge (K): Equipping healthcare staff with the necessary knowledge involves
providing comprehensive training on effectively using and interpreting clinical guidelines and
decision support systems. Offering hands-on sessions and demonstrations helps familiarize staff
with the tools and reinforce their importance in delivering high-quality care. Healthcare
organizations can facilitate a smoother transition toward standardized guidelines and decision
support systems by ensuring that staff are well-trained and confident in utilizing these resources.
Ability (A): Building staff ability requires ensuring access to user-friendly systems and
resources that facilitate the implementation of standardized guidelines. Offering technical
support and troubleshooting assistance helps address any barriers to adoption and empowers staff
to navigate the new tools effectively. By providing the necessary resources and support,
healthcare organizations enable staff to develop the skills and confidence to integrate
standardized guidelines and decision support systems successfully into their practice.
Reinforcement (R): Reinforcing the adoption of standardized guidelines and decision
support systems involves recognizing and celebrating successful implementation efforts. Sharing
stories of positive outcomes and presenting the tangible benefits achieved through their use
reinforces the importance of adhering to established protocols. By acknowledging and rewarding

180
staff for embracing these practices, healthcare organizations cultivate a culture of continuous
improvement and encourage ongoing adherence to standardized guidelines and decision support
systems.
Developing Shared Decision-Making Models
Awareness (A): It is crucial to raise awareness among healthcare providers and patients
regarding the advantages of shared decision-making in promoting patient-centered care and
improving treatment outcomes. Educating both parties about the benefits of involving patients in
decision-making fosters a deeper understanding of how collaborative approaches can positively
impact healthcare experiences and results. By highlighting the significance of shared decisionmaking, healthcare providers and patients can better appreciate its role in achieving optimal
health outcomes.
Desire (D): Fostering enthusiasm for shared decision-making requires emphasizing its
potential to enhance patient satisfaction, adherence to treatment plans, and overall health
outcomes. Encouraging healthcare staff to envision the positive impact of their involvement in
decision-making processes can motivate them to embrace collaborative approaches to care. By
illustrating the benefits of shared decision-making, healthcare professionals become more
enthusiastic about integrating these practices into their daily routines.
Knowledge (K): Equipping healthcare providers with the necessary knowledge involves
providing comprehensive training on shared decision-making principles, communication
techniques, and decision aids. By offering structured training programs, healthcare organizations
ensure that providers have the skills to engage patients in decision-making processes effectively.
Providing healthcare professionals with the knowledge and tools required for shared decision-

181
making empowers them to deliver patient-centered care and facilitate meaningful patient
interactions.
Ability (A): Building the ability of healthcare providers to integrate shared decisionmaking into their clinical practice requires offering support and resources. Access to decision
support tools, patient education materials, and consultation services helps facilitate collaborative
decision-making processes. By offering ongoing support and resources, healthcare organizations
enable providers to seamlessly incorporate shared decision-making into their practice, enhancing
patient satisfaction and treatment outcomes.
Reinforcement (R): Reinforcing the implementation of shared decision-making involves
recognizing and rewarding healthcare providers who successfully integrate these practices into
their work. Encouraging peer-to-peer learning and knowledge sharing creates a supportive
environment that sustains momentum and fosters a culture of patient-centered care. By
acknowledging and celebrating the efforts of healthcare providers, organizations reinforce the
importance of shared decision-making and encourage continued commitment to patient
engagement strategies.
Modeling Integration of Health Coaches As Patient Navigators
Awareness (A): Healthcare staff require education about the role of health coaches as
patient navigators and the potential benefits of integrating them into care teams. Healthcare
providers gain insight into the value of collaborative care models and patient-centered
approaches by understanding how health coaches can support patients in achieving their goals.
Through education, staff become aware of the positive impact that health coaches can have on
patient outcomes and the overall healthcare experience.

182
Desire (D): Cultivating enthusiasm for integrating health coaches necessitates
emphasizing how their involvement can enhance patient engagement, adherence to treatment
plans, and overall health outcomes. Presenting the potential benefits of additional support for
patients navigating complex healthcare systems encourages staff members to recognize the value
of incorporating health coaches into care teams. Generating enthusiasm for health coaches
involves illustrating the positive impact they can have on patient experiences and outcomes,
sparking a desire to integrate them into care teams.
Knowledge (K): Equipping healthcare staff with the necessary knowledge involves
providing comprehensive training on the roles and responsibilities of health coaches. This
includes imparting communication skills, motivational interviewing techniques, and strategies
for supporting behavior change. Additionally, offering interdisciplinary collaboration and role
clarification opportunities ensures that healthcare providers understand how to effectively
integrate health coaches into care teams and coordinate patient care.
Ability (A): Building the ability of health coaches involves ensuring they have the
necessary resources and support to fulfill their role effectively. This includes providing access to
patient records, referral pathways, and ongoing supervision and mentorship. Collaborating with
other healthcare providers to integrate health coaching into care plans ensures continuity of care
and maximizes the impact of health coaching on patient outcomes.
Reinforcement (R): Reinforcing health coaches’ contributions to patient care outcomes
involves recognizing and celebrating their efforts. Success stories and patient testimonials
evidence the tangible impact of health coach support on patient experiences and health outcomes.
Additionally, providing opportunities for professional development and career advancement

183
reinforces the importance of the health coach’s role on the healthcare team, motivating them to
continue making meaningful contributions to patient care.
In conclusion, implementing the ADKAR model alongside comprehensive strategies,
such as implicit bias training programs, standardized clinical guidelines and decision support
systems, shared decision-making models, and integrating health coaches as patient navigators,
presents a comprehensive approach to enhancing care for Black women with breast cancer. By
adopting all these recommendations, healthcare organizations can effectively manage change,
empower staff, and significantly improve patient care outcomes. Addressing key areas such as
self-efficacy, the intersectionality of Black women’s identities, implicit bias, care disparities,
health literacy, and emotional support is essential for equitable and compassionate care. This
multifaceted approach ensures that all aspects of care and survivorship are optimized to meet the
needs of Black women with breast cancer, thereby fostering an inclusive and supportive
healthcare environment.
Recommendations for Future Research
In this segment, the discourse evolves to critically address the imperative for augmenting
research on the intersectionality of Black women’s identities vis-à-vis their self-efficacy in breast
cancer treatment modalities. This proposal delineates a strategic framework for forthcoming
scholarly inquiries to enrich the corpus of knowledge regarding this demographic’s distinct lived
experiences and challenges. By synthesizing extant literature, the objective is to underscore the
exigency of conducting incisive, culturally congruent research endeavors that promise to refine
intervention strategies and bolster health outcomes for Black women confronting breast cancer.

184
Exploring Intervention Effectiveness
Empirical evidence underscores the recognition of culturally tailored interventions in
enhancing self-efficacy among Black women with breast cancer. Studies by Ashing-Giwa et al.
(2012) and Matthews et al. (2019) illustrate the positive effects of culturally sensitive approaches
on health outcomes, underscoring the role of cultural and social dynamics in patient recovery.
These findings advocate for developing culturally appropriate interventions that empower
patients in their health management. This approach promises to improve treatment experiences
and outcomes, indicating a need for further research into the specific mechanisms by which
culturally tailored strategies can lead to enhanced self-efficacy and more equitable healthcare
outcomes for this demographic.
Longitudinal Studies on Survivorship
The call for longitudinal studies to examine the long-term survivorship experiences of
Black women with breast cancer underscores a significant gap in current research. These studies
should aim to explore comprehensive outcomes, including quality of life, recurrence rates, and
sustained health behaviors over time. While initial efforts by James (2020) and Samuel et al.
(2018) have laid foundational work in these areas, there is a need for more extensive research.
Such studies will develop targeted interventions and support mechanisms that address this
population’s challenges, contributing to improved long-term care and survivorship outcomes.
Comparative Studies on Healthcare System Navigation
Investigating the differential healthcare experiences of Black women with breast cancer
compared to other racial or ethnic groups will identify obstacles and supports in the care
continuum. The research conducted by Sheppard et al. (2018) and Hershman and Tsui (2019) is a
model for such comparative studies, emphasizing the subtleties in navigating healthcare systems

185
and their impact on treatment outcomes. These studies aid in uncovering insights into the
systemic challenges and enabling mechanisms that significantly affect the success of breast
cancer treatments among diverse demographic groups. Future research can illuminate the paths
toward more equitable and effective healthcare solutions through this lens.
Impact of Social Determinants of Health
The necessity for exploring how social determinants such as economic status, education,
and community resources impact the breast cancer treatment journey for Black women is
paramount. Highlighting the significance of these factors, McCall et al. (2020) and Adler and
Newman (2002) contributed foundational insights into the complex interplay between social
determinants and health outcomes. Their work suggests that improving treatment experiences
and outcomes for Black women facing breast cancer requires addressing these determinants. This
area of research promises to unveil actionable strategies toward more equitable healthcare
delivery and support systems.
Psychological Support Systems
Acknowledging the research void in assessing the efficacy and role of psychological
support systems specifically designed for Black women with breast cancer is essential. The
significance of support mechanisms, such as counseling and peer support, has been underscored
by Hebert et al. (2009) and Siminoff and Graham (2014). However, these studies also point to
the necessity for more focused research on support tailored to the experiences of Black women
undergoing breast cancer treatment, highlighting an area ripe for further exploration to enhance
care and outcomes.

186
Conclusion
This dissertation presented insights into the lived experiences of Black women diagnosed
with breast cancer in the United States, emphasizing the role of self-efficacy and the impact of
intersectional identities on health outcomes. The mixed-methods approach concluded that selfefficacy plays a central role in health behaviors among the participants, influencing their
engagement in positive health practices, and revealed how cultural, socioeconomic, and
healthcare system dynamics influenced their treatment and recovery. The findings reveal a need
for the development of targeted, culturally competent interventions that address disparities in
breast cancer outcomes and for a healthcare system that upholds equity, justice, and inclusivity.
Moreover, the study illuminated the need for healthcare models responsive to Black
women’s unique challenges, advocating for patient-centered care that prioritizes clear
communication, emotional support, and personalized treatment plans. The research suggests a
pathway toward enhancing survivorship outcomes and improving healthcare quality via an
intersectional approach to healthcare delivery. These conclusions contributed to the broader
discourse on health equity and patient-centered care, offering a blueprint for transformative
healthcare practices recognizing and actively addressing this population’s specific needs and
barriers.

187
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Appendix A: Survey Protocol
The following sections present the survey procedures used in this study.
Qualtrics Survey Link
https://usc.qualtrics.com/jfe/form/SV_8c88zTAvTnsDQnc
Target Population
The target population for this survey is Black women in the United States who have been
diagnosed with breast cancer and have been in remission for at least 1 year. This group is of
particular interest because they have navigated the complexities of the healthcare system during
their breast cancer treatment and the post-treatment phase.
Introduction
You are invited to participate in a research survey to understand the experiences of Black
women diagnosed with breast cancer. Before deciding whether to participate, you must
understand this study’s nature, purpose, and expectations. This informed consent document will
provide you with all the necessary information to decide about your participation. Please take
your time to read and understand the contents of this document before agreeing to participate.
Purpose of the Study
This study aims to explore the experiences, perceptions, and insights of Black women
diagnosed with breast cancer. Your participation in this survey will help us understand how your
experiences have shaped your journey and how your insights can contribute to developing more
effective healthcare models for breast cancer survivorship.
Procedures
If you choose to participate, you will be asked to complete a survey of questions related
to your breast cancer experience, self-efficacy, and healthcare perceptions. The survey will

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include both closed-ended and open-ended questions. Your responses will be confidential and
analyzed collectively. Your participation is entirely voluntary, and you can withdraw without
penalty.
Risks and Benefits
Participating in this survey does not pose any significant risks to you. However, you may
experience mild emotional discomfort while recalling your breast cancer journey. The benefits of
participating include contributing to the understanding of the experiences of Black women with
breast cancer, potentially leading to improved healthcare models and services for individuals in
similar situations.
Confidentiality and Data Handling
Your responses will be treated with strict confidentiality. All data collected will be stored
securely and only accessible to the research team. Your name will not be associated with your
responses, ensuring anonymity. Any published results will present data in a way that does not
allow identification of individual participants.
Voluntary Participation and Withdrawal
Your participation in this study is entirely voluntary. You are free to skip any question
you do not wish to answer. If at any point you decide to withdraw from the survey, you may do
so without providing any reason, and your partial or completed responses will not be used in the
study.
Contact Information
If you have any questions or concerns about this study or your participation, contact
Fredrick D. Lee II at flee2945@usc.edu. If you have any questions or concerns about your rights

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as a research participant, you can contact the University of Southern California Institutional
Review Board at (323) 442-0114 or email irb@usc.edu.
Consent
Proceeding to the survey and providing your responses indicates that you have read and
understood the information in this informed consent document. You agree to participate
voluntarily and know you can withdraw without penalty. Your participation is highly valued and
will contribute significantly to the understanding of breast cancer experiences among Black
women. Thank you for considering this opportunity.
Table A1
Survey Protocol
Survey questions Response options RQ
Concept being
measured
Do you provide consent
to continue this
survey?
Yes
No
Inclusion criteria:
Only those providing
consent will be
included.
Are you currently 18
years of age or older?
Yes
No
Inclusion criteria:
Only those
responding “yes”
will be included.
Please provide your
residential zip code.
Text box Inclusion criteria:
Participants must
reside in the United
States
Please indicate your
racial classification.
Select all that apply.
Black/African American
White
Asian
Hispanic/Latinx
Native American/Indigenous
Pacific Islander
Inclusion criteria: all
surveys indicating
“Black/African
American” will be
included.
Have you previously
been diagnosed with
breast cancer?
Yes
No
Inclusion criteria: only
those with a prior
diagnosis of breast

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Survey questions Response options RQ
Concept being
measured
cancer will be
included.
Please indicate how long
you have been in
remission from breast
cancer.
1–4 years
5–8 years
9–12 years
13–16 years
17 or more years
Inclusion criteria: only
those with 1 or more
years of remission
will be included.
Please indicate your age
range at breast cancer
diagnosis.
18–24 years
25–34 years
35–44 years
45–54 years
55–64 years
65–74 years
75 years or more
Demographic info for
correlation
Please indicate your
highest level of
education.
High school not completed
High school diploma or GED
Vocational/technical
certification
Associate degree (e.g., AS, AA)
Bachelor’s degree (e.g., BA, BS)
Master’s degree (e.g., MS,
MBA)
Doctoral degree (e.g., PhD,
EdD)
Professional degree (e.g., JD,
MD)
Some college, but no degree
Other (Please specify)
Education info for
correlation
Please indicate your
annal income.
$0 - $29,999
$30,000–$49,999
$50,000–$69,999
$70,000–$89,999
$90,000–$109,999
$110,000 or more
Income info for
correlation
Please indicate your
marital status.
Single
Married
Divorced
Separated
Widowed
Domestic partnership or civil
union
Marital status info for
correlation
Please indicate the type
of breast cancer
Unilateral mastectomy
Bilateral mastectomy
Lumpectomy
Treatment info for
correlation

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Survey questions Response options RQ
Concept being
measured
treatment you received.
Select all that apply.
Radiation therapy
Chemotherapy
Other (Please describe)
How many years has it
been since your breast
cancer diagnosis?
5–9 years
10–14 years
15–19 years
20–24 years
25 or more years
Demographic info for
correlation
On a scale of 1 to 5, how
would you rate your
confidence in your
ability to manage your
breast cancer
treatment?
1 (Not at all confident)
2 (Slightly confident)
3 (Moderately confident)
4 (Very confident)
5 (Extremely confident)
1 Self-efficacy
On a scale of 1 to 5, how
would you rate your
confidence in your
ability to manage your
breast cancer recovery?
1 (Not at all confident)
2 (Slightly confident)
3 (Moderately confident)
4 (Very confident)
5 (Extremely confident)
1 Self-efficacy
On a scale of 1 to 5, how
often do you engage in
regular exercise of at
least 30 minutes per
session?
1 Never (0 days per week)
2 Rarely (1–2 days per week)
3 Sometimes (3–4 days per
week)
4 Often (5–6 days per week)
5 Always (7 days per week)
1 Self-efficacy
On a scale of 1 to 5, how
often do you practice
stress-reduction
techniques?
1 Never (0 days per week)
2 Rarely (1–2 days per week)
3 Sometimes (3–4 days per
week)
4 Often (5–6 days per week)
5 Always (7 days per week)
1 Self-efficacy
On a scale of 1 to 5, how
often do you adhere to
a healthy and balanced
diet as described by the
USDA MyPlate
nutrition guide?
1 Never (0 days per week)
2 Rarely (1–2 days per week)
3 Sometimes (3–4 days per
week)
4 Often (5–6 days per week)
5 Always (7 days per week)
1 Self-efficacy
On a scale of 1 to 5, how
well did you adhere to
your prescribed
medication regimen?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Always
1 Self-efficacy
On a scale of 1 – 5, how
well did you adhere to
1 Never
2 Rarely
1 Self-efficacy

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Survey questions Response options RQ
Concept being
measured
your prescribed
treatment regimen?
3 Sometimes 4 Often 5 Always
On
a scale of
1
– 5, how
often do you attend
regular medical follow
-
up exams for breast
cancer?
1 Never 2 Rarely
3 Sometimes 4 Often 5 Always
1 Self-efficacy
Please describe any
specific instances
where you felt your
confidence or belief in
your own abilities
influenced your
decisions related to
your breast cancer
treatment or overall
health.
Open response
1 Self-efficacy
Please describe how your
confidence or belief in
your own abilities
impacts your
motivation to engage in
health
-promoting
behaviors following
your breast cancer
diagnosis? Please
provide examples from
your experience.
Open response
1 Self-efficacy
To what extent do you
agree that your race
impacted the quality of
healthcare you
received during your
breast cancer journey?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
2 Lived experiences
To what extent do you
agree that your gender
influenced how
healthcare providers
communicated with
you about your breast
cancer treatment
options?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
2 Lived experiences

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Survey questions Response options RQ
Concept being
measured
To what extent do you
agree that your
financial status has
affected your access to
necessary resources for
managing your breast
cancer treatment?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
2 Lived experiences
To what extent do you
agree that healthcare
providers understand
the unique needs of
Black women with
breast cancer?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
2 Lived experiences
How satisfied are you
with the overall quality
of care you have
received during your
breast cancer
treatment?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
2 Lived experience
Please provide specific
examples of how your
race, gender, or
financial status
impacted your
interactions with
healthcare providers
during your breast
cancer journey.
Open response
2 Lived experiences
How do you think your
perceptions of your
race, gender, and
financial status
influence your feelings
of trust and confidence
in the healthcare
system?
Open response
2 Lived experiences
On
a scale of
1
–5,
indicate the extent you
think your personal
experiences with breast
cancer informs the
development of current
healthcare approaches.
1 Not at all 2 Slightly
3 Moderately 4 Very 5 Extremely
3 Self-agency

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Survey questions Response options RQ
Concept being
measured
On a scale of 1–5,
indicate how likely you
think active decisionmaking can improve
the breast cancer
treatment experience
for Black women.
1 (Not likely at all)
2 (Slightly likely)
3 (Moderately likely)
4 (Very likely)
5 (Extremely likely)
3 Self-agency
On a scale of 1–5,
indicate the likelihood
you would choose a
healthcare approach
that actively involved
you in decision-making
regarding your breast
cancer care.
1 (Not likely at all)
2 (Slightly likely)
3 (Moderately likely)
4 (Very likely)
5 (Extremely likely)
3 Self-agency
On a scale of 1–5,
indicate how likely you
think healthcare
approaches can be
adapted to address the
unique needs of Black
women with breast
cancer.
1 (Not likely at all)
2 (Slightly likely)
3 (Moderately likely)
4 (Very likely)
5 (Extremely likely)
3 Self-agency
On a scale of 1–5, how
much do you believe
your experiences as a
Black woman with
breast cancer could
influence the creation
of future healthcare
approaches that
prioritize the patient?
1 (Not likely at all)
2 (Slightly likely)
3 (Moderately likely)
4 (Very likely)
5 (Extremely likely)
3 Self-agency
Please share specific
aspects of your breast
cancer journey that you
believe could directly
contribute to the design
of healthcare
approaches or
strategies aimed at
empowering individual
decision-making and
involvement.
Open response 3 Self-agency

226
Survey questions Response options RQ
Concept being
measured
In your words, how
might healthcare
approaches be tailored
to address the specific
needs of Black women
with breast cancer,
considering your own
experiences and
insights?
Open response 3 Self-agency
Are you willing to share
your experiences and
perceptions about your
breast cancer journey
in a live interview?
Yes
No
Interview inclusion
criteria: Only those
indicating yes will
be prompted to
provide contact
details for the semistructured interview.
Contact name and
number
Open response For interview followup
Contact address Open response For interview followup
Contact email Open response For interview followup

227
Appendix B: Interview Protocol
The following sections present the interview procedures used in this study.
Introduction to the Interview
Hello, I am Fredrick D. Lee II, a doctoral candidate at USC. I am researching Black
women’s experiences with breast cancer treatment to inform healthcare practices better. Your
unique insights would be invaluable. Participation is voluntary, and you can opt out at any time.
With your consent, I would like to record our chat to capture your thoughts and assure
confidentiality accurately. Do you have any questions? Can we proceed with recording?
Respondent Type
Survey participants who agreed to participate in a live interview.
Introduction
You are invited to participate in a research study to understand the experiences and
perceptions of Black women undergoing breast cancer treatment. This study explores the
challenges, successes, and unique factors shaping the breast cancer journey. Before deciding
whether to participate, it is vital that you fully understand the purpose, procedures, risks, and
benefits of this study.
Study Procedures
If you choose to participate, you will be invited to engage in a live interview with the
researcher. The interview will be conducted remotely, using a video conferencing platform (e.g.,
Zoom, Skype, etc.), at a mutually agreed-upon time. The interview is expected to last
approximately 60 minutes. During the interview, you will be asked open-ended questions about
your breast cancer journey, self-efficacy, healthcare experiences, and thoughts on healthcare
models.

228
Recording Consent
With your permission, the interview will be audio-recorded for accuracy and reference.
The recording will be kept confidential and only accessible to the research team. Please indicate
your consent or refusal to have the interview recorded by checking the appropriate box below:
• I consent to having the interview recorded.
• I do not consent to having the interview recorded.
Risks and Benefits
Participating in the interview may evoke emotions related to your breast cancer
experience. However, the researcher will provide a supportive and empathetic environment
throughout the interview. The benefit of participating is that your insights will contribute to a
better understanding of the challenges Black women with breast cancer face, potentially leading
to improved healthcare support and outcomes.
Confidentiality
Your identity will be kept confidential to the extent provided by law. Any information
shared during the interview will be anonymized and reported in a way that does not reveal your
identity. All data will be stored securely and only accessible to the research team.
Voluntary Participation and Right to Withdraw
Participation in this study is voluntary. If you decide to participate, you can withdraw
without any consequences. You can also choose not to answer any question that you find
uncomfortable.
Questions and Concerns
If you have any questions about the study, the interview process, or any concerns, please
contact Fredrick D. Lee II at flee2945@usc.edu. If you have any concerns about your rights as a

229
participant, you may contact the University of Southern California Institutional Review Board at
(323) 442-0114 or email irb@usc.edu.
Consent
I have read the information provided above and understand the nature of the study. I have
had the opportunity to ask questions and have received satisfactory answers. I voluntarily agree
to participate in the live interview for the research study on Exploring the Breast Cancer Journey
of Black Women: Perceptions and Experiences. I understand that the interview may be audiorecorded for accuracy.
Table B1
Interview Protocol
Interview questions Potential probes RQ Key concept
Can you describe your confidence
in managing your breast cancer
journey?
How has this perception
affected your health
behaviors?
1 Self-efficacy
What specific challenges have you
encountered that have either
enhanced or hindered your sense
of confidence in dealing with
breast cancer?
1 Self-efficacy
Please share an instance where your
confidence played a crucial role
in your decision-making process
regarding your health during your
breast cancer experience.
1 Self-efficacy
How do you perceive the
connection between your
confidence and your ability to
adhere to treatment plans?
1 Self-efficacy
How do you perceive the
connection between your
confidence and your ability to
adhere to engage in positive
health behaviors?
1 Self-efficacy

230
Interview questions Potential probes RQ Key concept
In what ways do you feel your
confidence has contributed to
your overall well-being and
mental health as you navigated
through breast cancer treatment
and survivorship?
1 Self-efficacy
Please describe any instances where
you felt your racial identity
affected the quality of care you
received during your breast
cancer journey.
2 Lived experience
Please describe any instances where
you felt your gender identity
affected the quality of care you
received during your breast
cancer journey.
2 Lived experience
Please describe any instances where
you felt your financial status
affected the quality of care you
received during your breast
cancer journey.
2 Lived experience
How do you perceive your identity
as a Black woman influencing
your communication with
healthcare providers?
Can you provide any
examples?
2 Lived experience
Have you encountered any
difficulties or biases in accessing
healthcare resources and services
based on your racial, gender, or
socioeconomic identity?
If so, please share those
experiences.
2 Lived experience
How do you feel your identity as a
Black woman has shaped your
interactions with other healthcare
professionals during your breast
cancer treatment?
2 Lived experiences
In what ways do you think your
identity-related experiences have
contributed to your overall
satisfaction with the healthcare
system during your breast cancer
journey?
2 Lived experiences
Based on your own experiences,
what aspects of healthcare
approaches could be enhanced to
better support Black women’s
3 Self-agency

231
Conclusion to the Interview
Thank you so much for taking the time to share your valuable insights and experiences
with me today. Your input is vital to this study and the quest to improve healthcare practices for
Black women navigating breast cancer treatment. I genuinely appreciate your willingness to
Interview questions Potential probes RQ Key concept
autonomy during breast cancer
treatment?
What are specific strategies or
interventions that could be
integrated into healthcare models
to empower Black women in
taking control of their breast
cancer journey?
3 Patient-centric
models
How do you envision healthcare
approaches that respect and
promote autonomy aligning with
the unique needs and experiences
of Black women who have
undergone breast cancer
treatment?
3 Self-agency
In your opinion, how could
healthcare models better account
for the influences of race, gender,
and socioeconomic class
identities on autonomy in breast
cancer treatment?
3 Self-agency
Considering your journey, how do
you think healthcare models
could be adapted to ensure that
they are inclusive and actively
foster autonomy for Black
women with breast cancer?
3 Self-agency
What do you think is needed to
reduce the breast cancer mortality
rates for Black women?
Patient-centric
models
What do you want healthcare
policymakers to know regarding
the needs of Black women with
breast cancer?
Patient-centric
models

232
participate and contribute to this critical research. May I reach out to you in the future with any
additional questions?

Abstract (if available)

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Asset Metadata

Creator Lee, Fredrick Dwane, II (author)

Core Title Empowering Black women: Navigating breast cancer care and survivorship

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2024-05

Publication Date 07/09/2024

Defense Date 04/05/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag Black women,breast cancer,healthcare disparities,intersectionality,OAI-PMH Harvest,self-efficacy,survivorship

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia (committee chair), Hinga, Briana (committee member), Page, Erika (committee member)

Creator Email flee2945@usc.edu,radmanager@me.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113997ES9

Unique identifier UC113997ES9

Identifier etd-LeeFredric-13184.pdf (filename)

Legacy Identifier etd-LeeFredric-13184

Document Type Dissertation

Format theses (aat)

Rights Lee, Fredrick Dwane, II

Internet Media Type application/pdf

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Source 20240709-usctheses-batch-1177 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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