Drivers and Barriers to Health-Seeking Behaviors and Interactions: A Qualitative Study of Black Patients with Lung Cancer and with Peripheral Artery Disease

OBJECTIVES:

Lung cancer (LC) and peripheral artery disease (PAD) are two diseases with known racial disparities in diagnosis, treatment outcomes, and survivorship. However, there is limited understanding of how health system interactions may contribute to or exacerbate disparities for Black patients. To explore this, we interviewed U.S. Black patients with LC and PAD to identify drivers and barriers to health-seeking behaviors and healthcare interactions.

METHODS:

Participants included 30 Black patients with LC (n=15) and PAD (n=15). Semi-structured interviews, lasting 60 minutes each, were conducted virtually between September and November 2022. Thematic analysis was performed to identify emerging concepts. Factors influencing health-seeking behaviors and healthcare interactions were categorized according to domains within the Sense-Think-ACT-Relate behavior framework.

RESULTS:

Both patients with LC (mean age, 52.3 ± 11.8) and PAD (mean age, 54.6 ± 10.5) described similar factors within the framework, emphasizing trust and legitimacy, that influenced their behaviors. Patients were more likely to seek care if their doctor demonstrated an understanding of Black individuals’ lived experiences. Negative emotions, like fear of learning about an illness, feeling stigmatized during health encounters, or being unaware of disease symptoms delayed patients in seeking care. Further, some patients bypassed nearby clinicians to receive care from those located farther away, whom they perceived listened to their concerns and understood them and provided better care.

CONCLUSIONS:

Our findings suggest that several behavioral drivers and barriers exist for Black patients in receiving health care. Trust, legitimacy, and cultural understanding are paramount in clinical interactions. Further, close proximity to providers’ offices does not ensure access to care that meets patients’ needs. Health system interventions should focus on developing effective strategies to engender greater trust among Black patients and demonstrate an understanding of their lived experience and needs. These measures can improve patient-physician and health care interactions and, ultimately, patient outcomes.