Barriers and facilitators of breast cancer screening services amongst black African women in high income countries: a systematic review and meta-aggregation.

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Learn more: PMC Disclaimer | PMC Copyright Notice Discov Public Health . 2026 Apr 17;23(1):521. doi: 10.1186/s12982-026-01561-6 Search in PMC Search in PubMed View in NLM Catalog Add to search Barriers and facilitators of breast cancer screening services amongst black African women in high income countries: a systematic review and meta-aggregation Ugomma Nwadinigwe Ugomma Nwadinigwe 1 Institute of Health & Social Care Research, University of Bradford, Bradford, UK Find articles by Ugomma Nwadinigwe 1, ✉ , Imose Itua Imose Itua 2 Faculty of Health and Social Care, University of Bradford, Bradford, United Kingdom Find articles by Imose Itua 2 , Mel Haith-Cooper Mel Haith-Cooper 1 Institute of Health & Social Care Research, University of Bradford, Bradford, UK Find articles by Mel Haith-Cooper 1 , Chris Keyworth Chris Keyworth 3 Health and Social Psychology Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK Find articles by Chris Keyworth 3 Author information Article notes Copyright and License information 1 Institute of Health & Social Care Research, University of Bradford, Bradford, UK 2 Faculty of Health and Social Care, University of Bradford, Bradford, United Kingdom 3 Health and Social Psychology Research Group, School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK ✉ Corresponding author. Received 2025 Sep 16; Accepted 2026 Feb 8; Issue date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13090254  PMID: 42007027 Abstract Background Black African women are less likely to take up breast screening than other ethnic groups despite living in high income countries where breast screening is provided, to identify breast cancer early. Research often focus on access to breast screening in minoritised ethnic women generally, a heterogeneous group. A systematic review and a meta-aggregation were undertaken to synthesize the barriers and facilitators that influence utilization of breast screening services amongst Black African women in high income countries. Methods Nine databases were searched- Web of Science, Scopus, Medline, CINAHL, Cochrane, British Nursing Index, PsycINFO, AMED and Embase. The review was conducted in accordance with PRISMA and ENTEREQ guidelines for systematic review and meta-aggregation. 3153 articles were imported into Covidence, 23 articles were included in the study. Results 21 out of 23 studies took place in the United States (US), only two studies were from the United Kingdom (UK) and Australia. The findings were synthesized into three main headings- Individual level barriers, service provider barriers and health system barriers. Individual barriers include lack of awareness/poor knowledge around breast cancer and breast screening services. Also, lack of understanding of preventive services, fear of breast cancer diagnosis, cultural barriers/stigma, religious barriers and practical barriers. Provider level barriers relate to attitude of staff and racial discrimination. There were system level barriers related to access to screening. Facilitators include prompts from service provider. Conclusion This review revealed the need for country specific studies on barriers and facilitators to breast screening in Black African women, in order to develop targeted interventions that address the barriers distinctive to this population in high-income countries like the UK. Supplementary Information The online version contains supplementary material available at 10.1186/s12982-026-01561-6. Keywords: Breast cancer, Mammogram, Breast screening, Factors influencing, Review, Black African women Background Breast screening uses a breast x-ray called mammogram to detect cancers that are too small to see or feel [ 1 ]. In high income countries, Black African women, are less likely to take up breast screening than other ethnic groups of women [ 2 , 3 ]. According to American cancer statistics, Black women have 8% lower incidence rates of breast cancer, than women from other ethnic groups but have 41% higher mortality rate from breast cancer [ 4 , 5 ]. Black African women are also less likely to have screen detected breast cancer, with up to 25% of Black African women with breast cancer, diagnosed at stage 3 and 4 of the disease, when there are significantly lower survival rates [ 6 ]. A study in UK found that only 49% of Black African women respond to the first invitation for breast screening, this compares to 67% for White women and 63% for Black Caribbean women [ 7 ]. This is compounded by the fact that Black African women are more likely to develop aggressive types of breast cancer than other ethnic groups [ 8 – 10 ], therefore, early detection through breast screening is imperative for Black African women, to increase their survival rates. Most studies on barriers to breast screening focus on the general population [ 11 – 13 ] or on one particular country [ 14 ]. Other studies utilize a target population that has been grouped together, like ethnic minority groups or the Black population group [ 15 – 17 ], with these studies hardly highlighting barriers for Black African women. Inappropriate aggregation of ethnic groups often obscure the diversity and lived experiences of different ethnic population groups, without recognising significant differences in outcomes [ 18 ]. There could be many factors which influence Black African women’s uptake of screening such as culture, religion, recent migration, country of origin [ 19 ]. It is important to note that there are key differences between the Black African and Black Caribbean ethnic groups. Generally, migration to high income countries for Black Caribbean communities started earlier than in Black African communities. For instance, in the UK, migration from the Caribbean became more prominent following World War II. Subsequently, the Windrush population from the Caribbeans came into the UK to rebuild the country [ 20 ], while the population of Black African community started growing in the 2000s due to immigration and natural growth [ 21 ]. This indicates that there are generations of Black Caribbean women with historical knowledge and experience on the workings of the health system in their high-income country. This significant history is not applicable to Black Africans, as they have considerable proportions of more recent migrants [ 22 ]. The distinction between African and Black Caribbean population groups has been acknowledge in the US [ 23 ]. Furthermore, mammogram is not readily available in most African countries, instead recommendations for breast screening tend to focus on clinical breast examination and ultrasound [ 24 ]. In the US for instance, Somalia patients had significantly lower breast screening rates, for most of them, their first experience of a formal health system was after migration to the US [ 25 ]. Thus, they may not be aware of the concept of mammogram. An evaluation of eight cancer centres in the UK, has shown that, disparities in uptake can be influenced by age, time spent in the host country and country of birth [ 19 ], with first generation Black African women experiencing significant barriers to breast screening and longer treatment delays. So far, there is no comprehensive systematic review that explores barriers and facilitators to breast screening utilization amongst Black African women in high income countries. This systematic review aims to fill this gap, as it is important to identify barriers to uptake of breast cancer screening in this group, in order to tailor interventions that increase uptake. Methods A systematic review with meta-aggregation [ 26 , 27 ] and narrative synthesis [ 28 ] was undertaken, following the preferred reporting items for systematic review and meta-analysis guidelines (PRISMA) [ 29 ] and enhancing transparency in reporting synthesis of qualitative research (ENTREQ) guidelines [ 30 ]. The ENTREQ checklist is presented in supplementary files. Meta-aggregation helps in synthesizing findings while ensuring accurate presentation and representation of the primary studies [ 26 , 31 ]. The systematic review was registered with the international prospective register for systematic reviews https://www.crd.york.ac.uk/PROSPERO/view/CRD42023488845 . Eligibility criteria The SPIDER framework-Sample, Phenomenon of Interest, Design, Evaluation and Research Type was adopted, due to its comprehensiveness [ 32 ] and specificity [ 33 ]. All study types were included from 2012 to 2025 as the WHO action plan (2013–2020) for prevention and control of non-communicable diseases, published recommendations, including cost-effective interventions for early detection of breast cancer in different population groups [ 34 ]. Black African women were defined as women of African origin. Peer reviewed studies conducted in high income countries, published in English were included. The World bank’s definition of high-income country was adopted [ 35 ]. Conference abstracts, systematic reviews, review articles and grey literature were excluded. Search strategy and study selection Databases searched were Web of Science, Scopus, Medline, CINAHL, Cochrane, British Nursing Index, PsycINFO, AMED and Embase using MeSH terms (Table 1 ). Language restrictions were not applied during the search. Titles, abstract and keywords were searched with word variations enabled. The search was undertaken by the first author (UN) with the support of the specialist subject librarian, using the same search strategy for all databases. Retrieved studies were saved as RIS files and exported into Covidence and de-duplicated. The Cochrane library was searched as it provides systematic reviews that can be hand searched to obtain relevant studies. The reason for study exclusion is highlighted in the PRISMA diagram below (Fig. 1 ). Details of specific search strategy for the databases are in supplementary files. Titles and abstracts were screened, and then full texts were analysed. The processes followed, were checked by the second author (II) for consistency. Table 1. The search strategy What factors influence breast cancer screening in Black African Women in high income countries? S1) mammogram* or mammograph* S2) breast* N4 (screen* or “health examin*” or “health check” or investigat* or examin*) S1 and S2 combined with Boolean term OR. Now called S5 S3) (black* or Africa*) N4 (women or woman or female*) S3 and S5 combined with Boolean term AND. Now called S6 S4) “breast feeding” or breastfeeding or “breast milk*” or “breast surgery” or “breast conserving surgery” or “breast cancer survivor*” or “breast cancer treatment*” or “breast density” S6 and S4 combined with Boolean term NOT. Now called S7 Open in a new tab Fig.1. Open in a new tab PRISMA flowchart demonstrating search strategy. Assessment of methodological quality Two Joanna Briggs Institute (JBI) critical appraisal tools were used for quality assessment of studies for the qualitative studies ( n = 13) [ 36 ] and for the cross-sectional studies ( n = 8) [ 37 ]. Both checklists were combined for the mixed method studies ( n = 2). These tools are a pre-requisite for meta-aggregation dependability assessment, they consider issues on ethics, ensuring that the voice of the participants is represented through direct quotes from the field work [ 38 ]. First author (UN) appraised the studies and II independently checked the quality of the appraisal. Discrepancies were discussed and resolved. The overall quality of the studies is illustrated in the supplementary files. Certainty of evidence for the meta-aggregation Following the JBI manual, a ConQual approach (i.e. confidence of synthesized qualitative findings) was used for qualitative and mixed method studies. This establishes confidence in the evidence provided, focusing on the credibility of the findings [ 39 ]. Firstly, all the studies were ranked as “HIGH” out of “high , moderate , low , very low” ranking scale. Then, the studies were appraised using the JBI dependability scale (see supplementary files). 12 studies had four or five ‘yes’ responses and so the ranking was HIGH and remained unchanged. Three studies [ 40 – 42 ], had three ‘yes’ responses and so moved down one level. Therefore, the ranking of these three studies became MODERATE. Secondly, findings with illustrations were classed as unequivocal, findings that could be challenged and where a quote is not strongly linked to the finding were equivocal and findings without any supporting data were classed as unsupported and not included. Thirdly, findings from a minimum of two different studies formed the category section, and a minimum of two categories formed the synthesized finding. Finally, to get a high rating in the category section, the category must be supported by at least two findings with a high rating. Data extraction and synthesis UN extracted and synthesized the data utilising iterative categorisation to ensure all results and supporting data were extracted and categorized [ 43 ]. II independently checked the quality of the extraction process. A deductive and inductive coding approach was used [ 44 ]. Deductive codes were adopted from Scheppers framework on potential barriers to the utilization of health services by ethnic minorities [ 45 ]. Inductive coding approach were used-data emerging from the studies formed themes through line-by-line coding, using NVivo software. Due to the methodological heterogeneity and the analytical approach of the studies, a narrative synthesis was deemed appropriate for quantitative studies to support the qualitative research findings; while meta-aggregation was utilised for qualitative studies [ 46 , 47 ]. Where applicable, qualitative findings were supported with statistics from the cross-sectional studies as previously adopted [ 48 ]. Quantitative evidence was reported using percentages, inferential statistics or significance levels. Results Critical appraisal results The quality of the qualitative and mixed method studies was high, with assessment scores between 80% and 100%. Most studies scoring below 100% did not provide clarity around the influence of the researcher on the research process. While the overall quality for the quantitative studies was between 75% and 100%. Five of the studies scored 75% because they did not address confounding factors and strategies to deal with confounders. No study was excluded based on the quality of the studies in order to capture all relevant factors for this target population. Study characteristics Most studies were conducted in the US ( N = 21), one in Australia and the other the UK. Table 2 shows the summary of included studies. There were a total of 2944 Black African women across all studies. The age range of participants was 20 to 70 years, with most studies ( n = 16), reporting a range between 40 and 65 years. Nine studies reported on the country of origin of participants [ 40 , 49 – 56 ]. Seven studies highlighted language proficiency [ 40 , 51 , 53 – 57 ] with the majority of the studies recruiting English speaking participants. One study found 71% of participants indicated that their preferred language for health-related issue was not English language [ 51 ] and another study found one-third of the women were not proficient in English Language [ 40 ]. Seven studies reported the religion of participants as Christians and Muslim [ 40 , 49 , 50 , 52 – 54 , 58 ]. Across all 23 studies, 248 findings were extracted (as shown in the supplementary files). The synthesized findings were ranked high using ConQual methodology. The following section describes the accompanying synthesized themes with direct quotes. The themes were reported under the three parts of Scheppers model-individual, provider level and system level barriers. Figure 2 provides a summary of the meta-aggregation process, showing the link between the number of findings from the studies to categories/themes and the synthesized findings. Table 2. Summary of included studies and reported barriers and facilitators in included studies ( n = 23) Author (s)/date of publication Geographical area Aim Method/Study design Barriers Facilitators Adegboyega et al. 2019 [ 59 ] USA, To explore the relationships and expectations domain and identify perceptions, enablers, and nurturers of regular mammography among AA women using the PEN-3 model. Qualitative Study, Phenomenology Semi-structured interview N = 39 Mean age: 57 (+/-9.7) • Fear of Pain associated with Mammography Screening. • Fear of Results and the Unknown Fatalistic Belief. • Limited Knowledge of mammography Screening. • Lack of Personal Risk. • Cost • Access • Race related discrimination • Previous negative health care experiences. • Observation of other people’s experiences. • Lack of health-related social support Al-Amoudi et al. 2015 [ 40 ] USA- Seattle, Washington To provide additional insight into the knowledge and beliefs about breast cancer and breast cancer screening among immigrant Somali Muslim women in Seattle, Washington. Qualitative research via focus group discussion N = 14 Age range: 30 and 69 years • Lack of awareness of breast cancer or breast cancer screening prior to migration to the United States. • Not receiving a recommendation for breast cancer screening from their physicians. • Lack of information about where to go for screening. • Language is sometimes hard. • Pain from Mammogram. • Difficulty to get a Muslim doctor or a woman doctor. • Misconceptions about the aetiology of the disease, due to the prevalence of some traditional beliefs. Bamidele et al. 2017 [ 58 ] UK, Luton To explore the factors that lead to low uptake of the NHSBSP among Black African women in England and present action points to the local breast cancer services. Qualitative research using data from, focus group discussions and thematic analysis. N = 25 Age range: 35–62 years • Poor awareness and beliefs about breast cancer and risk factors. • Death warrant because there is no cure for it. • Stigma associated with a cancer diagnosis. • Not being registered with a GP. • Lack of time to attend. • Uncertainty about the screening procedure. • The efficacy of screening, risk about the procedure. • Anxiety about treatment options. • Overreliance on religious/spiritual interventions- cancer is witchcraft, evil spirit. Brandzel et al. 2017 [ 41 ] US, Seattle To understand the role reminder played in choices to obtain recommended cancer screening and to understand specific motivators and barriers faced by women in obtaining cancer screening services. Qualitative Study with purposive sampling. 5 Focus groups, N = 24 Age range 30–60 years. • Cancer as a hidden or forbidden topic in the family. • Preventive care not a norm. • Offensive health care experiences that were racist or culturally insensitive • Distrust and disrespect within the healthcare system. • Cost • Time to attend • Location not suitable. • Conflicting screening recommendation information-misalignment with perceived schedule or health care provider recommendation. • Belief in preventive care. • Strong and positive connection to a provider and willingness to attend screening. • Preference for advance notice and reminder. • Reminders from community-based associate. • Timing of reminder letters was important. Hall et al. 2015 [ 42 ] USA, Texas To assess how health professionals’ cultural competence contributes to African American women’s barriers to and receipt of mammograms. Qualitative research using Focus group discussions PEN3 framework N = 61 Age range: 35–65 years • Interactions with clinicians • Attitudes of insensitivity by the physicians and nurse practitioners. • Inequitable treatment for sickness and diseases. Henderson et al. 2018 [ 57 ] USA, Illinois To examine relationships between knowledge of, beliefs about, and barriers to well-woman visits, flu vaccines, and mammogram. Convergent parallel mixed methods design. Behavioural Model of Health Services Use. N = 143 Age range: 40–64 years • Fear • Past or current challenges associated with health insurance. • Health-care costs. • Discomfort • Dissatisfaction with providers. • Ease of getting appointments. • Ability to see desired providers. • Positive relationships or satisfaction with providers. • Affordable insurance or costs. McKinnon et al. 2023 [ 60 ] USA, Rhode Island To examine barriers that a diverse sample of women in Rhode Island face related to breast and cervical cancer screening, as well as motivators that encourage women to obtain screening services. Qualitative research using data from focus group discussions and semi structured interview guide Duration: September 2020 and January 2021. N = 13 Age range: >40 • Fear of screening procedure and potential resulting cancer diagnosis. • Lack of knowledge. • cultural beliefs and faith. • Family obligations. • Ineffective communication and bias in clinical care. • Family history. • Encouragement and navigation assistance. • Clinical reminders and coordinated systems. Mishra et al. 2012 [ 61 ] USA-Maryland To learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. Qualitative study using data from focus group discussions, using community-based participatory research principles. N = 28 n = 26 African American Age from 40 years and above. • Pain • Vanity • Procrastination • Destiny and fate. • Insurance and cost • Access-transportation and distance. Ndukwe et al. 2013 [ 49 ] USA To investigate knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the USA residing in the Washington D.C. metropolitan area Qualitative study design using data from focus group discussions. N = 38 Age range: 20–70 years • Fear of Pain associated with mammography. • Perceived lack of personal Risk. • Lack of health-related social support. Religious beliefs. • Cultural beliefs and stigma • Work schedule • Lack of privacy and opposite sex health care professional. • Ineffective communication. • Ineffective discussions amongst women on cancer. • Lack of transportation. • No consent from spouse. • Increased awareness. Cancer death in family/community. • Firsthand experience of cancer. • Lump in breast or any other sign. • Reminder from clinician. Obikunle and Ade-Oshifogun 2022 [ 62 ] USA To identify barriers to preventative screening for breast cancer among African American women. Qualitative study design. Structured interviews using open-ended questions, reflective summaries, and asking for clarifications. N = 14. Age range: 40 to 62 years. • Lack of knowledge of breast cancer screening. • Lack of knowledge of available resources. • Conflict with Cultural Beliefs. • The Norm- it is normal for people not to go for a regular checkup if healthy. • Fear of the Screening procedure and result. The stereotype that genetics affect the utilization of breast cancer screening resources. • Choice. • Poor Awareness and knowledge. Passmore et al. 2017 [ 63 ] USA - Maryland To explore the factors that influence decisions to screen or not to screen among African American women in Prince George’s County, Maryland. Qualitative study Sampling method- snowball sampling Focus groups. n = 26 African American women; health navigators ( n = 6) and community stakeholders ( n = 24) Age range:42–64 years • Confusion about recommendations and risk. • Family responsibilities or caregiving roles. • Poor Awareness and knowledge. • Fear of Pain Associated with Mammography. • Fear of Results and the Unknown. • Lack of black people in the commercials on breast screening. • Lack of Personal Risk. • Work schedules • Childcare responsibilities • Ineffective discussions amongst women on cancer. • Reminder from clinician. • Print media • Cancer death in family or community. Firsthand experience of cancer. • Wanting to live. Raymond et al. 2017 [ 50 ] USA-Minnesota To understand what Somali immigrant women, know about breast and cervical cancer, what are the attitudes toward screening and what cultural barriers are there to screen as well as cultural factors that would facilitate screening. Qualitative research using focus group discussions. The approach to analysis drew on the immersion Crystallization Method N = 29 Two focus groups were held with younger women age 20 to 35 and two were held with women age 36 to 65. • Concerns that radiation from the mammogram could cause cancer. • Concern about the pain caused by a mammogram. • Younger women had more concerns about modesty and feelings of shyness than the older women. Saadi et al. 2015 [ 52 ] USA To explore Bosnian, Iraqi, and Somali women refugees’ beliefs about preventive care and breast cancer screening to inform future community interventions and best practices. Qualitative research using Semi structured interview guide. Thematic analysis Grounded theory informed the design of this study, with interviews. N = 17 Somalian women refugees. Age range: 18 to 75 years old. • Shyness • Caring responsibilities • Lack of knowledge. • Having someone who spoke the language they understand. Zorogastua et al. 2017 [ 54 ] USA- New York To explore the breast and cervical screening rates and factors that influence this population’s disposition to adhere to cancer screening exams. Mixed Methods study. Focus group discussions (40 participants) & surveys Questionnaires (100 participants). Using mixed method Social ecological model N = 140 Age range: 18–70 years. • Healthcare practices-I don’t go unless I am sick.” • Medical mistrust. • Alternative medicine use. • Belief that radiation from mammograms could cause cancer. • Poor Awareness and knowledge. Guo et al. 2019 [ 64 ] USA To identify factors impacting African American women’s participation in breast cancer screening. Longitudinal study using secondary data analysis, data from SWAN. N = 766 African American women Age range: 40–74 years. • No healthcare insurance 6.4% • Healthcare cost unaffordable 7.2% • Transportation problems 2.3% • No healthcare provider available 3.7% • No time to visit healthcare providers 4.6% • Do not trust the physician 1.95 • Do not want to know the results 0.7% • Having friends that can be trusted available. • Helpers with daily chores available. Davis et al. 2017 [ 65 ] USA To explore the differences among African American women who were compliant and noncompliant with standard mammography screening recommendations. Cross-sectional study using structured questionnaire using closed-ended questions. N = 599. Age range: 41–93 • They simply did not think about attending breast screening (24.4%). • They were not told to do so by their doctor (18.9%). • Did not have enough time (15.7%). Women who did not get a mammogram were significantly more likely to: • Be concerned about not having insurance coverage . • Be distrustful of medical testing . • To report not having thought about getting a mammogram  . • The test was unnecessary . • Those not getting a mammogram in the past year were also significantly less likely to plan to schedule a mammogram the following year . • Whereas religious beliefs were not a factor  . Wells et al. 2017 [ 66 ] USA A qualitative examination to understand the barriers to screening, given the disparities in breast cancer mortality rates among this population. Qualitative study design (Thematic analysis) using telephone interviews N = 28. Age range: 40 to 70 years. • Feeling “lazy” and admitting to making excuses. • Those who had poor knowledge of procedural requirements had a slightly longer period since their last mammogram. • Lack of systematic skills like knowing where to go or number to call. • Lack of transportation. • Cost/lack of insurance. • Cancer death in family or community. • Wanting to live. • Wanting to know if something is wrong. • Scared of getting cancer. Sheppard et al. 2015 [ 56 ] USA- Washington, DC. To examine factors that are associated with higher endorsement of screening. Cross-sectional study using questionnaire. N = 200 Age range: 40 years and above • The likelihood of endorsing screening was higher among participants with English as a primary language (odds ratio = 3.83; 95% confidence interval: 1.24–11.87) and those with greater breast cancer knowledge (odds ratio = 1.04; 95% confidence interval. • Women with health insurance were more likely to endorse screening compared to uninsured women (OR = 3.3795%CI: 1.24–9.17). Harcourt et al. 2013 [ 51 ] USA-Minnesota To assess the rates of cancer screening and examine factors associated with cancer screening behaviour among African immigrant women in Minnesota. Cross sectional study using secondary data analysis. Revised Behavioural Model for Vulnerable Populations. N = 112 Age range: 40 years and above. Health care affordability (insurance premium) • Difficult to pay N = 37 (33%) • Not difficult to pay N = 74 (66%) Health care access (making appointments) • Not able: 26 (23%) • Able: 86 (77%) Trust in health care providers • No: 8 (7%) • Yes: 102 (91%) Patel et al. 2020 [ 67 ] USA- Tennessee To examine socio-demographic factors that influence decisions to use mammography and other breast cancer screenings in low-income African Americans. Cross-sectional study using questionnaire, survey questions modelled after the CDC’s Behavioural Risk Factor Surveillance System. N = 245 Age range: 40 years and above. • Fear of finding out I have cancer 56 (23%). • Not having health insurance 129 (53%). • Cost of cancer screenings 116 (47%). • Pain and discomfort of screenings 117 (48%). • Difficulty getting time-off work 128 (52%). • Not having enough information about screenings 132 (54%). • Not knowing where to get screened 136 (56%). • Transportation issues 146 (60%). • Trouble remembering to schedule screenings 149 (61%). • Finding childcare or caring for elders 161 (66%). Mosavel et al. 2015 [ 68 ] USA To compare the attitudes and beliefs of low-income, urban, African American mothers and their adolescent daughters regarding cervical and breast cancer screening. Cohort study-Using orally administered surveys regarding their cancer knowledge, beliefs and attitudes, and barriers to care. N = 64 Age range: 37–59. • Afraid results of mammogram will show something wrong n = 5 (15.6%). • Mammograms are painful n = 6 (19%). • Hard to find transportation to my appointment for mammogram 3 (9%). • Mammogram least of concerns, more important problems in life 2 (6%). • Keeping my appointment to get mammogram difficult 1 (3%). Ogunsiji et al. 2017 [ 55 ] Australia To report breast cancer screening status of African migrant women and factors associated with their breast cancer screening behaviour in Australia. Cross-sectional study using Breast Cancer Screening Beliefs Questionnaire. Duration: October 2013 and December 2014 N = 264 Age range: 18 to 69 years. • Some participants had heard about breast awareness (76.1%) and mammography (85.2%). • Psychological barriers (feelings of fear/embarrassment) 40.4/39.1 in BCSBQ scale of 0 to 100. • Practical barriers including lack of English-language proficiency and transport difficulties 77.1/70.3 in BCSBQ scale of 0 to 100. • A higher subscale score reflects a less perceived barriers to having mammogram. Savage et al. 2023 [ 53 ] USA- New York City To assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City. Cross-sectional study. Duration: December 2021 and March 2022. N = 42 Age range: 40 or over. • Having a mammogram is painful N = 13 (32.5%). • Lack of insurance N = 13 (30%). • Rude staff N = 11 (28.2%). • Having a mammogram would expose me to unnecessary x-ray radiation N = 1 (2.4%). • I am afraid to have a mammogram because I don’t understand what will be done N = 1 (2.4%). Open in a new tab Individual level barrier Most commonly, studies reported individual level barriers which hindered the uptake of breast screening. These barriers included a lack of knowledge of breast cancer and preventive services; fear of the pain associated with breast screening procedure and its outcome; trouble remembering to schedule breast screening; religious barriers and practical barriers. Lack of knowledge and misinformation 15 studies reported that women had limited knowledge of breast cancer, mammograms and how women can access breast screening services [ 40 , 41 , 49 , 50 , 53 – 56 , 58 – 60 , 62 , 63 , 65 , 67 ]. In a qualitative study [ 62 ] almost all women, (13 out of 14) did not know about resources available to them for breast screening. “I did not know about the mammogram resources for cancer screening , ” [ 62 ]. Sheppard and colleagues used the National Health Interview Survey [ 56 ] to assess breast cancer knowledge in 200 West African women, the mean cancer knowledge score was less than 60%; with 45% of 200 participants scoring less than 50%. Another study [ 67 ] found that 132 out of 245 participants (54%) did not have enough information about breast screening to encourage them to go for screening. As well as lacking knowledge, studies reported that women experienced misinformation. This included the belief that there was no cure for breast cancer and death is the result. This led to fatalistic fears and beliefs about breast cancer diagnosis [ 54 , 58 , 61 , 62 ]. “It’s really a death warrant because there is no cure for it , once you’re told that is it ” [ 58 ] (p215). Another participant believed that cancer could be prevented and treated through diet: “We do not have breast cancer in Somalia maybe because we eat the camel meat and drink camel milk….Camel milk and camel meat will protect , and is a treatment for cancer.” [ 40 ] (P.5). Seven studies explored the reasons why women lacked knowledge of breast cancer screening [ 40 , 41 , 49 , 56 , 58 , 59 , 63 ]. These included the stigma around cancer leading to it not being discussed within families/communities [ 40 , 49 , 54 , 58 ]. “I don’t know , us as African women , we don’t pretty much discuss that (screening) with one another. We just don’t; we don’t talk about things like that.” [ 59 ] p448 . In one study participants explained that women didn’t want to know if they had breast cancer as they believed it was linked to a faulty gene that was hereditary, which would reduce a woman’s chance of marriage [ 49 , 58 ]. “If maybe somebody’s mom had breast cancer… and she has girls , they might not come to [marry] one of those girls because they believe that since the mother had it that maybe… one of those girls might get it… so people… keep things quiet to protect their families” [ 49 ] (p751). Also, women could not relate to the importance of screening as there was no resources geared towards Black African women. “I’m assuming we probably are a high rate of breast cancer , African American women , we probably are. But do you hear it? I see a Susan G. Komen commercial , but nothing is geared as far as commercials to us.” [ 63 ](p730). Sheppard and colleagues examined factors associated with higher uptake of screening amongst West African women, speaking English was found to be associated with higher screening and increasing knowledge of screening (OR = 3.83; 95% CI: 1.24 to 11.87) when compared to non-English speaking participant [ 56 ]. Another barrier, reported by a study from the US was conflicting messaging on breast cancer screening guidelines amongst Black African women, community stakeholders and health navigators due to differences in recommendations from various organisations. “We as health care professionals , we can’t get the message straight. You’ve got one group saying (mammogram) every other year. You’ve got another group that says no , every year (Stakeholder’s group)” [ 63 ] (p729). Participants in four studies found that Black African women were deterred from taking up mammography as they had concerns about radiation causing cancer [ 50 , 53 , 54 , 65 ]. A study comparing compliance and non-compliance with standard mammography screening recommendations in African American women, found that 10.2% out of 128 participants had concerns about radiation [ 65 ]. “[Mammography] has radiation. I am one of the people who believe that the radiation that it produces actually causes [breast cancer]” p5 [ 50 ]. Lack of understanding of preventive health care Six studies reported that in the Black African community, it was perceived as normal not to access healthcare, including breast screening, if women felt well and had no symptoms [ 41 , 52 , 54 , 58 , 62 , 65 ]. While another participant explained that, prevention is usually not part of their health belief model especially for women who were raised in an African country but migrated to the USA [ 41 ]. “they asked me to come about three months ago but I just ignored it , the other invitation I got , I just tore it…myself , I just believe if there is something like that in me , I will find it out myself.” p215 [ 58 ]. “In Africa where I come from people go to the doctor when they are dying , then so by the time they get to hospital it’s already spread over the body.” [ 41 ]. Harcourt and colleague, examined factors associated with cancer screening behaviour among African immigrant women in Minnesota, reported that 87% ( n = 59/89) of participants who had a good self-perception of overall health, never screened for breast cancer [ 51 ]. Experience of cancer in the family or social circle Five studies noted that women who witnessed a family member or friend experience cancer were keener to attend screening [ 49 , 59 , 62 , 63 , 66 ] than women who did not have that experience. “I knew a lady who ignored her cancer for a long period of time , over years and the bump got bigger and bigger and bigger….And then I saw her on the porch on Friday and then Saturday morning , they said she had died. They said she had cancer. And then I think about her and I think about myself. That would make anyone check themselves. Some people think that it couldn’t happen to them , but I’m going to get checked. Whenever I think about her , I try to keep up with that stuff [ 66 ]. (P.332). Practical barriers and facilitators Across six studies [ 41 , 49 , 52 , 56 , 63 , 67 ] women described several practicalities around attending breast screening. “The reason why I didn’t make the appointment has been my schedule , because I work a pretty rigid schedule where I work.” [ 41 ] (p.1004). A survey of 245 women, found that 54% cited difficulty getting time-off work and 68% reported caring responsibilities as barriers to screening [ 67 ]. Ten US Studies, reported cost of screening due to lack of health insurance as a barrier for not taking up breast screening [ 41 , 51 , 53 , 57 , 59 , 61 , 64 – 67 ]. Women with health insurance were more likely to take up screening compared to uninsured women (OR = 3.37 95% CI: 1.24 to 9.17) [ 56 ]. Though lack of insurance created barriers, one participant in the study [ 66 ] was made more aware and motivated to attend screening. This is different as almost all the studies cited lack of insurance as a significant barrier and not as a motivator. I’m more motivated to attend to my health now , without insurance. Not having insurance makes me more aware and want to get the information. When I did have insurance , I already had all of the information , and I didn’t have to think for myself. Now [that I do not have insurance] , I have to find out more information on my own. When I had insurance , my doctor said to get it and I just did , but since I don’t have insurance now , I can’t be ignorant. I’m doing it now because I don’t have insurance [ 66 ] ( p332). “Most people are living pay-check to pay-check , and $25 [for a mammogram] is the difference between eating the next week or not” [ 41 ] (p1004). While one study reported a combination of cost implications and not knowing what the health insurance covers. “I think it’s the cost. With Group Health we don’t pay for the mammogram screening. I don’t think people are aware what their medical [insurance] provides”. [ 41 ] (p1004). Fig. 2. Open in a new tab Summary of the meta-aggregation process, showing the link between the number of findings from the studies to categories/themes and the synthesized findings Fear of the breast screening procedure and outcome Nine studies reported that a barrier to taking up screening was fear. Women feared that a mammogram procedure would be painful [ 49 , 53 , 59 – 63 , 65 , 67 ]. A study in the United States identified 50% ( n = 114/245) of women reported fear of pain associated with mammogram [ 67 ]. In addition, rumours of painful mammographic experiences discouraged others, as implied by the participant below. “It hurts; they smash you. It was worse so I didn’t go back.” [ 59 ] (p447). Fear of having cancer was reported as an additional barrier to screening uptake in nine studies [ 49 , 57 – 63 , 67 ]. Patel and colleagues in examining factors that influence breast screening compliance reported that 24% ( n = 54/245) of African women feared finding out they have cancer [ 67 ]. “ As if the pain from the machine pressure on the breast is not enough , the possibility of a breast cancer diagnosis is equally frightening ” [ 62 ] (p26). Also, two studies reported the fear that an impact of a diagnosis of cancer would have on their homelife and relationship [ 49 , 58 ]. “More often than not , they take off the breast…the husband might want the breast.he might not be thinking of the health implication , he might be thinking so am going to have a wife without breast , so that might influence people going for the screening because he might be saying so if there is something , they will cut your breast off and for a woman that is feeling insecure in her home…” [ 58 ] (p216). Religious barriers Religious barriers were reported in seven studies [ 40 , 49 , 54 , 58 , 60 , 62 , 65 ]. Three studies reported a strong sense of modesty and reluctance in the Muslim African community around having male health care providers assessing sensitive areas. Some said aspects of screening are against their religious belief like touching breasts. There was belief that cancer is God’s plan and can be cured by God [ 54 , 60 , 62 ]. While other participants associated cancer with curse, witchcraft or evil spirit [ 58 ] thus avoiding screening due to the belief that the religion will protect them. “.it’s like oh my God who is that witch that has afflicted the person…so it’s.hindered some people to go for help , so instead of going to the hospital or something they start thinking of the mother-in-law or whoever…they don’t seek for medical help on time…” [ 58 ] (p216). To some participants, if cancer is caused by an evil spirit or a curse, then to reverse this disease, a religious cure should be adopted. “We believe God gave us the disease and God can take it away.” [ 40 ] (P.5). Service provider barrier Studies reported that barriers at the service level within the healthcare team prevented Black African women from accessing screening services. These included barriers due to communication problems, staff attitude and racism within the health system. Prompts from service providers Three studies reported that participants had difficulties remembering to schedule screening [ 63 , 65 , 67 ]. Also, Patel and colleagues highlighted that 63% ( n = 144/245) participants had trouble remembering to schedule breast screening appointment [ 67 ]. Participants indicated that a reminder could make a difference between booking an appointment and not making one. Some women were prompted to attend screening due to provider recommendation, referral and reminders [ 49 , 59 , 60 , 63 ]. While participants in three studies highlighted that flyers/print materials and letters had an encouraging impact on breast screening [ 58 , 60 , 63 ]. “ The doctors always remind us—Did you go for your screening? They always remind us. And maybe that’s what’s making us motivated to do it .” [ 60 ] (p3157). However, ineffective communication deterred women from asking questions about screening [ 60 ]. 18.9% out of 128 participants did not take up a mammogram, because the doctor did not suggest this [ 65 ]. “I think that you don’t want to rub the doctor the wrong way , because I found even asking questions can be a problem”. [ 60 ] p 3156 . Previous experience of racism within the health system Five studies [ 41 , 42 , 57 , 59 , 60 ] reported that women being discriminated against by the service providers created a barrier to breast screening. Women felt they were treated differently due to their skin colour. Hendersen and colleagues reported that 17 women out of 124 felt they were treated worse than other races [ 57 ]. “I remember having surgery also a few years back , and I remember they couldn’t find my vein. And the nurse tells me my skin is too dark. I said , don’t touch me. My skin is not too dark” [ 41 ] (p1003). Two out of the five studies also reported that participants felt discouraged from getting screened due to stories associated with historic racism within the health care system [ 41 , 59 ]. These are stories of racism within the health system that has happened to African people. “You hear down south , especially with the African American men , and they did the experiment and how they ended up with a venereal disease. When the woman went in for one thing , you would become sterilized. And for a long time , I would keep going , but I was always afraid to go. We need more doctors of colour to talk to us to be more sensitive.” [ 41 ] (p1003). Attitude of health care professionals Poor attitude and rudeness of staff were reported as a barrier in four studies [ 42 , 53 , 59 , 60 ]. One study reported that 28.2% ( n = 11/39) participants (African immigrant women in New York) believed “Being treated rudely at the mammogram centre would keep me from having a mammogram” [ 53 ]. “When I first started coming over here to the Health Centre , I needed a mammogram , I just almost fought with the lady over there , from that day on I promised myself: “I’m never going to a city health clinic again.” And I’ve never been back in there , because they act around like they have authority over there; they act like it is their building , as a matter of fact , the whole system has got a problem with the attitude….they still need to respect the people that come here” [ 42 ] (p4). System level barriers The studies reported findings that related to barriers at a system level-policies, organisational and structural level factors that hinder screening uptake. Access to screening appointments Four studies reported concerns about the inflexibility and inability to make appointments for breast screening [ 41 , 51 , 59 , 66 ]. In one study 23% ( n = 26/112) of the participants reported difficulties making appointments for breast screening [ 51 ]. Another study reported that in some cases women had to book the appointment in person and then return to have the screening [ 66 ]. Conversely, women who could book an appointment on the same day attended the screening because they didn’t have time to dwell on their fears [ 57 ] . “I just turned 40 , so this is the year that I have to go and get the mammogram , and I’m scared , actually. I haven’t even scheduled it , but I’m gonna go because my hospital is [Hospital name] , and you can schedule an appointment the same day. But I’m just scared because everybody keeps telling me how it is.” [ 57 ] (p304). Participants also highlighted constraints with getting weekend appointments: “ I know if they could have a Saturday clinic for mammograms—open it up for people that work or people that have no vacation time , started their job , or just have different reasons why they cannot take off work. I think if they had more choices of when , they might come in. That might help .” [ 41 ] (p1004). Practical barriers also included access to health care services linked to distance to the service. Participants in five of the studies reported transportation barriers due to the distance to the appointment [ 61 , 64 – 67 ]. Examining the factors that predict breast screening compliance amongst low-income African American women showed that 62% ( n = 142/245) participants highlighted transportation barriers to breast screening [ 67 ]. “The distance , the travel time. The distance-a lot of people don’t ride the bus or can’t drive.” [ 61 ] (p 434). In some studies, participants reported that services for breast cancer screening were substandard in areas with a large Black African population. “We know that the new equipment goes to the higher paying areas and the older equipment comes to the lower paying areas of the community.” [ 59 ] p448 . “A lot of these places for the cancer screenings are it’s not where the black people are.” [ 41 ] p1004 . Discussion The is the first systematic review to explore barriers and facilitators that influence utilization of breast screening amongst Black African women, as a distinct population in high income countries. The prevailing barrier was that women lacked knowledge about breast cancer and screening. This, and misinformation were exacerbated by the stigma associated with cancer, conflicting messages and lack of advertisements geared towards Black women. Women experienced fear related to the outcome of screening, fatalistic belief and the belief in the impossibility of having breast cancer. Service and system level barriers included racism, staff attitudes, poor communication and difficulties obtaining suitable appointments. Some of the findings were comparable with findings from other studies exploring breast screening uptake in high income countries with minoritised ethnic groups more generally [ 14 , 16 , 17 , 69 ]. Similar individual level barriers include a lack of knowledge and fear around cancer were reported in these studies. These studies include South Asian women’s attendance at breast screening in emigrant countries [ 69 ] and barriers amongst Black, Asian, and Minority Ethnic women (BAME) in the UK [ 17 ]. Also, a lack of knowledge has been shown to be a prominent influencer in other cancer screening studies like cervical screening [ 70 , 71 ] and colorectal screening [ 72 ]. One of the distinctive findings from this review is the misconception that breast cancer can be prevented through diet by eating camel or drinking camel milk or is caused by evil spirit/witchcraft. These misconceptions have not been reported in other ethnic minority group studies related to breast screening. The difference in the findings may be due to the use of ethnic minority population group in general without delineating barriers specific to Black African ethnic group. Though the findings from this review highlighted the stigma around cancer which can be identified in other ethnic minority studies, however the difference from other studies is the uneasiness around discussing breast cancer due to discrimination and reduction in marriage prospects to the girl child if her mother has had breast cancer. Unfortunately, breast cancer stigma has been positively correlated with delayed screening [ 73 , 74 ]. This could lead to late presentation, late-stage cancer diagnosis, when mortality and morbidity rates are higher [ 75 ]. Even without stigma, there is fear or anxiety associated with the implications of obtaining abnormal screening results [ 76 ]. This fear is heightened in Black African community due to belief that cancer has no cure. In this review, fear of the impact of cancer diagnosis on the family stopped women from getting screened. Here, the problems associated with potential breast surgery alludes to the notion Black African women have, of who owns her body and the right to have treatment. From the findings, women indicate that the body especially the breast is owned by the man, usually the husband. Barriers to screening uptake could be compounded by perceived lack of spousal support, as cancer could lead to body image and sexuality problems that causes greater difficulties in relationships [ 77 ]. Consequently, interventions need to consider the complexity of stigma in Black African communities and the impact of a cancer diagnosis on the family and partner. Also, Black African ethnic group experience or view of the health system because of historical racism was not highlighted in other studies. Interestingly, language barrier and use of interpreters were not commonly highlighted in this review unlike other breast screening reviews [ 17 , 78 ]. This may have been due to Black African women living in the USA where most of these studies were undertaken, were able to speak English. It can be argued that the individual level barriers identified in this review are caused by the service and system in the way they operate e.g. a lack of tailored education and information has led to a lack of knowledge. It is important that public health interventions consider this when they are developed. Thought is needed on the best way of increasing women’s knowledge about breast cancer, as approaches focusing on explaining the disease and screening have not worked. Additionally, commonly used health education approaches have been shown to be ineffective [ 79 ]. This review found that women who felt they are in good health or have no symptom of breast cancer did not feel the need to have screening. Interestingly the wider literature studying Black African population groups, reported that those who are healthy do not often access preventive health services [ 80 , 81 ]. An East African study found that women did not take up screening when they felt well, as it is a waste of the provider’s time and resources [ 82 ]. This provides an insight into influences on health seeking behaviour and the focus on a curative approach to disease rather than screening for disease in African countries. This curative approach obviously influences the screening behaviour of Black African women in high income countries. The review by de Cuevas and colleagues has shown that the less time spent in a host country is associated with non-attendance for screening [ 69 ]. This may be due to the process of acculturation, leading to an increased understanding of preventive health care. Acculturation in healthcare is a cultural transaction of health beliefs, practices and values. With acculturation, immigrants may negotiate strategies from both heritage and host culture standpoints to determine the next course of action for their health [ 83 ]. In this case therefore, it is important to involve Black African women in intervention development in order to tailor the intervention by capturing relevant cultural standpoints. Barriers relating to mistrust in healthcare due to historic racism have not been reported in studies around other ethnic women groups. The unethical Tuskegee study, on untreated syphilis targeting African American men rather than the general population, generated great mistrust amongst Black African community and was alluded to by participants in this review. This highlights the implications of racism and misuse of healthcare research in black communities [ 84 ]. According to the US preventive task force, racism produces health inequities due to differences in access, awareness and increase in stressors [ 85 ]. In order to address the barriers around racism and poor staff attitudes- staff training on cultural awareness and periodic audits are needed. Conversely, this review found that good patient-provider relationship encouraged screening, highlighting the crucial role the service provider plays in creating and overcoming screening barriers. Public health practitioners need to be aware of the limitations of individual level interventions and further work is needed to address systemic barriers, possibly intervening at a service delivery level. The need to include communities in the design and delivery of interventions is recommended [ 89 ]. Implementing health interventions at an individual level can lead to a ‘downstream’ problem as it does not impact on the structural barriers leading to health inequalities [ 88 ]. For system level barriers, flexible appointments close to home at convenient times was found to be essential in this review. Evening or weekend appointments to provide some flexibility and to open up more appointment times for patients especially for those who work full time, have been previously suggested [ 86 ]or providing options to change an appointment time [ 87 ]. This review found that women perceived that breast screening services were poorer quality in areas with a dense Black African population. Indeed, a catchment area analysis on resource allocation, showed that for every standard deviation increase in the population of Black women in Delaware, there were 68% fewer mammography units and 89% fewer Breast Imaging centres of excellence [ 88 ]. This means that in areas with more population of Black women there are fewer breast screening facilities. Issues relating to access or location of services with its accompanying costs should be taken into consideration by service providers. Strengths and limitations This review provides robust evidence of barriers to breast screening focusing on Black African women, as the meta-aggregation approach followed in this review, provides transparency when interpreting the findings [ 36 ]. The main limitation is that most of the studies were carried out in the US, where health insurance is required and may not reflect other higher income countries like the UK where breast screening is free at the point of use. Also, some studies used English language as a selection criterion for including participants. Non-English women who were excluded from the studies may have had specific difficulties accessing screening services, which were not picked up in this review. Conclusions This is the first review to identify the barriers and facilitators that influence the utilization of breast screening services amongst Black African women in High income countries. One of the surprising outcomes was that only one study undertaken in the UK was eligible for inclusion. There are significant differences between the health system in the UK and other countries, including the pathways for accessing health services and the need for health insurance. This lack of UK studies exposes an appreciable gap in research, hence the need for more primary studies to address this gap. By understanding the nuance in a specific country such as the UK, targeted interventions can be developed to increase breast screening uptake amongst Black African women living in such countries. One of the prominent barriers is lack of knowledge and misconception around breast screening. Therefore, it is important that interventions explore how to increase breast screening knowledge and dispel misconceptions. There is need to look at the health care service, to identify problems around access to breast screening service and pathways that will facilitate access to screening. Health care providers could incorporate opportunistic prompts when participants explore other services. The right health intervention could lead to a change in behaviour, increasing screening uptake and reducing associated morbidity/mortality from breast cancer. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1. (85KB, docx) Author contributions U.N., M.C., I.I., C.K. conceived the idea. U.N. conducted the systematic review and meta-aggregation, searches, study selection, critical appraisal, data extraction, prepared the main manuscript text, figures and tables. I.I. checked quality of the systematic review process-searches, study selection, critical appraisal and data extraction. M.C and C.K. were involved with study selection, corrected the manuscript and cross-checked the systematic review process. C.K. reviewed the meta-aggregation process. Funding This work was supported by Breast Cancer Now [grant number 2023FebIFS1607]. Data availability No datasets were generated or analysed during the current study. Declarations Ethics approval and consent to participate Not applicable as this is a systematic review of studies based on published data. No ethical approval is required for publication. There was no direct human participation in this study. Consent for publication This is not applicable as this review do not have any participant’s data. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. NHS England. Your guide to NHS breast screening — Helping women decide 2013 [updated 17 October 2025. Available from: https://www.gov.uk/government/publications/breast-screening-helping-women-decide/nhs-breast-screening-helping-you-decide 2. Miller BC, Bowers JM, Payne JB, Moyer A. Barriers to mammography screening among Racial and ethnic minority women. Soc Sci Med. 2019. 10.1016/j.socscimed.2019.112494. [ DOI ] [ PubMed ] [ Google Scholar ] 3. Elewonibi BR, Thierry AD, Miranda PY. Examining mammography use by breast cancer Risk, Race, Nativity, and socioeconomic status. J Immigr Minor Health. 2018;20(1):59–65. 10.1007/s10903-016-0502-3. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Jatoi I, Sung H, Jemal A. The emergence of the Racial disparity in US breast-cancer mortality. N Engl J Med. 2022;386(25):2349–52. 10.1056/NEJMp2200244. [ DOI ] [ PubMed ] [ Google Scholar ] 5. Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal A, Siegel RL. Cancer statistics for African American/Black people 2022. Cancer J Clin. 2022;72(3):202–29. 10.3322/caac.21718. [ DOI ] [ PubMed ] [ Google Scholar ] 6. Cancer Research UK. Black African women almost twice as likely to be diagnosed with late stage breast cancer compared to white women. 2016. https://news.cancerresearchuk.org/2016/11/16/black-african-women-almost-twice-as-likely-to-be-diagnosed-with-late-stage-breast-cancer-compared-to/ 7. Jack RH, Møller H, Robson T, Davies EA. Breast cancer screening uptake among women from different ethnic groups in london: a population-based cohort study. BMJ Open. 2014;4(10):e005586. 10.1136/bmjopen-2014-005586. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Abraham HG, Xia Y, Mukherjee B, Merajver SD. Incidence and survival of inflammatory breast cancer between 1973 and 2015 in the SEER database. Breast Cancer Res Treat. 2021;185:229–38. 10.1007/s10549-020-05938-2. [ DOI ] [ PubMed ] [ Google Scholar ] 9. Arciero CA, Guo Y, Jiang R, Behera M, O’Regan R, Peng L, et al. ER+/HER2 + breast cancer has different metastatic patterns and better survival than ER–/HER2 + breast cancer. Clin Breast Cancer. 2019;19(4):236–45. 10.1016/j.clbc.2019.02.001. [ DOI ] [ PubMed ] [ Google Scholar ] 10. Gathani T, Chiuri K, Broggio J, Reeves G, Barnes I. Ethnicity and the surgical management of early invasive breast cancer in over 164 000 women. Br J Surg. 2021;108(5):528–33. 10.1002/bjs.11865. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 11. Ferreira CS, Rodrigues J, Moreira S, Ribeiro F, Longatto-Filho A. Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: a systematic review. Mol Clin Oncol. 2021;15(1):139. 10.3892/mco.2021.2301. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. Mottram R, Knerr WL, Gallacher D, Fraser H, Al-Khudairy L, Ayorinde A, et al. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open. 2021;11(11):e046660. 10.1136/bmjopen-2020-046660. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Tavakoli B, Feizi A, Zamani-Alavijeh F, Shahnazi H. Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies. BMC Womens Health. 2024;24(1):268. 10.1186/s12905-024-03096-x. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Rauch JI, Daniels J, Robillard A, Joseph RP. Breast cancer screening among African immigrants in the united states: an integrative review of Barriers, Facilitators, and interventions. Int J Environ Res Public Health. 2024;21(8). 10.3390/ijerph21081004. [ DOI ] [ PMC free article ] [ PubMed ] 15. Baird J, Yogeswaran G, Oni G, Wilson EE. What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators. Public Health. 2021;190:152–9. 10.1016/j.puhe.2020.10.013. [ DOI ] [ PubMed ] [ Google Scholar ] 16. Chan D, Li C, Law B, Xu B, Kwok C. Factors influencing the utilisation of mammography among ethnic minorities: a framework-driven systematic review and meta-analysis. J Immigr Minor Health. 2024;26(3):569–95. 10.1007/s10903-023-01564-4. [ DOI ] [ PubMed ] [ Google Scholar ] 17. Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and minority ethnic women in the united kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res. 2023;23(1):1–17. 10.1186/s12913-023-09410-x. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. DaCosta C, Dixon-Smith S, Singh G. Beyond BAME: rethinking the politics, construction, application and efficacy of ethnic categorization. Higher Education Research Action Group (HERAG); 2021. 19. Jones CE, Maben J, Lucas G, Davies EA, Jack RH, Ream E. Barriers to early diagnosis of symptomatic breast cancer: a qualitative study of black African, black Caribbean and white British women living in the UK. BMJ Open. 2015;5(3):e006944. 10.1136/bmjopen-2014-006944. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Sutherland ME. African Caribbean immigrants in the united kingdom: the legacy of Racial disadvantages. Caribb Q. 2006;52(1):26–52. 10.1080/00086495.2006.11672286. [ Google Scholar ] 21. Simpson L. What makes ethnic group populations grow? Age structures and immigration. Dynamics of diversity series. Manchester, England: ESRC Centre on Dynamics of Ethnicity; 2013. [ Google Scholar ] 22. Jayaweera H, Quigley MA. Health status, health behaviour and healthcare use among migrants in the UK: evidence from mothers in the millennium cohort study. Soc Sci Med. 2010;71(5):1002. . [ DOI ] [ PubMed ] [ Google Scholar ] 23. Wafula EG, Snipes SA. Barriers to health care access faced by black immigrants in the US: theoretical considerations and recommendations. J Immigr Minor Health. 2014;16(4):689–98. [ DOI ] [ PubMed ] [ Google Scholar ] 24. Olawole T, Oyetunde T, Uzomah U, Shanahan J, Hartmann K, Rotimi S, et al. Exploring the state of cancer imaging research in Africa. J Am Coll Radiol. 2024;21(8):1216–21. 10.1016/jjacr202404009. [ DOI ] [ PubMed ] [ Google Scholar ] 25. Morrison TB, Wieland ML, Cha SS, Rahman AS, Chaudhry R. Disparities in preventive health services among Somali immigrants and refugees. J Immigr Minor Health. 2012;14(6):968–74. 10.1007/s10903-012-9632-4. [ DOI ] [ PubMed ] [ Google Scholar ] 26. Byrnes K, Hamilton S, McGeechan GJ, O’Malley C, Mankelow J, Giles EL. Attitudes and perceptions of people with a learning disability, family carers, and paid care workers towards cancer screening programmes in the united kingdom: A qualitative systematic review and meta-aggregation. Psycho‐Oncology. 2020;29(3):475–84. 10.1002/pon.5311. [ DOI ] [ PubMed ] [ Google Scholar ] 27. Byrnes K, Giles E, McGeechan G, Hamilton S, O’Malley C, Mankelow J, editors. Attitudes of women with a learning disability and their carers, towards the NHS cervical and breast cancer screening programmes: A qualitative systematic review and meta-aggregation. British Psychosocial Oncology Society Conference 2019; 2018. 28. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC. Methods Programme Version. 2006;1(1):b92. [ Google Scholar ] 29. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021. 10.1136/bmj.n71. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 30. De Jong Y, Van Der Willik E, Milders J, Voorend C, Morton RL, Dekker F, et al. A meta-review demonstrates improved reporting quality of qualitative reviews following the publication of COREQ-and ENTREQ-checklists, regardless of modest uptake. BMC Med Res Methodol. 2021;21:1–11. 10.1186/s12874-021-01363-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 31. Longcoy L-TH, Mathew A, Jang MK, Mayahara M, Doorenbos AZ. Experiences of using patient decision aids for decisions about cancer treatment: a meta-aggregation of qualitative studies. Cancer Nurs. 2022;101097. 10.1097/NCC.0000000000001263. [ DOI ] [ PMC free article ] [ PubMed ] 32. Bradbury KUHAC, Conroy JT, CONDUCTING AND WRITING A LITERATURE. REVIEW. Navigating the Maze of Research: Enhancing Nursing and Midwifery Practice. 2023:28. 33. Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S, PICO. PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014;14(1):1–10. 10.1186/s12913-014-0579-0. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Global action plan for the prevention and control of noncommunicable diseases 2013-20202013. 35. World Bank Group. WDI - The World by Income and Region 2025 [Available from: https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html 36. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. JBI Evid Implement. 2015;13(3):179–87. 10.1097/XEB.0000000000000062. [ DOI ] [ PubMed ] [ Google Scholar ] 37. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Systematic reviews of etiology and risk. Joanna Briggs Institute reviewer’s manual. Volume 5. The Joanna Briggs Institute Adelaide, Australia; 2017. pp. 217–69. 38. Majid U, Vanstone M. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qual Health Res. 2018;28(13):2115–31. 10.1177/1049732318785358. [ DOI ] [ PubMed ] [ Google Scholar ] 39. Munn Z, Porritt K, Lockwood C, Aromataris E, Pearson A. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC Med Res Methodol. 2014;14:1–7. 10.1186/1471-2288-14-108. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 40. Al-Amoudi S, Cañas J, Hohl SD, Distelhorst SR, Thompson B. Breaking the silence: breast cancer knowledge and beliefs among Somali Muslim women in Seattle, Washington. Health Care Women Int. 2015;36(5):608–16. 10.1080/07399332.2013.857323. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 41. Brandzel S, Chang E, Tuzzio L, Campbell C, Coronado N, Bowles EJA, et al. Latina and Black/African American women’s perspectives on cancer screening and cancer screening reminders. J Racial Ethnic Health Disparities. 2017;4:1000–8. 10.1007/s40615-016-0304-2 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 42. Hall MB, Carter-Francique AR, Lloyd SM, Eden TM, Zuniga AV, Guidry JJ, et al. Bias within: examining the role of cultural competence perceptions in mammography adherence. SAGE OPEN. 2015;5(1). 10.1177/2158244015576547. 43. Neale J. Iterative categorization (IC): a systematic technique for analysing qualitative data. Addiction. 2016;111(6):1096–106. 10.1111/add.13314. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 44. Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. Int J Qualitative Methods. 2006;5(1):80–92. 10.1177/160940690600500107. [ Google Scholar ] 45. Scheppers E, Van Dongen E, Dekker J, Geertzen J, Dekker J. Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006;23(3):325–48. 10.1093/fampra/cmi113. [ DOI ] [ PubMed ] [ Google Scholar ] 46. Siddaway AP, Wood AM, Hedges LV. How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Ann Rev Psychol. 2019;70(1):747–70. 10.1146/annurev-psych-010418-102803. [ DOI ] [ PubMed ] [ Google Scholar ] 47. Dunn EL, Lawrence GP, Gottwald VM, Hardy J, Holliss B, Oliver SJ, et al. Thirty years of longitudinal talent development research: a systematic review and meta-aggregation. Int Rev Sport Exerc Psychol. 2024;1–28. 10.1080/1750984X.2024.2309623. 48. Jones CE, Maben J, Jack RH, Davies EA, Forbes LJ, Lucas G, et al. A systematic review of barriers to early presentation and diagnosis with breast cancer among black women. BMJ Open. 2014;4(2):e004076. 10.1136/bmjopen-2013-004076. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 49. Ndukwe EG, Williams KP, Sheppard V. Knowledge and perspectives of breast and cervical cancer screening among female African immigrants in the Washington D.C. Metropolitan area. J Cancer Educ. 2013;28(4):748–54. 10.1007/s13187-013-0521-x. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 50. Raymond NC, Osman W, O’Brien JM, Ali N, Kia F, Mohamed F, et al. Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women. BMC Public Health. 2014;14(1):1188. 10.1186/1471-2458-14-1188. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 51. Harcourt N, Ghebre RG, Whembolua GL, Zhang Y, Osman SW, Okuyemi KS. Factors Associated with Breast and Cervical Cancer Screening Behavior Among African Immigrant Women in Minnesota. JOURNAL OF IMMIGRANT AND MINORITY HEALTH. 2014;16(3):450 – 6.10.1007/s10903-012-9766-4. [ DOI ] [ PMC free article ] [ PubMed ] 52. Saadi A, Bond BE, Percac-Lima S, Bosnian. Iraqi, and Somali refugee women speak: A comparative qualitative study of refugee health beliefs on preventive health and breast cancer screening. Women’s Health Issues. 2015;25(5):501–8. 10.1016/j.whi.2015.06.005 . [ DOI ] [ PubMed ] [ Google Scholar ] 53. Savage LC, Minardi F, Miller SJ, Jandorf LH, Erblich J, Margolies LR, et al. Identifying frequently endorsed benefits and barriers to breast cancer screening for African-Born women in the NYC metropolitan area: a pilot study. J Racial Ethnic Health Disparities. 2023;1–10. 10.1007/s40615-023-01865-2. [ DOI ] [ PMC free article ] [ PubMed ] 54. Zorogastua K, Sriphanlop P, Reich A, Aly S, Cisse A, Jandorf L. Breast and cervical cancer screening among US and Non US born African American Muslim women in new York City. AIMS PUBLIC HEALTH. 2017;4(1):78–93. 10.3934/publichealth.2017.1.78. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 55. Ogunsiji OO, Kwok C, Fan LC. Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study. BMC women’s health. 2017;17(1):32.10.1186/s12905-017-0384-0. [ DOI ] [ PMC free article ] [ PubMed ] 56. Sheppard VB, Hurtado-de-Mendoza A, Song M, Hirpa F, Nwabukwu I. The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin. Prev Med Rep. 2015;2:517–23. 10.1016/j.pmedr.2015.05.012. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 57. Henderson V, Madrigal JM, Handler A. A mixed methods study: midlife African American women’s knowledge, beliefs, and barriers to well-woman visit, flu vaccine, and mammogram use. J Women Aging. 2020;32(3):292–313. 10.1080/08952841.2018.1549433. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 58. Bamidele O, Ali N, Papadopoulos C, Randhawa G. Exploring factors contributing to low uptake of the NHS breast cancer screening programme among black African women in the UK. 2017. http://hdl.handle.net/10547/622571 59. Adegboyega A, Aroh A, Voigts K, Jennifer H. Regular mammography screening among African American (AA) women: qualitative application of the PEN-3 framework. J Transcultural Nursing: Official J Transcultural Nurs Soc. 2019;30(5):444–52. 10.1177/1043659618803146. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 60. MacKinnon KM, Risica PM, von Ash T, Scharf AL, Lamy EC. Barriers and motivators to women’s cancer screening: A qualitative study of a sample of diverse women. Cancer. 2023;129:3152–61. 10.1002/cncr.34653. [ DOI ] [ PubMed ] [ Google Scholar ] 61. Mishra SI, DeForge B, Barnet B, Ntiri S, Grant L. Social determinants of breast cancer screening in urban primary care practices: A community-engaged formative study. Women’s Health Issues. 2012;22(5):e429. 10.1016/j.whi.2012.06.004. [ DOI ] [ PubMed ] [ Google Scholar ] 62. Obikunle AF, Ade-Oshifogun B. Perspectives of African American women about barriers to breast cancer prevention and screening practices: A qualitative study. African Journal of Reproductive Health. 2022;26(7):22 – 8.10.29063/ajrh2022/v26i7.3. [ DOI ] [ PubMed ] 63. Passmore SR, Williams-Parry KF, Casper E, Thomas SB. Message received: African American women and breast cancer screening. Health Promot Pract. 2017;18(5):726–33. 10.1177/1524839917696714. [ DOI ] [ PubMed ] [ Google Scholar ] 64. Guo Y, Cheng TC, Yun Lee H. Factors associated with adherence to preventive breast cancer screenings among Middle-aged African American women. Social Work Public Health. 2019;34(7):646–56. 10.1080/19371918.2019.1649226. [ DOI ] [ PubMed ] [ Google Scholar ] 65. Davis C, Cadet TJ, Moore M, Darby K. A comparison of compliance and noncompliance in breast cancer screening among African American women. Health Soc Work. 2017;42(3):159–66. 10.1093/hsw/hlx027. [ DOI ] [ PubMed ] [ Google Scholar ] 66. Wells AA, Shon E-J, McGowan K, James A. Perspectives of low-income African-American women non-adherent to mammography screening: the importance of information, behavioral skills, and motivation. J Cancer Educ. 2017;32(2):328–34. 10.1007/s13187-015-0947-4. [ DOI ] [ PubMed ] [ Google Scholar ] 67. Patel K, Gishe J, Liu J, Heaston A, Manis E, Moharreri B, et al. Factors influencing recommended cancer screening in low-income African American women in Tennessee. J Racial Ethnic Health Disparities. 2020;7(1):129–36. 10.1007/s40615-019-00642-4. [ DOI ] [ PubMed ] [ Google Scholar ] 68. Mosavel M, Wilson Genderson M, Ports KA, Carlyle KE. Communication strategies to reduce cancer disparities: insights from African-American mother–daughter dyads. Families Syst Health. 2015;33(4):400–4. 10.1037/fsh0000161. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 69. de Cuevas RMA, Saini P, Roberts D, Beaver K, Chandrashekar M, Jain A, et al. A systematic review of barriers and enablers to South Asian women’s attendance for asymptomatic screening of breast and cervical cancers in emigrant countries. BMJ Open. 2018;8(7):e020892. 10.1136/bmjopen-2017-020892. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 70. Lovell B, Wetherell MA, Shepherd L. Barriers to cervical screening participation in high-risk women. J Public Health. 2015;23:57–61. 10.1007/s10389-014-0649-0. [ Google Scholar ] 71. Marlow L, McBride E, Varnes L, Waller J. Barriers to cervical screening among older women from hard-to-reach groups: a qualitative study in England. BMC Womens Health. 2019;19:1–10. 10.1186/s12905-019-0736-z. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 72. Austin K, Power E, Solarin I, Atkin W, Wardle J, Robb K. Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study. J Med Screen. 2009;16(4):174–9. 10.1258/jms.2009.009080. [ DOI ] [ PubMed ] [ Google Scholar ] 73. Pakseresht S, Tavakolinia S, Leili EK. Determination of the association between perceived stigma and delay in help-seeking behavior of women with breast cancer. Mædica. 2021;16(3):458. 10.26574/maedica.2021.16.3.463. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 74. Tang W-z, Yusuf A, Jia K, Iskandar YHP, Mangantig E, Mo X-s, et al. Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2023;31(1):55. 10.1007/s00520-022-07506-4. [ DOI ] [ PubMed ] [ Google Scholar ] 75. Azamjah N, Soltan-Zadeh Y, Zayeri F. Global trend of breast cancer mortality rate: a 25-year study. Asian Pac J Cancer Prevention: APJCP. 2019;20(7):2015. 10.31557/APJCP.2019.20.7.2015. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 76. Smith S, McGregor L, Raine R, Wardle J, Von Wagner C, Robb K. Inequalities in cancer screening participation: examining differences in perceived benefits and barriers. Psycho-oncology. 2016;25(10):1168–74. 10.1002/pon.4195. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 77. Thompson T, Davis M, Pérez M, Jonson-Reid M, Jeffe DB. We’re in this together: perceived effects of breast cancer on African American survivors’ marital relationships. J Soc Social Work Res. 2022;13(4):789–815. 10.1086/713478. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 78. Woof VG, Ruane H, Ulph F, French DP, Qureshi N, Khan N, et al. Engagement barriers and service inequities in the NHS breast screening programme: views from British-Pakistani women. J Med Screen. 2020;27(3):130–7. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 79. Acharya A, Sounderajah V, Ashrafian H, Darzi A, Judah G. A systematic review of interventions to improve breast cancer screening health behaviours. Prev Med. 2021;153:106828. 10.1016/j.ypmed.2021.106828. [ DOI ] [ PubMed ] [ Google Scholar ] 80. O’Neal CW, Wickrama KS, Ralston PA, Ilich JZ, Harris CM, Coccia C, et al. Health insurance status, psychological processes, and older African americans’ use of preventive care. J Health Psychol. 2014;19(4):491–502. 10.1177/1359105312474911. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 81. Pullen E, Perry B, Oser C. African American women’s preventative care usage: the role of social support and Racial experiences and attitudes. Sociol Health Illn. 2014;36(7):1037–53. 10.1111/1467-9566.12141. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 82. Magwesela FM, Msemakweli DO, Fearon D. Barriers and enablers of breast cancer screening among women in East africa: a systematic review. BMC Public Health. 2023;23(1):1915. 10.1186/s12889-023-16831-0. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 83. Yong AG, Lemyre L, Farrell SJ, Young MY. Acculturation in preventive health for immigrants: A systematic review on influenza vaccination programs in a socio-ecological framework. Can Psychol. 2016;57(4):340. 10.1037/cap0000075 [ Google Scholar ] 84. Brawley OW. The study of untreated syphilis in the Negro male. Int J Radiation Oncology* Biology* Phys. 1998;40(1):5–8. 10.1016/S0360-3016(97)00835-3. [ DOI ] [ PubMed ] [ Google Scholar ] 85. Lin JS, Hoffman L, Bean SI, O’Connor EA, Martin AM, Iacocca MO, et al. Addressing racism in preventive services: methods report to support the US preventive services task force. JAMA. 2021;326(23):2412–20. 10.1001/jama.2021.17579. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 86. Ellis N, Gidlow C, Cowap L, Randall J, Iqbal Z, Kumar J. A qualitative investigation of non-response in NHS health checks. Archives Public Health. 2015;73:1–8. 10.1186/s13690-015-0064-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 87. Offman J, Wilson M, Lamont M, Birke H, Kutt E, Marriage S, et al. A randomised trial of weekend and evening breast screening appointments. Br J Cancer. 2013;109(3):597–602. 10.1038/bjc.2013.377. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 88. Webster JL, Goldstein ND, Rowland JP, Tuite CM, Siegel SD. A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening. Breast Cancer Research: BCR. 2023;25(1):137. 10.1186/s13058-023-01738-w. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 89. Gale NK, Kenyon S, MacArthur C, Jolly K, Hope L. Synthetic social support: theorizing Lay health worker interventions. Soc Sci Med. 2018;196:96–105. 10.1016/j.socscimed.2017.11.012. [ DOI ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Supplementary Material 1. (85KB, docx) Data Availability Statement No datasets were generated or analysed during the current study. 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