Listening to the Lessons: A Semi-Systematic Review of Black Women’s Health Decision-Making

Background: Black women’s healthcare experiences in the United States are frequently represented through deficit-oriented narratives emphasizing mistrust, nonadherence, or avoidance. Understanding Black women’s healthcare decision-making requires attention to broader historical, social, and relational landscapes. This semi-systematic review synthesizes contemporary qualitative research to examine how the health-related decisions of Black women in the United States is characterized.

Methods: A semi-systematic literature review with thematic analysis was used to capture research spanning diverse disciplines and theoretical traditions. Following PRISMA guidelines, comprehensive searches were conducted in Medline, PubMed, CINAHL, and EBSCO in October 2024. Studies were screened using predefined inclusion and exclusion criteria emphasizing (1) U.S.-based studies, (2) qualitative methods, (3) adult Black women as the population of focus, and (4) health-related decision-making. Three authors independently reviewed titles, abstracts, and full-text articles; the fourth author provided oversight to maintain consistency. Thirty-two studies met the final criteria. Individual coding, iterative team discussion, reflexive journaling, and collaborative refinement were used to ensure trustworthiness of findings.

Results: The 32 included studies spanned maternal health, reproductive health, cancer screening and treatment, HIV prevention and care, gynecologic care, clinical trials, and chronic disease management. Half employed explicit theoretical frameworks, ranging from critical and intersectional approaches to health behavior models. A primary theme, Generational Lessons, addresses how historical, cultural, and intergenerational influences shape Black women’s views of health and healthcare. Three additional subthemes emerged:

1. Normative Ideals: Decisions were informed by normative expectations passed down from previous generations emphasizing survival, faith, resilience and values such as strength, silence, self-reliance.
2. Mistrust: Acknowledges community messages of historical trauma, racial discrimination and lived experience on interpretations of healthcare providers and the healthcare system.
3. Communal Calling: Reflects the impact of faith, religious teaching, or ancestral values informing decisions to protect, model for, or uplift others.

Discussion: Findings reveal that for many Black women, decision-making occurs within a cultural and moral framework that honors ancestors, centers future generations, and reflects a deep-rooted sense of spiritual and communal belonging. These processes challenge deficit-based notions of mistrust and align with decolonial perspectives that frame decision-making as resistance and expertise. Healthcare systems and providers must adopt approaches that honor relational autonomy, acknowledge historical trauma, and promote epistemic justice to enable truly equitable shared decision-making.