Black women’s decisions about participating in breast cancer screening in the UK: a qualitative study

BACKGROUND: In the UK, women of Black African and Black Caribbean descent ('Black women') participate in breast screening at lower rates than White women, contributing to inequalities in breast cancer outcomes. This study explored Black women's decision about participating in breast cancer screening. METHODS: Seven focus groups were conducted with 47 women eligible for breast screening; 30 reported consistent participation, while 17 had never or inconsistently participated. Data were analysed using Reflexive Thematic Analysis and interpreted through the Capability, Opportunity, Motivation-Behaviour (COM-B) model. Findings were mapped onto the Behaviour Change Wheel (BCW) to identify potential intervention functions. RESULTS: Five themes describing Black women's decisions to participate in breast screening were developed: knowledge and awareness (psychological capability); emotional and motivational responses (reflective and automatic motivation); social influences and peer engagement (social opportunity); competing priorities (psychological capability and physical opportunity); and healthcare and access barriers (physical opportunity). A sixth theme captured participants' suggestions for improving screening services. CONCLUSION: Applying the Behaviour Change Wheel (BCW) identified relevant intervention functions and policy approaches, suggesting that community-driven and culturally inclusive strategies may enhance breast screening participation among Black women.