Navigating Cancer Risk: A Grounded Theory of Culturally Anchored Risk Engagement (CARE) Behavior Among Sub-Saharan African Immigrant Men

BACKGROUND: This grounded theory study explores the cultural beliefs and perceptions that shape cancer-related health behaviors among Sub-Saharan African immigrant (SSAI) men in the United States. Despite growing awareness of poor health outcomes affecting immigrant communities, there remains a significant gap in understanding the cultural drivers that influence engagement with preventive care and early cancer detection among SSAI men. METHODS: Guided by grounded theory, 36 SSAI men participated in in-depth interviews. Purposeful sampling was used to recruit eligible immigrants from SSAI men diagnosed with prostate cancer (12) and non-diagnosed men (24), capturing the rich diversity that exists among this population. Data were inductively analyzed following the key stages of open, axial, and selective coding, using constant comparison to enhance rigor. RESULTS: Data analysis culminated in the development of a conceptual framework, represented metaphorically as a tree that illustrates how core cultural beliefs (roots) give rise to intermediary thought patterns (stems), which ultimately manifest in specific health behaviors (leaves). Root factors represent deeply held beliefs that shape participants' worldviews and guide their subsequent actions. Three deeply held belief systems were identified as the perception of a strong link between poor diet and cancer, culturally embedded understandings of cancer from participants' countries of origin, and the low prioritization of preventive healthcare. These root beliefs informed a series of intermediary factors (the stem), which serve as a bridge linking root beliefs to observable behaviors by reinforcing and supporting the core ideas including participants' belief that the African diet is inherently healthy, the framing of cancer as a spiritual or religious affliction, and the view that medical care is necessary only when symptoms are present. These intermediary beliefs, in turn, lead to observable health behaviors (the leaves) which symbolize the outward, visible expressions in the form of health-related behaviors, including participants' reported avoidance of processed foods, reliance on religious healing over medical treatment, hesitancy to discuss cancer openly, and delays in seeking care until advanced stages of illness. CONCLUSION: The resulting grounded theory, Culturally Anchored Risk Engagement (CARE) Framework, explains how SSAI men make health decisions by interpreting cancer risk through culturally rooted lenses. The theory underscores the importance of culturally nuanced approaches in improving health equity and early detection in immigrant communities. By centering community voices and cultural context, this study contributes a nuanced understanding of how cultural frameworks influence health behavior and highlights opportunities for more responsive and equitable healthcare interventions targeting SSAI men.