Cultural, Societal, and Behavioral Contributors to Delays in Seeking Care for Postmenopausal Bleeding Among Disaggregated Populations of Black Women.

BACKGROUND

Endometrial cancer outcomes differ among Black women when examined by nativity, and timely evaluation of postmenopausal bleeding (PMB), the most common presenting symptom, may contribute to these disparities.

METHODS

This qualitative study explored cultural, societal, and behavioral factors shaping PMB appraisal and anticipated care-seeking among US-born Black, Caribbean-born Black, and Haitian Creole-speaking women in South Florida, guided by the Safer-Andersen Model of Total Patient Delay. Ten focus groups were conducted with 55 Black women aged ≥50 years recruited through purposive and snowball sampling. Discussions were held in English or Haitian Creole, audio-recorded, professionally transcribed, translated when needed, and analyzed thematically using a hybrid deductive-inductive approach. Reporting followed the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Three themes emerged: limited awareness and information-seeking regarding menopause and PMB; cultural and societal influences, including faith-based coping, traditional remedies, and limited family discussion of health history; and healthcare system barriers, including cost, lack of insurance, distrust, and communication challenges with providers. Subgroup differences were noted in preferred information sources, perceived susceptibility, and the role of religion in care-seeking.

CONCLUSIONS

Findings suggest that PMB appraisal and anticipated care-seeking vary by nativity and language among Black women. Nativity- and language-tailored community education and navigation strategies may improve symptom recognition and support timely evaluation, but future quantitative studies are needed to test whether these approaches reduce pre-diagnostic intervals for endometrial cancer.