'We know what the barriers are, but nothing changes' - Professional perspectives on promoting breast cancer screening initiatives for ethnic minority women.

BACKGROUND: Despite long-standing efforts to increase breast cancer screening uptake, there are substantial inequalities in access and outcomes for ethnic minority women. Despite much research focussing on the views of minoritised groups on barriers to their attendance, systemic factors have received limited attention.

METHODS: Seventeen professionals responsible for implementing initiatives to promote screening equity for minoritised groups took part in semi-structured online interviews. Data were analysed using reflexive thematic analysis.

RESULTS: Three themes were developed: (1) Structural inequities: moving from system centred design to community centred care: professionals described entrenched systemic misalignments that disadvantage women from minoritised communities, (2) Hostile environment effects on healthcare engagement: wider societal racism and exclusionary policies were seen to undermine trust and access, (3) Innovation within constraints: participants described grassroots, community centred strategies, though these often relied on individual initiative rather than system level support.

CONCLUSIONS: Professionals working to promote breast screening uptake for ethnic minority women described numerous systemic challenges that hinder equity. Structural reform to breast screening programmes which goes beyond translation and cultural competency is needed to produce greater equity in uptake for minoritised communities. Findings highlight the importance of designing healthcare systems so that they are more appropriate for ethnic minority women.