“What the heck is he doing here?” Impact of race, class and gender on Black men's healthcare seeking behaviors

Background It is well documented that Black men are one of the groups who are least likely to access healthcare. Few studies explore how Black men perceive the healthcare system and their responses to perceived mistreatment during healthcare encounters. This information can provide important insights regarding how to deliver culturally appropriate care to this population.  Methods Data were collected in the context of a colorectal cancer (CRC) screening program based in a free medical clinic in South Carolina. A series of three semi-structured interviews were conducted with Black patients. Clinical observations, document reviews, and interviews with patient navigators and clinical staff were conducted as part of an ethnographic case study. Data collection is ongoing, affective coding was used to categorize patients experiences. Results Fourteen interviews have been completed with five male navigation patients. Patients had a mean age of 55.4 (SD=2.22) years and over half had a high school education (60%). Men described experiences in which they felt unwelcomed or disrespected during healthcare interactions. These experiences were attributed to racial and class based bias on the part of healthcare providers. In response, some men actively avoided seeking care while others choose to alter their appearance and/or mannerisms to reduce the potential for negative healthcare interactions.  Conclusions Black men in this study described negative healthcare encounters caused distress and/or which discouraged them from seeking healthcare. These issues must be addressed in order to improve health care utilization in this population group.