Beyond knowledge: trust and the engagement of newly arrived refugee women in cervical cancer prevention

Background: Refugee women face unique challenges in accessing preventive healthcare services upon resettlement, particularly for cervical cancer screening and HPV vaccination. Despite national efforts to reduce cervical cancer incidence, uptake remains disproportionately low among newly arrived refugee populations. This study explores the experiences, perceptions, and contextual factors shaping cervical cancer prevention behaviors among newly arrived refugee women in the United States. Methods: We conducted in-depth, semi-structured interviews with 17 refugee women within their first two years of resettlement in a Midwestern U.S. city. Participants were purposively sampled to ensure variation in age, country of origin, and screening history. Data were analyzed using Braun and Clarke’s thematic analysis, guided by the Socioecological Model. Trustworthiness was strengthened through intercoder agreement, member checking, and reflexive memoing. Results: Four themes emerged: trust as a gatekeeper, highlighting how healthcare-seeking depended on perceived safety and relational trust; communication as access, reflecting challenges with language, interpretation, and navigating fragmented care; concordance and comfort, emphasizing the role of gender, cultural, and religious alignment with providers; and structural disorientation, describing the confusion around where, when, and how to access preventive services. Despite low awareness of HPV vaccination, most participants expressed openness when information was provided by trusted messengers. Conclusion: Refugee women’s engagement with cervical cancer prevention is shaped not only by knowledge but also by cultural safety, provider concordance, and systemic trust. Interventions must prioritize community-rooted education, gender-concordant care, and culturally responsive communication to improve prevention outcomes.