Purpose: Some of the most significant mental health concerns among US adults are depression, anxiety, substance abuse, and intimate partner violence. These concerns represent an ever-growing portion of the primary care population, especially in rural areas. However, few studies have examined factors influencing screening and treatment of these concerns by primary care providers, particularly in Appalachia. This study explores barriers and facilitators to mental health screening and treatment among women at a rural, primary care clinic in Appalachia. Methods: Eighteen patients and 4 providers were interviewed face-to-face. Thematic analysis was used to identify emergent themes. Findings: Patients identified 3 barriers (stigma, lack of support, and lack of education) and 2 facilitators (integrated care and positive experiences with providers). Providers identified 4 barriers (operational barriers, mental health competence, predicted patient reactions, and patient attitudes) and 3 facilitators (clinic characteristics, provider characteristics, and patient and provider education). Generally, patients focused more on individual and social factors influencing mental health service use, while providers were more aware of training gaps, logistical factors at the clinic, and systemic issues within the larger health care system. Both participant types emphasized specific interpersonal qualities and the importance of integrated services. Conclusions: Screening and treatment may be influenced by the availability and advertisement of integrated services, institutional support, strong patient-provider relationships, and provider training and experience. For rural south central Appalachia women, limited mental health resources may make these factors even more salient.

Breast cancer remains a significant public health concern worldwide, with persisting disparities in several aspects of breast cancer care. Implicit bias has emerged as a potential contributor to these disparities. While previous research has examined implicit bias in healthcare, particularly in the context of racial and ethnic disparities, no review has been conducted to examine the association of physician implicit bias and breast cancer care. There remains a need for further investigation into its role in breast cancer care. This scoping review aims to systematically analyze the existing literature on physician implicit bias in breast cancer care to discern its potential influence on healthcare disparities. Through this analysis, we aim to identify key gaps and patterns in the literature, as well as to gain a comprehensive understanding of the role of physician implicit bias in breast cancer care. Our findings are intended to inform future research directions and contribute to the ongoing discussion on healthcare disparities and outcomes. The scoping review employed a systematic search strategy across three databases: APA PsycINFO, PubMed, and Web of Science. The search focused on articles examining implicit bias in breast cancer screening, diagnosis, and treatment/outcome disparities. Inclusion criteria encompassed studies published between 2013 and 2023, with data extracted and summarized using EndNote. Screening and methodological quality assessment were conducted by two undergraduate students, with discrepancies resolved through discussion and consultation with the thesis chair. Six articles were included in the scoping review, primarily focusing on treatment-related disparities. Self-administered methods, including the Implicit Association Test, were commonly used to assess implicit bias among healthcare providers. The studies highlighted demographic disparities among physicians and identified variables such as physician characteristics, patient experiences, and race/ethnicity as factors influencing implicit bias in breast cancer care. The scoping review identified a limited number of studies addressing implicit bias in breast cancer care, indicating a need for further investigation, particularly in the areas of screening and diagnosis disparities. The findings underscore the importance of considering both provider and patient perspectives in understanding and addressing healthcare disparities. Future research should explore demographic factors such as physician age and gender and continue to examine variables influencing implicit bias to inform interventions aimed at promoting equitable care for all breast cancer patients. It is important to acknowledge that although factors like mistrust may shape behaviors that could affect healthcare disparities, the few studies identified in this scoping review did not test whether a correlation exists between these factors and predictors of healthcare disparities. This highlights the necessity for further research to explore potential associations between physician implicit bias and healthcare disparities.