Background <p>Black women are under-represented in clinical research, contributing to persistent health inequities and undermining the validity and generalisability of research findings. Understanding facilitators and barriers to their research engagement is essential to addressing these challenges. This study aimed to identify and synthesise evidence on barriers and facilitators which influence Black women’s participation in healthcare research, to inform inclusive recruitment strategies and equitable research designs.</p> Methods <p>This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024587308). Findings were narratively synthesised using thematic analysis and discussed iteratively through Patient and Public Involvement. Five databases were searched (CINAHL, PsycInfo, Embase, MIDIRS, MEDLINE) for studies published since 2010. Papers in any language were screened for inclusion. Patient and Public Involvement members informed review objectives and data interpretation. Primary research studies reporting on Black women’s experiences, attitudes, and facilitators/barriers to participating in any type of healthcare research. Studies were included if ≥ 50% (to ensure primary representation) of the sample recruited were Black women.</p> Results <p>Seventy-two studies were included. Most were from America and spanned research areas relating to oncology, Human Immunodeficiency Virus (HIV), dementia, maternity, and general health. Five overarching themes identified how Black women’s participation in healthcare research is shaped by a complexity of factors. These were <i>mistrust</i>, <i>interpersonal experiences, altruism, self-interest, and low health/research literacy and awareness</i>. Patient and Public Involvement consultations concurred that the findings aligned with a “bridge and barriers” analogy, illustrating how various factors can facilitate or prevent Black women from engaging with research opportunities. This provided a clear framework to guide culturally sensitive implementation for researchers, healthcare professionals, and policymakers.</p> Conclusions <p>Inclusive strategies for recruiting Black women into research must focus on co-constructing a bridge between communities and research systems. This requires structural and systemic change in research delivery environments and ongoing collaborations with all stakeholders including Black women, healthcare system providers, and research teams.</p> Trial registration <p>PROSPERO (CRD42024587308).</p>