Abstract P6-05-46: Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context

Abstract

Abstract Background: Marked disparities exist for African American women, relative to non-Latina white women, in the five-year survival rate for breast cancer. Black women breast cancer survivors also demonstrate relative disadvantage in specific quality of life (QOL) domains, persisting through at least two years after diagnosis. Although Black women have higher QOL in the spiritual domain relative to white women, disparities include lower physical QOL, as well as more pronounced depressive symptoms, perceived stress, fear of dying, unmet supportive care needs, and financial distress, with younger Black women (< 50 years) particularly at risk. African American breast cancer survivors also report receiving too little information from their oncologists during diagnosis, treatment, and follow-up care. Sociodemographic and medical factors only partially explain the QOL disparities. The goal of Project SOAR (Speaking Our African American Realities), a community-academic partnership, is to interrogate the potential relevance of the Strong Black Woman (or Black Superwoman) schema in the breast cancer context. The schema involves historically grounded expectations to prioritize caregiving over self-care, suppress emotions, present an image of strength, decline support, and strive to achieve success without adequate resources. Method: Black women were recruited via relevant email listservs and flyers distributed at local breast cancer events to take part in a study “to understand the unique experiences of African American women and their views on the Strong Black Woman concept as it applies during their breast cancer experience.” Eligibility criteria were self-identification as being: 1) an African American woman (or a Black woman living in the United States); 2) diagnosed with breast cancer (any stage, any diagnosis duration); 3) at least 21 years old; and 4) able to communicate in English. Three Gatherings (i.e., culturally curated focus groups) were held as half-day experiences in intimate settings (e.g., private homes, a church) in three California cities (Sacramento, Oakland, Los Angeles). Gatherings provided an entirely Black women’s space to discuss the breast cancer experience and the relevance and consequences of the Strong Black Woman schema, break bread together, and engage in an inspiring activity. Reflexive thematic analysis was conducted on the Gatherings transcripts with a critical realist, contextualist approach. Results: All participants (N = 37; age range = 30-94 years; M = 59 years) had heard of the concept of the Strong Black Woman. Reflexive thematic analysis yielded six themes: 1) historical legacy of Strong Black Woman; 2) navigating intersecting Strong Black Woman identities; 3) everyday challenges encountered on the battlefield by Strong Black Women; 4) Strong Black Woman in action during the breast cancer journey; 5) the complexities of seeking and accepting support; and 6) the liberated Strong Black Woman. Participants linked both negative and positive consequences with the Strong Black Woman schema. Negative consequences included the oncologic team and others expecting them to be strong and not to need support, as well as expectations of themselves to suppress emotions and to continue caring for others to the neglect of caring for themselves. Positive consequences included engaging in self-advocacy in the oncologic context, having a sense of resilience, and redefining strength to include expressing emotions and accepting help from others. Conclusion: Qualitative analysis revealed the relevance of the Strong Black Woman schema in the breast cancer context, as well as its negative and positive consequences. Future research can assess whether oncologic professionals’ awareness of the schema is useful in ensuring they offer support and refer Black women diagnosed with breast cancer to culturally relevant supportive resources. Citation Format: Tammie Denyse, Kimberly J. Martin, Yrvane K. Pageot, Praise Owoyemi, Annette L. Stanton, Jacqueline H. Kim. Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-46.