Perspectives Of African American Women Research Articles

A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions for African American Women: Implications for Promoting Health Equity.

African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47-4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation.

Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities.

BackgroundAfrican American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women’s views of what puts them at risk.AimsThis study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services.MethodsWe conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim.ResultsWomen identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population.ConclusionAfrican American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.

Perspectives of African American women about barriers to breast cancer prevention and screening practices: A qualitative study.

Breast cancer is a severe illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The study aimed to identify barriers to preventative screening for breast cancer among African American women (AAW) using a qualitative research design. We explored the influence of personal barriers, stereotypes, socioeconomic status, culture, attitudes, and beliefs on African American women's behavior regarding breast cancer screening. Fourteen African American women were interviewed. Data analysis was completed with Interpretative Phenomenology Approach (IPA). This study's findings demonstrated that African American women perceived the barriers to breast cancer screening include lack of information about available resources, belief that screening cannot change genetic predisposition, embarrassment from exposing the breast for a mammogram, fear of mammograms, and fear of a positive result. These findings may be used to develop interventions to increase AAW's participation in breast cancer screening.

Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities

Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities

Not a Death Sentence: Perspectives of African American Women Living With Lung Cancer .

To conduct a descriptive, qualitative study to describe the experience of female African American lung cancer survivors, their perception of living with lung cancer, and their desire and ability to adopt positive health-related behaviors. . The sample consisted of 18 African American women with a history of stages I-IIIa lung cancer. Three focus groups were conducted in a private conference center in two community hospitals in the southeastern United States. . A 20-item questionnaire was used to collect demographic, health status, and behavior information. A trained moderator led the audio-recorded focus group discussions using a semistructured interview guide. . Thematic analysis of the professionally transcribed data resulted in identification of four major themes. In addition, participants experienced stigma that influenced their perspectives on living with lung cancer. . Healthcare professionals should provide culturally tailored communication and support for female African American lung cancer survivors. Additional research is needed to inform the development of interventions focused on health behavior change to enhance lung cancer survivorship in this vulnerable and understudied group.

Abstract C57: Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework

Abstract Backgrounds: African American women have a higher mortality rate from breast cancer than any other ethnic group in the country, with an estimated 30,700 new cases of invasive breast cancer and 6,310 deaths expected to occur in 2016. In part the disparate breast cancer mortality rate suffered by African American women can be attributed to irregular mammography screening patterns, which contribute to later stages of diagnosis as compared with other racial ethnic groups. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity; however, African American women underutilize mammography screening according to goals set by Healthy People 2020. The purpose of this paper is to identify factors influencing regular breast cancer screening among African American women. Method: In-depth individual interviews were conducted with 39 African-American women, ranging in age from 42 to 79, who visited the ED of a public hospital with non-urgent complaints and those who were seated in the waiting area. Using qualitative analysis we identified Perceptions (individually held knowledge, attitudes, values or beliefs), Enablers (societal, systematic or structural influences) and Nurturers (supportive or discouraging influences from significant others) that influenced screening decisions. The sample included women who had been screened in the past two years and those who had not. Using the PEN-3 as a theoretical guide we explored, from the perception of the women, the factors that influence screening behaviors. Findings: The themes that emerged were placed within the appropriate cells (perceptions, enablers or nurturers) in the PEN-3 framework. The findings indicated that women's perceptions included fear of pain associated with mammography, fear of results, and fear of the unknown, fatalistic beliefs, and limited knowledge of personal risk for breast cancer. The only difference between the perceptions of women who had screened in the past two years and never screened women was knowledge. Women who had been screened in the past two years had more knowledge of mammography procedure and endorsed perceptions such as screening provides reassurance and maintenance of good health. Enablers identified included cost, access, gender and attitudes of the mammography provider, socioeconomic and race related discrimination, and previous experiences within the healthcare system. Previously screened women were more likely to have a source of insurance but both screened and unscreened women discussed financial burden associated with screening. Participants in both screened and unscreened groups emphasized the fact that their previous experiences within the healthcare influenced screening decisions. Nurturers identified included observations of family member's experiences with cancer, lack of health-related social support and shared mammography experiences within participants' social network. Women who receive encouraging feedback about mammography from their social network are more likely to have been screened. Conclusion: African American women suffer a significant disparity of breast cancer mortality as compared to other women in the U.S. Despite improvements in access, related to the enactment of the Affordable Care Act, this disparity persists. This study explores the influences on the decisions related to regular mammography screening from the perspective of African American women. The findings from this study underscore the critical need for development of culturally tailored interventions that address the issues salient to this population as well as interventions that leverage the powerful social networks that influence health care decisions in this population. Citation Format: Adebola Adegboyega, Arica Brandford, Jennifer Hatcher. Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C57.

Using Community-Based Participatory Research to Investigate Meaningful Prenatal Care Among African American Women.

In the United States, African American babies die more than twice as often as White babies. The cause for this difference remains elusive, yet is likely complex with one factor being inadequate cultural care of pregnant African American women. The purpose of this study was to explore African American women's perspectives of meaningful prenatal care. Community-based participatory research was employed for this study using photovoice. The sample included 11 African American mothers in an urban community in Midwestern United States. Five themes were abstracted from the data: (1) Access to Care; (2) Soul Nourishment; (3) Companionship; (4) Help Me, Teach Me; and (5) The Future. Meaningful prenatal care is influenced by culture. African American women need physical, social, and soulful support to enhance meaningfulness of care during pregnancy. The findings support that meaningfulness of prenatal care for African American women may be enhanced by accessible and uniquely designed, culturally congruent models of prenatal care.

African American female students in online collaborative learning activities: The role of identity, emotion, and peer support

The aim of the present study was to explore how African American female students perceived their experience of online collaborative learning. A qualitative study was conducted in a university in Southeastern United States. We conducted semi-structured interviews with nine African American female students in an online multimedia instructional design course. Data triangulation was achieved by including the analysis of the students’ emails, their posts on online chat room and bulletin boards. Results revealed that the perspectives of African American women towards online collaborative learning could be categorized into three themes: (a) peer support perceived as a give-and-take process with a sense of fairness, (b) group member role as a formation of identity, and c) “frustration” as a common response to differing levels of peer participation and interaction. These emerging factors reflected African American women’s perceptions towards online collaborative learning and provided profound implications for future research and practice.

Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care.

Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women's perspectives on barriers and facilitators to receiving PNC in an urban setting. We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes. Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support. Findings suggest important components in an ideal PNC model to engage low-income African-American women.

Perspectives among a Diverse Sample of Women on the Possibility of Obtaining Oral Contraceptives Over the Counter: A Qualitative Study

BackgroundThere is increasing support among stakeholders in the United States to make oral contraceptives (OCs) available over the counter (OTC). Previous research on the topic has focused on representative samples of U.S. women, Latina women, low-income women, and abortion clients. However, little is known about the perspectives of African American women, Asian American women, and young women. MethodsWe conducted 14 focus group discussions with 138 women. Twenty-three percent of participants were ages 18 or younger, 61% were African American, and 26% were Asian American/Pacific Islander. Community organizations recruited participants through convenience sampling and hosted the discussions. Focus groups were transcribed and coded thematically. FindingsWomen reported potential benefits of OTC access, including convenience and privacy. Many believed OTC availability of OCs would help to reduce unintended pregnancy and help to destigmatize birth control. Participants also expressed concerns about OTC access, such as worry that first-time users and young adolescents would not have enough information to use the pill safely and effectively, as well as concerns about whether women would still obtain preventive screenings. Women were also worried that the cost of OTC OCs would be higher if insurance no longer covered them. ConclusionsOverall, women were interested in the option of obtaining the pill OTC. Future research and advocacy efforts should explore women's concerns, including whether adolescents can effectively use OTC pills and ensuring insurance coverage for OTC contraception.

Qualitative Examination of African American Women's Perspectives about Depression

Gaining greater understanding about the various psychosocial, socio-cultural, and environmental factors that may influence experiences of depression among African American women (AAW) helps elucidate how this mental illness impacts the lives of this population. Sixty-three adult AAW comprised the study’s convenience sample. Specifically, focus group cohorts inclusive of women from an academic institution, a primary healthcare clinic, and an urban community setting were conducted. Results indicated six (6) dominant common themes as issues that may increase risk for depression among diverse AAW. Similarities and differences about perspectives that contributed to depression were delineated among the three cohorts of AAW. These results are important for mental/behavioral health researchers, practitioners, and public health professionals that are engaged in the design and implementation of culturally centered and gender-specific prevention and intervention strategies targeted to AAW at risk for depression.

Diabetes Connect: African American Women's Perceptions of the Community Health Worker Model for Diabetes Care.

Community health worker (CHW) interventions have potential to improve diabetes outcomes and reduce health disparities. However, few studies have explored patient perspectives of peer-delivered diabetes programs. The purpose of this qualitative study is to investigate possible benefits as well as risks of CHW-delivered peer support for diabetes from the perspectives of African American women living with type 2 diabetes in Jefferson County, Alabama. Four ninety-minute focus groups were conducted by a trained moderator with a written guide to facilitate discussion on the topic of CHWs and diabetes management. Participants were recruited from the diabetes education database at a safety-net hospital. Two independent reviewers performed content analysis to identify major themes using a combined deductive-inductive approach. There were 25 participants. Mean years with diabetes was 11.2 (range 6months to 42years). Participants were knowledgeable about methods for self-management but reported limited resources and stress as major barriers. Preferred CHW roles included liaison to the healthcare system and easily accessible information source. Participants preferred that the CHW be knowledgeable and have personal experience managing their own diabetes or assisting a family member with diabetes. Concerns regarding the CHW-model were possible breaches of confidentiality and privacy. The self-management strategies and barriers to management identified by participants were reflected in their preferred CHW roles and traits. These results suggest that African American women with diabetes in Alabama would support peer-led diabetes education that is community-based and socially and emotionally supportive.

Online collaborative learning activities: The perspectives of African American female students

This exploratory study examined the perspectives of African American female students toward online collaborative learning. The participants were nine African American female graduate students in an online multimedia instructional design course in the southeastern United States. A qualitative study was conducted, with data obtained from open-ended interviews, along with relevant posts on chat rooms and online bulletin boards in relation to an assessable collaborative online assignment. Data revealed that the perspectives of African American women toward online collaborative learning could be categorized into four themes, including (a) preference to work in a racially mixed group, (b) preference to be a leader in the group, (c) learning-oriented reasons (rather than social or peer oriented reasons) for online collaborative learning, and (d) timid attitude toward online discussions.

Review and evaluation of faith-based weight management interventions that target African American women.

This integrative review was conducted to present results of the use of recommended criteria to evaluate faith-based weight management interventions (WMIs) that target African American women. This group experiences the highest prevalence of adult obesity in the US when compared to other ethnic groups. "Best practice" WMIs can help to alleviate obesity. Faith-based interventions hold promise for helping to address the problem of obesity in African American women since a significant portion of these persons views the church as a trusted entity that advocates for their well-being. No systematic evaluation of faith-based WMIs has been reported even though there is an ongoing plea for the need for better evaluation of health interventions that prioritizes comprehensive description of their attributes (e.g., linkage to theory, interventionists' background, and dosage) to enable replication and a broader assessment of their validity to include appropriateness and feasibility). Critique criteria were applied to faith-based WMIs (n = 5) that target African American women. Findings highlighted the need for increased disclosure about the (1) interventionists' background, (2) intervention's location within the church setting, and (3) nature of any "pre-intervention"’ treatment. The review also indicated the need for interventions that are (1) designed from robust research methodologies (effectiveness) that include randomization of both church setting and participants, (2) deemed appropriate from the perspective of African American women targeted, and (3) are financially feasible-without steep participant incentives/implementation costs that compromise internal validity and any positive outcomes generated.

Exploring Media’s Impact on African American Women’s Healthy Food Habits in Kentucky

This qualitative study employs the uses and gratifications framework to explore the perspective of African American women in Kentucky, specifically urban Louisville and rural Hopkinsville, to understand their use of media as potential sources for gathering information about healthy food habits. Key findings include how the participants used media for instrumental purposes to educate themselves about healthy food habits, and that the specific media personalities were very important to the participants as they decided to make healthier food selections.

African American Women's Perspectives on Breast Cancer: Implications for Communicating Risk of Basal-like Breast Cancer

African American women suffer a disproportionately high burden of basal-like breast cancer, an aggressive subtype that has no targeted therapy. While epidemiologic research has identified key prevention strategies, little is known about how best to communicate risk to this population. This study explored women's knowledge, beliefs, and attitudes about breast cancer to learn about risk perceptions. Six focus groups were conducted in North Carolina with 57 women (ages 18-49). Age, race (especially perceptions of cancer as a "White disease"), and lack of family history of breast cancer were all shown to contribute to women's perceptions of low breast cancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little to no knowledge of breast cancer subtypes, and emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These findings will assist in developing health communication tools that encourage prevention.

African American Women's Perspectives on Breast Cancer: Implications for Communicating Risk of Basal-like Breast Cancer

African American Women's Perspectives on Breast Cancer: Implications for Communicating Risk of Basal-like Breast Cancer

“You Learn to Go Last”: Perceptions of Prenatal Care Experiences among African-American Women with Limited Incomes

African American infants die at higher rates and are at greater risk of adverse birth outcomes than White infants in Milwaukee. Though self-reported experiences of racism have been linked to adverse health outcomes, limited research exists on the impact of racism on women's prenatal care experiences. The purpose of this study was to examine the experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood. Transcripts from six focus groups with twenty-nine women and two individual interviews were analyzed to identify important emergent themes. Validity was maintained using an audit trail, peer debriefing, and two individual member validation sessions. Participants identified three areas of perceived discrimination based on: (1) insurance or income status, (2) race, and (3) lifetime experiences of racial discrimination. Women described being treated differently by support staff and providers based on type of insurance (public versus private), including perceiving a lower quality of care at clinics that accepted public insurance. While some described personally-mediated racism, the majority of women described experiences that fit within a definition of institutionalized racism-in which the system was designed in a way that worked against their attempts to get quality prenatal care. Women also described lifetime experiences of racial discrimination. Our findings suggest that African American women with limited incomes perceive many provider practices and personal interactions during prenatal care as discriminatory. Future studies could explore the relationship between perceptions of discrimination and utilization of prenatal care.

African American women's perspectives on ‘down low/DL’ men: implications for HIV prevention

African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as ‘down low’ or ‘DL’. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.

Battle Cries: Black Women and Intimate Partner Abuse ‐ by Hillary Potter

Battle Cries: Black Women and Intimate Partner Abuse. Hillary Potter. New York: New York University Press. 2008. 273 pp. ISBN 9700814767306. $23.00 paper. Battle Cries is Hillary Potter's analysis of interviews with 40 Black women who have left their abusive male partners. The book is rich with these women's perspectives on their own experiences (and often their perceptions of how their experiences differ from those of abused White women), providing us with multiple, concrete reminders that there is no universal woman. The experiences of these particular Black women are the foundation for Potter's most general point: We must not address intimate partner abuse from a belief that the experiences of this abuse are similar across races, ethnicities, cultures, nationalities, and sexual orientation (p. 200). Of course, as with all good qualitative work, this book gets well below such abstractions to illustrate the concrete ways in which the fact that these women are of African descent living in the contemporary United States inflects their experiences. Four substantive chapters are the heart of the book. Surviving Childhood covers the women's perceptions of the relevance of fheir childhood experiences for their adult reactions to abuse. Many of them had experienced or witnessed violence, and those experiences affected them in dramatically different ways. For example, for some of the women, observing the abuse of their mother led to a determination not to live with such abuse themselves, whereas for others, the experience kept them from recognizing their own abuse as quickly as they might have had they grown up in a more peaceful setting. Living Through provides a rich description of the structure of the abuse the women experienced, a description that validates the long line of feminist research that documents the role of coercive control in male intimate terrorism (Johnson, 2008). Fighting Back documents the resistance, both physical and otherwise, that characterizes most of these women. Although Potter emphasizes the cultural tradition of the strong Black woman as a major reason that Black women resist abuse, I was struck more by the extent to which these women's reactions sound very much like those described in other research on women dealing with coercive controlling violence. Despite Potter's tendency to label every behavior of these women as resistance, I strongly recommend the chapter as a rich discussion of the meaning and dynamics of resistance for these Black women. I have argued elsewhere that violent resistance is one of the most understudied types of intimate partner violence, and Potter's book is an important contribution to that literature. Getting Out is the final substantive chapter. It is the longest chapter in the book and discusses the diverse and complicated paths by which these women escaped from their abusers. Again, I would argue that most of this process is similar to that described in other studies of women who have left their abusers (e.g., Kirkwood, 1 993) but with elements that are specific to the experiences of African American women. For example, a number of the respondents reported that they were concerned about the stigma of being another single Black mother or were worried that if they left their partner they would deprive their children of a male role model - in short supply in their communities. The substantive chapters make Battle Cries a particularly rich addition to the research literature regarding (a) the dynamic and creative means by which women cope with intimate partner abuse and (b) the particular perspectives of African American women on that experience. In my view, Battle Cries is for that reason essential reading for professionals in the field, both researchers and practitioners. Two major concerns, however, temper my positive feelings about the book. First, the book did not get the editing it deserved. I found myself frequently confused by the author's sentences or lines of argument, and it was not unusual for me to conclude that I was indeed dealing with contradictions and non sequiturs. …