Development of a Conceptual Framework: How Being a Black Woman Affects Health and Well-Being

Background and Purpose: This study conducted formative research to support the development of a future Critical Consciousness (CC) health intervention to reduce Black women’s risks of HIV/STI exposure and problem drug use. We live in a society that systematically victimizes, exploits, and marginalizes people based on group membership such as gender, race, poverty or incarceration history. This constant maltreatment through structural forces and interpersonal experiences that disempower and devalue African American women can lead to maladaptive coping strategies such as risky sex, and drug use, thereby increasing HIV risks, rates of incarceration, and psychological and physical health problems. The importance of CC as a theoretical framework is twofold: first, CC is needed to understand the oppressive historical, social, political and economic forces and for action against these impediments that negatively impact health and well-being; and, second, CC facilitates consciousness and action against internalized oppression that unwittingly transforms people into their own oppressors. While research has explored the associations between discrimination and health, no research has explored how oppression affects the health of Black women. The proposed study addresses this gap by developing a conceptual framework of how experiences of oppression and marginalization may be linked to substance use problems and HIV/STI risk among Black women.

Methods: Six focus groups were conducted with 33 self-identified Black women (ages 18+) with substance use histories who reside in Newark, NJ and were recruited from outpatient treatment facilities using flyers and word-of-mouth. Focus groups used a Freirian-based critical dialogue technique, to explore participants’ understanding of structural and individual-level oppressive/marginalizing factors that may influence substance use and HIV/STI risk. Focus groups were transcribed verbatim and coded thematically using Dedoose, guided by a constructivist grounded theory (CGT) method. With CGT, knowledge is not only generated from the data shared by respondents, but by the researcher’s pre-existing knowledge and understanding of the social phenomenon. Data analysis followed a systematic process, which included: initial coding, focused coding, and theoretical coding.

Findings: Thematic analysis and descriptive statistics from the survey suggested that although participants experienced racism, sexism and other oppressive experiences due to marginalized statuses, many did not consciously identify a connection between those experiences and their health, HIV/STI risk, or substance use. However, the data revealed several pathways from oppression to HIV/STI risk and substance use at the individual, interpersonal and community levels that included internalized oppression, toxic stress, low self-esteem and strained unhealthy interpersonal relationships on which an intervention could focus.     

Conclusions and Implications: The study developed a conceptual framework that can be used to develop and test interventions. Findings highlight the importance of critical consciousness to build self-esteem, repair relationships, and empower communities. By developing interventions grounded in critical consciousness theory, attacking oppression and internalized oppression becomes the clinical intervention that can address health risk factors at multiple systemic levels from the individual to the community.