UCSF

Although disproportionately high rates of chronic disease and limited access to medical care are consistently reported among Black American women, there have been few empirical studies of the ways in which Black women themselves navigate illness experiences. Individual choices in responding to illness have the potential to support specific physical, social psycho-emotional, and spiritual priorities. Women who are members of cultural and religious communities often engage shared meanings as they interpret their circumstances and construct strategies for response. This dissertation identifies common themes in religious Black women’s experiences of chronic illness, explicates the meanings and strategies important in their responses to illness, and describes the effects of these strategies in their lives. Qualitative interviews were conducted with religious Black American women diagnosed with at least one chronic illness in San Francisco and the surrounding Bay Area. Recruitment took place in African Methodist Episcopal (AME) and Baptist churches, and in local organizations addressing the health needs of women of color. Data was collected through extensive participant observation and Photovoice, a participatory-action ethnographic research method designed to facilitate participants’ active role in directing research around issues that affect them. Semi-structured participant interviews utilized photo-elicitation methodologies, in which participants’ photographs served as illustrative prompts to guide and contextualize descriptions of social and physical experience. In narrative and visual analysis, several themes emerged regarding women’s changing relationships to divinity, other people, and themselves. Religious and organizational communities establish structure for members to seek and provide one another with meaningful support, yet also frequently promote interpretations that encourage women to prioritize the needs of others over their own. Changing social expectations and physical abilities constituted an ongoing challenge to each woman’s personal identity. Participants characterized faith as an orientation towards possibility, particularly in contexts of normalized uncertainty. Participant narratives describe coping as a nuanced, strategic process of response, guided by an individual’s priorities in responding to illness. Insight into collective systems of meaning can facilitate the development of social supports that address the immediate concerns of chronically ill individuals, particularly those who are members of systemically underserved populations.