Sis, Throw Your Cape Away: A Qualitative Study of Black Women's Lived Experiences and Perceptions of Health and Wellness

Abstract

Black women in the United States bear a disproportionate burden of chronic disease, mental health challenges, and adverse healthcare experiences — disparities rooted in a legacy of historical medical exploitation, systemic racism, and gendered oppression. Despite extensive documentation of these inequities, existing research remains limited in centering Black women's lived experiences and perceptions as the primary unit of analysis. This dissertation addresses that gap by examining Black women's perceptions of health and wellness through two culturally congruent frameworks: Superwoman Schema (SWS) and Black Feminist Theory (BFT). Eighteen focus groups (N = 81) were conducted with Black women across Virginia between January and December 2024, facilitated by Black women researchers and analyzed using Braun and Clarke's six-phase thematic analysis. Deductive codes informed by SWS and BFT were integrated with inductive coding to generate themes across two manuscripts. Manuscript 1 examined Black women's perceptions of physical activity and mental health. Five themes emerged: Mental and Emotional Health; Health Infrastructure; Burden of Black Womanhood; Societal Imposition; and Divine Intervention. Participants described physical activity primarily as a form of emotional regulation and identified key barriers and facilitators, including therapist concordance, hair politics, expectations of strength, and religious framing. Manuscript 2 examined Black women's experiences within clinical settings. Two themes emerged: Health Infrastructure and Medical and Clinical Experiences. Participants expressed a strong preference for racially and gender-concordant providers and described pervasive experiences of dismissal, medical mistrust, and traumatic clinical encounters across generations. Collectively, findings demonstrate that SWS and BFT are complementary analytical frameworks that illuminate how intersecting racialized and gendered expectations shape Black women's health behaviors and healthcare engagement. Perceived safety, cultural responsiveness, and patient-provider relationships are not ancillary components of care — they are central determinants of Black women's health outcomes. This research contributes to a growing public health evidence base that is not only designed to study Black women, but to be accountable to them.