Ethnic notions and healthy paranoias: understanding of the context of experience and interpretations of healthcare encounters among older Black women

Abstract

Objectives. To report the first-hand perspectives of older Black women within healthcare encounters that impact the trajectories of health-seeking behavior; to examine their perceptions, expectations, and beliefs about the role of cultural difference within predominantly White (US) healthcare settings; and to explore how sharing personal experiences (theirs and others’) as a fund of knowledge influences ethnic notions. This research is aimed at the development of community resource partnerships and effective healthcare service delivery with intervention and promotion efforts targeting older Black women.

Design. Ethnographic data collected over a 24-month period (2003–2005) from 50 older Black women in Tucson, AZ, USA are discussed on three levels: (1) expectations and beliefs; (2) the use of ethnic notions in the form of healthy paranoias as part of individual and communal health advocacy; and (3) perceptions of interethnic communication within healthcare settings, including feeling uncared for by healthcare providers and support staff.

Results. Disparities in older Black women's health and well-being are often constructed and filtered through ‘non-clinical’ influences, such as cultural differences, individual experiences, and beliefs about ‘race’ or ‘being’ a Black female.

Conclusions. Unfamiliarity with ethnic notions may cause misinterpretations and misunderstandings and may influence interactions between older Black women and healthcare providers.

Keywords:

• race
• older Black women
• ethnic notions
• healthcare
• ‘having to fight’
• interethnic communication
• funds of knowledge
• healthy paranoias

Acknowledgements

This study was supported by a grant from the National Institutes of Health/National Institute on Aging (F31-AG021329), and the writing was supported by NIH/NCCAM R01AT003314-03A1-S1. Thanks are extended to Victoria Stephani, Ph.D., for her assistance in reviewing the original dissertation work and for providing insight and suggestions in the revisions of this article; to Mimi Nichter, Ph.D., for her supervision of the doctoral dissertation from which this is derived; and to Cheryl Ritenbaugh, Ph.D., MPH, for her mentoring during postdoctoral period.

Notes

1. Hirschfeld's (1997) discussion of ‘race as a category of the mind and/or a category of power’ specifically notes that identity by ‘race’ is part our social fabric, as a category of the mind among Whites and African-Americans. Being predisposed to be on the receiving end of various acts of racial bias, such as discrimination, segregation, or physical attack is often part of a socialized, and culturally shared ‘unquestioned belief’ due to the racial status of ‘being’ Black in US society. In other words, as a category of the mind – racial bias may be ‘out of sight but never out of mind’ for Blacks (defined by Earl V. Pollard, personal communication, 22 Aug 2002).

2. The term Black experience is used in Kehoe's (2000) paper to refer to experiences in healthcare/clinical encounters and interactions with the healthcare system as perceived by the older Black women. These were often specifically focused on how the use of racial stereotypes emerged as disrespectful/inconsiderate treatment or their perceptions of discriminatory practices in those settings.

3. ‘Constructionism shapes the way in which we see things (even in the way we feel things) … and gives us quite a different view of the world … constructivism is the capacity to construct reality’ … it is the meaning making activity … how we are interpreting and constructing reality (Crotty 1998, p. 58). The perspectives offered by both sociocultural constructionism and constructivism proved most useful in the analysis and interpretation of the data for this ethnography.

4. I was able to address my concerns by implementing the following techniques suggested by Lincoln and Guba (2000): I used prolonged engagement, persistent observation through face-to-face interviews, triangulation during data collection and data analysis, peer debriefing, and finally member checks in which my working hypothesis were presented at a health-focused town hall meeting held in the local African-American community. All participants were invited to attend. I provided thick descriptions, I compiled an audit trail, and finally kept a self-reflexive journal as the backbone for keeping a study record of observations about the research.