Community Perceptions of Health Equity: A Qualitative Study.

INTRODUCTION: Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. METHODS: In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. RESULTS: The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. CONCLUSIONS: Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.

Dating Behaviors of Older Black Women.

The complexities of older Black women's dating behaviors and preferences were uncovered in this phenomenology study with 14 older Black single and/or widowed women. The participants recognized that, as older Black women, their sexuality did not simply pertain to whether they were dating, it encompassed various factors that influenced their decisions about whether to date. These factors were categorized into three major themes: pursuing intimacy, dating preferences, and barriers to dating. The adoption of the Black feminist standpoint theory helped to understand their dating experiences in the context of the participants' Blackness. The women's subjective experiences with dating and the challenges that they face as older Black women demonstrated the complexities and intersections of race, gender, class, and age within this contextual analysis. These findings hold important practical implications for understanding the influence of the older women's Blackness on their experiences and how it shapes their dating behavior. These understandings will help social workers and gerontologists better appreciate and validate older Black women's self-determination in their dating choices and the need to support them.

Living in a Paradox: How Older Single and Widowed Black Women Understand Their Sexuality.

The current phenomenological study explored how single and/or widowed older Black women understand their sexuality in the context of their Black matriarchal role and through their relational interactions with their children, families, friends, and their extended social networks. The women spoke about their sexuality in the contexts of Black matriarchy, concept of self, and communication. Black matriarchy was defined as the tenacity with which, as Black women and Black mothers, participants occupied a centralized role in their families, while concept of self reflected heavily on conflicting perceptions they held of their understanding of themselves as sexual beings. Regarding communication, many participants felt constrained in self-disclosing their sexual feelings and relationship status. Living in a paradox exemplified our interpretation of the women' struggles as they tried to balance the expectations of the roles they occupied in society with their own identity as a sexual being. Our findings offer a nuanced exploration of the various dimensions about how they understand themselves by providing invaluable insight into their world as older Black women. The implications for policy and practice pertain to assessing the fundamental historical and contemporary issues that older Black women face while simultaneously considering the convergence of race, gender, and sexuality.