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Perceptions of Black Women’s Health: Focus Group Report

Professor Bush, May 2022

By: Lucie James, Carly Toth, Grace Wharton, Elena Duncan, and Maggie Smith
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Situation Overview
GCI Health is a healthcare communications agency, founded in 2010 and headquartered

in New York, that is committed to people, driven work and programs. There are many racial

disparities among Black Women in the United States, especially in healthcare. According to the

Center for Disease Control, Black women are reported to be two to three times as likely to die of

a pregnancy-related cause than White women. Likewise, social and economic disparities that

prevail in the United States lead Black women to have a higher rate of diabetes, obesity, blood

pressure, depression, stroke, and Alzheimers. GCI Health is collaborating with Elon University

to determine what “healthy” looks like to Black women on college campuses.

This research will be used to create a dialogue that will lead to a better understanding of

the challenges Black women and girls face in pursuing optimal health, and identify the steps

needed to break down those barriers. This will facilitate more discussions about the health

disparities Black women face, and will be published. This will allow the public to help Black

women find supportive resources and create a vision of health that is inclusive, specific, and

what Black women can identify with.

Research Objectives and Research Questions

Our research objective is to determine what “health” looks like to Black women on

college campuses. Additionally, we want to determine participants’ personal visions of good

health, challenges or barriers faced in pursuit of good health, as well as support and information

needed to achieve their personal health goals. Through a focus group facilitated with Black
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women on the campus of North Carolina A&T, we are aiming to answer the following research

questions with qualitative data:

1. What does being “healthy” mean to Black women on college campuses?

2. What does “healthy” look like to them?

3. How does representation in their physical environment (i.e., PWI vs. HBCU) impact their

perceptions of health, if at all?

4. How frequently do participants seek care – for well visits, regular doctor’s visits,

specialists, etc.?

5. Outside of healthcare visits, what behaviors do participants engage in to maintain good

health? (e.g., eating habits, exercise, mental well-being, etc.).

6. ​What barriers or challenges do participants face in seeking/maintaining preventative care

and general wellness?

7. What types of health-related environments do participants feel supported in? What does a

supportive environment look like/feel like when participants are able to access health and

wellness-related care?

8. What support or information do they need to achieve their optimal vision of good health?

Procedures and Methodology

To obtain qualitative data regarding the research topic, we conducted a focus group via

Zoom. We had 3 total participants in our focus group. All participants were young black women

between the ages of 18 and 21 who were students at North Carolina A&T, a historically black

college/university (HBCU). During the focus group, we discussed how the participants define
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health, influences on their perceptions of health, their healthcare needs, their healthcare

challenges, and how attending an HBCU impacts their health.

To analyze our data, we first read over the transcript of the focus group. Then, after

taking notes on their answers, we created 5 different logical themes to code the transcript:

Personal Definition of Health, Balancing Mental and Physical Health, Awareness to Health

Challenges/Family Health, Relationships with Healthcare Provider, and Improvements Needed

for Health Resources. The research team then went through the entire transcript and divided the

participants’ answers into one of these 5 categories in order to analyze the data.

Participant Index
To protect the privacy of our participants, we will make references to them as Participant 1, 2, and

3. The following is a list of speakers and their corresponding demographics.

● Participant 1: Senior, Black Female

● Participant 2: Senior, Black Female

● Participant 3: Junior, Black Female

Detailed Findings
Personal Definition of Health

When discussing the meaning of health, participants in the focus group had similar ideas

on the definition of health and what it personally means to them. Generally, participants look at

health as including both mental and physical aspects, and creating a balance between the two.

Specifically, participants felt that even if one is physically healthy, this doesn’t necessarily mean
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overall health is the best. Participant 3 described being healthy as being “...physically, mentally,

and spiritually content.” Participants generally had a strong understanding of health and what

optimal health can look like. Participants were even open about sharing parts of their lives where

they aren’t healthy or lacking even though they have an awareness of what is “healthy.” For

example participant 2 shared that breakfast is often a meal skipped and her sleep schedule is not

perfect. These are aspects that can lead to an unhealthy lifestyle, and participant 2 was even

aware of that. Additionally, when moderator 1 asked what the word healthy means, participant 1

explained that there are stereotypes when it comes to what healthy means but defined it as “...if

you have control over what you eat and how, then that’s healthy to me.”

Within the focus group there was discussion around health being more than just physical,

and nowadays there is more emphasis on the mental side. When participants were shown a

healthy person and asked what this looks like to them, more of those mental aspects appeared in

their responses. For instance, participant 1 said “The first thing I noticed is she looks happy, so I

guess that correlates with health, like the state of your position in life.” When thinking about

health beyond the physical appearance, state of being becomes of importance, this was also

echoed by participants 2 and 3. While it can be overwhelming to think of all aspects of a healthy

lifestyle and trying to accomplish them, the majority of the participants felt that a routine is one

of the most important ways to stay healthy. For instance participant 2 said “When I think of

smart people, I think of the routine that they go by.” In regards to the figure shown by the

moderator, participant 2 felt that the figure must have a healthy routine of working out, eating,

and taking care of themself.

Along with creating a routine and maintaining physical health, participants agreed that

organization in life can create a healthy lifestyle. When addressing what the figure’s healthy
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actions would consist of, participant 3 said “She would have a computer with her or maybe a

planner, so I would think she is organized and that can help you mentally, making sure that

everything is in order.” This lead to a discussion around the pros of having an organized lifestyle

as this can lead to having a decent job and having overall better mental health. Participants also

felt that talking with others or writing things out can alleviate stress and improve mental health,

which then improves their physical health and overall well-being. Participant 2 explained, “There

are certain situations or thoughts that I keep in my head, or even writing it out can help to see

what I need to do next, or what I should do.” This also goes back to this sense of organization

and how participants felt that if parts of their life are put together then they are able to succeed in

other facets, which all helps to create an overall healthy lifestyle. Participants had a pretty fair

understanding of health, as well as an awareness to where they stand in terms of their personal

lifestyle.

Balancing Mental and Physical Health

As previously mentioned, when asked to define what health means to them, all three

participants emphasized the importance of mental well-being. For instance, when asked to define

what health is to them, Participant 1 said the word control comes to mind and that, “There's a lot

of different stereotypes on what healthy is like how many times we’re supposed to eat in a day

and how much you’re supposed to weigh, but I feel like if you have control over what you eat

and the stuff you eat, that’s healthy to me.” Participant 2 agreed, noting that health is made up of

physical health and mental health, but added that the first thought that came to her mind when

defining health was “going to the gym.” Additionally, Participant 2 went on to say how “self

care” comes to mind when speaking about health and part of that includes balancing physical
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health and mental well-being. When Participant 3 was asked to define health, she avidly agreed

saying, “I feel like being healthy is being mentally, physically, emotionally, and spiritually

content, because I feel like there's always going to be a time where maybe one of them is kind of

falling off, but overall, everything is in balance.” Overall, balance was a very important factor in

all the participants' definitions and perceptions of what being healthy looks and feels like.

The moderator showed a photograph of a young black woman in a library and asked the

participants to describe what kinds of things they believe “Regina” does to be healthy.

Participant 2 believed that Regina must have a “routine” and that hopefully she eats at least twice

a day, maybe three. Participant 1 noted that her own sleep schedule is decent and she thinks

Regina gets a good amount of sleep and exercise. She went on to say that Regina probably ate

breakfast and that Participant 2 herself tries to eat breakfast everyday and knows “it's bad for you

to skip it”. These perceptions of physical and mental health needing to balance each other out

shows that the participants’ perceptions of health waver between spiritual well-being and being

in tune with your body. Participant’s 2 and 3 said they take a more “holistic approach” to health

and drink a lot of tea and water to keep their physical bodies healthy. Participant 3 said that

mental and physical health are difficult to balance and that “I’ll absolutely love it and be thriving

and then another moment I can be completely overwhelmed.” Likewise, she said that being at a

large school is difficult for some people because of the environment being overwhelming at

times. The participants also discussed how their school allows them to balance their physical and

mental well-being. Participant 1 mentioned how her school could do more and that “As far as

support, I know that our school didn't start doing specific mental health and wellness days, where

everyone gets a break, but I wouldn't say it's not great, but it's not the best. They could do more.”

She added that students actually set the mental health days and implemented those themselves.
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This theme reveals that the environment and community drastically contribute to the

participants' balance of physical and mental health. Sleep cycle is dependent on stress levels and

the stress might stem from an “overwhelming environment” as Participant 1 mentioned. A lack

of sleep may be the contributor to the stress, and therefore causes the balance to shift. A healthy

lifestyle, as defined by the participants, is made up of balancing a supportive environment, a

good headspace, good eating choices, exercise, and self-care.

Family Health and Awareness to Health challenges

During the discussion, participants talked a lot about how their families discuss health,

and their health histories. Participant 1 explained that when she talks to others about her physical

or mental health it is generally her mom and her siblings. Participant 2 said she speaks to her

friends, while Participant 3 said she speaks to both her friends and mom about her health.

Generally when asked what impact their families have on their perceptions of health, Participant

1 and 3 took more of a mental health route and agreed that those conversations were not always

great but have gotten better. Participant 1 explained that when being able to talk to her parents

about mental health, “At first it was a little negative because sometimes not generally all, but

sometimes African American parents weren’t allowed to or their parents wouldn’t acknowledge

the issues they had.” She went on to explain that because of this, when she and her sister would

struggle from anxiety, at first her mother didn’t know how to talk about it. This is because when

her mom was struggling with panic attacks her parents didn’t help her, therefore when she saw

her children having issues with their anxiety it took her a little while before she could speak on

it. Participant 2 agreed, and said, “My parents are kind of the same way they’ve gotten better
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now with health, specifically because my little sister will actively say hey like could we go to

therapy, and then from there I feel like she broke the wall where they understand like okay, I can

get used to this, like it's okay to ask for help.” This participant also had a similar experience with

her parents. Participants 1 and 3 overall were open to explaining areas where their family

members have not been supportive, or understanding, but both Participant 1 and 3 expressed that

their parents now understand the importance of mental health and making sure their children are

receiving the proper care.

On the other hand, participant 3 talked more about health regarding the physical health

side. She explained that both sides of her family deal with obesity and her parents both struggled

as well. However she said, “They felt the need to have to push and get more active and they saw

me getting more active and being in sports and working on stuff like that, and I feel like that

pushed them too.” This participant has influenced her parents' perceptions of health and their

actions, by setting a good example.

Along with their discussions about how their families influence their health and

perceptions of health, they discussed specific health challenges that Black women face. When

asked, all three participants agreed that giving birth is a common health issue. Participant 3 said

“I think that giving birth is definitely huge within the Black community for Black women,

preeclampsia as well.” Preeclampsia is something that happens in pregnancy complications, and

is when the pregnant woman has high blood pressure. This connects to the next health issue the

participants said Black women face, which is high blood pressure. Participants 2 and 3 both

expressed how high blood pressure is common among Black women.

Another aspect of health that the participants acknowledged was mental health.

Participant 3 expressed “The mental aspect of your health, I think that’s another thing that Black
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women have to deal with, and it is not talked about within the Black community.” This connects

to earlier when the participants were saying that it took awhile for their parents to be comfortable

talking about mental health with their children. This also relates to how well the participants feel

like they are informed about health issues, both mentally and physically. Participant 2 expressed

that she doesn’t feel like she knows enough about health issues, she went on to say, “I know

specifically my mom, she doesn’t really go around telling me stuff, we are just now breaking the

law of her telling me stuff as I'm an adult, where sometimes she didn't really relay that

information to me.” All of this connects to how the participants were uncomfortable talking

about certain topics with their families, and also have not been informed enough about certain

health issues.

Relationship With Healthcare Providers

During the focus group, participants were asked about their relationship with their

healthcare provider’s. Participants’ were asked how often they visit a doctor or healthcare facility

for regular checkups. Two participants have similar responses to this question. Participant 2 said,

“I’ll usually go to the doctor like usually the yearly unless something is really bad then I’ll go,

but other than that, it’s usually just a yearly visit.” Participant 3 said, “I do the same thing. I don’t

usually do them at school, I’ll wait until I’m back home with my primary care physician.”

However, Participant 1 said, “We’ll do two to three year gaps, but I’ve been like getting on my

family about going more because we do have some issues on both sides of my family, like high

blood pressure and stuff like that, but I should go more often.”

Following the discussion of how often they see their healthcare providers, the participants

were asked what made them feel most supported when they went to healthcare facilities.
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Participant 1 said that the nurses made her the most comfortable, because they were funny and

kind. The nurses had made the atmosphere earlier for Participant 1’s experience. Participant 3

also felt the most comfortable with the nurses and the physicians in the facility because they had

answered all the questions and made sure the visit was thorough. Notingly, Participant 3 added,

“The physician gave me an in depth understanding about what was going on. And it was a

female physician, so I was a little bit more comfortable in that aspect as well, because I felt like

she knew what was going on from my perspective.”

On the contrary, they were also asked about what made their experiences with healthcare

providers and facilities uncomfortable. Participant 1 mentioned that the coldness of the hospital

made her uncomfortable. Participant 2 had an uncomfortable experience when they brought a

friend to the hospital. Participant 2 said, “I had actually taken somebody there because he had an

allergic reaction. I just didn’t like the service or how it was uncomfortable for him, and I just sat

there as people walked by or they didn’t care as much because they have a million other things

going on.” Participant 3 agreed with Participant 2 and told another story. Participant 3 said, “I

sent somebody to urgent care, and I felt the same way. I feel like they kind of brushed her off. If

this was severe, if she has a concussion or something, I’m going to make sure she’s okay. I feel

like they brushed off what the actual issue was, and they were making jokes about it.”

Two participants try and go to a healthcare provider yearly, but one wishes that they

would go more often due to the health issues in the family. Participants have all had experiences

in a healthcare facility that made them feel supported and comfortable, but they have also had

experiences that had left them feeling uncomfortable or feeling like they weren’t taken care of

well enough.
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Improvements Needed for Health Resources

At the end of the discussion, the participants dove into what they would like to see

improved on when it comes to healthcare, specifically on their own college campus. All of the

women expressed that their health centers could be doing more to educate them, specifically

when it comes to black women’s health. Participant 3 explained that she believes there are a lot

of things regarding health that she feels like she should already know about, but instead she’s

learning about now. She went on to say that the information she gets, specifically from A&T’s

health center, is very generalized and could be tailored more specifically to black men and

women.

Participant 2 said that currently, the campus health center mainly focuses on COVID and

STD/STI testing. The other participants agreed with her, stating how all they’ve really ever heard

from the health center is centered around COVID. When asked if they thought attending an

HBCU impacted their thoughts on healthcare, all of the participants replied that they didn’t think

it did. This could be due to the fact that most of the resources they find on campus regarding

health are generalized and could be found on a PWI campus as well. However, the participants

also believed that the students on campus could be better at asking the health center for more

specific resources.

Lastly, when asked how they could achieve optimal health, all three participants

responded with the same answer: money. Participant 3 said that “Who gets the best healthcare,

who gets the best resources, are the people with money.” She went on to list items such as a gym

membership, vitamins, and visiting a doctor that all benefit a person’s health but require an

expendable income to be able to afford it. Participant 1 even said that she had thought to herself

that she would never go back to a certain hospital because of the high bill that came afterwards.
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Overall, participants felt that their college campus could offer more education on health, and

there should be more financial options when it comes to healthcare and access.

Discussion and Implications – What does it imply?

1 - Resources and Support for Health

While the participants have an understanding of health and what a healthy lifestyle can

consist of there seems to be a lack of connection between students and health providers as well

as health resources. Some participants explained that money was an issue when it comes to

accessing a healthy lifestyle, therefore more affordable resources should be available but also

advertised. If participants had a stronger connection to healthcare providers then perhaps they

could find ways to access a healthy lifestyle without spending too much money. Additionally

being a college student and on a college campus can create difficulties with connecting to a

healthcare provider or having access to the best resources. Participants felt that their school

healthcare providers didn’t care much beyond COVID and sexually transmitted diseases. To

optimize these participants’ health and those in their community, having a healthcare provider

they can trust and confide in could improve their lifestyle and overall education on health.

Additionally college campuses healthcare providers should have an understanding of the

community they’re working with and be willing to help as well as create connections with

students. This group of participants revealed that talking with someone can be helpful when it

comes to mental and physical health, so having a trusted healthcare provider that is easily
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accessible could be advantagous. Additionally, since healthcare providers on college campuses

are already included, the money aspect that participants discussed could be less of a worry. In all,

participants expressed the need for more connection and understanding of the college community

from the healthcare providers.

2 - Conversations about Health

A common thing that the participants touched on was how in their families and in general

in the Black community, health and wellbeing isn’t talked about enough and this goes for both

mental and physical wellbeing. Some participants explained that it used to be hard for their

families to have open conversations about mental health, because sometimes in Black families,

those discussions weren’t warranted. This therefore made it harder for the participants to talk to

their parents about their mental health if they were struggling. Although partipants said it had

improved, this implies that families need to be more open to discussing mental health and

prioritizing wellbeing. Participants also expressed that in general the Black community doesn’t

talk enough about mental health issues.

In addition participants expressed that they have enough knowledge about all the health

issues that Black women face, because again, their families or an outside source have not

informed them or educated them enough. This implies the importance of learning about different

health problems not only through families, but through schools. Participants expressed their

concern for a lack of knowledge around health issues and this could be solved by having more

learning opportunities. To optimize health for these individuals, having people talk about mental

health struggles and continue to normalize it is very important, as well as having professionals
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educate Black women would be advantagous. Also, physically learning about different health

problems faced in the Black community will help them become more knowledgeable and aware.

3 - Comfort and Trust Between Patients and Healthcare Providers

Participants discussed what made them comfortable when visiting different healthcare

facilities. Some participants expressed that they enjoyed having nurses that were funny and kind.

Naturally, a patient's anxiety might be heightened by being in a medical setting. It is critical to

create a comfortable environment in which they feel at ease, as this will allow you to get to know

the individual better as well as allow them to communicate their concerns with you. This implies

that doctors need to create a pleasant environment that allows the patient to feel at ease, while

also remaining positive, and making eye contact with the patient. The participants also expressed

that a physician who gives patients an in depth explanation about what was going on, and made

sure that the visit was thorough, made them feel comfortable. This implies that doctors should

make sure that their patients understand what they are telling them and be thorough with their

visits.

Participants also told stories about what made them feel uncomfortable when visiting

healthcare facilities. Their main issue was that they felt as though physicians were dismissing the

severity of injuries, or making jokes about an injury in front of the patient. This implies that

doctors need more training to listen to the needs of their patients, and training on seeking

solutions for healthcare gaps among minorites. Healthcare providers should offer a charismatic

approach and not treat the patient to just be checked off, as this is when participants felt most

disconnected toward the healthcare professionals.

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Appendix
Moderator’s Guide

Introduction: Hi, my name is Maggie Smith, and I am a student in Professor Lee Bush’s Strategic
Research Methods class at Elon University. I will be the moderator for our focus group
discussion today. Also on the call are other members of my class team who are here to listen to
your ideas and thoughts.

A focus group is a small group discussion focusing on a particular topic. Today we will be
talking with you about your perceptions of what “healthy” looks like and any challenges you
face or support you need in achieving your health goals. In a focus group, there are no right or
wrong answers, only opinions. We want to hear from each of you equally today. Your thoughts
may be similar to or different from others in the group. Please feel free to speak up, even if you
disagree with someone, because it’s helpful to hear different points of view.

We are videotaping the Zoom session today and will then generate a transcript of the discussion.
Later, we’ll go through the comments and use them to prepare a report on our discussion. Please
be assured that all your comments are confidential, and your names will not be attached to your
responses. After the focus group, we will redact any names from the transcript and delete the
video recording. Also, if there are any questions you would prefer not to answer, please feel free
not to respond to them.

Are there any questions before we begin?

Warm-up: (10 minutes)

(students research teams to develop)
1. I’d like to begin by having each of you tell us your first name and a little about yourself
2. Can you describe what your campus life is like, and what you like to do in your free
time?

Body of Moderator’s Guide: (20 minutes)

(Student research teams develop based on research questions provided earlier in this document.
Each completed moderator’s guide will be reviewed by Professor Bush).

A. Defining Health
a. When you hear the word healthy, what are the first couple of words that come to
mind?
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b. When you hear the word wellbeing, what are some words you think of?
c. **Show a picture of a black woman**
i. This is Regina, if I told you Regina was healthy, what does that mean to
you?
ii. What kind of things would Regina do?
iii. What are her sleep patterns?
iv. What are her exercise patterns?
v. What does she eat?
vi. If Regina was mentally healthy, what does that mean? And what kinds of
things would she do to obtain optimal mental health?
d. What kinds of things do you do, if any, to achieve optimal health?
e. What aspects of health are most important to you?
B. Influences on your perceptions
a. Do you ever talk to others about mental or physical well-being and who might
that be?
b. What impact if any do friends and family have on your perception of health? Is
that a positive or negative impact?
c. Have you ever read about health? Any certain magazines or websites?
d. Have you ever had a friend or family member who had a health issue you were
concerned about and how did that impact you?
C. Healthcare Needs
a. What do you usually do if you don’t feel well?
b. Walk me through the process of when you need to go seek medical care…
c. Do you ever use on-campus health services? If so, tell me about that?
d. Outside of when you’re sick, do you ever visit a doctor or healthcare facility just
for regular checkups?
e. Think back to the last time you were in a healthcare facility, what about that
experience made you feel supported, or was there anything that made you feel
uncomfortable or that you didn’t like?
D. Healthcare Challenges
a. Describe how your physical environment helps or hurts your health?
b. Do you think there are health issues that black women specifically have to think
about and what might those be?
c. Do you feel you have enough information about those health issues?
d. What would you like to know that you don’t know, and how would you like to get
that information?

E. HBCU v. PWI
a. As a student at an HBCU, how do you think being at a primarily black college
influences your perceptions of health?
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b. Do you feel supported and what challenges are you facing being at an HBCU?
c. If there is one place on campus you’d go to restore your well-being on campus,
where is that?
d. What would your ideal place be on campus to restore your well-being?
i. What would it look like?
ii. What would be there?

Finish the sentence: I would be better able to achieve optimal health if I had _________.

Close: (2 minutes)
We are coming to the end of our discussion. As outlined in the consent form, we are conducting
these focus groups for GCI Health, a health communications company based in New York. From
the final reports from our class, GCI will synthesize this information into a narrative on Black
women’s lived experiences and highlight steps needed to optimize Black women’s health. They
will publish and amplify the results with influencers and the public to help create a vision of
health that is inclusive, specific, and that Black women can identify with.

Do you have any additional comments you’d like to make on our topic tonight?

If not, thank you so much for your participation. In the next few days, each of you will receive an
email with the $25.00 Visa gift card for your participation.