In recent years, there has been increased focus on rural and Appalachian health because of disparate chronic health outcomes when compared to the rest of the US. Appalachia, a subsection of the US, has even worse health outcomes related to chronic diseases. Although Appalachia is its own unique region, there is significant overlap with rural areas in terms of shared cultural characteristics (e.g., strong sense of community, distrust in outsiders, lack of trust in traditional medicine, and strong Christian religious affiliations and faith in God), limited access to healthcare services, and disparate health outcomes. The research presented in this dissertation is significant because it provides insight into and compares healthcare utilization rates in women in Appalachia and surrounding areas. Study 1: In addition to racial discrimination, Black Appalachian women often face other obstacles involving other types of negative interpersonal experiences when seeking healthcare. Despite these known disparities, Black women are frequently underrepresented in Appalachian health research. This study investigated healthcare experiences for sixteen Black Appalachian women using semi-structured interviews to identify and subsequently address ways to eliminate barriers to care. Interview questions utilized the theory of intersectionality and the Social Ecological Model to create a framework to describe the complexity of healthcare utilization and barriers to care while providing context into each participant's background and lived experience. Interview questions explored four topics: 1) barriers to medical care; 2) social support; 3) ideal and actual healthcare experiences; and 4) desired changes to improve quality of care. We used an inductive analysis process to create a robust thematic coding schema, organizing responses into 60 total themes and 141 codes, and reported the most frequent. Our results explore the ways in which one's intersectional identity as a Black Appalachian woman affects interpersonal interactions and experiences when engaging with the healthcare system. Participants frequently reported barriers related to scheduling conflicts and delays, experiences with rushed appointments and inhospitable providers and support staff, and desires for accurate collection of medical information. Participant responses often emphasized difficulties with the organization of the medical system, revealing specific areas for future intervention to improve quality of care for Black Appalachian women. Study 2: Use of the emergency department (ED) for low acuity conditions (e.g., back pain, dental pain, sore throat) and primary care places an additional strain on ED staff and resources, while increasing waiting and treatment times for high acuity patients. Factors such as race, gender, and insurance type have a strong association with the likelihood of a patient using the ED for a low acuity concern. Women are more likely to utilize healthcare services, which also holds true in the context of the ED. Using a sample of adult women from Virginia, West Virginia, Tennessee, North Carolina, and Kentucky, I investigated which demographic factors, age, race, geographic location (metro, nonmetro, rural), employment, and insurance coverage, affect a patient's likelihood to visit the ED for a low acuity condition within a southwestern Virginia hospital system. Log-binomial regression was used to estimate unadjusted and adjusted prevalence ratios of acuity level by race, age, rurality level, employment, and insurance type with corresponding 95% CIs. Our sample included 28,222 female patients who visited the ED between January 1, 2021 and September 30, 2022. Low acuity visits accounted for 15.9% (n=4,485) of visits during the timeframe. In summary, our results suggest that older age and location in non-metro area are the most salient factors contributing to a higher likelihood of low acuity ED visits among women. Race, a primary variable of interest, did not have the relationship to acuity that was expected based on previous literature; Black women patients were less likely to have a low acuity visit than white women patients. During our study period, overall number of visits remained steady, while there was an increase in proportion of low acuity visits. Further research is needed into the underlying causes to more definitively explain this increase. / Doctor of Philosophy / In recent years, there has been increased focus on rural and Appalachian health because of disparate chronic health outcomes when compared to the rest of the US. Appalachia, a subsection of the US, has even worse health outcomes related to chronic diseases. Although Appalachia is its own unique region, there is significant overlap with rural areas in terms of shared cultural characteristics (e.g. strong sense of community, distrust in outsiders, lack of trust in traditional medicine, and strong Christian religious affiliations and faith in God), limited access to healthcare services, and disparate health outcomes. Black/African Americans are another population with higher rates of chronic disease and poorer health outcomes compared to their white and Latinx peers. The combination of poorer health outcomes and higher rates of chronic disease negatively impacts life expectancy and quality of life. One driving factor in these poor health outcomes across all of these groups is low rates of healthcare utilization, whether due to decreased access (as is the case for many rural populations), or other as of yet unidentified challenges. Although literature exists about rural health outcomes, Appalachian health outcomes, and health outcomes focusing on Black women, there is very limited literature that examines the intersectional impact of these characteristics on health. Health disparity research in this region does not currently stratify differences in outcomes by both race and gender, which prevents a detailed analysis of the full extent of the gap in health outcomes. This research presented in this dissertation is significant because it provides insight into and compares healthcare utilization rates in women in Appalachia and surrounding areas across the lifespan. Knowing the contextual factors influencing healthcare seeking behaviors and utilization is the first step to designing effective interventions that improve women's access to care. Interventions need to be intentionally designed to consider, and ultimately, shift medical care and community attitudes to decrease health disparities in Appalachia. To successfully decrease health disparities, it is necessary to consider all of a patient's identities or characteristics. The same contextual factors that affect their healthcare utilization can also impact their care experience.

Black mothers socialize their daughters to embody the strong Black woman (SBW) schema to help them navigate gendered racist oppression. While research indicates that ascribing to the SBW schema offers Black women psychosocial benefits (e.g., increased self-esteem), identifying with the SBW schema has been linked to several negative psychological outcomes (e.g., anxiety, depression, and stress). Considering the evidenced negative implications associated with identifying with the SBW schema on Black women's mental health, the current study had three aims: (1) investigate the socialization messages Black women received about strong Black womanhood, (2) explore the extent to which they identified with these messages, and (3) assess the implications of this socialization on Black women's functioning. To address these aims researchers conducted semi-structured interviews with 11 Black college women (Mage = 20.09; SD = 1.04). For this manuscript, we extracted data pertaining to aim one and analyzed this data using a consensual qualitative research (CQR) data approach. Findings revealed messages Black women were given about strong Black womanhood (i.e., know your worth, depend on yourself, overcome societal barriers, little to no messages about strong Black womanhood, and additional responses) and illuminated behaviors mothers modeled that exemplified strength (i.e., self-sufficient, preserving, caretaking, and additional responses). Findings derived from this study have the potential to inform clinical intervention with Black women and, more specifically, provide insight as to how clinicians may work with Black women to mitigate the impact of the SBW schema on their mental health.

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In 1959, as a reaction to the 1954 Supreme Court's Brown vs Board of Education desegregation decision all public schools in Prince Edward County, Virginia were closed. This dissertation explores one group's response to the schools closings by examining the patterns of resilience that emerged among a group of African American women in Farmville, Prince Edward County, Virginia. Using a multi-disciplinary synthesis of research in education, history, geography, sociology, social movements, personal interviews and questionnaires this dissertation investigated the development of resilience at the grassroots level. African American women are taught early in their socialization process the value of independence, mutual aid, religiosity, community stability, and respect for elders. The school closings didn't just affect the children of Farmville, it changed families and communities, but most particularly it changed the lives of Farmville's women. Much of the research demonstrates that resilience and activism in oppressed communities has a dual nature that surfaces when those communities are under stress. Resilience among this group of African American women emerged both organically and as a result of their religious and community involvements. ii African American women experienced the cultural, educational, contextual, social, behavioral, and political worlds in Farmville, Virginia, from an "outsider within" perspective. When they stepped outside their socially and psychologically constricted lives they developed resilience fortified with both historic and personal commitment. In examining broadly the history of education in Virginia, the historic allegiances of African American women to community, religion, identity, education, and place a fuller understanding of the processes of the development of resilience emerges. This examination moved Black women from the margins to the center of the debate on resilience. The development of personal agency in Farmville was courageous and could have been physically dangerous. However, as the civil rights movement captured the American consciousness, the women of Farmville engaged in a unique social movement that would sustain a campaign for education parity. / Urban Education

The purpose of this research is to explore the processes and strategies through which members of a group or organization use their organizational identity to make salient a normatively dissonant identity. Using both the functionalist perspectives of social identity theory and the existing narrative literature on identity formation in organizations, a conceptual process model of identity formation is created that integrates the identification process with the interaction of multiple identities, including the identity as members of an organization, a normatively dissonant identity, and other salient preexisting identities such as race and gender. This research also examined part of this conceptual model empirically, using members of a national running organization for Black women, Black Girls Run!, using a mixed-methods design including interviews and surveys of participants. Distance running, as a form of physical activity, is not a normative identity for Black women in the United States. Findings from Study 1 showed that members developed a running identity that informed their running behavior. Study 2 highlighted the process through which members used their identity as members of the organization to negotiate through their dissonance and become runners using modeling strategies. Findings from this study contribute to both sport management and organizational literature by empirically demonstrating the effects of and the processes through which an organizational identity might create a pathway for marginalized groups to adapt previously dissonant identities. It highlights the importance of organizational identities in the formation of deeper connections with physical activity, which has been shown to be an essential element of health maintenance and a conduit for sustainable active behaviors. / Tourism and Sport

Thesis (MBA)--University of Stellenbosch, 2011. / This research report is an autoethnographic narrative that gives a first-hand account of life as experienced by a young Black South African woman living in post-apartheid South Africa. It is a story of her life as a young child who was adopted after the death of her mother and the subsequent abandonment by her biological father. It is also the story of a Black professional woman who struggles to negotiate her way through the corporate world after having had negative experiences in some of the organisations that she has worked for. It highlights the plight of Black professionals all over South Africa who resort to job hopping as a means with which to escape unfair treatment in the workplace. The narrative also deals with issues that are specific to women only. Her experiences of these issues include unfair treatment due to the fact that she was pregnant and later on unfair treatment due to the fact that she is a single mother. They also include the abuse that she has suffered at the hands of certain men in her life. All of these issues have gone a long way towards shaping her perceptions of the country in which she lives as well the role that she feels she is expected to fulfil in it. The narrative is an honest and authentic account of the events that have shaped her perception of corporate South Africa as it struggles to incorporate Employment Equity and Affirmative Action policy into their organisational culture. She highlights the fact that the organisational policies and systems in themselves may be perfect but due to the fact that they have to be implemented by people they often reflect some of the prejudice that exists in society. In sharing her story it is her hope that other Black people would make their stories known for she believes that it is only when these stories are let out in the open can we begin to have meaningful dialogue about them and in so doing come to a resolution that will benefit all of us as a nation. She believes that our failure to talk to one another can only serve to widen the gap that currently exists between Black and White South Africans.

Thesis (LLM)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: The South African land question presents complex legal and social challenges. The legal aspects of land are inextricably linked to other socio-economic aspects, such as access to housing, healthcare, water and social security. The Constitution provides for land reform in the property clause - section 25. This clause, while seeking to redress the colonial land dispossessions, by means of a tripartite land reform programme, also protects the property rights of all. The different legs of the land reform programme are redistribution, which is aimed at enabling citizens to access land on an equitable basis; restitution, which sets out to restore property rights or grant equitable redress to those dispossessed of land as a result of past racially discriminatory laws or practices and finally tenure reform. Tenure reform is premised on transforming the landholding system of those with legally insecure tenure as a result of past racially discriminatory laws or practices or granting comparable redress. The primary focus of this thesis is on tenure security for black rural women in South Africa, while using the Namibian experience with regard of the same group as a comparison. Historically, before colonialism, landholding was governed by the customary law of the various tribes in South Africa. This landholding system underwent extensive change through the colonial era that ultimately led to a fragmented and disproportionate distribution of land based on race, with insecure land rights particularly in rural areas, where women are the majority. With the dawn of the Constitutional era, South Africa embarked upon a social justice project, based on a supreme Constitution, embodying human dignity, equality, non-racialism, accountability and the rule of law. Land reform forms part of the social project and is governed by the Constitution and influenced by both the civil and customary law. With the South African tenure context, policy documents, legislation and case law will be analysed. In this process the role of the stakeholders and other related factors, for example customary practices are also considered. The analysis indicates that case law has played a significant part in addressing women’s plight with regard to equality, tenure reform and abolishing suppressive legislative provisions and practices. It is furthermore clear that the different categories of women are affected differently by the overarching tenure and other related measures. For a legal comparative study, Namibia was chosen for the following reasons: (a) both South Africa and Namibia have a shared colonial and apartheid background; (b) both countries have a Constitutional foundation incorporating human rights and equality; and (c) both countries have embarked on land reform programmes. However, contrary to the South African position, both the Namibian Constitution and its National Land Policy are more gender-specific. Tenure reform is an on-going process in Namibia in terms of which specific categories of women have benefitted lately. To that end the gender inclined approach may be of specific value for the South African situation, in general, but in particular concerning black rural women. Consequently, particular recommendations, linked to the specific categories of women, are finally provided for the South African position, in light of the Namibian experience. / AFRIKAANSE OPSOMMING: Die Suid-Afrikaanse grondkwessie beliggaam ingewikkelde regs- en sosiale uitdagings. Die regsaspekte wat verband hou met grond is ook onlosmaaklik gekoppel aan sosio-ekonomiese kwessies, soos byvoorbeeld toegang to behuising, gesondheidsdienste, water en sosiale sekuriteit. Die Grondwet maak vir grondhervorming in die eiendomsklousule, artikel 25, voorsiening. Die eiendomsklousule beoog om koloniale grondontnemings (deur ‘n drie-ledige oorhoofse grondhervormingsprogram) aan te spreek en terselfdertyd eiendomsregte te beskerm. Die oorhoofse grondhervormingsprogram bestaan uit herverdeling, waarmee billike toegang tot grond vir alle burgers bewerkstellig word; restitusie, waarvolgens herstel (of ander billike vergoeding) vir persone en gemeenskappe wat grond en regte as gevolg van rasdiskriminerende maatreëls verloor het, bewerkstellig word en laastens grondbeheerhervorming. Grondbeheerhervorming behels die aanpas of opgradeer van grondbeheervorme (of die betaal van billike vergoeding) in gevalle waar regte onseker (of swak) is weens rasdiskriminerende maatreëls en praktyke van die verlede. Die hooffokus van die tesis is op die regsekerheid (al dan nie) van grondbeheer van swart landelike vrouens in Suid- Afrika, met die Namibiese ervaring as regsvergelykende komponent. Histories, voordat kolonialisme ingetree het, was grondbeheer deur die tradisionele inheemse reg van die verskillende gemeenskappe in Suid-Afrika gereguleer. Hierdie grondbeheersisteme het grootskaalse verandering gedurende die koloniale tydperk ondergaan. Dit het eindelik tot ‘n rasgebaseerde, gefragmenteerde sisteem gelei waarvan die verdeling van grond disproporsioneel was en die grondbeheervorme regsonseker, veral in die landelike gebiede waar vrouens die meerderheid van die bevolking uitmaak. Toe die grondwetlike era in Suid-Afrika aanbreek, is daar met ‘n sosiale geregtigheidprojek (heropbou en ontwikkeling) begin. Hierdie benadering is op die Grondwet gefundeer waarin menswaardigheid, gelykheid, nie-rassigheid, rekenskap en regsorde beliggaam is. Grondhervorming vorm deel van die oorhoofse projek en word deur die Grondwet bestuur en deur beide die nasionale en die Inheems reg beïnvloed. Met betrekking tot die Suid-Afrikaanse grondbeheeristeem word beleidsdokumente, wetgewing en regspraak geanaliseer. In hierdie proses word die rol van belanghebbendes en ander verwante aspekte, soos byvoorbeeld Inheemse partyke, ook oorweeg. Die analise dui aan dat dit veral ontwikkelings in regspraak is wat ‘n groot bydrae gelewer het om vrouens se stryd om gelykheid en sekerheid van grondbeheer te bevorder en wat gelei het tot die afskaffing van onderdrukkende wetgewende maatreëls en praktyke. Dit is verder ook duidelik dat verskillende kategorieë van vrouens verskillend deur die oorhoofse grondbeheer- en ander verwante maatreëls, geaffekteer word. Namibië is vir die regsvergelykende analise geïdentifiseer omdat (a) beide Suid- Afrika en Namibië ‘n koloniale en apartheidsgeskiedenis deel; (b) beide jurisdiksies ‘n grondwetlike basis het waarin menseregte en gelykheid beliggaam word; en (c) beide lande grondhervormingsprogramme van stapel gestuur het. In teenstelling met die Suid-Afrikaanse benadering, is die Namibiese Grondwet en die nasionale grondbeleid egter meer geslag-spesifiek. Grondbeheerhervorming in Namibië is ‘n aaneenlopende proses waaruit veral sekere kategorieë vrouens onlangs voordeel getrek het. Om daardie rede mag die geslag-spesifke benadering wat in Namibië gevolg word vir Suid-Afrika ook van waarde wees, nie net in die algemeen by grondbeheer nie, maar spesifiek ook met betrekking tot swart landelike vroue. In die lig van die Namibiese ervaring word daar ten slotte spesifieke aanbevelings tot die Suid-Afrikaanse sisteem, gekoppel aan bepaalde kategorieë van vroue, gemaak.

Even with the rise of racial diversity in the workplace, African American women remain underrepresented in upper management and organizational leadership positions, making up only 1% of U.S. corporate officers. The purpose of this qualitative narrative inquiry study was to explore the daily experiences of African American women middle managers in regard to stereotype threat and the effect of these experiences on their engagement with leadership aspirations. The narrative inquiry method was used to address this gap and answer the research question, through storytelling from African American women in middle-management positions. This study was framed by 2 key concepts that focus on minority group workplace experiences with stereotype threat and the implications of these experiences on minority group members for their engagement with leadership aspirations: Inzlicht and Kang’s concept of stereotype threat spillover and Major, Spencer, Schmader, Wolfe, and Crocker’s concept of psychological disengagement. The data-gathering process involved semistructured telephone interviews with 7 college-educated African American women, in U.S.-based organizations, in which participants told the story of their stereotype threat experiences in middle management roles. Two of the 5 key themes uncovered were impact of stereotype threat spillover and disengagement from leadership and career aspirations. The information gathered from the narrative study will help drive social change by bringing awareness to the issue and reducing threat experiences of disadvantaged groups across organizations.

Introduction: The World Health Organisation (WHO) defines overweight and obesity as a condition in which an abnormal or excessive fat accumulation exists to an extent in which health and well-being are impaired. The most recent South African National Health and Nutrition Examination Survey (SANHANES) reported that the prevalence of overweight and obesity, according to body mass index (BMI) classification, in all South African women was significantly higher than in men (24.8% and 39.2% compared to 20.1% and 10.6% for women and men, respectively). Blood pressure is often increased in obese patients and is probably the most common co-morbidity associated with obesity. Currently approximately one third (30.4%) of the adult South African population has hypertension. Hypertension is responsible for a significant percentage of the high rates of cardiovascular disease and stroke in South Africa. Limited South African data are available regarding the agreement between the measures of adiposity, including BMI, waist circumference (WC) and percentage body fat (%BF), and the association with high blood pressure. Measures of adiposity were found in previous research to be ethnicity, age and gender specific. Measuring %BF to classify adiposity takes body composition into account and is a more physiological measurement of obesity than BMI. Objective: This study aimed to investigate the agreement between adiposity classified by BMI categories and %BF cut-off points, and the association between the different measures of adiposity and high blood pressure. Method: A representative sample of black women (n=435), aged 29 years to 65 years from Ikageng in the North West Province of South Africa were included in this cross-sectional epidemiological study. Socio-demographic questionnaires were completed. Pregnancy and HIV tests were performed and those with positive test results or those who declined HIV testing were excluded. Weight and height were measured and BMI was calculated. WC, %BF using dual-energy X-ray absorptiometry (DXA), and blood pressure were measured. Results: The prevalence of overweight (BMI 25.0 kg/m² – 29.9 kg/m²) was 24.4% and obesity (BMI ≥ 30kg/m²) was 52.4%. High blood pressure was found to be present in more than two thirds of the study participants (68.5%). In this study BMI, WC and %BF as measures of adiposity were significantly correlated. There were significant agreements between combined overweight/obesity that was defined by %BF (≥35.8% 29-45 years; ≥37.7% ≥50 years) and BMI ≥ 25kg/m² (ᵡ²=199.0, p<0.0001; κ=0.68, p<0.0001), and between the presence of high %BF and obesity only, that was defined by BMI ≥ 30 kg/m² (ᵡ²=129.1, p<0.0001; κ=0.48, p<0.0001). The effect size of the agreement between the WHO BMI category for combined overweight/obesity and %BF cut-off points according to the kappa value of κ=0.68 was substantial (κ range 0.61-0.80). The effect size of the agreement between the WHO BMI category for obesity only and %BF cut-off points according to the kappa value of κ=0.48 was moderate (κ range 0.41-0.60). No association was found between high blood pressure and BMI categorised combined overweight/obesity (ᵡ²=3.19; p=0.74), but a significant association was found between high blood pressure and BMI categorised obesity only (ᵡ²=4.10; p=0.043). A significantly increased odds ratio (OR) of high blood pressure existed in the obesity BMI category (OR=1.52; p=0.045) as opposed to the overweight/obesity BMI category (OR=1.51; p=0.075). There were significant associations between high blood pressure and WC ≥ 80cm (ᵡ²=10.9; p=0.001; OR=2.08; p=0.001), WC ≥ 92cm (ᵡ²=20.1; p<0.0001; OR=1.79; p=0.011) and %BF above the age-specific cut-off points (ᵡ²=6.61; p=0.010; OR=1.70; p=0.011). Discussion and conclusion: This study found that in a sample of black urban South African women significant agreements existed between adiposity defined by %BF cut-off points for combined overweight/obesity and both WHO BMI categorised combined overweight/obesity (BMI ≥ 25 kg/m2) and obesity only (BMI ≥ 30 kg/m2), respectively. A stronger agreement was found between WHO categorised combined overweight/obesity and %BF. Furthermore, this study concluded that the BMI category according to the WHO cut-off point for overweight/obesity had insufficient sensitivity to detect the presence of high blood pressure, and that the BMI category according to the WHO cut-off point for obesity alone could detect the presence of high blood pressure. The WHO BMI classification for obesity, in contrast to the WHO BMI classification for combined overweight/obesity, is therefore appropriate to classify these black South African women at increased risk for high blood pressure. The WC and %BF cut-off points used which were specific to ethnicity, age and gender, had significant associations with high blood pressure and have good capacity to detect high blood pressure. In this study abdominal obesity as defined by the South African cut-off point of WC ≥ 92 cm had a stronger association with high blood pressure, than the international cut-off point (WC ≥ 80 cm). The South African cut-off point is, therefore, more appropriate to screen black South African women for increased risk for high blood pressure. The study therefore concluded that a stronger agreement was found between WHO categorised combined overweight/obesity and %BF than with obesity only (BMI ≥ 30 kg/m2). To ensure consistency and accuracy, and to take body composition into consideration, it is recommended that, where possible, in clinical practice the appropriate WC and %BF cut-off points together with BMI categories should be used as measures of adiposity for diagnosis of overweight and obesity and to screen or detect an increased risk for high blood pressure. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015