Stress, the Superwoman Schema, and Cardiovascular Wellbeing Among Rural and Medically Underserved African American Women

Abstract

Cardiovascular disease in the leading cause of death among African American women. CVD risk factors that contribute to poorer health are higher among rural and medically underserved communities; highlighting racial and geographic disparities exist. The ideal cardiovascular health (ICH) tool was developed by the American Heart Association (AHA) to serve as a measure of cardiovascular wellbeing and address the need for prevention and treatment of CVD. Meeting the ideal standard for these metrics is associated with lower CVD risk and overall improved cardiovascular wellbeing. Yet to date, there is a dearth of literature evaluating ICH scores among rural and medically underserved African American women.Further, social conditions such as neighborhood cohesion and safety can lead to chronic exposure to stress and have been associated with increased risk for CVD and earlier onset of disease. The Superwoman Schema is a multidimensional framework that provide further understanding on how African American women process stress, which may serve to enlighten the mechanisms in which chronic stress becomes biologically embedded among this population.This dissertation explored factors related to cardiovascular wellbeing among rural and medically underserved African American women for the purpose of better understanding and thus informing efforts to reduce cardiovascular health disparities among this population. In chapter 2, we completed a scoping review of psychometric scales evaluating the strong black woman/superwoman construct in relation to stress-related health disparities. In chapter 3, a pilot study was conducted to assess the feasibility of using the MyChart patient portal to collect electronic health data and recruit rural African American women to collect self-report data on social neighborhood conditions and the Superwoman Schema. Finding from this study revealed strengths and limitations of EHR recruitment and qualitative interviews reported the experience of African American women in using MyChart. Qualitative findings from Chapter 4 revealed emerging factors that are embedded within the Superwoman Schema that help to better understand the stress and coping experience of rural and medically underserved African American women. Chapter 5 summarizes the results across all three chapters and provides implications for future research and practice.