Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming

Abstract

(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors’ lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the “strong Black woman” is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.

Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital

“…Most BCS who have limited income, are racial and ethnic minorities and receive care in public health systems lack access to and underutilize survivorship care resources even when these resources are available [17,18]. In addition, they are more likely to experience racial discrimination [15,19]. Latina BCS experience worse HRQOL and higher levels of pain, fatigue, and depressive symptoms as compared to White women [5,12] Furthermore, they are less likely to receive survivorship care services such as survivorship care information [20,21] and more likely to report unmet symptom needs [22].…”

Medical Advocacy among Latina Women Diagnosed with Breast Cancer

“…The value and impact of medical advocacy to achieve breast cancer equity has been increasingly studied [10][11][12] including among African American survivors and other marginalized populations [7,[12][13][14][15][16][17][18][19]. Past research has identified potentially universal experiences across racial and ethnic groups (e.g., reciprocity, or the value of "giving back") and culturally specific experiences with medical advocacy (e.g., navigating community mistrust, the need for minority breast health spaces/support groups).…”