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Rewriting the narrative of the Strong Black Woman Syndrome: a Black women's collective

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Rewriting the narrative of the Strong Black Woman Syndrome: a Black women's collective

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Content 1
REWRITING THE NARRATIVE OF THE STRONG BLACK WOMAN SYNDROME:
A BLACK WOMEN’S COLLECTIVE
by
Joann Gwendolyn Hall LISW-S
A Capstone Project Presented to the
FACULTY OF THE USC SUZANNE DWORAK-PECK SCHOOL OF SOCIAL WORK
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
Doctor of Social Work
August 2024

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Table of Contents
Abstract ............................................................................................................................................3
Acknowledgements ..........................................................................................................................4
Positionality Statement ....................................................................................................................6
Problem of Practice and Literature Review .....................................................................................7
Conceptual/Theoretical Framework ...............................................................................................15
Methodology ..................................................................................................................................17
Project Description.........................................................................................................................22
Implementation Plan ......................................................................................................................29
Evaluation Plan ..............................................................................................................................30
Challenges/Limitations ..................................................................................................................32
Conclusions and Implications ........................................................................................................33
References ......................................................................................................................................36
Appendices .....................................................................................................................................42

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Abstract
The Strong Black Woman Syndrome is a stereotype that has its roots in American enslavement,
where Black women were deemed strong and superhuman to justify working them as hard as the
men and abusing them in a myriad of ways. As we have moved through history, Black women
acculturated the role of The Strong Black Woman Syndrome to survive the sexism and racism
they faced. The Strong Black Woman Syndrome has also left Black women without the ability to
be vulnerable or express their true emotions. This paper posits that the stress of living up to the
Strong Black Woman Syndrome is contributing to significant health problems for Black women
and contributes to health inequities for Black women. This capstone project will build upon a
body of research related to Black women and the mental and physical effects of The Strong
Black Woman Syndrome. The health statics bear out the health inequities that Black women face.
Black women have higher rates of mortality due to coronary artery disease; stroke death rates are
higher in Black women. Black women also have higher rates of maternal mortality. The current
research highlights many different methods for addressing The Strong Black Woman Syndrome
as it relates to the health problems often associated with the syndrome. This capstone project will
contribute to the growing knowledge base by presenting a program that assists Black women in
addressing the Strong Black Woman Syndrome directly using Sister Circles and rewriting the
narrative of The Strong Black Woman Syndrome.
Keywords: Strong Black Woman Syndrome, Sister Circles, narrative, racism, sexism, health
outcomes, health inequities, stress, support groups

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Acknowledgements
There is an African proverb that states “it takes a village to raise a child “this proverb conveys
the message that it takes many people to successfully raise a child. This proverb embraces the
understanding that success is dependent on a collaboration of individuals coming together to
support a particular cause. I am very grateful that I had a village to support me as I went through
my journey completing my Doctor of Social Work. I want to begin by acknowledging my
ancestors, all those brave African and American men and women who struggled and died so that
I would be free to go to graduate school. It is also important to acknowledge both sides of my
family line, the paternal (Hall) side of my family and the maternal (Peterson) side of my family.
Both sides of my family valued education, learning to read and write when it was illegal to do so.
They finished high school, attended college and obtained advanced degrees against all odds. I am
proud to be a part of this lineage and to carry on the tradition of academic success. There are so
many in my village to thank I could never thank them by name. I do want to recognize my
external design team, colleagues, clients, community and students I work with in the Central
community of Cleveland. Without their undying love and support I would not have been able to
bring my Sister Circles to fruition. I must acknowledge all of those in my village who helped me
academically, editing my writing, staying up with me writing my papers, giving me technical
support with PowerPoints and presentations. All of the people in my life who called me to check
on my progress and offered me many types of support from having food delivered, giving me
advice and saying encouraging words. Having a community of people listen to me when school
was challenging, and I just needed someone to talk to. I want to thank all the prayer warriors in
my life who committed to praying for me as I went through this journey. I would be remiss if I
did not thank my capstone committee, Dr. Kay-Wicker, Dr. Sonji Kenyatta and Dr. Gary

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Boelhower your experience and expertise supported and guided me through the most crucial
times of doctoral program. Lastly, I want to thank my son Azikiwe whose ongoing and enduring
love inspires me every day.

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Positionality Statement
From the cotton fields to the doctorate degree is one way to encapsulate the measure of historical
significance that has brought me to the place where I am today. This is to say that as an African
American woman I don’t stand alone I stand with a long line of other African Americans whose
history and culture goes back to Africa and is very much shaped by the experience of the middle
passage, enslavement, the civil war, emancipation, Jim Crow, the civil rights movement, the
Black power movement, and the on-going fight for human and civil rights. As an African
American woman, I have to face not only the oppression of racism but also the oppression of
sexism. Misogynoir is a term developed to describe an anti-Black racist misogyny that Black
woman experience. Growing up in the 1960’s I was very aware of the battle Black people were
fighting, the right to be considered a full human being with all the rights and privileges others
had in this country. My mother was considered country poor, and my father was considered city
poor, together they were determined that their children were going to have opportunities they did
not have. My parents saw education as the key to advancement and they were very serious about
us having access to a good education and taking full advantage of our education, punishment
would be swift and harsh if any school rules were broken or if we did not live up to our academic
potential. As I grew into an educated Black woman it placed me in a position of privilege where I
could make a difference for my people and other marginalized groups of people. I was
determined to use the privilege of my education and my Black consciousness to advance social
justice. As a Black woman I saw the effects of sexism on Black women, especially as it pertained
to Black women expectation of themselves to be strong. My family picked cotton so I would not
have to. I am getting my doctorate to change a social norm so Black women no longer have to
carry the burden of strength.

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Problem of Practice and Literature Review
In 2013, when the Grand Challenges of Social Work (GCSW) were being proposed,
eliminating racism was considered but not adopted as one of the twelve Grand Challenges. There
was concern that racism, an insoluble problem, could not be solved in ten years because it has
been inextricably woven into the fabric of the other twelve Grand Challenges. Therefore, solving
the twelve Grand Challenges would also serve to eliminate racism (Lubben et al., 2018). In the
wake of the George Floyd murder and the ongoing prominence of the “Black Lives Matter”
movement, the Grand Challenges for Social Work committee announced on June 26, 2020, the
13th Grand Challenge of Social Work: eliminate racism. The thirteen Grand Challenges are
organized under categories according to their common themes and eliminating racism is
categorized under a “Just Society”. Racism is not the same as racial prejudice, discrimination,
hatred, or bigotry. Racism occurs when a particular group of people possesses the power to
execute systemic discrimination by institutionalizing policies and practices throughout society
and molding the cultural beliefs and values that sustain the racist policies and practices
(Dismantling Racism Works, 2021).
Disparities in Physical Health Status
One way to understand the effects of racism is to examine the disparate health outcomes
of Black women. A 2009 study makes it clear that the incidence, prevalence and morbidity rates
for coronary artery disease, hypertension, stroke, and congestive heart failure are all higher for
Black women (Williams, 2009). This is confirmed by the National Center for Health Statistics,
which reported that Black women have higher prevalence of major health conditions such as
stroke, heart disease, cancers, maternal morbidities, obesity, and stress (National Centers for
Health Statistics, 2019). A CDC report from 2019 also states that hypertension and other chronic

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illnesses are potential causes for the high maternal death rates for Black women. Consistently,
Black women have had the highest maternal mortality rates. In 2021 Black women’s maternal
mortality rate was 69.6 for every 100,000 live births compared to the national average of 21.5.
The CDC also reports that not only does hypertension and chronic illness affect Black women’s
maternal mortality, but the quality of care is often inferior for marginalized groups and implicit
racial bias can impact patient-provider care (Petersen, Davis, & Goodman, 2019).
Disparities in Mental Health Status
In addition to the physical conditions experienced by Black women, research indicates
disparities in emotional status as well. According to the article “Black Women and Depression,”
3.9 % of Black women report feelings of sadness compared to 2.9% of White women. Black
women report feeling hopelessness at 2.4% and White women at 1.9%. Black women report
feeling worthless at 1.8% compared to White women at 1.6%. Ten percent of Black women
reported that everything felt like an effort compared to 6% of White women who reported feeling
the same way. Though Black and White women have close rates of depressive symptoms, the
source of depression can be very different. For Black women, one must consider exposure to
racial trauma and sexism. Seales (2021) states that these numbers are evidence that we are facing
a crisis when it comes to Black women’s mental health. When Black women’s depression and
psychological distress are not treated it leads to life-threatening health conditions such as heart
disease and diabetes (Seales, 2021).
The higher levels of stress-related chronic illnesses among Black women point to the fact
that they experience higher levels of psychological distress (Tipre, M., & Carson, T. L. 2022).
Black women also experience stress through the obligation to maintain The Strong Black Woman
Syndrome. The Strong Black Woman Syndrome is a set of cultural expectations and beliefs

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about constant resilience, independence, strength, cognition, and behaviors related to Black
womanhood (Abrams et al., 2014). The syndrome reflected the harsh realities of intersectional
oppression (i.e., racism and sexism) during enslavement. Enslavers deemed Black women as
superhuman to justify working them as hard as men and physically and sexually abusing them
(Harris-Lacewell 2001). This syndrome proposes that Black women conduct themselves with
independence, emotional restraint and carry out the role of caretaker. At all costs, Black women
cannot show emotion without appearing weak, always giving the impression of being
independent, strong, and taking on others’ problems as their own (Jones et al., 2021). As a result,
many Black women lack the capacity to be vulnerable and/ or express their emotions. A 2015
study on Black women reported that to deal with emotional suppression, they used shopping,
excessive drinking and disordered eating, which often led to compulsive eating. This scenario
could be partly to blame for Black women’s higher rates of cardiovascular disease and obesity
(Watson, N. & Hunter, C. 2015). Further, while the Strong Black Woman Syndrome has made it
possible for Black women to be self-reliant. recent research has linked negative outcomes to The
Strong Black Woman Syndrome including depression, anxiety, and binge eating (Donovan &
West, 2015). A contemporary view of The Strong Black Woman Syndrome denotes Black
women as self-empowered and having perseverance, but without capacity for the expression of
their internal hardships, sadness, hopelessness, and depression (Collins, 2000).
A study on the stress of The Strong Black Women syndrome was associated with anxiety,
depression and loneliness. Black women reported that depression was an everyday occurrence in
their lives due to fatigue from supporting others while not taking care of their own needs and not
wanting to appear vulnerable (Beauboeuf-Lafontant, T. 2008). In a 2020 research study The
Strong Black Woman Syndrome was significantly correlated with anxiety. Black women reported

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they experienced anxiety on a regular basis as well as migraines, panic attacks and hair loss
(Liao, K. Y., Wei, M., & Yin, M. 2020) (Appendix A).
As a result of internalizing The Strong Black Woman Syndrome, Black women not only
feel that they must stand strong at all times, but they also feel they do not need protection,
emotional support, or nurturance (Epstein, Blake, & Gonzalez, 2017). If Black women do not
uphold the cultural standards of the Strong Black Woman, they run the risk of being “othered” by
their community. Othering can take the form of name-calling, being accused of not being Black,
and being ostracized (Carter & Rossi, 2016).
Additional Stakeholders
Review of the literature leads to understanding that the main stakeholders are the people
most affected by the syndrome: Black women. Although Black women are the main stakeholders
the Black family would be secondary stakeholders. They may be affected by women who fall
prey to The Strong Black Woman Syndrome. On the other hand, they can use their influence,
respect, love and most importantly, opportunities to support the Black women in their lives.
Therefore, these stakeholders need to be informed about the Syndrome. Black girls are also
included in this category, because their future wellbeing is dependent on better health outcomes
and they need to have a heightened awareness of The Strong Black Woman Syndrome, so they
can avoid the same patterns and eventually developing health problems.
Community stakeholders who value Black women have high interest, power, money and
resources. This includes community organizations that understand and operate from a social
justice and anti-racist perspective to change systems of oppression affecting Black women by
changing social norms. For the purposes of this capstone project, which is based in the

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Cleveland Ohio area, these organizations include but are not limited to The Northeast Ohio Black
Health Coalition, National Coalition of 100 Black Women, The Village of Healing Center,
Birthing Beautiful Communities, and the Black Women’s Health Imperative. Other community
stakeholders include the Black Mental Health Corporation, Black Emotional and Mental Health
Collective and the Cleveland chapter of the National Alliance on Mental Illness. All of these
organizations are based in or have chapters in Cleveland, Ohio (Appendix B).
Perpetuating the Strong Black Woman Syndrome
The Strong Black Woman Syndrome has an aspect of self-silencing. Self-silencing occurs
when Black women do not express themselves honestly to avoid loss of relationships, conflict,
and retaliation. They cannot be their authentic selves because of fear of rejection, loss, or
alienation and through self-silencing they protect their image of being strong (Jack and Dill,
1992). There are five behaviors associated with self-silencing: not asking for what one wants,
not telling others how one feels, presenting a calm professional exterior on the outside despite
feelings of anger and hostility, putting other’s emotional needs above one’s own, and judging
oneself by cultural standards that are not their own. Self-silencing can have severe mental and
physical health consequences when they persist over time (Jack and Ali, 2010).
Black women are taught to be strong from the time they are girls. Black women need to
be strong to survive under the oppression of racism and sexism and many other conditions that
they may face in their lives; therefore, strength becomes a part of Black womanhood (HarrisPerry, 2011). Black girls are given strong verbal messages to take pride in their racial identity, to
be assertive, and to be self-determined. Their training also involves non-verbal communication
as Black girls watch their mothers, aunts and other elder women in the community sacrifice
themselves for their families and communities by consistently putting others’ needs before their

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own. This sends the message that they must also make the same kind of sacrifice and the process
of internalizing The Strong Black Woman Syndrome begins (Epstein, Blake & Gonzalez, 2017).
Black women also police each other to maintain the tenets of The Strong Black Woman
Syndrome by using statements like: “What are you depressed about?”, “Don’t let them white
folks see you cry”, “Our people survived slavery, we can survive anything” (Stanton et al.,
2017).
Media also plays a role in perpetuating The Strong Black Woman Syndrome by
portraying Black female characters as devoid of feelings, dominant and independent, which
serves to reinforce The Strong Black Woman Syndrome and furthering the internalization of the
syndrome (Davis, 2015).
Solution Landscape
Sister Circles are a valued strategy, centering the self-help model for Black women with
the common concern of coming together to form relationships that allow them to heal and
enhance their wellbeing. Croom (2017) found that Black women were seeking relatable
experiences through Sister Circles; interviewees reported finding role models, a safe space for
discussion, and a space where they could be more themselves. A dissertation case study found
Sister Circles to be effective for collegiate Black women by providing a safe physical space for
emotional expression and a sense of belonging (Allen, 2019). Gaston, Porter & Thomas (2007)
reported that a curriculum-based Sister Circle assisted Black women in modifying their attitudes,
increasing their knowledge, and reducing risky behaviors in pursuit of positive health outcomes.
Richardson’s (2022) qualitative dissertation used semi-structured interviews with Sister Circle
participants to reveal themes. Through the positive, safe environment of Sister Circles, Black
women began to identify as a sisterhood and their sense of self-determination, self-discovery,

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and self-awareness increased. The group setting also fostered a sense of wellbeing (Richardson,
2022). Lastly, Sister Circles have been found to increase knowledge of the topic of interest and
authentic concern for other Black women as well aiding them in finding relatable role models
(Teasdell, Lee & Calloway, 2021).
A more recent 2023 research study assessed the effectiveness of Sister Circles with
pregnant women experiencing stress. Eighty women were involved in this study, their median
age was 27 years. The Kessler Psychological Distress Scale was used to measure stress. The
scale revealed that the women were experiencing moderate levels of stress. The Sister Circles
met weekly in a community center for two hours, for 11 weeks, and were led by undergraduate
and graduate Black female research assistants. At the end of the 11 weeks, a paired samples t-test
showed an increase in knowledge of understanding stress. The women reported an overall
positive experience and reported that writing a personal mission statement, cognitive
restructuring, visualization exercises and relaxation were most valuable. Lastly, they reported
they would recommend the Sister Circles to other Black women (Sommerville., Rowell, T.,
Stadulis, R., Bell.,D. & Neal-Barnett, A., 2023).
Although Sister Circles is a unique evidence-based practice, it is still possible to evaluate
its effectiveness by looking at other evidence-based practices that are similar to the Sister Circle
model. Literature searches using Ovid Medline(R), PsycINFO and ProQuest central databases
revealed 57 relevant articles showing the effectiveness of the support group model.
Solutions that have been used to address The Strong Black Woman Syndrome have
focused on mindfulness meditation with a cultural component. A qualitative research study was
conducted with 13 Black women and 2 Black men. Participants in this study were familiar with
meditation and had practiced it for some time. The participants reported that practicing

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mindfulness meditation increased their ability to cope with life stressors, increased social
connectedness and improved their ability to apply calming techniques in many different
situations. Participants suggested that mindfulness meditation would be more effective if it
incorporated African American music and literature. If it were developed to be more culturally
specific, they would be more likely to recommend it to family and friends (Woods-Giscombé, C.
L., & Gaylord, S. A. 2014). Although this was a small study, it highlights the positive effects of
mindfulness meditation for the African American community. All of these techniques are useful
when women find themselves dealing with the stress of living up to The Strong Black Woman
Syndrome.
A qualitative study completed in 2013 found that prior to being in a self-help group,
participants reported feeling a lack of hope, being at risk for developing a mental illness, and
isolation. After participation in the group, participants felt more in control, included and less
isolated, with increased resilience and the ability to take advantage of resources. These results
were ascertained using the UK National Mental Health Developmental Unit (NMHDU)
indicators (Seebohm et al, 2013).
The GROW (Goal, Reality, Options, Will) self-help group model is modeled after the 12-
step format of Alcoholics Anonymous (AA) using standardized literature. This group
methodology was specifically designed for those who have experience with living with mental
illness. A 2013 survey by the international GROW organization revealed the participants
experienced a significant decrease in the number of days they had to be hospitalized. The survey
also revealed that 85% of participants had an improved sense of self, 77% felt more connection
to their communities, 81% report they developed relationships that served as personal supports

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and 67% stated that they recovered from their mental illness through the GROW program
(Worrall et al., 2018).
Theoretical Framework
Grant and Osanloo (2014) state the importance of establishing a theoretical framework
for social research. It becomes the foundation of the research, acting as a blueprint to guide and
inform one’s capstone project. Their research reveals three important concepts regarding
theoretical frameworks. First, stating that a theoretical framework is the basis from which
knowledge will be constructed metaphorically and literally. Secondly, providing the theoretical
framework is the support for the rationale for the capstone project. Third, the theoretical
framework provides a grounding base and anchor for the literature review as well as the
methodology and analysis.
The theoretical framework guiding this capstone project is internalized racial oppression.
Internalized racial oppression is defined as acceptance by members of stigmatized races of
negative messages about their own intrinsic values and abilities. It is also characterized by not
believing in members of the same race as well as not believing in themselves. Internalized racial
oppression also involves perceiving limitations to one’s full humanity including one’s spectrum
of dreams, right to self-determination and allowable ranges of self-expression. It can also
manifest as an embrace of whiteness, the belief that “The White man’s ice is colder”, rejection of
ancestral culture, living a life that exhibits helplessness and hopelessness, and engaging in risky
health behaviors (Jones, C. 2000).
Internalized racial oppression is the appropriate framework to guide and inform this
capstone project. Internalized racial oppression speaks to the process in which The Strong Black

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Woman stereotype was embodied by Black women and influences the way they see themselves
and how they operate in the world. A research study published in 2010 with a total of 48 Black
women showed that Black women perceived that personifying The Strong Black Women
syndrome has caused them many liabilities including a strain in their interpersonal relationships,
emotional eating, poor sleep, postponement of self-care, stress, anxiety, depressive symptoms,
and adverse mental health (Woods-Giscombe, C. L. 2010).
A 2018 quantitative study of 194 Black women, ranging in age from 18 to 82, sought to
assess the degree to which these women had internalized The Strong Black Woman syndrome.
They were given the Superwoman subscale from the Stereotypical Roles of Black Women Scale.
The women were also given the self-silencing subscale, this scale assesses to what degree The
Strong Black Women Syndrome has caused them to self-silence. This study concluded that 80%
of the women reported depressive symptoms due to prolonged self-silencing (Abrams & Hill,
2019).
A research study of 158 Black women who ranged in age from 18 to 59 implemented the
Superwoman and Mammy subscales of The Stereotypical Roles for Black Women Scale to
assess the internalization of The Strong Black Woman Syndrome. The women were also assessed
on their perceived emotional and social support as well as levels of psychological distress. More
than half of the participants scored in the upper percentile of the subscales, meaning they
internalized the syndrome. The study also showed that the women who internalized The Strong
Black Woman Syndrome perceived less emotional and social support and had higher incidence
of psychological distress (Watson-Singleton, 2019).
A qualitative study of 82 Black women on a college campus ranging in age from 18 to 47
implemented a questionnaire developed by the researchers. The research tool consisted of open-

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ended questions asking them to describe The Strong Black Woman Syndrome and if they
identified with the image they described as well as other questions. Of 82 women, 71 agreed they
fit the image of the Strong Black Woman. When asked if their identification with the image
affected their mental health, 47 of the participants agreed. One of the participants who agreed
made the following comment: “Yes, I notice that it often causes me to refuse and avoid asking
for help from others […] thus trapping me in a rut and leaving me frustrated, yes, living up to an
image affects everyone’s mental health” (West, Donovan & Daniel 2016)
A TEDx talk by Dr. Natasha Katuta Mwila tells a true story of one of her students who
has internalized The Strong Black Woman syndrome. The young Black female student did not
turn her assignment in on time and approached her to ask if she could still turn in the assignment.
She asked the student why the assignment was not completed on time. The student told her that
she is the eldest of her siblings and that she must care for them because her mother works several
jobs and with all of this responsibility, she was not able to complete the assignment on time.
When Mwila asked her why she did not ask for an extension, the student responded that she was
too ashamed to ask for an extension because she did not want to disappoint her. The student told
her that she is constantly being told to be strong, grateful, and not to complain and she felt that
asking for more time would mean she failed (TEDxDeMontfortUWomen, 2020).
Methodology
Once the review of the literature was completed for this project, qualitative methods were
used to obtain information from Black women regarding their personal experiences in coping
with stress and other factors related to The Strong Black Woman Syndrome. Sixteen Black
women between the ages of 17 and 72 were interviewed via zoom, telephone, or in person. These
interviews were recorded and later transcribed for thematic analysis. Interview questions were

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developed by the researcher and external design team (See Appendix C). These open-ended
questions were designed to understand the lived experiences of Black women as it relates to The
Strong Black Woman Syndrome, methods of coping with stress, and the state of their health.
Through this sample of interviews, patterns began to emerge that showed how Black women
cope with stress. The interviews revealed that Black women often cope with stress through
avoidance, denial, overeating, drinking alcohol, smoking and overspending. Some healthy
coping mechanisms also emerged including spending time in nature, journaling, and involvement
in cultural activities. All the women interviewed expressed the experience of shouldering a great
deal of stress, feeling alone to handle their problems, and an obligation to do things without help.
All the women found it difficult to ask for help. Asking for help was synonymous with failure.
Some of the women were afraid they would not receive help even if they asked. Others would
not accept help when offered. All the women could identify with The Strong Black Woman
Syndrome and most saw it as a burden they had to carry. These women had learned the trait from
their grandmothers, mothers, and other Black women in their lives. Many of the women had
health concerns and they related them to stressors in their lives. The women recognized the
negative role racism played in their lives especially how it played out in the workplace. Some of
the younger women reported that they had started to recognize the burden of The Strong Black
Woman Syndrome in their lives and had begun to make serious efforts to change the narrative.
These Black women have expressed feeling that they do not have a safe space to be vulnerable in
society. Being strong is their only way to survive, but they want to do more than survive. They
want to live as full human beings and be allowed to express emotions and be vulnerable like
others.
Design Thinking

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For the purposes of this capstone, piloted Sister Circles took place in the Central
community of Cleveland, Ohio and were designed in partnership with the beneficiaries,
stakeholders, and community members. Community centers provided free space for groups to
meet weekly at low to no cost. The design criteria were informed by historical context and
culturally responsive research to assist participants in gaining insight into the causes and
symptoms of The Strong Black Woman Syndrome. Most importantly, the Circles were a safe
space where Black women could be vulnerable, be their authentic selves, and support each other
in the process. They did not have to meet anyone’s expectations and they were free to ask for
help and free to drop the role of superwoman.
Support groups come in a variety of forms and have been proven to be an effective
intervention for people who have mental health concerns, medical concerns, alcohol use disorder,
those in search of family support and other issues or concerns. Cost is also a factor when it
pertains to support groups. The low to no cost for support groups makes them more accessible
and more people have opportunities to become involved and receive treatment (Markowitz,
2015). Although support groups have many advantages there are also disadvantages. Support
groups are dependent on members’ willingness to openly share personal and intimate information
with others, which could be a barrier to people who are introverts or have social anxiety. Leaders
of support groups are not always trained mental health professionals. If a clinical concern arises
there may not be a professional available to provide the appropriate support. Confidentiality
cannot be guaranteed in a support group. In an open support group, there is no guarantee of
privacy; one may encounter a co-worker or someone else with whom she does not feel
comfortable sharing private information (Olivier, 2009).

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The design thinking that went into the prototype began with the development of the lowfidelity prototype. The low-fidelity prototype was a poster that provided a basic statement
describing The Strong Black Woman Syndrome and Black women’s health statistics as well as a
picture of a Black woman attempting an impossible task and many different Black women in a
circle. The circle was open and wide so comments and suggestions could be added. This lowfidelity prototype was tested with many different constituencies of Black women. The feedback
included the women wanting a group dynamic that was for Black women only, culturally specific
approaches, information about internalized racial oppression and The Strong Black Woman
Syndrome. They also stated they wanted to make and share a snack together and they wanted to
rewrite the narrative as a way to move forward and center themselves. Lastly, they stated a
manual, and a workbook would be helpful in facilitating the Sister Circles. The results of the
testing of the low-fidelity prototype went into the design of the high-fidelity prototype. This
design influenced the development of a manual and workbook for six Sister Circle sessions that
included sessions on internalized racial oppression, The Strong Black Woman Syndrome and the
outline for rewriting The Strong Black Woman Syndrome narrative. The high-fidelity prototype
was introduced to several Black women’s groups, and it was launched and completed by a
particular group of Black women in the Central neighborhood of Cleveland. This testing revealed
that the women wanted the Sister Circle to be named something that represented what the project
was actually doing. The women wanted the video materials to be repeated during the second
session and they wanted more time for discussion. The women felt it was very important to
choose the way the group began and ended. Lastly, they wanted the workbooks to be filled with
an array of art materials so they could creatively express their thoughts and feelings.

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Although Sister Circles are an evidenced-based practice for Black women, there are still
cultural inclusivity considerations. Facilitators must ensure that the Circles are developed for
Black women of all ages, socioeconomic statuses, sexual orientations, religious backgrounds,
hair types and skin shades. Inclusivity also entails avoiding Western-centric values and making
space for non-American Black women.
Design Justice Principles
Three design justice principles were applied during project development. The first
principle of design justice is “use design to sustain, heal and empower our communities as well
as to seek liberation from exploitative and oppressive systems” (Costanza-Chock 2020:6). The
Sister Circles were designed to be an empowering and healing force for the women in the Central
community, allowing them to be liberated from the burden of The Strong Black Woman
Syndrome, which is exploitative and oppressive. The second principle of design justice is
“centering the voices of those who are directly impacted by the outcomes of the design process”
(Costanza-Chock 2020:6). From the conception of the capstone project, stakeholders,
beneficiaries and community partners were involved in every step of the design process from the
low-fidelity prototype to the testing of the high-fidelity prototype. The sixth principle of design
justice is “believing that everyone is an expert based on their own lived experience, and that we
all have unique and brilliant contributions to bring to a design process” (Costanza-Chock
2020:7). This capstone project was highly influenced by the women who have been most
affected by The Strong Black Woman Syndrome. Their unique experiences and their desire to be
unburdened were a major factor considered in the design process.
Market Analysis

22
The literature review revealed that Black women’s health challenges are even more
problematic than that of their counterparts. The literature lists several causes for this and the
stress of living up to The Strong Black Woman Syndrome contributes. The resulting health
inequities necessitate the design of a tailored intervention. In addition to the literature review, the
16 interviews conducted as part of the preliminary research revealed that Black women
understand the connection between the stress of The Strong Black Woman Syndrome and the
health implications. The interviews also revealed that Black women are desperate to be relieved
of the burden of strength. They understand clearly what it costs them in terms of their health, and
they expressed a desperate need to be relieved of the burden of strength to improve their
wellbeing. The interviewees reported that they modeled The Strong Black Woman Syndrome for
their daughters and are concerned that their daughters may take on the syndrome and could be at
risk for health problems at some point. The women also reported that they witnessed their
mothers and grandmothers struggle with the burden of strength. The Black women in the Central
neighborhood of Cleveland recognized how trying to live up to The Strong Black Woman
Syndrome has caused them stress and contributed to health problems. As a result, they reached
out and ask for a group dynamic where women could support each other as they worked through
these issues.
Project Description
The core strategy for this Capstone Project focuses on Sister Circles, an evidence-based
intervention that builds upon existing friendships, fictive kin networks and a sense of community
built by Black women, making it a culturally specific intervention. Sister Circles can be loosely
organized or more structured to meet the needs of the population. They have been used to
address health issues, increase cultural values and beliefs, improve academic performance,

23
provide support, and help Black women develop resistance to the oppression they face daily
(Neal-Barnett, et al., 2021). Although there are effective interventions that address symptoms of
The Strong Black Woman Syndrome and related health issues, there is not a solution that directly
addresses the phenomenon of the syndrome itself. The present capstone presents a Sister Circle
that directly addresses The Strong Black Woman Syndrome using knowledge-building, group
dynamic, and rewriting of the narrative.
A manual and workbook for the Sister Circles includes multimedia content to be
dispersed over the six Sister Circle sessions about internalized racial oppression, The Strong
Black Woman Syndrome and the outline for rewriting The Strong Black Woman Syndrome
narrative. The legacy of storytelling, and oral tradition rooted in African American culture and
history were used to reframe the negative experiences Black women lived as the result of The
Strong Black Woman Syndrome. As a result of being a part of this study the women gained
insight into the level of control The Strong Black Woman Syndrome held over them; they began
to create narratives that centered themselves (Rodgers, S. T. 2021).
Sister Circles operate from a support group model, in which Black women come together
for a common goal. The advantages of support groups include learning interpersonal skills,
coping strategies, positive communication, social support, and decrease in isolation and stigma
(SAMHSA, 2015). In 2020 a Cochrane review assessed the effectiveness of Alcoholics
Anonymous (AA) 12-step program self-help group for people with Alcohol Use Disorder (AUD)
against Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT).
Cochrane reviewed 27 studies (21 RCT’s/quasi experiments and 5 randomized studies). This
review had a sample size of 10,565 male and female adults who had a diagnosis of AUD. Selfreporting surveys were used to measure the longest periods of abstinence, drinking intensity, and

24
physical or psychological problems related to alcohol abuse. The results revealed that those who
participated in AA support groups fared as well as those who received MET and CBT
interventions in the areas of achieving and maintaining abstinence, improved overall wellbeing,
the ability to cope with stress and developing interpersonal skills. This review also found that the
participants who were in AA were able to maintain sobriety from alcohol for longer periods of
time than participants who received MET and CBT (Kelly, 2020).
A 2016 research study found that interventions adapted to the culture of the client were
more effective than alternatives. This gives credence to the idea that interventions have an
advantage when they incorporate the client’s language, context and culture (Chu, J., Leino, A.,
Pflum, S., & Sue, S. 2016). Cognitive Behavioral Therapy (CBT) is an evidenced-based practice
that has proven to be effective in addressing the mental health needs of Black women. This
evidenced-based practice must be adapted to meet the cultural needs of Black women. The
adaptations must consider historical, social and cultural factors that cause anxiety and depression
and not just focus on symptom reduction. Encouraging culturally sensitive coping mechanisms
such as religion, spirituality and faith are an important aspect of adapting this intervention to
better meet the needs of Black women (Wallace, D. D., Carlson, R. G., & Ohrt, J. H., 2021).
Grand Challenge for Social Work
The thirteen Grand Challenges are organized under categories according to their common
themes and eliminating racism is categorized under a “Just Society”. Formulating Sister Circles
to address The Strong Black Woman Syndrome, which contributes to health concerns and health
inequities for Black women also addresses the health gap, which is under the broad category of
“Individual and Family Wellbeing”. When Black women are freed of the burden of The Strong
Black Woman Syndrome, it will improve their wellbeing as well as their families’ wellbeing.

25
Black women have struggled with The Strong Black Woman Syndrome since
enslavement, a trope that has haunted them ever since. It has been a destructive force in the lives
of Black women and in our society. Black women, through the internalization of the stereotype,
feel obligated to maintain it, leaving them without a space to be human. Review of the literature
reveals that this obligation has contributed to Black women having significant health problems
and has led to health disparities for Black women. There is no doubt that Black women have had
to be strong to survive racism, sexism, and life in this society as we know it, from the time of
enslavement to the present day, because systemic racism and sexism continues to exist for Black
women. Historically, there have been many examples of strong Black women who have fought
against oppression and for the human rights of all. Being strong is a matter of course for Black
women in America and not being allowed to have a full range of emotions has turned being
strong into a national health crisis for Black women.
This project will assist Black women in overcoming The Strong Black Woman
Syndrome, by offering Sister Circles to help Black women understand the historical nature of the
Syndrome, how it is tied to racism and sexism and how it continues to oppress Black women.
Understanding how the internalization process works and how to overcome it using culturally
competent approaches aids in rewriting the narrative. Sister Circles present the most viable
platform for helping Black women overcome The Strong Black Woman Syndrome because they
can be adapted to the needs of the participants and have been in existence in the Black
community for over 100 years. They represent Black women coming together to support each
other and healing together. Lastly the research tells us culturally based interventions offer the
most value for Black women. The women who were interviewed for this capstone project

26
affirmed this approach, indicating their desire to be free of the stress and obligation of The
Strong Black Woman Syndrome.
Design Criteria
The design criteria for this capstone were based on the needs of the Black women who
reached out and asked for help for a hardship in their life, which they knew was affecting their
health. The design criteria reflect the most effective way for the women to be able to take
advantage of the Sister Circles. The Circles must be in the community, within walking distance
and at no cost to participants. A manual and workbook with instructions for facilitators and
participants is also important to the design criteria. It is imperative that a historical and cultural
approach is taken as well as imparting evidence-based knowledge (Appendix D).
Prototype Description
The high-fidelity prototype for this capstone project has two components: a manual for
the facilitators and a workbook for the participants. The manual includes an introduction,
instructions, and research information that went into developing the Sister Circles. It also
includes the epilogue, references, suggested readings, appendices that include the logic model,
infographic, pre and post questions, exit interview questions and glossary. This manual will
provide complete information and instructions to any Black woman who already understands the
harm The Strong Black Woman Syndrome is doing to Black women and their health and wants
to help Black women rewrite the narrative.
The second component of the high-fidelity prototype is the workbook for the women who
participate in the Sister Circles. The workbook consists of introduction, inspiration on how to use
the workbook, a breakdown of the information that is to be reviewed during each Sister Circle,
pre and post questions, exit interview questions and an epilogue. The workbook will also be

27
filled with a variety of colored pens, markers, crayons, and watercolor paints to allow for artistic
and written expression of the concepts participants will be learning in the Sister Circles.
The objective of the manual and the accompanying workbook is to guide the facilitation
of the Sister Circles. During the Sister Circles, Black women are given the opportunity to be
exposed to information regarding The Strong Black Women Syndrome and how it can affect
their health and are given the opportunity to rewrite the narrative. (View high-fidelity prototype
here:
https://docs.google.com/presentation/d/1Q0KUVoidm1QiOhOAGOMr0SYTipx4wYZy/edit?usp
=sharing&ouid=107997744808639665929&rtpof=true&sd=true )
Theory of Change
Transformative learning theory will be the theory of change used to achieve the proposed
solutions of this capstone project. Transformative learning theory holds that adults, when
seriously challenged to assess their value system and worldview, are subsequently changed by
this experience. More specifically, Mezirow’s transformative learning theory posits that adult
learners who receive new information subsequently measure their past ideas and understanding
against the new information and shift their worldview through critical reflection (Taylor, E.
2000). Mezirow developed the theory of transformative learning in 1978 while conducting
research with adult women returning to school to pursue higher education. This theory has been
used extensively over time and has been modified and used with different therapeutic models and
populations. Transformative learning theory applied through the group experience will assist the
women toward becoming conscious of their behavior as it relates to The Strong Black Woman
Syndrome as they will be given new information, enabling them to evaluate their old beliefs and
create opportunities for new ideas and changes in behavior.

28
Revised Logic Model
The revised logic model reflects the inputs, outputs, outcomes, assumptions, and external
factors related to capstone “Rewriting the Narrative of The Strong Black Woman Syndrome: A
Black Woman’s Collective”. This logic model includes the components necessary to reach the
long-term goals of the Sister Circles. The long-term goals of the Sister Circles would be for
Black women to feel safe being vulnerable, express their true feelings and not view asking for
help as a sign of weakness. We will begin to see a change in the social norm that states that Black
women can only show strength (Appendix E).
Ethical Considerations
The ethical concerns that must be addressed for this capstone project include privacy and
surveillance. If confidentiality is broken it could erode the trust among the group members to the
point where members may not feel comfortable or safe sharing within the group. If the women in
the group are not able to share freely, the Circles will not build the group support that is needed
to rewrite their narratives. To address this ethical concern a strict rule stating that what is said in
the Sister Circles must stay in the Sister Circles will be added to the other group rules and
repeated weekly. During the testing of the high fidelity prototype this method worked very well.
Another ethical concern would be videotaping of the Sister Circle sessions. The
community centers where the groups are held record every event that takes place for safety
reasons. There may be women who do not want to be videotaped and to address this ethical
concern, there are designated areas where a woman can sit where they will not be in view of the
camera. During each Sister Circle session, the women will be reminded to sit in the designated

29
areas if they do not want to be recorded. When the Sister Circles were launched, the women who
did not want to be recorded were able to sit in a designated area and still be a part of the Circle.
Likelihood of Success
Success for this capstone project can be viewed in many ways, starting with the women
in the Circles gaining knowledge about themselves through learning about The Strong Black
Woman Syndrome. As women complete the Sister Circles and rewrite their narratives, they can
begin to make changes in their lives that have the potential to result in better health outcomes.
This could also lead to a reduction in the health inequities Black women face. Success for this
capstone would be to change a social norm that takes the burden of strength off the backs of
Black women. Given the feedback of women participating in the initial launch of the Sister
Circle it is expected that this project will have a high likelihood of success.
Implementation Plan
This capstone project will implement community-based Sister Circles specifically
designed for Black women of all ages who struggle with the internalization of The Strong Black
Woman Syndrome. These groups will take place in the Central community of Cleveland, Ohio.
Many local community organizations have offered the use of their space as a meeting place for
the Sister Circles. A community center that receives foodbank donations was chosen, so that the
donated food can be used by the women to prepare a snack for each of the six Sister Circle
sessions. The Sister Circles will be informed by culturally competent and historical research
materials to assist participants in gaining insight into the cause of The Strong Black Woman
Syndrome. The Sister Circles will consist of six sessions all following a similar format. The
format for the sessions begins with education and historical content, questions and discussions,

30
women working together to make snacks for each other, followed by more discussion and
reflection. During the fifth and sixth sessions, the women will begin to rewrite their narrative of
The Strong Black Woman Syndrome, finishing it during the sixth session.
The budget for the Sister Circles will consist of mostly in-kind donations as the Sister
Circles increase in numbers, they will be eligible for local grant money slated for grassroots
programming in the Central community. The Central community has grant money available for
programs, such as Sister Circles, once those programs have proven their effectiveness and are
seen as an asset to the community. It is also possible to obtain larger grants from the city of
Cleveland; the city has grants that support programming for Black women (Appendix F).
Sister Circles are marketed by word of mouth. The women who attend them share their
experiences, which is how they grow. It is a program of attraction rather than promotion.
Keeping the Circles small and intimate helps maintain a space wherein women feel comfortable,
and confidentiality is easier to maintain. As more and more women experience the Circles, they
will be in a position to facilitate a Circle, and this will allow for future growth.
Evaluation Plan
Data Collection Plan
The prototyping for the present capstone project was conducted during the learning
launch. Pretesting results showed that the majority of the women in the Sister Circles did not
have formal knowledge of The Strong Black Woman Syndrome despite their lived experience.
They did not know it was a syndrome that had its roots in history and that it contributed to health
problems and health inequities for Black women. The results also showed that self-care was not a
true priority for the women, but something they engaged in occasionally.

31
Post testing revealed that once Black women participated in a Sister Circle, their
knowledge and understanding of The Strong Black Woman Syndrome, its history and health
implications increased. Reviewing the results of the scales administered after they participated in
the Sister Circle showed women increased their recognition of the importance and need for selfcare.
The exit interviews also revealed that after experiencing a Sister Circle and rewriting the
narrative the women developed plans for ongoing and intentional self-care. While pre- and post
testing measures the increase in knowledge and awareness the women gained from attending the
Circles, exit interviews are a qualitative method designed to measure an increase in self-care and
other behavior changes after rewriting the narrative. Examples include one woman sharing that
in the past when she served dinner to her family, she would fix her plate last and often there was
not a lot of food left for her to eat so she would just eat what was left. Since participating in the
Sister Circle, she now puts the same amount of food on everyone’s plate and serves herself first.
Another woman shared that for Mother’s Day she always goes along with her family’s plan to go
to a seafood restaurant, even though she does not like seafood. This past Mother’s Day she took
herself out to a non-seafood restaurant and celebrated with her family later in the evening.
Measuring Social Change
The intention of this capstone project is to change a social norm that states that Black
women are only allowed to show strength. Once Black women rewrite the narrative of The
Strong Black Women Syndrome, they will be free from the burden of strength, and they will be
able to make choices in their lives that support their wellbeing. One way to measure social
change for this project will be to look at the examples that result from the data collection. The
data shows that after experiencing the Sister Circles, the women’s knowledge increases regarding

32
The Strong Black Woman Syndrome, and they begin to make choices that cause them less stress.
Longer term, as the women make better choices for themselves, their families will have to adjust
and their roles in the community will change. Black women will also reevaluate their roles in the
workplace as well as other areas in our society particularly the medical system. Black women
will no longer accept the Strong Black Woman role society has bestowed on them and they will
demand to be treated with care. Ultimately, the success of this capstone project will lead to better
health outcomes for Black women in the Cleveland area.
Communication Plan
Beneficiaries, stakeholders and community partners will be kept informed regarding the
Sister Circles through meetings held in the community. At these meetings updated information,
statistical data and plans for expansion will be shared. Community members will have the
opportunity to ask questions, make suggestions and offer information on community grant
funding. It is also important that the facilitators and participants who have experienced the Sister
Circles have access to data from the Sister Circles and an ongoing opportunity to share their
journeys and support for each other as they face the world differently. This communication will
take place through a social media apparatus, such as a private Facebook group, WhatsApp or
whatever platform the women prefer. Communication with the greater Cleveland community will
consist of facilitators conducting information sessions with organizations that support work in
the community that involves the empowering of Black women.
Challenges or Limitations
Foreseeable challenges to this capstone project would include losing access to the
community center where the Sister Circles meet and having access to the foodbank pantry. This

33
would necessitate finding another place for the Circles to meet and may incur a cost. To address
this challenge, it would be important to maintain relationships with community partners to
identify other spaces that can be used at no cost and provide food on-site. An additional
challenge would be a shift in the Ward 5 political leadership, the current councilmember is very
supportive of any program that empowers the people in the community and is very supportive of
the Sister Circles. To address this challenge, it is important to support the current leadership and
if the leadership changes it would be important to develop relationships with the new leadership.
The last challenge would be finding enough facilitators to sustain Sister Circles as the Circles
grow. To address this challenge there would need to be recruitment efforts to find facilitators,
seeking Black women who want to help other Black women. A good choice would be social
work students or retired social workers who could become facilitators and administer the Sister
Circles.
Conclusions and Implications
Lessons Learned
The present capstone project, Rewriting the Narrative of The Strong Black Woman
Syndrome: A Black Woman’s Collective proposes that Black women’s health is being
compromised by the burden of living up to The Strong Black Woman Syndrome which
contributes to health inequities. Sister Circles for this project will directly address The Strong
Black Woman Syndrome through a group dynamic that involves an educational component,
group support, and the rewriting of The Strong Black Woman Syndrome narrative. Sister Circles
have been an evidenced-based intervention used over time to help Black women support each
other as they overcome many different concerns in their lives. Many interventions aimed at
addressing The Strong Black Woman Syndrome focus on how to manage the stress related to the

34
syndrome. In contrast, this project will address the syndrome directly by rewriting the narrative
so Black women are in a better position to make choices that are not based on the burden of
strength.
The women in the Central community inspired the development of a project that
addressed the burden of strength they carried, as do many African American women. The leaders
of the community and the Black women in the community became the main external design team
partners, helping establish the design criteria for the Circles. The Strong Black Woman
Syndrome can affect Black women from all socio-economic levels however it hits harder for
Black women in the Central neighborhood due to the level of poverty they face. The women in
the community have shared their struggles with not having adequate food or resources needed for
daily life. Simultaneously, they cannot allow themselves to express their feelings or appear weak;
they must carry the burden of strength. This demographic also has less access to counseling,
therapy or other treatment modalities due to isolation in their communities and lack of financial
means. Due to these factors, the Black women in the Central community were chosen as the
beneficiaries and stakeholders to be the first to experience the Sister Circles.
Implications for Practice and Future Use
This capstone project embraces the core values of social work which include service,
social justice, dignity, worth of the person, importance of human relationships, integrity and
competence. It was important to use these core values as a guide for the design criteria. Dignity
and worth of the person were most important because The Strong Black Woman Syndrome
leaves Black women without their dignity and their worth as a person. The value of the
importance of human relationships plays a major role in the Sister Circles because the group
process involves the women working together to rewrite their narratives. If these core values are

35
maintained the Sister Circles will continue to be a safe place for women to overcome the
syndrome and create social change in their community.
Action Plan
Now that the Sister Circles have been launched and tested, they are ready to be released
to the Central community. The women who participated in the Sister Circles when they were
being launched are now in a position to become facilitators. Those who want to be facilitators
will be given a manual to read and information sessions will be set up to answer any questions
they may have and there will be opportunities to practice. Once they feel prepared a location
will be designated and a time will be set, emails and text messages will go out to the women who
expressed interest in being a part a Sister Circle. We will begin with two groups and monitor
them closely to maintain the integrity of the Circles. When these groups have been completed,
we will evaluate the data and plan the next round of Circles (Appendix G).

36
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Appendix A

43
Appendix B

44
Appendix C
1. How do you define stress?
2. How do you cope with stress? What role do you feel stress plays in your life and your
health?
3. How do you see other Black women in your life cope with stress?
4. How do you feel when you have to ask for help?
5. Tell me about a time when you put others before yourself, or your job, church or
community?
6. What is it like to feel you have to work twice as hard as your counterparts?
7. Do you have an example of a time you kept going and going even when you were tired
and sick because you did not want to let others down?
8. Are you afraid of disappointing family members or others, maybe even yourself? Why?
9. What happens when you feel you must present a certain image of strength and
competency at work even if you don’t feel that way?
10. What does it mean to you to be a strong Black woman?
11. Is it important to you to be seen as a strong Black woman?
12. Are you familiar with The Strong Black Woman Syndrome?
13. Do you identify as someone who has internalized or taken on The Strong Black Woman
Syndrome? Do you know any other Black women who have?
14. How do you think you acquired the syndrome?

45
Appendix D

46
Appendix E

47
Appendix F

48
Appendix G
Timeline for Implementation of Sister Circles
September 2024
 Secure space for Sister Circles
 Complete Memorandum of Understanding for community centers
 Obtain Liability Insurance
 Recruit facilitators
 Distribute manuals to facilitators
 Train facilitators and hold practice sessions
 Produce additional Sister Circle workbooks
 Order supplies for workbooks
 Hold community meetings to discuss upcoming Sister Circles
 Notify women who have signed up to participate in Sister Circles
 Determine the number of Circles needed to initially begin
 Set dates and times for Sister Circles to begin
October 2024
 Implement two to three Sister Circles that are set to meet weekly for six weeks
 Conduct regular check-ins with facilitators to assess progress, see if they need supplies
and address any problems or concerns may have
 Conduct exit interviews with facilitators
 Analyze data
 Hold community meetings to report progress and plans for continued Sister Circles

49
 Recruit facilitators for next six sessions of Sister Circles
On-going implementation plan for 2025
 Continue to implement Sister Circles for six weeks and break for six weeks and begin
again for another six weeks until the end of 2025
 Meet with community partners throughout the year for updates
 Recruit and train facilitators
 Conduct exit interviews
 Analyze data
 Update manuals and workbooks

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Asset Metadata

Creator Hall, Joann G. (author)

Core Title Rewriting the narrative of the Strong Black Woman Syndrome: a Black women's collective

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-08

Publication Date 08/08/2024

Defense Date 07/29/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag health inequities,health outcomes,narrative,OAI-PMH Harvest,racism,sexism,Sister Circles,Stress,Strong Black Woman Syndrome,support groups

Format theses (aat)

Language English

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Advisor Kay-Wicker, Robin (committee chair)

Creator Email jgh.lisw@gmail.com,jghall@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113998TDS

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