“having our say: Lessons learned from black women living in poor and underserved community about how to improve health promotion and service utilization

BACKGROUND: Often historically marginalized populations (e.g. poor African American women) are considered in the context of public health research subjects and recipients of services and rarely as research partners who can contribute significantly to the design of health services and interventions. The exclusion of women from poor communities at the front end of the research process can often lead to ineffective interventions and health promotion policies and can result in little or no effect in terms of creating positive change in health behaviors. Poor women are often situated at the intersection where poverty, environment, and behavior merge to create health disparities across the disease spectrum and as a result, their perspectives can prove invaluable in the design of effective health promotion policies and interventions for poor and under-served populations. Method: Using survey (n=105) and focus group (n=15) data from a study of black women living in a public housing community in an urban city (VA), this study examined the health behaviors, beliefs and attitudes of poor black women associated with high rates of STIs and marginal utilization of a community-based health clinic. RESULTS: The major findings from this study support the need for more tailored health interventions and health promotion policies that are created through a community-engaged or CBPR process; and the importance of a blended health services that include public and mental health services. The results also underscore the important role that cultural norms play on how health risks are conceptualized and health protective behaviors are adapted.