Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Mona N. Wicks, Ph.D.


Patricia A. Cowan, Ph.D. Joyce Carolyn Graff, Ph.D. Wendy M. Likes, Ph.D. Latrice C. Pichon, Ph.D. Elizabeth A. Tolley, PhD.


African American women, depressive symptomology, gender inequality, mixed methodology, religiosity/ spirituality, sexual health


Introduction: When looking at the health status of our nation, an examination of sexual and reproductive health reveals that there are multiple conditions related to sexual behavior posing a burden on the health of African American women (AAW). Disproportionate rates of sexually transmitted infections, unintended/teen pregnancy, and sexual violence in this group reveal the need to integrate a broader construct to address the multiple factors known to contribute to disparities in sexual and reproductive health affecting AAW. Current health promotion efforts including the encouragement of abstinence and condom use fail to address the multiple components involved in sexual health and/or risk behavior and have been unsuccessful in curtailing disparities in this population. Recently, the concept of sexual health has increasingly been recognized for its potential to improve population health for various groups by addressing pertinent emotional, relational, and sexual aspects involved in individuals’ sexual behavior, decision making, and negotiation. The Sexual Health Model is used in this study, to identify multiple dimensions involved in AAW’s sexual health and participation in behaviors known to increase their sexual risk.

Methods: A convergent parallel mixed methods design was used in this study to better understand AAW’s sexual health and risk behavior. Quantitative (QUAN) methods using questionnaires were carried out on the full study sample (N=50) to describe associations between selected emotional and relational factors (spirituality/religiosity, depressive symptomology, and gender inequality) and AAWs sexual health and risk behavior. In addition, qualitative (QUAL) methods, which included the completion of focus group interviews, were conducted for a subsample (n=19) of study participants to examine AAWs perceptions of sexual health. Respondent validation procedures were also carried out on a subset of the QUAL study sample to ensure the accuracy of thematic content analysis. Analysis for QUAN data was conducted using SAS 9.4 and for QUAL data using NVivo 10. Individual analyses were integrated to corroborate findings for a mixed methods interpretation.

Results: Study participants (mean age = 38.5) reported having good overall sexual health and low sexual risk. Significant associations were identified among specified emotional and relational factors and both outcome variables. Sexual health was negatively correlated with depressive symptomology (r = -.19, p < .20) and gender inequality (r=-.25, p < .10). Additionally, lower depressive symptomology and gender inequality demonstrate predictive properties for AAWs sexual health (R2 = .12, p < 0.05). Examination of sexual risk behavior reveal a positive association with gender inequality (r = .19, p < .20). Spirituality/religiosity were not correlated with either outcome variable. QUAL study results reveal five organizing themes that emerged from focus group data, including: 1) “The new normal”; 2) having to compromise; 3) taking responsibility; 4) securing an attachment; and 5) resolving ambiguity.

Discussion/conclusion: By taking a holistic approach to better understand AAW’s sexual behavior, this study provided important insights into the multiple factors involved in achieving an optimal level of sexual health for these women. In this study, women’s personal accounts acknowledged participation in risky sexual behavior that was motivated by their intuitive feelings or the existing dynamic within their intimate relationships. Additionally, for women having the ability to make decisions within relationships, did not consistently translate to making sexually healthy decisions. Taking a broader approach toward sexual health may significantly contribute to the improvement of disparate health outcomes among AAW. Pertinent emotional, relational, and sexual factors involved in women’s sexual health and behavior must be addressed in strategies to reduce AAWs sexual risk and yield sustainable behavior change.