Mama always said

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Material Information

Title:
Mama always said the transmission of health care beliefs among three generations of rural black women
Physical Description:
xiv, 221 leaves : ill., map ; 28 cm.
Language:
English
Creator:
Randall-David, Elizabeth, 1944-
Publication Date:

Subjects

Subjects / Keywords:
Traditional medicine   ( lcsh )
Women healers   ( lcsh )
Health education of women   ( lcsh )
Health attitudes   ( lcsh )
Anthropology thesis Ph. D
Dissertations, Academic -- Anthropology -- UF
Genre:
bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1985.
Bibliography:
Bibliography: leaves 207-220.
Statement of Responsibility:
by Elizabeth Randall-David.
General Note:
Typescript.
General Note:
Vita.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 000872595
oclc - 14558035
notis - AEG9858
System ID:
AA00002172:00001

Full Text











MAMA ALWAYS SAID:
THE TRANSMISSION OF HEALTH CARE BELIEFS AMONG
THREE GENERATIONS OF RURAL BLACK WOMEN















BY


ELIZABETH


RANDALL-DAVID


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHTIT.OSOPHY

















ACKNOWLEDGEMENTS


There


support,


are


a number


encouragement,


significant


and critical


people


comment.


who have


Special


provided


thanks


Otto


tion,


von Mering


scholarly


mentor


guidance,


and chairperson


rigorous


whose


standards


intellectual


motivated me


stimula-


to strive


for excellence


and relevance


in this


endeavor.


Other


members


doctoral


committee


provided


moral


support


thoughtful


criticism


from


his or her


unique


perspective.


Charles


Mahan,


a physician


who appreciates


the importance


of interface


between


health


care


delivery


and anthropological


principles,


long


been


role model


source


encouragement.


am indebted


to Molly


Dougherty


for her careful


critique,


her moral


support


above


for her inspiration.


initial


discovery


both


joys and


con-


tributions


of anthropological


inquiry


can be attributed


to her doctoral


dissertation.


Sally


Hutchinson


provided


not only


detailed


critical


comment,


but also


a sense


of humor


which


helped


me keep


this


experience


proper


perspective


during


discouraging


times.


Carol


Taylor


encouraged me


throughout


academic


and professional


career.


ability


to view


all difficult


situations


within


a broader


context


helped


me to develop


some


important


survival


strategies.


Todd


Savitt,











learning


stimulated


me to delve


into


areas


that


previously


had seemed


unimportant.


Acknowledgement


made


to the Nursing


Research


ion of the


Department


Health


and Human


Servi


ces


for their


financial


assi


stance


during


the lengthy


field work


period


of the doctoral


endeavor.


Thanks


to committee


members


Dougherty


and Carol


Taylor


donating


computer


Dorothy


time


Brunson,


the data


who typed


analy


sis.


earlier


The techni


drafts


Linda


expertise


Hague


of both


who aided


in data


analysis


, Ls gratefully


appreciate


Special


thanks


Janet


Eldred


miraculously


deciphered


my hieroglyphics


translated my many


drafts


into


a readable


document.


women


Macedonia-Grove


who warmly


shared


their


thoughts


and dreams


owe a sincere


debt


of gratitude.


Their


enerosit v


spirit


this di


zest


ssertation.


for living


Like


enriched


them


me far beyond


, my support


the data


tem of family


presented


and friends


has nutured


and sustained


me throughout


this


process.


Those


rejoiced


with


me in


discover


ies


rnd encouraged me


during


difficult


times


were


Sara


Jarvi


:ra Powers


, Bonnie


oats


, Byllye


Avery,


sister


Anne


my parents


Elizabeth


and James


Randall


Thank


for being


there.


To my

timism h


sons,


ave


Jonathan


provided


a very


Benjamin


special


whose


ener


youthful en

a heartfelt


.thusiasm and


"thanks


Words


cannot


convey


my appreciation


for their


devotion


, understanding


I rus I.. *1


r


r


.11 .t


1

















TABLE OF CONTENTSS


Page


ACKNOWLEDGEMENTS ................................................

LIST OF TABLES ..................................................

LIST OF FIGURES .................................................


xiii


ABSTRACT


CHAPTERS


I INTRODUCTION ............................

The Place of the Study ..................
Purpose and Approach of This Study ......
Background of the Study ................
Transmission of the Healing Tradition ...
Religico-Medical System ................
Hypertension: A Chronic Health Condition
with Compliance Problems ..............

II RESEARCH DESIGN AND METHODOLOGY .........

Choice of Overall Research Design .......
Recruitment of Subjects .................

Generational Groupings .............
Age Groupings .......................


Construction and Implementation of a Focused
Interview Guide ...........................


Professional Review of Interview Guide
Patient Review Panel: A Pilot Study .


Choice of Methodology ......











Page


III A NATURAL HISTORY OF A FIELD EXPERIENCE

Special Issues in the Fieldwork Process:
Reciprocity and Commitment Beyond the


Fieldwork Period


S. a .. .32


Phase 1: Entrance into the Community and the
Development of a "Clinical-Care-Bonded" Rapport
(3/81-12/81) ...................... ........ ...


Phase


Participant Observation and the Develop-


ment of Working Hypotheses (1/82-12/82) .

The Macedonia-Grove Hypertension Group
Key Informant Interviewing ...........


Phase 3: Construction and Implementation of a
Focused Interview Guide and Continued
Participant-Observation (1/83-8/83) .....................

Use of an Indigenous Field Assistant .................
Time and Setting of the Focused Interview ............
Participation in the First National Conference
on Black Women's Health Issues .....................


Leaving the Field (9/83-


IV AN ETHNOGRAPHIC PRESENTATION OF THE COMMUNITY IN


. .. ... .. ...... .... .. .. .. 49


The Setting ...............
Two Communities Become One
Population ................
Income Level ..............
Employment ................
Land Holding and Land Usage
Housing ... ....... ......
Transportation ......
Educational Facilities
Religious Facilities
Shopping Facilities ......


Recreational Facilities


Health Facilities


Other Community Based Services
Summary ..... ........ ... ....


49
.CC .C *. .~ ... .. .... 50
.. .52
.. ... ... .. .. .. ... ... 58
~C .S ** ..... .. ..* ..... *5. 56
........ S *t .. ..... *C. .. 58
.. ... ... .. ..59

S. .. .. .. *. .. .. 62

c. .. c .U. 63


. .. ... .. .. .. 63
.. .. . . 64


.. .... . ..... .. 65
S. ...... . 66


PLACE AND TIME


-- --- --











Page


Hattie:


A Mother,


Grandmother


Lenora:


, Aged


A Mother


Grandmother,
64 ........


Grandmother,


Great


ed 42


.. t. ....
.*......*. ..


Thawanda:


Daughter


and Granddaughter


Aged


DATA


ANALYSIS


RESEARCH


FINDING


S.................... 78


Qualitative
Quantitative


Data Analysis


Data


Analysis


Stt *** a.** **.... S78


Sociodemographic

Demographics
Family Struc


Patterns
Residential
Educational


Work


Research

.......


ture


Findings

..........


and Childr


Stability .....
Level .........


Outside the


Summary


Research


Findings


Information


Section


* *...** *55**5 *. 5*** *** S S

*5***** S*5 S *S S *5** **e5 S.


hearing


Home


ociodemographic


Findin


on Transmission


Practices


The Transmi


Beliefs


ssion


S. *5** *5S 5**** 55*~*5
.*. .55~.~*** S. St 55*
5***** S... S. S *SSt S.


S. ..... ...... ... .. 91
s .. .. ... 0. .. .. 93


Health


S**S S- **** S .. ~~ 5S94


Health


Information


. .. .. .. .. 94


Subse


action


Data


gath


ered


through


focused


interviewing


.. .......... 95


ubsection


Data


on source


health


information


gathered


through


participant
Subsection 3.


information ..
Corroboration


data


outside


Section


the research


The Transmission


community

of Health


* Care S S
Care


Practices


Section


Transmission


of Health


Beliefs


Subs


section


Health


beli


as measured


internal


vs external


health


locus


of control


scale


Subsection 2:
belief system


Role of


religion


health
.... *..... S











Page


Study Community Definition of Hypertension


Family group data
Age cohort data .


Study Community Beliefs about Etiology of
Hypertension ..........................
Study Community Beliefs about Signs and
Symptoms .. ............................


Part II: Health Practices Related to Hypertension


Study Community Practices for the Control of
Hypertension .............................
Study Community Referral Practices for
Hypertension ......... ......................
Study Community Beliefs about Consequences
of Uncontrolled Hypertension ............
Study Community's Beliefs and Practices
Related to Prevention of Hypertension ....


Concluding Summary


VIII DISCUSSION OF RESEARCH FINDINGS


The Sociocultural Context
Limitations of the Study


......a.
....... ..


Generalizability of the Data ....
Recommendations for Further Study


.......... a*a

a......a.* ..


* S S Sa a S a
*.a.a......S...
S..... ... .


IX CLINICAL APPLICATION OF RESEARCH FINDINGS


Statement of the Problem: Patient Non-compliance
Part I: Community Health Education .............


Older Black Women


as Health Educators


The Role of the Black Church in Community
Health Education ......................
The Role of Mass Media in Community Health
Education ............. .................
The Role of the School in Community Health
Education .......... .... ......... ...... .


Part II: Restructuring the Clinical Encounter ...










Page


Utilizing Information from Health Locus of
Control Test ...............................
Changing Patients' Behaviors through Utiliza-
tion of Existing Practices ................
Enlisting the Aid of Significant Others in the
Patient's Treatment Plan ....................


Summary


APPENDICES


A REVIEW OF PATIENT EDUCATION PAMPHLETS


B FOCUSED INTERVIEW GUIDE

REFERENCES ..................


BIOGRAPHICAL SKETCH

















LIST OF TABLES


Table

2-1


Page


Membership of generational groupings in age
cohorts ...................................


Membership of total sample in age cohorts


......... ...... 22


.. ...... .. ...... .. .. 22


Mean age of each cohort


Stages of the fieldwork process


Population of Macedonia-Grove (race by age) .............

Population of Macedonia-Grove (sex by age) ..............

Demographic profile of research community ...............


Income level of household in research


community


Age of houses in Macedonia-Grove


Housing: Construction and facilities
(obtained from community survey) ....


Who were you raised by


as a child?


S. .. . 86


Who were you raised by as a teen?


.. ........ .. .. ... 86


Ever lived away from Macedonia-Grove (for more
than one year)? ... ...... .... ............. ....


Of those who had lived away, for how long?


If lived away, where?


At what


age did you leave home?


.............. ..... .... 88


60











Table


Page


6-10


Major


source


of health


all respondents


information
= 96) ......


as reported
... .. ... .....QmoO OQ......


6-11


Major


sources


of health


information


cohort


....... 97


6-12


How often


read


newspaper


... .. .. 98


6-13


often


read


about


health


in the


newspaper


.... ... .. .. .. 98


often


read


. .... ... 99


How often


rea d


about


health


in magazines


.. ...... 99


often


listen


to the radio?


6-17


How often


hear


about


health


on the radio?


How often


watch


television?


6-19


How often


do you hear


about


health


on television


6-20


6-21


Types of health
television: ...


References


information


on health


obtained
S.....t. .


from
.. S...... ... .. .O..


in the home:


6-22


Has close


relative


or friend


who works


6-23


Home


remedies


some


common


health


problems


6-24


Health


locus


of control


scores


Ever


diagnosed


as hypertensive?


Length


Dependent


time


hypertensive


variable:


Kidney


(mean


number


problems


as poss


years)


ible


consequences


uncontrolled


hypertension


Definition


of hypertension


(open


ended


quest


ion)


Does
blood


hypertension mean


essure?


(forced


same


choice


thing


as high


question)


ma ga zi nes ?










Table


Page


don't


feel


sick,


can you


still


have


high


blood


pressure?


7-10


Is a


person


with


high


blood


pressure


sick?


7-11


7-12


Control


Control
forced


of hypertension:


hypertension


choice


ques


(open-ended


("yes"


questions)


responses


tions)


Home


remedies


high


blood


pressure


sequences


hypertension


("yes


responses


to forced


choice


ques


tions)


7-15


care


these things
of oneself?


happen


even


one does


take


7-16


Prevention


of hypertension:


7-17


Of those


means


who felt


to do


hypertension


("yes"


could


responses


prevent


to forced


choice


questions)

















LIST


OF FIGURES


Figure


Page


of Macedonia-Grove


. .. ... ... ... .. .. ... .. .. 51


Complete


chart


of codes


used


in data


analysis


5*5*e *** .79


















Abstract


of the University


Dissertation


Florida


for the D


degree


Presented


in Partial


of Doctor


to the Graduate


Fulfillment of
of Philosophy


School


the Requirements


ALWAYS


SAID:


THE TRANSMISSION


OF HEALTH


CARE BELIEF


AMONG


THREE


GENERATIONS


OF RURAL


BLACK


WOMEN


Elizabeth

May


Randall-David

- 1985


Chairperson:


Major


Otto


Department:


Von Mering
Anthropology


the field


health


care,


effective


information


transfer


a major


problem at


both


community


and individual


level.


Unfortunately,


the importance


cultural


beliefs


practices


.ie health


care encounter


are often


disregarded


or minimized.


This


research


examines


the transmission


of h 'alth


care


information,


attitudes,


practices


among


three


generations


women


in a


representative


rural


blac


community


in the Xmerican


South.


Rather


than


looking


at the community


as a single


entity,


this study


examines


the continuities


and discontinuities


in health


care


beliefs


practices


among


three


generations


of family


members


in four


cohorts.


lyper tension


a prevalent


health


problem


I-I


in the black
*. *


I F


--











Research


findings


indicate


that


older


women


in the community


are still


information.


perceived


However


as important


their


sources


influence


of general


been


health


attenuated


care


through


contact


with


health


care


system


and through


health


information


provided


cohorts


the mass media


reported


school


differential


based


degrees


health


of reliance


education.


on the


The four


various


sources


of health


information:


younger


women


relied


more


heavily


mass


media


health


care


professionals


for health


information


than


did older


women.


However,


data


regarding


health


care


practices


related


specifically


to hypertension


among


indicate


groups.


that


Although


in actuality


there


in general


are


few differences


responses


across


generations


were


similar,


there


was


a trend


towards


more


biomedically


congruent


beliefs


practices


among


younger


respondents.


Recommendations


are made


for incorporating


these


findings


into


both


clinical


practice


and community


education


to provide more


culturally


relevant


health


education


and medical


care


at both


individual


group


level.


generalization


these


conclusions


to other


communities


and other


health


problems


is indicated.
















CHAPTER


INTRODUCTION


The Place


the Study


Women


have


always


been


healers.


They


were


unlicensed


doctors


and anatomists


western


history.


were abortionists


pharmacists,


secrets


from


women


home


were


lectures,


cultivating


of their


to home
doctors
learning


nurses a
healing


uses.


village


without


from


each


They


counselors.


herbs
were


They


were


exchanging


midwives,


to village.


degrees,


other


barred


from


passing


traveling
centuries


books


on expert


ence
They


from neighbor


were


charlatans
heritage as
(Ehrenreich


called


to neighbor


"wise


women"


the authorities.


women


our history


and English,


1973


mother


the people,
Medicine is


to daughter.


witches


part


our birthright


, p. 3)


Authors


of anthropological


sociological


historical


and popular


literature


have


discussed


importance


women


as the chief


reposi-


tory


medical


folk


wisdom


and the primary


transmitter


of this


know-


ledge


succeeding


generations


Studies


done


in the American


South


(Hill


, 1976;


Dougherty


1976


, 1978;


Hill


and Mathews


1981


Mongeau


et al


1961


Murphree


, 1968


1976


Puckett,


1926;


Flint,


1979;


Watson,


1984)


indicate


that


in both


black


and white


rural


populations,


women


hold


S. the


reat


mass


of folk


medicine


their


hands


women


are the great


practitioners


the folk


doctors


They










Snow


(1974),


Harwood


(1981)


and Jackson


(1981)


indicate


that


this


role


is found


among


blacks


in urban


areas


as well.


This


finding


surprising


given


the shared


cultural


heritage of


blacks


in the New


World.


Most


urban


blacks


have


migrated


within


a generation


or two from


the rural


areas,


many


retain


close


ties


with


rural


kin.


However,


there


has been


little


attention


accorded


this


significant


role of

fact, d


women


in the medical literature


despite efforts


applied medical


or in clinical p

anthropologists


practice.


to integrate


sociocultural


awareness


into


the medical


encounter,


there


has been


little


regard


among


health


care


practitioners


for the cultural


belief


systems


their


patients.


In addition,


health


care


professionals make


certain


assumptions


about


health


care


information


flow


that


ignore


exis


ting


health


care


beliefs and


practices


that


patients


bring


to the


clinical

predicate


encounter.

d on the n


Most


lotion


health


that


health


patient education efforts are

information is transmitted


unidirectionally


from


the knowledgeable


health


care


practitioner


the unknowing


patient.


is presumed


that


the patient


wants


to know


then adopt


the scientific


"truths"


that


practitioner


presents.


There is little

powerful belief


evidence

system--i


to suggest

ts genesis


an appreciate,

or influence


of the patients'


in the clinical


situation.


Purpose


and Approach


of This


Study


This


research


examines


the influen


as healers


of black


women


l.


.L&L










beliefs


women

based


values


to another.


practices


are


Hypertension


on its prevalence


among


transmitted


was chosen as


the black


from one


the focus


population and


generation


Inquiry


its classifica-


tion as

common


a chronic

and chronic


condition.

conditions


(There

are mor


is some

e often


evidence

treated


suggest


within


that


the popular


folk


domain


while


acute


conditions


are dealt


with


in the biomedical


arena


(Hill


and Mathews


, 1981)


Through


qualitative


and quantitative


research


methodology,


study


elucidates


sources


health


information


and the continuities


discontinuities


that


exist


health


belie


, values


practices


vis a vis hypertension are


transmitted


from


one generation


to another


in this


representative rural


black


community.


Four


interrelated


hypotheses


were


formulated


based


on a


review


social


science


literature,


clinical


nursing


experience


and anecdotal


evidence.

beliefs a


femal


it i


nd behaviors are


relatives


hypothesized


orally


and other


that


passed


significant


health


from one

t female


care


attitudes,


generation

members of


to another


the


community


. However


influence


is thought


to be attenuated


exposure


media


to other


contact


sources


with


of health


care


the bio-medi


know


system.


mass


Thus,


it is hypothe-


secondly that


there


will


be less


reliance


on the female


based


oral


tradition


as a source


health


care


knowledge


in succeeding


generations


as a result


greater


exposure


to and reliance


on other


of health


era r


i n fnrmati nn


- rain


- TV msoa.inis


~nllrrps


.










An associated


hypothesis


to be tested


addresses


the degree


which


an individual


feel


she has control


over


own health.


This


health


belief


which


can be measured


Health


Locus


Control


standardized


testing


instrument


, is likely


to be influenced


by messages


provided


by mass


media


health


care


prof


essional


There


fore


it is


hypothe


sized


thirdly


that


health


care


belt


will


reveal


a decreasing


locus


of control


in succeeding


generations:


that


that


younger


members


the community will


believe


that


they


have


more


control


over


their


health


than


their


mothers


and grandmothers


believe


they


have


over


theirs.


final


clinically


relevant


hypothesis


spec


ifically


concerns


itself


with


transmiss


ion of knowledge


about


the detection


treat-


ment


prevention


of hypertension.


The three preceding


hypotheses


are to be


test


using


hypertension


as the clini


cal focus


of the


inquiry.


is hypothesis


zed that


members


the study


population


with


hypertension


will


have


a greater


knowledge


base


regarding


this


disorder


than


those


who do


not have


the condition.


This


hypothesis


is predi-


cated


tensive


on the


will


assumption


be more


that


motivated


those


have


to learn


about


been


diagnosed


illness


as hyper-


health


care


in general


as well


as have


a need


to learn


more


about


their


particular


condition.


Furthermore


, one might


assume


that


hypertensi


ves


have


greater


exposure


to the health


care


resources


related


to their


condi-


tion


than


do those


are not hypertensive.


summer


these


four


hvnoth


eses


comurl


maior


thrust


T


UL


1


111


V










conditions,


will


hopefully


practitioners


in delivering more cul-


turally


relevant


health


care


and assist


health


educators


in designing


more effective


instructional


interventions.


Thus,


the clinical


application


the cultural


realities


provides


the primary


purpose


this


research


endeavor.


Background


of the Study


review


the literature


indicates


that


black


women


repositories


health


care


information


derives


from a


long


tradition


both


informal


formal


healing


roles.


historical


overview


(Postell,


1976;


1970;


Harrison


Savitt,


, 1976)


1978;


indicate


Robinson,

s that th


1979;


ie Afric


Herskovits

an slaves


, 1941;

brought


Gutman,

many


their


traditional


health


care


beliefs,


values


practices


to the


New World.


continued


instance,


to be used


in America,


for healing


herbs


purposes


similar


while


to those


new herbal


in Africa


remedies


learned


from Native


Americans


and healing


concepts


from Europeans


became


incorporated


into


the Afro-American healing


practices.


However


Savitt


(1978)


maintains


that


the American


cultural


beliefs


took


precedence


the blacks


method


healing.


Maintenance


of these


beliefs


was


expressed


one former


slave


said


, "all


these doctor-


things


come


clear


from Africy,


allus


worked


mammy


me too"


(quoted


in Robinson,


1979,


89).


Black


women,


thus,


passed


on their


healing


pract


ices


to their


families and


communities.


Rovster


(1983)


indicates


that


often


these


B









whites


and blacks


in delivering


children


, letting


blood,


pulling


teeth,


administering


medicines


and nursing


the sick.


" In addition


to their


role


as nurse,


midwife


and herbalist,


black


women


functioned


conjurers


and rootworkers.


Using


African


tribal


magic,


violence,


persuasion


and considerable


sychology


these


conjure


doctors


cured


variety


of illnesses.


Although


many


these


traditional


healing


practices


were


viewed


as dangerous


the slave


owners,


they


were


retained


1976,


"clandestinely


p. 559)


as part


the slaves


of religious


themselves.


Thus,


observances"


(Harrison,


intertwinings


healing


religious


practices


that


will


discussed


later


in this


review have


a historical


tradition


in which


black


women


play


a key


role.


Postslavery


racial


medical


discrimination,


care


was


geographic


not available


inaccessibility


to blacks


and prohibititive


financial


costs.


Home


remedies


provided


family


members


or other


knowledgable


members


of the


community


remained


primary


form


health


care.


Thus,


black


women


continued


to be informal


health


agents


in their


communities.


More


formally,


black


women


began


to practice


medicine


physicians


around


1900


(Royster


, 1983).


They


continued


to function


midwives,


a role


which


eventually


was sanctioned,


indeed


controlled


, by


Public


Health Departments


many


southern


states


(Mongeau


et al.,


1961


Dougherty,


1978b)


until


recently.











Transmission


the Healing


Tradition


Robinson


(1979,


states


that


. prior


into


writing


rituals
another


were


among


to the late 20th


their
trans


members


beliefs


erre


century


or rituals


orally


in the


from


community


Africans
. Their


did
beli


not put
efs and


one generation


and within


individual


family


units.


is only


recently


that


black


women


writers


such


as Hurston,


Walker


and Morrison


have


begun


to incorporate


"the


traditional


Black


female


activities


of rootworking,


herbal


medicine,


conjure


and midwivery


into


the fabric


of their


stories


(Smith,


1976,


164).


Nevertheless


heavy


reliance


on the oral


transmission


health


care


beliefs


still


exists


among


rural


blacks


today


(Hill,


1976;


Snow,


1977a;


Taylor,


1976).


It is typically


within


context


the family


that


adult


members


transmit


the basic


values


patterns


social


behavior


other


cultural


the black


family


knowledge


to succeeding


is an extended


generations.


one--joining


many


structure


multi-generational


members


of the kin network


toge


their


for mutual


aid and


support


(Gutman,


1975

1976


Kunke


and Kennard,


Shimkin and


Demitri


1971


1971


Martin

Stack


and Martin,


1974


1978;


Frazier,


1939


herty,


Ladner,


1971


Robert


Hill,


1972;


Reubin


Hill


, 1970).


Thus,


the socialization


of children


involves


a variety


of adult


kin including


parents,


grand-


parents,


aunts,


uncles


adult


cousins


and siblin


Para-kins


ties










friends


neighbors


as well


as family


members


in the


socialization


process.


Though


Hill


(197


Lewi


(1975)


Ladner


(1971)


and others


have


emphasized


flexibility


adaptability


sex roles


within


black


family


, the


primary


responsibility


childrearing


appears


to be


purview


females


tack


, 1974;


Dougherty


, 1976;


taples


, 1978;


Martin and


Martin,


1978;


Mays


1979)


Some


social


scientists


(Frazier


1966;


Moynihan


have


blamed


the wide


spread


disorganization


pathology


with


which


they


character


the black


family


on this


imbalance


in the female-male


role


model


contribution


to family


living


view which


deri


ves


from an


implicit


nuclear


family


perspective


been


challenged


most


recently


Billingsley


(1968)


Ladner


(1971)


Robert


Hill


(1972)


and Stack


(1974)


These


investigations


, to the


contrary


have


emphasized


the strength and


resiliency


of the black


extended


family.


On the whol


the research


demonstrates


that


strong


kinship


bonds,


religious


orientation


, adaptability


family


roles, high


values


individualism


paired


with


strong


interpersonal


connectedness


strong


achievement


orientation


are strengths


of the black


family


It is


thought


that


these


adaptive


mechanisms


, report


edly


derived


from


African


cultural


heritage


"facilitate


the ability


of the family


meet


needs


its members


demands made


upon


it by


systems


outs


the family


unit


" (Nobles


and Nobles


1976


and "have


enable


the majority


of Blacks


survive


against


seemin


I--J .


--


ii J


- -


_ w










support


and aid,


members


of the black


community


are inclined


to consult


family members


health


advice


as a first


step


in dealing


with


illness.


This


consultation


system has


been


described


general


population


Friedson


(1970)


McKinlay


(1973),


Kleinman


(1978)


and others.


Indeed


of potential
confines of
select, dist
is reached.


In the black


whole


process


consultants
the nuclear


ant


, fro
family


authoritative


(Friedson,


community


seeking help in
m the intimate,


y


1970,


, however


through
laymen,
p. 377)


this


succe
until


volves a network
informal
ssively more
the professional


consultation


system


strengthened


the historical


tradition


self-help and


folk


healing


practices


combined


with


tightly


knit


familial


support


networks.


Within


the lay


referral


system,


it is generally


recognized


that


/older women


have


traditionally


served


as the primary


health agents


black


communities


in the South


(Dougherty


, 1976;


Hill


and Mathews,


1981)


As such,


they


influence


the utilization


of the mainstream


medical


system as


well


as transmit


health


care


beliefs,


values


practices


to other


members


the family


community


Kleinman


et al


(1978)


have


indicated


that


70-90


of all health


care


takes


place


in the popular


domain.


Salloway


and Dillion


(1973)


observed


that


there


is less


likelihood


utilization


of professional


health


sources


when


family


networks are


relied


on than


when


friend


coworker


networks


are consulted.


Therefore,


the influence


of these


black


women as


healers


is considerable.


L










Religico-Medical


System


strong


religious


orientation


of the


black


community


has led


an inextricable


blending


of the religious and


health


domains


(Snow,


1974,


1977b,


1978;


Hill


, 1973,


1976


Haskins,


1978;


Straight


1983:


Smith,


1976;


Doughtery,


1976;


Scott


, 1974;


Weidman,


1978).


This


phe-


nomenon


course,


unique


to blacks.


However,


the particular


religico-medical


system


of comprised


African


traits,


Voodoo


elements,


fundamentalist


Christianity


tenets


and modern


scientific


beliefs


distinctive of


blacks,


especially


those


raised


in the rural


South.


Snow


(1974


p. 8)


summarizes


the basic


themes


in this


system:


The world


individual


a hostile


is liable


and dangerous


to attack


place;


from external


sources;


The individual


is helpless


and has


no internal


resources


combat


such attack


must


depend


outside


Most


health


problems


are attributable


to disturbed


social


relation-


ships,


disharmony


with


nature,


or divine


punishment.


Appropriate


interventions


are determined


the perceived


causality


the illness.


Accordingly,


certain


practitioners


are utilized


disturbed


social


relations


(e.g.,


minister,


rootworker)


while


others


are enli


sted


help


with


disorders


caused


nature


imbalances


e.g.,


family members,


physician)


or divine


punishment


minister,


self-prayer)


Althnuoh


t-hi c


fnlk mpdir


-I. LIV


hspn


damSrihed


in onme


detail


f^ 1


U










that


younger


generation


of blacks


today may


adhere


less


strongly


these


beliefs


than


their


forbears


(Martin


and Martin,


1978).


To :summarize


thus


far,


partly


because


of familial


ties


community


resources,


and the blending


reli


gious


and health


domain


part


due to the inaccessibility


of reasonably


priced,


culturally


appropriate,


community


based


health


care


services


rural


blacks


still


participate


in a dual


system of


health


care.


Folk


medical


practices


exist


side by


side


with


mainstream medical


care


in this


population


well


as with


rural


whites


(Murphree,


1976)


urban


blacks


(Snow,


1977a)


and in other


ethnic


groups


as diverse


as Mexican


Americans


(Bauwens,


1977)


Native


Americans


(Adair,


1970)


and Italian


Americans


(Ragucci,


1972)


Thus,


this


dual


system


of health


care


is not


unique


to minority


populations


so much


in kind


as in degree.


Many


groups


rely


religious


healing


self-diagnosis,


and over-the-counter


medications.


However,


rural


blacks


appear


to rely


more


heavily


on folk medicine


some


conditions


than


others.


Data


gathered


Hill


and Mathews


(1981)


among


blacks


in North


Carolina


suggest


that


traditional


or folk


medicine


modern


is more


frequently


medicine more


often


utilized


employed


for chronic


acute


health


health


problems,


problems.


Hypertension


Chroni


Health


Condition


with


Compliance


Problems


Hypertension,


a chronic


health


pro blem


prevalent


in the black









fail


to alter


life


threatening


or disease


promoting


behaviors


fail


to keep


medical


appointments at


or on time.


Caldwell


et al. (1983)


found


that


noncompliance


was greater


patients who


were nonwhite


, less educated


from


lower


occupational and


lower


income


level


and with


shorter


duration


of di


sease.


Various


approaches


have


been


suggested


to ameliorate


situation


individual


patient


education


, 1980),


public


health


education


through


use


mass


media


(Alcalay


, 1983)


mobilization


of patient


support


systems


(Caplan


1979),


sychosocial


counseling


(Webb


, 1980)


increasing


Few studies


technical


skill


have focused


home


on the


monitoring


patients


belief


(Brody


system


, 1980)


or have


considered


role of


sociocultural


factors


compliance


problem.


review of


35 medical


journal


artici


and manuals


determined


that


only


seven


20%)


mentioned


the importance


eliciting


patients


attitudes


contrary


beliefs


, many


mnd


of those


developing


surveyed


an efficacious


blamed


treatment


the patient


plan.


treatment


failures.


A manual


on hypertension


control


nurses


other


health


prof


essional


explains


noncompliance


the following


manner


terms


a patient


who i


interaction


without


sati


actor


results
traits


, we first
and their


must


assess


influence


the individual
implication f


personality
or compliance


Is the patient
hypochondriac?


patient
covert)
punctual


hostile


To d


, aggre


ssive


determine


resistance, hos
the clinician c
ity. [Lateness


utility
an asse
can re


anxious


sence


, paranoid


and level


and opposition
ss appointment
flect hostility


(overt and
attendance


(Kochar


Daniel


, 1978,


125)










determining


the influence


of the


patients


belief


system or


other


sociocultural


factors.


review of


21 patient


education


brochures


on hypertension


showed


a similar


targeted


disregard


population


for the cultural


see


Appendix A


beliefs


for a complete


practices


list).


of the


Only


booklet


acknowledge


importance


sociocultural


factors


prevention


or treatment


of high


blood


pressure.


Much


more


prevalent


was the admonishment


to follow


the phy


sicians


orders,


"Most


the time


treatment


failure


is due


to patient


failure


to follow the


doctor


instructions"


(USV Laboratories


, 1980,


p. 2).


"The


biggest


obstacle


treatment


is the patient'


attitude


. those


who have


the condition


cooperate


fully


with


their


doctors.


sure


to do what


says"


(Merck


et al.,


1982,


This


sentiment


is expressed


implicitly


more


often,


explicitly


in 16 of the 21 brochures:


the other


five


emphasized


a physician-patient


partnership.


tacit


assumption


underpining


these


patient


education materials


as well

an empty


as most

vessel


health

into


education


which


efforts


"scientific


today


truths"


is that


patient


can be poured.


Without


consideration


the patient's


cultural


belief


system,


this modus


operandi


is ineffective


and often


, counterprodu


ctive.


summary,


a review


of the relevant


medical


and social


science


literature


supports


the need


for research


focusing


on the cultural


belief


systems


hypertensive


patients.


This


dissertation


research


explicates


sources


of health


information


and continuities and


v









health agents


in the black


community


will


be the


focus


the inquiry.


purpose


this


research


endeavor


to demonstrate


the relevance


of cultural


behavior


clinical


management.


generalizability


the research


finding


to other


rural


black


communities


in the South


to patients


with


other


chronic


illness


will


aid practitioners who are


working


with


a variety


of populations


deliver


more


culturally


relevant


health


care


improve


patient-physician


partnership.

















RESEARCH


CHAPTER
DESIGN A


METHODOLOGY


Choice


of Overall


Research


Design


research


was conducted


over


a two and


one


half


year


period


Macedonia-Grove,


a fictitious


name


given


a small


rural


community


North


Central


Florida.


This community was


selected


for a variety of


reasons.


is representative


of other


small


rural


communities


in the


Southeastern


United


States


with


regard


to its demographic


composition,


socioeconomic


status,


the degree


isolation


with


regard


to mainstream


America


the availability


community


services.


Furthermore,


community was


acce


ssible


to the researcher


since


she had


established


ongoing


relationships


with


many


the local


residents


in her


role as


nursing


coordinator


a small


health


clinic


located


in Macedonia.


research


constitute


focused


a geographically


on blacks


stable


in this


population


community


across


because


time


they


and thus


served


as a more


pure


cultural


group.


Furthermore,


health


care


professionals


readily


admit


a parti


cularly


limited


understanding


of the


cultural


belief


systems


this


population


. This


lack


of understanding


often


leads


to frustration


and inefficacy


clinical


encounters.


Therefore,


was hoped


that


research


findings


from


this


study would










Hypertension


was chosen


as a focus


inquiry,


a variety


reasons


relating


to prevalence,


chronicity


, and clinical


relevance.


is a major

American H


health


heart


problem


Association


blacks


(1979)


both


indicated


nationally


that


and locally.


of black


females


in the United


States


have


high


blood


pressure.


The Division


of Health


and Rehabilitative


Services


(DHRS)


for the State


of Florida


estimated


that


there


was a


prevalence


rat e


of 35 hypertensives


100 non-white


females--yielding


a total


of 3,


non-white


female


hypertensives


the research


county.


Since


the 1980


Census


Bureau reports


indicate


that


there


are


less


than


other


non-white


females


in the


research


county


one may


surmise that


most


of the non-white


females


referred


to above


are


black.


1977


medical


anthropology


survey


the research


community


(Albert


et al.)


reported


that


41.7


of the patients


interviewed


been


treated


for high


blood


pressure


in the preceding


year.


Reviewing


the files


of the community


health


clinic


39% of


patients


seen


during


month


period


(select


at random)


were


treated


hypertension.


Thus,


this condition


appears


prevalent


in the research


community.


Furthermore,


since


chronic


conditions


, e.g., hypertension


most


often


treated


in the popular


or folk


domain


rather


than


through


the biomedical


system


seems


reasonable


to infer


that


the influence


of orally


transmitted


beliefs,


attitudes


and practices


will


most


resilient


and readilv


ascertained


in this


domain.


HvDertension


are


-L


t.










community


in order


to shed


light


on a phenomenon


which


has clinical


importance.


Since


women are


commonly


held


to be


responsible


the health


care


their


family


and socializers


of succeeding


generations,


this


study


looked


women


rather


than men as


the transmitters


of health


care


eliefs


However,


health


care


attitudes,


beliefs


practices


are not static


across


time.


Ragucci


(1972)


points


out that


most


comparative


studies


that


deal


with


ethnic


differences


in perceiving


responding


to illness


disregard


or minimize


the differences


which


exist


between and


within


generations.


Ragucci


suggests


that


"valid


generalizations


about


cultural


differences


persistence


change


in health


beliefs


and associated


practices


require


adequate


sampling


at least


three


generations"


(1972


p. 164).


This


study


considers


continuities and


discontinuities


that


exist


as health


beliefs and


behaviors


are passed


from one


generation


to another.


Following


Ragucci


s suggestion,


this


research


sampled


three


generations.


Recruitment


Subjects


Because of


research


design


sampling


was neither


random nor


static.


Criteria


for inclusion


in the study


sample


changed


across


time.


defined


During


as all


early


black


stages


adults


fieldwork


resided


process,


research


the sample


community.


the research


progressed


see


the Chapter


III for detail


stages


fieldwork


Process)


the samDle


became


more


narrowly


defined


to include


.










This


then was


an opportunity


sample.


As the


researcher


became more


involved


community,


was referred


to new interviewees


through


others


in the


community--especially


through


the key


informants--thus


forming


a snowball


sample.


As the study


became more


formalized


and structured


, the sampling


became more


purposive.


In order


examine


the transmit


ssion


of health


care


beliefs


and practices


across


three


generations


subjects


were


identified


based


on the following


criteria


lifelong


residence


in the


research


community,


membership


lila


three


generation


kin or para-kin


group


ability


to comprehend


the interview


questions


and capacity


withstand


the interview


process


Generational


Groupings


Three


generational


groups


were


identified


parental


daughter


and grand-daughter


(G).


parental


group


included


women


years


or older


have


daughters


and grand-daughters


others who


community


functioned


women


in that


who had


role)


lived


still


away


dwelling


from


in the research


the community


years


, respectively


, but who


had returned


spend


their


elderly


years


there


were


excluded


from


the sample


on the basis


that


residence


in an


urban


area


for 45


or more


years


might


have


differentially


affected


their


health


care


bell


efs.


An additional


four women


were


disqualified


because


they


were


unable


to complete


the interview


411 nocQ 1r cn l ti


; 1 1 n aa r!










Not all of


those


they


cared


were


biological


daughters


or grand-


daughters


they


had all


functioned


in that


capacity


been


cared


and/or


lived


with


a member


the parental


generation)


These


women spanned


two age cohorts


( 36-59


years


years)


"daughter"


raised


women


generation

identified


cons


above.


sted


one


women


family


had been


two daughters


were


included


because


there


was some


question


the researcher


s mind


about


representativeness


one


subject


These


women


spanned


three


cohorts


years


, 36-59


years


and 60+


years).


The "granddaughter"


generation


was compri


women


been


raised


generation


labelled


"daughter


They


frequent


contact


with


women


in the parental


generation


their


grandmothers


These


women


spanned


cohorts


(13-20


years,


21-35


years )


Because


some


women


were


quite


young


two grand-


daughters


were


include


from


three


of the family


giving


a total


N of


total


generation


group


then numbered


that


group


were


in the


parental


group,


in the daughter


group


and 26


granddaughter


group


These


women


represented


23 family


or para-kin


groups.


Age Groupings


The problems


which


definition


"generation


present


year


woman


could


a "mother"


or "daughter"


a 24


year


7


w --


v













Table


Membership


generational


groupings


in age


cohorts


Generational


groupings


Age cohorts


Total


Parental

N


Daughter

N


Granddaughter
"G"
N


ou+ years

36-59 years

21-35 years

13-20 years


TOTAL










(13-20 years


old)


young


adults


years)


middle


adults


(36-59


years


older


adults


(60+


years)


modified


from


the groupings


outlined


Health


Services


Analysis


, Inc


for the Georgia


State


Department


Health


(1981)


In order


to make


statistically


valid


comparisons


age cohorts


well


as b


familial


groups


an additional


subjects


were


randomly


selected


several


age groups


informants


from


This


a list


yielded


of community


a total


residents


women


provided


ranging


from


cohorts


13-85


(Table


years.


2-2)


There


were


Table


subjects


shows


in each


mean age


four


each


cohort.


summary,


subjects


were


recruited


"family"


groups


or by


cohorts


sampling


allowed


for analysis


of the continuities


discontinuities


of health


care


beliefs


among


three


generations


women.


Since


generational


groups


were


not congruent


with


groups


, an additional


group


subjects


was recruited


in order


control


peer


group


influence.


This


study


sample


representative


of the community


as a whole


even


though


sampling


was purposive


rather


than


random.


was noted


above


, very


few women


were


exclude


from


the sample


based


on the selection


criteria.


study


sample


represented


the three


generational


families


the total


black


females


years


or older


distribution


the research


in the community


community

research


Because


sample


of the


of 96


was


Sr i1Iraflr"n oar 0 Ii na a rirt


nnnrni-, an


nrdnti olltr


~h~nl


nrt


1


T- r i-a


n T


t


ST









Table


Membership


total


sample


in age cohorts


From


Additional


Age cohort


family
groups


subjects
recruit


Total


subjects


60+


1-3


years

9 years

5 years


13-20 years


TOTAL


Table


2-3.


Mean


of each


cohort


Cohort


ge range
(years)


Mean age
(years)


72.6


Middl


Young


21-35


28.1


Teen


13-20










number


young


adults,


21-35


years


and 76%


the total


teen


group,


13-20 years.


Construction


Focused


and Implementation


Interview Guide


preparation


use of


a structured


or focused


interview guide


is simply


a formalization


of basic


interviewing


techniques


(Pelto,


1970)


which


provides an


explicit


documentation


of the ethnographer


learning


during


informal


fieldwork


(Agar,


1980).


Thus,


a structured


interview


guide


was constructed


during


the third


stage of


fieldwork


process


(see Chapter


for a detailed


description


the three


stages


fieldwork)


testing.


in order


The focused


to provide


interview


quantifiable


guide


data


(Appendix


for hypotheses


was


designed


elicit


accurate


responses


falling


within


a series


of specified


informa-


tional


categories:


demographic


questions


= 16),


internal


versus


external


health


locus


of control


= 15)


, stated


sources


health


information


and specific


know


edge


regarding


the definition


= 8)


causes


= 24)


symptoms


= 13),


control


= 17),


consequences


= 12)


prevention


= 15)


of hypertension.


content


for the


inclusion


particular


questions


was derived


from

and


clinical p

information


practice

culled


data

from


gathered

relevant


through

social


participant


science


observation


and popular


literature.


example,


there


were


no choices


listed


under


section,


"causes


hypertension,


that


not been


offered


one of









believes


Coreil


or she


Marshall


has control


(1982)


over


matters


administered


health and


test


illness.


to populations


that


are similar


to the research


population


, poor whites


living


rural


Appalachia


poor


blacks


living


in rural


Haiti).


use of


standardized


instrument


allows


cross


cultural


comparisons


adds


to the reliability


of the research.


format


questions


was patterned after


Pelto


s (1970)


recommendation


that


effective


interview


schedules


should


contain


mixture


both


open


ended and


fixed


alternative


or closed


questions.


focused


interview


guide


constructed


this study


contained


open


ended


questions


followed


forced


choi


ces


within


each


content


section.


Professional


Review


Interview Guide


The focused


interview


guide


went


through


drafts


before


finalized.


To achieve


anthropologists


intrinsic


a physician


validity,


a stati


stician


a panel


three medical


and a research


evaluator


reviewed


various


drafts


of the guide.


Reviewers


made


suggestions


concerning


rewording


some


questions


to provide


clarity


reviewers


suggested


a couple


of additional


questions


based


on their


clinical


experience


with


the study


population.


Patient


Review Panel


A Pilot


Study


pilot


study


to explore


feasibility


the research


sign


was conducted


a health


clinic in


Univer


sity


Town.


This


clinic


draws


was


T










following


domicile,


criteria--black,


educational


female,


aged


achievement


years


ranging


or older,


from


rural


through


12th


grade--were administered


the fourth


draft


the focused


interview


guide.


Three of


five


interviewees


were


hypertensive.


There


were


couple


of translations


health


terms


into


common


vernacular,


i.e.,


stress


= "worryation";


loss


of sexual


desire


= "lose one


nature"


that


were


incorporated


into


the interview


guide.


With


these


exceptions,


pilot


test


indicated


that


focused


interview


guide


was


socioculturally valid,


contained


wording


that


was clear


appropriate


and that


it would


elicit


required


information


hypothesis


testing.


fifth


draft


the interview


guide


was


reviewed


three


women


from

There


the research


were


community who


no additional


were


not part


suggestions made


during


the study


this


sample.


review cycle


the fifth


draft


was the


actual


draft


administered


to the study


sample


of 96


women.


Some


problems


present


during


coding


created


need


a sixth and


final


draft.


Although


it does not


differ


content


from


the fifth


draft,


the final


draft


in a


more


usuable


form


future


research


endeavors.


summary,


valid


focused


and reliable data


interview


regarding


guide


was


designed


transmission


to elicit


health


care


beliefs


forced


practices


choice


among


open


three


ended


generations


questions


of rural


on the


black


interview


women.


guide are


design


to elicit


information


reaardine


transmission


opnpral


1. JL


*


1*^










a description


and justification


the choice


methodoloy


in this


research


endeavor.


Choice


of Methodology


Several


of the major


contributors


to anthropological


methodology


(Pelto,


1970


Agar,


1980;


Spradley


, 1980)


as well


as sociologists


McCall


examining


Simmons


cultural


(1969)


behavior


and Glaser


from a


variety


Strauss


(1967)


different


advocate


approaches.


use of


both


qualitative


quantitative


data


minimi


constraints


each method


when


employed


alone and


greatly


adds


to the


reliability


validity


the findings.


Pelto


argues


that


both


insider


as the "emic"


definition and


point


categorization


view,


behavior,


and the outsider's


often


definitions


referred


signifi-


cant


actions


or cultural


categories,


often


referred


as the "etic"


point


view,


are


important


for a complete


picture


of the


phenomenon


under


investigation.


methodologies


to colle


Therefore

ct data o


this study


used multiple


n the transmission


of health


research

h care


beliefs


among


three


generations


women


in the research


community y.


These


included


both


qualitative


and quantitative


approaches.


There


is disagreement


in the literature


whether


or not it is


necessary


to enter


the field


with


a theoretical


model


explicitly


stated.


Agar


(1980


172)


example


, believes


that


precise


theoretical


operational


definition


the variables


and a clear


statement


of the hypothesized


covariation


before


the research


begins,


zes










recapitulate,


the ethnographer


enters


the field


with


a broad


definition


the research


problem about


which


she/he


formulated


some


"ideas


to check


As more


data


are collected


research


problem


becomes more


narrowly


focused and more


clearly


defined.


Subsequently


the hypotheses


or "ideas


to be


checked


out"


become more


precise


and informed.


Theory,


then


derived


form


the data


rather


than


vice


versa.


Pelto


(1970)


however


, would argue


that


all research


is structured


in terms


some


sort


theoretical


constructs.


describes


the three


level


theory:


a very


general


meta


theory


an implicit,


often


unconscious


personal


theory;


explicit


theory


He advocates


formulating


a hypothe


sis which


defines


tentative


theory


or supposition


provis


ionally


adopted


to explain


certain


facts


to guide


in the investigation


others


(Pelto,


1980, p. 45).


Working Hypotheses


tentative


Health
passed


hypotheses


care
from


which


attitudes


one


tives and other


guided my


beli


generation
significant


investigation


behaviors


to another
female me


are


female


mbers


community.


were:


orally


rela-


of the


There


will


less reliance


on thi


femal


based


oral


tradition
succeeding


as a source
generations


health


care


as a res


knowledge
greater


in
exposure


to and


tion,
books,


reliance


radio


schools,


on other


sources


, magazines


contact


with


of health


newspapers


the medical


care


informa-


movies


system.










following


is a


description


the methodologies


employed


this


study


to move


from a


more


generalized metatheoretical


a more


explicit


theoretical


level.


Data


Generating Methods


Pelto


(1970)


states


that


examining


cultural


behavior


with a


variety


of different


approaches


greatly


enhances


credibility


research


results.


shifting


back and


forth


between


qualitative


quantitative


research methodologies


suggested


a number


methodologists


(Agar


, 1980;


Pelto,


1970;


McCall


and Simmons,


1969)


The data


generating methods


employed


in this


research


include


respondent


observation,


informant


examination


interviewing,


of secondary


structured


source


unstructured


materials.


The fieldwork


process,


which


is described


in detail


in Chapter


III,


proceeded


in three


distinct


ges.


first


two stages


were


characterized


standard


ethnographic


research


methods:


participant


observation,


informant


interviews


an examination


a variety


documents


other


secondary


source


material.


Demographic


data


were


obtained


in part


through an


examination


the 1980 U


Census materials.


This


information


is essential


not only


descriptive


purposes


as documentation


the research


community


as representative


other


small


rural


black


communities


in the


American


South.


Data


regarding


family


structure


and residency


patterns


in the research


community were


gathered


through


Qenealooical


innl iri S.


L


/-*










A 1977


Needs Assessment


of the


research


community


(Albert


et al.)


provided


data


concerning


health


problems


as perceived


community


residents as


well


as those


identified


health


care


providers


local


voluntary


health


clinic.


nurse


researcher


was able


corroborate


information


regarding


diagnosis


health


practices


compliance


with


prescribed


regimes


through


access


to patient


charts at


health


clinic.


content


analysis


fiction


black


women


writers

1979b,


1978


(Hurston


1982;


, 198


1969a


Angelou


Bambara


, 1969b

1971. 1


, 197


, 1983;


973


, 1977;


Walker


, 1977;


Naylor


1971


Morrison,


, 1983)


, 1973a,


1973;


provided


1973b,


change


data


1976

1977.


regarding


black


woman


s experience


in the


rural


South


which


was


helpful


placing


data


from


study


a larger


cultural


context.


Likewise


, the


researcher


s attendance


at conferences


or events


outside


the community which


focused


on the


experiences


black


women


provided


contextual


back


round


against


which


data


from


this


study


could


examined.


Analyses


of hymns


sung


a local


gospel


group


revealed


important


data


regarding


beliefs about


the rol


religion


health


care


beliefs


in the research


community


as well


as in other


black


communities


in the South.


Thus,


an examination


of secondary


sources


not only


elded


important


data


regarding


the community


under


study


served


as a vehicle


assessing


the representativeness


community.


Methods


used


for gathering


primary


data


were


participant


observa-


tion and


informant


resnondent


nn. tj. -r A''; V


informants


were


v


. I-


.


CnXLL










the community;


time


to spend


with


researcher;


had good rapport


with


the researcher.


Because


there are


cliques and


groupings


based


on geographical


proximity,


one


informant


was


chosen


for the


area


of Macedonia-Grove


called


Macedonia and another


to be invaluable


both


the Grove


in terms


data


locale.

they pr


These


ovided


women

direct


proved

v and


in the


increased


access


to other


informants which


they


provided


through


informal


effective


referrals and


to check


introductions.


, expand and


informant


evaluate data


interviewing


gathered


is an


through


participant


observation.


Interviews with


other members


the community ranged


from


informal


conversations


to structured


sessions


utilizing


the focused


interview


guide.


Likewise,


interviews


varied


in depth and


breadth


content.


Participation


in and


observation


both


routine


special


events


in the


community


provided


rich


ethnographic


information.


Participant


observation


informant


interviewing


as key methods of


data


collection


will


described more


fully


in the


next


chapter.


At this


point


it is important


to emphasize


wealth


infor-


mation


that


was collected


through


these


methods.


The qualitative


data


gathered


through


these


standard


ethnographic


methodologies


was essen-


tial


to the formulation


focused


interview


guide described


earlier


in this


chapter


The administration


this


structured


instru-


ment


generated


quantifiable


data


which


not only


supplemented


but also


verified


challenged


various


aspects


:he aualitati


data.


I IIILU


. 1-


r


v -- --


YL










scale within


focused


inter view


guide allowed


cross cultural


comparisons and added


to the generalizabilit


the findings


In summary,


the examination


cultural


behavior


through


a variety


approaches adds


to the reliability,


validity


comparability


the data.


Thus,


both


qualitative


quantitative methodologies were


employed


to test


research


hypotheses.
















CHAPTER


A NATURAL HISTORY


OF A


FIELD


EXPERIENCE


The following


accounts


the fieldwork experience


offer


reader


a glimpse


into my


journey


discovery


as I


moved


from using


wide angle


lens,


as Spradley


(1980


refers


to it


a more


narrow


focus


for my


field


research.


overview


both


elaborates


data


collection


strategies


discussed


in the preceding


chapter


sheds

work


light o

endeavor


in special


discu


issues

ssion


constraints


of these


special


encountered


issues


in the field-


in the fieldwork


process


will


be followed


a chronology


of the


three


phases


of the


one-half


year


formal


fieldwork


experience.


Special


Issues


and Commitment


the Fieldwork


Beyond


Proc


ess:


Fieldwork


Reciprocity
Period


McCall


and Simmons


(1969)


contend


that


it i


important


researcher


to be


aware


of and explicitly


state


her/his


ases,


especially


as they


relate


to the research


endeavor


As


a firm


reliever


in patient


associated


s/consumer


with


rights


felt


this research


strongly


character


that


rized


the fieldwork


reciprocity


in aid,


support


open


communication.


tried


to reciprocate


concern,


knowledge


and encouragement


that


women


in the


community


offered me


--










served


as a


culture


broker


with


the medical


system


helping


people


with


referrals


to appropriate


health


social


service


agencies,


interpreting medical


information


for them


(especially when


they


or their


relatives


were


hospitalized)


advising


them on


common


health


problems--i.e.,


what


to do


head


lice.


tried not


confuse


my role


as a


researcher


with my


role


as a nurse


at times


this


role


conflict


posed


thorny


ethical


dilemmas.


example,


when


women


clearly


demonstrated misinformation


regarding


hypertension


during


the structured


interview,


felt


torn


between


providing


correct


information and


misinformation


thereby


thereby


contaminating


possibly


my research


contributing


and not


to the


correcting


informats


health.

mation


directly


led to harmful


intervened


only


practices.


in those cases


However,


where


the misinfor-


not undertake


overwhelming


task of


re-education


the entire


research


community


during


the fieldwork


process.


After


the fieldwork was


completed,


worked


with


women


in the


community


to organize


hypertension


education


screening


programs


be held


at local


churches.


part


this


effort,


trained


several


women


in the skills


of blood


pressure measurement,


the techniques


organizing


implementing


community


programs


the harnessing


available


human,


financial


educational


resources.


reciprocity


issue


created


certain


difficulties


me when


was time


to leave


the fi


eld.


personal


commitment


to individuals


gro UDS


within


the community


strengthened


resolve


nont t hp lika manv









formed,


continued


my participation


in significant


community


events,


i.e.,


dedication


the new community


center,


and remained


informal


source


health


care


information.


Perhaps


over


time


some


these


involvements


will


lessen.


However,


commi tment


to reciprocity


does


pose


practical


problems


in the resolution


the fieldwork


process.


following


description


documents


the fieldwork activities


they


unfolded


in three


distinct


time


periods.


first


phase


which


lasted nine


months


(3/81-1


/81)


consi


sted


entrance


into


research


community


the establishment


a clinical


care-bonded


field


rapport.


Phase


two (1/82-1


2/82)


was characterized


intensive


participant


observation


which


elded


extensive


ethnographic


data


led to the development


working


hypotheses.


During


the third and


final


phase


the formal


fieldwork


experience


(1/83-9/83)


a focused


interview


guide was


constructed and administered,


further


data


were


gathered


participant


observation and


preparations


learning


field


were


accomplished.


postfield


period


(10/83-12/84)


consisted


data analysis,


the dissertation


write-up


continued


contact


with


several


community residents


(Table


3-1).


Phase


a


Entrance


into


the Community


a "Cliriica1-Care-Boide~d1'


Rapport (3181-12/81)


th Dveonen


--r


initially


became


involved


with


the research


population


when


took a p


art-time


as the Clinic


Coordinator


for a small


medical


2/81


the DeveloDment


(3/81-1


RaDDort













Table


3-1.


Sta ges


of the fieldwork


process


Sample Focus of inquiry


Stage


(3/81-12/81)


Entrance


into


development


care


bonded


community
clinical


rapport


All member
community


s of black
primarily


those who attended


health


clinic


General
attitude


practices
to health


beliefs


related


Social


Stage


networks


(1/82-9/83)


Participant
in community
Development


hypotheses;
informant i


observation
events;
of working


interviewing


Black


women


community


those
group
women


Genealogies


especially


in hypert


Sources


ension


in older


s quilting


of health


information


Health


group


beliefs,


attitudes,
and


practices
general a
specific


both


hypertension


stage


(1/83-9/83)


Construction and


mentation
interview
Attendance
conference


women


Post


imple-


focused


guide;
at national
on black


s health


Fieldwork


Black


women--


generational


ings


Sources


group-


and age cohorts


care
Healt
belie
pract


issues


of health


information
h attitudes,
fs, and
ices both


general and
specific to
hypertension


(10/83-12/84)


Data analysis;
Dissertation write-up


Maintenance


contact


Generalizability
of findings to


with


informants


other


communities


^a *. *a .L *A


nthpr


WnlllPn










previous


training


experience


as a registered


nurse


director


a woman


s clinic


attitudes


but also


beliefs


suitable

a rural,


researching


primarily


the health


black community


care


in the


South.


responsibilities


included


supervising a


volunteer


medical


staff


for a weekly


clinic


open


to community


residents


general


health


problems.


Liaison


with


referral


to other


medical


facilities and


social


service


agencies


was an


important


aspect


nursing


role.


During


with many


the nine months


the community


worked at


residents


the clinic,


used


became


clinic


familiar


their


primary


health


care


was seen


them as


someone


they


could


turn


for help


with


with a variety

clinic patients


of problems.

and their f


Rapport


ami lies.


was easily


This


established


was demonstrated


openly


affectionate


embracing


whenever


saw patients


either


in the


clinic


or community


setting.


Whenever


a significant


time


elapsed


between


contacts,


those


with


whom


established


good


rapport


would


greet


me with a


a statement


about


how much


they


had missed


seeing me.


The development


this


strong


"clinical


care


bonded


rapport


most


helpful


during


more


formal


aspects


the research,


especially


in phases


two and


three


of the fieldwork.


It afforded


me access


community


residents


in social


contexts other


than


the clinic


and opened


doors


to significant


community


events.


had established


a social


role


that


legitimized


a kind c


information


gathering


behavior--especially


was










know my


business,


they


expressed


a feeling


"safety"


h'seui t


in revealing


tion


personal


an outsider


matters


to me.


especially


safety


one


in a helping


of revealing


role


all


informa-

owed me


access


to information


that


other members


the community


were


aware


Thus


, my


role


as a "clinical"


researcher


greatly


aided


fieldwork endeavor.


Although


was extremely


busy


in my


role


as Clinic


Coordinator


during


the weekly medical


clinics


manage


to interview many


patients


informally


regarding


their


health


beliefs.


At thi


point


research my


questions


were


broad


, general


inquiries


into


patients'


beliefs


range


about


health


causes


problems.


diagnosis

I also


cures


gathered


prevention


a great


deal


a wide


information


on social


networks


, daily


routines,


power


structures


community


The data


gathered


during


period


helped


me narrow my


focus and


define more


precisely


research


problem.


summary


the first


nine


months


in the community


was in the


participant


observer


but I


was limited


by my


role


at the


health


clinic


Although


important


data


were


gathered


a clinical


care-bonded


rapport


was established


during


this time,


there


were


certain


constraints


that


role


as the Clinic


Coordinator


imposed


the research.


a pragmatic


level


there


was a problem


with


limit


time


, given


other


commitments


to school,


work


family


obligations.


The responsibility


became


so overwhelming


that


my work


hor ri


i nrrs a Sc


fnmm


Iii I ~ I1 SS YI *ln. r.A muon1d ;


ira~lr


rnc~fl


isonir


I


fniin ~


E l l 11


f-u


1LJr









involved


there.


was


so busy


participating


that


little


time


observe.


Clearly,


there


was a role


conflict


between my


functions


researcher


Clinic


Coordinator.


second


constraint


on my


research


that


the job created


tactical


problem


of being


identified


with


the clinic.


As I


became


more


familiar


with


the community


and interacted


with


residents


who did


utilize


the clinic,


learned


that


there


were


some


negative


feelings


about


the clinic.


These


feelings


stemmed


from a


variety


sources:


personality


conflicts


with


staff


, perceived


needs


the community not


being met,


feelings


that


health


care


there


was inadequate,


lack


community


involvement


in the clinic


s decision


making


Board


Directors.


began


to wonder


being


affiliated


with


the clinic


ultimately


going


to limit


access


to the community.


Gradually,


came


to feel


that


there


were


more


constraints


than


advantages

nine months


to continuing my

. I discontinued


affiliation


role


with


as Clinic


the clinic.

Coordinator


Thus,

and b


after


,egan


focus


on my


role as


researcher.


Phase


Participant


of Working


Observation


Hypotheses


(1/82-1


the Development
2/82)


In the second


phase


research


which


lasted


12 months,


became


involved


in traditional


ethnographic


fieldwork.


Agar


characterizes


ethnographer


as assuming


a learning


role,


having


long


term


intensive


personal


involvement


with


the research


community,


looking


at phenomena


was










research


community


several


times


(3-4)


each


week.


Although


have


been


preferable


to immerse


myself


totally


in the


community


establishing


residence


there,


economic


familial


constraints


dictated


that


remain


in University


Town and


commute


to the research


community.


Commuting


to rather


than


living


in the research


community


both


offered


benefits


and imposed


constraints.


Commuting


allowed


me time


reflect


on the day


s events


and make


some


sense


of what


had observed.


Commuting


also


gave


me the opportunity


give


community


residents a


ride


into


University


Town.


In addition


to serving


as reciprocity


their


help


in my


research


endeavor,


this transportation


service


pro-


vided


a context


significant


data


collection.


Often


important


data


were


revealed


during


the trips


into


town


which


did not


come


out in


other


contexts.


Additionally,


living


outside


the community minimized


the reactive effects


that


a researcher's


presence


often


has on the


research


site.


Thus,


there


were


apparent


benefits


my non-residence


in Macedonia-Grove.


There


were,


however


limitations


problems


created


living


outside


the research


community.


problem encountered


commuting


rather


than


living


in the research


community


was created


living


two worlds


simultaneously.


culture


shock


one experiences


when


entering


a culture


different


from one's


own was experienced


some


degree


everytime


entered


and left


the research


community.


Often


impact


of the intensity


and severity


-A-


the problems


fari no


npnnl P


|











dealing


with


life and


death


crises?


could


deal


with


someone


from


the research


studying


community thr

comprehensive


eatening


exams


suicide when


as though


was in the middle


was constantly


shifting


gears


(between


research


and school,


between


research


family,


between


different


value


systems


between


different


roles


and statuess.


times


this


activity


created


a physical


and emotional


strain


on me.


Secondly,


the limitations


on my ability


to witness


all the


significant


aspects


of life


in the research


community


were,


course,


increased


residence


outside


community.


never


was faced


with


having


to make


it through a


day,


week,


month


, or year


in the


community--dealing


with


many


obstacles


created


poverty


geographic


isolation,


poor


health,


and racism.


On the other


hand


never


truly


experienced


intense


joys


brought


the close


kinship


and friendship


in mutually


bonds


enjoyable


between


members


activities.


community


On both


accounts


as they


feel


shared


a loss--


one which


was unavoidable


given


my personal


responsibilities


needs.


Thus,


there


were


both


advanta


and disadvantages


in living


outside


minimize


research


community.


the disadvantages


in order


tried


to maximize


to optimize


the advantages


data


collection.


primary


technique


employed


during


the second


phase


con-


tinuous


research


interaction


with


the field situation


was participant


observation.


Attendance


at church


services


, weddings,


funerals,


sewing


-~~~~~~~" 2 1L----


r-


---


,,1


*


,


L..-


1










Focused


observations


were


recorded


in field


notes


as soon after


event


as possible,


usually within


several


hours.


Additionally,


reactions


feelings


regarding


fieldwork


process


were


recorded


my personal


journal.


Through


participation


in an ongoing


community


based


hypertension


group,


greatly


enriched


know


edge


base


about


the health


attitudes,


beliefs


practices


its significance


will


women


describe


research


the hypertension


community


group


Because


some


detail.


The Macedonia-Grove


Hypertension


Group


hypertension


group


initially


began


as a


pilot


project


of the


local


health


clinic


during


the final


week of


tenure


there


as Clinic


Coordinator


task


was the design


and implementation


a program


that


would


educate


group


members


regarding


the risk factors


related


high


blood


pres


sure


so that


behavioral


changes


could


occur.


part,


goal


was determined


responses


to a


community


needs


assessment


conducted


several


years


earlier


(Albert


et al


1975)


and i


part


the specifications


a small


grant


that


had been


obtained


clinic


for this


project.


The

whom had


group,

been d


which met


diagnosed


weekly


was comprised


as hypertensive


a physic


15-20 women,

ian and most


all of

of whom


were


obese.


Each


group


session


began


with a


blood


pressure


measurement


and weight


recording


for each


woman.


During


the first


session.


-fc ^-


the first









the first


six sessions


were


devoted


to various


facets


of healthful


weight


control


technique.


Activities


related


to this


included


a group


discussion


and under


what


circumstances members


indulged


overeating;


behavior


an exploration


modification


demonstrations


ways


of weight


techniques


prepare


reduction


helpful


traditional


plans


dietary


foods


that


plans;


with


employed


cooking


less


cholesterol,


collection


sodium,


exchange


and fat


of low


a session


calorie,


on menu


healthful


planning;


recipes.


was possible


to include a


session about


weight


control


education


sorting


content


regarding


game


was


of commonly


sodium as


introduced


consume d


a risk


to impart


foods


factor


in hypertension.


knowledge


drinks.


regarding


A card


the sodium


Thanksgiving


dinner


for the


principles


community


covered


was planned


group


and prepared


discussions


group members


demonstrations.


using


Through


this event,


community member


group members g

s in attendance


raphically


that


demonstrated


nutritionally


to the 85


sound menus could


also


taste


good.


Exercise


was gradually


introduced


as an excellent


form


weight


control,


exercise


stress


sessions,


reduction,


group


cardiovascular


members


workout.


enthusiastically


After


suggested


several


that


"exercise


class,


as it


was renamed,


meet


twice


each


week


to maximize


its benefits.


Thus,


after


three months,


the hypertension


group


evolved


into


an "exercise


class


which met


twice


weekly


for the


next


one and


one-half


years.










informal


observations.


This


data


were


recorded


in field


notes


soon


after


observation.


Participation


in this


group


further


strengthened


clinical-care-bonded


rapport


with


both


women


in the


group


other


community


residents.


This


legitimization


was most


helpful


during


phase


three


the fieldwork


process.


identity


with


the "exercise


class"


afforded me


easy


access


into


homes


women


whom


previously


had not


met.


Thus


, participation


in the ongoing


hyperten-


sion


group


both


yielded


important


data


strengthened


my rapport


with


members


of the community.


Informant


Interviewing


In addition


to participant


observation,


informant


interviewing


yielded


important


data


that


contributed


to the development


of the


working


hypotheses


crucial


to the


next


phase


the fieldwork


process.


Phase


struction


and Implementation


Focus


ed Interview Guide


Participant-Observation


nd Continued
(1/83-8/83)


Using


data


gathered


through


clinical


nursing


experience


(phase


participant


observation


(phase


and a


review


relevant


social


science


and medical


literature


constructed


an interview


guide


designed


to test


the working


hypotheses


(see


Appendix).


This


interview


schedule


was subjected


to both


a professional


and patient


review


process,


as mentioned


in the preceding


chapter.










data.


sociology


was a 25


who therefore


year


had a


old college


basic


graduate


with


understanding


a major


research


desi


and data


collection.


Training


the field


assistant


consiste


explaining


the research


desi


gn, going


over


each


question


with


insure understand

her doing several


the intent


interviews


content


and discussing


the item


problems


, observing


encountered


during


independently


administered


interviews.


Fifteen


weekly meetings


with


indigenous


interviewer


provided


a good


eedback


loop


which


insured


that


questions


were


getting


desired


data.


It al


served


as an opportunity to


uncover


deletions,


errors


and incomplete


responses


which


could


then


correct


supplemented


had been


observation


next


identify


week.


as a community


was reinforced


with


importance


concern


the fi


confidentiality,


during


assi


which


participant


stant.


community


field


assistant


provided


access


an age


cohort


with


which


not personally


have


a great


deal


rapport


previously


established


, teenagers


Therefore,


in addition


being


time


effective,


use of


a community


field


assistant


broadened


the qualitative data


base


improved


the previous


limited


access


an important age


cohort


interviews


were


divided


evenl y


between


two interviewers


based


on previously


established


rapport


with


particular


interviewer


mndi


genous


field


worker


completed


intervi


completed


interviews.


-


i l










in a


study


about


high


blood


pressure


that


researcher


conducting.


No one


refused


to be interviewed.


On the


contrary,


most


were


eager


to participate.


mutually


agreed


upon


time


was set up when


the interview would


take


place.


Although


occasionally


subjects


forgot


appointment


were


not home


at the agreed


upon


time,


scheduled


time


was generally


adhered


Almost


everyone was


inter-


viewed


own home


but three


women


were


interviewed at


relative


s or friend'


home.


home environment


and interviewer


was a comfortable


but occasionally


crying


one for


babies


both


or curious


he informant

neighbors


would


create distractions.


The interview would


be discontinued


until


there


were


no further


distractions.


Quite


often


the data


obtained


during


the distraction


was


worth


delay


Furthermore,


other


data


could


be obtained


through


observation,


e.g.,


watching


women


cook adding


lots


of salt.


Interviews


asted


from


40 minutes


to three


one-half


hours.


interviews


of older


women


tended


to last


the longest


They


seemed


thrilled


at the


opportunity


to share


their


knowledge and


ideas


with


young


person


experiences.


provided


shortest


was interested


Both in

the older


interviews


terviewers


women


were


in them


agreed


greatly


with


that


enhanced


their


meaningful


the richness

the research


teenagers


who perhaps


life


of detail

endeavor.


because


their


limited


life experiences


had less


additional


information


share


was


S










questions


on the focused


interview


guide


were


recorded


in the


space


allocated


for them.


Additional


data


and verbatum


responses


were


recorded


hand


on the back


the interview


protocol


interviewer


. The


nurse


researcher


reviewed


this


additional


qualitative


data and added


to the field


note


records.


Participation


in the First


National


Conference


on Black


Women


Health


Issues


While


administering


the focused


interview


guide,


continued


collect


data


through


participation and


observation


community


events


in phase


In addition,


was


afforded


opportunity


to place


data


planning


a larger


committee


cultural


context


for the First


through


National


participation


Conference


on a


on Black


Woman


Health


Issues


held


in Atlanta,


Georgia,


in June,


1983.


From


exposure


to black


women


from


urban


and rural


areas


across


the United


States,


differing


socioeconomic


classes


and different


educational


backgrounds,


broadened my


knowledge


experiences.


base


was able


regarding


to note


black


which


women's


experiences


health

were


concerns


shared


all black


women


and which


ones


varied


according


to the variables


noted


above.


This


understanding


was furthered


attendance


at the


confer-


ence


itself


where


1,800


black


women


gathered


to share


their


concerns.


experience


as an outsider


and minority


(one


15 white


women)


provided


new experiences and


insights.


Unlike


the research


community


where


racial


differences


seem


to hinder


my acceptance,


there










black


women


often


experience


in the


white


world.


summary,


information


and insights


gathered


during


course


this


conference


broadened


my perspective


and provided


data


regarding


the generaliz-


ability


research


findings


from


the study


community y


to other


black


communities.


Leaving


Field (9/83-


final


stage


of fieldwork


consisted


of preparations


leaving


the field.


was discussed


earlier


in the


section


entitled


"Special


Issues


in the Fieldwork


ocess


task


was difficult


for me


accomplish.


addition


own issues


exercise


group


become


dependent


on my


facilitation.


Though


exercise


tried


class


for six months


to two group members


to transfer


demonstrated


leadership of


leadership


potential,


was unsuccess


ful i


effecting


this chan


When


went


away


an extended


period


of time


, at the


end of the


structured


interviewing


phase


of fieldwork


group


members


not meet


their


own in my


absence


Though


they


cited


bad weather


as an excuse


not meeting


was evident


that


group


lacked


a leader


willing


to take


char


exerci


group.


Thus,


exercise


dissolved


after


one and one-half


years


of weekly


meetings.


own ambivalence


a vis reciprocity


coupled


with


group


members


ependence


on my


leader


ship made


the task


of leaving


the field


iiori ill f1 ni r 1 dond n'r~nuor anc Imnnrt~n1- firma inct ii-


was


ass


t


in~arrtl


~nbl~P131"


IJ~ c


V13rV


I 1


| r i r,










further


involvement


everytime


a group


member


called


and suggested


that


really


have


to start


exercise


group again.


When


new


community


center


was recently


completed


director


for the facility


was hired


, daily


exercise


classes


were


scheduled.


Thus


after


a lapse


almost


a year


exercise


group


rejuvenated


the community.


continued


though


limited


involvement


with


the research


community


one year


after


the termination


fieldwork


leaving


experience


the field


testifies


proximity


to the difficulty


own residence


experienced


to that


research


site


and the bonds


which


had been


formed


with


women


in the


research


community made a


complete


break


impossible.


was
















CHAPTER


AN ETHNOGRAPHIC


PRESENTATION


OF THE


COMMUNITY


PLACE AND TIME


description


of the


major


sociodemographic and


ethnographic


features


research


community


will


provide


a context


in which


interpret


the research


findings.


Because


the community


is a microcosm


of the larger


culture


to which


it belongs,


serves as


a useful


focus


for discovering


cultural


behavior


and social


relationships.


Through an


appreciation


representativeness


this


research


site,


reader


will


gain


an understanding


the potential


generalizability and applicability


these


findings


to other


small


rural


black


communities


in the American


South.


following


description


described


is by no means


Arensberg


intended as


Kimball


an indepth


(1965).


community


However,


study


population,


economic


education


, occupational


religious and


social


features


of the


study

which


community

to view t


briefly


he resear


outlined be

ch findings


low will

discuss


provide a backdrop against

d in later chapters.


The Setting


Macedonia-Grove


a rural


community


in North


Central


Florida,


originally


established


as two separate


farming


communities


in the


was










from


University


Town,


an educational


medical


center


with


population


of approximately


115,000 in


1980,


Macedonia-Grove


still


the feel


a rather


isolat


and underdeveloped


farming


community.


Travel


along


one of


the four


paved


roads


in the


area


(Figure


4-1)


reveals


planted acreage


inter


spersed


with


clusters


houses


trailers.


ride


down


one


of the many


dirt


roads


that


lead


through


wooded


areas,


pastures


and fields


eventually


brings


the traveller


more


groups


homes.


Thus,


there


are far


more


people


living


in the


community


than


travelling


state


maintained


paved


roads


might


indicate.


A large


percentage


of the community


residents


live


away


from


the heavily


travelled


paved


roads.


friendliness


typical


many


rural


communities


evidenced


people


waving


as one passes


on foot


or by


car.


There


is also


curiosity


about


state


"outsiders"


maintained


travel


roads.


through


Particular


the community


attention


on other


is given


than


to anyone


with


a prolonged


stay


in the community


(i.e.,


more


than


one


hour).


community


gs, playing


is generally


children,


quiet


an occasional


punctuated


tractor


sounds


and passing


barking


cars.


community


heard.


gathering


On Sunday,


places


songs


usual


prayers


sounds


emanate


of people


from


one


socializing


of the five


churches.


Two Communities


Become


Sixteen


years ago,


two small


communities


Macedonia and


v


-..















******..........
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I 17'mjti from


15 miles from
University town


Key:


u n.


000000


1 mile


State roads, asphalt \
County roads, graded \


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S


(Illl(l(lrli










recreational


purposes


could


erected.


Through


fund


raising


efforts,


land


was purchased


and a building


was moved


into


community.


However,


within


several


years


vandals


destroyed


the old house


used


as the community


center.


new


center


constructed


community


volunteers


just


been


completed.


Several


recreational


educational


activities


have


already


been


scheduled


there.


people


Macedonia-Grove


consider


a community


although


there


no official


recognition


county,


state


or national


mechanisms


that


this


entity


exists.


For example,


the postal


routes


based


two different


post


offices--one


in University


Town,


other


in a


small


town


several


miles


from Grove.


Unfortunately,


the U.S.


Census


Bureau


does


not consider


Macedonia-Grove


an entity


(i.e.,


it is


unincorporated).


community


cuts


across


census


tracts


enumera-


tion


districts.


Thus,


obtaining


precise


demographic


data


was most


difficult.


following


profile


was derived


extrapolation.


Population


total


population


is 1,317;


43.4% or


573 of these


are black.


Women make


57.4%


the total


population,


thus


numbering


678.


There


are approximately


288 black


females


in the community.


Of these,


are 13


years


or greater


the eligible


category


for this


research.


(See


Tables


4-1 to 4-3


more


complete


population


statistics.)


are












Tabi


4-1.


Population


Macedonia-Grove


(race


Age Black White Total



< 5 51 42 93

5-17 160 171 331

18-64 295 474 769

65+ 67 57 124


Total 573 744 1317


SOURCE:


U.S.


Census


Bureau


Report


(1980)













Table 4-2.


Population


of Macedonia-Grove


(sex


age)


Age Male Female Total


Total


1317


Mean


= 27.6


years


SOURCE:


U.S.


Census


Bureau


Report


(1980).













Table


4-3.


Demographic


profile


research


community


Total


Total


Total


population


black


female


of community


population


population


1,317


of community


community


Total


black


female


population


of community


Total


black female


population


of community


age:


13-20
21-35
36-59
60+


years
years
years
years
years


= 70
= 31
= 78
= 74
= 35


Obtained


through


extrapolation


from


U.S.


Census


Bureau


Report


(1980).










poverty


threshold


a family


four


was noted


in the U.S.


Census


materials


as $7,412


annual


income.


In addition,


many


the elderly


the community


income


exist


$3,782.

years r


on Social


Ine mean

esiding wit


Security


income


them was


benefits


families

$10,527


with a


with

in 198


mean


annual


children u

0. Female


nder


headed


households


fared


less


well


with


a mean annual


income


589.


per capital


income averaged


$2,714


annually.


(See


Table


detailed


income


statistics.)


Employment


For those


were


employed


1980


the largest


occupational


categories


were


service


jobs


(which


included


custodial


domestic


road


work)


farming


according


to U


Census


reports.


There


little


opportunity


income


generation


within


community


itself


other


than


through


child


care,


nursing


care


the elderly,


transporta-


tion


services


farm


work.


The majority


those


employed


commute


jobs


in University


Town


where


they


work


one


of the


many


hospitals


nursing

function

service


homes,


businesses,


primarily

workers or


in private


as custodial


homes


workers,


domestics.


or at the University.


nursing


occupy


assistants,


secretarial


They


cafeteria


positions.


Some


commute


research


one of four


community)


where


nearby


they


towns


engage


(each


in factory


0-15 miles

or prison


from

work.


Many


of the above


mentioned


jobs


involve


evening


and night


shift


work.


In nearly


young


black


families


(aged


24-44)


both


the male


and












Table 4-4.


Income


level


households


in research


community


Income Percent Households



< $5,000 41.6 127

$5,000-$7,499 10.2 31

$7,500-$9,999 4.6 14

$10,000-$14,999 27.5 84

$15,000-$19,999 11.1 34

$20,000-$24,999 < 1.0 4

$25,000-$34,999 3.6 11

Total 305


SOURCE:


Census


Bureau


Report


(1980)










heads


household


received


to Families


with


Dependent


Children


(AFDC).


more


typical


pattern


was


young


woman


to work,


leaving


family


or friends


care


for her children


during


working


hours.


Land


Holding


and Land


Usage


Most


the people


in the research


community


live on


land


that


been


in their


families


several


generations.


This


heir


land


passed


live


down from


in close


one generation


proximity


to another.


one's siblings,


Thus,


parents,


one


is likely


grandparents,


aunts,


uncles


and cousins.


Many


of the


families own


large


amounts of


acreage


(40-80 acres)


which


is currently worth


between


$2,000 and


$3,000


acre.


However,


there


is little


readiness


to sell


this


land


because


community


residents


feel


strongly


that


this


land


belongs


to the


next


generation


and thus


should


be passed


on to them.


Some


residents


have


hogs


cows


but in general


the land


is used


agricultural


purposes


rather


than


production


of livestock.


Most households


plant


large


gardens


for personal


consumption


as well


acreage


income


generating


crops such


as tobacco,


peanuts,


watermelon,


corn,


beans


peas.


Neighbors


and kin


often


exchange


produce


from


these


plots


thereby


supplementing


their


own


supplies.


Fishing


in nearby


ponds


and lakes


provides additional


food


supplies.


Hunting,


once


a popular


means


for obtaining


meat,


has diminished


L~mml~; E S


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,,1,


M~ n n rl A~ : ~






59


Housing


The U.S.


Census Materials


report


that


the median


value of


housing


in the Macedonia-Grove


area


is $16,500.


Housing


features


note


age of house,


type


construction,


plumbing


electrical


heating,


cooling


and kitchen


facilities.


Nineteen


percent


of the


houses


were


years


or more;


were


at least


years


old.


Mortgage


payments


housing,


then


are concerns


approximately


one


half


households


from wood.


(Table


This


4-5).


type


A majority


the houses


of building material


was


used


(64%)


are constructed


in all of


the older


homes.


Most


of the older


community


residents


live


in wooden homes.


Trailers,


owned


or being


purchased


of the community


residents


primarily


are inhabited


room heaters


primarily


(55%)


young


and cooling


adults.


Heating


is accomplished


through


use of


fans


. Most


the homes


with


central


heat


(34%)


central


air (13%)


were


trailers.


community


residents


have


a stove


and refrigerator.


Fifty-five


percent


(55%)


have


a separate


freezer


storage


food.


During


the spring


summer


months


foods


are


frozen


consumption


throughout


rest


year.


There


were


of the


population


indoor


who do


plumbing


not have


(same


water


respondents).


facilities

Everyone h


or complete


as electricity


working

y, tele-


vision and


radio.


Ninety


percent


(90%)


have


a telephone.


Table


more


complete


data


on facilities.)


Tr ansnnrttsri nn


are












Table


of houses


in Macedonia-Grove


of house


Percent


Total
number
houses


> 45

35-44

25-34

15-24

10-14

6-10


years


years


years


years


years


years


years


TOTALS


SOURCE:


Census


Bureau


Report


(1980).










Table


4-6.


Housing:
community


Construction


and facilities


(obtained


from


survey)


Percent


Total


number


respondents


of houses
represented


Housing


(Total


number


= 96)


Material

Wood
Trailer


Concr


ete/brick


Heating


(primary


source)


Fireplace
Room heaters


Central


heat


No heat

Cooling:

Fans


Central


Air conditioning
No cooling


units


*Multiple


sources


used


Kitchen

Stove
Refri


facilities:


gerator


ezer


water


Other


separate)
facilities


facilities:


Electricity


Complete
indoor
Televisio


working
plumbing










Obtaining


rides


to nearby


towns


for shopping


and/or


medical


appoint-


ments


is particularly


problematic


the elderly


Often,


they


will


pay a neighbor


$10.00 round


trip


this


service


one


of their


family members


not available.


contribution


is usually


made


a family member


performs


this


function.


There


is a minibus


service


to University


Town available one day


week


but this


seldom


utilized


to inconvenient


scheduling.


Educational


Facilities


There


are no longer


schools


in the research


community.


until


years ago


there


was an elementary


school


in Grove.


When


that


school


no longer


functioned,


students


commuted


to another


nearby


miles


distance)


rural


community


to attend


school.


Twelve


years ago,


part


of the school


desegregation


program,


students


from Macedonia-Grove


began


to be


bused


into


University


Town for


their


elementary,


middle


high


school


experiences.


Therefore


, many


their


classmates


reside


areas


to 30 miles


from


the research


community


and thus


are not


readily


available


contact


outside


the school


setting.


Religious


Facilities


There


are five


churches


in Macedonia-Grove


where


blacks attend


services,


prayer


groups,


choir


practice


and other


community


functions.


The prominent


religious


sects


are Baptist


Holiness,


and Methodist.


nr .4.


r


J


I





r


1










community


churches.


One such


occasion


Women


s Day--when


women


the churches


from ushering


plan


execute


to preaching


reading


entirety


reciting and


of the church


singing


service


special


selections.


Often


women


from other


congregations


community


invited


meal


to participate


served


In general,


in these


women


attendance


at church


services.


sponsoring


is most


There


church


regular


is usually


after


among


an ample


services.


the elderly,


women and


young


children.


Young


and middle


aged men


consistently


participate


in church


services.


Shopping


Facilities


There


one small


general


store


located


in Macedonia


where


can purchase


sodas


, candy


bread


other


"spur


of the moment"


items.


store


not readily


accessible


to those


live


in the Grove


area


. Grove


residents


frequent


a convenience


store


a nearby


town


miles)


incidental


items.


The majority


of the


community


s shopping


is carried


out in University


Town


where


ces


are more


economical


selection


more


complete.


Likewise,


medications


other medical


supplies are


purchased


in University


Town


because


there


are no drug


stores


Macedonia-Grove.


Recreational


Facilities


The only


buildings


other


than


residences


and churches


"juke


a hang-out


where


adolescents


young


adults


gather to


are


are










There


is a community


park


where


football


basketball


and baseball


games are


played


and where


youths


"hang-out"


with


their


peer


groups.


There


are no


other


recreational


facilities,


e.g.,


bowling


alleys,


movie


theaters,


skating


rinks,


etc.,


available


in Macedonia-Grove.


closest


facilities


for these


activities


are in University Town.


Television,


which


a major


source


entertainment,


limited


reception


of only


two chann


els compared


to 10 or


more


channels


available


in University


Town.


Health


Facilities


Seven


years


ago,


a small


health


clinic


which


had been


operating


an adjacent


community moved


to Macedonia-Grove.


This


clinic,


staffed


primarily


volunteer


health


care


providers


from


University


Town,


offers


cost


primary


health


care


to community


residents


one evening


week.


utilization


of the clinic


services


the community


has been


erratic.


Very


few of


the people


Macedonia-Grove


rely


exclusively


on this


clinic


for their


formal


health


care


needs.


Most


retain a


relationship


with


a private


physician


or clinic


in University


Town


as well.


Typically,


the community


clinic


is used


acute


illnesses


minor


accidents


that


coincide


with


once


weekly


clinic


schedule,


blood


pressure


checks


and prescription


renewals


for school


employment


physical.


clinic


s limited


resources


necessitates


Cn A14: e4


m


L.


ralnrro~~~~~~- 1\ ar 4-r oTna iC, 14 rr' 4-yr Ia a lf


r^


rd Cnr F~ 1


nr


nl


I










There are


no practicing


healers,


i.e.,


root


doctors,


faith


healers,


midwives


or prayer


ladies


in the community


at this


time


although


each


these


practitioners


existed


there


in the


past.


Neither


do the public


health


nurses


visit


the community now


as they


as recently


as 10


years


ago.


Community residents


voice


sorrow over


loss


this


visiting


nurse


service,


but do


not express


sadness over


disappearance


of the other


Other


healers


Community


listed above.


Based


Services


Though


it is considered


an outreach


area


for University


Town-based


community


agencies


(e.g.,


library mobile


unit


stops


there


once


month,


surplus


commodities are


distributed


there


another


agency,


university f

recreational


raternities


events


sororities


community


occasionally


children)


sponsor


Macedonia-Grove has


formal


community


based


services


and remains


relatively


undeveloped


with


regard


to health


and social


services.


Many


residents


of University


Town,


for instance,


have neither


heard


Macedonia-Grove


nor know


where


it is located


or what


life


in that


area might


like.


Given


proximity,


this


lack


of knowledge


among


University


Town


residents and


health


professionals


testifies


to the isolated


nature


of Macedonia-


Grove.


Macedonia-Grove


residents


hope


that


the newly


built


community


center


will


enable


them


to attract


more


recreational,


educational,


health an


social


services


into


their


community


(i.e..


county


a


u


I










extended


families


and friends


as informal


support


in times


of need


rather


than


on university-based


community


agencies.


Summary


brief


profile


indicates


that


the research


community


relatively


stable,


economically


depressed


rural


area


which


historically


relied


on its own resources


coping


with


the challenges


of survival.


It is characterized


a subsistence


economy


with


tremendous


kin and


exist


reliance


neighbors.


in nearby


on non-cash


Although


University


transfer


a multitude


Town,


produce and


health


transportation


services


social


difficulties,


among


services


economic


limitations


and other


constraints


often


impose


barriers


to utilization


these


facilities.


Within


the community,


strong


family


ties


firm


religious


conviction


promote


family


and church


as permanent


institutions


support


and strength.


These


coping


strategies


will


become


more


apparent


when


we examine


research


findings


subsequent


chapters.


At this


point


however


must


be emphasized


that


Macedonia-Grove


is representative


a whole


genre


of communities.


SOClo-


demographic


and ethnographic


profile


describes


many


other


small


rural


communities


in the American


South


(Hill,


1977).


Therefore,


research


findings


from


this


community will


be applicable


to other


locales


well.










women


from Macedonia-Grove--an


older


woman,


her daughter


granddaughter--as


they


move


through


their


activities


of daily


living.
















CHAPTER


ORDINARY
THE ET


FAMILY LIVING


HNOGRAPHIC


WITHIN


PRESENT


Introduction


The following


description


depicts a


typical


weekday


in the lives


of three w

behavioral


omen


from Macedonia-Grove.


realities


expressive


such it i


the demographic


a statement


social,


of the


and ethno-


graphic


facts


presented


in the precedin


chapter.


Each


woman


representative


generation


to which


she belongs


apropos


activities


of daily


living


, chores


and responsibilities,


recrea-


tional op

presented


portunities.


this


To insure


and all chapter


anonymity

s that fo


names


allow are


fictitious


people

ones.


synoptic


overview


equips


the reader


with


a view of


women


s lives


in the research


community


provides a


context


in which


to examine


the socialization


of succeeding


generations.


Especially


noteworthy


the number


care


variety


the children


family


in the


members


course


and close


a typical


friends who


Child


take


care


activities are


interwoven


among


many


other


tasks


and responsibilities


and are


highly


dependent


upon


the availability


femal


caretakers.


Jones


Family










Macedonia-Grove.


Three


hundred


yards


away


Hattie


s only


child,


Lenora,


aged


ves


with


her husband


, Leroy


her daughter


Lakeisha,


years


old.


Lenora


s and Leroy


s two


sons


Leroy


"Junior


and Jerome,


, no longer


live


in the


community.


Both


young


joined


states


200 mil


army


Lenora


from her


after


s sixth


home


high


school


child,

There


eventually


Cheryl,


much


atte


fluidity


settled


in distant


nds a college


movement


located

between


two houses


, especially


among


the women and


children,


as the


events


a day


unfold


Hattie:


Mother,


Grandmother,


and Great


Grandmother


, Aged


typical


the life


Hattie


begins


when


she arises at


6 A.M.


Like many


rural


people


, she


is accustomed


to rising


early


work


in the


fields


She no


longer


works


outside


the home


but she


wakens


early and


gets


prepare


breakfast


for her husband,


early


riser


and her


randdaughers


Each


granddaughter


eats


piece


toast


, gulps


a glass


of milk


grabs


a banana


to take


with


her as she hurriedly


departs


from


home


must


catch a


school


and the other


rushes


to meet


carpool


a commute


to work


University


Town.


:15 A.M.


the house


has calmed


down


Only


Wiley


and Hattie


are home.


Hatti


fries


bacon,


makes


grits


and brews


some


coffee.


warms


up peas


leftover


from last


night'


meal


toasts


several


pieces


white


bread.


After


breakfast


Hattie


straightens


mnk r a


-% -I-


rI r W ;c IS**a


W 1 v


and rhrat


nn tho nhnnm


men


hnllcP


wi th


liUII


U


5JI|II


i










popular


past-time


women


in the community who are


home


during


the day.


Hattie


gets


out her quilting


and works


on her latest


project--


a lap


cover


for residents


a nursing home


in University


Town.


Hat tie


s quilting


group


consists


of 8-10 other


women her


meet


weekly


in each


other


s homes.


Group


members make


articles


for them-


selves,


their


families


and friends,


as well


as undertaking


community


projects.


They


exchange


ideas


, materials,


and skills


while


socializing


and sharing


in a


communal


lunch.


Today


is Hattie


s group


meeting


so she


prepares a


cornbread


to take


with


her.


warms


some


leftover


greens


and macaroni


cheese


Wiley


to eat in her absence.


Her nephew,


who is also


another member


s grandson,


arrives


give


her a ride


to her cousin


home


where


the quilting


group


is gathering


today.


She takes


onions


from her


garden


to share


with


cousin


in addition


to the cornbread


and her quilting


project.


Hattie


animated


arrives


conversation


at quilting


group.


as the members


There


greet


each


is much


hugging


other.


group


member


brought


All the members


take


great


turns


grandbaby


holding


whom


and playing


she is caring


with


today.


the baby.


discussion


ensues about


all the different


children


each


them has


"raised"


--younger


siblings


their


own


children


grandchildren,


now


great


grandchildren.


Hattie


talks


about


her newly


born


great


..'~~~~~r I. I *I*I. 0.


I


P


I


*


1111


t


1










Hat tie,


have made


lots


progress


on their


project


since


last meeting.


Others


have not.


After


begins

some o


an hour


to ready


or so


the food


f the members


makes


hostess


warms


some


retreats


to the kitchen and


the vegetables already


kool-ai d


and sweetened


prepared


tea to drink


gets


with


the dessert


preparation.


out of the


Soon


box.


the meal


Several


ready


group


It consists


help


summer


squash


mustard


greens


cornbread


, stewed


chicken and


fried


fish.


vegetable


have


been


cooked


with


fatback


so they


are greasy


and salty


chicken


fish


likewise


are


seasoned


with


salt.


For dessert


, there


is pear


made


one of


the members


with


pears


from


own


tree


some


brownies.


hostess


provided


ice cream which


most


members


eat along


with


a sampling


and the brownies.


Members


the group who


report


they


diabeti


only


eat a little


bit" (several


bites)


each


of the


sserts


Mealtime


the cost

picking


wash


conversation


a variety


and canning


dishes


revolves


of foods


activities


away


around


at diff


After


where


erent i

lunch,


leftover


food


locationss

Hattie


food.


Then


was obtained,


recent


and another


they


woman


return


their


after


quilting


the meal


another


Around


hour


or so


P.M.


Many


women


women


ready


use snuff


to return


home


Discussions


rides


need


ultimately


lead


a resolution


which


everyone


sets


taken


care


Membhpr


nnotnrcsni


hrm


SfI


1Ji th


U


rJ -


1 1 f


.










own house


begins


preparation of


evening


meal.


Vegetables


particular


are cooked


over


a low


heat


for several


hours,


so it is


necessary


to begin


cooking


in the late


afternoon.


Soon


Hattie


s nine


year


old granddaughter


comes


home


from


school


on the


school


bus.


After


changing


into


her play


clothes,


runs


over


to her grandparents'


house.


Hattie


"watches


over"


her granddaughter


while


the child


s mother


naps.


A neighbor


comes


over


to play


two of them


run around


the yard and


in and


out of both


ses.


When


Hattie


s teenage


granddaughter


comes


home,


she takes


over


supervision


the nine


year


old.


Hattie


spends


a lot of time


each


sitting


on her


screened


porch.


From


this


vantage


point


she keeps


track


of the "comings


goings


many


the community members.


knows


who is in


University


Town


shopping


and who


gone


a nearby


town


to buy


chickens.


People


beep


their


horn


wave


as they


pass


her house.


She also


uses


this


time


to read


from


her Bible,


an important


activity


that


engages


in at least


once


a day.


P.M.


most


the poeple


in Macedonia-Grove


work


shifts


have


returned


to the community.


Thus,


Hattie


granddaughters


live


with


are


home


the time


supper


is ready


at 6:30


P.M.


Hattie


Wiley


are usually


joined


two older granddaughters


the evening meal


However,


if the granddaughters


like


the food


better


at their


mother'


house


next


door,


they


might


choose


to eat there.


Sometimes


teena


eats


in both


places.


someone


is not home at


v v


-- v


La


--


_










After


dinner,


Hattie


Wiley watch


television


a couple


hours and


then


retire


to bed early


(9:30


P.M.).


If the


next


expected


to be more


strenuous


than


usual


i.e.


, a trip


into


University


Town


or a holiday with much


visiting


and activity


, the bedtime


earlier.


Lenora:


A Mother


and Grandmother,


Aged


Lenora


s typical


differs


a great


deal


from her


mother


Lenora


works


the night


shift


a hospital


complex


in University Town.


She is just


returning


from


work when


rest


family


is waking


prepares


breakfast


and readies


her nine


year


daughter


school.


hours.


home


After


her "baby"


husband


do not


works


correspond much


leaves


12 Noon


during


school


to 8 P.M.


the week


, Lenora


so their


Lenora


goes


to bed for


waking


sometimes


hours at


wakes


prepare


the noon-time


meal


husband.


Otherwise,


"makes


with


leftovers


from


night


before.


Lenora


eats


"breakfast"


when


she wakes


and then


does household


chores--washing


and ironing


clothes


for her children,


husband


parents,


sweeping,


straightening


vacuuming


the house.


The tele-


vision


usually


turned


on during


this


time.


Watching


the daytime


"soaps"


is a popular


past-time


in Macedonia-Grove.


Lenora


"keeps


with


several


these


stories.


discussion


recent


happenings


in the lives of


these


characters


will


a significant


part


Lenora


s interactions


wi th


her co-workers


later


that


even ne


"'










several


hours.


Usually


Lenora


takes


a nap


during


this


time


P.M.


leaving


food


teenage


The evening meal


(including


the husband


daughter


in charge of


sometimes eaten


and two older


with


daughters


"checking


the entire


sometimes


on the


family


only


youngest


daughter


sometimes


only


her husband)


This


seems


to depend


on the appetites


whims


schedules


various


participants.


Lenora


begins


getting


ready


for work


immediately


after


supper


drives


over


a cousin'


house


so that


two of


them can


ride


into


Univ


ersity


Town


together


Lenora


is afraid


to drive


the 20 miles


along


relatively


deserted


roads


alone at


night.


She and


cousin


usually


arrive


one-half


hour


before


they


need


clock


in because


they


"hate


to be


rushed


early


arrival


also


allows


socializing


with


other workers


before


their


shift


officially


begins


at 10:30


P.M.


Lenora


works


in the housekeeping


department


the health


center


medical


college.


wing


the building


totally


deserted


during


the evening


Lenora


works


a pair


with


another


black


woman.


Together


they


are


a part


a team


people


are


responsible


for cleaning


a large


number


laboratory


offi


ces


, lavatories


conference


rooms


Lenora


stays


busy


most


inht.


She hurries


finish


her work


4:30


.-5 A.M.


so that


can get


together


with


other members


surreptiously


team


watching


purpose


a television


social


in one of


zing


and/or


conference


rooms.


There


. they


take


turns


watchinge


the suDervisor"


does not


V


W J


SJnv










Thawanda:


A Daughter


and Granddaughter


Aged


A typical


for Thawanda


begins


early


since


meets


school


bus at


A.M.


She takes


a 21


trip


into


a high


school


located


in an


exclusive


section


of University


Town


school


is attended


many


the children


middle


upper


class


white


professional


business


rural


people


areas


as well


and from


as by


other


blacks


parts


bussed


city


in from

. Twent


various

y percent


outlying

t of the


student


population


are black.


Though


there


are not open hostilities


between


the racial


groups,


there


is little


real


mixing


of the


socially.


Most


the black


students


eat together


at lunch


time


social


primarily


with


other


blacks.


same


true for


white


students.


Thawanda


and her


friends


talk


about


ususal


teen


topics


--bo


fashions


, make-up and


hair


styles


recent


parties,


school


work


school

each


events.


other


They


during


walk

asses


between


Thawanda


asses to

social


gether


zes


with


and usually


sit with


some


cousins


who live


outside


the community


but who


to the


same


school


does


Since


Thawanda


does


not have


own


transportation


, she


limit


her after


school


activities.


must


catch


school


back


to the


community


or arrange


for her sister


to pick


up after


work.


Thus


Thawanda


usually


does


not socialize


with


her school


friends


outside


the school


context


An exception


to this


pattern


Friday ni


ht football


and basket-










with her


school


friends


, though


gets


a ride


to and


from


event


with


someone


from


the community.


On the weekends


Thawanda attends


barbeques


other


together


in the


community.


Some


of these are multigenerational


events


such


as family


reunions,


while


others


are limited


to her


peer


group


Teen


parties


at private


homes


or at the


community


center


and activities


at the "juke"


usually


involve


alcohol


consumption


, recreational


drug


usage


i.e


., marijuana


cigarette


smoking.


Teen


participation


such activities


at family


events


not sanctioned


the adults--


especially


those of


the grandparental


generation.


does


not mean


that


these


behaviors


are


not present


on these


occasions


rather


that


they


are more discreetly


participated


During


community


events


there


much more


interaction


between


sexes


in the


teenage


young


adult


group


than


in the other


cohorts.


(Middle-aged and


older


people


tend


spend most


their


time


sex segregate


interactions


at such gatherings


Thawanda


jokes


with


boys


girl


are her


or slightly


older


interacts


food


little


or bring


with adults


her grandfather


except


to bring


something


from


her grandmother


truck.


a plate


Occasionally


she plays


with


some


the babies


or toddlers


wonder


Thawanda


s life


a more


serious


side


as well


wants


attend


college


like


two older


sisters


did.


Thus


she i


taking


courses


at high


school


which


will


prepare


her for future


study,


computer


nror~rammine


math


- accounting -


For ths lst-


Cllmmorc


,


K


..I I


I f I










Like


older


sister


Cheryl


Thawanda


looks


forward


to attending a


state


university where


she hopes


major


in business


administration.


expresses


appears


ambivalence


comforted


about


leaving


the knowledge


family


that


other


to attend


family


college


community


members


have done


so with


no apparent


problem.


When


Thawanda


gets


home


from


school


(around


certain


household


responsibilities


chores.


I'e p


out"


around


her grandparents


her mother


house


s cooking


dusting


and loosely


sweeping


supervises


"watches


younger


over"


sister


Thwanda


ves


her grandmother


to a


nearby


store


to purchase


some


food


supplies.


These


activities


are interspersed


with


watching


the "soaps"


on television.


talks


music


After


to her friends


on the record


supper


in the evening


on the telephone


player


reads


room


does


magazines


grooms


homework


, listens


her hair


usually


goes


sleep


around


11 P.M.


summary


synoptic


overview


of the ordinary weekday


lives


of three


women


from


research


community


provides


a context


in which


specific


health


care


beliefs


practi


ces


can be


examined.


proximity


their


of the three


daily


ves


generations


provides


as they


an opportunity


about


much


activity


exchange of


information

behaviors.


health


transmission


The specific


neral


beliefs


attitudes


and hypertension


attitudes


beliefs, and

in particular


and modelling


behaviors


will


vis a vi


be closely


na nn tlln Ffr 1 lnta n rhofn


Vd m; n a ~


rk rlnt nr


















CHAPTER


DATA ANALYSIS


RESEARCH


FINDINGS


convergence


evidence


was obtained


the different


data


eliciting


techniques


discussed


in Chapters


II and


III.


qualitative


data


obtained


through


participant


observation


informant


interviewing,


secondary


source


review,


, fiction,


were


coded and


analyzed


independently


of the quantitative


data,


the materials


generated


focused


interviews and


the demographic


data


gathered


through


secondary


source


review.


method


of data


analysis


afforded


opportunity


to supplement,


corroborate,


or correct


impressions


gathered


data


source.


data


was thus


made more


valid


reliable


employing multiple


strategies


analysis.


Qualitative


Data


Analysis


copious


field


notes


gathered


during


over


4500


hours


fieldwork in


research


community were


anal


using


a combination


of techniques.


record


Observations


in chronological


were


order.


first


recorded


a periodic


in the field


basi


either


note


weekly


monthly


depending


on availability


of time


and number


observations,


the chronological


record


was xeroxed


then


coded


using


general


S:A Ir


.
fl a 4% %W t 4%t~ 1 '-Sn a n a t a at 44.....


. a


-S


one


*


,C


nACnn Ar; nn


k


1


~nrL
















Ethn


Ethnographic


description


Hist
Hous
Emnpl
Educ
Rec
Ch


historical


information


= housing
= employment/income
= education
= recreation
= church


generating


activities


health


Tran
Shop


care


= transportation
= shopping


community
activities


resources
of daily


living


Heal


healers


Demographic


Ntwk


= geneologies
= networks


Function


friend
church


Tran


relatives
neighbor


References


= childcare
= transportation
= financial
= errands


housekeeping


to caretakers


family members
mother
grandmother
aunt
sister
cousin


other


family


member


others


in community










Info


Source


of Information


Radio


general
specific


Television


Prnt


info


Receiver


info


Print


MAG
NP
BK
Bib
Phit


magazine
newspaper
books
bible
pamphlet


2 rel


school
female


relative


grandmother


aunt


mother
cousin
sister


other


female


relative


d' rel


male


relative


grandfather
father


other


male


relative


physician
nurse
neighbor
friend


phar
min
Ch
Dent


= pharmacist
= minister/preacher
= church
= dentist


health


care


work


(relative


or friend)


chir
Mdwf


chiropractor
midwife


heal:


Women


as healers


= caretakin


elderly
child
other


Ctxt
Func


context


= type
sick =-
main =-
info =-


caretaking


tending
general


information


function


sick


maintenance


giving


type


remedy


- ..


- J










Rx med
pract


prescription medication


(advice


practices


= over


counter


medication


HERB


Home


& Herbal


Remedies


Condition/remedy/mode


Religion


of administration/information/age


Health


= causality
= fate


as God'


instrument


prayer
ritual
luck


DIET


Dietary


Influences


on Health


etiology/cause


prevention


cooking


general
specific


techniques


Fd pref


food


Weather


preferences


Influences


on Health


= cold
= hot


rainy
lightning


Hypertension


Def
Explain


Definition
Explanation


Numerical


parameters


= Etiology/cause
= cure/control/treatment


evention


Refer


-= Symptoms
= Referral


S. '- '


= Con


seauences


I


-- v










Opler


(1945)


suggests


that


the identification


of frequently


occurring


themes


denotes


a postulate


or position


declared


or implied,


and usually


controlling


behavior


or stimulating


activity


which


tacitly


approved


or openly


promoted


1.11


society"


198).


Therefore


the field


narrative


was subjected


to content


analysis


in order


discover


both


general


and specific


health


care


beliefs


, attitudes,


and practices


the members


of the research


community.


source


mode of


transmission


various


health


care


information


were also


noted.


In addition


, general


ethnographic


and demographic


categories


were


identified


in order


to describe


research


community


place


it within a


larger


context.


The xeroxed


field record


thus coded


was


then


filed


in folders


labelled


specific


the general


as fieldwork


headings


progress


in Figure


new


Coding


themes


emerged


became more


new


codes


more


specific


headings


within


existing


codes


were


added


Thus,


analysis


of the qualitative


data


was an ongoing


process


throughout


fieldwork


process.


Likewi


data


collected


from secondary


sources


e.g.


both


fiction


and nonfiction


written


black


women


were


subjected


to the


same


content


analysis


In addition


to classification


content


categories


, field


notes


were


xeroxed


and filed


in folders


cohort


, generation


group


family membership


Thus


, the


same


piece


of data


might


be filed


to four


folders.


system


of data


assification


is comparable


a a A 4 n n n A ~ -aa 4 -- 4:-Er-S


*1


f~l~1.j


A -


,,~:,,


- J










health


care


beliefs


are transmitted


from


one generation


to another


female


relatives and


other


female


members


the research


community.


Process


related


data,


feelings about


role


conflicts,


ethical


dilemmas


, pros


cons


residing


outside


the research


community,


were


recorded


in my


personal


diary.


These


recordings


were


reviewed


during


the formal


period


data analysis


Recurrent


themes


were


identified


color


coded


highlighting,


blue


= reciprocity


issues


, green


= rapport


building,


yellow


= ethical


dilemmas,


pink


fieldwork


constraints.


These


color


coded


notes


were


reviewed


appropriate


inclusion


in the field


narrative


of thi


research


report.


Quantitative


Data


Analysis


The quantitative


data


gather


through administration


focused


interview


guide


were


analy


with


computer


assistance


using


the Statistical


previous


Analysis


experience


methodologies


reatly


was hired


facilitated


System


(SAS).


ethnographic


to write


the task


research


as well


run the


quantitative


evaluator


as quantitative


program.


analysis


research


assistance


Simple


frequencies


were


run on all subjects


demographic


, health


locus


control


sources


of health


information


hypertension


variables


delineated


on the


focused


interview


guide


(Appendix


In addition


, frequencies


on the


above


named


variables


were


run by


cohorts


generation,


and by


diagnosis


., hypertensive


non-hvnprtpnqi v


An ~nm1vc *- '1*vononr -'., A4- ~fl~n, -. j-


, n,


bn


I h hl~~f A \


l~drl


L


|









Data


order


were


to compare


transferred

graphicall


from computer

v the results


printouts

obtained


to tabular


charts


different


cohorts,


generational


groupings


and family


members.


Finally


quantitative and


qualitative


data


sets


were


combined


in order


to provide


a more


valid


reliable


and comprehensive


reportage


the research


findings.


Examples


the complementary nature


of the


two data


sets


will


apparent


in the


following


sections


qualitative


quantitative


data


sets


were


analyzed


determine


the validity


four


interrelated


hypotheses which


guided


the research


endeavor


However,


before


examining


the data


related


hypotheses


testing


it i


important


to ascertain


the representativeness


of the study


sample.


Therefore


the sociodemographic


features


research


sample


will


first


presented.


It is


followed


specific


data


relating


to the transmission


of health


care


beliefs,


attitudes,


practices


in the


community


Macedonia-Grove.


Sociodemographic


Research


Findings


Demographics


As mentioned


earlier,


sample


for the


focused


interview


included


black


women


from


the research


community who


ranged


in age


from


to 85


years


sample


was comprised


women


represented


23 respondents


family

were a


groups


dded


three


to the sample


generations

e in order


each.


examine


An additional


the data


four


age cohort


groups


as well


as by


three


generational


groupings.










Family


Structure and


Childrearing


Patterns


Fifty-eight


percent


the respondents


had been


raised


as a


child


both


parents


their


mother


alone


another


female


relative


i.e.


, grandmother


or aunt


, and 2%


a non-kin


female


member


the community


Only


had been


raised


a male


relative


alone


(Table 6-1).


When examining


these


data


age cohbrts,


one


notices


some


differ-


ences among


groups.


More


young


adults aged


years


were


raised


their


mothers


or single


female


relatives


than


both


parents


whereas all


the other


groups


including


teens


had been


primarily


raised


both


parents.


difference


between age cohorts


is even


more marked when


one examines


the data


childrearing


during


teen


years


(Table


6-2)


groups


demonstrate


less


involvement


father


during


teen


years


but this


pattern


is particularly notice-


able


in the


young


adult


age cohort.


Residential


Stability


Data


from


the study


sample


confirmed


the assertion


that


they


represent


a relatively


stable


rural


-based


population


(Tables


6-6).


thirds


of the


respondents


never


lived


awa y


from


research


community


while


another


lived


away


than


years.


Of those


who lived


away


from


the research


community


(33%)


most


(23%)


lived


in nearby


rural


communities


during


their


younger










Table 6-1


were


raised


as a


child?


Respondents


Adults
(60+)


Middle
Adults


-59)


Young
Adults


1-35)


Teen


13-20)


Both p

Mother


parents

only


Female
relative

Non-female
relative


Male


relative


Table


6-2.


were


raised


as a teen?


Respondents


Adults
(60+)


Middle
Adults
36-59)


Young
Adults


-35)


Teen


-20)


Both p

Mother


parents

only


Female
relative