THE CATHOLIC UNIVERSITY OF AMERICA An Ethnography of African American and Sierra Leonean Hair Salon Patrons and Their Perceived Health Concerns A DISSERTATION Submitted to the Faculty of the School of Nursing Of The Catholic University of America In Partial Fulfillment of the Requirements For the Degree Doctor of Philosophy in Nursing © Copyright All Rights Reserved By Diona Martyn Washington, D.C. 2011 An Ethnography of African American and Sierra Leonean Hair Salon Patrons and Their Perceived Health Concerns Diona Martyn, Ph.D.(c), R.N., PH.C.N.S. Director: Janice Agazio, Ph.D., R.N., C.R.N.P. The current state of health research in the United States has largely categorized U.S. born and foreign-born individuals of “Black or of African descent” into very broad ethnic groups such as Black American or African American. However, these broad groupings have discounted and overlooked the variation of cultures found among Black populations. An aspect of relevance is that cultural beliefs and patterns may influence the perceptions and health concerns of Black populations. Understanding the perceived health concerns and the influence of culture on those health concerns can assist in the development of gender-specific and culturally appropriate nursing care for Black women. The aim of this six-month exploratory, qualitative study was to identify and explore the perceived health concerns of African American and Sierra Leonean women using focused ethnography as the methodology and the techniques of participant observation. Furthermore, this study sought to identify cultural components among the chosen groups that may affect their perceived health concerns. This study also explored the cultures of the Black hair salons, a context where health information is exchanged among Black women. Seventeen key informants, ten African American women and seven Sierra Leonean women were interviewed using a semi-structured format. The following five domains were developed for each group: a) culture (African American or Sierra Leonean), b) spirituality, c) roles/responsibilities, d) health, and e) health concerns. Based on the findings, the following conclusions were drawn: The salon culture facilitates an environment of closeness and trust among the patrons, stylists, and salon owners. Women of both groups feel comfortable when discussing general and personal information in the salons. Therefore, information related to health and health concerns are easily discussed in the salons. Data related to the cultures of the two groups revealed the importance of family, traditions, celebrations, and foods. The key informants revealed health concerns related to conditions affecting themselves, family members, and close friends. The following health conditions were major concerns for both groups of women: 1) obesity/weight gain, 2) weight-related health conditions (diabetes and hypertension), 3) stress, and 4) cancer. This dissertation by Diona Martyn fulfills the dissertation requirement for the doctoral degree in nursing approved by Janice Agazio, Ph.D., as Director, and by Kenneth Miller, Ph.D., Janalyn Cantey Edmonds, Ph.D., and Lucy Cohen, Ph.D., as Readers. _________________________________ Janice Agazio, Ph.D., Director _________________________________ Kenneth Miller, Ph.D., Reader _________________________________ Janalyn Cantey Edmonds, Ph.D., Reader _________________________________ Lucy Cohen, Ph.D., Reader ii Dedication I dedicate this book to my family and to the loving memory of Jerrick Micale Horne. iii Table of Contents Dedication .......................................................................................................................... iii List of Figures .................................................................................................................... vi List of Tables .................................................................................................................... vii List of Appendices ........................................................................................................... viii Acknowledgements ............................................................................................................ ix Chapter I: The Problem ....................................................................................................... 1 Background ............................................................................................................. 5 Purpose .................................................................................................................. 11 Research Questions ............................................................................................... 11 Definition of Terms .............................................................................................. 12 Limitations of the Study ....................................................................................... 14 Significance .......................................................................................................... 14 Assumptions .......................................................................................................... 15 Summary ............................................................................................................... 16 Chapter II: Review of the Literature ................................................................................. 17 African American Migration Patterns ................................................................... 21 African American Cultural Aspects ...................................................................... 23 Sierra Leonean Cultural Aspects .......................................................................... 29 Sierra Leonean Migration Patterns ....................................................................... 35 Health Research .................................................................................................... 36 Summary ............................................................................................................... 47 Chapter III: Methodology ................................................................................................. 48 Research Design ................................................................................................... 48 Current Study ........................................................................................................ 51 Methods ................................................................................................................ 52 Key Informants ..................................................................................................... 54 Protection of Human Subjects .............................................................................. 55 Procedure .............................................................................................................. 57 Data Collection ..................................................................................................... 58 Pilot Study ............................................................................................................. 59 Data Analysis ........................................................................................................ 59 Summary ............................................................................................................... 61 Chapter IV: Findings and Data Analysis .......................................................................... 62 Description of the Salons ...................................................................................... 73 Process of Identifying Pattern Categories and Themes ........................................ 84 Salon Domain ....................................................................................................... 88 African American Key Informants ....................................................................... 93 Spirituality Domain ............................................................................................. 103 iv Roles/Responsibilities Domain ........................................................................... 105 African American Hair Salon Patrons and Health .............................................. 106 Health Concerns Domain .................................................................................... 107 Health Domain .................................................................................................... 111 Sierra Leonean Key Informants .......................................................................... 115 Spirituality Domain ............................................................................................. 123 Roles/Responsibilities Domain ........................................................................... 127 Sierra Leonean Hair Salon Patrons and Health .................................................. 129 Health Concerns Domain .................................................................................... 130 Health Domain .................................................................................................... 135 Profile of African American and Sierra Leonean Hair Salon Patrons ................ 139 Summary ............................................................................................................. 139 Chapter V: Summary, Discussion, and Conclusion ........................................................ 141 Problem ..............................................................................................................