The Giscombé Superwoman Schema Questionnaire (G-SWS-Q) consists of five sub-domains. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that disproportionately impacts Black women and for which psychosocial mechanisms are of high relevance to well-being. The main objective of this study is to validate the G-SWS-Q factor structure among a sample of Black women living with SLE using confirmatory factor analysis (CFA).
Methods
Participants are part of Georgians Organized Against Lupus, a population-based SLE cohort in Atlanta. We measured SWS using the G-SWS-Q containing 35 items across five subdomains. We restricted to those identifying as Black women (n = 584). CFA was performed and model fit was assessed using standard fit indices and procedures for model re-specification in Mplus 8.1.
Results
The mean age of respondents was 48 years (SD: 13.3)) and number of years of living with SLE was 16 (Median: 14.6, IQR: 7.9-21.22). All items were retained in the scale. After modifying the model by adding within latent factor error covariances, we obtained satisfactory model fit (RMSEA = 0.052; CFI = 0.90; SRMR = 0.063), which suggested that the factor structure is valid in this sample of Black women with SLE.
Conclusions
Our findings confirm the factor structure suggested by G-SWS-Q for Black women living with SLE. The SWS has the potential to better understanding of psychosocial mechanisms underlying adverse health outcomes experienced by Black women by centering a gender- and race-specific orientation, with implications for engagement with health behaviors and disease management. In SLE, framing studies connecting chronic symptoms and their connection to quality of life with SWS may elucidate these mechanisms.
Woods-GiscombeCLAllenAMBlackAR, et al.The giscombe superwoman schema questionnaire: psychometric properties and associations with mental health and health behaviors in African American women. Issues Ment Health Nurs2019; 40, 672–681.
2.
Watson-SingletonNN. Strong black woman schema and psychological distress: the mediating role of perceived emotional support. J Black Psychol2017; 43: 778–788.
3.
Beauboeuf-LafontantT. Behind the mask of the strong black woman: voice and the embodiment of a costly performance. Temple University Press, 2009.
4.
CarterLRossiA. Embodying strength: the origin, representations, and socialization of the strong black woman ideal and its effect on black women’s mental health. Women Ther2019; 42: 289–300.
5.
CollinsPH. Black feminist thought: knowledge, consciousness, and the politics of empowerment. Routledge, 2002.
6.
WestCM. Mammy, sapphire, and jezebel: historical images of black women and their implications for psychotherapy. Psychother Theor Res Pract Train1995; 32: 458–466.
7.
WoodardJBMastinT. Black womanhood: essence and its treatment of stereotypical images of black women. J Black Stud2005; 36: 264–281.
8.
ThomasAJWitherspoonKMSpeightSL. Toward the development of the stereotypic roles for black women scale. J Black Psychol2004; 30: 426–442.
9.
Woods-GiscombéCL. Superwoman schema: african American women’s views on stress, strength, and health. Qual Health Res2010; 20: 668–683.
10.
ErvingCLMcKinnonIIVan DykeME, et al.Superwoman schema and self-rated health in Black women: is socioeconomic status a moderator?Soc Sci Med2024; 340: 116445.
11.
AllenAMWangYChaeDH, et al.Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress‐coping model among African American women. Ann N Y Acad Sci2019; 1457: 104–127.
12.
McDanielGAkinwunmiSBrenyaV, et al.Superwoman schema: uncovering repercussions of coping strategies used among black women at high risk for HIV. Ethn Health2023; 28: 874–894.
13.
ThorpeSDogan-DixonJMaloneN, et al.Just be strong and keep going’: the influence of superwoman schema on black women’s perceived expectations of coping with sexual pain. Cult Health Sex2023; 26: 346–361.
14.
Watson-SingletonNNSpiveyBNHarrisonEG, et al.Double-edged sword or outright harmful? associations between strong black woman schema and resilience, self-efficacy, and flourishing. Sex Roles2024; 90: 1123–1135.
15.
KnightonJ-SDoganJHargonsC, et al.Superwoman schema: a context for understanding psychological distress among middle-class African American women who perceive racial microaggressions. Ethn Health2022; 27: 946–962.
16.
WatsonNNHunterCD. Anxiety and depression among African American women: the costs of strength and negative attitudes toward psychological help-seeking. Cult Divers Ethnic Minor Psychol2015; 21: 604–612.
17.
NelsonTCardemilEVOverstreetNM, et al.Association between superwoman schema, depression, and resilience: the mediating role of social isolation and gendered racial centrality. Cult Divers Ethnic Minor Psychol2022; 30: 95–106.
18.
ErvingCLMcKinnonIIThomasTCS, et al.Black women as superwomen? The mental health effects of superwoman schema, socioeconomic status, and financial strain. Soc Probl2024; 72: 759–782.
19.
NelsonTCherryM. Sister outsider: superwoman schema, emotion regulation, and psychological distress among black college women. J Black Psychol2024; 50: 631–658.
20.
FarrAMCarterJSWebber-RitcheyK. Relationships among the endorsement of superwoman schema and health outcomes. J Obstet Gynecol Neonatal Nurs2024; 54: 88–101.
21.
ErvingCLZajdelRABlevinsKM, et al.The association between superwoman schema and subjective sleep quality among black women. Sleep Health2024; 10: 302–307.
22.
HarrisCLGoldmanBMGurkasP, et al.Superwoman’s kryptonite: the superwoman schema and perceived barriers to weight management among US black women. J Health Psychol2022; 27: 2887–2897.
23.
Sheffield-AbdullahKMWoods-GiscombeCL. Perceptions of superwoman schema and stress among African American women with pre-diabetes. Arch Psychiatr Nurs2021; 35: 88–93.
24.
LewisTTParkerRMurdenR, et al.Network stressors, personal stressors, and ambulatory blood pressure in African-American women-does superwoman schema play a role?Health Psychol2023; 42: 485–495.
25.
KyalwaziANWoods-GiscombeCLJohnsonMP, et al.Associations between the superwoman schema, stress, and cardiovascular health among African-American women. Ann Behav Med2024; 58: 863–868.
26.
LimSSDrenkardC. Understanding lupus disparities through a social determinants of health framework: the georgians organized against lupus research cohort. Rheum Dis Clin N Am2020; 46: 613–621.
27.
LimSSBayaklyARHelmickCG, et al.The incidence and prevalence of systemic lupus erythematosus, 2002-2004: the Georgia lupus registry. Arthritis Rheumatol2014; 66: 357–368.
28.
IzmirlyPMWanISahlS, et al.The incidence and prevalence of systemic lupus erythematosus in New York county (Manhattan), New York: the manhattan lupus surveillance program. Arthritis Rheumatol2017; 69: 2006–2017.
29.
SomersECMarderWCagnoliP, et al.Population-based incidence and prevalence of systemic lupus erythematosus: the Michigan lupus epidemiology and surveillance program. Arthritis Rheumatol2014; 66: 369–378.
30.
Dall'EraMCisternasMGSnipesK, et al.The incidence and prevalence of systemic lupus erythematosus in San Francisco county, California: the California lupus surveillance project. Arthritis Rheumatol2017; 69: 1996–2005.
31.
ScalziLVHollenbeakCSWangL. Racial disparities in age at time of cardiovascular events and cardiovascular‐related death in patients with systemic lupus erythematosus. Arthritis Rheum2010; 62: 2767–2775.
32.
ShahTPalaskasNAhmedA. An update on gender disparities in coronary heart disease care. Curr Atheroscler Rep2016; 18: 28.
33.
Danoff-BurgSFriedbergF. Unmet needs of patients with systemic lupus erythematosus. Behav Med2009; 35: 5–13.
34.
SeawellADanoff-BurgS. Psychosocial research on systemic lupus erythematosus: a literature review. Lupus2004; 13: 891–899.
35.
LeungJRaJBakerEA, et al.Not having the real support that we need: patients’ experiences with ambiguity of systemic lupus erythematosus and erosion of social support. ACR Open Rheumatol2019; 1: 135–144.
36.
MonahanRCBeaart-van de VoordeLJEikenboomJ, et al.Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity. Lupus2021; 30: 1124–1132.
37.
WilliamsEMBrunerLAdkinsA, et al.I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med2016; 3: e000144.
38.
YoshidaKBohnJYoshidaMK. Package ‘Tableone’. R foundation for statistical computing.
KlineRB. Principles and practice of structural equation modeling. Guilford publications, 2023.
41.
ChaeDHDrenkardCMLewisTT, et al.Discrimination and cumulative disease damage among African American women with systemic lupus erythematosus. Am J Public Health2015; 105: 2099–2107.
42.
PratherCFullerTRJeffriesWL, et al.Racism, African American women, and their sexual and reproductive health: a review of historical and contemporary evidence and implications for health equity. Health Equity2018; 2: 249–259.
43.
AralSOAdimoraAAFentonKA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet2008; 372: 337–340.
44.
GerendMAPaiM. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev2008; 17: 2913–2923.
45.
GrahamG. Disparities in cardiovascular disease risk in the United States. Curr Cardiol Rev2015; 11: 238–245.
46.
LorigK. Self-management of chronic illness: a model for the future. Generations: Journal of the American Society on Aging1993; 17: 11–14.
47.
JensenMPNielsonWRKernsRD. Toward the development of a motivational model of pain self-management. J Pain2003; 4: 477–492.
48.
DrenkardCDunlop-ThomasCEasleyK, et al.Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test. Lupus2012; 21: 1586–1593.
49.
FortinPRNevilleCJulienAS, et al.Measuring the impact of MyLupusGuideTM in Canada: results of a randomized control study. Arthritis Care Res2022.
50.
WilliamsEMHyerJMViswanathanR, et al.Peer‐to‐peer mentoring for African American women with lupus: a feasibility pilot. Arthritis Care Res2018; 70: 908–917.
51.
BernalGEDomenech RodríguezMM. Cultural adaptations: tools for evidence-based practice with diverse populations. American Psychological Association, 2012.
