Who Sees the Barriers? Community Connectedness and Structural Health Awareness Among Black Women

Background and Purpose: Black women in the United States occupy a distinct social location shaped by the compounding effects of racism, economic marginalization, and limited access to community resources — conditions that disproportionately constrain their health and well-being. Central to the democratic ideal of health as a collective good is understanding how individuals recognize and respond to these structural conditions. Yet research examining the community-level mechanisms through which structural barriers are perceived and internalized among Black women remains limited.

Methods: Data were drawn from the RAND American Life Panel Culture of Health survey, a national probability sample. The analytic sub-sample included 185 Black women identified by self-reported race and gender; survey probability weights were applied throughout. Survey-weighted hierarchical linear regression was conducted in Stata across four steps: (1) demographic controls (age, income, education, insurance status); (2) primary predictors — community health goals, perceived barriers, and social equity orientation; (3) moderators — community connectedness and willingness to act; and (4) six interaction terms (each moderator × each structural predictor). The outcome, Health and Well-being Interdependence, was a 20-item composite scale (α = .892) measuring perceived social and structural influences on health. All continuous variables were mean-centered prior to interaction analysis; variance inflation factors (VIF) assessed multicollinearity at each step.

Results: The full model was statistically significant, explaining 52.2% of variance in health interdependence (R² = .522, F(15, 164) = 6.14, p < .001). Community health goals was the strongest predictor (β = 1.07, p < .001). Perceived barriers were also positively associated with health interdependence (β = .13, p = .026), indicating that Black women who perceived greater structural barriers held stronger collective health beliefs. A significant Community Connectedness × Perceived Barriers interaction emerged (β = −.16, p = .037): the positive association between perceived barriers and health interdependence was significantly stronger among Black women with lower community connectedness — supporting the Structural Vigilance framework. All VIF values were below 2.0; no other interaction effects were statistically significant.

Conclusions and Implications: Findings suggest that community connectedness buffers — and at lower levels, amplifies — the relationship between structural barrier awareness and collective health beliefs among Black women. The structural vigilance observed among less-connected women reflects not a deficit, but an adaptive, informed responsiveness to systemic inequity. For social work practice, these findings caution against interventions that build community ties without simultaneously sustaining critical structural awareness. “Critical connectedness” — fostering both social support and advocacy orientation — is essential for translating vigilance into collective action, a democratic health imperative. Policy efforts should leverage willingness to act as an indicator of community resilience while dismantling the structural conditions that necessitate such vigilance.