Date of Award


Document Type

Dissertation: On-Campus Access Only

Copyright Status, No Creative Commons License

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing




Purpose: It is not known how the newly single widowed older adult African American/Black woman (WOAAW) navigates intimacy after a long-term monogamous relationship, where there is potentially an increased risk of sexually transmitted illnesses. The purpose of this research was to understand the decision-making and planning process involved in navigating new sexual intimacy. Research Questions: 1. What is the WOAAW’s planning and decision making when entering an intimate relationship? 2. Does this process leave the WOAAW vulnerable to sexually transmitted illnesses (STIs) and the human immunodeficiency virus (HIV)? 3. Are loneliness, gender, power, or Afrocentrism relevant to the WOAAW in this process? Study Aims: 1. To gain an understanding of the process that precipitates the WOAAW to enter a new intimate relationship after the end of a long-term relationship. 2. To identify the process of decision making regarding choosing an intimate partner and having intimate relationship(s). 3. To discover their understanding and navigational skills regarding STI prevention. 4. To identify health-teaching information needs surrounding the decision to engage in an intimate relationship. Background: The newly single older woman who is widowed faces challenges when planning the emotional and social journey of redefining her future. Ending a long-term relationship may leave women uncertain of the future, feeling lonely and vulnerable. Widows, in particular, are subject to socially unfavorable situations leading to negative health outcomes including STIs. African Americans/Blacks have the most severe burden of HIV of all racial/ethnic groups in the United States. In 2010, African American women accounted for 6,100 (29%) of the estimated new HIV infections among all adult and adolescent African Americans. This number represents a decrease of 21% since 2008. Most new HIV infections among African American women (87% or 5,300) are attributed to heterosexual contact. The estimated rate of new HIV infections for African American women (38.1/100,000 population) was 20 times that of White women and almost 5 times that of Hispanic/Latino women (CDC, 2015). Methodology: This study investigated the WOAAW’s decision-making process of entering into a new intimate relationship. Physiological and psycho-socio-cultural components of the decision-making process were elucidated through the use of grounded theory guided by Strauss and Corbin’s (1998) methodology. Findings: The basic social psychological problem was a need to redefine self after widowhood. Spiritually guided decision making for intimacy was identified as the core concept or mid-range theory for widowed older African American women (WOAAW) as they relied heavily on God, a higher power, and the church to alleviate feelings of loneliness and loss. Five categories emerged from the widows who were interviewed: a) HIV/STI Matters to Me, b) Relationship Re-ordering, c) Redefining Myself, d) Living Through It, and e) Financial Stability. The basic social psychological problem was solved through intimacy in a sexual and non-sexual context. Intervening conditions that influenced intimacy decision making were: age/experience, Afrocentrism, knowledge, time, spirituality, and gender/role. Seven decision-making strategies associated with spiritually guided decision making for intimacy were: denying, accommodating, avoidance, reliance, reminiscing, planning, and pursuing support. Conclusion: Spiritually guided decision making for intimacy was identified as the core concept as the WOAAW reported the process of how spirituality was an integral component of decision making after widowhood despite the possibility of HIV/STI exposure. It was identified that the imbalance of spirituality over practical health-promoting behaviors may affect intimacy decision making, predisposing widows to STI/HIV. Significance to Nursing and Health Care: This study provided the groundwork for developing a mid-range theory that informs the health care community of ways to deliver culturally sensitive informed care to this growing segment of the population.

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At the request of the Author, this Dissertation is no longer open-access and is now only available to the Molloy College community.