Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Health Policy and Management


Christian Grov

Alexis Pozen

Committee Members

Christian Grov, PhD, MPH

Alexis Pozen, PhD

Sean Arayasirikul, PhD

Subject Categories

Public Health


house ball community, health justice, health equity, leadership, CBPR, intravention


Background: The House Ballroom Community (HBC), an underground queer subculture, has been leading actions in large urban cities throughout the Unites States to address health inequities exacerbated by stigma, systemic neglect, and economic disparities, such as the HIV/AIDS epidemic. The HBC is an inventive and dynamic space that posits new leadership paradigms for health equity and health justice, where collective actions and their resulting social impact center the embodied knowledge of their members to create social change.

Methods: Community-based participatory research (CBPR) was a fundamental method and framework for each of the studies (Aims 1, 2, and 3). The meaningful involvement and engagement of the HBC through a standing Community Planning Committee (CPC) of House Lives Matter (HLM) initiative ensured that the work was aligned with the community’s public health priorities and interests. A novel conceptual framework, the Intersectionality Research for Transgender Health Justice (IRTHJ) was applied to the HBC/HLM (Aim 1). Overall, a mixed methods approach was taken to understand the constructs of leaders and leadership within the HBC (Aims 2 and 3). Semi-structured interviews were conducted with twelve HBC leaders to explore how leadership functions within the HBC as an intravention strategy improving HBC members’ health outcomes and overall wellness (Aim 2). A survey was implemented during the third annual HLM Leadership Convening in September 2018 with HBC leaders to measure leadership at the individual, group, and community level. ANOVA was used to identify statistical significance between respondents demographic/HBC-specific characteristics and their Multifactor Leadership Questionnaire Form (MLQ-6S). Content analysis was conducted on three open-ended questions that was part of the leadership survey (Aim 3).

Results: The IRTHJ framework posits three tenets of action including: naming intersecting power relations, disrupting the status quo, and centering embodied knowledge. Aim 1 expanded the framework adding a fourth tenet: the physical being and humanness of more sexual and gender expansive people of color as it relates to not just centering embodied knowledge but utilizing it to develop community-driven solutions (intraventions). Leadership in the HBC was defined as living in your truth, authentically, and unapologetically. HBC leaders were organic intellectuals, who utilized both their experiential learning and lived experience expertise to inform their decision-making. HBC leadership was pedagogical through teaching HBC history, storytelling, and infusing survival narratives among its members to develop/teach new leaders, where their history was essential to their overall resiliency and sustained impact as leaders (Aim 2). HBC leaders’ who were cisgender women were associated with Transformational Leadership (TL) styles (Inspirational Motivation pp = 0.03), whereas passive/avoidant leadership was generally reported by older (p = 0.05), not very involved in the community (pp = 0.02) respondents. Leadership at the House- (group) level was seen more positively than at the community-level (Aim 3).

Conclusions: Leadership in the HBC has not yet been studied or published in this context. Discussion of HBC leadership offers insights into how the HBC provides unique support to members through cultural labor, resulting in more focused and responsive intraventions that enhance health outcomes in the HBC. HLM is an example of how CBPR can be used to transform design, implementation, and interpretation of health justice and health equity research.

Available for download on Tuesday, May 16, 2023

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