A conversation with Cheryl Giscombé: the unique stress black women face

Nursing professor Cheryl Giscombé answers questions about the health challenges African-American women face and the pressure to live up to the “strong black woman” persona.

Cheryl Giscombe looks at a test tube.

The Melissa and Harry LeVine Family Professor of Quality of Life, Health Promotion, and Wellness at the UNC School of Nursing, Cheryl Giscombé is working to understand the stress-related health disparities among African-Americans and finding ways to help people reduce their stress.

Here she shares her thoughts about why black women face higher rates of stress-related illness and how to balance out the potentially dangerous effects of extreme stress.

What is the focus of your research?

My research focuses on interventions to reduce stress-related health conditions that cause disparity. I’m interested in reducing stress and improving well-being in primarily African-American women, but in African-Americans in general who face disproportionately high rates of stress-related illnesses.

The more I’ve learned about the role of psychological stress, the more I have wanted to find ways to ameliorate it. Stress is unavoidable — it’s part of life — but how do you help people manage it so that it doesn’t cause their health to be at risk?

How does your work fit into the mission and values of the School of Nursing?

The mission of the School of Nursing aligns with Carolina’s mission: “Of the people, for the people.” We’re trying to be first in nursing globally to provide quality care and do cutting-edge research for the health of all people. So, we’re very interested in community-engaged work and looking at the biosocial factors we can help to improve to reduce morbidity and mortality.

What is Black Superwoman Syndrome, or the Superwoman Schema, and how does it affect the health and well-being of African-American women?

This idea looks at what might be different about the stress experiences of women, and of African-American women in particular. I came across a lot of popular literature where African-American women described their experience of stress related to race and gender, including the concept of being the “strong black woman,” but I wasn’t seeing that captured in empirical research. I was able to start doing some of that work by looking at how race and gender matter in the measurement of stress.

I refer to it as Superwoman Schema. Chronic stress is a challenge for all people, but women, in general, are more likely to take on caregiving roles. They’re often more likely to prioritize the caregiving of others over their own self-care. Then given the circumstances of African-American women in the U.S., it may be that stress — or not having the resources to overcome with the challenges you face — is more prevalent and detrimental among African-American women. If that’s true, we want to develop interventions and new ways of thinking. How do they manage that stress and take care of others without sacrificing themselves?

What is the solution to health disparities caused by social and cultural factors?

I’m really interested in mindfulness-based interventions to help women manage stress in their lives. I was introduced to mindfulness as a high school student, and from early-on I really wanted to explore that as a potential intervention for African-American women.

I think it’s generational. If you don’t see your aunt or your mother or grandmother doing intentional things to care for themselves as part of their routine, you don’t know how to do it, or you don’t know you should do it. Even if you do know you should do it, you may have guilt about it. When you’re working so hard just to live, finding the space to take care of yourself with the resources you have, including time, is challenging. Women may put it off and say, “I’ll get to that later,” but every day they say that. Saying “I’m going to go to the beach or take a vacation once a year” is not enough to balance out the potentially dangerous effects of stress, so how do people integrate it into their everyday lives?

Why is cultural sensitivity so essential to providing quality care in the field of nursing?

The ways that healthcare providers interact with patients can have a significant impact on their outcomes, or even their decision to engage. Some people fear they’ll be treated with bias, either intentionally or unintentionally, and that can make people say, “Why bother [going to the doctor]?” or make them not as trusting of their care team. Those kinds of things impact patient decisions to adhere to treatment plans.

For example, my grandmother was a nurse, and she was a really proud woman, but when she became sick, she wouldn’t let me call 911. She wouldn’t let me take her to the emergency department, but she would let me take her to the urgent care near the house. She was nauseated and having trouble keeping food down, and when we went to urgent care, the provider just said she needs to stop eating greasy foods and to go to the drug store and get an antacid. She didn’t eat that stuff; that provider just assumed that. She allowed me to take her to the emergency department after that, and it turned out she had metastatic cancer, and she died within three weeks. That is enough to keep me doing what I do. All healthcare professionals of all backgrounds need to have cultural sensitivity as part of their education strategies for understanding how to really interact fully with the patients for which they care.

What is the most rewarding part of working in the UNC School of Nursing?

I’m a North Carolinian at heart. I’m from North Carolina, my parents are from North Carolina, and multiple generations of grandparents are from North Carolina. I love serving the state. And there are endless possibilities of people with whom to work. Our students, staff and faculty, their enthusiasm is amazing, and the expertise of people who are attracted to Carolina is amazing. There’s no shortage of opportunity and resources to do the work and to serve people across the state as well as around the globe.