Hello, and welcome to Listen Up People, a podcast
of the USC Suzanne Dworak -Peck School of Social
Work. I'm Dr. Eric Rice, professor and associate
dean for research. Today, we are going to be
talking about social work and health interventions.
When people think about social work and health,
I think many of us think about hospital -based
social workers. But my colleagues today are here
to share about the health interventions that
they work on that go beyond hospitals and medical
facilities. to shine a light on how social determinants
can impact health and how interventions can be
developed to better reflect the context and cultures
of people in need. So I have the pleasure of
introducing two of my colleagues who are leading
experts in this field. First, I'd like to introduce
Dr. Jane Lee, who is an associate professor here
at this school. and her colleague and my colleague,
Dr. Shinhyi Wu, associate professor of social work
and industrial systems engineering, and a senior
scientist at the USC Edward R. Roybal Institute
on Aging. It's wonderful to have you both here
today. Welcome. Thank you. Thanks for having
us. So I want to start off with a question that
I ask most of my guests at the beginning of the
episodes, which is, How did you get interested
in doing this kind of work? So maybe I'll turn
first to Shinyi and then to you, Jane. So Shinyi,
how did you get interested in doing health intervention
work? So this went back a long history. So I'm
very interested in understanding how people do
things differently, which has an impact in life
and health happen to be the things I'm most interested
in. In the early part of my career, I got to
evaluate a model called chronic illness care
model, which are implemented in healthcare system
to help patients better manage their chronic
illnesses. And we saw quite a bit of differences
in how the clinics are implementing the model
and how patients are benefiting from this new
type of programs to better manage their health.
So that got me into thinking about what are the
variations. And I see clinics with less resources
such as safety net clinics suffer them. They
didn't benefit as much. So I wanted to do something
to change that. So I began to develop some models
to help clinics to do it. And that wasn't enough.
So I want to do some intervention to help patients
directly. So that gets me into this type of work.
Very cool. Very cool. Jane, what led you to health
interventions? Yeah, so interesting, Shinyi. For
me, it really started when I was in my MSW program.
And I was interning at a domestic violence agency.
And I was working primarily with immigrant women.
I began to see firsthand that many of the tools
and approaches that I was learning about really
didn't fully account for what these women were
actually experiencing. So factors like language
barriers, lack of health insurance, barriers
related to their immigration status or... difficulty
finding, you know, work or employment and all
of those factors affected not just their safety,
but their overall health and well -being. And
I think that experience really opened my eyes
to how social determinants of health show up
in people's everyday lives and how interventions
have to be responsive to those realities and
so it pushed me towards community -based research
and towards understanding cultural and social
context, especially within immigrant communities
and to focus on developing health interventions
that are really grounded in people's lived experiences
and their communities. That's amazing. You know,
you said a phrase that I know we use a lot in
social work and and some other related health
disciplines. But you said the phrase social determinants
of health. And I'd love to take a beat. and give
our audience a little bit of a definition. What
is this phrase, social determinants of health?
What does this mean? Can you unpack it a little
bit for us? Of course. So I think we're talking
about the idea that people's health and well
-being isn't just shaped by their individual
choices or biology. It's actually shaped by the
conditions and characteristics in which they
live and work and connect with other people and
so as I mentioned in my work with immigrant communities
we know factors like whether or not someone has
health insurance or language barriers or you
know what language they speak that has implications
for being able to access health services which
can you know influence whether someone can stay
healthy or get the care that they need. So when
we think about improving health, it's not just
about, you know, providing the medical services
or as you mentioned, you know, like care in a
hospital, but it's also about addressing those
social and structural conditions. It's so interesting
that you basically just made the causal connection
between what language you speak and your health.
I don't think most people outside of perhaps
social work and public health and maybe sort
of medical fields in general ever think about
what language you speak could impact your health.
I mean, that is such a fascinating and important.
concept just to deal with. And I think, you know,
another phrase that gets thrown around a lot
in the context of this work, which neither of
you have used quite yet, but I'll throw it out
there. I'll be the jargon laden one is behavioral
health, right? So this idea that we oftentimes,
you know, social determinants of health impact
our wellbeing, but it's through this concept
of behavioral health. And so I know Shinyi, I
know you have done a lot of work around behavioral
health. I mean, do you maybe want to give our
audience a little bit of an understanding of
like, what is behavioral health? Like, what does
that even mean? Yeah. So I think that comes from
my background of a systems engineer. So I'm very
interested in what are those processes and the
steps that gets to the outcomes. So the structural
components that Jane mentioned are very important,
but health is a process. So how we eat, how we...
physical activities, our sleep, how we manage
stress, our choice of taking medications or adherence
to the medications or choose other substance
to manage stress. These are all behaviors that
could impact on outcomes. So my research and
my intervention are targeting on these behavioral
processes that we can either improve or make
this decision differently that can improve patients'
outcomes. Thank you for sharing that. It's so
important, I think, for people to understand
this idea of social determinants and what it
is that we're talking about with this behavioral
health because so much of our health is impacted,
as you said, Jane, by things out. that one might
not think about like language or the neighborhood
that we live in. And the causal linkages are
oftentimes through the things that we make decisions
about that impact our health. So thank you for
clarifying that for us as well, Shinyi. I wanna
get into the weeds a little bit with both of
you on the work that you're actually doing in
this space. So I know, Jane, you alluded to at
the beginning that you're really interested in.
immigrant health and sort of the context. I mean,
what are some of the health -related interventions
that you are working on now that you're most
excited about? Yeah, so there's a lot there,
but a lot of my work is focused on HIV prevention
and care as one of the primary outcomes. And
what I've always been drawn to is interdisciplinary
research and collaboration, which, you know,
she needs a great example of that given her background
in engineering. But the reasons I love social
work and looking at health outcomes like HIV
prevention through a social work lens is it really
brings together insights from so many different
fields. And with my work in HIV prevention, one
of the kind of frameworks I use come from health
communication. And I'm doing some work on this
idea of key storytellers. which comes from communication
infrastructure theory, which is really just looking
at how information flows within communities.
You mentioned a lot of the different factors
that go into different health outcomes. And in
any community at the individual level, there
are certain people, whether they're kind of have
formal roles or informal roles. And these people
are individuals that folks might turn to for
guidance or support. for trusted information.
And so these are kind of the key storytellers
that in my research with Latino men who have
sex with men for HIV prevention, I really wanted
to understand who those key storytellers are
and how they share information about HIV prevention,
especially considering differences in language,
geography, access to resources, including health
and HIV prevention resources. So the goal is
to really build interventions that amplify those
voices, those trusted voices that are already
doing a lot of this important work within their
own communities. So whether it's HIV prevention
or mental health or oral health, I really think
about it with with attention to social determinants
and thinking critically about the resources and
strengths that are already within the community.
I love that. I love that. I often spend time
thinking about the context is almost always the
most important part of the problem. And both
of your work hones in on the importance of that.
Shinyi, you know, you and I have known for one
another for quite some time, and I know about
a lot of your health related work, but there's
a project that you've been working on recently
that I really want to nudge you to talk about,
which is around, if I remember the context exactly
correctly, it's about Chinese Americans and whether
or not they're going to uptake a particular kind
of surgery. Can you maybe tell us a little bit
more about this and again, how context and language
and all of this matters in the work that you're
doing? Before that, may I respond to Jane's work?
Oh, of course. Go for it. You and I actually
went back a long time when we both work on HIV
-related work. And part of my work was actually
evaluating cost effectiveness of different interventions
treating HIV. But the type of intervention you're
doing, Jen, is new. So maybe at some point I
could update my analysis to include your type
of intervention. I think all three of us have
worked on HIV -related interventions in the course
of our careers. We probably just have done a
whole episode on HIV -related interventions,
not health interventions. I know, Shinyi, your
most recent one is not in the space of HIV, and
so maybe you can tell us a little bit about that
one, too. Yes. So the work I did with HIV and
the work I'm actually doing right now have some
common theme, which is how do we deliver care
more effectively and efficiently as well as more
affordable? So when I evaluate HIV interventions,
I look at the cost effectiveness. In the specific
project I'm currently doing right now is that
we know there's intervention that's effective
and that benefit patients of different cultural
backgrounds or different languages. But certain
groups of patients, like Chinese, Americans,
are less likely to accept that type of interventions.
So that type of decision making make me wondered
why and how we could help them. So I think really
social work helped me to have this concept of
getting into listen to people's story. So I first
begin this project with interviews with patients
to understand the experiences. And part of that,
I get to understand why they make decision this
way could be they are lacking the information
from providers because patients don't speak English
as fluently and the information they were given
were in English. So that's the language part
that could affect health. The other issue is
patients' assessment of their conditions are
different, grounding their cultural background.
Like in Chinese culture, people feel that they
should sustain discomfort, part of the reason.
believe it or not, so they don't want to bother
other people, including their providers. So those
stories and those information needs are the reason
that I began to develop these interventions,
which is intended to support patients to make
more patient -centered decision making. The context
is, as I said before, it's just so important.
And I know, Jane, your work with HIV, you take
context. Very, very, very, very seriously. Can
you maybe tell us a little bit more about some
of your work, you know, relates to this sort
of idea that Shinny was sharing with us as well?
Yeah, I mean, I resonate a lot with what Shinyi
was saying, because we're talking a lot about,
you know, implementation issues. Just because
an intervention is, quote unquote, effective
doesn't mean it's necessarily going to work for
all communities, right? We have to look at what's
feasible, what's acceptable in different populations
and groups. So really asking these questions
about, you know, implementation science and what
can be really sustainable outside of the research
study or a specific kind of clinical trial that
we might be doing. So really thinking about the
sustainability of such efforts. And I think one
important way to really ensure that is to involve
communities in research and in our studies, and
even in the questions that we ask, because they
understand the context. They understand their
priorities. We might have a particular interest
of an area. Even my work, as I mentioned when
I was doing kind of DV work, I realized we're
we're talking about issues related to domestic
violence, but some of my clients' priorities
were kind of beyond that. They need a safe place
to stay. They need to find a job. And so all
of these other factors come in. So I think it
is really important to center communities in
our work and make sure that they are bringing
in their perspective so that, at the end of the
day, the interventions really work for them and
address their priorities. I think that in social
work we almost take for granted that people should
talk to people in communities, but I don't think
that it's necessarily something that a lot of
other fields do, but I know having seen presentations
by both of you over the last year that both of
you take very seriously the communities that
you work with and part you partner with them
you know it's not just that you're studying them
but you're actually partnering with them you're
actually involving them legitimately and earnestly
in the process of helping you understand what's
happening and to create solutions. I think it's
a really beautiful thing that I've seen in both
of your work. Shinyi, you alluded to this project
where you were interviewing a lot of people around
some of the cultural barriers to believe it.
What's the condition that you're addressing in
this particular intervention? It was like a type
of surgery, right? Yeah, it's a condition related
to congestive nose. It's called the chronic...
Okay, it's a surgical procedure and that some
people, and you found this, as you were saying
before, that there are folks who are not wanting
to take up this surgery, which has been shown
to be effective. After you found out from the
community what some of the barriers were, what
were some of the ideas that you then brought
as possible solutions? So the surgery is called
endoscopic surgery, which is the non -invasive
surgery. the term sounds to some patients is
not an option they will take. This is the last
resort. Despite our study shows patients have
significantly improved their quality of life.
This is a disease. It's not life or death disease.
This is a quality of life disease. But the improvement
in quality of life is dramatic. It's even greater
than treating your heart disease or diabetes.
but patients are still concerned about it. So
utilizing the community concept, through the
interviews, we try to bring people in the community
to share their experiences and convert that into
a story in our intervention. So we use storytelling
in our intervention. So we provide a website,
one of the interventions component I often use
to make information more accessible, available,
and more standardized. as part of the communication.
And so we provide information about the conditions
in the language that patients are familiar with
so we can address the language barriers. We use
visuals to help improve the understanding. So
those are standard communication tools we use.
We ask patients what they frequently ask questions
so we can make the information more succinct
to answer patients, especially patients with
cultural or different language background, they
have different type of questions. So we try to
make this process very clear to understand the
information. But more innovative is that patient
story part. So we ask patients if we can convert
their interviews into story to share with others.
And we found very interesting the patients. When
they first see the website, they go to the patient
stories and looking for people most similar to
them. Race, language, gender. I love that because
a lot of my work right now is also kind of involving
peers, right? Because it's this idea that it's
not just about the information that you get,
but who's delivering it, who's kind of sharing
their experiences and can you relate with them?
And do you kind of see yourself in them? And
oftentimes when that's the case, you're more
likely to, you know, want and trust that information
or utilize that information. So I think that's
so that's so important because it isn't the case
that, you know, if the interventions exist, people
will use them or, you know, there will be uptake
of them. You need to understand how to best engage
folks and make sure that it's acceptable and
think about norms as well. So so many parallels,
which I love. Yeah. Yeah, I see those parallels
as well, too. And I'm glad that you highlighted
some of them. Another parallel that I was going
to try to prompt you about, though, is also the
use of technology. Right. I know that you've
also thought, Jane, a lot about how you can take
advantage of of particular social media. You
want to talk a little bit about that too? Yeah,
so you know the idea of using social media too
really came from the community itself when you
know social media platforms were becoming more
popular. It was actually community partners who
were like you know how can we use this as a tool
for HIV prevention, especially for Latino immigrant
communities. And so they were interested in it
because it was something that was developing.
And a big question for me was also, you know,
there might be a digital divide, right? did the
people we want to reach even have access to social
media or reliable technology? So similar to Shinyi,
our early work was really focused on understanding
people's experiences with these platforms, asking
whether they wanted to even receive HIV prevention
information that way. And so we also wanted to
think about how we can make any content that's
delivered on social media platforms meaningful
and culturally relevant. So it wasn't just information
being pushed out. the communication that actually
resonated and I think what's exciting is that
you know social media and technology are constantly
evolving and new tools are being developed so
that means we have to keep listening to the community
and adapting how we use these tools because the
ways that we're connecting and sharing information
and engaging with each other are rapidly changing.
Indeed, indeed. I mean, I could riff with you,
the two of you about that aspect of this work
for hours. I mean, having done HIV prevention
related work around social networks and social
media and all this stuff. I mean, I, I love it.
I think it's also kind of cool that this episode
is going to be airing during National HIV AIDS
Awareness Month in December. And so I think it's
nice that we've had a, you know, Jane, your work
explicitly, but also Shanee for you to remind
me about your origins in HIV prevention and care
work. And also then reminding me, oh yeah, right,
Eric, you do a lot of HIV oriented work as well
too. And you also like to center the voices of
the communities and all this. It's really...
fun to share this time with you, thinking about
these important issues. You know, we're kind
of running toward the end of the time that we
have together, but I always want to make sure
that I leave my guests time to leave something
of a parting thought for our listeners, because
I think my intention here is to introduce people
to topics, knowing that there's so much more
to be said about both of your lines of research
about health interventions. We could have a whole
series just on health interventions. But since
you're here with us today, I'd like to give you
an opportunity to leave our audience with some
parting thoughts, perhaps something that you
think they might. misunderstand about health
interventions or something that you think that
from your own work, working with the communities
that you work with, you really want to elevate
for our audience to think about. So maybe I'll
turn to Shinyi first and then to Jane.
Shinyi, what would you like to leave our listeners with?
studying health interventions for a long time,
I began to think about the intervention fit with
individuals. We have talked about people with
different languages, different social determinants
of health, so the intervention is not. one size
fits all. I think researchers will use intervention
based on evidence, based on the data we know
the best, based on the community needs. And I'm
hoping with the technology, we will be able to
deliver more patient -centered fit of the type
of intervention. with individuals' needs and
their different experiences and the sort of determinants
surrounding them. So the type of work I begin
to do is to also look into more patient -centered,
as well as understanding different type of patients,
like different type of decision -making, different
type of health behaviors, so we can do more intervention
that's based on patients' person strengths. That's
wonderful. Jane, what would you like to leave our listeners with?
Yeah, I reflect. I'm reflecting on some
of what she needs that I agree, you know, one
size doesn't fit all. And to a point you mentioned
earlier about, you know, is research taking place
on communities or really with communities? And
that's a question I really, you know, ask my
students to think about in our in classes that
I teach, like how was the research done and were
community perspectives integrated? And I think
that's really key because, you know, health doesn't
happen in isolation. So we really need to understand
the broader environments that people live in,
their relationships and all of the different.
structural factors that shape their experiences.
So I think it is really understanding community
perspectives. And I hope it's not just social
work, but that all research kind of works more
towards that approach, like really engaging community
perspectives, recognizing also the diversity
within communities, taking an intersectional
approach as well, recognizing the multiple identities
that people have. And also, You know, really
asking when we design health interventions, like
what are community or cultural strengths that
we can build on? And I think that can really
help ensure that interventions are not just evidence
based, but also, you know, culturally informed
and really responsive to the realities of the
communities that. they're meant to serve. Well,
thank you so much for that. It's beautifully
put by both of you. And I think with that mission
in mind, I have every confidence that both of
you are going to continue to develop yet more
interventions that really hit people in the places
where they are. And it's great to have colleagues
like you that are so committed to really listening
to community and really developing programs with
those communities that serve those communities
and the nuance and the heterogeneity and the
individuality and the strength that those people
bring, which I'm left with a lot of warm fuzzy
feelings today after having this conversation
with you, which is nice because health interventions
are oftentimes when we're seeing people at not
such great points, you know, HIV is a very serious
disease, sinus conditions that you're talking
about, you know, shinny, I mean, these are serious
things and it's great to have, you know, a moment
of hope and inspiration. that we're going to
be... working with communities to build interventions
that work for those communities. Well, if you,
the audience want to learn more about the research
here at the USC Suzanne Dworak-Peck School of
Social Work, you can visit our school's website
at dworakpeck.usc .edu. And if you have any
questions for the guests on our show or you want
to support our transformative research and programs
here at the school, you can contact us at listenuppeople@usc.edu.
And Jane, Shinyi, thank you both.
Once again, it was wonderful to have you.
Thank you, Eric. Pleasure.