Dr. Ashley Love on communication about mental health in AANHPI communities

10 Minutes to Better Patient Communication

Dr. Ashley Love returns to the show to talk about her experiences with mental health and communication in AANHPI communities. She shares powerful stories about the importance of culture and context in communication, the heterogeneity in the broad AANHPI classification, how AI can help make communication easier, and when she realized clients’ complaints about a stomach ache meant something more.

May is Mental Health Awareness month and Asian American and Pacific Islander (AAPI) Heritage Month. Today’s episode combines the two. We talk about mental health awareness in the AAPI community with researcher, educator, and friend of this show, Dr. Ashley Love.

Hi everybody, I’m Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication, recently ranked number 20 of the Top 100 podcasts in the social sciences by Goodpods. If you want to take your communications to the next level we’ve got the way. BRIDGES is our continuous improvement process. We evaluate your communication on 7 important dimensions to help you reach more people. For more information visit Health Communication Partners or message me on Linked.

Yes, I’m so delighted to have Dr. Ashley Love back to the show. She was on the show during COVID and she has some remarkable stories to tell us. So this episode might go a little bit more than 10 minutes. Okay, here’s Dr. Love.

Dr. Liebel: I’m live via Zoom with Dr. Ashley Love. Dr. Love is Director of graduate studies at the Dreeben School of Education, University of the Incarnate Word, and she is an active duty military spouse. If you recognize her name, it’s because she was on this show before! four years ago. So Dr. Love, welcome back to the show.

Dr. Love: Thank you so much, Dr. Liebel. I cannot believe it’s been four years since I’ve been on this show. Where did the time go?

Dr. Liebel: Honestly! It was during COVID. You were talking about your work as the former state epidemiologist of Delaware. and difficult communication during COVID was something that we all needed to learn about. So welcome back. Thanks for… coming back on the show. Thank you for agreeing to kind of let us know what you’ve been working on. So I get to ask you these questions again. What is a patient communication or patient education issue that you are facing?

Dr. Love: No, thank you so much for having me back. And one of the issues that I feel passionate about is talking about mental health, especially among Asian American,
native Hawaiian and Pacific Islander. I know it’s a mouthful, so I’m going to use the acronym A-A-N -H -P -I. Why is it so important to talk about this? It’s because we need to focus on culture. We also have to pay attention to the way we communicate. and also think about the context in which we are communicating.
mmhmm. I mean, I’m already going to agree with you on all three of those. So this is a significant issue, communication, mental health among AA nh HPI populations.

So how are you facing this significant issue?

Yeah, no, it’s a great question as a practitioner, researcher, educator, and also as an individual of Asian American descent, i’m Korean American, raised in New Jersey, and I definitely can relate to some of the things that we’re going to be talking about today. So I started my work back in, oh my goodness, over two decades ago in New York City in Flushing with Korean American aging population. And we were looking at nutritional studies as well as the Asian Americans, looking at some of the curriculums. And when Dr. Liebel, when you were communicating with me, I was in San Francisco, Northern California area, during COVID, where we were facing some of the mental health, and also some of the things that the AA NHPI population was facing due to the COVID and where it originated from. And what really propelled me was the Atlanta shooting in March of 2021, of the six Asian American descent women who were killed due to their identity. So that’s a lot, right?

It is a lot. I mean, you’ve been you’ve been dealing with mental health communication among AANHPI populations for more than 20 years. So I know the next question is a very loaded one to ask: what have you been learning? There’s got to be a lot, but maybe a couple things that you want to share with us that you have learned, that you think would be valuable for the audience today.

That’s a great question. The role of culture and context really matters, especially for AANHPI population. I could probably share two stories as a researcher practitioner as well as a personal story.

Love it, love it.

The first one is when I was in Flushing, Queens, as a practitioner as well as a researcher, I was doing a nutritional study with 65 and over Asian American, particularly Korean American elders. Because I speak a third grade level Korean. So I was able to communicate with them and also have rapport. And one of the things that I discovered was that a lot of the folks were having stomach pain. So they would say “my stomach hurts.” And I realized as a Korean American, that the stomach, that phrase “my stomach hurts” was not really referring to actual stomach being hurt. It was about the loneliness, depression, or some of the mental anguish that they were experiencing as an elder, or aging population in United States. And not, the whole stigma of mental health–having mental health disease or status. And also bringing shame. And also putting a burden on the family. They weren’t able to communicate that. So in order to communicate what they’re feeling, they were referring to “my stomach hurts.” And I realized that gave me an opening to kind of talk about, “Tell me a little bit more. Like, what is your living situation like?” And some of them lost their spouses, some of them were experiencing language barriers, so they weren’t able to get the support that they needed. And it was just a very isolating experience for some of them, just because they’re in a new culture, even if they lived in United States for a long time. It’s hard to assimilate and also acculturate into another culture when you lived in another place.

I love this story about, you know, “my stomach hurts,” talking about the stomach instead of talking directly about mental health issues. And your recognition that the stomach was kind of, a way to talk about mental health issues without talking about them. So that people could save face. So that people were talking about something that was a little bit more acceptable, you know, a stomach ache. I think that’s really, I mean, about the importance of your listening and the importance, for all of us, remembering that we need to take culture into consideration when we’re thinking about communication. Thanks for that story, Dr. Love. What’s the next one?

Oh, the next one is my own personal story. I am active duty military spouse, over 20 years, and I had the wonderful opportunity to be stationed in South Korea. I was so excited just because I’m Korean American and I wanted to live in Korea. And when we got stationed in Korea, we were there for about three years. I realized even someone who is coming from health professional, public health, I spoke the language somewhat– third grade level– I was not seen as one of the Koreans in the culture. And that’s one of the reasons why I was talking about role of culture and context really matters–because I grew up in United States. So I may look Korean, but the culture that I come from was very different than South Korea. So that was the experience that I experienced as well. That gave me that aha moment where, wow, like I thought I was the same.

Wow

But yeah, the context really matters.

Wow. Well, thank you for that. Thank you for that personal story as well. So do you have any advice for people who are working with AANHPI patients or populations?

Yeah, and we are making really great progress. but we do need to develop and curate more specialized curricula. There are some out there, but for each group, just because this group is very heterogeneous. there’s over 50 different languages, 100 different ethnic groups that are in the group.

Thank you for pointing that out too, right? AAHNPI is not one homogenous group.

Exactly. And it could be challenging for some of the mental health providers. However, what we are seeing after the COVID pandemic is the technology, the tools that are being developed, is going to help us. So the progress is faster. And easier. So for example, video chatting, like having a zoom call is no big deal anymore.

Right?

Yeah, an instant connection like telehealth in the medical health care setting. We’re not just solely dependent on translators on the ground, but we can invite them into a zoom setting. And also the fact that we can use tools like artificial intelligence.

That’s a really good point about AI and language, especially these highly contextualized languages. Have you gotten a chance to use this yet?

Yes! actually, one of my personal stories that’s inspiring a lot of the research and also the work I’m doing at the university, is working with my mom. Of course, English, although she lived in the United States for a long time, sometimes the medical terms for patients is really hard, even if you’re a native speaker. So she feels very, very comfortable in Korean. And for years, I’ve been trying to translate the Medicare terminology into Korean. And as soon as AI came out, I decided, “Hey, let’s see if it could translate the Medicare A, part B, all those different parts into something that my mom can understand conversationally.” And in minutes, as opposed to years

This is true, too

It instantly produced something that was manageable for my mom to understand completely, actually. With the different parts and some of the nuances in different parts. So that was just amazing when we saw that.

I just love this. Here you are, trying for years to translate this, as a public health professional, as an educated person who’s trying to translate, who knows both languages, and still! AI comes in and goes “boink, here you go.” And your mom’s like, “Oh, yay!”

Exactly. The reason is because I realize I don’t know the jargon. I don’t, some of the context that you have to present, some of this medical terminology in a way that makes sense. We have used Google Translate. They’re wonderful, but it’s not the natural language generator and et cetera that the AI is able to do. So, we’ve been, it’s been a great experience, especially some of the legal languages, or medical terminologies that I’m unable to translate. We were able to do that.

Well, and not to put too fine a point on it, but I think this is a really encouraging story for practitioners of any social or cultural background who are gonna be dealing with patients who are AANHPI. You don’t have to be an insider. You don’t have to speak the language. You know, this is something you can educate yourself, and you have some tools at your disposal that you can use, so that you can be more culturally relevant. so that you can be more appropriate with this patient or with this population. Dr. Ashley Love, thank you for coming back on the show.

Thank you so much for having me. Wow, the time always flies when I talk to you!

Thanks again to Dr. Ashley Love for coming back to our show. This has been 10 minutes, eh, maybe a little bit more than 10 minutes to better patient communication from Health Communication Partners. Audio Engineering and Music by Joe Liebel. Additional Music from Alexis Rounds.

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