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Elisa J. Sobo Ph.D. , Professor Department of Anthropology

Research

Table of Contents

New  Research

Recently Completed Research

Early Research

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    New Research

    Healthcare’s New Priorities

    Dr Sobo is presently co-directing a Robert Wood Johnson Foundation funded project concerning the implementation of national healthcare priorities for the National Quality Forum (NQF). Via the National Priorities Partnership (NPP), a collaborative of 32 major national organizations that collectively influence every part of the healthcare system, six sets of National Priorities and Goals were agreed upon that, if implemented and brought to scale, could transform health care in America. The NQF project considers the activities of the NPP in developing the Priorities and Goals, awareness of the Priorities and Goals in the healthcare community, their adoption and integration, and their impact on system changes across the nation.

    Ethnomedical Ideas about Healthy Child Development and their Impact on Education

    Dr. Sobo is presently laying the groundwork for an ethnographic study regarding how ethnomedical understandings about healthy child development affect educational strategies and standards. The proposed work, which bridges medical anthropology and the anthropology of education, may eventually be developed to include how particular school systems produce particular health risks and outcomes as the ‘developmental pediatric philosophies’ that ground them are put into practice in the classroom, on the playground, and at home. As well, the relationship of particular versions of developmental pediatrics to the production of particular kinds of citizens will be explored.

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    Recently Completed Research

    Selling Medical Travel

    More US-based patients than ever are travelling abroad for medical or dental services. Beyond financial incentives, what cultural factors have supported this medical travel trend? Because of their interest in selling medical travel, medical travel agencies (MTAs) have vested interests in this question, so (with some funding from the Ethics Center in Science and Technology, and lots of help from SDSU students Elizabeth Herlihy and Mary Becker) Dr. Sobo designed a project examining MTA Websites. Findings enhance our understanding of the care seeking process as experienced within the context of globalized, mass-mediated healthcare consumerism.

    Some related publications

    • Sobo, E.; Herlihy, E.; Bicker, M. (In Press). Selling Medical Travel to US Patient-consumers: The Cultural Appeal of Website Marketing Messages. Anthropology and Medicine. 18(1):TBD.

    • Sobo, EJ (2009). Medical Travel: What it Is and Why it Matters [editorial]. Medical Anthropology. 28(4):326-335.



    Implementation Science and Evidence-Based Care in the Veterans Administration (VA) Healthcare System

    Some health services delivery groups or units have no problem implementing evidence-based improvements while others struggle mightily with change. With funding from the Veterans Health Administration or VHA’s Quality Enhancement Research Initiative (QUERI), Dr. Sobo examined reasons for this in the context of the VHA’s HIV/AIDS care initiatives.

    Through a longitudinal observation and interview study that was nested within an ethnographically-oriented participant-observation investigation of the QUERI-HIV endeavor as a whole, she developed a conceptual model for the successful implementation of quality improvement initiatives. The model focuses on encouraging cross-cultural dialog or exchange amongst stakeholders and aligning reward structures with culturally-preferred outcomes. This work has helped pave the way for more effective implementation of evidence-based care and best practices as well as enhancing our understanding of the socio-cultural world of ‘implementation science’.

    Some related publications:

    • Sobo, E; Bowman, C; Gifford, A. (2008). Behind the scenes in healthcare improvement: The complex structures and emergent strategies of implementation science. Social Science & Medicine. 67(10):1530-1540.

    • Sobo, E; Bowman, C; Halloran, J; Asch, S; Goetz, M; Gifford, A. (2008). “A Routine Thing”: Clinician Strategies for Implementing HIV Testing for At-Risk Patients in a Busy Healthcare Organization (and Implications for Implementation of other New Practice Recommendations) Anthropology & Medicine. 15(3):213-225.

    • Sobo, E; Bowman, C; Halloran, J; Aarons, G; Asch, S; Gifford, A. (2008). Enhancing Organizational Change and Improvement Prospects: Lessons from an HIV Testing Intervention for Veterans. Human Organization. 67(4):443-453.



    Optimizing healthcare for Children with Special Health Care Needs

    While at Children’s Hospital, Dr. Sobo engaged in a long-term program of research regarding the barriers to care faced by families of children with special health care needs (CSHCN), such as Down syndrome. Again and again, parents reported feeling confused and stymied by the complexities of the healthcare and social services systems. In a number of research projects, Dr. Sobo and colleagues asked, “What is it about our health care system that causes people to have to struggle so hard for care to which they are entitled?”

    A number of specific barriers were identified and characterized, and a comprehensive framework for understanding families’ and providers’ experiences was provided. In addition to describing parents’ ‘functional biomedical acculturation’ (2003) or adaptation to the biomedical world, Dr. Sobo identified issues that cut across chronic or disabling childhood conditions and override specific diagnostic labels.

    The work was variously funded by the Agency for Healthcare Research and Quality (AHRQ), the National Library of Medicine (NLM), and the Children’s Foundation.

    Some related publications:

    • Sobo, E. & P. Kurtin, eds. (2007). Optimizing Care for Young Children with Special Health Care Needs: Knowing and Navigating the System. Baltimore: Brookes Publishing.

    • Sobo, EJ; Seid, M; Gelhard, L. (2006). Parent-identified barriers to pediatric health care: A process-oriented model and method. Health Services Research. 41(1):148-172.

    • Prussing, E; Sobo, EJ; Walker, E; Kurtin, P. (2005). Between 'desperation' and disability rights: a narrative analysis of complementary/alternative medicine use by parents for children with Down syndrome. Social Science and Medicine. 60(3):587-598.

    • Prussing, E; Sobo, EJ; Walker, E; Dennis, K; Kurtin, P. (2004) Communicating about complementary/alternative medicine: Perspectives from parents of children with Down syndrome. Ambulatory Pediatrics 4(6):488-494.

    • Seid, MS; Sobo, EJ; Gelhard, L; Varni, JW. (2004). Parents' reports of barriers to care for children with special health care needs: Development and Validation of the Barriers to Care Questionnaire. Ambulatory Pediatrics 4(4):323-331.

    • Sobo, E.J. & M. Seid. (2003). Cultural issues in health services delivery: What kind of ‘competence’ is needed? Annals of Behavioral Science and Medical Education. 9(2):97-100.



    Qualitative Methods in Health Services Research

    To share lessons learned from her longstanding interest in research methods and her experience applying anthropology to problems in healthcare, Dr. Sobo has written a number of methodologically-oriented publications in which she presents socio-cultural anthropology as a valuable resource for improving healthcare. Her latest methods book, for instance, sheds light on the entire investigational enterprise as a situated and negotiated process. Power dynamics, including those that affect field entry, data ownership, research deliverables, and authorship decisions are addressed. The book also is ‘ethnographic’, and so has relevance not only for those who would like to know more about qualitative health research methods but also for scholars and others interested in this particular slice of ‘biomedical culture’.

    Funding for some of the projects whose methods contributed to this body of work was from the Veterans Healthcare Administration, Children’s Foundation, California Department of Health Services, Emergency Medical Services Authority of California, Agency for Healthcare Research and Quality, and The California Endowment.

    Some related publications:

    • Sobo, E. (2009). Culture and Meaning in Health Services Research: A Practical Field Guide. Left Coast Press.

    • Sobo, E; Bowman, C; Gifford, A. (2008). Behind the scenes in healthcare improvement: The complex structures and emergent strategies of implementation science. Social Science & Medicine. 67(10):1530-1540.

    • Sobo, EJ; Seid, M; Gelhard, L. (2006). Parent-identified barriers to pediatric health care: A process-oriented model and method. Health Services Research. 41(1):148-172.

    • Sobo, E., Billman, G., Lim, L., Murdock, W., Romero, E., Donaghue, D., Roberts, W., Kurtin, P.S. (2002). A Rapid Interview Protocol supporting Patient-centered Quality Improvement: Hearing the Voice of the Parent in a Pediatric Cancer Unit. The Joint Commission Journal on Quality Improvement. 28(9):498-509.

    • Sobo, E., Simmes, D., Landsverk, J., & Kurtin, P.S. (2003). Rapid assessment with qualitative telephone interviews: Lessons from an evaluation of California’s Healthy Families program & Medi-cal for children. American Journal of Evaluation. 24(3):399-408.

    • Sobo, E. (2003). A Model Protocol for Applying Anthropology in Rapid Health Services Evaluations. Practicing Anthropology. 25(2):39-42.

    • de Munck, V. & E. Sobo (1998). Using Methods in the Field: a Practical Introduction and Casebook. SAGE/AltaMira.



    Cultural Competence in Health Care

    Dr. Sobo has worked both to increase cultural competence in healthcare as well as to highlight the misdirection of cultural competence initiatives that essentialize ethnicity, blame culture for all of the dominant healthcare system’s ills, and deny the need for better communication across the board. Her most recent cultural competence research was in support of a multi-state investigation of communication-related, negative hospital quality and safety events for children from Spanish speaking, limited English proficient (LEP) families, funded by The California Endowment. Examples of other work in this area include an Aetna Foundation funded project focused on the provision of information about immigrant cultures to emergency department personnel, and the provision of general (legally required) cultural competence training to clinicians.

    Some related publications:

    • Sobo, E. & Loustaunau, M. (2010). The Cultural Context of Health, Illness and Medicine, 2nd edition. Santa Barbara, CA: Praeger.

    • Bethell, C; Simpson, L; Read, D; Sobo, EJ; Latzke, B; Hedges, S; Kurtin, PS. (2006). Communication and the Quality and Safety of Hospital Care for Children from Spanish Speaking Limited English Proficient Families. Journal for Healthcare Quality Online (May/June Web Exclusive).

    • Sobo, E. (2004). Good Communication in Pediatric Cancer Care: A Culturally-Informed Research Agenda. Journal of Pediatric Oncology Nursing (special issue). 21(3):150-154

    • Sobo, E., Simmes, D., Landsverk, J., & Kurtin, P.S. (2003). Rapid assessment with qualitative telephone interviews: Lessons from an evaluation of California’s Healthy Families program & Medi-cal for children. American Journal of Evaluation. 24(3):399-408.



    Mantram Repetition and Childbirth Outcomes

    This study (led by Lauren Hunter and Jill Bormann of the School of Nursing here at SDSU) asked whether and how a meditation-related approach to stress reduction might work to improve womens’ birth-related experiences and outcomes when giving birth in a highly technologized hospital setting. The mantram process provides a good stopgap while we work toward higher-level system change.

    Some related publications:

    • Hunter, LP; Bormann, J; Belding, W; Sobo, EJ; Axman, L; Reseter, BK; Hanson, SM; Miranda, V (In press). Satisfaction with the use of a spiritually-based mantram intervention for couples. Journal of Applied Nursing Research. [ANR-D-08-00080R2 / Accepted for publication June 2009]

    • Hanson, S; Hunter, LP; Bormann, J; Sobo, E. (2009). Paternal Fears of Childbirth. Journal of Perinatal Education. 18(4), 12–20.

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    Early Research

    Jamaican Health and Healing

    Dr. Sobo’s original dissertation research project was carried out in Jamaica and explored people’s perspectives on how bodies work, how we stay healthy, what makes us sick, and how health is restored and maintained using botanical and spiritual techniques. The work contributed to anthropological theory regarding embodiment, emotion, health and social identity, ethno-physiological and ethno-medical universals, the cross-cultural basis of menstrual taboos, and problems inherent in typical public health data collection strategies (for example, with reference to operational definitions).

    Some related publications:

    • Sobo, E. (1997). Reproductive Health Traditions in the Caribbean. Journal of Caribbean Studies, Special Issue: Health and Disease in the Caribbean 12:72-94.

    • Sobo, E. (1996). The Jamaican Body's Role in Emotional Experience and Sense Perception. Culture, Medicine, and Psychiatry, 20:313-342.

    • Sobo, E. (1996). Abortion Traditions in Rural Jamaica. Social Science and Medicine 42(4):495-508.

    • Sobo, E. (1993). Bodies, Kin, and Flow: Family Planning in Rural Jamaica. Medical Anthropology Quarterly n.s. 7(1):50-73.

    • Sobo, E. (1993). One Blood: The Jamaican Body. Albany: State University of New York Press.



    HIV/AIDS prevention and risk perception/denial

    In the early 1990s, Dr. Sobo’s interest in lay health beliefs or knowledge led to her involvement in HIV/AIDS prevention research. She worked with homeless adolescents concerning, among other things, trust in expert opinion (this work was funded by the Armington Foundation); and she conducted a major project with adult women (funded variously by the Community AIDS Partnership Project, Cleveland Foundation, Spring Foundation, and Southern Area Health Education Center as well as New Mexcio State University).

    Dr. Sobo found that the participants viewed prevention messages as important—for other people. HIV/AIDS risk denial, and women's strategic use of unsafe (condomless) sex to build and to maintain this denial, was linked to the high cultural value placed on monogamous sexual relationships. Also from this project, Dr. Sobo was among the first to demonstrate the need for routinized HIV testing, in which people opt out rather than having to opt in and stigmatize themselves.

    Follow-on research regarding risk perception dealt with elective and day surgery.

    Some related publications:

    • Sobo, E. (1995). Choosing Unsafe Sex: AIDS Risk Denial among Disadvantaged Women. Philadelphia, PA: University of Pennsylvania Press.

    • Sobo, E. (1995). Romance, Finance, Social Support, and Condom Use Among Impoverished Urban African-American Women. Human Organization 54(2):115-128.

    • Sobo, E. (1994). Attitudes Toward HIV Testing Among Urban Impoverished African-American Women. Medical Anthropology 16(2):17-38.

    • Sobo, E. (1993). Inner-city Women and AIDS: The Psycho-social Benefits of Unsafe Sex. Culture, Medicine and Psychiatry 17(4):455-485.

    • Sobo, E., G. Zimet, H. Cecil & T. Zimmerman (1997). Doubting the Experts: AIDS Conspiracy Rhetoric and AIDS Misconceptions among Runaway Adolescents. Human Organization 56(3):311-320.

    Follow-on publications regarding risk:

    • Sobo, EJ (2005). Parents’ Perceptions of Pediatric Day Surgery Risks: Unforeseeable Complications, or Avoidable Mistakes? Social Science & Medicine. 60(10):2341-2350.

    • Sobo, E. (2001). Trust, Hope, and the Rationalization of Medical Risk through Talk of Trust: An Exploration of Elective Eye Surgery Narratives. Anthropology & Medicine 8(2/3):265-278.



    Living with HIV/AIDS

    While the early HIV/AIDS work dealt with primary prevention, Dr. Sobo’s later work dealt with the social risks of living with HIV/AIDS. This work (some of which was carried out with Gill Green and with funding from Durham University in the UK)further explored the idea that, in crafting and seeking to maintain certain kinds of selves, people seek to live up to the cultural expectations for personhood that they have internalized. A positive HIV diagnosis has the potential to shatter one’s previously crafted sense of self but it also provides the individual with a potential new identity facet that may be integrated wholly, partially, or not at all into a new sense of self. One area of particular interest for this research was seropositivity self-disclosure, especially in the context of intimate and sexual relationships.

    Some related publications:

    • Green, G. & E. Sobo (2000). The Endangered Self: Managing the Social Risks of HIV. Routledge / Taylor & Francis. [Awarded: ‘Medicine & People’ book award.

    • Sobo, E. (1997). Self-disclosure and Self-construction among HIV-Positive People: The Rhetorical Uses of Stereotypes and Sex. Anthropology & Medicine 4(1):67-87.

    • Sobo, E. (1995). HIV Seropositivity Self-Disclosure to Partners: Implications for Client Care. Holistic Nursing Practice 10(1):18-28.



    Nutrition

    Dr. Sobo’s original dissertation included some discussion of body ideals and of diet’s contribution to health and growth. Her interest in nutrition came to the fore in the late 90s, with her involvement in the Olestra Post-Marketing Surveillance Study (OPMSS, funded by Proctor & Gamble). Dr. Sobo’s key research focus was children’s nutrition, and among other activities she organized a methodologically important exploration of how dietary recalls for children are conducted. Dr. Sobo also was involved with research concerning eating pathology and obesity in women at risk for breast cancer recurrence.

    Some related publications:

    • Sobo, E. & C. Rock (2001). "You ate all that!?": caretaker-child interaction during children's assisted dietary recall interviews. Medical Anthropology Quarterly. 15(2):222-244.

    • Sobo, E., C. Rock, M. Neuhouser, T. Maciel & D. Neumark-Sztainer (2000). Caretaker-child Interaction during Children’s 24-Hour Dietary Recalls: Who Adds What to the Recall Record? Journal of the American Dietetic Association 100(4):428-433.

    • Sobo, E. (1997). The Sweetness of Fat: Health, Procreation, and Sociability in Rural Jamaica, In C. Counihan and P. Van Esterik (eds.), Food and Culture: A Reader. New Brunswick, NJ: Rutgers, pp.256-271 (reprinted from N. Sault, ed., Many Mirrors, Rutgers University Press, 1994).

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