The Handbook of Global Health Communication

Rafael Obregon, Silvio Waisbord, Rafael Obregon, Silvio Waisbord

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118241905
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

International in scope, The Handbook of Global Health Communication offers a comprehensive and up-to-date analysis of the role of communication processes in global public health, development and social change

• Brings together 32 contributions from well-respected scholars and practitioners in the field, addressing a wide range of communication approaches in current global health programs
• Offers an integrated view that links communication to the strengthening of health services, the involvement of affected communities in shaping health policies and improving care, and the empowerment of citizens in making decisions about health
• Adopts a broad understanding of communication that goes beyond conventional divisions between informational and participatory approaches

Part I

Perspectives on Communication and Global Health

1

Theoretical Divides and Convergence in Global Health Communication

Silvio Waisbord and Rafael Obregon

Introduction

This chapter offers a survey of theories in global health communication. The goals are to analyze the genealogy of key theories and debates, compare concepts and arguments, and their differences, and to discuss the possibility of theoretical convergence.

Global health communication has straddled both academic debates and programmatic interventions. Given this position, theories were not only developed to produce evidence-based generalizations that explain relations among variables and offer predictions about a range of phenomena. They have also been formulated to provide conceptual guidance to health programs aimed at promoting changes and reaching specific outcomes. Such expectations about the empirical implications of theories have not been limited to conceptual frameworks produced in the mold of scientific positivism and empirical research. Theories rooted in the humanities and interpretative frameworks have also maintained close connections with health programs. Scholars in health communication (Fishbein, 2000; Fishbein and Yzer, 2003) and communication for development and social change (Melkote and Steeves, 2001; Morris, 2004; Gumucio-Dagron and Tufte, 2006; Servaes, 2008), the two fields that underpin the theoretical edifice of global health communication, have refined theories to contribute to addressing concrete health challenges. Just like general theories about public health, they are intended not simply to explain phenomena. They were designed to pursue specific programmatic goals based on normative imperatives too – in other words, to pursue social good (Kreps, 1989; Rogers, 1994).

Aside from whether scholars were primarily driven to provide programmatic prescriptions or contribute to academic debates, theoretical paradigms have been increasingly used to provide intellectual justification to global health interventions. The incorporation of theory into program design has been far from a linear and predictable process. Instead, given the predominance of biomedical approaches in global health, it has been a bumpy ride. Gradually, as program managers realized the need for social-behavioral approaches and acknowledged the solid conceptual foundations in communication studies, communication scholarship gained a stronger footing.

The main argument presented in this chapter is as follows: the field is still characterized by a theoretical divide between information/media effects and participatory/critical theories that mirrors broad differences in health communication and communication studies at large. Despite efforts to bridge these theoretical traditions, the divide remains grounded on different conceptions of communication and its place in promoting better health worldwide. Finding bridges, let alone reconciling differences, seems unlikely given that theories and models are based on antithetical epistemological and analytical premises and ask different questions about the nature of communication and the conditions required to address challenges in contemporary health that impede cross-pollination across disciplinary and conceptual traditions.

Theories about global health communication have conceptually drawn from theoretical debates in the field of communication at large, and have been empirically informed by hundreds of studies about the role of communication in health programs in diverse international settings. Conceptually, theories and models have been influenced by the evolution of development communication and health communication as two separate branches of communication studies. Therefore, the genealogy of the field is rooted in the convergence of theories originally intended to analyze and explain the role of communication in processes of social, economic, and political development as well as the role of communication in improving health conditions and indicators in the United States. Since then, global health communication has straddled both parallel lines of research in the discipline. Consequently, it has been influenced by theoretical debates and research with different goals.

Empirically, theories have largely been informed by international, rather than global, studies in health communication. This difference is not insignificant. “Global” refers to health and communication issues that affect the world as a whole and, concomitantly, to approaches that analyze them as phenomena with planetary dimensions and implications. Examples of such global framework are theories about the role of communication in addressing health risks and challenges that transcend geographical and cultural borders, whether the spread of infectious diseases or the impact of climate change. Conversely, “international” alludes to the intersection between health and communication in specific local, regional, and national cases throughout the world. Examples are the analysis of the role of communication in immunization campaigns in a given country or strategies to promote care and treatment of people living with HIV/AIDS in a community. Whereas the former put global perspective at the forefront, the latter are focused on specific local dimensions. No question, the vast majority of studies have fallen into this second category. Even as globalization theories and approaches have remarkably influenced contemporary debates in the social sciences, theory-building remains grounded in distinct community and national studies. Moreover, studies are also focused on individual health issues and experiences that reflect the stove piping mindset in global health at large (Brown, Cueto, and Fee, 1996).

The study of health communication in a global context needs to be placed as the prolongation of two scholarly traditions, “development communication” and “health communication,” two separate fields of analysis and practice. This section discusses the former; the next section addresses the latter.

Health in Development Communication

Theory-building and conceptual debates in global health communication are linked to the genealogy of “development communication” in the 1950s. Specifically, the study of health communication in international context continued the analytical premises of modernization theory, which was the “dominant paradigm” in the field of development communication in its early decades. Although modernization studies were not primarily concerned with health outcomes, they were based on epistemological premises that are similar to the socio-psychological and communication theories that came to dominate the study of global health communication.

Modernization theory dominated the early generation of development communication studies. One of its basic tenets was that development problems were rooted in cultural obstacles, namely, the persistence of traditional attitudes and knowledge. As long as traditional cultures persisted, modernization theorists argued, development was impossible (McClelland, 1961; Hagen, 1962). Besides its uncritical assumption that development meant the Western model of development, modernization put forth a causal argument inspired by a particular socio-historical interpretation of the West. It was embedded in two key analytical premises. First, it offered a functionalist explanation of society according to which there is a necessary correlation between political, economic, and cultural systems. A “modern” democratic polity and capitalist economy necessitate a “modern” culture characterized by individualism, scientific values, innovation, entrepreneurship, secularism, and so on. Second, modernization argued that “culture” (including psychosocial characteristics as well as knowledge and attitudes) is the independent variable that explains “development.” By embracing these premises, modernization offered a cultural-functionalist argument with obvious programmatic implications. Addressing the problems of underdevelopment required cultural change, that is, the transformation of prevalent psychological and cultural traits.

The blend of a view that emphasized the primacy of cultural change in large processes of social transformation with communication theories about powerful media effects set the paradigm that defined the field of development communication. If the mass media have significant impact on psychological and cultural attributes, as several studies have contended, then they could be instrumental in promoting cultural changes in “underdeveloped” countries. Put it differently, seminal writings (Lerner, 1958; Schramm, 1964) in development communication drew from both modernization theories (which were prevalent in international studies) and media studies to argue that exposure to the mass media was vital for cultural change and, subsequently, for “modern development.” The “modern” media were viewed as agents of positive change, as they could expose people to “modern” knowledge and attitudes.

Implicit in this line of argument was a conceptual model that basically understood communication as the transmission of information and the study of persuasion. Media technologies were critical because they allowed the mass distribution of information and, as “propaganda” studies suggested, were capable of influencing knowledge and attitudes among large numbers of people. Communication was conceived as a unidirectional process by which those with access to the media can influence the minds of the many who don’t. It is about how ideas are disseminated in society, and how people can be persuaded to believe, think, and act in certain ways.

Such an “informational/persuasion” view of communication was present in Everett Rogers’ (1962) study about the diffusion of innovations. Rogers suggested that information is a critical yet not sufficient condition for the adoption of new ideas. His well-known model of five stages and his distinction between types of “adopters” stressed the significance of awareness and knowledge of innovations (whether new farming methods or scientific advances) in adopting them. Knowledge does not necessarily lead to effective change, but the latter does require modifications in levels of awareness and knowledge. According to Rogers, development communication was the intentional transference of ideas and information to change belief and behaviors. It is about how sources persuade receivers.

Rogers and Schramm eventually moderated early assumptions about the power of the media. They acknowledged the importance of interpersonal communication in processes of persuasion. Also, they recognized the importance of sociocultural factors in motivating people to change beliefs and behaviors. In response to his critics, Rogers (1976) even admitted that participation should be a key component of communication. For him, communication is a “process in which participants create and share information with one another in order to reach a mutual understanding” (Rogers, 1986, p. 199). Yet the paradigm still espoused the conception of communication as information transmission and persuasion. Even if it was recognized that people participated on more leveled conditions, communication was basically conceived as information sharing. Put it differently, despite the widening of who participated, the basic conception of communication didn’t change.

What matters for understanding the intellectual lineage of international/global health communication is that fundamental tenets of modernization theories resonated with the early systematic application of communication theories to health issues as development problems. Just like modernization, those studies subscribed to the view that communication was primarily concerned with information and persuasion – it was a scientific field interested in conditions and strategies that maximize the impact of information transmission on knowledge, attitudes, and behaviors. The role of theory, then, was to identify continuities and develop explanations about how information dissemination and exchange modify awareness, knowledge, and beliefs about health issues and, ultimately, contribute to changing health practices.

The strong push for family planning programs in international aid in the 1960s and 1970s set the stage for a wealth of studies about the impact of communication programs on health indicators. Evidence of this approach was the work of Schramm (1971) and Rogers (1973) who extensively analyzed communication interventions implemented to support population programs worldwide. As a consequence, conclusions and theories about health (as well as development) communication were largely informed by findings about the effect of interventions and media campaigns on beliefs about family size, knowledge of family planning methods, information about health systems, and the like. These studies summarized previous findings and identified key questions that were subsequently addressed by a wealth of studies (Piotrow et al., 1997).

Theories about Health Communication: Behavior Change and Media Effects

At the same time, health communication emerged as distinct scholarly field of inquiry in the United States (Kreps, Bonaguro, and Query, 1988). The combination of pioneering theoretical insights and landmark programmatic experiences (Farquhar and Maccoby, 1975) shaped the flourishing of health communication. Theoretically, the field has been defined by the combination of interdisciplinary approaches (Kreps and Maibach, 2008; Nussbaum, 1989) and concepts grounded in social psychology and the “media effects” research in communication studies. Analytically, it has engaged with a vast range of communication processes and health issues (Parrott, 2004). A detailed analysis of the development of key theories falls outside the scope of this chapter. Several articles have already compared core concepts and arguments as well as the applicability of theoretical constructs across health issues and settings (Brashers and Babrow, 1996; Noar and Zimmerman, 2004).

What matters for understanding theory in global health communication is how theoretical concepts and methodological approaches developed by health communication, primarily in US academia, exerted a notable influence. First, because groundbreaking studies were rooted in social psychological theories, communication has been typically understood as a human process of information transmission and reception. This also explains why the focus has been on individuals rather than on broad social, political, and economic forces. The impact of the latter on health communication has been eclipsed by the paramount interest in barriers and motivations at the individual level. Questions about individual cognition and psychological and social attributes in exposure to and the processing of health information have been dominant. Second, individualistic premises underlay the research on the impact of health information on behaviors. Collective behaviors were basically conceived as the aggregation of individual practices rather than as distinct phenomena explained by specific dynamics and causes. Third, the tradition of empirical research and applied knowledge in health communication also influenced the research agenda of global health communication. Theory was meant to provide solid conceptual footing and evidence to guide interventions to affect health behaviors. Fina...

Table of contents

• Cover
• Series page
• Title page
• Copyright page
• Dedication page
• Notes on Contributors
• Acknowledgments
• Introduction
• Part I: Perspectives on Communication and Global Health
• Part II: Theoretical Perspectives on and Approaches to Health Communication in a Global Context
• Part III: Case Studies of Applied Theory and Innovation
• Part IV: Crosscutting Issues
• Part V: Conclusions: Rethinking the field
• Index