Janice L. Krieger and Jordan M. Neil
Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.
A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being.
CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice.
In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.
Central to many definitions of the term “cultural imperialism” is the idea of the culture of one powerful civilization, country, or institution having great unreciprocated influence on that of another, less powerful, entity to a degree that one may speak of a measure of cultural “domination.” Cultural imperialism has sometimes been described as a theory, especially where scholars build a case that the cultural influence of the stronger entity has had a pervasive, pernicious impact on the weaker.
The term evolved from 1960s neo-Marxist discourses within cultural, media, and postcolonial studies that contextualized the post–World War II “independence” wave of new nations emerging from colonial servitude. It was propelled by the writings of nationalist revolutionaries, revolutionary theorists, and their sympathizers of the 1950s and 1960s, but it has sweeping relevance across human history. The foremost western theorist of cultural imperialism in the West was Herbert Schiller. The concept was adopted and endorsed in the 1970s by both UNESCO and the Non-Aligned Movement.
Following Oliver Boyd-Barrett, the concept may denote a field of study embracing all relationships between phenomena defined as “cultural” and as “imperialism.” These encompass cultural changes that are (1) enforced on a weaker entity and (2) occur within both stronger and weaker entities through contact, contest, and resistance, including (3) assimilation of social practices encountered by the stronger in the weaker entity, and (4) original hybrids manifesting cultural traces of both stronger and weaker entities.
The concepts of cultural and media imperialism were much critiqued during the 1980s and 1990s, and many scholars preferred alternative concepts such as globalization and cultural globalization to analyze issues of intercultural contact, whether asymmetrical or otherwise. John Tomlinson critiqued the concept, identified four different discourses of cultural imperialism, and argued in favor of its substitution with the term “globalization.” Mirrlees has placed Tomlinson’s work in context by describing the dialectical—parallel but mutually aware—development of both a cultural imperialism and a cultural globalization paradigm. Both are influential in the 21st century.
“Imperialism” commonly references relations of conquest, dominance, and hegemony between civilizations, nations, and communities. “Cultural imperialism” relates primarily to the cultural manifestations of such relations. Culture and empire relate in many different ways, fueling different theories that often play on dichotomous discourses, including territorial/non-territorial, totalistic/partial, benign/malign, ephemeral/perpetual, superficial/essential, voluntary/involuntary, intended/unintended, welcome/unwelcome, forceful/peaceful, noticed/unnoticed, linear/interactive, homogeneous/heterogeneous, and acceded/resisted.
The concept has affinities with hegemony, the idea that stability in conditions of social inequality is achieved not mainly by force but by securing the consent of the masses (starting with co-option of their indigenous leaders)—through persuasion and propaganda—to the elite’s view of the world. This process is commensurate with forms of democracy that provide the appearance but not the reality of choice and control. Fissures within the ranks of the elites and within the masses create spaces for resistance and change.
Culture encompasses the totality of social practices of a given community. Social practices are manifest within social institutions such as family, education, healthcare, worship, labor, recreation, language, communication, and decision-making, as well as their corresponding domains. Any of these can undergo change following a society’s encounter with exogenous influences—most dramatically so when stronger powers impose changes through top-down strategies of command and influence.
Analysis of cultural imperialism often incorporates notions of media imperialism with reference to (1) print, electronic, and digital media—their industrialization, production, distribution, content, and capital accumulation; (2) cultural meanings that media evoke among receivers and audience cultures; (3) audience and media interactions in representations of topics, people, and ideas; and (4) relationships between media corporations and other centers of power in the reproduction and shaping of social systems.
Media are logically subsumed as important components of cultural imperialism. Yet the significance of media can be understated. The concept of mediatization denotes that “knowledge” of social practices draws heavily on media representations. Social practices that are experienced as direct may themselves be formed through exposure to media representations or performed for media.
Discourses of cultural imperialism speak to major current controversies, including: cultural suppression and genocide; ideas of “globalization”; influential economic models of “capitalism” and “neoliberalism”; ideologies that are embedded in the global spread of concepts such as “modern,” “progressive,” “growth,” “development,” “consumerism,” “free market,” “freedom,” “democracy,” “social Darwinism” and “soft power”; cultural specificity of criteria and procedures for establishing “truth”; instrumentalization for the purposes of cultural conquest of academic disciplines such as psychoanalysis, economics, social anthropology, or marketing, or environmental crises, especially as linked to western ideologies that underwrite humanity’s “right” to dominate nature.
John D. H. Downing
Social movements are the matrix of many forms and formats (technologies, genres) of media that contest dominant power. Such media are in many ways the lifeblood of such movements. Media activism denotes collective communication practices that challenge the status quo, including established media. Frequently, such media are underfunded or unfunded and have a much shorter life cycle than capitalist, state, or religiously funded media. They are a “tribe” within a much larger continent of nanomedia (also called alternative media and citizens’ media). Their functions may spill over at times within the operation of established media, especially in times of social turbulence and crisis.
The “dominant power” in question may be quite variously perceived. Extreme-right populist movements, as in several European countries, may define the political establishment as having betrayed the supposed racial purity of the nation, or in the case of India’s Islamophobic Hindutva movement, as having traduced the nation’s religious purity. Labor movements may attack capital, feminist movements, or patriarchal and sexist structures. Sometimes these movements may be local, or regional; other times, they are transnational.
The impact of these media is still a matter of considerable debate. Often, the debate begins from a false premise—namely, the frequently small size and/or duration of many social movement media projects. Yet women’s right to vote and the abolition of slavery in the Americas were not won overnight, and neither was the dismantling of South Africa’s racist apartheid system. The Hindutva movement goes back over a century. We should not hold social movement media to a higher standard of impact, any more than we should ascribe instantaneous power to established media.
Social movements wax and wane, and so do their media projects. But the persistence of some such media activism between the peaks of movement activism is generally essential to the regeneration of social movements.
Marla L. Moon
A visual impairment can affect cognitive, emotional, neurological, and physical development. Visual impairment impairs reading speed and comprehension, and is often mistaken for a learning disability. Learning is accomplished through complex and interrelated processes, one of which is vision. As a result, visual impairments limit the range of experiences and kinds of information to which one is exposed. A reliance on visual cues in health and risk messages intensifies these effects with regard to health information. The millions of children and adults who are affected by visual impairments worldwide thus require specific consideration regarding how best to make health information accessible for them. The reliance on caretakers to address the health information needs of those living with visual impairments violates their privacy and threatens their emotional well-being. Technological and modality advances that rely on touchscreens that lack tactile or auditory cues marginalize a broad segment of society that is in need of gateways to overcome barriers to accommodating visual impairment. In designing strategic health and risk messages, consideration should be given to this scope of possible limitation and its implications for access to and processing of health and risk information. Health and risk message designers should understand both the realities of challenges to accessing information for the visually impaired and strategies for addressing these realities and the scope of the issue worldwide and across the lifespan.