Health promotion communication interventions invariably raise ethical issues because they aim to influence people’s views and lifestyles, and they are often initiated, funded, and influenced by government agencies or powerful public or private organizations. With the increasing use of commercial advertising tactics in health promotion communication interventions, ethical issues regarding advertising can be raised in health promotion communication when it applies techniques such as highly emotional appeals, exaggerations, omissions, provocative tactics, or the use of children. Key ethical concerns relate to infringing on people’s privacy, interfering with their right to freedom of choice and autonomy, and issues of equity (such as by widening social gaps, where mainly those who are better off benefit from the interventions). Interventions using digital media raise ethical issues regarding the digital divide and privacy. The interventions may have unintended adverse effects on the psychological well-being of individuals or groups (e.g., by inadvertently stigmatizing or labeling people portrayed as negative models). They can also have an effect on cultural aspects of society (e.g., by idealizing particular lifestyles or turning health into a value) and raise concerns regarding democratic processes and citizens’ consent to the interventions.
Interventions can have repercussions in multicultural settings since members of diverse populations may hold beliefs or engage in practices considered by health promoters as “unhealthy,” but which have important cultural significance. There are also ethical concerns regarding collaborations between health promoters and for-profit organizations. Identifying and considering ethical issues in the intervention is important for both moral and practical reasons. Several ethical conceptual frameworks are briefly presented that elucidate central ethical principles or concerns, followed by ethical issues associated with specific contexts or aspects of communication interventions.
Worldwide, key behavioral risk factors for ill-health and premature death include smoking, alcohol, too much or too little of several dietary factors, and low physical activity. At least three structural factors (biological attributes and functions, population size and structure, and wealth and income disparities) modify the global impact that the risk factors have on health; without accounting for these structural drivers, the effect of government-driven incentives to act on the behavioral risk factors for improved health will be suboptimal. The risk factors and their impact on health are further driven by malleable circumstantial drivers, including technological developments, exposure to products, social influences and attitudes, and potency of products. Government-driven incentives, which can be both positive and negative, can act on the circumstantial drivers and can impact on the behavioral risk factors to improve or worsen health. Government-driven incentives include a range of policies and measures: policies that reduce exposure; regulation of the private sector; research and development to reduce potency; resource allocation for advice and treatment; direct incentives on individual behavior; and, managing co-benefits and adverse side effects. Within a framework of government-driven whole-of-society approaches to improve health, an accountability system is needed to identify who or what causes what harm to health to whom. A health footprint, modeled on the carbon footprint is proposed as the accounting system.
Amy E. Chadwick
Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment.
Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors.
The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies.
Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope.
Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested.
To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope.
Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention.
Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy).
Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.
The focus of intergroup communication research in the Baltic countries is on interethnic relations. All three countries have Russian-speaking urban minorities whose process of integration with Estonian, Latvian, and Lithuanian majorities has been extensively studied. During the Soviet era when the Russian-speaking communities in the Baltic countries were formed, they enjoyed majority status and privileges. After the collapse of the Soviet Union, there was a status reversal as Russian speakers become minorities in the newly emerged national states. The integration of once monolingual Russian-speaking communities has been the major social challenge for the Baltic states, particularly for Estonia and Latvia where they constitute about 30% of the population. Besides the Russian-speaking minorities, each of the Baltic countries has also one other significant minority. In Estonia it is Võro, a linguistically closely related group to Estonians; in Latvia it is Latgalians, closely related to Latvians; and in Lithuania, it is the Polish minority. Unlike the Russian-speaking urban minorities of fairly recent origin, the other minorities are largely rural and native in their territories.
The intergroup communication between the majorities and Russian-speaking minorities in the Baltic countries has often analyzed by a triadic nexus consisting of the minority, the nationalizing state, and the external homeland (Russia). In recent analyses, the European Union (through its institutions) has often been added as an additional player. The intergroup communication between the majorities and the Russian-speaking communities is strongly affected by conflicting collective memories over 20th-century history. While the titular nations see the Soviet time as occupation, the Russian speakers prefer to see the positive role of the Soviet Union in defeating Hitler and reconstructing the countries’ economy. These differences have resulted in some symbolic violence such as relocation of the Bronze Soldier monument in Estonia and the riots that it provoked. Recent annexation of Crimea by the Russian Federation and the role of the Ukrainian Russian speakers in the secessionist war in the Eastern Ukraine have raised fears that Russia is trying to use its influence over its compatriots in the Baltic countries for similar ends. At the same time, the native minorities of Võro and Latgalians are going through emancipation and have demanded more recognition. This movement is seen by some among the Estonian and Latvian majorities as attempts to weaken the national communities that are already in trouble with integrating the Russian speakers. In Lithuania, some historical disagreements exist also between the Lithuanians and Polish, since the area of their settlement around capital Vilnius used to be part of Poland before World War II. The Baltic setting is particularly interesting for intergroup communication purposes, since the three countries have several historical parallels: the Russian-speaking communities have fairly similar origin, but different size and prominence, as do the titular groups. These differences in the power balance between the majority and minority have been one of the major factors that have motivated different rhetoric by the nationalizing states, which has resulted in noticeably different outcomes in each setting.
Michael L. Hecht and Michelle Miller-Day
Adolescent substance use and abuse has long been the target of public health prevention messages. These messages have adopted a variety of communication strategies, including fear appeals, information campaigns, and social marketing/branding strategies. A case history of keepin’ it REAL, a narrative-based substance abuse prevention intervention that exemplifies a translational research approach, involves theory development testing, formative and evaluation research, dissemination, and assessment of how the intervention is being used in the field by practitioners. The project, which started as an attempt to test the notion that the performance of personal narratives was an effective intervention strategy, has since produced two theories, an approach to implementation science that focused on communication processes, and, of course, a school-based curriculum that is now the most widely disseminated drug prevention program in the world.
At the core of the keepin’ it REAL program are the narratives that tell the story of how young people manage their health successfully through core skills or competencies, such as decision-making, risk assessment, communication, and relationship skills. Narrative forms not only the content of curriculum (e.g., what is taught) but also the pedagogy (e.g., how it is taught). This has enabled the developers to step inside the social worlds of youth from early childhood through young adulthood to describe how young people manage problematic health situations, such as drug offers. This knowledge was motivated by the need to create curricula that recount stories rather than preaching or scaring, that re-story health decisions and behaviors by providing skills that enable people to live healthy, safe, and responsible lives. Spin-offs from the main study have led to investigations of other problematic health situations, such as vaccination decisions and sexual pressure, in order to address crucial public health issues, such as cancer prevention and sex education, through community partnerships with organizations like D.A.R.E. America, 4-H clubs, and Planned Parenthood.
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.
The concept of media literacy has been circulating in the United States and Europe since the beginning of the 20th century as a means to acknowledge the set of knowledge, skills, and habits of mind required for full participation in a contemporary media-saturated society. The concept continues to morph and change as a result of rapid changes in digital media, mass media, social media, popular culture, and society. There are a number of competing approaches to media literacy in the United States and around the world. But the acquisition of digital and media literacy competences cannot be conceptualized merely as a set of technical and operative skills; rather, these competencies are embedded in a process of cultural change.
Empowerment and protection have long been identified as the two overarching themes in the media literacy education community, reflecting a dynamic and generally productive tension between those who see media literacy education as a means to address the harms, risks, and challenges of growing up in a media and technology-saturated cultural environment and those who see media literacy as a tool for personal, social, cultural, and political empowerment. Contributing to these distinctive perspectives is the rise of a community of scholars and practitioners who conceptualize media literacy as an expansion of literacy, which has traditionally been understood as the sharing of meaning through spoken and written language. Media literacy can also be understood as a form of advocacy or as a social movement, aimed in particular at young adults, children, and parents; many see it as a specialized academic field associated with either media studies or education. A set of key concepts and core principles have been developed as a result of increased contact among members of the media literacy community, through national and international conferences and increased publication in academic journals. These concepts emphasize the relationship between authors and audiences, messages and meanings, and representation and reality. Among educational practitioners and scholars, an interest in media literacy pedagogy has developed to explore how critical analyses of media texts, tools, and technologies are integrated into elementary, secondary, and higher education, as well as in libraries, museums, and other informal learning settings. As media literacy has entered the education and cultural system, a number of policy issues have emerged. The rise of media literacy in Europe, led by a mandate from the European Commission, has exacerbated an interest in examining policy issues that either support or limit the implementation of media literacy education in relation to economic development or the preservation of cultural heritage. Today, media literacy initiatives occurs in many nations; it is evident that differences in cultural values, press freedoms, media systems, education structures, education policy, and media technology all shape the specific direction, goals, implementation, and assessment of media literacy initiatives.
Matthew Bost and Matthew S. May
Michael Hardt and Antonio Negri are among the most powerful theorists of communication and social change under present-day global capitalism. In their Empire trilogy and other individual and collaborative works, Hardt and Negri argue for the fundamentally communicative nature of contemporary power. Their analyses demonstrate the ways that media technology, global flows of finance capital, and the contemporary shift to economies based on information and affective or emotional labor create new, more complex networks of oppression and new possibilities for more democratic social change. Hardt and Negri’s work, therefore, shifts the focus of critical communication and cultural theory from attaining or challenging political power within the nation-state and invites scholars to rethink sovereignty as empire: an interconnected global phenomenon appertaining to capitalism in the late 20th and early 21st centuries. They furthermore reimagine dissent as a constitutive process of resistance and mutual aid through which the multitude simultaneously withdraws from empire and composes itself through the social communication of struggles across time and space. Hardt and Negri’s work has been taken up in communication studies to theorize the materiality of communication; the labor performed in cognitive, communication, and service industries; contemporary media audiences and reception; and historical and contemporary social movements, from the Industrial Workers of the World to the Arab Spring and Occupy Wall Street.
Mary E. Triece
A study of social movements advances a people’s history of the United States, providing a window into the ways ordinary people often took extraordinary measures to make laws, workplace conditions, the educational system, the quality of home life, and public spaces more open and responsive to the needs and concerns of marginalized groups. With the rise of industrial capitalism in the early 1800s came a host of social ills that prompted individuals to form organizations that enabled them to operate as a force for social change. As the Native American Chief Sitting Bull is purported to have said, “As individual fingers we can easily be broken, but together we form a mighty fist.”
The 1800s through the early 21st century provides numerous examples of people acting together as a mighty fist. As early as 1824, workers in textile mills in the Northeast United States enacted work stoppages and strikes in reaction to wage cuts and deplorable working conditions. The movement to abolish slavery in the mid-1800s provided a way for disenfranchised black men and women, such as the eloquent Frederick Douglass and Maria Stewart, as well as white women, to speak and organize publically. In the area of labor, female and black workers, excluded from the more formal organizing of trade unions through the American Federation of Labor, organized their own labor meetings (e.g., the National Labor Convention of the Colored Men of the United States), unions (e.g., the Women’s Trade Union League), and strikes (e.g., the Uprising of 20,000). By the late1800s through the 1930s, American socialism and the Communist Party, USA, influenced the philosophy and tactics employed by labor activists, many of whom were factory girls who played a formidable role in mass walk-outs in the Progressive Era. Struggles for workplace and civil rights continued throughout the 20th century to undo Jim Crow and segregation, to advocate for civil rights, to advance the rights of women in the workplace, and more recently, to fight for the rights of the lesbian/gay/bisexual/transgender communities, undocumented workers, and immigrants, and to fight against the police repression of black and brown communities and against imperialism and globalization. Activists’ tools for resistance have been as diverse as their causes and include petitioning formal legislative bodies, picketing and rallying, engaging in work stoppages, occupation of public spaces (e.g., sit-downs, walk-outs, occupying squares and parks), and most recently, using social media platforms, blogs, and other forms of Internet activism to facilitate empowerment of marginalized groups and progressive social change.
The Internet has provided an important tool for facilitating international connections of solidarity in struggle. Although what follows focuses specifically on movements in the United States from roughly the 1800s to the present, efforts should continue to focus on the ways movements join forces across and around the globe.
Holley A. Wilkin
When it comes to health and risk, “place” matters. People who live in lower-income neighborhoods are disproportionately affected by obesity and obesity-related diseases like heart disease, hypertension, and diabetes; asthma; cancers; mental health issues; etc., compared to those that live in higher-income communities. Contributing to these disparities are individual-level factors (e.g., education level, health literacy, healthcare access) and neighborhood-level factors such as the socioeconomic characteristics of the neighborhood; crime, violence, and social disorder; the built environment; and the presence or absence of health-enhancing and health-compromising resources. Social determinants of health—for example, social support, social networks, and social capital—may improve or further complicate health outcomes in low-income neighborhoods.
Social support is a type of transaction between two or more people intended to help the recipient in some fashion. For instance, a person can help provide someone who is grieving or dealing with a newly diagnosed health issue by providing emotional support. Informational support may be provided to someone trying to diagnose, manage, and/or treat a health problem. Instrumental support may come in the help of making meals for someone who is ill, running errands for them, or taking them to a doctor’s appointment. Unfortunately, those who may have chronic diseases and require a lot of support or who otherwise do not feel able to provide support may not seek it due to the expectation of reciprocity. Neighborhood features can enable or constrain people from developing social networks that can help provide social support when needed. There are different types of social networks: some can enhance health outcomes, while others may have a more limiting or even a detrimental effect on health. Social capital results in the creation of resources that may or may not improve health outcomes.
Communication infrastructure theory offers an opportunity to create theoretically grounded health interventions that consider the social and neighborhood characteristics that influence health outcomes. The theory states that every neighborhood has a communication infrastructure that consists of a neighborhood storytelling network—which includes elements similar to the social determinants of health—embedded in a communication action context that enables or constrains neighborhood storytelling. People who are more engaged in their neighborhood storytelling networks are in a better position to reduce health disparities—for example, to fight to keep clinics open or to clean up environmental waste. The communication action context features are similar to the neighborhood characteristics that influence health outcomes. Communication infrastructure theory may be useful in interventions to address neighborhood health and risk.
Norms are regularized patterns of attitudes and behavior that characterize a group of individuals, separate the group from other groups of individuals, and prescribe and describe attitudes and behaviors for group members. Relying on social identity theory and self-categorization theory, the role played by group norms within groups and the processes by which such norms are promulgated within groups are discussed. Norm talk or the communication of normative information within groups is explored, as a major proportion of communication within groups is dedicated to clarifying ingroup identities and group attributes such as attitudes and behaviors that characterize the group. Group members can glean normative information by attending to norm talk for instance, by listening to the content of fellow group members’ communications, from their behavior, and from influential or prototypical sources within the group.
According to self-categorization theory, once individuals categorize themselves as members of a salient group or category, they represent normative information cognitively as ingroup prototypes. Prototypes are a fuzzy set of group attributes (such as attitudes and behaviors that characterize the group) and simultaneously minimize differences within groups while maximizing differences between groups. Thus, clear group prototypes help create distinct identities that are clearly demarcated from other groups. Group members should be especially attentive to information that flows from prototypical sources within groups—such as leaders and ingroup media sources—while efforts should be made to differentiate from marginal or deviant members who deviate from the prototype and reduce clarity of ingroup prototypes. The processes through which attending to information communicated by different sources within groups—both prototypical and non-prototypical—help group members seek normative information and clarification of ingroup prototypes are discussed.