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Gary L. Kreps
Ehealth, also known as E-health, is a relatively new area of health communication inquiry that examines the development, implementation, and application of a broad range of evolving health information technologies (HITs) in modern society to disseminate health information, deliver health care, and promote public health. Ehealth applications include (a) the widespread development of specialized health information websites (often hosted by government agencies, health care systems, corporations, professional societies, health advocacy organizations, and other for-profit and nonprofit organizations); (b) the widespread use of electronic health record (EHR) systems designed to preserve and disseminate health information for health care providers, administrators, and consumers; (c) an array of mobile health education and support applications that have often been developed for use with smartphones; (d) mobile health behavior monitoring, tracking, and alerting equipment (such as wearable devices and systems imbedded in vehicles, clothing, and sporting equipment); (e) interactive telemedicine systems for collecting health data and delivering health care services remotely; (f) interactive adaptive tailored health information systems to support health education, motivate health behaviors, and to inform health decision making; (g) online social support groups for health care consumers, caregivers, and providers; (h) health promotion focused digital games to engage consumers in health education and train both providers and consumers about health promoting procedures; (i) dedicated computer portals that can deliver a variety of digital health information tools and functions to consumers, caregivers, and providers; and (j) interactive and adaptive virtual human agent systems that can gather and provide relevant health information, virtual reality programs that can simulate health environments for training and therapeutic purposes, and an ever-increasing number of digital applications (apps) for addressing a range of health conditions and activities. As information technology evolves, new ehealth applications and programs are being developed and introduced to provide a wide range of powerful ehealth systems to assist with health care and health promotion.
Ehealth technologies have been found by many researchers, practitioners, and consumers to hold tremendous promise for enhancing the delivery of health care and promotion of health, ultimately improving health outcomes. Many popularly adopted ehealth applications (such as health websites, health care portals, decision support systems, and wearable health information devices) are transforming the modern health care system by supplementing and extending traditional channels for health communication. The use of new ehealth applications enables the broad dissemination of relevant health information that can be personalized to the unique communication orientations, backgrounds, and information needs of individuals. New ehealth communication channels can provide health care consumers and providers with the relevant health information that they need to make informed health care decisions. These ehealth communication channels can provide this information to people exactly when and where they need it, which is especially important for addressing fast-moving and dangerous health threats. Yet, with all the promise of ehealth communication, there is still a tremendous amount of work to be done to make the wide array of new ehealth applications as useful as possible for promoting health with different audiences. This article describes the current state of knowledge about the development and use of HITs, as well as about strategies for improving ehealth communication applications to enhance the delivery of health care and the promotion of public health.
Maureen P. Keeley
End of life communication includes both verbal and nonverbal messages that transpire following a diagnosis of a terminal illness and death. The circumstances that occur at the end of life create opportunities for unique and important communication. Specifically, communication at the end of life is impacted by numerous and complicated factors: First, cultural views on death and dying often determine what is talked about, when it can be talked about, and who is included in the conversations. Second, the fears, desires, and needs of the terminally ill must be taken into account at the end of life as it is their personal end of life journey. Third, the nature of the relationships between the terminally ill and their family and friends have tremendous influence on the nature and topics of conversations that will be shared. Fourth, interactions with healthcare professionals (preferably with palliative care specialists) tend to be more task focused, emphasizing end of life decision making and comfort care for the terminally ill. Fifth, as people are tending to live longer with terminal illness and often doing so far from their family, professional caregivers and hospice volunteers are also engaging in meaningful and significant communication with the terminally ill.
Communication at the end of life often determines whether or not the dying are allowed to die with dignity, with some control over their final wishes, and whether they are ultimately able to obtain some peaceful closure. Within close relationships communication at the end of life has the potential for authentic conversations that bring people closer, heal old wounds, and allow the terminally ill and close others to create some final memories and to say goodbye to one another. Communication at the end of life with health professionals has the potential for both the terminally ill and their family members to have greater satisfaction with end of life decisions and control of pain for the terminally ill, as well as better outcomes regarding grief and bereavement following the death for family members. For hospice volunteers and professional caregivers, communication at the end of life teaches the necessity and complexities of interactions at the end of life for the larger society.
Suruchi Sood, Amy Henderson Riley, and Kristine Cecile Alarcon
Entertainment-education (EE) began as a communication approach that uses both entertainment and education to engender individual and social change, but is emerging as a distinct theoretical, practice, and evidence-based communication subdiscipline. EE has roots in oral and performing arts traditions spanning thousands of years, such as morality tales, religious storytelling, and the spoken word. Modern-day EE, meanwhile, is produced in both fiction and nonfiction designs that include many formats: local street theater, music, puppetry, games, radio, television, and social media. A classic successful example of EE is the children’s television program Sesame Street, which is broadcast in over 120 countries. EE, however, is a strategy that has been successfully planned, implemented, and evaluated in countries around the world for children and adults alike. EE scholarship has traditionally focused on asking, “Does it work?” but more recent theorizing and research is moving toward understanding how EE works, drawing from multidisciplinary theories. From a research standpoint, such scholarship has increasingly showcased a wide range of methodologies. The result of these transformations is that EE is becoming an area of study, or subdiscipline, backed by an entire body of theory, practice, and evidence. The theoretical underpinnings, practice components, and evidence base from EE may be surveyed via the peer-reviewed literature published over the past 10 years. However, extensive work in social change from EE projects around the world has not all made it into the published literature. EE historically began as a communication approach, one tool in the communication toolbox. Over time, the nascent approach became its own full-fledged strategy focused on individual change. Backed by emerging technologies, innovative examples from around the globe, and new variations in implementation, it becomes clear that the field of EE is emerging into a discrete theoretical, practice, and evidence-based subdiscipline within communication that increasingly recognizes the inherent role of individuals, families, communities, organizations, and policies on improving the conditions needed for lasting social change.
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.
European communications policy is defined as European level coordination of national policies by institutions such as the European Union (EU), Council of Europe (CoE), European Broadcasting Union (EBU) and European Audiovisual Observatory (EAO). The focus in this article is on European Union initiatives that are, in general, directly binding on Member States. They comprise of policies governing cross-border broadcasting (television and radio), telecommunications relating to media, content distribution (networks and subsidies), public service definitions, advertising and quotas. The focus is on current policies, with historical accounts of how they came into being. It draws on primary source material and provides secondary reading suggestions under the section Further Reading. A distinction is made between hard law, which is directly binding, and soft policy coordination, which takes place between the European Union institutions and national regulatory authorities (NRAs). The policy areas under discussion are: cross-border broadcasting (television and radio), telecommunications relating to media, distribution (networks and subsidies), public service definitions, advertising and quotas. European Union initiatives are comprised of four main components: legislation (Directives, Regulations, and Decisions), soft governance (self-regulation and other forms of European level coordination), competition law and distributive policies (the MEDIA programme and Creative Europe). Directives, regulations, decisions and competition case rulings are directly binding on member states. Soft policy coordination takes place between the European institutions and national regulatory authorities (NRAs). It is used primarily to coordinate standard-setting between NRAs and establish common EU positions on international platforms. It has also been instrumental in setting benchmarking exercises and the exchange of best practice in areas where there is no EU legal basis for legislation such as media transparency, freedom, pluralism and independence.
Stephen M. Croucher
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 European Union (EU) is an economic, political, and social conglomeration of twenty-eight member nations. These member nations work together via a system of supranational institutional and intergovernmental negotiated treaties and decisions by member states. While the EU has been able to continue its development in various stages since the 1950s, a key issue continually facing the EU has always been integration at different levels. Integration of new member states, integration of individuals and cultures within member states, and most recently integration of immigrants (newcomers of different designations) into the EU.
While the EU has strict guidelines regarding the integration of new member states into the EU, no policies or procedures are strictly in place regarding the integration of individuals into the EU. Issues of national sovereignty are critical to EU member states when discussing how to integrate newcomers. Most recently, during the heightened wave of refugees entering the EU through its Southern and Eastern borders, the issue of how to integrate newcomers into the EU has come to the forefront of national and EU policymakers. Key questions facing the EU and its member states include this: What are the national integration policies, and how do they differ? What does it mean to be European? What is the future for the EU in response to increased legal, illegal, and irregular migration?
Patric R. Spence, David Westerman, and Robert G. Rice
Humans often prefer representations that are cognitively easier to store, and such representations are easier to retrieve later to make judgments about the social world. Exemplification theory draws on physiological memory mechanisms and argues that simple, iconic, concrete, and emotionally arousing depictions of events (exemplars) are favored and thus more likely to be stored and used than are abstract, inconsequential depictions or representations. Inconsequential information or representations are forgotten because they are not processed as being essential for survival. Exemplified events vary on a continuum of how accurately they represent a larger occurrence of events. Through specific uses of pictures, quotes and other depictive strategies, concrete, iconic, and emotionally arousing information is often added to a story. Research has documented the strength of specific exemplars in creating inaccurate estimations of events and perceptions of severity and susceptibility. Moreover, in the presence of a risk, portrayals with exemplars have been shown to motivate individuals to intend to change behavior. Exemplification is a strong theory that is understudied and underutilized. The theory has strong explanatory, predictive, and organizing power, and it has application to phenomena in contexts such as media effects, persuasion, crisis and risk communication, health communication and public relations.
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.
Facework represents an important mediation of the intersection between an individual’s private self-conception and the individual’s need to cooperate—or not—in a society, especially at the interpersonal and organizational levels of communication. More clearly, facework builds on the notion of a metaphorical ‘face’, which represents how an individual is viewed—that is, respectfully or not—by others in an interaction. Facework is, then, in its basic form, the interpersonal skills or strategies (i.e., work) needed to maintain or elevate, and in some cases, hinder, others’ perception of an individual’s right to deserve respect. Culture mediates this interaction even further by dictating whose face an individual should be most concerned (i.e., face-concern) with during an interactional exchange. For example, individualistic cultures (e.g., United States, Canada, Germany) prioritize that individuals generally should be most concerned with protecting their own sense of respect (i.e., self-face) while interacting or in conflict, while collectivistic cultures (e.g., China, South Korea, Japan) prioritize the focus on maintaining the other individual’s (i.e., other-face) sense of dignity and respect in an interaction. Yet, individuals in either individualistic or collectivistic cultures may also choose to try to enact concern with both themselves and others in an interaction (i.e., mutual-face).
Other iterations of facework strategies and/or concerns—all at least partially mediated by cultural values and social norms—have emerged, including: face-negotiating, face-constituting, face-compensating, face-honoring, face-saving, face-threatening, face-building, face-protecting, face-depreciating, face-giving, face-restoring, and face-neutral. Notions of face and facework has also given rise to several face-oriented communication theories such as Face-Negotiation Theory (FNT), which aims to examine and predict, generally, how individuals in various cultures might negotiate and manage conflict(s) and conflict styles. Original understandings of face are primarily grounded in Erving Goffman’s sociological work on facework and Penelope Brown and Stephen Levinson’s Politeness Theory, works that have been used to examine and compare communication practices in multiple intercultural and cross-cultural contexts.
Alice M. Kiger, Donna M. Fagan, and Edwin R. van Teijlingen
Faith communities play an important role in health promotion in some parts of the world, notably North America and sub-Saharan Africa. They appear to be less prominent in the United Kingdom, despite the fact that it is a high-income country with a well-developed national public health system. Faith communities can be instigators of health promotion (faith-based health promotion), or they can provide settings where other agencies can conduct health promotion (faith-placed health promotion). Key opportunities and barriers for faith-based and faith-placed health promotion can be found by drawing on examples from the United States and Africa.
Families shape individuals throughout their lives, and family communication is the foundation of family life and functioning. It is through communication that families are defined and members learn how to organize meanings. When individuals come together to form family relationships, they create a system that is larger and more complex than the sum of its individual members. It is within this system that families communicatively navigate cohesion and adaptability; create family images, themes, stories, rituals, rules, and roles; manage power, intimacy, and boundaries; and participate in an interactive process of meaning-making, producing mental models of family life that endure over time and across generations.