Wayne A. Beach, Kyle Gutzmer, and Chelsea Chapman
Beginning with phone calls to an emergency psychiatric hospital and suicide prevention center, the roots of Conversation Analysis (CA) are embedded in systematic analyses of routine problems occurring between ordinary persons facing troubling health challenges, care providers, and the institutions they represent. After more than 50 years of research, CA is now a vibrant and robust mode of scientific investigation that includes close examination of a wide array of medical encounters between patients and their providers. Considerable efforts have been made to overview CA and medicine as a rapidly expanding mode of inquiry and field of research. Across a span of 18 years, we sample from 10 of these efforts to synthesize important priorities and findings emanating from CA investigations of diverse interactional practices and health care institutions. Key topics and issues are raised that provide a unique opportunity to identify and track the development and maturity of CA approaches to medical encounters. Attention is also given to promising new modes of research, and to the potential and challenges of improving medical practices by translating basic and rigorous empirical findings into innovative interventions for medical education. A case is made that increasing reliance on CA research can positively impact training and policies shaping the delivery of humane and quality medical care.
Religion encompasses many forms of communication: between groups, within groups, and with God (or other deities). Such communication can be especially powerful when group members highly identify with their religious group and the beliefs therein. Equally, it can be divisive, as evidenced by religion-based intergroup conflict and intolerance (which often overlaps along ethnic or political lines). However, not all religious communication is verbal or explicit. Religious individuals also commonly transmit their beliefs, values, and identities through symbols, physical spaces, and music. Likewise, communication with God is often pursued with silent prayer, meditation, or ritual, which also serve to reinforce one’s spirituality alongside religious group boundaries. Taken together, these varying forms of communication have implications not only for religious intergroup relations (e.g., intergroup contact or conflict), but also for intragroup relations (e.g., the strengthening of social ties) and individual health outcomes (e.g., effective communication with health care providers and coping practices). Given the importance of religious identity for many individuals, the benefits for individual well-being and intragroup relations, and yet the intergroup strife that religious group divisions can incite, the ways in which we communicate our religious group identities deserve closer attention.
Paul W. Speer and Leah Marion Roberts
Agents of change serve as catalysts for stimulating social change, particularly at community and societal levels of analysis. We often think about the characteristics of individuals who act as change agents, such as their capacity to motivate others or their training skills. However, organizations and disciplinary fields can also serve as agents of change. There is an emerging awareness in the fields of public health and community organizing as to how these respective fields can collaborate to leverage their collective insights and skills to become effective agents of change for community health outcomes. Importantly, while public health is concerned with the social determinants that shape health inequities in all communities, community organizing is focused on community issues that residents confront as constraints or problems in their daily lives. There is an inchoate understanding within the fields of public health and community organizing that the social determinants addressed in public health are often the same issues identified and addressed by community organizing groups.
Both disciplines work as agents of change through their traditional efforts; however, there is promise in the evolving collaborations between these two fields. Recognition that both fields are addressing the same community phenomena is an important step, but whether collaborations and shared practices become distributed and institutionalized is an open question. Public health possesses research and analytic sophistication capable of identifying different social determinants and the pathways through which such determinants contribute to poor community health outcomes. In contrast, community organizing supplies an understanding of social change that requires the exercise of power through the participation and active engagement by those most directly affected by local issues or social determinants. One tension in this emergent collaborative practice stems from the fact that, at times, these different disciplinary skill sets are at odds. Whereas public health has a deep value of data analysis and expertise, community organizing prioritizes the participation and self-determination of those impacted by community problems. Fundamentally, the tension here is between the value placed on expertise versus the value placed on public participation. Neither value is inherently superior to the other; understanding how these two values can complement one another to address social determinants that shape community health outcomes is critical for realizing the promise of these organizational agents of change.
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.
Kevin A. Whitehead
In the wake of what has been called the “discursive turn” or “linguistic turn” in the social sciences, research at the intersection of language and communication and race and racism shifted from being largely dominated by quantitative and experimental methods to include qualitative and particularly discursive approaches. While the term “discursive” potentially encompasses a wide range of modes of discourse analysis, discursive approaches share a focus on language use as social action, and as a constitutive feature of actions, events, and situations, rather than as merely a passive means of describing or transmitting information about them. When applied to the study of race and racism, such approaches have examined ways in which language functions to construct, maintain, and legitimate as well as subvert or resist racial and/or racist ideologies and social structures.
Research in these areas has made use of a range of empirical materials, including “elite” texts and talk (media texts, parliamentary debates, academic texts, etc.), individual interviews, focus groups and group discussions, “naturally occurring” talk-in-interaction from conversational and institutional settings, and text-based online interactions. Although these different data types should not be seen as strictly mutually exclusive, each of them serves to foreground particular features of racial or racist discourse(s), thus facilitating or constraining particular sorts of discourse analytic findings. Thus, different data sources respectively tend to foreground ideological features of racial discourse(s) and their intersection with power and domination, including examination of “new” racisms and the production and management of accusations and denials of racism; discursive processes involved in the construction and uses of racial subjectivities and identities; interactional processes through which prejudice and racism are constructed and contested; and the everyday interactional reproduction of systems of racial categories, independently of whether the talk in which they occur can or should be considered “racist.”
Sophie Christman Lavin and E. Ann Kaplan
Ecocinema involves the human gaze looking at cinema through the lens of the environment, in a manner analogous to the way feminists provided the cinematic lens of gender in the 1970s. However, as with feminism, enormous differences pertain in regard to how the ecocinema lens is mobilized.
In analyzing films from the late 1800s to the early 21st century, ecocinema studies has evolved to include critical lines of inquiry from perspectives of psychology, feminism, socioeconomics, science, and activism. Research frames used in these inquiries include: setting and landscape in films, ecological analyses of mainstream and independent fictional films, posthuman cinematic representations, transnational and regional, and more recently, trauma in speculative dystopian films. Ecocinema critics analyze films of various types, including Hollywood, independent, transnational, documentary, animated, art cinema, and especially climate fiction (“cli-fi”) films.
Ramachandra Guha’s transnational typology of environmental ideologies will provide a useful starting place for the mapping of different perspectives in ecocinema. Guha distinguished utopian wilderness environmentalism, pervasive in the United States, from the agrarian focus typical in India. Meanwhile, most developed nations utilize scientific industrial methods to exploit the environment. Oftentimes, these latter approaches are grounded in growth economies and are thus in conflict with the unrealistic ideals of so-called neo-primitivism (NP). Neo-primitivism involves returning to simple, sustainable lifestyles within or close to the natural world—lifestyles that do no environmental damage. NP is beloved by many, but the consensus is that it is idealistic to consider going back to this way of life. A film such as Avatar (produced and directed by James Cameron in 2009) addresses the complexity of diverse constructions of nature by providing examples of utopian wilderness ideology that compete with, and are opposed to, the destructive scientific industrialism that disregards and dominates nature without compunction. Other films, such as Amazon Sisters (Sweeny, 1992), Elemental (Koch, Roshan, & Vaughan-Lee, 2012), Into the Wild (Blocker, Hildebrand, Kelly, & Penn, 2007), or Grizzly Man (Beggs & Herzog, 2005), act as simultaneous celebrations and critiques of wilderness ideologies and deal with gender and racial identities, and thus they have been a central focus of ecocinema scholarship.
Although films from all genres have historically engaged environmental issues, it was rarely in a way that made a self-conscious or critical statement about the human impact on the natural world from the perspective of ecological concerns—this is the focus of ecocinema. See for example, Birt Acres’s Rough Sea at Dover (1895), the Lumiere Brothers’ Oil Wells of Baku (1896), Thomas Edison’s Sorting Refuse at Incinerating Plant, NYC (1903), and the British South Africa Company’s Rhodesia To-Day (1912). In the early 21st century, the genre that most often engages with the contemporary politics of climate change is the documentary. Documentaries, such as An Inconvenient Truth (Guggenheim, 2006), Manufactured Landscapes (Baichwal, 2006), Into Eternity (Eskilsson & Madsen, 2010), Chasing Ice (Ahrens & Orlowski, 2012), E-Waste Tragedy (Esteve, Popp, Úbeda, & Dannoritzer, 2014), This Changes Everything (Cuarón & Lewis, 2015), among others, critique human damage to the planet and thus position viewers as ethical witnesses. Such works hope to influence the outcome of our shared anthropocentric future.
The analyses of ecocinema are addressed using two distinct methods—the macro and the micro. The macro method studies how films represent the large-scale processes of earth-based climate systems, and its lens evaluates how films represent climate and environmental dilemmas facing humans as a species. The micro-lens provides enhanced analyses that explore how gender, race, and class figure into the cultural work climate fantasies perform. This lens indexes the ways in which various cultures are often disproportionately impacted by climate systems.1 Oftentimes the macro and micro levels are both incorporated in a single film and reveal the intersection between climate and culture, as seen in Taklub (Trap, Castillo & Mendoza, 2015), a film that portrays Super-typhoon Haiyan and its impact on residents in Tacloban, Philippines. As background to mapping the texts, evolving science discourses will be emphasized as evidence for global warming but with the understanding that this evidence relies on modeling. Although our main concern with this cultural work in ecocinema is how climate change impacts across gender, race, and class, the inequalities revealed also speak to the politics of climate change evident in cinematic treatments of the issue.
Kristin L. Farris and Maureen P. Keeley
Social support in the context of chronic illness management is important, as individuals diagnosed with these conditions and their loved ones often experience increased distress, reduced relational quality, and diminished physical health as a result of coping with these long-term symptoms. Therefore, diagnosed individuals and their close relational partners rely on others to provide support in their time of need. The communication of social support is characterized by “verbal and nonverbal behavior produced with the intention of providing assistance to others perceived of needing that aid” (MacGeorge, Feng, & Burleson, 2011, p. 317). Individuals living with these chronic illnesses and their loved ones often turn to a variety of interpersonal others, including friends, family, health care providers, and support groups to manage the difficulties that accompany their physical symptoms. Although some researchers suggest that diagnosed individuals seek support most frequently from close relational partners, other scholars assert that chronic care support groups (whether meeting face to face or via computer-mediated channels) offer support recipients an opportunity to discuss their challenges and receive help from experientially similar others.
On the one hand, regardless of the support provider, individuals who have been diagnosed with chronic conditions generally perceive effective supportive communication to be messages in which their support providers enact competent tangible assistance in managing the illness, provide an opportunity for them to vent their feelings, and express messages of empathy and affection, among others. Ineffective messages, on the other hand, are those in which diagnosed individuals feel their partners are overly involved in helping them make decisions about their care or portraying negative attitudes or discomfort around them. Overall, research in this area suggests that support recipients and their relational partners have improved emotional, relational, and physical outcomes when they perceive support to be available or receive effective support from these resources.
Ilona Fridman and E. Tory Higgins
Regulatory Focus Theory differentiates between two motivational orientations: promotion and prevention. Promotion-oriented individuals focus on advancements, growth, and making progress toward their hopes and aspirations, whereas prevention-oriented people are more concerned about safety, security, and fulfilling their responsibilities. Promotion-oriented individuals tend to focus on moving toward a better state ensuring gains and improvements. In contrast, prevention-oriented people tend to focus on ensuring against making mistakes and maintaining a current satisfactory state rather than moving to something worse. When individuals pursue desired ends using their preferred means (ensuring gains for promotion, and ensuring against losses for prevention), they experience regulatory fit, which makes them “feel right” about what they are doing. Regulatory fit is associated with strengthening engagement and intensifying evaluative judgments.
The advantages of regulatory fit could be utilized in communications to motivate individuals’ healthy behavior. The messages that encourage healthy behavior could be framed in a way that fits recipients’ personal goal orientations. For instance, to increase motivation among promotion-oriented people for getting vaccinations, the message might state, “A flu vaccine helps you to continue achieving your goals even during a flu season.” This message emphasizes advancements and gains that fit a promotion orientation. To increase motivation among prevention-oriented people to choose healthy options, the messages could instead highlight avoiding losses: “A flu vaccine helps you avoid strength-sapping illness during a flu season.” Past studies on health communications have demonstrated that regulatory fit tends to facilitate participants’ willingness to follow the message and engage in healthy behavior.
Could regulatory non-fit messages also work? When individuals pursue desired ends using non-preferred means—ensure gains for prevention-oriented individuals or ensure against losses for promotion-oriented individuals—they experience regulatory non-fit. Non-fit makes them “feel wrong” about what they are doing. Regulatory non-fit is associated with weakening engagement and de-intensifying evaluative judgments. How might a non-fit health message be helpful?
What if individuals’ initial attitudes toward a healthy option were negative, even anxiety producing, despite that option serving their interests better than alternative options? It would be better if the individuals could thoughtfully consider the potential benefits of the option without their negative feelings rejecting it. For a thoughtful decision to be made, the intensity of the initial negative feelings could be decreased. A regulatory non-fit message, in this case, could be an effective tool. By making people “feel wrong” about their initial reaction, it could weaken their engagement and de-intensify the negative reactions, for example, reduce anxiety about the option. Thus, the regulatory non-fit message could help an individual to reconsider potential advantages of the initially disliked option.
While the ways in which Regulatory Focus and Regulatory Fit theories can be applied to improve health communications are known, important questions remain. For example, are there circumstances when fit or non-fit messages could make people feel that their decision-making autonomy is being threatened? Can fit or non-fit messages create resistance? If so, how can this be avoided? Both fit and non-fit messages are persuasive techniques. Is there a downside to these techniques? What can be done to ensure that these persuasive techniques are not just effective but are also ethical?
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.
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.