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.
The spiral of silence theory provides insight into the ways in which perceptions of public opinion can lead to changes in opinion expression behavior. Conceptualized in a political communication context, the central claim of the theory is that individuals’ fear of social isolation motivates them to continuously evaluate the climate of opinion through both experiences with the media and interpersonal communication. Upon assessment, individuals either find themselves in a situation where their opinion aligns with the majority or minority. Accordingly, those who find their opinion does not align with the dominant opinion are likely to conceal their opinions while those who find their opinion aligns with the majority are more likely to express them.
Empirical research testing the spiral of silence theory has predominately focused on measurement of focal variables and methods of empirical testing. Advances have been made in regard to micro-level factors, such as creating universally applicable measures of psychological attributes. However, limited work has explored macro-level factors, such as appropriateness of issues, application to computer-mediated communication environments, and tools used to identify circumstances vulnerable to spiral of silence effects. Nonetheless, the practical value of the spiral of silence theory for health and risk communicators can be utilized by modifying campaign efforts to anticipate and counteract fluxes in public opinion.
Scientific advances, technological development, and changes in risk consciousness have led to stronger demands on society to manage and control various kinds of risks. Risks should be assessed, prevented, controlled, and communicated in order to prevent negative impacts. Risks related to the environment and health are probably some of the most research-dependent examples. It is primarily scientific experts that provide knowledge to authorities, organizations, and citizens about environmental and health risks and thus exert considerable influence on the understanding and management of risk. At the same time, there are actors in society—especially citizen and interest organizations—that question whether risk regulation is reliable and relevant. There are also demands that citizens should have more transparency and control over risk regulation. The current situation is characterized thus by a paradox: Issues relating to environment and health are seen as increasingly expert dependent while citizens simultaneously demand increased influence over them. This development is especially noticeable in the European Union, with its strong emphasis on the rights of citizen and consumers to have access to information about risk and also opportunities to influence their regulation.
In response to this situation, risk governance has been put forward. It refers to a body of ideas for how to more responsibly and efficiently deal with complex risks issues, where there are different interests and standpoints about how to regulate them. Fundamental ideas of risk governance are openness, transparency, participation, inclusion, deliberation, and reflexivity; that experts involved should be open to questioning the situation; should not conceal issues of uncertainty and pluralism (that there exist different legitimate understandings, evaluations, and recommendations); and should be receptive to the input and participation of other stakeholders. This means that risk regulation should no longer be organized into three discrete activities: risk assessment, risk management, and risk communication (aiming at a one-way transfer of knowledge from the regulators to the public).
Stephen M. Croucher
The European Union (EU) is an economic, political, and social conglomeration of 28 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 respectively, 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/procedures are 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: What are the national integration policies, and how do they differ? What is the future for the EU in response to increased legal, illegal, and irregular migration?
Dani Filc and Nadav Davidovitch
The medical encounter is one of the most important channels of communication between the patient and his or her caretaker. Apart from its therapeutic effect, the medical encounter serves to convey information about a symptom or disease; construct a diagnosis and give information about the expected course of a disease (“prognosis”); and discuss treatment plans, including risks and benefits. The centrality of the medical encounter makes ethical considerations fundamental, not only within the clinical context but also within the broader context of health promotion. Furthermore, since the medical encounter is characterized by asymmetry and dependence, it can create problems of abuse of power or subordination. The current dominant liberal bioethical approach tends not to take into account the power relations within the medical encounter, or the social context in which the medical encounter takes place. It is in this sense that a republican egalitarian approach to bioethics can be of use. Instead of traditional bioethics emphasis on the individual and on personal autonomy, a radical egalitarian health rights approach will stress the importance of social structures, and the need for a different institutional framework that works toward making a universal right to health possible. Such an approach also emphasizes the centrality of politics in building adequate institutions and in modifying those social structures that cause inequities in health. These considerations have important consequences on how the medical encounter should be constructed, such as in the case of conveying risk and disclosing medical errors.
Amber K. Worthington
Health risk messages may appeal to the responsibility of individuals or members of interdependent dyads for their own or others’ health using many different message strategies. Health messages may also emphasize society’s responsibility for population health outcomes in order to raise support for health policy changes, and these, too, take many different forms. Message designers are inherently interested in whether these appeals to personal, interdependent, and societal responsibility are persuasive. The central question of interest is therefore whether perceptions of responsibility that result from these messages lead to the desired message outcomes. A growing body of empirical research does suggest that there is a direct persuasive effect of perceptions of personal responsibility and interdependent responsibility on health intentions or behaviors, as well as indirect persuasive effects of responsibility on intentions or behaviors via anticipated emotions, specifically regret, guilt, and pride. Research also suggests that perceptions of societal responsibility increase support for public health policy (i.e., the desired message outcome in societal responsibility messages). Important to this area of research is a conceptual definition of responsibility that lends itself toward identifying specific message features that elicit perceptions of responsibility. Specifically, attributions of causation and solution, obligation, and agency are identified as effect-independent message features of responsibility.
Roxanne L. Parrott
Health and risk policymaking focuses on decisions made and actions undertaken to set standards and pass laws to promote healthcare and public health quality, while achieving global health security. Policymakers in governments and institutions deliberate for the purposes of achieving effective and efficient policies, revealing both acceptance and rejection of evidence from health and risk, prevention, and economic sciences, as well as gaps in these domains. Health and risk communicators function implicitly within the boundaries of these decisions and actions, while contributing to prevention science related to strategic messaging and information dissemination. Policymakers face barriers to their efforts residing in the sheer volume of health and risk sciences research; the lack of evidence demonstrating that policies lead to intended outcomes (often, because a policy has not been trialed/implemented); and the absence of economic analyses associated with costs of interventions proposed and undertaken. The precautionary principle (PP) based on adopting caution when evidence is absent, uncertain, or ambiguous regarding possible harm to humans or the environment may function as a guide in some situations. Advocates may draw attention to particular issues in other cases. Policies may be stalled owing to the policy context, including election cycles, legislative and institutional bureaucracies, competing agendas, and fragmented systems of healthcare. Health and risk communicators may collaborate with policymakers and work to translate evidence into useful formats to facilitate the application of evidence to policymaking decisions and actions.
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.
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 concept of ambiguity tolerance (TA), variously called Uncertainty Avoidance, Ambiguity Avoidance, or Intolerance, can be traced back nearly 70 years. It has been investigated by many different types of researchers from clinical and differential, to neuro- and work psychologists. Each sub-discipline has tended to focus on how their variable relates to beliefs and behaviors in their area of expertise, from religious beliefs to reactions to novel products and situations.
The basic concept is that people may be understood on a dimension that refers to their discomfort with, and hence attempts to avoid, ambiguity or uncertainty in many aspects of their lives. There have been many attempts to devise robust and valid measures of this dimension, most of which are highly inter-correlated and require self-reporting. There remains a debate as to whether it is useful having just one or more dimensions/facets of the concept.
Using these tests, there have been many correlational studies that have sought to validate the measure by looking at how those high and low on this dimension react to different situations. There have also been some, but many fewer, experimental studies, which have tested very specific hypotheses about how TA is related to information processing and reactions to specific stimuli. There is now a welcomed interest by neuroscientists to explore the concept from their perspective and using their methodologies.
These studies have been piecemeal, though most have supported the tested hypotheses. There has been less theoretical development, however, of the concept attempting to explain how these beliefs arise, what sustains them, and how, why, and when they may change. However, the concept has continued to interest researchers from many backgrounds, which attests to its applicability, fecundity, and novelty.