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.”
Michael Mackert, Sara Champlin, and Jisoo Ahn
Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to health outcomes and costs to the U.S. health-care system. Approximately one-quarter to one-half of U.S. adults struggle with health information, which includes understanding patient education materials, reading medication labels, and communicating with health-care providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability.
Increased attention to the field of health literacy has resulted in debates about the definition and the best ways to assess health literacy; there is also a strong and growing movement within the field of health literacy research and practice to frame health literacy less as a deficit to overcome and more as an approach to empowering patients and improving outcomes. As health-care providers have recognized the importance of health literacy, workshops, and training programs have been developed and evaluated to improve the care of low-health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low-health-literate audiences with traditional and new digital media, which can also increase access for patients with hearing or visual impairments. Additionally, recent policy changes in the United States, including those related to the Affordable Care Act, contribute to a greater focus and regulation of factors that impact health literacy. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and health-care costs, and improved strategies for improving the health of lower health literate patients. Development and review of health literacy pieces can aid in shared decision making and provide insights for patients on various health-care services.
Ee Lin Lee
Language is an arbitrary and conventional symbolic resource situated within a cultural system. While it marks speakers’ different assumptions and worldviews, it also creates much tension in communication. Therefore, scholars have long sought to understand the role of language in human communication. Communication researchers, as well as those from other disciplines (e.g., linguistics, anthropology, psychology, and sociology), draw on each other’s works to study language and culture. The interdisciplinary nature of the works results in the use of various research methods and theoretical frameworks. Therefore, the main goal of this essay is to sketch the history and evolution of the study of language and culture in the communication discipline in the United States.
Due to space constraints only select works, particularly those that are considered landmarks in the field, are highlighted here. The fundamentals of language and the development of the Sapir–Whorf hypothesis in leading to the formation of the language and social interaction (LSI) discipline are briefly described. The main areas of LSI study—namely language pragmatics, conversation analysis, discourse analysis, and the ethnography of communication—are summarized. Particular attention is paid to several influential theories and analytical frameworks: the speech act theory, Grice’s maxims of implicatures, politeness theory, discursive psychology, critical discourse analysis, the ethnography of speaking, speech codes theory, and cultural discourse analysis. Criticisms and debates about the trends and directions of the scholarship are also examined.
Maricel G. Santos, Holly E. Jacobson, and Suzanne Manneh
For many decades, the field of risk messaging design, situated within a broader sphere of public health communication efforts, has endeavored to improve its response to the needs of U.S. immigrant and refugee populations who are not proficient speakers of English, often referred to as limited English proficient (LEP) populations. Research and intervention work in this area has sought to align risk messaging design models and strategies with the needs of linguistically diverse patient populations, in an effort to improve patient comprehension of health messages, promote informed decision-making, and ensure patient safety. As the public health field has shifted from person-centered approaches to systems-centered thinking in public health outreach and communication, the focus in risk messaging design, in turn, has moved from a focus on the effects of individual patient misunderstanding and individual patient error on health outcomes, to structural and institutional barriers that contribute to breakdown in communication between patients and healthcare providers.
While the impact of limited proficiency in English has been widely documented in multiple spheres of risk messaging communication research, the processes by which members of immigrant and refugee communities actually come to understand sources of risk and act on risk messaging information remain poorly researched and understood. Advances in risk messaging efforts are constrained by outdated views of language and communication in healthcare contexts: well-established lines of thinking in sociolinguistics and language education provide the basis for critical reflection on enduring biases in public health about languages other than English and the people who speak them. By drawing on important findings about language ideologies and language learning, an alternative approach would be to cultivate a deeper appreciation for the linguistic diversity already shaping our everyday lives and the competing views on this diversity that constrain our risk messaging efforts.
The discourse surrounding the relationship between LEP and risk messaging often omits a critical examination of the deficit-based narrative that tends to infuse many risk messaging design efforts in the United States. Sociolinguists and language education specialists have documented the enduring struggle against a monolingual bias in U.S. education and healthcare policy that often privileges proficiency in English, and systematically impedes and discriminates against emerging bilingualism and multilingualism. The English-only bias tends to preclude the possibility that risk messaging comprehension for many immigrant and refugee communities may represent a multilingual capacity, as patients make use of multiple linguistic and cultural resources to make sense of healthcare messages. Research in sociolinguistics and immigration studies have established that movement across languages and cultures—a translingual, transcultural competence—is a normative component of the immigrant acculturation process, but these research findings have yet to be fully integrated into risk messaging theory and design efforts. Ultimately, critical examination of the role of language and linguistic identity (not merely a focus on proficiency in English) in risk messaging design should provide a richer, more nuanced picture of the ways that patients engage with health promotion initiatives, at diverse levels of English competence.
Julie E. Volkman
In health and risk communication, evidence is a message feature that can add credibility, realism, and legitimacy to health and risk messages. Evidence is usually defined into two types: statistical or narrative. Statistical evidence employs quantifications of events, places, phenomena, or other facts, while narrative evidence involves stories, anecdotes, cases, or testimonials. While many health and risk messages employ statistical or factual information, narrative evidence holds appeal for health and risk communication for its utility in helping individuals learn their risks and illnesses through stories and personal experiences. In particular, narratives employed as evidence in a health or risk message especially hold value for their ability to communicate experiences and share knowledge, attitudes, beliefs, and ideas about complex health issues, propose behavior change, and assist individuals coping with disease. As a result, the personal experiences shared, whether they are from first-hand knowledge, or recounting another’s experience, can focus attention, enhance comprehension for risks, and recall of health and risk information. Furthermore, readers engage with the story and develop their own emotional responses which may align with the purpose of the health and risk message. Narratives, or stories, can occur in many ways or through various points of view, but the stories that “ring true” to readers often have a sense of temporality, coherence, and fidelity. As a result, formative research and pre-testing of health and risk messages with narratives becomes important to understand individual perceptions related to the health issue and the characters (or points of view). Constructs of perceived similarity, interest, identification, transportation, and engagement are helpful to assess in order to maximize the usefulness and persuasiveness of narratives as evidence within a health and risk message. Additionally, understanding the emotional responses to narratives can also contribute to perceptions of imagery and vividness that can make the narrative appealing to readers. Examining what is a narrative as evidence in health and risk messages, how they are conceptualized and operationalized and used in health and risk messages is needed to understand their effectiveness.
Nathan A. Crick
Poststructuralism represents a set of attitudes and a style of critique that developed in critical response to the growth and identification of the logic of structural relations that underlie social institutions—whether they exist in terms of politics, economics, education, medicine, literature, or the sciences. Poststructuralism should therefore not be thought of as a distinct philosophy that exists separately as its own “structure”—a proposition that would undermine its most fundamental attitudes. Rather, poststructuralism should be thought of as developing or arising only in response to pre-existing structures and, as a set of attitudes, helping us better understand, interpret, and alter our social environment by calling established meanings into question, revealing the points of ambiguity and indeterminacy inherent in any system, rejecting the rationalistic piety that all systems are internally coherent and circle around an unchanging center, showing how discourses are carriers of power capable of turning us into subjects, and placing upon us the burden of ethical responsibility that accompanies the acceptance of freedom.
Although poststructuralism by its very nature as a set of attitudes denies any attempt at comprehensive definition, this essay examines three of the major postructuralist thinkers in order to relate their thought to the study of communication. First, following Derrida, poststructuralist thought invites a critical deconstruction of any discourse that presents itself as completely coherent, centered, and rational. Poststructuralist approaches thus do not argue against a position by harnessing counterarguments drawing on a different set of principles. Rather, it deconstructs a discourse by occupying it and exposing the gaps, contradictions, paradoxes, and deferments, thus revealing its established hierarchies, binaries, logical conclusions, and principles to be far more loosely structured and poly-vocal than its advocates wish to present them. Second, following Barthes, poststructuralism refuses to locate any single point of origin of any text that can ground its meaning—particularly by pointing to some ground of the author. Although not denying that writers exist, Barthes refuses to identify the meaning of a text with the author’s biography and intentions, instead inviting multiple interpretations from the perspective of individual readers who encounter the text as a unique event. Therefore, just as discourses do not have a unified structure, neither do individual texts or the authors that produce them. Lastly, following Fouacult, poststructuralism invites an inquiry into how discourses, texts, and acts of communication are always implicated in relations of power that act upon possible actions. Following the first two propositions, poststructuralism does not analyze these relations of power as completely structured and determinate, however. Power relations are always within a dynamic relationship with acts of resistance, thereby constantly leaving space for freedom and possibility.
Nathan A. Crick
When John Dewey announced that communication was the most wonderful of all affairs, he recognized the centrality of communication within the tradition of American pragmatism. In other traditions of philosophy, such as idealism or empiricism, communication certainly played a role, but usually it was a secondary function of transmitting ideas from one mind to another. In idealism, ideas were discovered through intuitive revelation of the whole and only later expressed through transcendent eloquence, whereas in empiricism, particular data was attained purely by the senses and communication served a kind of documentary function of fact gathering. Pragmatism, however, inverted this traditional hierarchy. By arguing that the meaning of our ideas was only found in their effects and consequences in experience, particularly those consequences brought about through shared experience, pragmatists made communication both the origin and consummation of knowledge—regardless if that knowledge was practical, scientific, aesthetic, or social. Consequently, pragmatists believed that improving the quality of communication practices was central to improving not only the state of knowledge but the quality of our experience living together in a common world.
Janet B. Ruscher
Prejudiced attitudes and stereotypic beliefs about outgroups can be reflected in language and everyday conversations. Explicit attitudes and beliefs may be expressed through use of group labels, dehumanizing metaphors, or prejudiced humor. More implicit attitudes and beliefs may be leaked through variations in sentence structure and subtle word choices. Empirical work shows that such prejudiced attitudes and stereotypic beliefs can spread within ingroup communities through one-on-one conversation as well as more broadly through vehicles such as news, the entertainment industry, and social media. Individuals also convey their prejudiced beliefs when communicating to outgroup members as message recipients. Outgroups who are members of historically disadvantaged groups, in particular, are targets of controlling or patronizing speech, biased feedback, and nonverbal behavior that leaks bias.
Mikaela L. Marlow
Discourse analysis is focused on the implicit meanings found in public discourse, text, and media. In the modern era, public discourse can be assessed in political or social debates, newspapers, magazines, television, film, radio, music, and web-mediated forums (Facebook, Twitter, and other public discussion). Research across a variety of disciplines has documented that dominant social groups tend to employ certain discursive strategies when discussing minority groups. Public discourse is often structured in ways that marginalize minority groups and legitimize beliefs, values, and ideologies of more dominant groups. These discursive strategies include appealing to authority, categorization, comparison, consensus, counterfactual, disclaimers, euphemism, evidence, examples, generalizations, rhetorical questions, metaphors, national glorification, and directive speech acts. Evoking such discourse often enables prevailing dominant groups to reify majority social status, reinforce negative assumptions about minorities, and maintain a positive public social image, despite deprecating and, sometimes, dehumanizing references.
Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen
Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials.
In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.