Moral framing in health promotion: lessons from an Indonesian case study.

Abstract

In this article we illuminate the important, yet typically underreported, role played by moral framing in public health messaging. We present case studies from West Java, Indonesia to demonstrate how moral framing is used to motivate health volunteers and to promote behavior change in line with government health policies. We used qualitative research including participant observation, job shadowing, interviews and focus groups with health promotion workers and community members. Findings were analyzed using thematic and discourse analysis. We identified three moral frameworks typically used to encourage shifts in normative health practices in Indonesia: Islamic values, right to health, and evidence-based public health policy, represented as indicative of modernity. Health workers tailor these moral frameworks to audiences in their health promotion work. While the immediate goal is to meet health performance targets, the broader goal is to generate forms of health citizenship commensurate with Indonesia's political environment of democratic decentralization. COVID-19 presents an opportune moment for the public health community to reevaluate the power of moral framing in health messaging, and how it can be used both as a compelling means of establishing community norms toward the common good, as seen in our Indonesia case study, and also as a mechanism used by counterpublics to challenge these norms and appeal to alternative values and versions of reality.