Critical Health Communication Research Articles

Predictors for psychosocial consequences of screening for liver diseases in Germany: a LASSO approach

Abstract Background Medical screening is extensively used across various disciplines for early disease detection and prevention of severe progression aiming to reduce disease-specific burden, improve quality of life and promote health. However, screening is debated due to unclear evidence of its overall benefits from a public health perspective. Screening is associated with improved health behavior and cost-effectiveness. However, studies identified adverse effects of screening like psychosocial burden. Most results originate from cancer screening and it is unclear whether they are transferable to other contexts. Within a research program, a systematic screening procedure to detect patients with liver cirrhosis at early stage in an asymptomatic general population was evaluated. In this study, we aimed to identify patient characteristics that predict and explain variance in psychosocial outcomes of screened patients. Methods This study analyzed data from 523 participants who underwent a systematic liver disease screening in Germany from Jan 2018 to Feb 2021. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on the outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ). The constructs measured by the PCQ are social, physical and emotional dysfunction associated with screening. Results We identified lower severity of comorbidities, higher subjective social status, stronger social support, older age, better critical health communication skills and higher health literacy as relevant predictors of lower psychosocial dysfunction, indicating their protective role in preventing psychosocial burden of screening. Conclusions From a public health perspective, medical screening offers should take into account patients’ individual context regarding their subjective social status, health impairments, personal social networks and health literacy skills to reduce post-screening psychosocial burden. Key messages • Social support, age, health literacy and higher subjective social status were positively associated with lower psychosocial consequences of liver screening. • The findings indicate that liver screening should be carried out, taking into account the individual’s situation and resources available.

(Re)making Scales: Communicative enfranchisement in Women’s Narrative Discourses About Health Dismissal

ABSTRACT Dismissal of women’s health concerns is a discursive phenomenon with social and material consequences. A burgeoning literature documents how women experience dismissal through various forms of disenfranchising talk. Yet, women are not only subjected to disenfranchising talk; they are called to respond to it. Meaning, analyses of disenfranchisement should also examine efforts toward enfranchisement. One process by which scholars can study communicative (dis)enfranchisement is through people’s scalar activity, or how they contextualize experiences at different levels of social reality. Studies of scale demonstrate that the language people use to narrate their personal experiences has meaning for how they position themselves in relation to other social actors, as well as how they make statements about what matters, how much, and to whom. Drawing on 36 interviews with women whose health issues have been dismissed, we apply scale as a theoretical lens and methodological tool to study how women use language in particular, meaningful, and patterned ways in narratives about health dismissal. Our findings suggest that women’s narrative discourse is enfranchising in so much as women critique, resist, and transform the contexts of their dismissal. We document how they and others scale “realness” and “normality” across narrated and narrating events. We also note how women scale up from their own experiences to women’s experiences writ large, asserting truth claims about issues borne of the broader U.S. healthcare system. Findings have implications for how critical health communication researchers study how women’s health issues are constructed in talk.

“It comes in waves”: A relational dialectics approach to exploring living grief in U.S. emerging adults with invisible illness

Experiencing the onset of (invisible) chronic illness in emerging adulthood prompts a unique grieving process that is disenfranchised due to social discourses that sanction grief to death-related loss. Guided by relational dialectics theory, the present study analyzes the retrospective narratives of 57 emerging adults with acquired invisible illness (e.g., chronic overlapping pain conditions, autoimmune disease) about their meanings of grief. We interrogate competing discourses of grief to illustrate how participants make meaning of invisible, chronic illness and its resulting losses. Contrapuntal analysis led to the identification of a dominant Discourse of Grief as a Tsunami (DGAT) and marginalized Discourse of Grief as Waves (DGAW). The interplay of these discourses constructed meaning through dialogically contractive practices, synchronic interplay, and dialogic transformation. We offer implications for critical interpersonal and health communication theorizing and practical applications for individuals wading through the unique grief of chronic illness. Limitations and future directions are discussed.

Recapturing Communicative Erasure: Black Women Farmers’ Lived Experience, Political Voice and Cultural Knowledge as Critical Health Communication Praxis

ABSTRACT In this paper, we conduct a case study analysis of the National Women in Agriculture Association (NWIAA), an international, Black women-led farm assistance organization founded in 2008 and based in Oklahoma City, Oklahoma. Drawing on the Culture-Centered Approach (CCA) and grounded in interviews and observational fieldwork, we center the perspectives of NWIAA chapter leaders (n = 16) to examine how they describe motivations for farming, challenge power inequities, engage with intersectional barriers, and develop locally situated solutions across agricultural and community health contexts. The analysis argues that Black women farmer’s historical lived experiences, political voice, and shared deep-rooted agricultural knowledge provide an innovative and emancipatory praxis for rethinking health communication intervention approaches that address food system-generated disparities. This study contributes important takeaways for health communication practitioners, policymakers, and advocates addressing food inequities. It extends the CCA as a first step in developing community-driven, context-specific food insecurity health communication interventions within marginalized communities across the United States and beyond.

Body politics, reproductive rights, and digital media advocacy within stigmatized contexts: a critical discourse analysis of Weibo discussions on IUDs in modern-day China

ABSTRACT This article explores prevalent beliefs surrounding the use of IUDs among Chinese women and how such discourses intersect with issues of gender, culture, and politics. Incorporating a critical health communication perspective and the framework of body politics, we conducted a critical discourse analysis of 420 Weibo posts discussing IUDs. We investigated the nuanced ways in which Chinese women reflect upon, resist, and redefine prevailing stigmatizing narratives regarding women’s reproductive health and contraception, which often overshadow discussions on medical risks and women’s autonomy in fertility choices. The analysis reveals that contemporary women’s online discourses resist traditional gender roles and historical glorification of one-child families by empathizing with their mothers and reconstructing the collective memory of China’s family planning era. Simultaneously, their narratives reinforce the national policy of promoting childbirth and patriarchal discipline by highlighting proactive IUD removal to enable pregnancy and fostering competition among women, without interrogating the underlying structural issues.

A Dialogue on Un/Precendented Pandemic Rhetorics

Inspired by conversations at the 2021 Rhetoric Society of America Institute workshop on Pandemic Rhetoric(s), this dialogue assembles graduate student, early-, mid-career, and established rhetoric of health and medicine (RHM) and critical health communication scholars to discuss a keyword that has structured political, social, and biomedical thinking about COVID-19: un/precedented. In identifying un/precedented as an organizing temporal rhetoric for the pandemic, we interrogate how recurrent appeals to the pandemic’s novelty both allow for and limit our capacities to meet the pandemic’s tremendous exigencies head-on. Leveraging our unique scholarly and community commitments, we theorize how un/precedentedness 1) becomes complicit in government inaction, 2) (re)asserts conceptual and literal borders, 3) justifies state and national public health mandates, and 4) obscures other historical and contemporary pandemics. We conclude by offering possibilities for interdisciplinary and longitudinal research into the far-reaching effects of contagious disease.

Defining health through a critical materialist political economy lens.

It has been recognized since antiquity that the organization of society and how it distributes resources are the primary determinants of health. Yet most definitions of health in the academic and practice literatures limit their focus to the individual's experience of health and functional abilities, neglecting the structures and processes of societies in which the individual is embedded. We draw upon developments in the critical health communication and critical materialist political economy of health literatures to provide a definition of health that directs attention to the role that economic and political systems play in either equitably or inequitably distributing the resources necessary for health. Since these distributions interact with the individual's unique biological and psychological dispositions and situations to produce health, it is important to identify their sources and means of making their distributions more equitable. Because it is through communication that humans interpret society, themselves, and others, a concise definition of health that draws attention to these societal features and their roles on a day-to-day basis in promoting or threatening health is essential.

Representing cervical cancer in a government social media health campaign in China: moralizing and abstracting women’s sexual health

This article analyses an award-winning film produced as part of the Chinese government’s ‘Healthy China Initiative’ to increase awareness of cervical cancer among young women. The film was designed to be social media friendly, using a more accessible popular style, and it achieved over 350 million views on Chinese social media. The aim had been to shift away from a tradition of more formal, authoritative public information content. Using multimodal critical discourse analysis in the broader tradition of critical health communication studies, the findings support other critics of Chinese public health information in relation to women’s reproductive health. Despite the accessible style, the authors find a highly conservative ideology of womanhood, where the actual nature of cervical cancer, caused by the very common Human Papillomavirus, is obscured in a highly moralized message about sexual abstinence. The film also represents a view of Chinese health services that glosses the difficulty of access for many, as well as public concerns about corruption and clientelism.

Testing the effectiveness of narrative messages using critical health communication

ABSTRACT Background: Latinos suffer from health disparities associated with excessive consumption of sugar-sweetened beverages. This study aimed to test the effectiveness of messaging using critical health communication approaches and delivered by two narrative modalities (video and comic book) with similar content that aims to empower Latinos to advocate for social change and to make individual behavior change related to sugary beverage consumption. Methods: Participants (N = 129 Mexican American women between 18 and 29 years) completed an online survey before and after exposure to an embedded stimulus. Participants were randomly assigned to a stimulus, a narrative message in video or comic book format, both developed using critical health communication approaches that focused on individual harms and social causes of sugary beverage consumption. Results: Paired sample t-test results showed that both narrative messages increased intentions to reduce sugary beverage consumption (Video: P < 0.01; d = 0.43; Comic: P = 0.03; d = 0.28). Both groups also demonstrated significant improvements in sugary beverage-related media literacy (Video: P = 0.01, d = 0.34; Comic: P = 0.05, d = 0.25), public health literacy (Video: P = 0.05, d = 0.24; Comic: P = 0.01, d = 0.32), and empowerment to engage in sugary beverage-related community movements (Video: P = 0.003, d = 0.38; Comic: P = 0.034, d = 0.27). Conclusions: This study provides initial evidence indicating the effectiveness of narrative messages in two modalities using critical health communication for promoting individual behavioral intention and social activation in reducing sugary beverage consumption.

Speech acts in appeals for social distancing and public compliance intentions during the Covid-19 pandemic in Indonesia

Government-issued communication messages are critical in resolving health problems such as the COVID-19 pandemic. The decision of linguistic speech acts also influences the behavior of obedient and disciplined individuals. Gender, age, and race are all predictors of social distancing compliance (Pedersen Favero, 2020). However, no studies have been published examining the form of speech acts that can control public conduct in accordance with social distancing on each of these social variables. Thus, this study examined the intention of public compliance through the pragmatic interpretation of the government’s appeal for social distancing. The present study was conducted with a cross-sectional design survey involving 1339 respondents through online data collection. The findings of this study reveal that different speech acts have varying effects on people’s intentions to follow the health protocol appeal. This study makes a theoretical contribution by demonstrating that gender, age, and education level influence the perlocutionary style of speech actions in critical health communication. These findings will aid the government in developing effective messages on health risk reduction behavior through the selection of appropriate speech acts.

“Male-supported, female-initiated”

HIV and AIDS remain one of the leading public health challenges in the world, with young women in sub-Saharan Africa bearing the brunt of HIV infection. Female vulnerability to HIV infection is exacerbated by socio-cultural, economic and biological dynamics. Vaginal microbicide, one of the first topical pre-exposure prophylaxis (PrEP) innovations for HIV prevention can offer new hope for women, but an understanding of the local cultural context and its influence on product acceptability is fundamental for effective HIV communication strategies. Critical health communication navigates through the complexities of cultural discourses to create awareness among women in dominant cultural settings. As a means of understanding the key determinants for effective HIV communication, this paper used thematic analysis of data from a study among female students at the University of KwaZulu-Natal regarding their preferences and the acceptability of two microbicide technologies: the tenofovir gel and the dapivirine ring. Keyfindings indicate that microbicides give women more options for self-protection and cater for diverse sexual encounters, and that their covert use empowers women to use the products even if male partners do not support this. However, women felt more empowered with “male-supported, female-initiated” HIV prevention options. The study suggests that in providing HIV preventionoptions to women, culturally appropriate messages must be considered. We suggested that topical PrEP must be communicated as a “male-supported, female-initiated” HIV prevention option in rural KwaZulu-Natal contexts.

Sharing Black trauma as COVID-19 crisis communication tactic: assessing communications from a regional hospital system in Albany, Georgia

ABSTRACT Background The predominantly Black city of Albany, Georgia, and its metropolitan region, was hard hit during the first wave of COVID-19. In the midst of the wave, the local hospital produced a video of a Black man dying from COVID-19 as a part of its crisis communication strategy. The purpose of this study is to critically interrogate a crisis communications tactic used by one healthcare delivery system during the COVID-19 pandemic. Methods We conducted a quantitative content analysis of the reception of the video, measured through comments, and did a critical-cultural qualitative review of the video through a critical health communication lens. Results The majority of comments (81.7%, n = 67) were categorized as affective coping (emotional support or emotional venting). The remaining minority of comments fell into the remaining categories (cognitive coping and conative coping). Almost half of affective coping strategy comments (49%, n = 46) were sub-categorized as emotional support, while 51% (n = 48) of affective coping strategy comments were sub-categorized as emotion venting. Conclusion As healthcare and public health institutions begin to reckon with the impact of racism in our own field, important implications exist for crisis communication practices within these institutions. We offer alternative strategies for culturally safe crisis response practices for healthcare institutions.

From Dominant Perspective to Critical Perspective in Health Communication: Analysis of Turkish Television Health Programs in terms of Critical Health Communication

Health communication, which has become a discipline since the mid-twentieth century, has become more crucial especially with the complexness of healthcare applications and health information practices. This has led to an increase in the number of researches and academic studies in the field of health communication and, also different approaches emerged regarding this debate. In order to improve the health of the individual and society, the theories used in the field of health communication are generally limited to individual information and behavior change models. Both the health behavior models, and health communication theory/models used are socio-psychological based approaches. Therefore, the methods used are individually focused. As a result, communication is typically understood as health information transfer and perception. After the changing economic-political approach and public broadcasting replaced by private broadcasting in the 1980s, it’s observed that the health communication practices on television started to show an approach towards the consumption of health services and products. This view mentioned above was called ‘dominant health communication’ in the 1990s and a new approach of the field emerged. Critical approach discusses that health is a social phenomenon and that all responsibility cannot be given to the individual. In this case, outside the individual factors such as economy, politics, culture, environment, education gender and even geography are important in the development and outcomes of health. In this study, it will be discussed that the ongoing health communication practices, which is termed dominant health communication, do not provide a solution to the existing health inequality in the society, on the contrary, they provide the reproduction and dissemination of the ideologies of the sovereign powers and a consent for the consumption of health products and services in the society. Therefore, in this study, health programs on mainstream television channels in Turkey will be analyzed in terms of critical health communication. Critical discourse analysis will be used as the main method of the study. Keywords: critical health communication, dominant health communication, critical discourse analysis, Turkish television health programs

Editorial: Doing Critical Health Communication: A Forum on Methods

Editorial: Doing Critical Health Communication: A Forum on Methods

Advancing Visual Health Communication Research to Improve Infodemic Response

ABSTRACT During public health crises like the ongoing novel coronavirus pandemic, there is a need to amplify and improve critical health communication messages. This need is due to pandemics producing infodemic conditions, meaning the public information environment is oversaturated with information of questionable accuracy and utility. The strategic use of visuals can be leveraged to improve the quality of health communication during public health crises and lessen the unintended effects of infodemic conditions. In this essay, we review previous visual communication theorizing and research that provide insights for effective and efficient use of graphical (e.g., data visualizations) and illustrative (e.g., photos, illustrations, and content features) visuals. We also discuss and advocate for more systematic research on visual misinformation and visual narratives, as there are significant gaps in the literature about how people interpret, act on, and engage with these visual content types. More systematic research about these areas of visual health communication research will improve public communication during future public health crises.

How to Have (Critical) Method in a Pandemic: Outlining a Culture-Centered Approach to Health Discourse Analysis

In this elucidative essay, we offer a broad outline of the culture-centered approach health discourse analysis as a warrant for the relevance of critical health communication amid the global COVID-19 pandemic. While there is a proliferation of methods and approaches health discourse analysis, we outline one broad approach, based on the theoretical tenets and political commitments of CCA. In particular, we emphasize (a) the heuristic value of the CCA's primary and theoretical components-the matrix of culture, structure, and agency, and (b) the importance of exploring discursive erasure as two central principles that guide analysis within this framework. Given the range and scale of existing and likely future transformations in social, political, and cultural understandings of health in the wake of the global COVID-19 pandemic, we offer, through this how to essay, a rationale for the continued relevance of critical health communication.

A Critical Reflexive Account From Participatory Theater With Asylum Seekers: Lessons for Framing Trauma and Resilience in Refugee Status Determination

Critical Health Communication scholars can play a significant role in the asylum seeking process by expanding the legal understanding of migrant trauma. Legal processes like Refugee Status Determination (RSD) define the course of an asylum seeker’s life. Legal determinations hinge on the persuasiveness of narratives of persecution to decide on the legitimacy of asylum claims. Participatory methods, such as participatory theatre, either support or resist legal processes by drawing on narratives of trauma or community engagement, respectively. Methods that rely on trauma narratives validate notions of individual suffering, while methods that use community engagement address the social and communal dimensions of health, including isolation. This essay develops a critical, reflexive account of my situated practices as a theatre practitioner working with asylum seekers, and later, as a character reference for my participants’ legal claim. I show how participatory projects focusing exclusively on promoting migrant resilience through participation can fail to engage with the power that RSD has to determine the course of migrant lives. Importantly, the legal framework of RSD frames an asylum seeker’s every move through the lens of persecution and trauma. As my critical reflections demonstrate, participatory practitioners working with asylum seekers must be aware of how the goals of their engagement may interact with the limitations of the legal process. Such awareness demands strategic forms of engagement aimed at shaping the legal understanding of migrant trauma and persecution.

Navigating Publishing Critical Health Communication Research

Publishing critical health communication scholarship comes with challenges. In reflecting on my own experiences, I discuss the ways in which health communication is designed to favor post-positivistic research. Through looking at reviewer comments and general academic conversations, I discuss the barriers critical health communication scholars face. In the end, I provide suggestions for ways that critical health communication scholars can move forward as leaders in our subfield.

The Fixed Childfree Subjectivity: Performing Meta-Facework about Sterilization on Reddit

ABSTRACT Although sterilization is the most common and effective form of birth control available, childfree individuals often report difficulty actually obtaining the procedure. The ideological and material constraints that impede access have been well documented, including physicians’ pronatalist perceptions that childless women will regret sterilization when they mature or meet the right partner. However, researchers have demonstrated that childfree women experience low levels of regret after sterilization, indicating that physicians’ reluctance is empirically unfounded. In order to mitigate physicians’ hesitancy, childfree individuals organize and communicate online in order to share health-related information, seek support, and engage in identity work to more effectively procure the procedure. The current study contributes to critical health, interpersonal, and family communication conversations by employing performative face theory to study online interactions on the childfree subreddit, the largest and most active online forum dedicated to child freedom. Through critical-qualitative analysis of a cross-section of subreddit posts about sterilization, this study demonstrates how subreddit discourse draws upon ideological and metaphorical associations to articulate the fixed childfree subjectivity, which rejects negative significations of regret in favor of positive notions of repair and permanence. Users further engage in subversive meta-facework, or facework presented online about facework users engaged in offline, which maintains shared face and denaturalizes taken-for-granted linkages between gender, identity, and parenthood. Implications for health activism across individual, relational, communal, and cultural levels are discussed.

A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed?

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as “dangerous,” “a matter of lifestyle,” “a unique story and experience,” and “socially situated.” We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.