Critical Health Communication Research Articles

Embodied Methods in Critical Health Communication

At the center of questions posed about power are issues of embodiment—which bodies are judged to be healthy and which are not, which identities are affirmed or privileged and which are stigmatizes or marginalized, which material practices are pathologized and which are lauded. Critical health communication research may be enacted by critical-interpretive researchers who employ critical theorizing frameworks that guide their questions posed, co-construction of data, and forms of analysis and representation.

Critical Health Communication Method as Embodied Practice of Resistance: Culturally Centering Structural Transformation Through Struggle for Voice

The Marxist roots of critical methodology envision method as anchor to an emancipatory politics that seeks structural transformation. Drawing on our negotiations of carrying out culture-centered health communication projects amidst neoliberal authoritarianism, we explore the nature of academic-activist-community collaborations in envisioning democratic infrastructures for socialist organizing of health. Method is thus inverted from the hegemonic structures of Whiteness that construct extractive relationships perpetuating existing and entrenched health inequities to partnerships of solidarity with subaltern communities committed to a politics of “placing the body on the line.” We work through the concept of “placing the body on the line” to depict the ways in which the body of the academic, turned vulnerable and weaponized in active resistance to neocolonial/capitalist structures, disrupts the hegemonic logics of power and control that shape health within these structures. Examples of culture-centered projects at the global margins offer conceptual bases for theorizing embodied practice as resistance to state-market structures that produce health injustices. The body of the academic as a methodological site decolonizes the capitalist framework of knowledge production through its voicing of an openly resistive politics that stands in defiance to the neoliberal structures that produce health inequities. We challenge the communication literature on micro-practices of resistance, interrogating concepts such as “strategic ambiguity,” “pragmatic interventionism” and “practical engagement” to offer method as embodied practice of open/public resistance, as direct antagonism to state-market structures. Through the re-working of method as embodied resistance that is explicitly socialist in its commitment to imagining health, culture-centered interventions imagine and practice Marxist advocacy and activist interventions that disrupt the intertwined hegemonic logics of capital and empire.

Health Communication and Citizenship Among Sex Workers in Mysore, India: Beyond “Centers” and “Margins”

In the last couple of decades, there has been a significant turn towards critical and “culture-centered” approaches to health communication. Through the lens of critical ethnography, this paper aims to unsettle dominant Eurocentric and exclusionary notions of citizenship tied to a legislative and juridical framework of rights--as entitlements and obligations emanating from the “nation-state”. Instead, by focusing on the communicative practices of members of Ashodaya Samithi, a sex worker collective responding to local forms of discrimination and violence and susceptibility to the HIV infection, we disrupt dichotomous notions of political “centers” and “margins” by emphasizing how local forms of resistance and transnational alliance-building constitute complex socialities that enable sex workers to navigate risks, demand services, expand their rights and freedoms, while fulfilling individual and collective responsibilities. We argue that, in the “developing” world, emergent forms of citizenship are more likely to be found not in some concentrated center of cultural authority like the nation-state, or its ancillaries, but in more dispersed sites where postcolonial struggles may appear as uncivil, coarse, insurgent, impure, ambiguous, marginal, and thus threatening to more purified, populist portraits of nationhood redrawn by politicians and health officials. This paper highlights alternative voices often blocked by the dominant discourse, thereby potentially re-centring health communication in marginalized spaces. By juxtaposing field data and theory, this paper also aims to demonstrate how to engage in Critical Health Communication research with rigor and quality.

Problematizations in Assisted Dying Discourse: Testing the “What's the Problem Represented to Be?” (WPR) Method for Critical Health Communication Research

In this paper I test the methodological potential of a set of six questions, called the ‘What’s the Problem Represented to be?,’ or WPR approach, borrowed from the field of discursive policy analysis (Bacchi 2012) for doing critical health communication (CHC) research. WPR is generative for critical health researchers because it shares the goal of challenging implicit and explicit causality and correlation within discourse. I apply these questions to examine the case of legalized medical assistance in dying (MAiD) in Canada, arguing that their simplicity and capaciousness facilitate critical responses to care disparities. This particular case is edifying for CHC researchers, because ideals of good living, ‘dignified’ death, and the role of medicine are all crystallized within legal, media, and medical discourse on assisted dying. Debating what death can or should look like depends on a clearer understanding of how the logics of embodied difference (especially ability, race, and gender) are always already stacking the odds against equal political participation in, and access to health. The WPR approach flips the ‘proper objects’ of health-centered critical research, beginning by scrutinizing proposed solutions in order to rethink the problems implicit therein. Asking such questions as “How has this representation of the ‘problem’ come about?”, “What effects are produced by this representation of the ‘problem’?” and “How has it been (or could it be) questioned, disrupted and replaced?” productively situates the researcher between the discursive practices governing health and health care praxis itself. Ultimately, I argue that the WPR method encapsulates some of the best critical perspectives from the corpus of CHC research praxis, making it a helpful tool for advancing health communication research.

Doing Critical Health Communication: Negotiating the Terrain of Transdisciplinary Collaboration

In this article, we think about how critical health communication scholars can speak to audiences outside the discipline in order to make an impact on public health and policy, health promotion, and health care delivery. We take into consideration how are we situated in our relationship with transdisciplinary research as well as the challenges and opportunities involved in collaborating with transdisciplinary teams including the ways we can navigate the inherent method/ological tensions in such collaborations. We focus on how the methodological considerations of “critical” health scholarship are situated vis-a-vis the epistemic status quo commitments in the disciplines of our potential allies.

Constructing the (Healthy) Neoliberal Citizen: Using the Walkthrough Method “Do” Critical Health Communication Research

Introduction. Since the launch of Web 2.0, we have witnessed a trend towards digitizing healthcare tools for use by both patients and providers. Clinical trials focus on the ways that digital health technologies result in better outcomes for patients, increase access to healthcare and reduce costs. Critical approaches which explore how these technologies result in changes in patient embodiment, power relations and the patient-provider relationship are badly needed. Objective. To provide an instruction case example of how Light, Burgess and Duguay’s (2018) walkthrough method can be mobilized to study apps to address critical health communication (CHC) research questions. Methods. We apply the walkthrough method to the BEACON Rx Platform. In doing, we conduct a detailed technical walkthrough and evaluate the environment of expected use to answer the following questions: How does the platform shape (and how is it shaped by) understandings of what it means to be healthy? Who are its ideal users? How does this impact its environment of expected use? Conclusions. This paper demonstrates the potential contributions of the walkthrough method to critical health communication research, namely how it enables a detailed consideration of how an app’s technical architecture and environment of expected use are embedded with symbolic representations on what it means to be healthy and what practices should be engaged in to maintain “good” health. It also demonstrated that, despite the rhetoric that digital health technologies democratize healthcare, the BEACON Rx platform is a risk monitoring tool by its very design.

Critical Health Communication Methods: Challenges in Researching Transformative Social Change

This reflexive essay describes how methodological choices involved with critical commitments to understanding the economic and political roots of health status lead to challenges in the field that intersect with the politics of academic training, visibility, and publishing. Through the lens of my own research experiences, I discuss lessons learned as well as ways that I continue to struggle. I consider issues that are primarily personal and those that we should address as a field. In the essay, I describe six observations from my experiences researching transformative social change that have implications for critical health communication scholars and the discipline of health communication.

Critical Health Communication Methods at the U.S.-Mexico Border: Violence Against Migrant Women and the Role of Health Activism

This essay re/envisions what critical health communication methods look like on the U.S.-Mexico border in reproductive justice contexts. For example, traditional health communication theories and methods have privileged objectivity, generalizability, and the creation of critically important health communication patterns and concepts that have guided the development, deployment, and execution of health communication programs and cultural competence programs. However, in this article, we discuss the utility and application of an intersectional/critical health communication reproductive justice method and envision its praxis in contexts like the U.S.-Mexico border. As two Chicana feminist reproductive justice/health communication scholars, our own research on reproductive feminicides throughout the U.S. and Latin America has necessitated the blending of a variety of theoretical and methodological approaches--border theories, intersectionality, Chicana feminisms, and health communication theories and methods. Thus, this essay traces the blending of these theories and methods and discusses how critical intersectional feminist health communication methods can be utilized in activist ways to resist reproductive and gendered violence at the U.S.-Mexico border.

Examining Assumptions in Science-Based Policy: Critical Health Communication, Stasis Theory, and Public Health Nutrition Guidance

Recent work in rhetoric of science, technology, health, and medicine argues for a shift away from critique, even as some health communication scholars call for critical engagement with the situated, ideological nature of scientific claims supporting public health messages. We suggest that critique of scientific claims remains important to rhetoricians of health and medicine, but that such critique must go further in examining interactions between science, values, and public health policy. We offer an adapted version of stasis theory as a framework for pursuing this end. Using the U.S. public health nutrition policy Dietary Guidelines for Americans as a case study, we engage this framework to explore how science-based nutrition policy provides a discursive lens that influences how subsequent scientific evidence is produced, interpreted, and employed.

Indigenous Health Organizing at the Margins: Creating Access to Health by Building Health Infrastructure

ABSTRACT Socio-economic challenges, communicative barriers, and the lack of health infrastructure constitute and reinforce obstacles to health for all, especially for those who live in the underserved spaces of the Global South. This research addresses such contextual adversities by investigating how indigenous people in a remote Himalayan village collectively took ownership of a health-organizing initiative. The result of this initiative was the creation of a four bed mini-hospital designed to increase community members’ access to basic curative and preventative health care. Grounded in praxis-based critical health communication approaches, this research challenges top-down and externally-dictated interventions by placing subalterns at the forefront of a bottom-up and community-led health initiative. The centrality of discursive engagements and local-centric participatory actions of marginalized indigenous participants in this research calls for culture- and communication-centric research initiatives for increasing access to health at the margins.

Health Communication in the Time of Ebola: A Culture-Centered Interrogation

This brief essay is a commentary on how critical health communication theory can contribute to an understanding of the cultural dynamics of infectious disease pandemics. In particular, we focus on a specific trajectory of health communication theorizing—the culture-centered approach—and its heuristic and pragmatic utility in enhancing knowledge about public health crises like infectious disease outbreaks. In the backdrop of the mobilizations against the 2014 Ebola virus disease epidemic in the 3 West African nations of Guinea, Sierra Leone, and Liberia, indigenous cultural practices were construed as pathogenic and local agency of affected communities disregarded, even as the global risks of the epidemic were highlighted. In contrast to this interventionist notion of culture, the culture-centered approach offers a heuristic rubric through which to scrutinize the dialectical interrelationship between indigenous cultural practices, structural determinants of health, and the everyday agency of individuals of affected communities. We argue that such a listening-based paradigm of communication theorizing is instrumental in developing authentic, ethical, and effective health communication practice in public health crises.

Health Communication and the HIV Continuum of Care.

:Health communication is a broad term that applies to the fundamental need for practitioners, policy makers, patients, and community members to understand one another around health promotion and health care issues. Whether in a consultation between nurse and patient, a health clinic director's engagement with the health ministry, or a community campaign for encouraging HIV testing, all have critical health communication elements. When people's needs are not perceived by them to be addressed or clients/patients do not understand what is being communicated, they are unmotivated to engage. Health communication may be deployed at multiple levels to encourage positive behavior change and affect HIV treatment outcomes. As countries move to treatment for all as soon as possible after testing, health communication can help address significant losses at each stage of the HIV continuum of care, thereby contributing to achieving the 90-90-90 global treatment goals. This JAIDS supplement presents compelling studies that are anchored on the health communication exigencies in highly diverse HIV and AIDS contexts in low and middle income settings. Our special focus is health communication needs and challenges within the HIV continuum of care. We introduce the supplement with thumbnails summaries of the work presented by an experienced array of public health, behavioral, and clinical scientists.

Health Activism Targeting Corporations: A Critical Health Communication Perspective

ABSTRACTHealth activists and health social movements have transformed medical treatment, promoted public health policies, and extended civil rights for people with illness and disability. This essay explores health activism that targets corporate-generated illness and risk in order to understand the unique communicative challenges involved in this area of contention. Arguing for greater critical engagement with policy, the article integrates policy research with social movements, subpolitics, and issue management literature. Drawing from activist discourse and multidisciplinary research, the article describes how a wide array of groups groups build visibility for corporate health effects, create the potential for networking and collaboration, and politicize health by attributing illness to corporate behaviors. The discussion articulates the implications of this activism for health communication theory, research, and practice.

Structure and agency in long-distance truck drivers’ lived experiences of condom use for HIV prevention

Condom promotion has emerged as a mainstay of targeted HIV prevention interventions in India, with its emphasis on individual behaviour change and personal responsibility. However, such approaches often do not account for marginalised populations’ structural vulnerability to HIV, arising from social, economic and political factors in the lived environment. In this paper, I use a critical health communication framework to analyse how structure and agency interact in influencing condom use among long-distance truck drivers in India. Drawing on an abductive discourse analysis of condom-use discourses among truckers and peer educators in two Indian cities, findings reveal that while truckers understand the biomedical logic of condoms as barriers, they also express anxiety about condom breakage and experience structural barriers to condom use. The paper concludes by calling for greater attention to structural vulnerabilities in future HIV prevention efforts with truck drivers.

Toward the Development of Critical Health Communication Praxis

The field of research and practice that is generally incorporated under the rubric of health communication is currently dominated by social psychological models of behavior and theoretical perspectives informed by the stimulus–response school of communication. This article argues that the field needs to incorporate critical cultural and political theory into its scholarly inquiry and informed practice to a greater extent than it currently does.