Culture-centered Approach Research Articles

Meanings of Care: A Culture-Centered Approach to Left-Behind Family Members in the Countryside of China

Critical studies of health communication foreground the importance of meanings as organizing frameworks for constituting health. The contested and contradictory meanings articulated around health offer insights into the constraining and enabling roles of structures. Through ethnographic fieldwork conducted in a village in China embedded within the activist framework of the culture-centered approach, this project explores understandings of family care amid left-behind families in rural China against the backdrop of the migration of the middle generation of working adults from families located in rural contexts to cities. We work with the culture-centered approach to explore local meanings of care, understanding everyday care as integral to the health of an aging population that has been erased from the discursive space by market reforms and the hegemonic narrative of national development in China.

Music and health communication in The Gambia: A social capital approach

Drawing on ethnographic research with kanyeleng fertility society performers and health workers in The Gambia (2012–2013), this paper uses a social capital approach to analyze the relationship between musical performance and health communication. Health communication research has demonstrated the important role of social capital in mediating the impact of interventions. Music research has drawn attention to performance as a site in which social relationships and obligations are produced and negotiated. In this paper, I bring these two perspectives together in order to open up new ways of thinking about musical performance as a culturally appropriate strategy in health communication. Drawing on participant observation as well as individual and group interviews with performers and health workers (126 participants), I argue that kanyeleng performance facilitates health communication by building on existing social networks and forms of social capital. This research contributes to a paradigm shift in research on performance and health communication, moving away from individual-focused behaviour change communication, and toward a culture-centered approach that considers community participation in relation to broader social and structural issues. This research suggests that musical genres such as kanyeleng performance may help build trust between health professionals and target communities while also facilitating information dissemination and public debate on sensitive health topics.

Narratives of Stress in Health Meanings of African Americans in Lake County, Indiana

ABSTRACTAcross the life course, African Americans bear an unequal burden of disease compared to other racial groups. In spite of the widespread acknowledgment of racial health disparities, the voices of African Americans, their articulations of health and their local etiologies of health disparities are limited. In this article, we highlight the important role of communication scholarship to understand the everyday enactment of health disparities. Drawing upon the culture-centered approach (CCA) to co-construct narratives of health with African Americans residents of Lake County, Indiana, we explore the presence of stress in the everyday narratives of health. These narratives voice the social and structural sources of stress, and articulate resistive coping strategies embedded in relationship to structures.

Food Insecurity in Singapore: The Communicative (Dis)Value of the Lived Experiences of the Poor

ABSTRACTFood insecurity is a form of health disparity that results in adverse health outcomes, particularly among disenfranchised and vulnerable populations. Using the culture-centered approach, this article engages with issues of food insecurity, health, and poverty among the low-income community in Singapore. Through 30 in-depth interviews, the narratives of the food insecure are privileged in articulating their lived experiences of food insecurity and in co-constructing meanings of health informed by their sociocultural context, in a space that typically renders them invisible. Arguing that poverty is communicatively sustained through the erasure of subaltern voices from mainstream discourses and policy platforms, we ask the research question: What are the meanings of food insecurity in the everyday experiences of health among the poor in Singapore? Our findings demonstrate that the meanings of health among the food insecure are constituted in culture and materiality, structurally constrained, and ultimately complexify their negotiations of health and health decision making.

Effective CALD community health communication through research and collaboration: an exemplar case study

ABSTRACTHealth communication is identified as an important strategy in achieving health outcomes, particularly in supporting preventative approaches to combatting disease and ill health. In Australia’s multicultural society, health communication needs to address a number of culturally and linguistically diverse (CALD) communities in order to achieve health objectives and social equity. While cross-cultural and intercultural communications have been widely studied, research shows that health communication often fails to achieve its objectives, particularly in CALD communities. This analysis examines a case study that highlights three key ingredients of effective health communication targeting CALD communities – in-depth qualitative formative research, a collaborative community-based approach, and cultural competency. The case study not only reveals how a culture-centred approach and social ecology model of health communication achieved results that exceeded targets by up to 100% on a relatively small budget, but also revealed gaps in cultural competency that disadvantage some groups. This study contributes to health communication theory and practice, as well as public communication generally, by providing insights into ways to increase effectiveness as well as cost-efficiency, which in turn creates scalability and sustainability.

A Culture-Centered Approach to Improving Healthy Trans-Patient–Practitioner Communication: Recommendations for Practitioners Communicating withTrans Individuals

ABSTRACTThe following manuscript explores trans individuals’ lived experiences with practitioners and the types of advice they suggested be provided to practitioners treating trans patients to improve the trans-patient–practitioner relationship. Thirteen semi-structured qualitative interviews were conducted with individuals who self-identified as trans. Interviews were analyzed using thematic analysis (Braun & Clarke, 2006; Owen, 1984). Data analysis revealed that changes in practitioner’s communication behavior during office visits as well as modifications to office logistics and e-health particulars would contribute to a healthy communication environment. Interviewees explained that these variations may potentially improve trans-patient–practitioner communication. We conclude by offering practical and theoretical implications as well as areas of future research for trans health communication.

A cultural and contextual analysis of health concepts and needs of women in a rural district of Nepal.

Globally, individuals and groups have different notions of health promotion influenced by their social and cultural contexts. Effective primary health care and healthy public policy depend on a clear understanding of people's perceptions of health and their health needs. Women in the Far Western Region (FWR) of Nepal live in one of the most remote and rural areas in that country, and their general health status is one of the worst in that country. In this study we explored the socio-cultural health concepts and needs of women in a district of Nepal's FWR. Qualitative research methods and a culture-centred approach guided the study, with 30 women from the district of Dadeldhura in the FWR participating in in-depth interviews. Data were analysed through qualitative content analysis. The women's concepts of health included 'absence of disease', 'no tension', 'peace in the family' and 'being able to work'. The participants felt good health required good food, wealth, education and employment for their children, and a healthy community (free of drug or alcohol addiction). 'Money is everything' also emerged as a main theme, linking the concept of wealth to good health. To improve health, respondents recommended that the government provide financial support for education and employment and a focus on listening to and caring for the country's rural poor. Overall, participants' perceived health as not just about themselves but their families and communities. Socially as well as culturally determined gender roles influenced the health concepts and needs of the women. This study's findings can be used to guide public health leaders in priority-setting and in determining strategies for women's health promotion in rural districts of Nepal and other similar cultures.

Understanding Culture and Its Influence on HIV/AIDS-Related Communication Among Minority Men Who Have Sex With Men

ABSTRACTScholarly research and government surveillance reports demonstrate that African American and Latino men who have sex with men (MSM) bear an inequitable burden of new HIV infections. Among the estimated 31,896 HIV infections attributed to male-to-male sexual contact in 2011, approximately 62% occurred in African American (38.2%) and Latino (23.5) MSM. Simultaneously, recent scholarship on minority MSM and HIV/AIDS reports a dearth of qualitative communication research that address this health issue. This manuscript reports a research study that seeks to fill this gap in health communication theory and praxis. Through in-depth interviews with 17 MSM of color, this article draws upon the culture-centered approach to demonstrate how cultural and contextual nuances, (in)access to structural resources, and participants’ agentive capacity to act upon available knowledge/resources influences the ways they manage (the threat of) HIV/AIDS.

African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities

ABSTRACTOver the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care.

Listening to Chinese Immigrant Restaurant Workers in the Midwest: Application of the Culture-Centered Approach (CCA) to Explore Perceptions of Health and Health Care

ABSTRACTThis study engages with the culture-centered approach (CCA) to explore Chinese immigrant restaurant workers’ perception of the U.S. health care system and their interactions with the health care system in interpreting meanings of health. Chinese restaurant workers are marginalized because of their struggles on the job, their immigrant identity, and their negotiations with the structural contexts of occupation, migration status, and culture. In-depth interviews were conducted with 18 Chinese immigrant restaurant workers that lasted an average of 1.5 hours each, and were audiotaped. Interviews with participants highlighted critical issues in access to health care and the struggles experienced by restaurant workers in securing access to health, understood in the context of work. Critical to the workers’ discourse is the acknowledgment of structural constraints such as lack of insurance coverage, immigration status, and lack of understanding of how the U.S. health care system works.

Narratives of Food Insecurity in Tippecanoe County, Indiana: Economic Constraints in Local Meanings of Hunger

Food insecurity and its most extreme form, hunger, have increased exponentially in the United States since 2006. This essay seeks to contribute to our understanding of hunger by attending to the context of the financial crisis as an organizing frame for understanding local meanings of hunger. Within a broader framework of the culture-centered approach (CCA) that works to identify and develop locally rooted solutions to food insecurity, we describe through locally grounded stories of food insecurity the financial climate where large percentages of U.S. households have been cast into poverty because of the crash of an unregulated economy. These local understandings of hunger in the context of the economy offer entry points for organizing a food-insecure coalition that seeks to address the stigma around food insecurity.

Culture-centered approaches: the relevance of assessing emotional health for Latinos with type 2 diabetes

ObjectiveWithin Latino culture, there is a belief that strong emotions can cause diabetes. Because of this belief and evidence regarding the bi-directional relationship between depression and diabetes, the objectives of...

Women's Health Identities in the Transition From Military Member to Service Veteran

As servicewomen leave behind their military rank and status to become veterans, they must learn to effectively navigate a fragmented structure of care and communicate their health care needs. This study proposes a culture-centered approach to understanding how structural changes contribute to a reduction in positive health perception and behavior as active duty servicewomen transition to a veteran status. Results suggest during the process of disengagement from military cultural norms, women veterans’ health care prevention service utilization decreases, and their physical and mental health decreases through the transition. These findings highlight the need for widely available and culturally appropriate programs to meet the needs of this unique patient population.

Long Distance Truck Drivers and the Structural Context of Health: A Culture-Centered Investigation of Indian Truckers’ Health Narratives

Long-distance truck drivers (truckers) in India have been identified as a “high-risk” group for the HIV/AIDS epidemic, and are consequently the targets of prevention and education-based interventions. While such interventions have addressed risk at the level of individual behavior, little attention has been paid to the structural barriers to health for truckers. Research among truckers in India has ignored the economic, social, and cultural context of health. In this article, I employ the culture-centered approach (CCA) to health communication in documenting truckers’ narratives of health, which are innately connected to social and institutional structures around their lives. The data included 36 narrative interviews that I conducted as part of my fieldwork with Indian truckers, in addition to field notes and a reflexive journal. Through a reflexive analysis of these narratives, I present three themes: (a) the everyday violence of trucking, (b) health as sacrifice, and (c) migration and HIV/AIDS. I discuss how communication interventions can attend to the relationship between trucker health and the structural barriers they encounter.

Questioning dominant development practices

Guided by modernist monologic epistemologies, the dominant approach to subaltern development espouses economic-centered interventions. Contemporary theorization of development argues that the process fundamentally operates as a discourse to depict the underserved as the site of control. Further, it unilaterally exercises structural forces and applies hegemonic logic to create, sustain, and reinforce the material and communicative marginalization. The culture-centered approach (CCA), an alternative critical communicative framework, calls for a reflexive engagement with the narratives and discourses that emerges from the lived experiences of the subalterns. Grounded in the CCA, this paper uses subaltern discourses to consider the nature and consequences of dominant development practices on the lives of indigenous subalterns of the Himalayan region of eastern India. As such, this study, on the one hand, examines how dominant development practices operate as discourse and creates conditions of marginalization in subaltern spaces. On the other hand, this analysis seeks to foreground the narratives of communicative absences, discursive violence, and subaltern negotiations in the dialogic spaces of decision-making.

Exploring the meanings and experiences of health among Filipino female household service workers in Hong Kong

Purpose – The purpose of this paper is to explore the meanings and experiences of health of Filipino female household service workers (FHSWs) in Hong Kong (HK). Design/methodology/approach – It draws theoretic insights from culture-centered approach to health communication and uses in-depth interviews and field notes. Findings – For FHSWs, meanings of health are contingent on work. Health is valued not just because it allows FHSWs to fulfill the daily demands of employers but also it provides assurance for sustained employment contracts. Relative to formal labor and migration policies, informal rules and regulations of employers put unreasonable demand for FHSWs to be healthy. Furthermore, FHSWs experience health along the themes of periphery and center, physical and non-physical, internal and external, and right and privilege. Research limitations/implications – The experiences and meanings of health reported in this paper are limited to FHSWs in HK and may differ from other countries. Employers, non-government organizations, and private and public health care personnel need to be included to generate a more nuanced discussion of migration health in HK. Practical implications – In designing health promotion for FHSWs, employers as target audience should also be considered. Originality/value – Despite growing evidence, the consequences of international and temporary labor migration on women’s health largely remain under-theorized. To date, this paper is one of the few to engage health communication theory in rethinking migration health scholarship.

Decolonizing Communication for Social Change: A Culture-Centered Approach

The role of communication in planned social change is portrayed as a linear conduit for inducing pro-development behavior change in the “undeveloped” world. Later versions of social change communication started incorporating culture and participation into multicultural participatory development programs. This essay suggests that development discourses, including their later incarnations incorporating culture and participation, serve as vehicles for capitalist market promotion. These new forms of planned social change communication, scripted in the narratives of local empowerment, community-based participation, and entrepreneurship, work to systematically erase subaltern communities. Building on the theoretical framework of the culture-centered approach (CCA), I examine the ways in which dialogues with the margins of development discourse resist these dominant conceptual categories of development. The subaltern, standing in for the popular, resists neoliberal interventions through her active participation in popular politics.

Proposing a culture-centered approach to career scholarship: The example of subsistence careers in the US Arctic

In this article, I draw from the culture-centered approach to explore contemporary negotiations of career and work, positing career as a form of cultural practice. Rooted in postcolonial theory and subaltern studies, the culture-centered approach examines the active accomplishment of culture through everyday communicative practices, amidst the structural conditions that frame lived experiences, and focusing specifically on marginalized groups. I first trace how culture is conceptualized in extant career studies, in the psychological, sociological and communicative streams. Identifying both key gaps and paradoxes in the literature, I outline the culture-centered approach, suggesting four key principles to reconceive career as cultural practice. Specifically: career draws on both structure and action; career agency is hybridized across individuals/collectives; career agency is layered and contested; and career is both discursive and material. The framework is illustrated using an example from an ongoing study on the negotiation of subsistence careers by Native Alaskans in the US Arctic.

Having Their Say: Sex Workers Discuss Their Needs and Resources

In many countries where HIV/AIDS is prevalent, social, cultural, and economic factors often mitigate the adoption of healthy reproductive behaviors and practices. One group that is particularly susceptible to mitigating influences is women who work in the sex trade. In this article, we utilize a culture-centered approach to determine how a population of sex workers in Nairobi, Kenya, perceives their individual, social, and structural needs and resources in relation to the public, their families, friends, and peers. We conclude the article with next steps regarding collaboration with media representatives and policymakers.

Critical metaphor analysis of citizenship education discourse

Drawing upon critical public relations literature, this article calls for public relations research to critically examine the content in national narratives as the precursor to reconstructing a more tenable discourse on nation building and national interests. In the culture-centred approach, a deconstruction of the dominant discourse is the initial step to opening the space for participation. In line with the culture-centred approach, I conducted a critical metaphor analysis on 58 speeches delivered by Singapore government leaders on the necessity of national education for national survival. The analysis reveals eight metaphoric themes: CONTAINER, with BUILDING as a subset of that theme, JOURNEY, REMEMBERING, SEEING, MORALITY, CULTIVATION and LABOUR. This article discusses the four most salient themes of CONTAINER, BUILDING, REMEMBERING and MORALITY. Locating these themes in the socio-political context of a semi-authoritarian democracy reveals the ideational preoccupations of the government as the agent-organisation seeking to preserve its hegemonic leadership. The research highlights the usefulness of critical metaphor analysis for critical culture public relations practitioners and researchers in uncovering the propositions and agenda latent in naturalised discourse pervading a society.