Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.
Janice L. Krieger and Jordan M. Neil
Central to many definitions of the term “cultural imperialism” is the idea of the culture of one powerful civilization, country, or institution having great unreciprocated influence on that of another, less powerful, entity to a degree that one may speak of a measure of cultural “domination.” Cultural imperialism has sometimes been described as a theory, especially where scholars build a case that the cultural influence of the stronger entity has had a pervasive, pernicious impact on the weaker. The term evolved from 1960s neo-Marxist discourses within cultural, media, and postcolonial studies that contextualized the post–World War II “independence” wave of new nations emerging from colonial servitude. It was propelled by the writings of nationalist revolutionaries, revolutionary theorists, and their sympathizers of the 1950s and 1960s, but it has sweeping relevance across human history. The foremost western theorist of cultural imperialism in the West was Herbert Schiller. The concept was adopted and endorsed in the 1970s by both UNESCO and the Non-Aligned Movement. Following Oliver Boyd-Barrett, the concept may denote a field of study embracing all relationships between phenomena defined as “cultural” and as “imperialism.” These encompass cultural changes that are (1) enforced on a weaker entity and (2) occur within both stronger and weaker entities through contact, contest, and resistance, including (3) assimilation of social practices encountered by the stronger in the weaker entity, and (4) original hybrids manifesting cultural traces of both stronger and weaker entities. The concepts of cultural and media imperialism were much critiqued during the 1980s and 1990s, and many scholars preferred alternative concepts such as globalization and cultural globalization to analyze issues of intercultural contact, whether asymmetrical or otherwise. John Tomlinson critiqued the concept, identified four different discourses of cultural imperialism, and argued in favor of its substitution with the term “globalization.” Mirrlees has placed Tomlinson’s work in context by describing the dialectical—parallel but mutually aware—development of both a cultural imperialism and a cultural globalization paradigm. Both are influential in the 21st century. “Imperialism” commonly references relations of conquest, dominance, and hegemony between civilizations, nations, and communities. “Cultural imperialism” relates primarily to the cultural manifestations of such relations. Culture and empire relate in many different ways, fueling different theories that often play on dichotomous discourses, including territorial/non-territorial, totalistic/partial, benign/malign, ephemeral/perpetual, superficial/essential, voluntary/involuntary, intended/unintended, welcome/unwelcome, forceful/peaceful, noticed/unnoticed, linear/interactive, homogeneous/heterogeneous, and acceded/resisted. The concept has affinities with hegemony, the idea that stability in conditions of social inequality is achieved not mainly by force but by securing the consent of the masses (starting with co-option of their indigenous leaders)—through persuasion and propaganda—to the elite’s view of the world. This process is commensurate with forms of democracy that provide the appearance but not the reality of choice and control. Fissures within the ranks of the elites and within the masses create spaces for resistance and change. Culture encompasses the totality of social practices of a given community. Social practices are manifest within social institutions such as family, education, healthcare, worship, labor, recreation, language, communication, and decision-making, as well as their corresponding domains. Any of these can undergo change following a society’s encounter with exogenous influences—most dramatically so when stronger powers impose changes through top-down strategies of command and influence. Analysis of cultural imperialism often incorporates notions of media imperialism with reference to (1) print, electronic, and digital media—their industrialization, production, distribution, content, and capital accumulation; (2) cultural meanings that media evoke among receivers and audience cultures; (3) audience and media interactions in representations of topics, people, and ideas; and (4) relationships between media corporations and other centers of power in the reproduction and shaping of social systems. Media are logically subsumed as important components of cultural imperialism. Yet the significance of media can be understated. The concept of mediatization denotes that “knowledge” of social practices draws heavily on media representations. Social practices that are experienced as direct may themselves be formed through exposure to media representations or performed for media. Discourses of cultural imperialism speak to major current controversies, including: cultural suppression and genocide; ideas of “globalization”; influential economic models of “capitalism” and “neoliberalism”; ideologies that are embedded in the global spread of concepts such as “modern,” “progressive,” “growth,” “development,” “consumerism,” “free market,” “freedom,” “democracy,” “social Darwinism” and “soft power”; cultural specificity of criteria and procedures for establishing “truth”; instrumentalization for the purposes of cultural conquest of academic disciplines such as psychoanalysis, economics, social anthropology, or marketing, or environmental crises, especially as linked to western ideologies that underwrite humanity’s “right” to dominate nature.