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Cultural Fusion in Physician–Patient Communication and Decision Making in Japan  

Miho Iwakuma and Daisuke Son

The term “cinemeducation” was coined by Matthew Alexander in 2002, and according to P. Ravi Shankar, it refers to the use of clips from movies and videos to educate medical students and residents on the psychosocial aspects of medicine. As a counterbalance to the biomedicine-centric medical curricula, cinemeducation deals with the psychosocial aspects of medicine and sensitive topics in healthcare, including but not limited to depression, family and marital counseling, doctor–patient relationships, family systems, addiction, mental illness, cultural competency, and foreign patients and their healthcare beliefs. Cinemeducation is particularly useful when the viewing is followed by a discussion, which engages students in active learning of clinically relevant concepts such as informed consent (IC), palliative care, and patient-centeredness. In other words, cinemeducation provides students in the healthcare fields with opportunities to learn about the humanistic aspects of medicine by watching movies or clips that provide insight into human experiences and challenges in medicine. A famous Japanese medical TV series, Shiroi Kyoto (The Great White Tower) will be examined to discuss the cultural fusion that has occurred in Japan, specifically with regard to clinical communication. Based on a novel authored by Toyoko Yamazaki in the 1960s, this series is of interest because the novel was made into a drama twice, first in the 1970s and again in 2003. Accordingly, several significant changes in health communication are noticeable between the first and second versions. Social changes in paternalism in medicine, palliative care, and IC that were adapted from the West and localized in Japan, as cultural fusion are evident in several noteworthy scenes.


A Culture-Centered Approach to Health and Risk Communication  

Mohan Jyoti Dutta

The culture-centered approach (CCA) to health and risk communication conceptualizes the communicative processes of marginalization that constitute the everyday meanings of health and risks at the margins. Attending to the interplays of communicative and material disenfranchisement, the CCA situates health inequalities amidst structures. Structures, as the rules, roles, processes, and frameworks that shape the distribution of resources, constitute and constrain the access of individuals, households, and communities to the resources of health and well-being. Through voice infrastructures cocreated with communities at the classed, raced, gendered, colonial margins of capitalist extraction, the CCA foregrounds community agency, the capacity of communities to make sense of their everyday struggles with health and well-being. Community voices articulate the interplays of colonial and capitalist processes that produce and circulate the risks to human health and well-being, serving as the basis for community organizing to secure health and well-being. Culture, as an interpretive resource passed down intergenerationally, offers the basis for organizing, and is simultaneously transformed through individual and community participation. Culture-centered health communication, rooted in community agency, drawing upon cultural stories, resources, and practices in subaltern contexts, takes the form of organizing for health, mobilizing agentic expressions toward structural transformations.


Development and Effects of Internet Addiction in China  

Qiaolei Jiang

Internet addiction is a growing social issue in many societies worldwide. With the largest number of Internet users worldwide, China has witnessed the growth of the Internet along with the development and effects of Internet addiction, especially among the young. Originally reported anecdotally in mass media, Internet addiction has become an issue of great public concern after more than 20 years. The process of Internet addiction as an emerging risk in the Chinese context can be a showcase for risks related to information and communication technologies (ICTs), health, and everyday life. The term Internet addiction was first coined in the Western context and has since been recognized as a technology-driven social problem in China. Plenty of anecdotes, increasing academic research, and public awareness and concerns have put the threat of Internet addiction firmly on the policy agenda. Therefore, for prevention and intervention, research projects, rehab facilities, welfare services, and self-help programs have spread all over the country, and related regulations, policies, and laws have changed accordingly. Although controversies remain, through the staging of, and coping with, Internet addiction, people can better understand China’s digital natives and contemporary life.


Diffusion of Innovations from the West and Their Influences on Medical Education in Japan  

Mariko Morishita and Miho Iwakuma

In the 19th century, Western medicine spread widely worldwide and ultimately diffused into Japan. It had a significant impact on previous Japanese medical practice and education; it is, effectively, the foundation of contemporary Japanese medicine. Although Western medicine seems universal, its elements and origins as it has spread to other countries show localized differences, depending on the context and time period. Cultural fusion theory proposes that the culture of a host and influence of a newcomer conflict, merge, or transform each other. It could shed light on how Japanese medicine and medical education have been influenced by and coevolved with Western medicine and culture. Cultural fusion is not assimilation or adaptation; it has numerous churning points where the traditional and the modern, the insider (indigenous) and the outsider (immigrant), mix and compete. In Japan, medicine has a long history, encountering medical practices from neighboring countries, such as China and Korea in ancient times, and Western countries in the Modern period. The most drastic changes happened in the 19th century with strong influence from Germany before World War II and in the 20th century from the impact of the United States after World War II. Recently, the pressure of globalization could be added as one influence. Since cultural fusion is ubiquitous in Japanese medical fields, examples showing how the host and newcomers interact and merge can be found among many aspects of Japanese medicine and medical education, such as curricula, languages, systems, learning styles, assessment methods, and educational materials. In addition, cultural fusion is not limited to influence from the West but extends to and from neighboring Asian countries. Examining cases and previous studies on cultural fusion in Japanese medicine and medical education could reveal how the typical notion that Japan pursued Westernization of its medicine and medical education concealed the traditions and the growth of the local education system. The people involved in medicine in the past and the present have struggled to integrate the new system with their previous ideals to improve their methods, which could be further researched.


Digital Communication Effects on Loneliness and Life Satisfaction  

Philipp K. Masur

The question of whether and how digital media use and digital communication affect people’s and particularly adolescents’ well-being has been investigated for several decades. Many studies have analyzed how different forms of digital communication influence loneliness and life satisfaction, two comparatively stable cognitive indicators of subjective well-being. Despite this large body of empirical work, the findings remain ambivalent, with studies resulting in positive, negative, or nonsignificant effects. Several meta-analyses suggest that the overall effect of digital communication on life satisfaction is probably too small to suggest a detrimental effect. The net effect of digital communication on loneliness, by contrast, is positive, but likewise small. Yet the studies on which these meta-analyses are based suffer from several limitations. They often adopt a limited perspective on the phenomenon of interest as a disproportionate amount of work focuses on interpersonal differences instead of intra-individual, contextual, and situational effects, as well as their interactions. Furthermore, studies are often based on cross-sectional data, use unvalidated and imprecise measurements, and differ greatly in how they conceptualize digital communication. The diversity in studied applications and forms of digital communication also suggests that effects are most likely bidirectional. Passive digital communication (e.g., browsing and lurking) is more likely to result in negative effects on well-being. Active and purposeful digital communication (e.g., posting, liking, conversating), by contrast, is more likely to result in positive effects. Future research should therefore investigate how the various levels of digital communication (including differences in devices, applications, features, interactions, and messages) interact in shaping individuals’ well-being. Instead of expecting long-term effects on comparatively stable cognitive indicators such as life satisfaction, scholars should rather study and identify the spatial and temporal boundaries of digital communication effects on the more fluctuating affective components of well-being.


Games Addiction: A Comprehensive Overview  

Felix Reer and Thorsten Quandt

The study of addictive media use has a rather long tradition in media effects research and constitutes an interdisciplinary field that brings together scholars from communication science, psychology, psychiatry, and medicine. While older works focused on radio, film, or television addiction, newer studies have often examined the excessive use of interactive digital media and its consequences. Since the introduction of affordable home computer systems in the 1980s and 1990s, especially the pathological use of digital games (games addiction) has been discussed and investigated intensively. However, early research on the topic suffered from considerable methodological limitations, which made it difficult to assess the spread of the problem objectively. These limitations notwithstanding, the American Psychiatric Association (APA) decided to include the addictive use of digital games (Internet gaming disorder) as a “condition for further study” in its diagnostical manual, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), in 2013. A few years later, the World Health Organization (WHO) officially acknowledged addictive game use as a diagnosable mental condition (gaming disorder) by listing it in the 11th edition of the International Classification of Diseases (ICD-11). Some scholars viewed the decisions of the APA and the WHO with skepticism, arguing that healthy players may be stigmatized, while others greeted them as important prerequisites to facilitate appropriate therapies. Despite the question of whether the inclusion of disordered game use in the manuals of the APA and the WHO has greater advantages than disadvantages, it definitely triggered a research boom. New scales testing the APA and the WHO criteria were developed and applied in international studies. Representative studies were conducted that indicated that at least a small percentage of players seemed to show playing patterns that indeed could be considered problematic. Further, the correlates of gaming disorder have been examined extensively, showing that the addictive use of digital games is associated with particular demographics, motivations, and personality aspects as well as with other diverse impairments, such as physical and psychological health issues and problems in the social and working lives of affected players. However, the debate about the accuracy of the definitions and diagnostic criteria postulated by the APA and the WHO has not ended, and more high-quality research is needed to further improve the understanding of the causes, consequences, and specifics of gaming disorder. In addition, new aspects and innovations, such as micropayments, loot boxes, and highly immersive technologies such as virtual reality or augmented reality systems, may expose gamers to new risks that future debates and research need to consider.


Global Health and Critical Studies  

Mohan Jyoti Dutta

Amid the large scale inequalities in health outcomes witnessed globally, communication plays a key role in reifying and in offering transformative spaces for challenging these inequities. Communicative processes are integral to the globalization of capital, constituting the economic conditions globally that fundamentally threaten human health and wellbeing. The dominant approach to global health communication, situated within the global capitalist logics of privatization and profiteering, deploys a culturally targeted and culturally sensitive framework for addressing individual behavior. The privatization of health as a commodity creates new market opportunities for global capital. The extraction of raw materials, exploitation of labor, and the reproduction of commoditization emerge on the global arena as the sites for reproducing and circulating health vulnerabilities. By contrast, the culture-centered approach to global health foregrounds the co-creative work of building communicative infrastructures that emerge as sites for resisting the neoliberal transformation of health care. Through processes of grassroots democratic participation and ownership over communicative resources, culture-centered interventions create anchors for community-level interventions that seek to transform unhealthy structures. A wide array of social movements, activist interventions, and advocacy projects emerging from the global margins re-interpret the fundamental meanings of health to create alternative structures for imagining health.


Knowledge and Comprehension  

Ashley R. Kennard, Courtney Anderegg, and David Ewoldsen

Knowledge and comprehension are essential components of an individual’s understanding of a health text. Whether reading a health pamphlet or watching a health campaign in the form of a public service announcement (PSA), or watching edutainment programming, individuals gain knowledge about the health topic being discussed. Knowledge, however, can only be retained if the individual can also comprehend the text or video. Often comprehension in a health context focuses on health literacy or the degree to which individuals can process and understand health information in order to make informed health decisions. Health literacy is commonly viewed in terms of the readability (e.g., reading level, complexity) of the health text or script. However, in order for individuals to gain knowledge and use that knowledge appropriately and effectively in making health decisions, individuals need to comprehend or understand what the text is conveying. Because comprehension is such an important component of gaining and using health knowledge, we must understand how we store health knowledge in memory. A schema is a mental representation that stores knowledge as interrelated pieces of information. Schemas tend to be a fairly static representation of knowledge. A mental model is a more dynamic mental representation in that we use mental models to process, organize, and comprehend incoming information. In a mental model, there is a correspondence between an external entity and the constructed mental model of that entity that allows people to counterfactually manipulate information and engage in problem solving. A situation model is the most contextualized mental representation because it encompasses a specific event or set of interrelated events. There are several ways in which to examine comprehension processes. One way is to examine the most basic level of comprehension by investigating the importance of language and semantic representation of a text. A more complex way to examine comprehension is to view the activation levels of various words or concepts important in creating a representation of the story structure in memory. One model that specifically examines concept activation is the landscape model. The model posits that greater frequency of activation and the strength of activation of a concept determine the concept’s overall activation level. The higher the activation level of a concept in a text or video, the more likely the concept will be included in the mental representation for the text or video and stored in memory. A third way to study comprehension is to examine how concepts change throughout a text and how the concepts relate to one another. The event-indexing model describes how individuals create situation models based on five dimensions of information: time, space, protagonist, causality, and intentionality. Throughout the process of gaining information, the individual updates the situation models for a text on each of the five dimensions. When events have similar dimensions in common, the events are connected in memory; thus, describing health information with similar dimensions in common (e.g., a protagonist the entire way through the text, events happening in the same amount of time) will be better recalled later. Empirical work on comprehension of both text and video messages has demonstrated the landscape model and event-indexing model’s ability to examine comprehension processes based on the format, language, and organization of the information. Health message design can benefit from utilizing these comprehension models to ensure that knowledge is received by the intended audience and comprehended, and thus able to be used in future experiences.


Medical Tourism and Communication  

Alicia Mason

Medical tourism (MT), sometimes referred to as health tourism or medical travel, involves both the treatment of illness and the facilitation of wellness, with travel. Medical tourism is a multifaceted and multiphase process involving many agents and actors that requires careful planning and execution. The coordinated process involves the biomedical, transportation, tourism, and leisure industries. From the communication perspective, the process can be viewed as a 5-stage model consisting of the: (a) orientation, (b) preparation, (c) experiential and treatment, (d) convalescence, and (e) reflection phases. Medical tourism is uniquely situated in a nexus of academic literature related to communication, business and management, travel and tourism, policy and law, healthcare and health administration. Communication permeates and perpetuates the medical tourism process and does so at the levels of interpersonal interactions (provider-patient communication), small group (healthcare teams), organizational (between healthcare providers), and mass and computer-mediated communication (marketing, advertising, and patient social support). This process may, in some cases, involve high rates of international and intercultural variation. Further study of the MT process can help to gain a better understanding of how healthcare consumers evaluate information about medical procedures and possible risks, as well as the specific message features and effects associated with various communication channels and information delivery systems. Continuing scholarly efforts also should focus on the relationship between medical tourism and communication.


Science and Communication  

Celeste M. Condit and L. Bruce Railsback

Whether understood as a set of procedures, statements, or institutions, the scope and character of science has changed through time and area of investigation. The prominent current definition of science as systematic efforts to understand the world on the basis of empirical evidence entails several characteristics, each of which has been deeply investigated by multidisciplinary scholars in science studies. The aptness of these characteristics as defining elements of science has been examined both in terms of their sufficiency as normative ideals and with regard to their fit as empirical descriptors of the actual practices of science. These putative characteristics include a set of commitments to (1) the goal of developing maximally general, empirically based explanations certified through falsification procedures, predictive power, and/or fruitfulness and application, (2) meta-methodologies of hypothesis testing and quantification, and (3) relational norms including communalism, universalism, disinterestedness, organized skepticism, and originality. The scope of scientific practice has been most frequently identified with experimentation, observation, and modeling. However, data mining has recently been added to the scientific repertoire, and genres of communication and argumentation have always been an unrecognized but necessary component of scientific practices. The institutional home of science has also changed through time. The dominant model of the past three centuries has housed science predominantly in universities. However, science is arguably moving toward a “post-academic” era.


Structuration Theory and Health and Risk Messaging  

Joel Iverson, Tomeka Robinson, and Steven J. Venette

Risk can be defined using a mathematical formula—probability multiplied by consequences. An essential element of risk communication is a focus on messages within organizations. However, many health-related risks such as Ebola extend beyond an individual organization and risk is better understood as a social construction cogenerated within and between systems. Therefore, the process is influenced by systemic and supra-systemic values and predilections. Risk from a structurational perspective allows an understanding of the public as well as organizational responses to risk. Structuration theory provides a useful lens to move beyond seeing organizations as something that flows within an organization to understanding how organizations are enacted through communication. Structuration theory articulates the connections between systems and structures through the action of agents, whose practices produce and reproduce the rules and resources of social life. Within the structuration tradition, organizational communication scholars have shifted to an understanding of the communicative constitution of organizations (CCO). Specifically, one of the theories of CCO is the Four Flows Model. The four flows highlight the ways people enact organizations and provide a means to analyze the various ways communication constitutes organizations. The four flows are membership negotiation, activity coordination, reflexive self-structuring, and institutional positioning. Membership negotiation enacts the inner members and outsiders at a basic level including socialization, identity, and assimilation. Activity coordination produces collective action around a specific goal. Reflexive self-structuring is the decentralized enactment of structures for the organization through the communication of policies. Institutional positioning covers the macro-level actions where people in the organization act as an entity within the environment. When considering the public reaction to Ebola, a simple way to evaluate risk perception is the intersection of dread and control. The U.S. public considered Ebola a serious risk. From a structuration perspective, the viral nature of twitter, media coverage, and public discussion generated resources for fear to be exacerbated. Structuration theory allows us to position the risk beliefs as rules and resources that are reproduced through discourse. The organizational implications fall primarily into the two flows of institutional positioning and reflexive self-structuring. For institutional positioning, U.S. healthcare organizations faced general public dread and perceived lack of control. Within the United States multiple policies and procedures were changed, thus fulfilling the second flow of organizational self-structuring. The Ebola risk had a significant impact on the communicative constitution of health-care organizations in the United States and beyond. Overall, risk is communicatively constituted, as are organizations. The interplay between risk and health-care organizations is evident through the analysis of American cases of Ebola. Structuration theory provides a means for exploring and understanding the communicative nature of risk and situates that risk within the larger systems of organizations.