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Article

Rocio Garcia-Retamero, Dafina Petrova, Adam Feltz, and Edward T. Cokely

Graphical displays generally facilitate the communication of complex information and are ubiquitous in media. Unfortunately, people differ in their ability to extract data and meaning from graphical representations of quantitative information (i.e., graph literacy). This means that for some people, even well-designed, simple graphs will cause confusion and misunderstanding. Research on the psychology of graph comprehension focuses on two instruments that efficiently assess fundamental graph literacy among diverse adults. The Objective Graph literacy scale is a well-established instrument with good psychometric properties that measures skill via cognitive performance testing (e.g., interpreting and evaluating various graphs). The recently developed Subjective Graph Literacy scale is a brief self-report of graph literacy that can outperform the objective test in notable ways, while reducing text anxiety. Emerging applications in clinical research and practice, including computerized decision aids, can personalize content as a function of one’s graph literacy.

Article

Masato Kajimoto and Jennifer Fleming

News literacy is an emerging field within the disciplines of media literacy, journalism education, information technology, and other related areas, although there is no unified definition or consensus among researchers as to what exactly the news literacy curriculum should entail. Its core mission is broadly recognized as “citizen empowerment” in that the critical-thinking skills necessary to the evaluation of news reports and the ability to identify fact-based, quality information encourage active participation and engagement among well-informed citizens. One dominant instructional paradigm, which some researchers refer to as the “journalism school approach,” emerged in the mid-2000s and distinguished “news literacy” from its longer-recognized counterpart, media literacy. Lessons in news literacy classrooms focus exclusively on the deconstruction of news content. While news literacy often shares many of its analytical goals and theoretical frameworks with media literacy education, it also contains specialized pedagogical methods specific to the process of news production, which are not applicable to other types of media content. Despite some heated discussions among scholars, particularly in the United States, with different standpoints on whether this pedagogy is more or less effective than the approaches taken by media literacy educators, the difference between the two and other related fields, such as digital literacy and web literacy, is often ambiguous because in practice, neither discipline is particularly standardized and each instructor’s understanding of the field, as well as their academic training, has a significant impact on students’ learning experiences. Globally, the debate over the—often subtle—nuances that differentiate these various approaches have even less significance, as educators around the world translate and adapt news literacy concepts to fit the unique circumstances and environments found in their own country’s news media, political, and technological environments. Perhaps the most pressing issue in the current state of news literacy is a lack of a cohesive body of peer-reviewed research, or in particular, a research design that appropriately measures the efficacy of educational models. News literacy studies grounded in social science methods are limited. Scholarship on critical news instruction and skill development, which has been traditionally conducted under the umbrella of media literacy, is mostly comprised of descriptive accounts of educational interventions or self-reported surveys on media attitudes, content consumption behaviors, or analytical skills. In the United States, a body of quantitative work based on an assessment instrument called a “news media literacy scale” has influenced how researchers can contextualize and measure news literacy, and some qualitative analyses shed light on specific pedagogical models. Interest in educational intervention and related research has increased rather dramatically since 2016 as global concerns over “post-truth” media consumption and the “fake news” phenomena have become part of academic discourse in different disciplines. Collaborative works among scholars and practitioners in the areas that could potentially inform the design of effective news literacy curriculum development, such as cognitive science, social psychology, and social media data analysis, have started to emerge as well.

Article

During the past few decades we have witnessed increased academic attention on resistance to persuasion. This comes as no surprise, as people are often persuaded by external forces when making important decisions that may affect their health. Public health professionals, scholars, and other concerned parties have developed numerous trainings, interventions, and regulations to teach or assist people to resist unwanted persuasion, deriving from media exposure (e.g., advertising) or social pressure. The extant literature on resistance induction encompasses strategies such as inoculation, media literacy interventions, trainings on specific persuasive techniques, warnings, and social influence interventions. Although the research findings of the discussed strategies vary in how straightforward they are, they do offer promising avenues for policymakers and health communication professionals. Furthermore, several avenues worthy of further study can be identified.

Article

Hearing loss is common, with approximately 17% of the population reporting some degree of a hearing deficit. Hearing loss has profound impacts on health literacy, health information accessibility, and learning. Much of existing health information is inaccessible. This is largely due to the lack of focus on tailoring the messages to the needs of deaf and hard of hearing (DHH) individuals with hearing loss. DHH individuals struggle with a variety of health knowledge gaps and health disparities. This demonstrates the importance of providing tailored and accessible health information for this population. While hearing loss is heterogeneous, there are still overlapping principles that can benefit everyone. Through adaptation, DHH individuals become visual learners, thus increasing the demand for appropriate visual medical aids. The development of health information and materials suitable for visual learners will likely impact not only DHH individuals, but will also be applicable for the general population. The principles of social justice and universal design behoove health message designers to ensure that their health information is not only accessible, but also equitable. Wise application of technology, health literacy, and information learning principles, along with creative use of social media, peer exchanges, and community health workers, can help mitigate much of the health information gaps that exist among DHH individuals.

Article

Michael Mackert, Sara Champlin, and Jisoo Ahn

Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to health outcomes and costs to the U.S. health-care system. Approximately one-quarter to one-half of U.S. adults struggle with health information, which includes understanding patient education materials, reading medication labels, and communicating with health-care providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability. Increased attention to the field of health literacy has resulted in debates about the definition and the best ways to assess health literacy; there is also a strong and growing movement within the field of health literacy research and practice to frame health literacy less as a deficit to overcome and more as an approach to empowering patients and improving outcomes. As health-care providers have recognized the importance of health literacy, workshops, and training programs have been developed and evaluated to improve the care of low-health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low-health-literate audiences with traditional and new digital media, which can also increase access for patients with hearing or visual impairments. Additionally, recent policy changes in the United States, including those related to the Affordable Care Act, contribute to a greater focus and regulation of factors that impact health literacy. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and health-care costs, and improved strategies for improving the health of lower health literate patients. Development and review of health literacy pieces can aid in shared decision making and provide insights for patients on various health-care services.

Article

Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Determinants of health can be categorized along a number of dimensions, but common designations consider behavioral, social, and environmental factors that lead to health disparities, as well as differences in access to health care and health services. Of central interest to communication researchers, differences in health literacy and health information seeking are revealed between advantaged and disadvantaged groups. Media influences involve the effects of access or exposure to different kinds of health information on the health behavior and health outcomes of different groups, as well as the effects of health disparity media coverage on public support for initiatives to reduce health disparities. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions. Taking a broader view, this essay briefly discusses trends in scholarship on health disparities, noting the precipitous increase in academic journal article publications on the topic, including the publication of journals specifically focused on publishing health disparities scholarship. Future directions for research are suggested, and recommendations for interventions to improve health disparities offered by the Principal Investigators of the 10 Centers for Population Health and Health Disparities are presented. Finally, an annotated list of primary sources (books, special issues of journals, reports) and a list of sources for further reading are offered to provide a starting point for beginning scholars to orient themselves to research in health disparities.

Article

Kathryn Greene, Smita C. Banerjee, Anne E. Ray, and Michael L. Hecht

Results of national epidemiologic surveys indicate that substance use rates among adolescents remain relatively steady or even show slight declines; however, some substance use rates, such as electronic cigarettes, are actually rising. Thus, the need for efficacious drug prevention efforts in the United States remains high. Active Involvement (AI) interventions are a promising avenue for preventing and reducing adolescent substance use, and they create opportunities for adolescents to experience a core feature of engagement that is common to these interventions, such as producing videos, posters, or radio ads; or generating themes and images for messages such as posters. Existing interventions grounded in theories of Active Involvement include programs delivered face-to-face and via e-learning platforms. Narrative Engagement Theory and the Theory of Active Involvement guide the components of change in AI interventions. Youth develop message content during participation in Active Involvement interventions. Advanced analytic models can be applied to address new research questions related to the measure of components of AI interventions.

Article

Bella figura—beautiful figure—is an idiomatic expression used to reflect every part of Italian life. The phrase appears in travel books and in transnational business guides to describe Italian customs, in sociological research to describe the national characteristics of Italians, and in popular culture to depict thematic constructs and stereotypes, such as the Mafia, romance, and la dolce vita. Scholarly research on bella figura indicates its significance in Italian civilization, yet it remains one of the most elusive concepts to translate. Among the various interpretations and references from foreigners and Italians there is not a single definition that captures the complexity of bella figura as a cultural phenomenon. There is also little explanation of the term, its usage, or its effects on Italians who have migrated to other countries. Gadamerian hermeneutics offers an explanation for how bella figura functions as a frame of reference for understanding Italian culture and identity, which does not disappear or fuse when Italians interact with people from different countries but instead takes on an interpretive dimension that is continually integrating new information into the subconscious structures of the mind. In sum, bella figura is a sense-making process, and requires a pragmatic know-how of Italian communication (verbal and nonverbal). From this perspective, bella figura is prestructure by which Italians and some Italian migrants understand and interpret their linguistically mediated and historical world. This distinction changes the concept bella figura from a simple facade to a dynamic interplay among ever-changing interpretations and symbolic interactions. The exploration of bella figura is relevant to understanding Italian communication on both local and transnational levels.

Article

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.

Article

Adolescent substance use remains a significant public health challenge, with recent approaches to address these problems including actively engaging adolescents in message planning and/or production as a prevention strategy. There are two benefits of this active involvement strategy. First, engaging adolescents in message planning or producing substance prevention messages is a form of participatory research that results in participant-generated messages for use in future intervention efforts. This participatory form of research is increasingly common in a wide range of topics and populations, particularly disenfranchised or stigmatized groups. It is important to focus on the second benefit of engaging adolescents in message planning and prevention: the effect of engaging in planning or producing substance prevention messages on the adolescents themselves. If done properly, the process of engaging adolescents in planning (or producing) anti-substance messages can provide longer-term benefits of delaying onset of substance use (strengthening resistance) as well as changing patterns for those already using. Some examples of this strategy exist with media literacy, although applied with a great deal of variability. The increased popularity of these planning/production approaches requires greater explication of how, when, and why they produce effects for participants. Two different theoretical perspectives address this active involvement intervention approach: narrative engagement theory and the theory of active involvement. Beyond these theories, sensation seeking is positioned as a moderator to explore for active involvement intervention effects.

Article

For Paulo Freire, the Brazilian activist educator and philosopher of education, communication is at the heart of pedagogy, teaching, and learning through praxis that involves reflection and action ultimately to address social injustice and dehumanization. Dialogue is at the center of his pedagogical approach, as means to individuation and humanization. Dialogue assumes participants to be on an equal level even in the presence of difference. In his literacy work, Freire required teacher-facilitators to co-investigate the most important themes in the lives of students. These themes were codified into pictures and brought to dialogue that animated the re-creation of knowledge of participants’ world and themselves in it and, in the process of learning how to read, achieving knowledge of the word. The objective of this approach was not to reproduce “banking” education but to promote revolutionary emancipation of individual and society. Freire developed his work in the context of life in the state of Pernambuco, in the challenging circumstances—socially, historically, and geographically—of the Brazilian Northeast Region. He experienced poverty and hunger and was lucky in his access to education thanks to the efforts of his mother. He rose through the ranks of civil service, serving at state and national levels, addressing the literacy and emancipatory needs of the population, particularly adults in rural areas. Exiled during the military dictatorship in Brazil, Freire lived in Chile, the United States, and Switzerland, where he worked on education projects worldwide.

Article

Gayatri Spivak is one of the foremost intellectuals of the 20th and 21st centuries. Although a literary critic, her work can be seen as philosophical as it is concerned with how to develop a transnational ethical responsibility to the radical “other,” who cannot be accessed by our discursive (and thus institutionalized) regimes of knowledge. Regarded as a leading postcolonial theorist, Spivak is probably best seen as a postcolonial Marxist feminist theorist, although she herself does not feel comfortable with rigid academic labeling. Her work is significantly influenced by the deconstructionist impulses of Jacques Derrida. Additionally, the influence of Gramsci and Marx is prominent in her thinking. Spivak’s work has consistently called attention to the logics of imperialism that inform texts in the West, including in Western feminist scholarship. Relatedly, she has also written significantly on how the nation, in attempting to represent the entirety of a population, cannot access otherness or radical alterity. This is best seen in her work on the subaltern and in her intervention into the famous Indian group of Subaltern Studies scholars. Other related foci of her work have been on comprehending translation as a transnational cultural politics, and what it means to develop a transnational ethics of literacy.

Article

Zazil Reyes García

The growing field of visual rhetoric explores the communicative and persuasive power of the visual artifacts that surround us. This relatively new branch of rhetoric emerged in the late 20th century, disrupting a discipline that was traditionally concerned with the spoken and written word. The artifacts studied through the lens of visual rhetoric comprise visual images and objects that are human created and culturally meaningful. They include two-dimensional images, such as political cartoons and video advertising, and three-dimensional objects such as museums and murals. Visual rhetoric can also include the analysis of embodied performance and thus examine the body as argument. Although much of the scholarship focuses on the power of images in shaping people’s understanding of the world, there is also a recognition of the power of looking. Meaning does not reside in the images around us; we participate in its construction. To better understand visual rhetoric, it is important to review its emergence as an area of study, its definitions, and some of the recurring themes in the scholarship.

Article

Studies of how children and young people relate to news have made important contributions to the field of journalism. As early as the early 1900s, children’s and young people’s news exposure was considered with interest. News exposure plays an important role for citizenship in democracies, and for news media organizations, recruiting new generations of audiences is important for survival in the future. From the early days, scholars have mainly focused on four areas in studies of news children and young people. First, the role of mass media as an agent of political socialization and how news exposure can inspire children and young people to civic engagement. Second, the introduction of television and television news increased the numbers of studies of children’s and adolescent’s emotional reactions to news coverage, and the emotional reactions to violence in the news coverage in particular. Third, an increasing focus on children’s rights and children as a minority group has further inspired studies of representation of children and young people in the news. Finally, inspired by methodological approaches focusing on people’s motivation for the use of different media and how they were used (“uses and gratification” studies), a main area for researchers has been to grasp how children and young people engage with news and how they do so in changed media environments. In the last decade, journalism studies have increasingly focused on how children and young people receive, evaluate, produce, and share news in social media.

Article

Popular media are a source of information, a powerful socializing agent, and generate sociopolitical and sociocultural meanings that impinge on health promotion and/or disease prevention efforts and individual lived experiences. Thus, motivated by the goal of improving individual and social health, multidisciplinary scholars attend to the implications of entertainment and news media with regard to a range of topics such as individual health threats related to prevention, health conditions and illnesses, patient–provider interactions and expectations, public health issues related to crisis management and health recommendations, and public policy. Scholarship in this line of research may approach the study of popular media guided by the social scientific tradition of media effects theory to explain and predict response or by critical theory to consider ideological implications and employ different methodologies to describe and evaluate the images of health and health-related matters to which people are being exposed or that focus on media representations or audience (both individual and societal) response.

Article

Media literacy describes the ability to access, analyze, evaluate, and produce media messages. As media messages can influence audiences’ attitudes and behaviors toward various topics, such as attitudes toward others and risky behaviors, media literacy can counter potential negative media effects, a crucial task in today’s oversaturated media environment. Media literacy in the context of health promotion is addressed by analyzing the characteristics of 54 media literacy programs conducted in the United States and abroad that have successfully influenced audiences’ attitudes and behaviors toward six health topics: prevention of alcohol use, prevention of tobacco use, eating disorders and body image, sex education, nutrition education, and violent behavior. Because media literacy can change how audiences perceive the media industry and critique media messages, it could also reduce the potential harmful effects media can have on audiences’ health decision-making process. The majority of the interventions have focused on youth, likely because children’s and adolescents’ lack of cognitive sophistication may make them more vulnerable to potentially harmful media effects. The design of these health-related media literacy programs varied. Many studies’ interventions consisted of a one-course lesson, while others were multi-month, multi-lesson interventions. The majority of these programs’ content was developed and administered by a team of researchers affiliated with local universities and schools, and was focused on three main areas: reduction of media consumption, media analysis and evaluations, and media production and activism. Media literacy study designs almost always included a control group that did not take part in the intervention to confirm that potential changes in health and risk attitudes and behaviors among participants could be attributed to the intervention. Most programs were also designed to include at least one pre-intervention test and one post-intervention test, with the latter usually administered immediately following the intervention. Demographic variables, such as gender, age or grade level, and prior behavior pertaining to the health topic under study, were found to affect participants’ responses to media literacy interventions. In these 54 studies, a number of key media literacy components were clearly absent from the field. First, adults—especially those from historically underserved communities—were noticeably missing from these interventions. Second, media literacy interventions were often designed with a top-down approach, with little to no involvement from or collaboration with members of the target population. Third, the creation of counter media messages tailored to individuals’ needs and circumstances was rarely the focus of these interventions. Finally, these studies paid little attention to evaluating the development, process, and outcomes of media literacy interventions with participants’ sociodemographic characteristics in mind. Based on these findings, it is recommended that health-related media literacy programs fully engage community members at all steps, including in the critical analysis of current media messages and the production and dissemination of counter media messages. Health-related media literacy programs should also impart participants and community members with tools to advocate for their own causes and health behaviors.

Article

Jessica Gasiorek and R. Kelly Aune

A majority of the extant literature in health and risk message processing focuses—for obvious reasons—on social influence and compliance-gaining. Interpersonal and relational issues with doctors and patients are a secondary focus. In contrast, research that specifically addresses comprehension of health and risk messaging is somewhat scant. However, other domains (e.g., cognitive psychology, reading studies) offer models and studies of comprehension that address message processing more generally. This material can usefully inform research in a health and risk context. An important aspect of any communicative event is the degree to which that event allows interactivity. This can be described in terms of a continuum from static messaging to dynamic messaging. Message features may affect simple comprehension (in the former case) and active understanding (in the latter case) of messaging along this continuum. For static messaging, text features are the dominant focus; for dynamic messaging, how communicators cooperate, collaborate, and adjust their behavior relative to each other’s knowledge states is the focus. Moderators of these effects, which include sources’ dual goals informing and influencing targets, are also important to consider. Examples of this include direct-to-consumer-advertising (DTCA) of pharmaceutical medicines and pharmaceutical companies, which must meet the demands of the government regulatory bodies (e.g., fair and balanced presentation of benefits and risks) while simultaneously influencing the message processing experience of the target to minimize negative perceptions of their products. Impediments to creating understanding can arise in both the highly interactive setting of the face-to-face doctor-patient context as well as more static messaging situations such as PSAs, pamphlets, and pharmaceutical package inserts. Making sense of message comprehension in health and risk communication is complex, and it is complex because it is broad in scope. Health and risk communication runs the gamut of static to dynamic messaging, employing everything from widely distributed patient information leaflets and public service announcements, to interactive web pages and massively connected social networking sites, to the highly interactive and personalized face-to-face meeting between doctor and patient. An equally comprehensive theoretical and methodological tool box must be employed to develop a thorough understanding of health and risk communication.

Article

Explanations designed to teach, rather than to support scientific claims in scholarly works, are essential in health and risk communication. Patients explain why they think their symptoms warrant medical attention. Clinicians elicit information from patients and explain diagnoses and treatments. Families and friends explain health and risk concerns to one another. In addition, there are websites, brochures, fact sheets, museum exhibits, health fairs, and news stories explaining health and risk to lay audiences. Unfortunately, research on this important discursive goal is less extensive than is research on persuasion, that is, efforts to gain agreement. One problem is that explanation-as-teaching has not been carefully conceptualized. Some confuse this communication goal and discursive type with its frequent verbal and visual features, such as simple wording or diagrams. Others believe explanation-as-teaching does not exist as a distinctive communication goal, maintaining that all communication is solely persuasive: that is, designed to gain agreement. Explanation-as-teaching is a distinct and important health communication goal. Patient involvement in decision making requires that both clinicians and patients understand options underlying health-care choices. To explore types of explanation-as-teaching, research provides (a) several ways of categorizing health and risk explanations for lay audiences; (b) evidence that certain textual and graphic features overcome predictable confusions, and (c) illustrations of each explanation type. Additionally, explanation types succeed or fail in part because of the social or emotional conditions in which they are presented so it is important to note research on conditions that support patients, families, and clinicians in benefiting from explanations of health and risk complexities and curricula designed to enhance clinicians’ explanatory skill.