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Article

Health Promotion and Risk Reduction in Congregations  

Dennis Myers, Terry A. Wolfer, and Maria L. Hogan

A complex web of attitudinal, cultural, economic, and structural variables condition the decision to respond to communications promoting healthy behavior and participation in risk reduction initiatives. A wide array of governmental, corporate, and voluntary sector health-related organizations focus on effective messaging and health care options, increasing the likelihood of choices that generate and sustain wellness. Researchers also recognize the significant and multifaceted ways that religious congregations contribute to awareness and adoption of health-promoting behaviors. These religiously based organizations are credible disseminators of health education information and accessible providers of venues that facilitate wellness among congregants and community members. The religious beliefs, spirituality, and faith practices at the core of congregational cultural life explain the trustworthiness of their messaging, the health of their adherents, and the intention of their care provision. Considerable inquiry into the impact of religion and spirituality on health reveals substantive correlations with positive psychological factors known to sustain physical and psychological health—optimism, meaning and purpose, hope, well-being, self-esteem, gratefulness, social support, and marital stability. However, the beliefs and practices that create receptivity to health-related communications, care practices, and service provision can also be a deterrent to message impact and participation in healthy behaviors. When a productive relationship between spirituality and health exists, congregational membership offers rituals (e.g., worship, education, mission) and relationships that promote spiritual well-being. Research demonstrates increased life satisfaction and meaning in life, with health risk reduction associated with a sense of belonging, enriched social interactions, and shared experiences. Congregations communicate their commitment to wellness of congregants and community members alike through offering a variety of congregationally based and collaborative wellness and risk reduction programs. These expressions of investment in individual and community health range across all age, gender, and ethnic demographics and address most of the prominent diagnostic categories. These programs are ordered along three dimensions: primary prevention (health care messaging and education), secondary prevention (risk education), and tertiary prevention (treatment). Applying the dimensions of sponsorship, goal/mission, focus, services, staffing, and intended outcome highlights the similarities and differences among them. Several unique facets of congregational life energize the effectiveness of these programs. Inherent trust and credibility empower adherence, and participation decisions and financial investment provide service availability. These assets serve as attractive contributions in collaborations among congregations and between private and public health care providers. Current research has not yet documented the best practices associated with program viability. However, practice wisdom in the planning, implementation, and evaluation of congregationally based and collaborative health-related programs suggests guidelines for future investigation. Congregational leaders and health care professionals emphasize well-designed needs assessment. Effective congregational health promotion and risk reduction may be linked to the availability and expertise of professionals and volunteers enacting the roles of planner/program developer, facilitator, convener/mediator, care manager/advocate, health educator, and direct health care service provider.

Article

Direct-to-Consumer Advertising and Health and Risk Messaging  

Kimberly A. Kaphingst

Direct-to-consumer advertising of prescription drugs (DTCA) is a multibillion-dollar industry in the United States, affecting the health-care landscape. DTCA has been controversial, since a major increase in this type of advertising resulted from re-interpretation of existing regulations in the late 20th century. Health and risk communication research can inform many of the controversial issues, assisting physicians, policymakers, and the public in understanding how consumers respond to DTCA. Prior research addresses four major topics: (1) the content of DTCA in different channels, (2) consumers’ perceptions of and responses to DTCA, (3) individual-level factors that affect how consumers respond to DTCA, and (4) message factors that impact consumers’ responses. Such research shows that the presentation of risk and benefits information is generally not balanced in DTCA, likely affecting consumers’ attitudes toward and comprehension of the risk information. In addition, despite consumers’ generally somewhat negative or neutral perceptions of DTCA, this advertising seems to affect their health information seeking and communication behaviors. Finally, a wide range of individual-level and message factors have been shown to have an impact on how consumers process and respond to DTCA. Consumers’ responses, including how they process the information, request prescription drugs from providers, and share information about prescription drugs, have an important impact on the effects of DTCA. The fields of health and risk communication therefore bring theories and methodologies that are essential to better understanding the impact of this advertising.

Article

Communities of Practice in Health and Risk Messaging  

Nicola Andrew

A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being. CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice. In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.

Article

Perceptions of the Childfree  

Elizabeth A. Hintz and Rachel Tucker

Being voluntarily childless (i.e., “childfree”) is a growing trend in the United States and around the world. Although most childfree people know early in life that they do not wish to become parents, the decision to forgo having children is an ongoing process that requires childfree people to construct a life that deviates from the normative family life cycle. Increasing rates of voluntary childlessness is a trend spurred by a variety of shifting social, economic, and environmental factors. Yet despite the increasing normalcy of voluntary childlessness, childfree people (and especially childfree women) face social sanctions for deciding not to become parents, being broadly perceived more negatively than childless people (who do not have children but want them) and parents. Such sanctions include social confrontations in which others (e.g., family members) question or contest the legitimacy of their childfree identity. Media coverage of voluntary childlessness forwards the notion that motherhood and femininity are inseparable and that voluntary childlessness is an issue that primarily concerns and affects women. Furthermore, childfree people face discrimination in health care contexts when seeking voluntary sterilization and in workplace contexts when “family-friendly” policies create unequal distributions of labor for those without children. Members of the childfree community use the Internet to share resources and seek support to navigate challenging interactions with outsiders. Beyond this, although some studies have begun to interrogate the roles of geographic location, race, and sexual orientation in shaping the experience of voluntary childlessness, at present, a largely White, wealthy, able-bodied, cisgender, heteronormative, and Western view of this topic is still perpetuated in the literature.