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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

Health Literacy and Health/Risk Communication  

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

Ethical Issues in Health Promotion and Communication Interventions  

Nurit Guttman

Health promotion communication interventions invariably raise ethical issues because they aim to influence people’s views and lifestyles, and they are often initiated, funded, and influenced by government agencies or powerful public or private organizations. With the increasing use of commercial advertising tactics in health promotion communication interventions, ethical issues regarding advertising can be raised in health promotion communication when it applies techniques such as highly emotional appeals, exaggerations, omissions, provocative tactics, or the use of children. Key ethical concerns relate to infringing on people’s privacy, interfering with their right to freedom of choice and autonomy, and issues of equity (such as by widening social gaps, where mainly those who are better off benefit from the interventions). Interventions using digital media raise ethical issues regarding the digital divide and privacy. The interventions may have unintended adverse effects on the psychological well-being of individuals or groups (e.g., by inadvertently stigmatizing or labeling people portrayed as negative models). They can also have an effect on cultural aspects of society (e.g., by idealizing particular lifestyles or turning health into a value) and raise concerns regarding democratic processes and citizens’ consent to the interventions. Interventions can have repercussions in multicultural settings since members of diverse populations may hold beliefs or engage in practices considered by health promoters as “unhealthy,” but which have important cultural significance. There are also ethical concerns regarding collaborations between health promoters and for-profit organizations. Identifying and considering ethical issues in the intervention is important for both moral and practical reasons. Several ethical conceptual frameworks are briefly presented that elucidate central ethical principles or concerns, followed by ethical issues associated with specific contexts or aspects of communication interventions.

Article

Rhetorical Approaches to Health and Medicine  

Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen

Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials. In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.

Article

Health Care Teams as Agents for Change in Health and Risk Messaging  

Kevin Real and Andy Pilny

Effective communication in health care teams is central to the delivery of high-quality, safe, dependable, and efficient patient care. Understanding how health care team communication operates within healthcare systems is important. Viewing health care teams in hospital settings as creators and channels for diffusions of health and risk messages is an important contribution to health communication scholarship. Health care teams are essential elements of healthcare systems. In many instances, they are components of multiteam systems embedded within larger network ecosystems. These teams are not identical, thus, considering how team type (e.g., unidisciplinary, multidisciplinary, interdisciplinary) shapes distinct communication processes offers a better understanding of how these teams facilitate health and risk message diffusion. TeamSTEPPS is an important framework for essential teamwork behaviors that facilitate team processes in healthcare systems. Significantly, we develop specific communication competencies drawn from observation work that facilitate health care team effectiveness. Ideas developed by Kurt Lewin are utilized to consider how different types of multiteam systems can be effective as channels and facilitators of health and risk messages. We end the chapter with examples from field research. A set of hospital nursing unidisciplinary teams comprise a network of teams that form a heterarchical structure with important messages flowing between teams. An innovative form of hospital interdisciplinary rounds relies on specific communication practices to create and exchange health and risk messages to patients, families, health care team members, and other healthcare stakeholders.

Article

Communicating Religious Identities  

Renate Ysseldyk

Religion encompasses many forms of communication: between groups, within groups, and with God (or other deities). Such communication can be especially powerful when group members highly identify with their religious group and the beliefs therein. Equally, it can be divisive, as evidenced by religion-based intergroup conflict and intolerance (which often overlaps along ethnic or political lines). However, not all religious communication is verbal or explicit. Religious individuals also commonly transmit their beliefs, values, and identities through symbols, physical spaces, and music. Likewise, communication with God is often pursued with silent prayer, meditation, or ritual, which also serve to reinforce one’s spirituality alongside religious group boundaries. Taken together, these varying forms of communication have implications not only for religious intergroup relations (e.g., intergroup contact or conflict), but also for intragroup relations (e.g., the strengthening of social ties) and individual health outcomes (e.g., effective communication with health care providers and coping practices). Given the importance of religious identity for many individuals, the benefits for individual well-being and intragroup relations, and yet the intergroup strife that religious group divisions can incite, the ways in which we communicate our religious group identities deserve closer attention.

Article

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.

Article

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.

Article

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.

Article

Counterfactuals in Health and Risk Messaging  

Irina A. Iles and Xiaoli Nan

Counterfactual thinking is the process of mentally undoing the outcome of an event by imagining alternate antecedent states. For example, one might think that if they had given up smoking earlier, their health would be better. Counterfactuals are more frequent following negative events than positive events. Counterfactuals have both aversive and beneficial consequences for the individual. On the one hand, individuals who engage in counterfactual thinking experience negative affect and are prone to biased judgment and decision making. On the other hand, counterfactuals serve a preparative function, and they help people reach their goals in the future by suggesting effective behavioral alternatives. Counterfactual thoughts have been found to influence an array of cognitive processes. Engaging in counterfactual thinking motivates careful, in-depth information processing, increases perceptions of self-efficacy and control, influences attitudes toward social matters, with consequences for behavioral intentions and subsequent behaviors. Although it is a heavily studied matter in some domains of the social sciences (e.g., psychology, political sciences, decision making), counterfactual thinking has received less attention in the communication discipline. Findings from the few studies conducted in communication suggest that counterfactual thinking is a promising message design strategy in risk and health contexts. Still, research in this area is critically needed, and it represents an opportunity to expand our knowledge.

Article

Migrants and Migrant Workers  

Cheng Zeng

Massive migration both within and between countries has been witnessed over the last two centuries. Migration is a multifaceted event with significant socioeconomic, cultural, political consequences for both receiving and sending countries/regions. Migrants typically move to a more developed region with the hope of obtaining better employment and living standards. Migrants, a cheap labor source with high achievement motivation, seem to be the ideal workforce for aging societies that have an urgent need for working populations. Despite migrants being needed for local economic growth, migrant workers are often marginalized in host societies. In addition, lacking human, social, and cultural capital, migrants are more disadvantaged in the job markets, especially during economic downturns. Life establishment in host societies is by no means an easy task for migrants who are also confronted with issues such as cultural differences and extra socioeconomic pressures. Institutionalized and daily discrimination from host societies also have significant negative impacts on migrants’ professional and everyday lives. Thus, migrants often report lower levels of happiness, job satisfaction, and health than their local counterparts. It is urgent to facilitate migrants’ integration and diminish social division between migrants and locals to improve migrant workers’ life quality in the host societies.

Article

Creating Authentic and Lasting Community Relationships to Enhance Awareness and Understanding of Cancer Research  

Linda Fleisher, Evelyn González, and Armenta Washington

Building and sustaining relationships fundamentally requires mutual trust based on authentic and reciprocal communication. Successful academic and community partnerships require a deep understanding of the needs of all stakeholders facilitated through dialogue and ongoing communication strategies. This dialogue is especially crucial to address health disparities and bridge the divide between academics and other professionals and the communities they serve. Innovative and sound health communications and community engagement approaches can help to address this divide. For those working with communities to improve health, Community Based Participatory Research (CBPR) principles can serve as a compass to guide those efforts of building on the strengths and resources within the community and ensuring co-learning to address social inequities. Moreover, using innovative and interactive health communication strategies, such as community forums, photovoice projects, and the development of culturally sensitive and relevant messaging, can empower and engage the community, facilitating long-lasting relationships between the academic institutions and communities that ultimately address the unique concerns and values of those most in need.

Article

Narratives in Health and Risk Messaging  

Julie E. Volkman

In health and risk communication, evidence is a message feature that can add credibility, realism, and legitimacy to health and risk messages. Evidence is usually defined into two types: statistical or narrative. Statistical evidence employs quantifications of events, places, phenomena, or other facts, while narrative evidence involves stories, anecdotes, cases, or testimonials. While many health and risk messages employ statistical or factual information, narrative evidence holds appeal for health and risk communication for its utility in helping individuals learn their risks and illnesses through stories and personal experiences. In particular, narratives employed as evidence in a health or risk message especially hold value for their ability to communicate experiences and share knowledge, attitudes, beliefs, and ideas about complex health issues, propose behavior change, and assist individuals coping with disease. As a result, the personal experiences shared, whether they are from first-hand knowledge, or recounting another’s experience, can focus attention, enhance comprehension for risks, and recall of health and risk information. Furthermore, readers engage with the story and develop their own emotional responses which may align with the purpose of the health and risk message. Narratives, or stories, can occur in many ways or through various points of view, but the stories that “ring true” to readers often have a sense of temporality, coherence, and fidelity. As a result, formative research and pre-testing of health and risk messages with narratives becomes important to understand individual perceptions related to the health issue and the characters (or points of view). Constructs of perceived similarity, interest, identification, transportation, and engagement are helpful to assess in order to maximize the usefulness and persuasiveness of narratives as evidence within a health and risk message. Additionally, understanding the emotional responses to narratives can also contribute to perceptions of imagery and vividness that can make the narrative appealing to readers. Examining what is a narrative as evidence in health and risk messages, how they are conceptualized and operationalized and used in health and risk messages is needed to understand their effectiveness.

Article

Gender as a Consideration When Designing Health and Risk Messages  

E. Michele Ramsey

Given the impact of gender on health, healthcare decisions, and treatments for illness, as well as the increased inequities encountered by non-white men and women, messages about health and health risks are affected by purposeful assumptions about gender identity. While the term sex denotes the biological sex of an individual, gender identity is about the psychological, cultural, and social assumptions about a person associated with that person because of his or her sex. Gender and health are intimately connected in a number of ways, and such connections can differ based on race, ethnicity, age, class, religion, region, country, and even continent. Thus, understanding the myriad ways that notions of gender affect the health of females and males is fundamental to understanding how communicating about risks and prevention may be tailored to each group. Gender role expectations and assumptions have serious impacts on men’s health and life expectancy rates, including self-destructive behaviors associated with mental health and tobacco use, self-neglecting behaviors linked to the reluctance of men to seek treatment for ailments, reluctance to follow a physician’s instructions after finally seeking help, and risk-taking behaviors linked to drug and alcohol use, fast driving, guns, physical aggression, and other dangerous endeavors. Because gender role expectations tend to disfavor females, it is not surprising that gender generally has an even greater impact on women’s health than on men’s. Even though biological factors allow women, on average, to live longer than men worldwide, various gendered practices (social, legal, criminal, and unethical) have serious impacts on the lives and health of women. From sex discrimination in research and treatment regarding issues linked to reproductive health, depression, sexual abuse, alcohol and drug abuse, the sex trade, and normalized violence against women (such as rape, female genital mutilation, forced prostitution/trafficking, and domestic violence), women’s lives across the globe are severely affected by gender role expectations that privilege males over females. While some general consistencies in the relationships between gender, women, and health are experienced worldwide, intersections of race, ethnicity, class, age, country, region, and religion can make for very different experiences of women globally, and even within the same country. The recent years have seen an increasing call to reconsider the binary means by which we have defined sex and gender. Advances in our understandings of lesbian, gay, bisexual, intersex, and transgendered individuals have challenged traditional notions and definitions of sex and gender in important and complex ways. Such an important shift warrants a stand-alone discussion, as well as the recognition that sexual orientation should not be automatically linked to discussions of sex and gender, given that such categorization reifies the problematic sex/gender binaries that ground sexist and homophobic attitudes in the first place.

Article

Communicating about Genes, Health, and Risk  

Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick

The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.

Article

Limited English Proficiency as a Consideration When Designing Health and Risk Messages  

Maricel G. Santos, Holly E. Jacobson, and Suzanne Manneh

For many decades, the field of risk messaging design, situated within a broader sphere of public health communication efforts, has endeavored to improve its response to the needs of U.S. immigrant and refugee populations who are not proficient speakers of English, often referred to as limited English proficient (LEP) populations. Research and intervention work in this area has sought to align risk messaging design models and strategies with the needs of linguistically diverse patient populations, in an effort to improve patient comprehension of health messages, promote informed decision-making, and ensure patient safety. As the public health field has shifted from person-centered approaches to systems-centered thinking in public health outreach and communication, the focus in risk messaging design, in turn, has moved from a focus on the effects of individual patient misunderstanding and individual patient error on health outcomes, to structural and institutional barriers that contribute to breakdown in communication between patients and healthcare providers. While the impact of limited proficiency in English has been widely documented in multiple spheres of risk messaging communication research, the processes by which members of immigrant and refugee communities actually come to understand sources of risk and act on risk messaging information remain poorly researched and understood. Advances in risk messaging efforts are constrained by outdated views of language and communication in healthcare contexts: well-established lines of thinking in sociolinguistics and language education provide the basis for critical reflection on enduring biases in public health about languages other than English and the people who speak them. By drawing on important findings about language ideologies and language learning, an alternative approach would be to cultivate a deeper appreciation for the linguistic diversity already shaping our everyday lives and the competing views on this diversity that constrain our risk messaging efforts. The discourse surrounding the relationship between LEP and risk messaging often omits a critical examination of the deficit-based narrative that tends to infuse many risk messaging design efforts in the United States. Sociolinguists and language education specialists have documented the enduring struggle against a monolingual bias in U.S. education and healthcare policy that often privileges proficiency in English, and systematically impedes and discriminates against emerging bilingualism and multilingualism. The English-only bias tends to preclude the possibility that risk messaging comprehension for many immigrant and refugee communities may represent a multilingual capacity, as patients make use of multiple linguistic and cultural resources to make sense of healthcare messages. Research in sociolinguistics and immigration studies have established that movement across languages and cultures—a translingual, transcultural competence—is a normative component of the immigrant acculturation process, but these research findings have yet to be fully integrated into risk messaging theory and design efforts. Ultimately, critical examination of the role of language and linguistic identity (not merely a focus on proficiency in English) in risk messaging design should provide a richer, more nuanced picture of the ways that patients engage with health promotion initiatives, at diverse levels of English competence.

Article

Using Pictures in Health and Risk Messages  

Sarah C. Vos and Elisia Cohen

Using pictures (also called images) in health and risk messages increases attention to messages and facilitates increased retention of message content, especially in low-literate populations. In risk communication, researchers have found that pictorial warnings stimulate communication and that images without text can communicate risk information as effectively (or, in some cases, more effectively) than text. However, little empirically based guidance exists for designing images for health and risk messages because most studies use an absence-presence model and compare visual communication to textual communication, rather than compare different types of visual communication. In addition, visual communication theories focus on describing the “how” aspect of communication instead of offering proscriptive guidance for message design. Further complicating the design of visual messages is that the number of possibilities for a visual message is, like text-based messages, almost infinite. Choices include colors, shapes, arrangement, and the inclusion of text, logos, icons, and so on. As a result, best practices on visual messages often draw on design recommendations. Before the widespread advent of Internet use and the adoption of social networking sites like Facebook and Twitter, using images—especially color images—could be cost prohibitive. However, these online platforms facilitate the distribution of visual content, and many public health organizations use these platforms to distribute visual messages. The need for guidance and research on using pictures effectively is growing. Although there has been increasing focus on images in health messages, many questions still exist about how visual messages should be composed and what their effect is. The existing evidence suggests that visual information can improve persuasive and, on social networking sites, diffusion outcomes. However, visual information may be prone to misinterpretation. Researchers should also evaluate ethical considerations when choosing pictures. Message testing is highly recommended.

Article

Cross-Cultural Adaptation  

Young Yun Kim

Countless immigrants, refugees, and temporary sojourners, as well as domestic migrants, leave the familiar surroundings of their home culture and resettle in a new cultural environment for varying lengths of time. Although unique in individual circumstances, all new arrivals find themselves in need of establishing and maintaining a relatively stable working relationship with the host environment. The process of adapting to an unfamiliar culture unfolds through the stress-adaptation-growth dynamic, a process that is deeply rooted in the natural human tendency to achieve an internal equilibrium in the face of adversarial environmental conditions. The adaptation process typically begins with the psychological and physiological experiences of dislocation and duress commonly known as symptoms of culture shock. Over time, through continuous activities of new cultural learning, most people are able to attain increasing levels of functional and psychological efficacy vis-a-vis the host environment. Underpinning the cross-cultural adaptation process are the two interrelated experiences of deculturation of some of the original cultural habits, on the one hand, and acculturation of new ones, on the other. The cumulative outcome of the acculturation and deculturation experiences is an internal transformation in the direction of assimilation into the mainstream culture. Long-term residents and immigrants are also likely to undergo an identity transformation, a subtle and largely unconscious shift from a largely monocultural to an increasingly intercultural self-other orientation, in which conventional, ascription-based cultural categories diminish in relevance while individuality and common humanity play an increasingly significant role in one’s daily existence. Central to this adaptation process are one’s ability to communicate in accordance to the norms and practices of the host culture and continuous and active engagement in the interpersonal and mass communication activities of the host society.

Article

Communication, Aging, and Culture  

Robert M. McCann

Research into age and culture strongly suggests that people of different adult generations, regardless of culture, typically regard others and act in ways that display bias in favor of one’s own age group. While people across cultures share some basic patterns of aging perceptions, there is considerable variance in views on older people from one country to the next. Over the past two decades, the tenor of communication and aging research has shifted dramatically. Traditional research into aging across cultures painted a picture of Asia as a sort of communicative oasis for elders, who were revered and communicated to by the younger generations in a respectful and mutually pleasing manner. Compelling evidence now suggests the opposite, which is that (interregion variability in results notwithstanding) elder denigration may be more pronounced in Eastern than Western cultures. Accelerated population aging, rural-to-urban shifts in migration, new technologies, rapid industrialization, and the erosion of cultural traditions such as filial piety, may partially account for these results. Additionally, there are well-established links between communication and the mental health of older people. Specifically, communication accommodation in all of its forms (e.g., over accommodation, nonaccommodation, accommodation) holds great promise as a core predictor of a range of mental health outcomes for older people across cultures.

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.