The main objective of this thesis is to illustrate the benefits of using a cultural studies approach in the field of health communication research in Thailand. In this thesis I apply a cultural studies approach to examine the construction of meanings involving drug use and abuse in Thai television advertisements and dramas. The thesis has as its focus analyses of television texts and audience responses. The major arguments advanced in this thesis are that: (a) the causes of drug use and abuse are complex; (b) drug use and abuse, particularly given the 'risk culture' and 'risk society' of the post-modern world, are products of individual social and cultural contexts; (c) cultural studies assist us to better understand the cultural dimension of human behaviour, including the causes of drug use and abuse; and so (d) by adopting a cultural studies approach to the design and production of health promotion campaigns, such campaigns may be made more effective. The thesis argues that in designing health promotion campaigns, health professionals should be concerned to better understand the complexity of their audiences and the manner in which members of those audiences construct meanings and make sense of texts. Should they do so, the designers of health promotion campaigns may, thereby, develop a more sophisticated understanding of what is necessary to contribute to changing audience behaviour. This, in turn, may assist them to improve the design and effectiveness of future health promotion campaigns. The principal tool drawn from cultural studies used in this thesis is textual analysis. This research method involves making an educated guess at some of the most likely interpretations that might be made of a text. In addition, it demonstrates the complexity of the process of making media texts. The texts analysed in this study are selected from two genres of television: television advertisements and television dramas. I analyse television advertisements used in health promotion / drug prevention campaigns broadcast in Thailand in the period from 1990 to 2004 and two well known Thai television dramas entitled Kam See Than Don: KSTD (1999) and Num Poo: NP (2002).

The current patient-centred healthcare approach encourages individuals to assume greater roles in decisions about their health. The premise is that patients who are well informed about healthcare options are more likely to adhere to prescribed treatments and achieve better health outcomes. This approach assumes that patients have an adequate level of health literacy. While a range of definitions exist, health literacy is commonly defined as an individual’s ability to seek, understand and utilise health information to make appropriate health decisions. / Health literacy is increasingly recognised as a complex multi-dimensional concept which involves interactions between individual abilities and broader environmental factors. However across definitions, there has been little consultation with patients to understand what is important to effectively seek, understand and utilise health information. The lack of a consensual understanding has led to debate as to what health literacy represents and how it should be measured. A range of measures exist with the predominant approach being the testing of individual literacy abilities. However measures do not assess the range of attributes described in definitions. Thus a considerable gap exists between how health literacy is defined and how it is measured. This thesis focused on addressing this gap. The objectives were to: (i) critically appraise existing health literacy measures (ii) develop a conceptual framework from the patient perspective and (iii) use this framework to develop a comprehensive measure of health literacy. / A multi-method qualitative and quantitative approach was used: / (1) Systematic review and appraisal of the content, development and psychometric properties of health literacy measures. / (2) In-depth consultations with patients across healthcare and disease continuums to develop a conceptual framework. / (3) Development of a new health literacy measure based on the conceptual framework using a classical test theory approach. / A critical appraisal of the literature revealed that the majority of health literacy measures are not based on a conceptual framework and none appeared to adequately measure a person’s ability to seek, understand and utilise health information. Content focussed primarily on reading, comprehension and numeracy skills and scoring was poorly defined. Only five of the 19 measures had evidence of acceptable reliability. / The conceptual framework of health literacy from the patient perspective identified 17 key elements: six individual abilities and 11 broader contextual factors that are important to seek, understand and utilise health information and expanded previous conceptualisations of health literacy. This informed the development of the Health Literacy Management Scale (HeLMS) which measures six generic and potentially modifiable abilities and three specific broader social factors. Overall the HeLMS measures an individual’s ability to seek, understand and utilise health information within the healthcare setting. The HeLMS consists of 29 items across eight domains. Rigorous psychometric testing demonstrates that it possesses strong construct validity and high reliability (coefficient α >0.80 for all eight domains). / This research provides unique contributions to the conceptualisation and measurement of health literacy. Limitations in the content and psychometric properties of previously developed measures have been identified through a systematic process. A conceptual framework derived from the patient perspective identifies a range of components that provide new insight into: (i) constructs that should be incorporated to measure health literacy and (ii) areas that need to be addressed to improve health literacy. The development of the HeLMS now allows for a more comprehensive assessment of health literacy. Information from the conceptual framework and the HeLMS are likely to be useful tools to inform the development of public health initiatives to enhance patient participation in the management of their health.

Due to high frequency and occurrence of chronic kidney diseases in Taiwan, as well as the low public awareness, this research aims to explore the knowledge construction process of Hemodialysis in health broadcasting programs from a health communication point of view. This research intended to answer the following questions: 1) What are health radio program audience types? 2) How does the knowledge on hemodialysis differ among audiences? 3) What is the knowledge construction process among audience in regards to hemodialysis? Data were collected by ten episodes of the Kaohsiung Police Ration Station¡¦s ¡§Medical Network¡¨ program for a six month period (January ~ June 2011). This research has utilized content analysis method on the audience type, quantitative description on questions identified by the audience and qualitative methods to summarize and interpret the audience¡¦s knowledge construction process on hemodialysis. The results showed that the main audiences for health broadcast programs are mostly male, age 31 to 50 years, holding profession as drivers, service personnel and potential patients. Among them, the potential patients and their family members most often times ask diagnostic questions, falling into the compelled group in seek of knowledge. Those who have not been diagnosed with the disease often times bring up knowledge confirmation questions, belonging to the proactive knowledge chaser group. These two groups also demonstrated different hemodialysis knowledge construction processes. While the radio program host plays the role of knowledge enhancer to the diagnostic-need group (potential patients), the role transfers to a knowledge transformation model for the knowledge confirmation group (non-patients). Participating physicians follow the treatment process of ¡V examination, diagnosis and treatment to deliver information. The research process shall provide broadcasters or other media professionals a best practice on how the audience absorbs information - to study the distribution and motives of the audience and to deliver the knowledge of health and illnesses.

Throughout history, men have played a significant role in the field of nursing. However, they currently represent only 12% of nursing students and 9.6% of Registered Nurses. As a minority in their occupation, male nurses experience gender-based barriers and negative stereotypes that female nurses do not. Research has addressed these barriers and stereotypes, but has lagged in identifying the consequences of exposure to them other than men's reluctance to enter or stay in the field. With the nurse-patient relationship at the core of quality healthcare, it is important to further clarify the consequences of stereotype exposure for male nurses in the clinical setting. The purpose of this dissertation was to investigate the communicative consequences of exposure to gender-based stereotypes among male nurses through the theoretical lens of stereotype threat (Steele & Aronson, 1995). Stereotype threat describes the apprehension individuals experience from the prospect of confirming a negative self-relevant stereotype. In the reported experiment, the salience of gender-based stereotypes (women are more empathic than men; men are better managers than women) was controlled for while male and female nursing students completed a simulated nurse-patient interaction task. Findings from this study highlight the influence of subtle stereotyping in simulated nurse-patient interactions. Specifically, men were less grammatically accurate when participating under conditions of threat than when not under conditions of threat. This finding provides a need for caution as healthcare is experiencing a shift towards e-health, which will rely heavily on both the spoken and written word. Additionally, findings suggest that the disruptive potential of making salient stereotyped attributes (e.g., empathy) may be offset by patient gender. For example, male participants were less tentative under conditions of threat with a female patient than a male patient. The influence of patient gender provides optimism that a shift in gender-based stereotyping is occurring. Therefore, it is an optimal time to increase recruitment and retention efforts of men in the field of nursing. Recommendations for such efforts are offered as well as future directions for stereotype threat research in interpersonal communication and healthcare. / text

Obesity is an epidemic that causes physical, emotional, and financial tolls for both individuals and communities. The United States experienced a dramatic increase in obesity rate from 1990-2010 (Flegal, Carroll, Ogden, & Curtin, 2010), with more than one-third of adults and 17% of children in the United States now considered obese (Ogden, Carroll, Kit, & Flegal, 2012). Although most people agree obesity is a problem (Oliver & Lee, 2005), it is a disease with multiple causes (Wake & Reeves, 2012) and no straightforward solution (Phil & Heuer, 2009). Informed by theory and research on agency and attributions, the current study examined effects of explicit arguments and linguistic agency assignment on attributions of responsibility for obesity and support for public obesity policies. Participants (N = 211) were randomly assigned to read one of six versions of a health flyer defined by a 3 x 2 (Explicit Argument x Agency Assignment) factorial design and thereafter completed a questionnaire derived from previous research. Respondents across conditions agreed that obesity is a serious health threat, but differed in how they attributed responsibility for the illness. Those who read a message that consistently assigned agency to the disease (e.g., Obesity causes health problems) endorsed genetics as the cause to a greater degree than others who read a different version assigning agency to humans (e.g., Obese people develop health problems). In contrast, the human agency version prompted higher attributions of individual responsibility and greater support for upstream public policies aimed at reducing obesity (e.g., a snack tax on junk food, eliminating soft drinks from public schools, adding warning labels to foods with high sugar content). Results suggest explicit arguments are less effective in shifting perceptions of a stigmatized health threat than the implicit arguments created by linguistic agency assignment. The findings demonstrate specific message features that affect social attributions of illness (Heider, 1958; Weiner, 2006) and perceptions of responsibility for the onset and solution of health problems (Barry, Brescoll, Brownell, & Schlesigner, 2009; Niederdeppe, Shapiro, & Porticella, 2011). Theoretical implications, practical applications, and future research directions are discussed. / text

Unsafe injection practices put patients and healthcare providers at risk of infectious disease and have been associated with a wide variety of procedures and settings. Safe Injection Practices are part of Standard Precautions and are aimed at maintaining basic levels of patient safety and provider protections. However, from 1999 - 2009, more than 30 outbreaks of Hepatitis B or Hepatitis C from unsafe injection practices have occurred resulting in more than 150,000 patients being notified of potential exposure. Breaches in injection safety have the potential to be high profile and sensitive, and although individual incidents may vary, the actions that follow are consistent and predictable. Therefore, in collaboration with the Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP), I have compiled resources and templates to assist state and local health departments and individual healthcare facilities in their efforts to effectively communicate with the public and media about these incidents. Once the decision to notify patients has been made, this toolkit will serve as a guide to help the intended users through the notification process. Its purpose will be to help organizations notify patients, establish communication resources to support patient notifications, plan media and communication strategies, and plan the release of notification letters and other media. This toolkit will suggest practical ways to achieve effective communication using a stepwise approach. Resources and example materials are provided in this toolkit to facilitate the implementation of some essential tips and strategies. Once finalized and cleared by the CDC, this toolkit will be available to users through the CDC’s Injection Safety homepage.

The aim of this project was to examine which factors are important in influencing communication between health professionals and patients. Communication Accommodation Theory (CAT) was the theoretical framework adopted in this project. CAT proposes that individuals are influenced by their personal and social identities and that, in many cases, it is an individual's group or social identity that is most salient in an interaction. The underlying theoretical assumption in this project was that communication between health professionals and patients is characterised by intergroup rather than interpersonal salience and convergent methodologies were used to test this proposition. In addition to CAT, the linguistic category model (LCM), which is also used to investigate individuals' perceptions of intergroup salience, was adopted to complement the findings derived from CAT. There were seven studies in this project. The first study described the methodology for obtaining the data set used in Part 1 of the thesis. Participants wrote retrospective descriptions of a satisfactory and unsatisfactory conversation with a hospital staff member which they had experienced as a hospital in-patient. Study 1 provided a profile of the participants. In Study 2 the stimuli were participants' written recollections of 69 unsatisfactory and 79 satisfactory conversations. The LCM was used to test for differences in participants' perceptions of differing levels of intergroup salience between the two types of descriptions. While intergroup bias was evident, the results were complex. In Study 3 a qualitative and quantitative analysis of the same data set was conducted. This study explored differences between patients' and health professionals' goals, sociolinguistic strategies, and the patients' descriptions of the health professionals across the two types of conversational descriptions. Results revealed differences in goals, strategies, and descriptions. In the descriptions of satisfactory conversations, participants reported goals concerning reassurance and developing relationships. These two goals were not evident in the descriptions of unsatisfactory conversations, where attending to role relations was of greater importance. Participants reported the use of different sociolinguistic strategies for themselves and for health professionals across the different conversation types, which indicated that, for reports of satisfactory conversations, participants viewed their interactions with health professionals as more personal and positive than in the unsatisfactory ones. Participants described the health professionals in their descriptions of satisfactory conversations in more undifferentiated terms than the health professionals in the descriptions of unsatisfactory ones. Study 4 comprised two parts. First, using the data set from Studies 2 and 3, a qualitative analysis was conducted which explored thematic differences between the descriptions of satisfactory and unsatisfactory conversations. This analysis indicated more interpersonal themes for the satisfactory interactions and more negative intergroup themes for the unsatisfactory ones. Second, 134 participants rated 16 exemplar descriptions from the data set on 13 items derived from CAT. In general, the exemplars of satisfactory descriptions were rated as containing accommodative use of discourse management, emotional expression, and interpersonal control strategies. Exemplars of the unsatisfactory interactions were rated as more overaccommodative or counteraccommodative on these strategies. Study 5 introduced Part 2 of the thesis and involved a second data set. The stimuli were real-time videotaped interactions between health professionals and patients. Participants rated 25 videotaped interactions on 28 questions developed to tap the intergroup and interpersonal salience of the interaction. Of these 25 interactions, participants rated seven as highly intergroup and seven as highly interpersonal. These 14 interactions formed the stimuli for the Study 6. In Study 6 an LCM analysis of these 14 videotaped interactions compared the intergroup with the interpersonally rated interactions for levels of intergroup bias. The interpersonally salient interactions suggested lower intergroup bias than did the intergroup ones. This and other findings from the LCM analysis are discussed. Study 7 used a CAT perspective to examine six of the 14 videotaped interactions used in Study 6. These six interactions represented three videotaped interactions that were rated as highly intergroup, and three that were rated as highly interpersonal.. Participants provided ratings on both interactants' strategies, and health professionals' goals. They also rated the interactions for outcome measures, including patient satisfaction, and effective communication. Results indicated that the interactions rated as interpersonally salient were perceived as attending to relationship needs and emotional needs. Generally the interpersonal interactions were also rated as providing a more satisfactory outcome than the intergroup interactions. Together the seven studies provide evidence that interactions between health professionals and patients are essentially intergroup interactions. However, such interactions have the potential to move through dimensions of high intergroup and high interpersonal to dimensions of low intergroup and low interpersonal. Each pair of combinations provides different outcomes of communication effectiveness and satisfaction for the patient. Further, this research project demonstrates the ability of CAT to pick up on the dynamics of health provider and patient communication. It also highlights the usefulness of convergent methodologies to understand the complexities of patient and health professional interactions.

The global health system is ill prepared to handle communicable health crises, much less effectively communicate about them, as evidenced by the West African Ebola outbreak. Although some critics have argued that the delay in international response contributed to the fast spread of the disease, others place greater blame on local cultural practices. The current study investigated how risk/crisis communication was produced, deployed, and received. This is particularly critical as the World Health Organization guidance on crisis/risk communication is not based on systematic evidence-based research Again, risk communication on communicable diseases is still relatively new and the body of research lacks both rigorous empirical evidence and evaluation research on event-specific risk communication efforts. Guided by the protection motivation theory and social mobilization theory, and using a comparative case study approach, this study sought to examine how crisis risk communication was undertaken and received in Liberia and Ghana and the implications for health crisis risk communication. Data was collected via interviews with communication and social mobilization team representatives in the two countries, document reviews, surveys of a cross section of inhabitants in Margibi and Shai Osudoku districts, and focus group discussions with purposively selected participants in the two countries. The study finds that expert-led top-bottom communication interventions used at the start of the outbreak were ineffective in getting target audiences to make the recommended behavior changes in Liberia. Messages developed induced fear rather than action. Furthermore, one in five respondents today, cannot identify the main signs and symptoms of Ebola. Again, the more worried people were about Ebola, the more vulnerable they felt. Finally, respondents moved through a cycle from equilibrium to defense to protection and then back to equilibrium as they sought to make sense of the disease and the communication they received about Ebola. It is recommended that risk communication include bottom-up community-led communication approaches and systems that are embedded within community culture and reality and used by community members. Again, the research challenged the assumption in risk perception studies that increasing knowledge and self-efficacy lowers risk perception thus suggesting the need for further studies in this area. / 10000-01-01

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-09-04T11:21:45Z No. of bitstreams: 1 Diss Magali Sampaio. 2013.pdf: 967465 bytes, checksum: 94cb3fefc1c1d43d8a6bca373bdfb3e6 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-09-04T11:22:25Z (GMT) No. of bitstreams: 1 Diss Magali Sampaio. 2013.pdf: 967465 bytes, checksum: 94cb3fefc1c1d43d8a6bca373bdfb3e6 (MD5) / Made available in DSpace on 2013-09-04T11:22:25Z (GMT). No. of bitstreams: 1 Diss Magali Sampaio. 2013.pdf: 967465 bytes, checksum: 94cb3fefc1c1d43d8a6bca373bdfb3e6 (MD5) Previous issue date: 2013 / Torna-se cada vez mais pertinente investir em estudos que focalizem práticas dialógicas entre os atores sociais envolvidos no processo saúde-doença-cuidado. Parte-se do entendimento da comunicação e educação em saúde como processos que ultrapassam os esforços de abordagens com enfoque puramente informativo, e que se julgam capazes de influenciar comportamentos saudáveis, leva-se em conta os saberes circulantes, as representações e as crenças locais acerca de doenças de difícil controle, uma vez que estes são aspectos que podem influenciar no sucesso das abordagens em saúde, especialmente no caso da tuberculose - uma doença antiga, com forte estigma associado, e cujos índices epidemiológicos são alarmantes, apesar dos recursos disponíveis para seu tratamento e cura. As práticas de comunicação e educação em saúde que abordam esta doença devem levar em conta os aspectos supracitados, sendo necessário horizontalizar as relações e promover o diálogo entre os diversos saberes (popular e técnico) a fim de aumentar a busca pelos serviços de saúde e a adesão ao tratamento. Seguindo esta concepção, uma tecnologia de comunicação em saúde foi desenvolvida - o “Guia de Comunicação e Saúde: melhorando a interação comunicativa entre profissionais de saúde e comunidade no controle da tuberculose” (GCS-Tb) -, e disponibilizada aos participantes de um curso de extensão que visou transferir esta tecnologia. Esta pesquisa objetivou analisar o desenvolvimento de competências necessárias para a utilização do GCS-Tb, definindo-se como uma abordagem qualitativa de um processo de transferência dessa tecnologia. Considera-se que a aplicação do GCS-Tb permitiu o desenvolvimento das competências técnicas, organizacionais, comunicativas, pessoais e sociopolíticas, necessárias à utilização das estratégias propostas, além de estimular a reflexão acerca das práticas de intervenção sobre tuberculose em comunidades. / Salvador

This research examines information flow in online, interest-based networks to determine if existing models of information dissemination are adequate to describe the communication processes that occur in online publics. This study finds that a small number of primary influencers from within online communities are central to information collection, collation, and distribution in online, interest-based networks. This finding is inconsistent with one-step, two-step, and multi-step flow models, which privilege mass media as the central source of information. To more accurately depict online information flow in interest-based networks, this study introduces the radial model of information flow. Furthermore, the results of this study show that communication processes in online publics are best explained using a combination of the transmissive paradigm of communication, on which information flow models are based, and a ritual view of communication. This research also contributes to the ongoing development of the situational theory of publics by identifying organized publics as a key subgroup of active publics. Organized publics are networks of individuals within active publics who frequently and consistently communicate on a shared interest or concern. Organized publics form active online communication networks and prepare for advocacy related to a shared interest, making them of particular interest to public relations professionals. Using a case study approach, this dissertation uses online network analysis and qualitative cluster analysis to study the role of community influencers in information flow and cultural development within the online young adult cancer community. Instead of focusing exclusively on social media as channel for message dissemination, the results of this study indicate that successful relationship building can best by achieved by public relations practitioners who work to develop authentic presences in online communities. This research shows that embracing a participatory model of public relations that actively engages primary influencers in the planning and campaign implementation processes can promote authentic online presences.