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[BACKGROUND
PAPER]
WHAT WE KNOW ABOUT INFORMATION SEEKING AND USE
AND
HOW RESEARCH DISCOURSE COMMUNITY
MAKES
A DIFFERENCE IN OUR KNOWING
by
Brenda Dervin
Ohio State
University
Columbus, OH, USA
dervin.1@osu.edu
CITATION
AND COPYRIGHT INFORMATION
©
Dervin, B. 2001. Cite as: Dervin, B. (2001). What we know about information
seeking and use and how research discourse community makes a difference in our
knowing. Background paper prepared for Health Information Programs Development,
National Library of Medicine, Bethesda, MD. Available
[online]: http://communication.sbs.ohio-state.edu/sense-making/art/artabsdervin01nlm.html
ABSTRACT
The
purpose of this position paper is to describe the current state of empirical
study into everyday health information seeking and use and what implications
these research findings have for the design of information systems to better
serve user needs. Drawing on the
two fields that give the most attention to the study of information seeking and
use - - library and information science (LIS) and communication (COMM), this
position paper addresses how the two fields study information seeking and use
differently and what differences these differences make in results. The paper then draws propositional
themes out of each body of work showing where the propositions converge and
diverge. A major conclusion is that
while the two fields differ in numerous ways, they have both converged on a
conclusion that expertise-based transmission systems do not succeed
communicatively. Bottom-line, what
is needed to better serve user needs are systems and procedures built on
dialogic communication principles which allow users to access systems and
expertise in terms of the time-space contexts of their needs. The first draft of this paper was
submitted October 22, 2001 as a background paper to Eliot R. Siegel, PhD,
Associate Director for Health Information Programs Development, National Library
of Medicine, Bethesda, MD. This version, while still dated 2001,
has undergone systematic checking and corrections for all citations and
references as well as an editing.
The paper will be updated based on a new literature review in 2005 and
that revised paper will be linked to this one.
OVERVIEW
OF PURPOSE
My
purpose in this background paper is to summarize what I understand about
everyday health information seeking and use as supported by empirical work, and
to draw out the implications of this understanding for research and ultimately
for information system design. My
guiding focus is NLM's desire to get a handle on how MEDLINEplus can be
maximally useful and used by its mandated users, and how to conduct research to
create useful input for website design.
I
will implement my purpose with a propositional journey through my understanding
of everyday citizen health information seeking and use in a way that allows me
to illustrate why I approach research problems as I do. To this end, in this
essay I focus extensively on two academic disciplines and the work they do that
is relevant to health information seeking and use. It was not my intent to
provide such an extensive background paper, but as I dug into the literatures it
became apparent that I had to, in order to communicate well. The two literatures
that pertain most directly to health information seeking and use include one
from the communications field (COMM) focusing on information campaign design;
the other from the library and information science field (LIS) focusing on
information seeking and use.
The
difficulty is that there is very little overlap between these two literatures
and, in fact, the portrait that one gets of information seeking and use from the
two seems on the surface entirely unrelated to each other. Since my goal is to
present a propositional overview of what I think we know with reasonable
evidential support, I had to come to grips with the seeming incommensurabilities
of these two fields. In short, I had a nagging feeling that there was insight to
be gained from the effort even though it took far more time than intended.
Throughout
this paper, I will refer the members of the mandated publics of institutions by
a variety of names -- patrons, patients, users, publics, audiences, clients,
customers, and so on, depending on the research literature I am drawing from. In
all cases, my intended focus is the designated persons whom an institution or
system is mandated to serve even if only a small percentage is actually served.
In addition, I will draw on research from beyond the health information context
when I think it helps complete the portrait. I do this because research shows,
as I emphasize in my propositional presentation below, that the substantive
focus of information seeking generally accounts for less variance in information
seeking and use than other factors and that many important aspects of
information seeking and use are generalizable across substantive contexts.
I
proceed in five sections:
1:
A
background commentary on two academic
disciplines
2:
On
health information seeking and use: The public communication campaign
literature
3:
On
information seeking and use in context: The library and information science
literature
4:
On
online communication: More of the same
A BACKGROUND COMMENTARY
ON TWO ACADEMIC DISCIPLINES
What
seems like a simple task is in actuality not so because it requires I share as
briefly as possible my understanding of what these two disparate literatures
have to say that is pertinent. The difficulty is that these literatures say
different things. It isn't so much
that the literatures conflict, but rather that they provide potential insights
about this or that piece of what seems on the surface to be two different
puzzles. The puzzle pieces rarely seem to touch, or even in many cases to cohere
around the same end.
Even
for those places where the puzzle pieces do seem potentially relevant to each
other, the large differences in interpretive frameworks which drive the two
literatures makes developing a cohesive picture extraordinarily difficulty. The
difficulty is that the interpretive frames within which research is presented
necessarily drives how evidence is collected and interpreted, and it is here that these disparate research
approaches seem -- at least on the surface -- to be most
incommensurate.
This
problem requires attention because it is otherwise hard to understand why the
portrait of citizen information seeking and use that one gets from viable but
disparate literatures seems so entirely different. Does demography and
personality predict information seeking and use, as one research genre seems to
suggest? Or not, as another contends? Does cultural context provide avenues for
more effective health provision, or not? Are quantitative surveys an effective
way to learn about users? Or, are there efficient and effective alternatives?
And, so on.
None
of these questions have simple answers except when answered within narrow
literature confines. If one looks broadly, little is straightforward because, in
fact, the social sciences are, in important ways, in disarray (Carter, 1990,
1991; Dervin, 1991, 1993). There are wide varieties of competing "paradigms,"
which have very little communication with each other. In psychology, for
example, there are sub-fields -- clinical, social, ecological, and humanistic --
which have very little overlap with each other and present increasingly
disparate findings even about the same phenomena. In sociology, there is a
marked divide between quantitative and qualitative approaches even when they
focus similarly. The same is true of anthropology with its recently emerging
thrusts into, for example, critical and dialogic anthropology in contest with
traditional anthropology. And, for a variety of reasons, the communication field
is even more marked by polarities and disparate camps without communicative
bridges between. Communication mirrors sociology in its division into
qualitative and quantitative camps; and is further riddled by lack of robust
dialogue between U.S. scholars and communication scholars in the rest of the
world. This is a striking loss because in fact there is strong evidence that
capacities to dialogue across competing paradigms are stronger in the academy
outside the United States, particularly in Scandinavia, New Zealand, Australia,
and Canada.
Traditionally,
we would think that these divides could be transcended with quality
state-of-the-art-reviews and meta-analyses. Indeed some useful ones do exist within
genres. However, there are few that focus between genres because the fundamental
difficulty is not a lack of synthesis of evidence, but rather a lack of tools
for comparing seemingly disparate research approaches (Carter, 1990, 1991, in
press; Dervin, 1991, 1993). The
ways in which these disparate research genres ask questions and answer them are
so radically different that they appear incommensurate.
It
is too easy to say that the approaches differ methodologically because in fact
there is very little explicit attention to methodology in social science
research today (Dervin, 1999a). In quantitative studies, methodology is reduced
to method as if the mapping of random error is sufficient assessment; while in
qualitative studies, it is usually reduced to philosophic critique. Little
research attends explicitly to building bridges between theoretic assumptions
and broadly-defined methods -- that is, the methods of framing questions,
collecting and analyzing data, and interpreting results. Comparison of why
different research genres approach the same phenomena in such different ways
with such different results requires methodological comparison; unfortunately,
we are bereft of even a discourse that would allow such a
comparison.
Moreover,
our difficulty synthesizing across research perspectives is compounded because
we lack sophisticated tools for meta-analyses of research that are useful across
different research approaches. While once (in the 70s) there was a trend
emphasizing that all quantitative research should report variance accounted for,
now we see such figures only in very constrained genres of attention (e.g.,
public communication campaign penetration and effect rates is a notable
exception as exemplified by Snyder, 2001). When we move from more
straightforward persuasion and impact studies to studies attempting to test
complex theories, however, the problem of comparing results becomes more
difficult. Finally, when we move from quantitative studies to qualitative, we
see in some quarters a rejection of any kind of meta-analysis across contexts
and more generally a lack of frameworks for doing so.
Despite
these difficulties, my own research trajectory has traveled across these two
genres in good part because a central focus of its mission has been to build
bridges between them. Further, my work has been applied to a wide variety of
substantive attentions (e.g. library use, health information seeking, electronic
system use) which on the surface makes its trajectory look capricious. In
actuality, in all applications I have focused on how to conduct research to
assist in the design of more useful and effective communication and information
systems and procedures. This is an
important point for understanding what I write below. I take it as a given -- an
assumption based on evidence -- that there are more commonalities in information
seeking and use across substantive contexts than uniquenesses. The trick is to find a conceptual
framework which allows these commonalities to show while at the same time
honoring the uniquenesses of substantively different terrains. This has been one of my major goals --
the search, if you will, for what I call the universals of human sense-making
and sense-unmaking. It is a premise
of my Sense-Making Methodology that expanding our research foci beyond
substantive terrains provides better avenues for accounting for more variance in
human information seeking than the highly compartmentalized approaches that
currently dominate our work.
The
Sense-Making Methodology, which I have been working on since 1972, has been
developed as a tool for this alternative way of thinking about information
seeking and use. Its development has been pursued in many contexts with the
primary mission being to find better ways to think about and study users (i.e.,
audiences, mandated publics, patrons, patients, citizens, readers, and so on),
thereby permitting more effective research that more usefully informs the design
of communication/information systems and practices. Constant challenges in this
work have included, for example, how to conceptualize needs to permit
comparisons across applications contexts, and how to conceptualize users to
increase research capacity to account for variance in predicting use.
Even
though the Sense-Making Methodology has been applied in multiple, seemingly
disparate contexts, the research has all had the same purpose as specified above
and is brought to bear in this paper as one cumulative body, including studies
by Dervin and by others who have used the methodology. The application contexts include studies
of:
*Health
information seeking and use
(Baker,
1998; Brendlinger, Dervin, & Foreman-Wernet, 1999; Dervin & Clark, in
preparation; Dervin, Harlock, Atwood & Garzona, 1980; Dervin, Harping, &
Foreman-Wernet, 1999; Dervin, Jacobson, & Nilan, 1982; Dervin, Nilan, &
Jacobson, 1981; Dervin, Nilan, Krenz, & Wittet, 1982; Frenette, 1999;
Nelissen, van Eden, & Maas, 1999)
*Environmental
information seeking and use
(Madden,
1999; Murphy, 1999)
*Users
of libraries and information systems
(Dervin,
1992, 1997, 1999a, 2001e; Dervin & Clark, 1987; Dervin & Dewdney, 1986;
Dervin & Fraser, 1985; Dervin & Nilan, 1986)
*Everyday
citizen information seeking and use and sense-making
(Atwood
& Dervin, 1981; Coco, 1999; Dervin, 1984, 1997, 1999a; Dervin, Zweizig,
Hall, Kwan, & Lalley, 1977a; Dervin et al., 1976, 1977b; Nilan & Dervin,
1999; Palmour, Rathbun, Brown, Dervin, & Dowd, 1979)
*Information
seeking and use of professionals
(Cheuk,
1998; Cheuk & Dervin, 1999; Teekman, 1999)
*Information
use by targeted campaign audiences
(Dervin,
1981, 1989a, 1995, 1997; Dervin & Frenette, 2001; Dervin & Shields,
1999)
*Communication/information
gaps between "haves" and "have nots"
(Dervin
1980, 1982, 1989b)
*Researching
journalistic audiences and designing more communicative journalistic systems
(Dervin
& Foreman-Wernet, in press; Dervin & Huesca, 2001; Dworkin,
Foreman-Wernet & Dervin, 1999; Huesca & Dervin, in press; Spirek,
Dervin, Nilan, & Martin, 1999)
*The
uses and perceptions of users of telecommunication systems
(Dervin,
1995; Dervin & Shields, 1999)
*Participant
dialogues (in person and online) in multiple settings (e.g., informal,
organizational, governmental, citizen participation)
(Dervin,
1994b; Dervin & Clark, 1993; Dervin & Huesca, 1997; Dervin, Osborne,
Jaikumar-Mahey, Huesca, & Higgins, 1993; Dervin & Schaefer, in press,
1999; Schaefer, 1999)
*Organizational
knowledge management
(Cheuk,
2002; Dervin, 1998)
*Patrons
and audiences of arts institutions, popular and elite
(Dervin,
Wyszomirski, & Foreman-Wernet, 2000; Foreman-Wernet & Dervin, 2000)
*Media
practitioner encoding and sense-making
(Higgins,
1999; Huesca, 1999)
Along
with Carter (1990, 1991, in press), Thayer (1978, 1982, 1996) and Stephenson
(1980, 1995/6), I share a belief that if the communication field can construct
methodologies that focus on communication as communication, we would be more
able to free our field from its reliance on other disciplines. The difficulty with the approaches of
other disciplines is that they necessarily truncate their foci to particular
levels of analysis (i.e., psychology for the individual; sociology for the
collective; anthropology for the spatially bound collective) rather than to
communication processes which serve as linkages between levels (Dervin, 1991,
1993, 1994a, 1997; Dervin & Clark, 1989, 1993).
It
is because of this background that I am bringing to bear on this position paper
my understanding of what we know about everyday citizen health information
seeking and use, drawing on two primary literatures: the communication (COMM)
field's study of health information seeking in the context of public
communication campaigns; and the library and information science (LIS) field's
study of information seeking and use.
Each
of these literatures is, of course, served by other literatures. For example:
health information seeking and public communication campaigns overlaps the
extensive work in health communication generally, and also the work using
personality predictors of health behaviors (e.g., locus of control as predictor
of responses to uncertainty in health situations), the persuasion literature
(e.g., testing alternative ways of framing messages and attempting to map these
alternatives to cognitive predispositions and other personality attributes of
audience members), and a variety of literatures outside the COMM field which
focus on physician-patient interactions.
Similarly, information seeking and use research in LIS overlaps with
related genres, for example: work on information retrieval; database searching;
classification; indexing; and so on.
In
my judgment, the two literatures I have selected for primary focus this this
paper are most pertinent to the propositional narrative I want to present below
and provide a sufficient portrait of relevant related literatures. Adding the
related bodies of work adds detail but does not change the direction of the
narrative.
I
do occasionally add ancillary literatures from what could best be termed the
"cutting edge" of health studies.
For example, I include work from medical anthropology, ecological
psychology, and contextual psychology, as well as qualitative approaches to
health communication, nursing, and public health. An interesting aspect of the
difficulty one faces trying to get a handle on what we know in these terrains is
that in fact the ancillary literatures rarely inform the primary COMM and LIS
literatures. This seems true even
when their general sensibilities are in agreement and when the ancillary
literatures add important new understandings. Another interesting aspect is that
these cutting edge literatures tend to rise from the human support systems of
health care delivery rather than its core expertise systems. It is generally
fair to say that knowledge experts (e.g., subject specialists) focus on
transmission more than communication while their support systems (e.g.,
librarians, nurses) focus more on dialogue.
In
building my portrait of what we understand about health information seeking and
use, it is important to understand that although my own work has a significant
presence in both the COMM and LIS research genres, it does not have a
straightforward relationship to either. Sense-Making Methodology (Dervin, 1999a)
draws primarily for its methodological viewpoints on the work of theorists and
methodologians in the COMM field but not the sectors of the COMM field that
informs most of those doing research focusing on information transmission and
campaigns. Likewise, it could be
said that my work is informed by interpretive and qualitative scholarship even
though I apply the approach more often quantitatively while my doctoral students
have applied it more often qualitatively.
In the COMM field when it comes to compilations that focus on information
seeking and use, you usually see numerous citations to my work, and I am
generally identified as in the top 5% of communication academics in terms of
productivity and citations. But clearly, I am not a player in the COMM field's
approach to campaign studies, which is also the primary terrain where the COMM
field focuses on information seeking and use.
On
the other hand, in LIS many would label my work as the major force. Its
impact has been measurably significant. Vakkari (1997) noted that Dervin &
Nilan (1986) set new directions for studying information seeking and use in LIS
and that ". . .Dervin has today the most marked
metatheoretical influence on the studies of INS [information seeking] (p. 457).
Williamson (1997) commented in the same volume that the theoretical contribution
of Dervin ". . .has been profound. . ." (p. 337).
Others in LIS have written review articles on Dervin's work (Morris, 1994;
Neill, 1987; Savolainen, 1993) and there is currently a LIS doctoral
dissertation in preparation in Australia focusing on the constructing of meaning
and significance of Dervin's work in the LIS field. A citation analysis by
McKechnie, Pettigrew, & Joyce (2001) named Dervin along with Kuhlthau as the
two most cited theorists in human information behavior research. The differences
in the impacts of my work between COMM and LIS are another illustration of how
disparate these two fields seem.
However,
both the COMM and LIS literatures offer us some understanding of health
information seeking and use. Both fields focus on non-expert information seeking
and use. From the field of COMM with its focus on health communication and
communication campaign research, the traditional framework has focused on
assuring that appropriate health care is delivered to citizens. The central
theme of this work has been gaining compliance -- organizing informational
messages and health care delivery in such a way that there is an increased
probability that patients will comply with prescribed medical treatment or
citizens will attend to their health in mandated ways. From the field of LIS
with its emphases on information seeking and use, the traditional framework has
focused on serving needs -- assuring that a seeker goes away from the
information system with informational help.
Despite
the differences in their mandates, up until the mid 1980s at a foundational
level there were marked similarities in the literatures of these two fields. For
both, the task at hand was one of getting the right information to laypersons.
For the communication field this was conceptualized most often as a task of
enticing attention, persuading viewpoint, and encouraging behavior, all by using
appropriate information. For the library and information science field, this was
conceptualized most often as a task of facilitating access and mediating system
structures to link the user with a need to appropriate
information.
The
societal challenges that became increasingly evident as we moved into the 1980s
impacted both fields. Both faced growing recognition of the diversities of their
mandated publics, particularly in terms of gender, culture, and class
identities. Both faced the exponentially growing information stockpile and the
understanding that their "information" -- the stuff they transmit to their
publics -- was but a tiny point in an increasingly chaotic, disorganized,
uncontrolled, and rapidly growing information environment. And, both faced the
cynicism and malaise increasingly associated with the idea of information (or
knowledge) as having uncontested and neutral expert
foundations.
For
both fields what was formerly thought of as primarily a task of
well-orchestrated information transmission became infinitely more complex. Given the logics of their original mandates it is
not surprising that the two fields responded by pursuing different paths.
The
COMM field saw itself facing growing evidence of the limited effects possible
from health communication campaigns, and low compliance rates with medical
prescriptions. Researchers set themselves for the most part to the task of
finding ways to get the best results they could but with lower expectations. The
result of this journey is exemplified by the excellent compilation by Rice &
Atkin (2001) in which a wide variety of strategies are reviewed. In essence, the
communication approach to health information remained one of focusing on
persuasion and compliance but with more modest expectations and with greatly
complexified roads for getting there. Research began to pursue, for example,
multivariate models for predicting campaign impact (McGuire,
2001).
Many
arguments could be advanced of why LIS traveled a much different road because in
fact fundamentally both COMM and LIS as fields of practice rest their ultimate
measures of accountability on their communicative success with individual
members of their mandated publics. But fact is that the COMM fields had never
relied conceptually on an assumption of effective communication to each
individual member of an audience. In contrast, LIS as a practice measures itself
on such personalized and effective services. Hence, the forces of now apparent
diversity and complexity in society hit LIS practitioners in ways that only
became visible much later to the COMM fields. The result in the LIS field was a
period of deep reflexive evaluation of purpose and some of the first robust
calls for "user-oriented" approaches to research.
The
result was a marked turn in how LIS studied its users. The turning point is
usually punctuated with the Dervin & Nilan (1986) review (Morris, 1994;
Vakkari, 1997) focusing on information needs and uses in which they called for a
turn from transmission theories of users to sense-making or interpretive
theories. There are still transmission studies of information seeking and use in
LIS but they co-exist side-by-side with interpretive
studies, and discussions in LIS engage the contests and disagreements between
approaches. These debates inform LIS research and have allowed LIS research to
move in deliberate albeit struggling steps toward a
more holistic approach and to more heuristic theorizing. In my judgment, this is
why in general LIS is producing more useful research for understanding
information seeking and use in an electronic information environment than is
COMM.
As
background it is important to understand that the same kinds of calls for an
interpretive turn were made in the communication field (e.g., Carter, 1990;
Dervin, 1991; Stephenson, 1980; Thayer, 1982) but in communication, for myriad
reasons, a bifurcation resulted with the transmission orientation to
communication and the interpretative orientation to communication ending up for
the most part in separate literatures with relatively little overlap between.
Hence, to this day one can readily identify in the field of communication those
scholars who take transmission orientations to their studies and those who take
interpretive orientations. The former are usually quantitative and the latter
qualitative. The former most often rely on persuasion oriented theories to guide
their research, focusing on what produces greater attention, attitude change,
behavior change, and so on. The latter focus on understanding
how information users make sense of the health related life situations or
understanding the forces of society and culture that constrain such
sense-making. Both poles argue methodological issues but usually only
within their genres. For the most part even departments of communication in
Class I research universities increasingly show the same bifurcation. And, for
the most part, the literatures from the two poles do not inform each other.
Hence, the meaning-making thrust in health communication literature exists quite
independently of the focus on introducing change in the health communication
campaign focus. In even a single journal devoted to health studies (i.e.,
Journal of Health Communication), one finds the same disparities.
Further,
in actuality, explicit study of user information seeking and use has not been an
explicit focus in COMM studies since the late 70s and early 80s. At the more
quantitative end of the COMM field with its focus on transmission and
persuasion, information seeking and use has been mostly hidden in studies of
knowledge gain resulting from message transmission -- that is, do patients get
the doctor's information; do campaign audiences learn the intended facts. At the
more qualitative end of the COMM field with its focus on interpretation, studies
have often marginalized the concept of information as outside its theoretic
purview and focused instead of meaning-making. Or, they have examined how what
society calls information is inscribed by and in societal forces.
The
situation in LIS is entirely different. The same paradigmatic and methodological
tensions exist but they are muted and remain in dialogue. The result has been
the emergence of an identified literature genre now labeled "information seeking
in context" established formally in 1997 with the publication of the first
conference proceedings (Vakkari, Savolainen, & Dervin, 1997) and followed
by, in turn: Wilson & Allen (1999); Hšglund & Wilson (2000, 2001).
An
interesting impact of the LIS versus COMM field difference is that the LIS field
is not as constrained intellectually by the current emphasis on cultural
differences as the answer to communication dilemmas. Both LIS and COMM moved
from transmission theories of communication to cultural relativistic theories
and then to constructivist theories (which can be conceptualized as a more
detailed relativism, now applied at the individual rather than cultural level).
Both tumbled from there into the postmodern crisis (Dervin, 1994). What happened
next differs because the COMM field bifurcated into divisions that represent the
different steps of the journey -- transmission, cultural relativism,
constructivism, and postmodernism. In contrast, LIS's studies of information
seeking and use took all four perspectives onto one road. For this reason, in
LIS studies of information seeking and use cultural differences have taken their
place among a battery of alternative predictors. It is fair to say that for the
COMM field the primary research work that is being applied to understanding
information seeking and use and compliance still focuses on demographic,
personality, and lifestyle differences as the primary means of differentiating
users with cultural identification being a much-emphasized current approach. In
contrast, in LIS the primary means of differentiation has moved to descriptors
of context, situation, and practices. In an important way, in the COMM field the
unit of analysis remains the person; in LIS, it has become the moment of
intersection between user and system. As Zweizig & Dervin (1977) termed it,
the focus has involved a move from looking at use to users to uses.
The
discussion I have presented above rests, of course, on stereotypes. In between
the cracks of the main thrusts of the portrait I present above we find ourselves in the best and the worst of times for
social science scholarship. It is both exciting and confusing because the dust
of the postmodernism crisis (e.g., objectivity vs. subjectivity) has settled a
bit so researchers are searching for viable mediating alternatives, and because
the new technologies offer flexibilities in literature review as well as data
collection and processing not before possible. Young scholars in particular are
abrading their boundaries, and wherever one looks at the cutting edge one sees
calls for genuine dialogue across fields and at the same time calls for
approaches that break out of old restraints. The propositional review below
absorbs these innovations to the extent that cumulative evidence warrants it.
Finally,
before proceeding, it is important to distinguish between the rhetorical needs
of a political climate and what evidence says about human behavior. Two examples
will suffice.
One
concerns expertise, particularly medical expertise. Despite considerable
evidence about the elusiveness and changeability of medical knowledge and the
struggle of patients as well as doctors coping with overwhelming contradictions
in the medical information marketplace, medical knowledge systems still rest in
practice on transmission assumptions. Any recommendations regarding system
design and practice must be sensitive to this gap between evidence and normative
practice.
The
second concerns cultural differences, the by-word of the current moment for
accounting for differences between people. Evidence shows that in fact class,
education, and geographic locale are usually far stronger predictors than ethnic
identity per se; and further that when people who are culturally different see
their worlds similarly they are more like each other in terms of sense-making
and sense-unmaking than if they are culturally the same but see their worlds
differently. Given this evidence -- which I will present below -- if we speak
based on evidence alone we might suggest that there are more efficient ways to
conceptualize differences than culture. In fact, cultural differences when
reduced to ethnic and demographic attributes fast generate an astonishing number
of different ways one must design and implement communication. Take, for
example, only ten identity attributes with two values each. Intersecting them
yields more than one thousand possible communication designs if the intent is to
appeal to each identity sub-group (e.g., a group of older Hispanics, recently
immigrated, living rurally, and so on).
However,
the more fundamental issue for our societal moment is not the impracticality of
what I will call below a "noun" framework for understanding difference. The more
fundamental issue is that it is simply not rhetorically appropriate to
de-emphasize cultural categories even if they do not predict well. Further, it
is also true that evidentially there are conditions when culture is highly
predictive. Therefore, the more important goal is to identify the conditions
under which cultural differences are important to communication design. I will
speak to the issue of how to navigate these contradictions below.
In
proceeding below, I generally focus on the COMM literature in the first section
of the presentation and the LIS literature in the second. Occasionally, I cite
work from one area to support the other and vice versa. My format for the
presentation of propositions is to present the propositions as a continuing
coherent narrative illustrating under each proposition with relevant citations
from the literature: studies, as well as theoretical essays and
state-of-the-art-reviews. I do attempt to provide some degree of detail in
reporting studies because I am attempting to find connections between work ordinarily thought of as disparate in focus, so I want
to make the connections I see more visible
SECTION 2: ON HEALTH
INFORMATION SEEKING AND USE: THE PUBLIC COMMUNICATION CAMPAIGN
LITERATURE
2.1:
SOURCE-ORIENTED: Traditionally, the COMM field has not focused on information
seeking and use as a focal phenomenon for study. Rather the phenomenon of
interest has been compliance gaining via message construction and campaign
design. Traditionally, the approach has been source-oriented. The view is based
on institutional maps of the world, not the maps of
people-struggling-in-situations. The information presented is framed within a
worldview as defined by the expert institution, which has often focused on
victim-blaming and been ignorant of the experiential conditions and societal
constraints within which laypersons make sense of the world. This impact of this
difference on possible effectiveness seems fundamental given our basic
understandings of how communication works; yet, this is still the major
criticism to be launched against most public communication campaigns.
*Myrick
(1998), in his assessment of the effectiveness of a state-run HIV prevention
campaign in Alabama targeted to African Americans, noted that the target
audience saw the campaign as involving a White power structure targeting a
minority audience as in need of repair.
*Tardy
& Hale (1998) reported from their participant observation study of mothers'
conversations relating to health and illness that the conversations served to
"crack the code" of institutional messages and practices and at the same time
allowed the women to bond to each other. Their data led these researchers to say
that ". . .what is labeled noncompliance in the
institution could be labeled strength or survival outside the institution; not
survival of the body, perhaps, but survival of identity and spirit" (Tardy &
Hale, p. 153).
*Baer
(1996) concluded from his study of perceptions of health -- physical and mental
-- that the biomedical categories of health institutions may be inappropriate
not only to ethnic minorities but also to the mainstream population. He said of
his informants that ". . .their ideas and formulations of this domain of
existence were so different from the ways these issues were categorized by the
NCHS [National Center for Health Statistics] that the questions seemed
irrelevant to their lives and very 'distant' from their daily concerns" (Baer,
p. 63).
*Brendlinger,
Dervin, & Foreman-Wernet (1999) concluded that a traditional health
department survey of knowledge resulting from an HIV/AIDS awareness campaign
tapped how well audience members had memorized the institution's story but was
missing altogether how respondents constructed their own pictures.
*Sobo,
Zimet, Zimmerman, & Cecil (1997) came to the same conclusion in their review
of AIDS campaigns. They suggested that in their study of adolescent runaways,
high AIDS "knowledge" scores reflected rote memorization rather than
comprehension and application.
*Nelissen,
van Eden, & Maas (1999) in their Sense-Making study of practitioners and
patients in a comprehensive cancer center found that while health practitioners
focused on medical information, patient question-asking focused more on
non-medical questions.
*Dervin,
Jacobson, & Nilan (1982) found much the same in their study of information
seeking and use by blood donors -- much of the question asking focused on issues
which information systems traditionally term "subjective." In this context, many
donor questions focused on blood donors' struggles with themselves.
*Dejong
& Wallack (1999) evaluated the drug czar's antidrug media campaign as
ignoring the best of campaign research in its development. In particular, the
campaign neglected issues of audience involvement and
efficacy.
*Any
number of campaign studies still take a
blame-the-victim stance toward campaign failures. Often, these unwittingly take
on racist and stereotyped stances. For example, Donnelly, Mowery, & McCarver
(1998) judged their inner-city African American mothers as having inadequate
knowledge about substance abuse. Yet, knowledge levels were above average when
compared across a large number of campaigns in a variety of communities (Snyder,
2001). Or, Stephenson & Witte (2001) concluded that ". . .most people are incapable of accurately assessing their own
vulnerabilities to risky health behaviors" (p. 98). Yet, Klingemann (1995)
challenged risk related research as being obsessively oriented toward defining
risk taking as negative when in fact voluntary risk taking is part of both human
life-facing and even human pleasure-seeking. And, Dervin, Harpring, &
Foreman-Wernet (1999) emphasize on interviewing approaches can easily yield
distorted and shallow pictures of what is really going on in how people make
sense of their health struggles.
*Hillier,
Harrison, & Warr (1998) evaluated safe sex campaigns to adolescents and
concluded that they neglected teenager social contexts and the realities of
their lives and paid virtually no attention to assisting teens with the barriers
they saw to implementing safe sex alternatives.
2.2:
BAD GUESSES: Because of their focus on institutional frameworks, message and
campaign designers often make wildly wrong guesses about what publics do and do
not want. These guesses are usually erroneously confirmed by the usual
approaches to survey research because of the ways in which researchers
unwittingly constrain their data collection to yield the very answers they
expect.
*Carlson,
Siegel, Wang, Jichaun, & Faick (1996) in their ethnographic and survey
studies found evidence that contradicted the common myth in public health
literature suggesting that drug users find needle-sharing a desirable
behavior.
*When
the California Public Utilities Commission mandated informed consent for its
citizenry before the introduction of caller-ID, a marketing firm proposed an
education campaign based on the assumption that the public for the most part
would not care. Dervin (1995) noted in her assessment of the proposed campaign
that research increasingly showed the general public to be very attentive to
privacy issues.
*From
qualitative audience and policy studies of health mandates have come insights on how health campaigns ignore social
realities. Dievler & Pappas (1999), for example, noted how the common focus
on race and ethnicity as a predictor of health behaviors and susceptibilities
ignores the fact that social class and economic issues are as likely to offer
better explanations. The problem is made even more difficult because popular
media sometimes offer highly distorted views of medical realities, as for
example in television's treatment of HIV/AIDS as a deviant and stigmatizing
disease (Tulloch & Lupton, 1997).
*In
a Sense-Making study of information seeking in leisure time situations, Spirek,
Dervin, Nilan & Martin (1999) compared information seeking as it occurred
while reading newspaper leisure time coverage versus as it occurred in natural
everyday settings. The questions asked were significantly different. Further, a
comparison of question-asking in natural situations by college students versus
those asked by a general population sample showed few significant differences.
2.3:
COMPLIANCE IS AN INSTITUTIONAL CONCEPT: Compliance as a construct is derived
from an institutional map of the world. Human beings struggling with situations
as they move through time-space do not refer to their actions as compliant or
non-compliant. They naturally refer to struggles, useful information, useless
information, constraints, and so on.
*The
struggle with "who is the blame" for the relative lack of success of compliance
gaining activities has been, of course, a continuing theme for attention since
Bauer's (1964) germinal piece on "the obstinate audience." Dervin (1981, 1989a)
summarized this work by suggesting the operating metaphor was one of
conceptualizing audience members as if they were empty buckets. The obstinate
audience includes buckets that are either leaky (with holes in the bottom), or
stubborn (with lids put on tightly).
2.4:
DECREASING TRUST: Decreasing public confidence in expert information and the
institutions mandated to supply it has a major impact on communication
effectiveness making both attention and impact harder to achieve. This
phenomenon is generalizable across the U.S. population.
*A
Pew-funded study (http://www.pewtrust.org/, 1997) documented
that citizen evaluations of governmental institutions were lower than their
evaluations of trades people and local news -- at the bottom of the
institutional credibility grid.
*Sobo,
Zimet, Zimmerman, & Cecil (1997) cited a series of studies showing
"considerable mistrust" of statements regarding HIV/AIDS made by experts. Some
studies showed as many as 20% of African American men as seeing AIDS as a
governmentally sponsored form of genocide. In one study, the figure was 65% for
African American religious leaders. Other studies showed that as many as 40% of
adolescents did not trust government information on AIDS.
*Siegel
& Raveis (1997) found their minority (African American and Puerto Rican)
male informants both judged social service organizations as disinterested in
them.
*Guttman,
Boccher-Lattimore, & Salmon (1998) found a widespread mistrust in expert
information regarding the probability of AIDS
transmission.
*Tardy
& Hale (1998) found their informants -- young mothers in a toddlers'
playgroup -- distrustful of physicians.
2.5:
IGNORING SOCIAL FORCES AND ETHICS: A recent trend in campaigns research -- an
important one in the context of this background paper -- is the turning of
attention to placing the campaign in a larger political, social, and economic
context. It has been widely argued in recent work that this lack of attention
has been a major weakness in both campaign research and design. Ignoring these
larger contexts, some charge, is at best simply bad top-down,
transmission-oriented communication. At worst, it treats target audiences as
dupes without awareness of their larger environments.
*Proctor
(2001) warned that the prescriptive and eliminative aspirations of public
communication campaigns could have an unfortunate similarity to the same kinds
of aspirations manifested in the public education goals of the Nazi regime. He
called for reflexive examination of purpose particularly vis-â-vis how goals may
marginalize and stigmatize in ways parallel to negative forces in society. He
has also called for attention to how politics shapes the information that is the
focus of communication campaigns relating to cancer (Proctor,
1995).
*Myrick
(1998) noted how important it was that the HIV/AIDS campaign in Alabama targeted
at African Americans be aware of the adversarial history that had been
established in the past when Tuskegee stigmatized and targeted blacks with their
syphilis experiments.
*Guttman
(1997), in an important review article, discussed the ethical dilemmas faced by
health campaigns and often ignored in campaign design and research. Issues she
raised included: the ethics of persuasion and coercion; the possibility of
infringing on individual rights; the problem of targeting certain
sub-populations as particularly needy and the resulting stigmatization of
population sub-groups; the potential exploitation of family, community, and
cultural groups as vehicles for implementing campaigns; the de-emphasis on a
broader vision of social values.
*DeJong
& Wallack (1999) criticized the drug czar's antidrug media campaign for its
lack of attention to societal infrastructures (e.g., treatment programs) that
could support the campaign's objectives.
*Dervin
& Frenette (2001) challenged that campaigns and campaign research as must
focus on campaign and compliance efforts by attending to issues of social power
and ethics, how social class is often implicated in expert knowledge, how
audiences are increasingly weary of being judged wanting, and how audiences are
increasingly savvy about contradictions in the information marketplace.
*In
noting that there is in actuality little agreement about what constitutes an
information campaign effect, Salmon & Murray-Johnson (2001) noted that the
conceptualization of effectiveness has been more an accident of different
researcher's rhetoric than coherently adopted conceptualizations. They offered a
six category conceptualization as a potential organizing tool for research:
definitional (getting a phenomenon defined as a social problem); ideological
(implementing a definition of the problem as either individual and/or social);
political (using the campaign to garner political support); contextual
(assessing the match and interaction of selected mechanisms for change --
engineering vs. enforcement vs. education); cost (campaign costs not only in
terms of penetration, but in terms of savings to society and population); and
programmatic (the specific goals as defined for a given information campaign).
Their categories clearly made room for a specific focus on societal forces.
*This
trend is supported by an increase in campaign studies focusing not on
understanding audience members but on understanding the societal mechanisms that
promote particular behaviors. Alcohol use is a prime example where attention has
turned in good part to eliminating sources of media messages that promote
alcohol (Casswel, 1995, 1997).
*Another
example of a discourse analytic approach to studying health communication is
Jones (1998), who analyzed the way in which media, government, public, and
celebrity each brought their own theories of self and communication to bear on
the construction of AIDS celebrity in Hong Kong.
*Another
example comes from Harrison & Cantor (1997) focusing on understanding how
media presentations of thinness contribute to eating disorders.
*Others
calling for campaign research and design to include emphasis on social contexts,
societal power structures, and ethics include: Lupton (1994); Lyons &
Rittner (1998), Rakow (1989), Wallack (1989); Weiss & Tschirhart
(1994).
*One
frequent criticism is that campaigns in attempting to avoid controversy leave
behind reality as living people know it. One often cited example is the
reference in HIV/AIDS campaigns to bodily fluids instead of tears, sweat,
salvia, vaginal fluids, and so on (Ratzan, Payne, & Massett, 1994).
*Singer
(1998) provides an interesting counterpoint to the above arguments in his book
on the political economy of AIDS. He argues that AIDS policy is implicated in
societal racism, classism, homophobia, and so on, but he notes that changing
entrenched societal conditions is not an easier challenge than changing
individual behavior. The point the above authors make, however, is that ignoring
societal conditions introduces a communication gap between institution and
intended audience.
2.6:
LOW IMPACT: Given everything we know about what makes communication work more
effectively, it is not surprising therefore that in general attention to mass
mediated campaign messages ranges from usually dismal to moderate; and
compliance with medical expertise is rarely higher than 50% and often as low as
1-2%. A general caveat is that public communication campaigns work at best
modestly well and do so at great cost. In general, the larger the campaign
budget the greater the exposure and the redundancy of exposure and the greater
the impacts. Other factors relating to higher impacts include legal sanctions
and a chance intersection with some issue that has independently captured public
concern.
*A
host of authors has commented on the limits of campaign potential: Brendlinger,
Dervin, & Foreman-Wernet (1999); Freimuth & Mettger (1990); Myrick
(1998); Ratzan, Payne, & Massett (1994).
*Atkin
(2001) summarized the relatively modest effects from campaigns, noting that
effects varied depending on the behavior change mandated, the receptivity of the
audience, and the quality and quantity of messages.
*In
the campaigns he reviewed, Snyder's (2001) meta-analysis of campaign effects
found exposure rates ranged from a low of 13% to a high of 99% with an average
of 40%; and behavior change ranged from a low of 1% to a high of 41%; with an
average of 7-10%. Impacts on behavior were higher when the behavior involved
legal sanctions (17%); and when introducing new behaviors (12%) rather than
changing old ones (5%) or preventing behaviors deemed negative
(6%).
*Exposure
to campaign messages is a necessary condition for behavior change, of course,
and most frequently described as a linear positive relationship. Kane, Gueye,
Speizer, Pacdquemargolis, & Baron (1998), for example, found the impact of a
family planning campaign in Mali was directly related to intensity of exposure.
*Occasionally
a campaign has large impacts and usually this means the public had a readiness
already established by other means. A recent example outside the health
communication terrain illustrates the point: B. Givens (personal communication,
June 11, 1996) reported on the public education campaign on caller-ID mandated
by the state of California. The essential design of the campaign was mandated by
Dervin (1995) in her evaluation of the initially proposed public education
campaign, which she deemed seriously inadequate. Dervin concluded that because
of increases in privacy intrusions resulting from advances in telecommunications
technology, the public was already alert to privacy issues. When a campaign was
built around the slogan "your phone, your privacy, your choice," in a 3-month
period penetration rates were an exceptionally high: 74% general awareness; 69%
knowledge of how to prevent exposure of phone numbers; and 50% planning to
choose maximum security protection.
2.7:
RICOCHET EFFECT: A phenomenon that is not uncommon in public communication
campaigns is the ricochet effect where the campaign produces effects opposite to
those intended.
*Hafstad
& Aaro (1997) in their study of a mass-mediated anti-smoking campaign
targeted at adolescents found that a relatively high proportion of female
smokers decided not to quit as a reaction to the campaign.
*Herrmann
& McWhirter (1997), in their review of efforts to impact young people's
smoking, substance abuse, and sexual activity, found that some interventions
inspired the very behavior they were designed to prevent, and others inspired
refusal and resistance not to the targeted negative behavior but to the desired
campaign effect.
*McGuire
(2001) in reviewing the campaign literature specifically emphasized the ricochet
effect as being possible depending on the particular confluence of mediating
factors along any step in what he described as the multi-step campaign influence
chain.
2.8:
MULTI-STEP CAMPAIGN MODELS: The dominant response to the above within the
compliance-gaining and campaign literature has been to develop complex
predictive models incorporating measures of audience members' prior experience,
beliefs, prior knowledge, attitudes, and a host of other factors. While this has
increased predictive capacity, its important impact has been to change how
planners focus on message and campaign design -- moving slowly, and sometimes
reluctantly, from more institutional oriented frameworks to more
receiver-oriented frameworks.
*McGuire
(1989, 2001) has provided some of the best overviews of this body of work
presenting what he terms a communication persuasion matrix composed of groups of
factors in multiple domains: source, message, channel, receiver, and target
goal. He also conceptualizes the persuasion process in a series of steps: tuning
in, attending, liking, comprehending, acquiring relevant skills, agreeing,
storing in memory, retrieving from memory, deciding to act, acting, cognitive
integrating, persuading others. He describes the process as a very complex
multi-step chain which can easily ricochet to opposite impacts depending on the
intersections of mediating factors.
2.9:
MORE LIKE US EFFECT: In general, studies show that those most impacted by
compliance-gaining messages and campaigns are more likely to be more like the
very persons designing those campaigns in terms of demography, personality, and
lifestyle. Those "more like us" were also more likely to use sources, and
channels, and evaluate source credibility as we do.
*Guttman,
Boccher-Lattimore, & Salmon (1998) found in their survey that those more
likely to be informed about AIDS and expert sources of AIDS information were the
more educated. They also saw the experts as more credible.
*Rimal,
Flora, & Schooler (1999) concluded that in general education was positively
associated with most behavioral impacts from campaigns.
*Dervin
(1980, 1981, 1989b) reviews literature documenting the ways in which audience
members most impacted by campaigns are more like system designers
demographically and otherwise. She documents the same phenomena for LIS systems
as well. She terms the research genre that focuses on "knowledge gaps" as an
institutionally-inscribed view of the world. Those least like the experts are
most likely to be ignorant of expert knowledge. The difficulty with this
conceptualization, however, is that it ignores context and life conditions. Most
health experts, for example, would be ignorant of most aspects of migrant worker
life and survival, or of inner-city life and survival. In this context, the
experts would be in "knowledge gap." Dervin concludes the knowledge gap
hypothesis, while useful in some social planning contexts, must be applied
cautiously and must be examined reflexively so as to avoid insofar as possible
culturally and economically insensitive stigmatizations. Further, she emphasized
that designing systems based on knowledge gap hypotheses is doomed to failure.
*O'Keefe,
Boyd, & Brown (1998) found in a large Midwestern survey of exposure to
health information that their more educated respondents were more likely to
learn from print media.
*Trotter
et al. (1999) showed beliefs about AIDS in four culturally diverse Latino
communities were better predicted by education and income. The higher these
indicators were the more likely respondent's beliefs were closer to biomedical
beliefs. This work is an example of a medical anthropology project that has
concluded that the important gaps in communication in health care settings are
not between ethnic groups but between experts and laypersons (Baer,
1996).
2.10:
INFORMATION IS NOT ENOUGH: A general caveat of the campaign approach to
understanding information seeking is that information is usually necessary but
rarely sufficient. Across studies, the stability of this finding seems to hold.
It is, however, confounded by usual survey study emphasis on highly detailed
attributes of medical knowledge -- the kind that average citizens deem
unnecessary to their own health-facing approaches except for when their
situations warrant it. Hence, there is some counter-evidence that when people
come to information in a state of readiness information may be enough. This
issue is discussed below.
*Bakker
(1999) reviewed literature documenting that knowledge about AIDS was not
sufficient to cause behavioral risk reduction. Other mediating variables
accounted for the change. Among others making the same point: McGuire (1989,
2001); Rimal, Flora, & Schooler (1999).
*Davis,
Noel, Chan, & Wing (1998) showed that while their large sample of Hong Kong
adolescents had a lot of misinformation about HIV/AIDS, as judged by expert
standards, in fact few reported that they engaged in at-risk behaviors.
*Brendlinger,
Dervin, & Foreman-Wernet (1999) found that while the health department
wanted assessments of the knowledge levels of respondents on a battery of
detailed HIV/AIDS facts (e.g., can a baby get the virus from a nursing mom? does
it take only a few days to test positive? can you get infected by a mosquito?
and so on), their Sense-Making survey respondents focused on these items only if
their situational conditions warranted it.
*Myrick
(1998) in his review of HIV/AIDS prevention campaigns directed at rural African
Americans concluded that while most campaigns do successfully disseminate
information about the presence and danger of HIV/AIDS they rarely provided
contextualized information relating to specific behaviors and to skills for
modifying behaviors. Myrick saw this emphasis on behavioral efficacy as vitally
important for campaigns targeted at ethnic minorities.
2.11:
NOVELTY IS NEEDED: There is some evidence that the information that is presented
even if it does not directly impact change does need to be "new" in some way.
For some, this involves linking information with societal approved stimulators
such as entertainment and celebrity endorsement. For others, it involves simply
a need for new information because old information has already been processed.
*Donohew,
Lorch, & Palmgreen (1998) tested message strategies based on presenting
information in novel and sensation-arousing ways and found that in general they
got significant impacts but their results were stronger for those with
compatible cognitive needs.
*Petty
& Cacioppo (1996) presented evidence lending some support to the idea that
in fact depending on the audience involvement with the message the kind of
novelty used may or may not have impact. They described what they called a
"peripheral route" focusing on supplementary cues such as celebrity endorsement
and a "central" route focusing on cognitive engagement and
decision-making.
*Snyder
(2001) in his meta-review of campaign studies noted that campaigns offering new
information had higher behavior change impacts (14% compared to the 7-10% on
average).
2.12:
TREAT PEOPLE AS IF THEY ARE HUMAN: In general research agrees that recipients of
health information are more receptive when they feel respected and are treated
as capable and able agents rather than as recipients of behavioral modification
theory. The most general form of this understanding is manifested in a call to
turn from transmission approaches to communication approaches, focusing on
audiences as active and not passive, focusing on process and not outcomes. In
effect, it is fair to say that this call has become a general rhetorical stance
in campaign and information seeking literature. Even those implementing top-down
transmission campaigns still talk about them communicatively. But, bottom line,
the call to being communicative has slowly meant changes in either campaign
design and/or how campaign and information behavior research is approached. This
is more true for LIS research than for COMM research,
although here I focus primarily on the latter.
*Clatts
(1994) challenged in his conclusions after 10 years of AIDS ethnography that ".
. .AIDS prevention has become an exercise in behavioral
modification theory, an enterprise that seems to me to have more to do with
social control than with the prevention of a disease" (pp.
94-95).
*In
a review of health campaigns in general, Rimal, Ratzan, Arntson, & Freimuth
(1997) called for involving target audiences in genuine dialogue and in changing
public policy.
*Ruben
(1993) did a content analysis of critical incidents in health care focusing on
what patients remembered and concluded, as others have, that more than anything
else patients want to feel listened to, respected, and cared for.
*Tones
(1996) offered a deep critique of the social marketing approach to drug use
education, prevention, and policy.
*Myrick
(1998) called for attention to modeling campaign and health information efforts
as involving mutual responsibility.
*A
variety of other authors warn about using this or that technique to approximate
dialogic communication when in fact the intent is to ensure compliance (Guttman,
1997; Opie, 1998; Ratzan, Payne & Massett, 1994).
2.13:
ADDING COMMUNICATION INTERVENTIONS: The most common version of the
implementation of this call to focus on campaigns communicatively has been to
actually add communication interventions to campaign design in the form of
interpersonal, group, family, and/or community activities. The underlying
assumption here is that it is not possible to package messages in such a way to
promote this kind of communicative impact from within the message itself.
Therefore, communication activities must become carrier. This change has
consistently been shown to increase campaign impacts, improving exposure,
awareness and behavioral change, but within limits and with the possible ricochet effects identified above.
*Rimal,
Flora, & Schooler (1999) documented that exposure-induced information
seeking and discussion accounted for four times more variance in health behavior
change than exposure alone.
*Rimal,
Ratzan, Arnston, & Freimuth (1997) in their review of campaigns concluded
that the difference between the usually low impacts from campaigns and those
that had gained moderate successes were due primarily to explicit interventions
focused on increasing involvement.
*When
Valois, Adams, & Kammerman (1996) combined interpersonal communication (live
phone-in support sessions) with mass communication (televised program) on
smoking cessation, results showed a success rate on behavior change at the end
of one year of 17% compared to 5-15% for previously televised only
efforts.
*Dervin
(1995) in her review of campaigns emphasized the importance of adding
interpersonal, family, and community interventions as a substantial part of
campaign design.
*As
part of the Stanford Five-City Project, Rimal & Flora (1998) emphasized the
need to focus on families, as opposed to individuals, to change dietary
behaviors. Their campaigns were more successful when they conceptualized both
children and adults as potential sources of influence. In another report, Rimal,
Flora, & Schooler (1999) emphasized the importance of interpersonal
communication in campaign impacts.
2.14: THE CULTURAL ROUTE TO