Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

WOMEN, CYCLING, AND THE PUBLIC SPHERE: HOW DISCURSIVE AND COMMUNITY PRACTICES AFFECT ENGAGEMENT

This thesis considers the impact that discursive and community practices have on women’s access to the public sphere by examining female cyclists and a cycling community in Miami, Florida via interviews and observation. In the interviews, female cyclists frequently reported fears for their safety, including concern over harassment, when riding in public space. I interviewed participants of the cycling community and observed Emerge Miami’s meetings and events, where publicly organized cycling excursions were a major component. Using the theoretical and methodological lenses of Feminist Critical Discourse Analysis and Communities of Practice, I examined the interviews to understand how participants discursively framed and contextualized gender-based harassment. I found two meta-discourse frames in operation: a normative frame (that essentially accepted the status quo) and a feminist frame (that challenged the “naturalness” of women’s harassment as just what one had to live with). The feminist frame offered a pathway for women to exert control over their experiences and alter the cultural understanding of harassment’s meaning and effect. The local community practices of Emerge Miami also challenged the normative frames that often silence women, employing explicitly invitational practices, which demonstrates how local discursive and social activity can impact and increase women’s involvement by creating a more accessible space for women to engage with their local cycling community.