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.

Nongovernmental organization staff views of global water privatization

More than 1 billion people lack access to clean water and proper sanitation. As part of efforts to solve this problem, there is a growing shift from public to private water management led by The World Bank and the International Monetary Fund (IMF). This shift has inspired much related research. Researchers have assessed water privatization related perceptions of consumers, government officials, and multinational company agents. This thesis presents results of a study of nongovernmental (NGO) staff perceptions of water privatization. Although NGOs are important actors in sustainable water related development through water provision, we have little understanding of their perceptions of water privatization and how it impacts their activities. My goal was to fill this gap. I sampled international and national development NGOs with water, sanitation, and hygiene (WASH) foci. I conducted 28 interviews between January and June of 2011 with staff in key positions including water policy analysts, program officers, and project coordinators. Their perceptions of water privatization were mixed. I also found that local water privatization in most cases does not influence NGO decisions to conduct projects in a region. I found that development NGO staff base their beliefs about water privatization on a mix of personal experience and media coverage. My findings have important implications for the WASH sector as we work to solve the worsening global water access crisis.