Rebecca de Souza

The Past, Present, and Future of Health Development Campaigns: Reflexivity and the Critical-Cultural Approach

In contemporary society, health issues have gained increasing urgency in both political and academic spheres. Looking back at the failure of the modernist development initiatives, there is the need to realize that we live in a time of increasing sociopolitical complexity. The present moment is perhaps best understood in terms of a complex tension and linkage between the past and present, global and local, modern and postmodern. The critical-cultural approach to health campaigns is an approach that, through the reflexive interrogation of modernist assumptions underlying health communication campaigns, attempts to foreground the tensions inherent in the practice of health campaigns. This essay discusses the manner in which the critical-cultural approach interrogates modernist assumptions and provides an alternative paradigm for approaching the theory and practice of health campaigns by suggesting the necessity for reflexivity. Specifically, we discuss how the perspective interrogates the role of the media in development, the significance of culture, the locus of health responsibility, the impact of structural conditions, and the politics of knowledge, providing examples of campaigns that illustrate this reflexivity.

Creating “Communicative Spaces”: A Case of NGO Community Organizing for HIV/AIDS Prevention

This study uses the case study method to investigate the processes used by a local nongovernmental organization called the Society for Peoples Action for Development to organize sex workers in the slums of Bangalore, India, for HIV/AIDS prevention. The nongovernmental organization–facilitated HIV/AIDS program is based on the new paradigm of community organizing that encourages community participation and capacity building. Grounded in the culture-centered approach, this study documents the processes used to organize the women, while highlighting the role of communication in these processes. The study identifies 4 primary processes used to mobilize the community, namely collectivization, community awareness and sensitization, capacity building, and providing legal education and support. Each of these processes highlights the importance of attending to the economic, social, and political realities that shape the health of women. The common thread linking these processes together is the notion of “voice.” More specifically, each process serves as a catalyst to produce discursive practices that enable women to provide support to each other, increase awareness in the community about the problems that they face, build self-reliance through financial skills training and communication training, and defend their legal rights. In addition, the study suggests that the primary role of nongovernmental organizations should be the creation of “communicative spaces,” which are discursive and material spaces within marginalized communities and mainstream society where cultural participants can identify problems (oftentimes beyond the realm of health), manage solutions to those problems, and advocate for health and social change.This study uses the case study method to investigate the processes used by a local nongovernmental organization called the Society for Peoples Action for Development to organize sex workers in the slums of Bangalore, India, for HIV/AIDS prevention. The nongovernmental organization–facilitated HIV/AIDS program is based on the new paradigm of community organizing that encourages community participation and capacity building. Grounded in the culture-centered approach, this study documents the processes used to organize the women, while highlighting the role of communication in these processes. The study identifies 4 primary processes used to mobilize the community, namely collectivization, community awareness and sensitization, capacity building, and providing legal education and support. Each of these processes highlights the importance of attending to the economic, social, and political realities that shape the health of women. The common thread linking these processes together is the notion of “voice.” M...

Finding Meaning in the Loss of a Child: Journeys of Chaos and Quest

The death of a child can be one of the worst things to happen to a family. Despite the significance of such a powerful event, parental loss is an area that has not been fully explored in the literature. This study uses narrative methodology to explore the grief experienced by 10 parents before and after the death of their child. We found four primary tensions in the stories written by parents: a time of chaos and control; disruption and normalcy in family life; heartening and disheartening experiences with others; and senselessness and meaning in death. The analysis illuminates the personal, familial, and social nature of grief. Parents grieve the loss of their child, but they are also deeply affected by changes in family and social relationships. The discussion elaborates on the transformation that some parents reveal as they move from “chaos” to “quest” narratives, and the role of narratives in health and healing.

NGOs in India's elite newspapers: a framing analysis

Non-governmental organizations (NGOs) are deeply embedded within the socio-political landscape of India. NGOs were instituted by the Indian government specifically for the purpose of nation-building at the time of national independence in 1947 (Muttalib, 1987). In recent times however, NGOs have come under much scrutiny because of the expanding neoliberal agenda, and global discourse surrounding NGOs often involves questions of accountability. Communication scholars have studied NGOs in various contexts, but what remains unexplored is the question of how NGOs are portrayed within the media, which in contemporary society constitutes the public sphere or space of public opinion. It is important to look at the media because public legitimacy can have serious consequences for an NGOs ability to garner funds, influence policy, and build trust in beneficiary communities. This study thus asks the research question: How are NGOs framed in the Indian media? A qualitative analysis was employed to identify news frames or ‘interpretive packages’ used to talk about NGOs in two of the most widely-circulated English daily newspapers in India. The analysis identified four frames: the ‘do-good’ frame, protest frame, partner frame, and the public accountability frame. The findings show that, for the most part, NGOs are represented in a positive and even a nationalistic light, in spite of the larger global discourse interrogating NGO practices. The discussion elaborates on institutional, political, and historical reasons why NGOs are portrayed favorably in the newspapers.Non-governmental organizations (NGOs) are deeply embedded within the socio-political landscape of India. NGOs were instituted by the Indian government specifically for the purpose of nation-building at the time of national independence in 1947 (Muttalib, 1987). In recent times however, NGOs have come under much scrutiny because of the expanding neoliberal agenda, and global discourse surrounding NGOs often involves questions of accountability. Communication scholars have studied NGOs in various contexts, but what remains unexplored is the question of how NGOs are portrayed within the media, which in contemporary society constitutes the public sphere or space of public opinion. It is important to look at the media because public legitimacy can have serious consequences for an NGOs ability to garner funds, influence policy, and build trust in beneficiary communities. This study thus asks the research question: How are NGOs framed in the Indian media? A qualitative analysis was employed to identify news fra...

Local perspectives on empowerment and responsibility in the new public health.

The new public health is compelling because it uses the discourse of empowerment and participatory methodologies to promote health citizenship, but it has also been criticized for reinforcing an individual locus of responsibility while overlooking the role of the state in providing healthy environments. Thus far, much of the discourse surrounding the new public has tended to be the purview of public health experts and professionals. This study uses the interpretive approach to health communication to understand how debates regarding rights and responsibilities inherent in the new public health are appropriated by six employees at two community-based organizations that provide support to HIV-positive (HIV+) people in South India. I ask the question: How is the term “empowerment” understood by these individuals? Three primary dimensions of power emerged from my study: power from self-acceptance and inner strength, power from family and society, and power from self-reliance. In talking about empowerment, participants implicitly and explicitly made assumptions about who was responsible for health and health care; they argued that the individual and community were responsible for health, and reframed “rights” in terms of duty and citizenship. The discussion speculates on reasons for the heightened sense of personal responsibility, as well as implications it has for community health practice.The new public health is compelling because it uses the discourse of empowerment and participatory methodologies to promote health citizenship, but it has also been criticized for reinforcing an individual locus of responsibility while overlooking the role of the state in providing healthy environments. Thus far, much of the discourse surrounding the new public has tended to be the purview of public health experts and professionals. This study uses the interpretive approach to health communication to understand how debates regarding rights and responsibilities inherent in the new public health are appropriated by six employees at two community-based organizations that provide support to HIV-positive (HIV+) people in South India. I ask the question: How is the term “empowerment” understood by these individuals? Three primary dimensions of power emerged from my study: power from self-acceptance and inner strength, power from family and society, and power from self-reliance. In talking about empowerment, par...

An Evaluation of the Peer Helper Component of Go !: A Multimessage, Multi-“step” Obesity Prevention Intervention

Background Obesity prevention efforts typically involve changing eating and exercise behaviors as well as the physical and social environment in which those behaviors occur. Due to existing social networks, worksites are a logical choice for implementing such interventions. Purpose This article describes the development and implementation of a peer helper intervention, which was part of a multicomponent obesity prevention program conducted at a hospital worksite. It also presents qualitative evaluation findings of peer helper perceptions, roles, and institutional outcomes. Methods Fifty-one male and female employees were recruited to promote healthy eating and physical activity amongst their peers. They received health and communication skill-building training. Semistructured interviews were conducted with 20 peer helpers to evaluate this component of the intervention. Results Findings showed that peer helpers took on many helping roles, became effective role models, and contributed to creating health-promoting social and environmental changes at work. Discussion We found evidence for synergies between the peer helper component and other components of the campaign and present recommendations and questions related to best practices for peer helper interventions at worksites. Translation to Health Education Practice Training on the use of peer helpers and the incorporation of peer helper components into interventions is needed.

A qualitative study of roles performed by peer workers in the context of HIV in India.

&NA; While peer interventions have been shown to be effective in HIV prevention and support amongst intravenous drug users, women, youth, and other high‐risk populations, less is known about the particular roles peers play in disenfranchised and non‐Western contexts. This study examined the various roles peer workers played in the context of HIV in Karnataka, a southern Indian state. In‐depth interviews were conducted with HIV‐infected peer workers engaged in providing counseling, outreach, and health education to other people living with HIV. Grounded analysis revealed five roles: role model, persuader, maven, going the extra mile, and micro‐level advocacy. In the Discussion section, these roles are used to explore the relationship between peer work and empowerment. Findings showed that in addition to personal empowerment, peers were crucial to building social capital and challenging existing social norms in the community.