Emergent Health Communication Scholarship from and about African American, Latino/a/x, and American Indian/Alaskan Native Peoples

ABSTRACT

It is a privilege and honor to welcome you to this special issue of Health Communication which is based on scholarship that advances various divergent health issues pertinent to African American, Latino/a/x, and American Indian/Alaskan Native (AI/AN) peoples. The vision for this special issue which is a microcosm of the impactful research literature emerging from our field by Black, Latino/a/x, and American Indian peoples was to call attention to and acknowledge the breath of theoretically grounded and methodologically appropriate research in health communication. The 16 original articles featured in this issue reflect a robust compilation of topics from medical mistrust to tribal and elder leaders as health communicators and health promoters. The vision for the issue is that these articles serve as a platform that starts a meaningful and needed dialog within the field of health communication about the need for accessible and diverse scholarship from often-absent voices and/or narratives.

The process of developing a worldview that differs from the dominant worldview requires active intellectual work on the part of the knower, because schools, society, and the structure and production of knowledge are designed to create individuals who internalize the dominant worldview and knowledge production and acquisition processes. (Ladson-Billings, 2021, p. 158)

The field of health communication has experienced an emergence of scholarship by African American, Latino/a/x, and American Indian/Alaskan Native (AI/AN) communication scholars over the past decade. These scholars are ambitious and passionate and have a clear vision of how the field could better encompass the experiences of Black, Brown, and Indigenous folks of color.

As a senior scholar, I am transfixed by their ability to vocalize through their respective research endeavors the importance and need for more transparent and immersive scholarship. Scholarship that locates our lived experiences and narratives as central to shift the dominant culture paradigms is deeply valuable.

These scholars are committed to their own specific research areas to invigorate and reimagine conversations among clinicians, public health professionals, classroom environments, and communities. They are unabashedly calling for more equitable, community-centric, tribally centered, and transparent scholarship on topics of health disparities, health care, marginality, medical mistrust, social justice, and media and new technology as it relates to people of color. Their work advances various divergent health issues pertinent to Black, Latino/a/x, and AI/AN groups so that we clearly understand the powerful aspect of the human condition to know and be known as it relates to the negotiation of health and communication (Ladson-Billings, 2000). Invariably, this research provides a space to amplify the voices of our collective lived experiences through the vehicle of rigorous engaged scholarship.

It is a privilege to welcome you to the manifestation of this special issue. This is a compilation which I have envisioned for the past two decades. One does not always have the privilege to bring to fruition a compilation of this magnitude. For that reason, I am deeply appreciative of the receptiveness, support, and mentorship of the editor, Dr Teri Thompson. When I requested in a simple e-mail to Dr Thompson that the journal Health Communication provides a space for Black, Latino/a/x, and American Indian/Alaskan Native health communication scholars to advance innovative scholarship, she without hesitation said yes. The call went out in October 2019. There were 50 plus abstract submissions from which 25 went through the blind-review process. Sixteen were accepted for publication. Over the course of the months, in the midst of the COVID-19 pandemic, these scholars excelled. Thank you to the team of folks who etched out time in their busy lives to read through the first round of abstracts – Dr Kristina Ruiz-Mesa, Dr John Youngblood, Dr Lorenda Belone, and Dr Diane Francis. Thank you to the blind review scholars – a collection of experienced expert professors and practitioners – who understood the challenge and goal to not simply read the 16 manuscripts but provide detailed recommendations to each author with the intent to mentor them through the publication process and understand the importance of their research. The outcome is a profoundly rich compilation of scholarship which is a testament to the agility and dedication of people to work collectively to complete something greater than themselves. I hope each scholar can pause to see themselves in the issue, but more importantly, the worth of their voices and health and health-care research scripted into this special issue and into the field. Representation does matter.

The histories of Black, Brown, and Indigenous people in the U.S. are steeped in high rates of infectious diseases, chronic illnesses, mental health illnesses, low birth rates, infant mortality rates, and high maternal mortality that stem from centuries of racism, invisibility, inequality, and marginalization. The current cultural and political climate marks a point in which our experiences, stories, and truths are being mindfully and intentionally studied and shared. Shifting the paradigm continues to take time, but we must thoughtfully and strategically pursue this end, understanding that our field is enriched when we incorporate communication perspectives from health scholars of the African American, Latino/a/x, and American Indian/Alaskan Native diaspora. The 16 peer-reviewed articles featured in this special issue address these critical intersections.

This issue begins with Lillie Williamson’s article on the topic of medical mistrust. She notes that African Americans consistently report higher levels of medical mistrust than their White counterparts. She observes that even though most studies call for more research on medical mistrust, they neglect the vicarious experiences that transpire among Black people. Her detailed recruitment strategies used snowball sampling to garner participation from underserved populations in her online survey. Medical mistrust was measured with the Medical Mistrust Index (MMI) and her analytic procedure applied structural equation modeling to the hypothesis that racial discrimination leads to less trust in health care. Dr Williamson’s findings provide a wealth of insights, among which is that health-care providers must recognize the impact of the media environment and ways they represent and remind people of structural barriers and oppressive systems especially during the COVID-19 pandemic. Dually important, she notes, is the extension of research that investigates medical mistrust among Latino/a/x and Indigenous populations.

Next, Soroya Julian McFarlane and colleagues dive into the topic of community-based participatory research (CBPR) as a method that “centers on effective dialogue between research and community stakeholders with the goal of creating an equitable partnership for health and social change” (2021, p. 2). The authors provide a comprehensive 10-year systematic review of the status of empirical research on elements of CBPR that have been used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Their review notes a large increase in CBPR and a positive outcome in community participation. Findings address the value of more transparency about the extent of community participation and more accurate, thorough descriptions about the nature of partnership with minority communities with the intent of building on the literature on community-engaged methods.

Camille Saucier and colleagues explore the rates of unplanned pregnancies among Black and Latina teens using an entertainment-education video intervention – “Plan A.” The video intervention, which was developed in close collaboration with Black and Latina women aged 18–19, sought to ensure that the content was relevant, engaging, and motivational. The sample included Black, Latina, and non-Latina White women, with younger and White women included for comparison purposes. The authors found that exposure to “Plan A” significantly improved attitudes toward long-acting reversible contraceptives (LARCs) among all age groups and specifically among young Black and Latina women. They state that their findings may be explained by participant’s identification with the Black and Latina lead characters, both of whom model positive reproductive health behaviors. One of the most valuable conclusions from this study is the realization that collaborative approaches with intended audiences (Black and Latina women) can result in more dynamic entertainment-education interventions.

Moving from entertainment-education videos to entertainment programming, Diane Francis and LeChrista Finn used a culture-centric approach to investigate the role of television storylines in facilitating health-related conversations on the social media site Twitter. The authors examined Twitter conversations on the fictional television drama “Queen Sugar” to investigate sexual and police-involved trauma. Using a culture-centric model of narratives in health promotion, they classified 1671 tweets into four main thematic categories (identification, social proliferation, emotions, and intention). Although the authors note some limitations with the use of their hashtag #QueenSugarTalks and an inability to examine demographic data, they contend that Twitter may be an important vehicle for engaging difficult conversations, specifically for mental health communication with Black Americans.

As we consider the theme of police brutality and mental health among Black communities, Deion Hawkins' article introduces us to another important juxtaposition of scholarship. Drawing on Critical Race Theory (CRT), he addresses the too frequent incidents of police brutality. His article takes a phenomenological approach as he analyzes 27 semi-structured interviews with African Americans on topics of psychological distress, trauma, and police brutality in the Black community. His findings acknowledge the importance and usefulness of creating trauma-based communication models that frame brutality as a health communication issue as well as blueprints that advance police–community relationships in Black communities.

Although Critical Race Theory has been a debated framework, it is an imperative theoretical approach for understanding inequity. As such, the next article by Melissa J. Vilaro and colleagues provides a comprehensive overview of race and the usefulness of CRT for the development of culturally tailored approaches to reduce cancer inequities, specifically colorectal cancer (CRC). The authors investigate the use of virtual health assistants (VHA) to promote colorectal cancer screening among rural Black and White study participants. Their analysis with 28 focus groups (Black = 85, White = 69) tested the VHA intervention on mobile phones. Not only did Black focus group members prefer receiving information about colorectal cancer risk from VHA, they also expressed the value of sharing the intervention and colorectal cancer screening messages with younger members of their network. Among other recommendations, the authors observe the value of Critical Race Theory, health communication, and technology as a bridge for inclusive colorectal cancer messages.

Comfort Tosin Adebayo and colleagues also propose Critical Race Theory as a means to understand Black women’s experiences of pregnancy-related complications. The authors note the intersections of race, maternal health, marginality, and the structural barriers to pregnancy that are specific to how Black women are impacted by maternal health care. The study recruited 31 African American women to engage in interviews that took place in Milwaukee County, Wisconsin. The authors’ findings ask health-care administrators to be more vigilant in addressing the needs of African American women and other minority populations. This includes trainings that address racism and health inequities that might manifest knowingly and unknowingly in institutional practices. They also encourage active collaborations among individuals and organizations that care for women of color.

Derek Griffith and colleagues center the theoretical framework of African American Manhood to address the importance of scholarship that is population-specific and uses individualized messages to address minority health and achieve health equity. Their scholarship articulates the value of synergistically weaving manhood, tailored health messages for African American men, and intersectionality together. Their use of illustrations of African American men provides a powerful depiction of how distinct messaging can address societal factors like racism, gendered norms, values, and social expectations of Black men across a lifespan. The scholarship has a dynamic extension to other racial/ethnic groups and is valuable toward a better understanding of screening hesitancy, particularly of people of color, as well as distinct health intervention messages and educational materials for Black men.

Natasha R. Brown and La’Marcus T. Wingate introduce readers to health-related memorable messages and self-reports of diet and exercise behavior among Black women. Additionally, the authors use Control Theory to explain behavioral responses to memorable messages. Their cross-sectional survey was used to understand the relationship between receipt of memorable messages and dietary and exercise behaviors in Black women. Findings from this study suggest that receiving memorable messages not only impacts dietary choices but also acts to motivate greater frequency of exercise among Black women. Although the authors address the limitations of their work, they note that their research expands the literature on memorable messages and how Black women might enact holistic health-promoting behaviors through diet and exercise behaviors.

Charles R. Senteio and Matthew K. Ackerman tackle the critical topic of Black patients, dialysis, and awareness of transplantation and being on the transplant list. They present the implication of this racial disparity using Uncertainty Management Theory (UMT) to understand African American barriers and to getting on the transplant list and remaining there. Twenty-four Black end-stage renal disease (ESRD) patients participated in semi-structured interviews sharing their dialysis experiences and their understanding of transplants. The authors found that uncertainty is multilayered and social support can both dissuade the patients from getting on the transplant list and decrease uncertainty, especially when individuals wanted to be on the transplant list so they could be with family. The authors call for improved patient education surrounding treatment options and better communication of relevant transplant health information.

One observation that I have noted from this special topic issue is that we have a long way to go in the field of health communication toward advancing literature from and about American Indians. The article from Crystal Y. Lumpkins and colleagues is a relevant and necessary contribution. The authors delve into the topic of tribal and elder leaders as health communicators and health promoters within the Central Plains communities (Kansas, Iowa, Missouri, and South Dakota). Thirty-nine in-depth interviews were conducted by members of the Center for American Indian Community Health. The interviewees were all members of federally recognized tribes living in reservation and urban tribal communities across the region. The results from this compelling study indicate that these elders and tribal leaders do not necessarily see themselves as “authority” health communicators or health promoters within their tribe or community. However, the elders did feel that social and cultural authority using tailored and targeted messages from trusted sources could bolster health communication programs and have a positive impact on health outcomes among American Indian populations. The article ends by encouraging those who partner with Indigenous communities to communicate with community members to better understand if they feel health communication via trusted leaders would be useful.

A second distinct contribution to American Indian scholarship comes from Victoria LaPoe and colleagues. The authors use mediatization theory to understand US media coverage and Indigenous US media coverage of COVID-19. The goal was to observe its potential to impact policy decision and thus address the importance of evaluating health coverage of Indigenous communities by both Indigenous and non-Indigenous news sources. The authors used a qualitative textual analysis of the Indigenous and mainstream digital new sources, collecting 326 news stories for analysis. The findings from this study are deeply profound, providing a robust and important contribution to health communication scholarship. One primary take away is that mainstream news sources must produce stories about Indigenous health issues that are free from stereotypes which have “inculcated enduring schemas about Indigenous people” (2021, p. 10). Additional findings note that for diverse coverage, newsrooms must have reporters who are connected to Indigenous communities and that these reporters should have space to tell specific stories and need other critical opportunities for covering health in Indian country.

Latino/a/x scholarship was another important contribution included in this special issue. First, we hear from Monica Gallegos and Chris Segrin, who investigate the relationship between Latina/o cultural values of familism and health. The Latino Health Paradox, which is the central component of their scholarship, is investigated in combination with the theoretical model of loneliness and health. This study included 139 Latina/o and 116 non-Latina/o White participants who were from a parent study that documented the Latino health paradox in the sample. The authors’ findings suggest that familism may be a psychological resource in the Latina/o community and thus makes sense of lower loneliness and indirectly greater health. One valuable insight from the authors is understanding how cultural values, especially those based on interpersonal connections, can protect outcomes related to health and wellbeing.

Next, Suzanne Burdick and Sarah Nicholus provide a pilot study on a dually important topic, Latinx lesbian, gay, and bisexual (LGB) adolescent patients’ disclosure of personal sexual orientation and health to health-care providers. Their article highlights the layers of marginalization that reside between Latinx LGB patients’ cultural identity, sexual orientation, and sexual health. The authors used a participatory action research paradigm to conduct one-on-one interviews with participants that identified as Latinx. They found that Latinx LGB individuals have different reasons and motivations for disclosing information to health-care providers. One important call to action is to encourage health-care providers and systems to engage in diversity, equity, and inclusion training to mitigate unconscious bias and inadvertent microaggressions.

Yonaira M. Rivera and colleagues shed light on social media platforms, specifically one of the largest – Facebook – as a means to engage with and empower Latinos/as to participate in cancer control and prevention. Their mixed-methods study explores how Latinos/as engage with and act on cancer prevention screening information (CPSI) on Facebook. Findings from this study suggest that cultural values and other aspects of cultural connection influence how Latinos/as engage with, interpret, and act on cancer prevention screening information on Facebook. This work, which is the first to explore these phenomena, offers a valuable perspective on how to leverage social media, using it to curtail the effects of health misinformation as well as to create cancer education interventions and communication campaigns that have culturally tailored content.

To round out this special issue, we hear from authors Sarah De Los Santos Upton, Carlos A. Tarin, and Leandra H. Hernandez, whose scholarship is creating a powerful research space on environmental and reproductive justice, the U.S.–Mexico border, and health communication. In their article, they use reproductive feminicidio to explore the public advocacy efforts of Familias Unidas as a case study on gender violence against women on the reproductive spectrum. Their work identifies three rhetorical strategies – familia, comunidad, and (in)justicia – employed by Familias Unidas to shape their public argument(s). The most generative analysis this article brings forward is the reality that organizing efforts can highlight how “issues affecting marginalized communities are frequently obfuscated in health communication literature” (2021, p. 9).

In closing, the articles published in this special issue Emergent Health Communication Scholarship from and about African American, Latino/a/x, and Native American/First Peoples each highlight the importance of synergy and collective voices while they envelop the importance of representation – particularly at this time in our history. Each article speaks to the depth and breadth of talent, diversity of methodology, and the locations of health behaviors, perspectives, and health communication topics. They offer theoretical and practical approaches and applications to consider when engaging in research in partnership with and/or on African American, Latino/a/x, and Alaskan Indian/Native American peoples. The vision for this undertaking is to make sure Black, Latino/a/x, and American Indian researchers have a seat at the table of scholarship that is transpiring in the field of health communication. The publication process has its own set of challenges, but I hope we see a growth in theoretically grounded and methodologically appropriate scholarship from a breadth of racially, gendered diverse folks. I especially hope that scholars see the field of health communication and this journal as a safe and accessible space for their often-absent voices and/or narratives.

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No potential conflict of interest was reported by the author.

Additional information

Funding

The author reported that there is no funding associated with the work featured in this article.