 |
 |
 |
|
  AN EXEMPLAR STUDY IN THE HIV/AIDS CONTEXT OF THE USE OF SENSE-MAKING AS AN APPROACH TO PUBLIC COMMUNICATION CAMPAIGN AUDIENCE RESEARCH
Brenda Dervin
Lois Foreman-Wernet
Abstract.This article presents an exemplar of the uses of the Sense-Making Methodology in two ways: as a tool for audience research in the formative stages of planning public communication campaigns; and as a methodological critique, offering an empirical comparison of the portrait of the audience that emerged from a Sense-Making driven survey versus a traditional close-ended survey. This article rests on recent critiques of the traditional survey, which until recently was the only acceptable approach to audience research. The critiques call for diversification of research approaches and attention to how surveys often ignore political, economic, social, and cultural issues. The study reported here compared the two audience surveys in the same context -- an HIV/AIDS education campaign. The traditional survey consisted primarily of closed-ended measures of knowledge, attitudes, and behavior. The Sense-Making survey elicited respondent narratives regarding three HIV/AIDS related situations using Sense-Making mandated open-ended questions. The resulting portraits of the audience confirmed a major theme in recent audience research literature -- that the audience portraits were in many ways incommensurate. The traditional survey appeared to tap frustration and how well audiences had memorized the dominant story, but was missing altogether the stories arising out of situated lives tapped by the Sense-Making survey. The purpose of the study reported here was
to provide an exemplar of the use of the Sense-Making Methodology as a
tool for audience research to be used in the formative stages of public
communication campaign development, and to illustrate the important ways
in which a Sense-Making study differs from a traditional audience survey.
The first section of the article presents a brief review of the "state
of the art" in campaign audience research. The purpose of this review is
to provide a context within which the attributes of Sense-Making as an
approach can be described and compared to the traditional audience survey.
In approaching this article in this way, the purpose is to provide an exemplar
in at least two senses. One is an example of the use of Sense-Making as
a research approach. The second is an example of the use of Sense-Making
as a tool for methodological critique.
The particular context which is the focus of this article is public
education relating to HIV/AIDS. Despite a high level of awareness among
the general public, the AIDS epidemic continues to pose a tremendous threat
to human life. According to the National Institutes of Health, nearly 14
million people worldwide have died from AIDS, and more than 30 million
are currently living with the AIDS virus. Although the AIDS-related death
rate has declined in the United States in recent years, the rate of new
infections has not changed. Thus, while new treatments are delaying death,
the spread of the epidemic clearly has not slowed. Indeed, there have been
alarming increases in AIDS-related deaths among women, ethnic and racial
minorities, heterosexuals, adolescents, drug users, and people more than
50 years old. The disease continues to disproportionately affect the most
disenfranchised in society: those who are poor, those who are homeless,
and those with addictive or mental disorders. (Nathanson,
1999; Siegel & Raveis, 1997)
Even though the Center for Disease Control in 1992 made health communication
a priority in the national HIV/AIDS prevention strategy by stressing the
role of communication in the research, planning, implementation, and evaluation
stages of all educational efforts (Myrick, 1998),
the current status of the epidemic belies any claim to success. Recent
literature suggests there are two related critical reasons for this failure.
One is that the design of public communication campaigns continues to be
conceptualized according to the traditional sender-message-receiver model.
In effect, institutions focus on messages or information that they hope
will result in the desired behavior changes or responses from recipients.
The second is that audience research which serves the formative stages
of public communication campaigns has embedded within it the very same
top-down transmission model.
The Transmission Model of the Public Education Campaign
In this view, the job of audience research is to determine people's
knowledge, attitudes, and behaviors as they relate to HIV/AIDS. The job
of the campaign, then, is to attempt to eliminate what are perceived to
be deficiencies or deviancies through information or persuasion.
Under such a transmission model of communication, knowledge about the
institution's audience is most often achieved through audience surveys
or polls that focus on AIDS/HIV as defined by the sponsoring institution.
Respondents are asked questions that allow researchers to match respondent
attitudes, knowledge and behavioral reports with the institution's ontological
assumptions. In other words, respondents are asked to place themselves
on a "map" that has been "created" by the institution and its researchers,
rather than on "maps" that reflect their own worldviews, experiential conditions,
and life struggles. Given this transmission view of the campaign, the system
map imposed on the audience is necessarily antiseptic, removed from political,
economic, and social struggles and advanced as if it were an unproblematic
representation of absolute truth.
While the transmission model of communication still dominates AIDS research
and education, in the face of repeated failures there has been an outburst
of creative attentions, including: 1) critiques of the inattentions in
public communication campaigns to the political-economic-social forces
which impact health policy and public education; 2) criticisms of the traditional
audience survey as a tool for formative assessment; and, 3) a call for
diversifying research and, in particular, moving toward more audience-oriented
approaches. Each of these trends is reviewed briefly in turn below.
Inattentions to Political-Economic-Social Forces
It is fair to say that criticisms of research approaches and pursuit
of alternatives are the major keys in discussions regarding HIV/AIDS audience
research. Relatively few authors have argued the need for campaigns to
be grounded in more attention to political-economic-social forces, but
those who have have advanced strong arguments. 1
Dievler and Pappas (1999), for example, argue that
there needs to be greater institutional understanding of the complex social
dimensions of public health problems as well as more consideration of how
issues of social class and race affect the politics of the policy-making
process and its successful implementation.
Across authors the arguments can be described as pursuing five major
themes suggesting that public communication campaigns: 1) privilege authoritative
worldviews (institutions' and researchers') over lay people's worldviews;
2) treat scientific knowledge as if it were absolute across time and space
and free of error, particularly in relationship to the mandates of the
campaign; 3) define the major problem of the campaign as the ignorance,
apathy, or inappropriate beliefs and attitudes of the audience; 4) blame
the victim by putting the burden of the success of the campaign primarily
on the individual member of the audience; and 5) remove campaign mandates
from their political, economic, and social contexts. 2
One example of this kind of critique came from Myrick
(1998) who noted how too many public health programs seemed to involve
white public health administrators transmitting assumed-to-be true, accurate,
and value-free information to less capable minorities. Another from Carlson,
Siegel, Wang, & Faick, (1996) focused on the false assumptions
and stereotypes that public health efforts too often bring to their approaches
to specific target audiences, particularly marginalized groups. Clatts
(1994), echoed the point even more strongly: Of particular concern is the fact that AIDS prevention has become an. . . enterprise that seems to me to have more to do with social control than with the prevention of a disease. We continue to represent AIDS as a disease that strikes "the other.". . . (Clatts, 1994, pp. 94-95) The Traditional Survey and Its Criticisms
The primary tool for gaining an understanding of audiences in the formative
stages of public communication campaign design has been the audience survey
implemented primarily through a series of closed-ended questions. Criticisms
of the survey have had a long history As early as 1964, for example, Bauer
spoke to this criticism in his article on the "obstinate audience," where
he argued that researchers should use a transactional model of communication
because: It opens the door more fully to exploring the intention and behavior of members of the audience and encourages inquiry into the influence of the audience on the communicator by specifically treating the process as a two-way passage. . . . But the persistence of the one-way model of influence discourages the investigation of both directions of relationship. (Bauer, 1964, p. 327) More recent expressions of this concern have come from some of today's most prominent experts on the public opinion survey. Krosnick in his 1999 review on "survey research" stated that for the first time in decades conventional wisdom about survey research is being challenged. Likewise, Yankelovich, a recipient of an important public opinion research award, in a 1996 article focusing on a "new direction for survey research" said: Far from giving leaders insight into the real concerns of the public, [surveys] often add to the disconnect that separates the leadership class . . . from the mainstream of the citizenry. (Yankelovich 1996, p. 2) This concern has been widely mentioned although
the ways in which authors have attended to it have varied. At one extreme,
among researchers strongly anchored in quantitative variable analytic traditions
one sees a call for going beyond measures of what people know, feel, and
think because these are not necessarily related to what people do. In this
context, there have been, for example, calls for better sampling of target
audience groups as well as calls for the introduction of measures focusing
on audience involvements with issues as well as their relevant community
and family networks. 3
Other authors, however, clearly have not seen the adding of new and
different variables to the survey roster as a sufficient, or even a necessary,
remedy. They have focused far more on the dialogic impacts of imposing
a system map of HIV/AIDS on audiences. A list of the impacts with sample
studies emphasizing each can be summarized as follows.
1) That traditional surveys have measured primarily how well people
are acquainted with mainstream medical knowledge or have reflected rote
memorization rather than the deep internal interpretive frameworks within
which people act in their lives (Sobo, Zimet, Zimmerman
& Cecil, 1997; Warwick, Aggleton & Homans,
1988).
2) That surveys have produced misleading, invalid, and/or irrelevant
data which, while it looks scientific, may simply express people's frustrations
(Donsbach, 1997; Yankelovich,
1996).
3) That survey researchers have judged within their own worldviews the
behaviors of audiences as uninformed and self-destructive when in fact
these behaviors may be informed and rational. Pinkerton
& Abramson (1992) suggested, for example, that people who take
risks have concluded from available information that the risks are worth
the gamble.
4) That surveys, most of which are funded by government, have ignored
in their data collection the context of the relationship between the citizenry
and government. Recent studies have found, for example, that there is a
great deal of mistrust of citizens toward governmental and expert information
(e.g. Guttman, Boccher-Lattimore, & Salmon, 1998).
Siegel
and Raveis (1997) and Sobo et al. (1997) concluded
from their studies that those perhaps most at risk, including minorities,
were more likely to not trust information about HIV/AIDS that is provided,
and believe that information is being deliberately withheld. The point
here is that if respondents are not provided with an entry for talking
honestly about their judgments and doubts with the very institutions asking
them questions there can be no foundation for open dialogue.
5) That while public health officials are concerned with identifying
how different population sub-groups differ in their deviations from the
institutionally endorsed map, there is evidence that the biggest gap is
not between different socio-economic subsets of the audience but between
lay people and health professionals. In effect, there is an institutional
view which is highly different from lay views, so different that they appear
incommensurate (Baer, 1996).
Reaching for Alternative Research Approaches
These criticisms of the public communication campaign and the traditional
audience survey that has supported it intersect on a central theme. As
Clatts put it: . . . the undaunted search for quick-fix models forces us to crawl into very narrow boxes and it jeopardizes our ability to see the world as it is, as well as our ability to offer constructive ideas about how to change it. [Our] models. . . lead us down conceptual paths that have little or no relevance to the way people actually live, and hence inevitably to strategies and policies that have no efficacy in terms of prevention. (Clatts, 1994, p. 95) In the context of these criticisms, it is
not surprising that there has emerged in recent work a variety of calls
for diversifying approaches to audience research for public communication
campaign formation. Some of the calls have pointed toward alternative approaches:
in-depth and conversational interviews, surveys using open-ended rather
than closed-ended items, focus groups, ethnographic fieldwork, case studies,
text analyses. Some call for combining traditional quantitative approaches
with alternative qualitative approaches. 4
The portrait that emerges is one suggesting that the close-ended traditional
survey is no longer the only accepted approach to campaign audience research.
If anything, there appears to be a widespread interest in diversifying
research approaches and using methods which do not impose worldviews on
respondents. From long-time purveyors of the traditional survey have come
arguments that high response rates on representative samples are not necessary
for representativeness; that conversational interviewing can significantly
improve data; that there are "distinct disadvantages" to the use of closed-ended
survey questionnaire items; and, that open-ended items are "not as problematic
as they seemed" (Krosnick , 1999, 543-4). At the
same time, from postmodern-oriented researchers come calls for applying
postmodern and critical approaches to health care research in more straightforward
and less esoteric ways (perhaps even using some tools of quantification)
while retaining the postmodern emphasis on the problematizing of truth
claims about reality. 5
The common thread throughout these criticisms is a call for culturally
and experientially sensitive audience-oriented research -- for understanding
how members of the audience make sense of, categorize, and give meaning
to the issues and concerns about which the campaign intends to communicate;
for approaching the intersection with audiences with a dialogic stance;
for setting all interpretations within the larger context of socio-political-economic
forces. A Sense-Making Exemplar The purpose of the exemplar study reported
here is to illustrate how the Sense-Making Methodology was applied to the
HIV/AIDS campaign context in one small pilot study. In essence then, we
conducted an audience survey but did it in a Sense-Making way. A secondary
purpose is to compare the results of the Sense-Making survey with those
of a traditional, mostly closed-ended telephone survey questionnaire conducted
in the same context. This section starts with an explication of Sense-Making
as a methodology which attends to the mandates described above. This is
followed by sections focusing, in turn, on: 1) the traditional survey and
its context; 2) the exemplar Sense-Making study -- its sampling, questionnaire,
fielding, and analytic approaches; 3) results, cast within the context
of comparing the Sense-Making survey to the traditional survey; and 4)
conclusions.
Sense-Making's Methodological Framing
The Sense-Making approach has been developed for more than 25 years
by Dervin and her colleagues and has been applied in a wide variety of
research contexts. It is the most widely cited theoretic and methodological
approach to the assessment of user needs and evaluations in the field of
information and library science (Morris, 1994; Savolainen,
1993, Vakkari, 1997). It has been applied in
a variety of health communication contexts (summarized in Dervin,
1989; 1992; 1999b)
and has most recently been reported in a large-scale empirical study of
the communication needs and assessments of telephone users designed to
address issues of the gap between policy makers and citizens in the telecommunications
arena (Dervin and Shields, 1999, Shields,
Dervin, Richter, & Soller, 1993).
Sense-Making's practical mandate from the beginning (Dervin,
1989) has been the development of a methodological approach that allows
institutions to listen to citizens (by any other name, e.g. users, patients,
audiences, patrons, clients, customers) on their own terms. Sense-Making
as a methodology is built on an elaborate critique not only of the imposition
of traditional approaches to audience research, but also the lack of methodological
systematization of both traditional and alternative approaches. What Dervin
(1999a) means by this is that we have few examples of approaches to
research that attempt to explicitly build bridges between their philosophical
assumptions relating to methodology and their actual methods. Dervin and
colleagues have made some progress in doing so but it is a project still
very much in process.
Sense-Making's philosophical assumptions include both ontological and
epistemological incompleteness. Accepting ontological incompleteness assumes
that reality is itself incomplete, at least in part, both because of changes
across time and space, but also because of inherent discontinuities. Accepting
epistemological incompleteness assumes that any so-called "expert" knowledge
is at least partly incomplete because human observing is constrained to
particular time, space, cultural, physiological and psychological contexts.
Taken together, these assumptions require researchers using Sense-Making
interviews to share their role as "theorists" with respondents, inviting
respondents to name and interpret their worlds and to draw connections
and conclusions. Inherent to this mandate is an assumption that human beings
are to some degree or another social theorists who have both potential
and interest, given communication procedures which genuinely invite dialogue,
to connect their particular circumstances to larger social forces.
Thus, the Sense-Making survey differs from the traditional survey in
four important aspects. First, the Sense-Making survey invites respondents
to develop their own constructs used in their maps -- i.e. to "name" their
own worlds, in Freire's (1970) terms. Second, the
Sense-Making survey invites respondents to explicitly draw connections
among those constructs -- to name, for example, the effects they see resulting
from exposure to information or the reasons why they are being asked to
do something with which they do not agree. Third, the Sense-Making survey
invites respondents to talk freely about successes, failures, and struggles
particularly vis-a-vis the structures and forces within which their lives
have material being. Fourth, the Sense-Making survey is based on the idea
that to be human is to be inherently mandated to bridge those "gaps" that
are manifestations of epistemological and ontological incompleteness. 6
This metatheoretic assumption does not imply that humans are constantly
in a state of linear problem-solving. Rather, it assumes that gap-bridging
is an inherent mandate of the human condition.
To implement these mandates, the Sense-Making Methodology rests on a
central metaphor that as people "move" they constantly face gaps in their
life-moving journeys. Operationally, in the Sense-Making interview, this
is implemented by asking people to describe critical life situations, describing
the gaps they saw themselves as facing, the situations and historical conditions
that gave rise to the gaps, the bridges they built across gaps, and the
outcomes of doing so. As a methodology, Sense-Making then requires that
the framing of research questions, the collecting of data, and the consequent
analyses and interpretations be framed with attention to a core set of
basic concepts: time, space, history, movement, gap, and power (energy).
A vital aspect of the methodology implied by its attention to time,
space, and movement is that Sense-Making posits a theory of the human subject
as both potentially changeable and potentially stable across time-space.
It does not assume, as most traditional audience surveys have, that the
person is the carrier of consistencies across time-space (as conceptualized
in many uses of demographic and personality variables) or even that the
person is the appropriate unit of attention in data collection. Rather
it is the person-situation-practice intersection which Sense-Making assumes
as its central unit. While actual analyses may focus on the person because
policy makers construct the world that way, Sense-Making suggests that
it is only by focusing on moments of practice, what Sense-Making calls
"verbings" (Dervin, 1999a) that we can invite
our respondents to fully share with us their pertinent life stories with
their successes and struggles and their understandings of their material
conditions and the forces that operate in their lives.
The Traditional Survey and its Context
The traditional survey, commissioned by the health department of a large
southern state, was administered to 2,503 respondents in a statewide telephone
sample obtained by random-digit dialing. A check of the sample to the state's
census data on gender, ethnicity/race, age, and education showed a close
match. 7
The average interview took about 20 minutes and was conducted in English
or Spanish, depending on the preference of the respondent. The questionnaire
consisted of items assessing respondent demographic characteristics, attitudes
about several AIDS-related social policy issues, knowledge about AIDS and
the HIV virus, information sources used to learn about AIDS, and behavior
that might place the respondent at risk of contracting the HIV virus. For
purposes of comparison with the Sense-Making surveys, this paper reports
only on the 10 knowledge, seven attitude, and seven behavior items from
the traditional survey that focused specifically on HIV/AIDS. The actual
items and responses are presented below in the section on results.
The Exemplar Sense-Making Study
The Sense-Making survey used the same random-sampling procedures including
random digit dialing but was limited to one telephone area code. The phone
interviews were conducted one month after the launching of the traditional
survey described above. The sample size was 63 respondents. A comparison
of the demographic variables of the Sense-Making sample with those of the
traditional survey showed a close match. 8
The respondents were interviewed with the use of a Sense-Making survey
instrument described below. Like the health department questionnaire, the
Sense-Making instrument was designed to take about 20 minutes although
some Sense-Making phone surveys in other contexts have successfully used
average interviewing times of up to 40 minutes. The interview was conducted
in English or Spanish, depending on the respondent's preference.
Some readers may be given pause by the comparison presented herein between
a traditional survey with 2,503 respondents and a Sense-Making survey with
only 63. Statistical analysis is not, however, the purpose. The intent
is to examine the patterns and character of the differences and extract
implications for the conduct of campaign research. The comparison is one
that is particularly appropriate in the context of the literature review
which introduced this paper and its attention to the possibility that large
surveys do not necessarily produce representative results.
For the purposes of this study, the Sense-Making survey was designed
to elicit information about what respondents did, felt, and thought when
they faced gaps relating to AIDS, and how they saw their experiences (including
mass media and campaign exposures) as affecting them. Specifically, in
the study reported here, the intent was to determine: 1) the nature of
the situations in which respondents faced gaps relating to AIDS; 2) the
nature of the gaps they faced in these situations; 3) the nature of the
cognitive bridges they constructed; 4) the successes and failures they
saw in their gap bridgings; and 5) the effects (outcomes, impacts) they
saw as resulting from their successes and failures. The particular Sense-Making
framework applied was that most often used in prior studies of information
seeking and use.
Respondents were asked to discuss at least two situations, sometimes
three. In the first situation, respondents described a time when they had
heard or learned something about AIDS. After that description, respondents
were asked if they had gotten any new ideas in that situation and what
the effects of those ideas were. They were then asked if they remembered
having any questions at that time. In regard to the question they identified
as most important, they were asked: a) how important that question was
then and now; b) how easy or difficult they thought it was to get an answer
to that question, then, and now; c) if they tried to get an answer and,
if not, why not; d) if they had tried to get an answer, how they tried
and what problems they encountered; e) whether they ever got an answer;
and, f) how getting an answer impacted them.
The same set of interview questions was asked of respondents in describing
up to two additional situations. For the second situation, respondents
described a time when they or someone they knew may have been exposed to
AIDS. For the third situation, which was elicited only from respondents
who had not mentioned mass media in either of their first two situations,
respondents described a time when they had read, heard or saw something
about AIDS in the mass media.
On the surface, it might appear that the traditional and Sense-Making
surveys have few points of comparison. The link conceptualized for this
article is twofold: 1) a comparison of the relative emphases respondents
in the different studies placed on the authoritative map as manifested
in the items of knowledge, attitudes and behaviors introduced by the health
department in the traditional survey; and 2) an examination of how respondents
in the Sense-Making study conceptualized their own maps in terms that illuminate
our understanding of the differences between the traditional survey and
the Sense-Making survey.
To attain this comparison, five different operations were conducted:
1) extrapolation of a battery of the knowledge, attitude and behavior items
from the traditional survey relating specifically to AIDS/HIV; 2) application
of this list of items through deductive content analysis of the Sense-Making
interviews; 3) comparison of these two lists; 4) inductive content analysis
of the Sense-Making interviews in order to define a list of cognitions
(ideas constructed and questions asked) presented by the respondents and
a list of effects from these cognitions as presented by the respondents;
and 5) extraction of qualitative themes from the Sense-Making interviews
which illuminate the pattern of findings from the content analyses.
The quantitative Sense-Making data in this study was derived via content
analysis of the Sense-Making interviews. Interjudge coding reliabilities
were calculated using the Stempel percentage agreement index (1955)
between the judgments of the master coder (senior author of this paper)
and one other person. Reliabilities across all measures ranged from 90
to 100%. The outcomes of these operations are presented in the results
section below in two phases. The first focuses on the results of the deductive
content analysis of Sense-Making responses driven by the the traditional
survey's categorizations of HIV/AIDS issues. The second focuses on the
results of the inductive content analysis of Sense-Making responses driven
by application of Sense-Making's attention to movement through time-space
from situations, across gaps, to outcomes.
Thus, in the presentation that follows, the two studies are first compared
based on the assumptions underlying the traditional survey. Then the Sense-Making
survey is presented in a manner consistent with its own assumptions. Results
are discussed below in three stages -- first by focusing on the results
from the deductive analyses; second by focusing on the results from the
inductive analyses; and third by extracting major qualitative themes arising
at the intersection of both analyses.
Results from Deductive Analyses
The items from the traditional survey used in this comparison include
all of the items asked about knowledge, attitudes and behaviors in relationship
to AIDS. Table 1 reports the percentages of respondents in the traditional
survey who gave correct responses (as judged by the health department)
to 10 knowledge questions, who agreed or disagreed with 10 attitude statements,
and who reported that they had or had not participated in a set of seven
assumed to be risky or protective behaviors.
===========================================================================
Table 1. The percentages of respondents in the traditional Department
of Health survey responding in pertinent ways to items tapping knowledge,
attitudes, and behaviors, compared to percentages of respondents in the
Sense-Making survey mentioning same points of attention.
=========================================================================== A direct comparison between responses to the
traditional survey and those from the Sense-Making survey is not possible.
The traditional survey focuses on judging respondents' answers as in line
or out of line in some way -- did respondents know the "facts" the health
department assumed they should know? did they disagree with attitudinal
items considered to be "inappropriate"? did they report behaviors judged
to be "risky" or protective? In contrast, the Sense-Making survey invited
respondents to talk about HIV/AIDS from entirely within their own phenomenological
worlds. Because of these disparities, Table 1 does not attempt to present
an item by item comparison. Rather, the focus is on what percentage of
the Sense-Making respondents even named one or more of the specific knowledge,
attitudinal, or behavior items which were the focus of the traditional
survey.
The pertinent results in Table 1 can be summarized very succinctly.
The map of categories regarding HIV/AIDS imposed by the traditional survey
on its respondents was a weak fit when applied deductively to narratives
provided by the Sense-Making survey respondents. Only 31.7% of the 63 Sense-Making
respondents mentioned one or more of the specific issues implied by the
10 knowledge items; only 17.5% talked in any way about any of the specific
attitudinal items; and only 25.4% mentioned one or more of the risky or
protective behaviors.
Results from the Inductive Analyses
The inductive analyses described here focus on the Sense-Making survey
respondents' reports of their cognitions vis-a-vis facing HIV/AIDS related
situations, and the effects they saw these cognitions as having on them
and their lives. Table 2 focuses on the cognitions which were coded into
10 categories -- six directly related to AIDS as a disease, and four relating
to concerns regarding AIDS in the context of their lives, relationships,
and communities. Table 2 also reports the percentage of respondents who
mentioned at least one cognition in each of the 10 categories along with
a selection of three or four verbatim statements by respondents which served
to define each category.
===========================================================================
Table 2. Results of the content analysis of respondent narratives focusing
on their cognitions (ideas and questions), with illustrative quotes and
percentages of respondents mentioning a category one or more times. ===========================================================================
Cognitions were derived from respondent descriptions of questions and
confusions they faced and answers they constructed. What does not show
in Table 2 is the large amount of cognitive activity reported by these
63 respondents. They reported 194 ideas, or a mean of 3.1 ideas per person;
and 105 questions, or a mean of 1.7 question per respondent. Ideas and
questions taken together, the respondents in the Sense-Making study produced
299 cognitions, for a mean of 4.8 per respondent. Only one respondent reported
having no ideas or questions in the situations discussed.
Table 2 shows that AIDS transmission was by far the most common topic
for the respondents (74.6%). Other categories mentioned by at least a quarter
of the respondents included: concern for self, family, or friends (58.7%);
feelings toward people with AIDS (31.7%); AIDS symptoms (28.6%); and the
cure and treatment of AIDS (25.4%).
Table 3 reports the results of the inductive analyses coding respondent
reports of the effects having cognitions had on them. The effects of the
cognitions were coded into two broad categories -- behavioral and emotional.
Under the behavioral effects eight individual variables were coded. In
addition, six emotional effects of the cognitions were also coded and three
composite variables were calculated tapping respondent reports of one or
more emotional effects in general and one or more positive and/or negative
effects. Table 3 also reports the percentages of the 63 Sense-Making respondents
who mentioned effects as a result of their cognitions, along with verbatim
statements which served to define each category.
===========================================================================
Table 3. Results of the content analysis of respondent narratives focusing
on the effects (impacts and outcomes) they described as resulting from
their cognitions, with illustrative quotes and percentages of respondents
mentioning a category one or more times. ===========================================================================
Only 12% of the respondents reported no effects; the others mentioned
a wide range of effects. More than half of the respondents reported taking
some action as a result of their cognitions. No one action seemed to take
preeminence, but looking for more information was reported by the largest
percentage of respondents (15.9%). Other behaviors reported by at least
10% of the Sense-Making respondents include sharing information (12.7%),
being careful about casual contacts (12.7%), and being careful about sexual
behavior (11.1%).
Almost 40% of the Sense-Making respondents mentioned an emotional effect
as a result of their cognitions. Once again, no one emotional effect seemed
to take preeminence. The emotional effect most reported was becoming scared
or anxious (17.5%). The only other emotional effect reported by at least
10% of the respondents was the opposite effect, becoming relieved (11.1%).
Other frequencies pertinent to this discussion, but which are not shown
in tabular form, include: 1) that in the Sense-Making study, 69.8% of the
respondents indicated they knew the "official" information about AIDS was
that it could be contracted only through sexual behavior, intravenous drug
use or blood contact; and 2) 22.2% of the respondents explicitly indicated
that they did not trust the accuracy of this "official" information.
Qualitative Themes in Results
The purpose of this final results section is to draw major themes from
the intersection of the deductive and inductive results above in terms
of their implications in the context of the literature review which grounds
this paper.
Necessarily, this discussion must start with asking why the map of knowledge,
attitudinal, and behavioral items imposed on respondents aligned in so
few ways with the Sense-Making narratives. One possible interpretation
could be that the Sense-Making respondents were very different from their
health department survey counterparts. But the demographic comparisons
of the samples suggests otherwise.
A second possible interpretation is that the Sense-Making respondents
were much less knowledgeable than their counterparts in the health department
survey. But the data from the Sense-Making study indicates clearly that
the Sense-Making respondents were neither apathetic nor passive in relationship
to AIDS. For example, looking at the Sense-Making data on "knowledge,"
almost 70% of the respondents, without being asked, made statements that
indicated they believed one can get AIDS through sexual transmission, intravenous
drug use or blood transfusions. Perhaps more interesting, however, is that
about 22% of the respondents in the Sense-Making study volunteered that
although they knew the "official" information about getting AIDS (drugs,
sex and blood transfusions), they doubted that information. Some actively
disbelieved; most questioned how the government and experts could be so
sure.
These numbers do not indicate apathy or passivity, but a way of framing
"knowledge" that is different from the health department's. The respondents
did not focus on the technical details that interest the health department.
Rather, they discussed issues that directly pertained to their lives.
The sheer amount of cognitive activity in relationship to AIDS was also
high among the Sense-Making respondents. The Sense-Making interviewers
had asked them what ideas they had during a particular situation and what
questions they had asked. The 63 respondents reported 299 cognitions (new
ideas or questions) during their interviews, or almost 5 per respondent.
The range of these cognitions was also impressive, including cognitions
about the disease itself; the respondents' reactions to the disease in
relationship to themselves, family members, friends, co-workers and acquaintances;
the respondents' feelings toward people with AIDS; their desire for or
the quality of AIDS information; and political concerns.
A basic premise of the Sense-Making approach is that respondents necessarily
share in the task of theorizing their worlds. Reflecting back on this premise
and review of the state of the literature which grounds this report, it
is particularly useful to look more closely in two areas that the traditional
versus Sense-Making surveys treated very differently -- confidence in AIDS
information and other political concerns.
The percentage of respondents in both samples reporting lack of confidence
in information was surprisingly close considering that the traditional
survey asked the question directly and the Sense-Making instrument did
not. In the traditional survey, 28.5% of the respondents reported that
they were "not at all confident" or "not too confident" about the completeness
and accuracy of the information they were getting about AIDS while 22.2%
of the respondents in the Sense-Making study mentioned they did not trust
the information provided by "official" sources. However, the difference
in how this data was contextualized in these studies is an example of what
happens when respondents are allowed to theorize within the interviewing
process.
In the health department survey, after being asked about their confidence
in AIDS information, respondents were immediately asked a series of questions
regarding how much they trusted information about AIDS from a variety of
sources, including mass media, doctors and other health workers, religious
leaders, spouses and sexual partners, and friends. Interestingly, they
were not asked about how much they trusted information that came from government
or other official sources, such as the Surgeon General or reports of government
sponsored research. This was particularly noteworthy considering that the
study was funded by a governmental agency and the survey did ask respondents
if they had read the pamphlet that had recently been mailed out to citizens
by the Surgeon General's office.
In contrast, in the Sense-Making survey, the interviewing approach was
designed as a dialogic interface which asked respondents to describe their
material worlds in terms of gap-facing and gap-bridging. This, in effect,
invited respondents to talk about their struggles with bureaucracies and
structures because such struggles are a universal feature of life-facing.
As a result, when respondents in the Sense-Making study talked about their
lack of confidence in AIDS information they also freely shared how they
had blamed the government and official sources for that mistrust. Reasons
for not trusting official information included: some respondents did not
understand how government could be so sure of all the ways AIDS can be
transmitted when they do not yet have a cure; others charged the information
provided being confusing or contradictory; and others indicated that mistrust
began to develop after children and heterosexual adults began to come down
with the disease. Some respondents indicated they felt the government just
did not know, others that the government was keeping information away from
the public in order to avoid panic.
When respondents were given the opportunity to theorize about AIDS information
from their own worldviews, their responses reinforced criticisms of the
transmission model of communication campaigns. In particular, these respondents
challenged the assumption that the responsibility for good health should
rest primarily with the individual and not with political or social institutions;
they made it clear that there were aware of discrepancies between their
views and those of the experts, and they were aware as well of conflicts
and confusions in so-called authoritative reports.
Likewise, considering how each survey treated political issues illustrates
similar concerns. The health department survey asked respondents a series
of attitude questions, at least four of which could be labeled as overtly
political -- about HIV-positive children attending school, HIV-positive
school employees working with children, quarantining people with AIDS,
and legal protections for people with AIDS. In addition, the survey also
asked a series of questions about whether certain people should be tested
for the HIV virus, including prostitutes, people arrested for having sex
with prostitutes, people arrested for intravenous drug use, prison inmates,
health workers such as doctors and dentists, people getting married, people
applying for medical insurance, and pregnant women.
In the Sense-Making study, respondents volunteered no information relating
to HIV positive school employees working with children or whether people
with AIDS should have legal protection. Less than 5% mentioned quarantining,
and in all cases they were against it. And a few more (6.3%) mentioned
HIV positive children attending schools -- and in this case, they were
all supportive of it.
Five people in the Sense-Making study mentioned testing, mandatory or
otherwise. One woman, in the context of talking about men who go to bars
and "do bad things" with women there, wondered if it would be feasible
to test those prostitutes. Speaking within the context of the Hispanic
community, however, she was afraid that this would not be feasible because
many of the women might avoid the test because they might be illegal immigrants.
A man was concerned that mandatory testing would be a violation of civil
liberties and could be used by "sleazy people" to discriminate against
or harass certain employees. Another man was concerned about what would
be done with test results, especially since he was also concerned with
the possibility of inaccurate results, in particular false positives.
One woman was concerned about public clinics not disclosing the identities
of people with AIDS in their own communities. This respondent felt her
rights were being ignored in that she did not have enough information about
her co-workers to decide with whom she would associate. In a similar vein,
one woman whose daughter was a dentist wondered if it would be fair to
have people fill out a questionnaire before they were treated.
The Sense-Making results also reported political concerns not mentioned
by the health department survey at all. One man was concerned about the
profit motive in relationship to developing AIDS treatment. A woman whose
brother had AIDS was concerned about a homosexual being barred from taking
care of her or his lover with AIDS because of parental disapproval.
In all these cases, the Sense-Making respondents went beyond the questions
asked in the health department survey, putting their ideas and questions
in larger or more elaborated contexts and thus developing and sharing their
own "maps" in ways that seemed to have only a surface relationship to the
portrait presented by the imposed traditional health survey.
Our qualitative understanding of respondents that emerged from the traditional
health department survey and the Sense-Making survey is very different.
It has been beyond our purpose in this study to do a deep qualitative dig
of the Sense-Making narratives although, clearly, even the few qualitative
responses listed for defining purposes in the Tables suggest that behind
these are illuminating stories which would introduce even more of a gap
between the two audience research approaches. A statement made by Baer
(1996) on the implications for survey research from his studies of
physical and mental health among Mexican American migrants usefully summarizes
our results: Respondents' . . . ideas and formulations of this domain of existence were so different from the way these issues were categorized by the [health department] that the questions seemed irrelevant to their lives and very "distant" from their daily concerns. (Baer, 1996, p. 63) Conclusions This comparison of a traditional, mostly closed-ended
survey with an alternative Sense-Making survey with similar respondents
on the same topic adds to the literature calling for a turn toward more
open-ended audience research to support the planning of public communication
efforts generally and AIDS/HIV campaigns in particular. Secondly, it adds
to the literature that refutes the idea of the "obstinate audience" and
argues that the audience is not obstinate but operates from a different
worldview from the institution.
The purpose in this article has not been to offer Sense-Making as a
panacea for health communication planning. In the turn to a multiplicity
of approaches, it is only one of many that use a more open-ended approach
to interviewing than the often used, closed-ended survey. While those utilizing
Sense-Making argue that, in fact, it is based on a more deeply and methodologically
developed theory of how to conduct interviews which invite genuine dialogue
(Dervin, 1999a), it is beyond the purpose of
this paper to make that argument here.
One of the basic premises of the Sense-Making Methodology is that, in
fact, the study of any phenomenon will require multiple approaches, with
each grounded in terms of their histories, assumptions and practices. The
traditional system-mapping survey can be seen as having utility within
some perspectives. It may be as useful to know whether citizens believe
AIDS can be transmitted through saliva as it is to know whether college
students can calculate a statistic using the currently accepted formula.
The point is, however, that system mapping surveys must be understood as
such with their results humbled in the context of their own perspectivities.
Further, these results suggest that even when the task at hand is mapping
to system views, that mapping will be more useful if done by starting from
within audience perspectives and reaching for methods less formulaic than
those traditionally used in the past.
This article has restricted its attention primarily to the use of Sense-Making
for data collection. There are many mandates of the Sense-Making Methodology
which we have not pursued here. Some of these are directly pertinent to
the campaign planning situation (Dervin, 1989) --
for example, the mandate to extrapolate data in such a way that resulting
recommendations are based on situational conditions rather than population
sub-groups.
Our purpose here, however, has been to intersect with the review of
the state of the literature regarding audience research for campaign planning
which was presented in the first section of this paper. The main concluding
thrust of that review pertained to the call for genuinely audience-oriented
research approaches. The primary strengths of the Sense-Making approach
as exemplified here are that it was developed to meet just such a mandate
and includes a systematic way of interviewing and collecting data, emphasizing
respondents' worldviews over those of the institution, anchoring the results
firmly in specific situations and material conditions, and privileging
respondents as theorists with relevant understandings of causes, connectivities,
and effects. Endnotes 1. See, for example:
Clatts, 1994; Dervin, 1989;
Dievler & Pappas, 1999; Freimuth
& Mettger, 1990;
Lupton, 1994; Opie,
1998; Rakow, 1989; Singer,
1998; Wallack, 1990; Weiss
& Tschirhart, 1994).
2. See, for example: Baer, 1996;
Bauer, 1964; Crawford, 1977;
Dervin, 1989; Donsbach, 1997;
Freimuth & Mettger, 1990; Krosnick,
1999; Lupton, 1994; Myrick,
1998; Rakow, 1989;
Tullock
& Lupton, 1997;
Wallack, 1990; Yankelovich,
1996.
3. See, for example: Bakker,
1999; Bowen & Michal-Johnson, 1990; Donohew,
Lorch, & Palmgreen, 1998; Eldridge, St. Lawrence,
Little, Shelby, Brasfield, Service, & Sly, 1997; Flora
& Maibach, 1990; Maibach, Kreps, & Bonaguro,
1993;
Mays & Cochran, 1988; Myrick,
1998;
Petty & Cacioppo 1996;St.
Lawrence, Jefferson, Banks, Cline, Alleyne, & Brasfield, 1994.
4. For examples, see: Dervin,
1989; Hines, 1993; Romkens,
1997; Singer & Marxuach-Rodriquez, 1996;
Tullock & Lupton, 1997;
Carlson
et al., 1996; Dievler & Pappas, 1999; Myrick,
1998; Warwick, Aggleton, & Homans, 1988;
Wingood, Hunter-Gamble, & DiClemente, 1993.
5. Cheek (1999) calls for
less esoteric postmodern approaches in health care research. For an example
of a fully developed call for more attention to systematic methods in the
context of critical research, see Morrow 1994.
6. This idea was originally suggested to Dervin
by Carter's work: see, for example, Carter 1991,
1990.
7. For a fuller description of the project,
see Shoemaker, McAlister, & Vacalis, 1988.
8. The Sense-Making data reported here comes
from Brendlinger's unpublished dissertation (Brendlinger
1990). The actual year of data collection was 1988. Certainly public
responses vis-a-vis AIDS have changed since this time but the purpose here
is not attention to the responses as such but an exemplification of Sense-Making
as an approach to audience research and a comparison between it and the
traditional audience survey approach. Given the results of our literature
research, these questions seem even more pertinent today than in 1988.
Brendlinger presented a version of this work in 1995 at the Speech Communication
Association (now the National Communication Association). While HIV or
HIV/AIDS may be the more accurate term, the term AIDS or AIDS virus is
frequently used in this article because it reflects the vernacular. References Baer, R.D. (1996).
Health and mental health among Mexican American migrants: implications
for survey research. Human Organization, 55(1), 58-66.
Bakker, A.B. (1999). Persuasive communication about
AIDS prevention: need for cognition determines the impact of message format.
AIDS
Education and Prevention, 11(2), 150-162.
Bauer, R. A. (1964). The obstinate audience: The
influence process from the point of view of social communication. American
Psychologist, 19, 319-328.
Bowen, S. P & Michal-Johnson, P. (1990). A rhetorical
perspective for HIV education with black urban adolescents. Communication
Research, 76, 848-866.
Brendlinger, N. (1990). The influence of research
methods on policy development: a comparison of a survey and a Sense-Making
study about Texans and AIDS. Unpublished doctoral dissertation, University
of Texas at Austin.
Carlson, R.G., Siegel, H.A., Wang, J. & Faick,
R.S. (1996). Attitudes toward need "sharing" among injection drug users:
combining qualitative and quantitative research methods. Human Organization,
55(3), 361-369.
Carter, R.F. (1991). Comparative analysis,
theory, and cross-cultural communication. Communication Theory, 1(May),
151-158.
Carter, R.F. (1990). Our future research agenda
-- confronting challenges - or our dying grasp. Journalism Quarterly,
67(2), 282-285.
Cheek, J. (1999). Influencing practice or simply
esoteric? Research health care using postmodern approaches. Qualitative
Health Research, 9(3), 383-392.
Clatts, M.C. (1994). All the king's horses and
all the king's men: some personal reflections on ten years of AIDS ethnography.
Human
Organization, 53(1), 93-95.
Crawford, R. (1977). You are dangerous to your
health: The ideology and politics of victim blaming. International Journal
of Health Services, 7, 663-680.
Dervin, B. (1999a, in press). On studying
information needs and seeking methodologically: the implications of connecting
metatheory and method. Information Processing and Management.
Dervin, B. (1999b). Chaos, order, and Sense-Making:
A proposed theory for information design. In R. Jacobson (Ed.), Information
design. Cambridge, MA: MIT Press, 35-57.
Dervin, B. (1992). From the mind's eye of the
user; the sense-making qualitative-quantitative methodology. In J. D. Glazier
and R. R. Powell (Eds.), Qualitative research in information management.
New York: Libraries Unlimited, 61-84.
Dervin, B. (1989). Audience as listener and learner,
teacher and confidante: The Sense-Making approach. In R. E. Rice and C.A.
Atkin (Eds.), Public communication campaigns, 2nd edition. Newbury
Park, CA: Sage, 67-86.
Dervin, B. & Shields, P. (1999). Adding the
missing user to policy discourse: understanding US user telephone privacy
concerns. Telecommunications Policy, 23, 405-535.
Dievler, A. & Pappas, G. (1999). Implications
of social class and race for urban public health policy making: a case
study of HIV/AIDS and TB policy in Washington, D.C. Social Science &
Medicine, 48, 1095-1102.
Donohew, L., Lorch, E.P., & Palmgreen, P.
(1998). Applications of a theoretic model of information exposure to health
interventions. Human Communication Research, 24(3), 454-468.
Donsbach, W. (1997). Survey research at the end
of the twentieth century: theses and antitheses. International Journal
of Public Opinion Research, 9(1), 17-28.
Eldridge, G.D.; St. Lawrence, J.S.; Little, C.E.;
Shelby, M.C.; Brasfield, T.L.; Service, J.W. & Sly, K. (1997). AIDS
Education and Prevention 9, Supplement A, 62-76.
Flora, J.A. & Maibach, E.W. (1990). Cognitive
responses to AIDS information: the effects of issue involvement and message
appeal. Communication Research, 17(6), 759-774.
Freimuth, V. & Mettger, W. (1990). Is there
a hard to reach audience? Public Health Reports, 105, 232-238.
Freire, P. (1970). Pedagogy of the oppressed.
New York: The Seabury Press.
Guttman, N., Boccher-Lattimore, D. & Salmon,
C.T. (1998).
Public Health Reports, 113(5), 465-471.
Hines, A.M. (1993). Linking qualitative and quantitative
methods in cross-cultural survey research: techniques from cognitive science.
American
Journal of Community Psychology, 21(6), 729-746.
Krosnick, J.A. (1999). Survey research. Annual
Review of Psychology, 50, 337-367.
Lupton, D. (1994). Toward the development of critical
health communication praxis. Health Communication, 6(1), 55-67.
Maibach, E. W., Kreps, G. L. & Bonaguro, E.
W. (1993). Developing strategic communication campaigns for HIV/AIDS prevention.
In S. C. Ratzan (Ed.), AIDS: Effective health communication for the
90s. Washington, D.C.: Taylor & Francis, 15-35.
Mays, V. M. & Cochran, S. D. (1988). Issues in
the perception of AIDS risk and risk reduction activities by Black and
Hispanic/Latina women. American Psychologist, 43, 949-957.
Morris, R. (1994). Toward a user-centered information
service. Journal of American Society for Information Society, 45(1),
11-30.
Morrow, R.A. (1994). Critical theory and methodology.
Thousand Oaks, CA: Sage Publications.
Myrick, R. (1998). In search of cultural sensitivity
and inclusiveness: communication strategies used in rural HIV prevention
campaigns designed for African Americans. Health Communication, 10(1),
65-85.
Nathanson, N. (1999). Statement on fiscal
year 2000: President's budget request for the National Institutes of Health.
[Web Page]: URL: http://www.nih.gov/od/oar [August]
Opie, A. (1998). "Nobody's asked me for my view":
users' empowerment by multidisciplinary health teams. Qualitative Health
Research, 8(2), 188-206.
Petty, R.E. & Cacioppo, J.T. (1996). Addressing
disturbing and disturbed consumer behavior. Is it necessary to change the
way we conduct behavioral science? Journal of Marketing Research, 33(1),
1-8.
Pinkerton, S. D. & Abramson, P. R. (1992).
Is risky sex rational? Journal of Sex Research, 29, 561-568.
Rakow, L. F. (1989). Information and power: Toward
a critical theory of information campaigns. In C. T. Salmon (Ed.), Information
campaigns: Balancing social values and social change. Newbury Park,
CA: Sage, 164-184.
Romkens, R. (1997). Prevalence of wife abuse in
the Netherlands: combining quantitative and qualitative methods in survey
research.
Journal of Interpersonal Violence, 12(1), 99-125.
Savolainen, R. (1993). The sense-making theory:
Reviewing the interests of a user-centered approach to information seeking
and use. Information Processing and Management, 29(1), 13-28.
Shields, P., Dervin, B., Richter, C. & Soller,
R. (1993, November). Who needs 'POTS-plus' services? A comparison of residential
user needs along the rural-urban continuum. Telecommunication Policy,
pp. 563-587.
Shoemaker, P. J., McAlister, A. & Vacalis,
T. D. (1988).
AIDS: Public knowledge. attitudes, & behaviors in
Texas. [Interagency Cooperation Contract no. IAC (88-89)-1013], Austin,
TX: Texas Department of Health AIDS Division and Public Health Promotion,
August.
Siegel, K. & Raveis, V. (1997). Perceptions
of access to HIV-related information, care, and services among infected
minority men. Qualitative Health Research, 7(1), 9-31.
Singer, M., Ed. (1998). The political economy
of AIDS. Amityville, NY: Baywood.
Singer, M. & Marxuach-Rodriquez, L. (1996).
Applying anthropology to the prevention of AIDS: the Latino gay man's health
project. Human Organization, 55(2), 141-148.
Sobo, E.J., Zimet, G.D., Zimmerman, T. & Cecil,
H. (1997). Doubting the experts: AIDS misconceptions among runaway adolescents.
Human
Organization, 56(3), 311-320.
Stempel, G.H. (1955). Increasing reliability in
content analysis. Journalism Quarterly, 19, 449-455.
St. Lawrence, J.S., Jefferson, K.W., Banks,
P.G., Cline, T.R., Alleyne, E. & Brasfield, T.L. (1994) Cognitive-behavioral
group intervention to assist substance-dependent adolescents in lowering
HIV infection risk. AIDS Education and Prevention, 6(5), 425-435.
Tullock, J. & Lupton,. D. (1997). Television,
AIDS, and risk: a cultural studies approach to health communications.
Sydney, AU: Allen and Unwin.
Vakkari, P. (1997). Information seeking in context:
a challenging metatheory. In P. Vakkari; R. Savolainen; B. Dervin (Eds.),
Information seeking in context. London, UK: Taylor Graham, 451-464.
Wallack, L. (1990). Mass media and health promotion:
Promise, problem, and challenge. In C. Atkin & L. Wallack (Eds.), Mass
communication and public health. Newbury Park, CA: Sage, 41-51.
Warwick, I., Aggleton, P. & Homans, H. (1988).
Constructing commonsense -- young people's beliefs about AIDS. Sociology
of Health & Illness, 10, 213-233.
Weiss, J., & Tschirhart, M. (1994). Public information
campaigns as policy instruments. Journal of Policy Analysis and Management,
13(1), 82-119.
Wingood, G. M., Hunter-Gamble, D. & DiClemente,
R. J. (1993). A pilot study of sexual communication and negotiation among
young African-American women: Implications for HIV prevention. Journal
of Black Psychology, 19(2), 190-203.
Yankelovich, D. (1996). A new direction for
survey research. International Journal of Public Opinion Research, 8(1),
1-9.
Copyright 1999 Communication Institute for Online Scholarship, Inc. This file may not be publicly distributed or reproduced without written permission of
the Communication Institute for Online Scholarship, P.O. Box 57, Rotterdam Jct., NY 12150
USA (phone: 518-887-2443). |
