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The Electronic Journal of Communication / La Revue Electronique de Communication


Volume 9 Numbers 2, 3, 4 1999

When Respondents are Theorists
WHEN RESPONDENTS ARE THEORISTS:
AN EXEMPLAR STUDY IN THE HIV/AIDS CONTEXT
OF THE USE OF SENSE-MAKING AS AN APPROACH
TO PUBLIC COMMUNICATION CAMPAIGN AUDIENCE RESEARCH


Nancy Brendlinger
Bowling Green State University
Bowling Green, Ohio USA
nbrendl@bgnet.bgsu.edu

Brenda Dervin
The Ohio State University
Columbus, Ohio USA
dervin.1@osu.edu

Lois Foreman-Wernet
The Ohio State University
Columbus, Ohio USA
wernet.1@osu.edu

 
 

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.

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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. 

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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.

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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.

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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.

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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.

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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.

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