001 2013 4 B PDF

# 2008 University of South Africa
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University of South Africa
Muckleneuk, Pretoria
COM2048/1/20092012
98299581
3B2
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Contents
INTRODUCTION viii
PART A: INTERCULTURAL COMMUNICATION
Study unit 1: THE STUDY AND HISTORY OF INTERCULTURAL

COMMUNICATION 2
1.1 Why study intercultural communication? 3
1.2 The history of the study of intercultural communication 7
13 Conclusion 12
Study unit 2: CULTURE, COMMUNICATION, CONTEXT, POWER

AND HISTORY AND INTERCULTURAL COMMUNI-
CATION 15
2.1 Culture and communication 16
2.2 Conclusion 26
Study unit 3: IDENTITY AND INTERCULTURAL COMMUNICATION 28

3.1 Introduction to identity and intercultural communication 28
3.2 Conclusion 34
Study unit 4: LANGUAGE, NONVERBAL AND INTERCULTURAL

COMMUNICATION 36
4.1 Introduction to language and intercultural communication 36
4.2 Introduction to nonverbal codes and cultural space 41
4.3 Conclusion 45
Study unit 5: UNDERSTANDING INTERCULTURAL TRANSITIONS 47

5.1 Introduction 47
5.2 Thinking dialectically about intercultural transition 49
5.3 Types of migrant groups 49
5.4 Migrant-host relationships 50
5.5 Cultural adaptation 51
5.6 Conclusion 56
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Study unit 6: POPULAR CULTURE AND INTERCULTURAL COM-
MUNICATION 57
6.1 Introduction 58
6.2 Learning about culture without personal experience 58
6.3 Consuming and resisting popular culture 59
6.4 Representing cultural groups 59
6.5 US popular culture and power 61
6.6 Conclusion 62
Study unit 7: CULTURE, COMMUNICATION AND INTERCULTUR-

AL RELATIONS 63
7.1 Introduction 63
7.2 Thinking dialectically about intercultural relationships 64
7.3 Benefits and challenges of intercultural relationships 65
7.4 Intercultural relationships 66
7.5 Conclusion 68
Study unit 8: Conflict and the future of intercultural communication 69

8.1 Introduction 70
8.2 Characteristics of intercultural conflict 70
8.3 Two theoretical approaches and the dialectical perspective 71
8.4 Social science approach to conflict 72
8.5 Interpretive and critical approaches to conflict 73
8.6 Managing intercultural conflict 74
8.7 The future of intercultural communication 75
8.9 Conclusion 76
PART B: DEVELOPMENT COMMUNICATION
Study unit 9: THE MODERNISATION THEORY OF DEVELOPMENT 80

9.1 Introduction 80
9.2 Basic concepts in development communication 83
9.3 Development problems of the Third World 85
9.4 How societies change and develop 89
9.5 Early theories of social change and development 91
9.6 Modernisation theory and economic growth: the dominant
paradigm in development 93
9.7 Development communication: the communication approach
of the dominant paradigm 99
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9.8 Communication models for development: the dominant
approach 110
9.9 Conclusion 113
Study unit 10: DEPENDENCY THEORY: CRITICAL ISSUES IN

DEVELOPMENT COMMUNICATION 115
10.1 The failure of modernisation theory and criticism of the
dominant paradigm 115
10.2 Critical evaluation of the modernisation approach to develop-
ment 116
10.3 Critical evaluation of the modernisation theory approach to
development communication 119
10.4 Development and underdevelopment in international perspec-
tive: dependency theory 124
10.5 The role of communication in the underdevelopment of the
Third World 129
10.6 Alternative development communication in the Third World 131
10.7 Critical evaluation of the dependency paradigm 141
10.8 Conclusion 142
Study unit 11: ANOTHER DEVELOPMENT: THE MULTIPLICITY-IN-

ONE-WORLD PARADIGM FOR PARTICIPATORY
DEVELOPMENT COMMUNICATION 144
11.1 Another development: the multiplicity-in-one world paradigm
for participatory conceptions of development 145
11.2 New role for communication in development 149
11.3 Communication for participatory development 150
11.4 Development support communication (DSC) 152
11.5 Participatory development communication: dialogue for eman-
cipation and empowerment 155
11.6 Media for participatory communication in development 161
11.7 Participatory research in development communication 173
11.8 Conclusion 174
PART C: HEALTH COMMUNICATION
Study unit 12: HEALTH COMMUNICATION: AN INTRODUCTION 182

12.1 Introduction 183
12.2 The different worlds we live in 183
12.3 Definitions and basic concepts 186
12.4 The field of health communication 189
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12.5 Two opposing paradigms in health communication 193
12.6 Multicultural contexts in health communication 199
Study unit 13: Contexts in multicultural health communication 204

13.2 Intrapersonal communication and health beliefs 206
13.3 Interpersonal communication and relationships 210
13.4 Communication in multicultural groups in healthcare 214
13.5 Communication in multicultural organisations in healthcare 221
13.6 Health communication in the mass media 228
Study unit 14: NONVERBAL, INTRAPERSONAL AND INTERPERSO-

NAL SKILLS IN HEALTHCARE 237
14.2 Nonverbal communication in healthcare 239
14.3 Intrapersonal and interpersonal skills 247
Study unit 15: The skill of interviewing in health communication 265

15.2 The interviewing process defined 266
15.3 Types of interview in health communication 267
15.4 Phases in the interviewing process 271
15.5 Communication techniques in the interviewing process 275
Study unit 16: Multicultural communication in health campaigns 281

16.2 General background 284
16.3 Defining health communication campaigns 285
16.4 Theoretical approaches to health communication campaigns 287
16.5 A multicultural health communication campaign model 293
Study unit 17: Ethics in multicultural health communication 308

17.2 Ethical dilemmas 309
17.3 What is ethics? 310
17.4 Some background on ethics and morals 311
17.5 How do ethics differ from morals? 312
17.6 How do ethics relate to health communication? 313
17.7 Principles of biomedical ethics 314
17.8 The issue of informed consent 316
17.9 Honesty and truth 318
17.10 The role of culture in ethics 320
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Study unit 18: The influence of ideology on health communication 323
18.2 What is ideology? 324
18.3 The influence of ideology on health communication 325
18.4 Three distinctive cultural ideologies 328
18.5 Ideology: guidelines and strategies 331
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Introduction
Welcome to the Department of Communication module COM2048. The aim of this
module is to provide theoretical foundations for the study of intercultural, development
and health communication. We introduce you to these fields of study and to their ideas,
concepts, models and theoretical approaches. We hope that you will gain a broader
understanding of intercultural, development and health communication, giving you the
confidence to talk about issues and problems in these areas and helping you gain
knowledge and skills to apply when solving problems in intercultural, development and
health communication. We hope that you find your studies interesting and stimulating.
This module consists of three parts:
Part A: Intercultural communication (compulsory)

Part B: Development communication
Part C: Health communication
Each of the three parts is divided into study units. Each study unit explains what you
should be able to do when you have worked through the study unit. Each study unit in
this study guide contains the following sections:
. Overview
. Activities
. Case studies (in some study units)
. Test yourself
The overview provides a brief summary of what the study unit is about.
The activities are aimed at making your studies an interactive learning experience.
Interactive means that you work actively with the study material. Each activity asks you
to do something answer a question or think about an issue or do a particular task.
The case studies are descriptions of a communication situation in the context of

intercultural, development and health situations. You need to study the cases and think
about them and then do an activity.
The test yourself section at the end of each study unit is an opportunity for you to
check yourself on the section and ideas that you have studied.
To complete this module you need to study the compulsory Part A and select one of the
two parts in the study guide and master the entire contents of the two parts and the
study units within each part to be able to write the examination.
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For part A: Intercultural communication, you will require the prescribed book. For part
B: Development communication and part C: Health communication this study guide
serves as your prescribed book.
The prescribed book for part A: Intercultural communication is:
Martin, JN & Nakanyama, TK. 2007. Intercultural communication in context. 4th

edition. New York: McGraw-Hill.
For part B: Development communication and part C: Health communication this study
guide provides you with all the study materials for these parts.
Study package
Your study package consists of the following:
. This study guide.

. Tutorial Letter 101.
. Additional tutorial letters, which you will receive during the course of your studies.
. A prescribed book that you will have to purchase yourself.
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PART A
Intercultural communication
NB: Part A is compulsory for all students. To complete this section you need to acquire
the prescribed book: Martin, JN and Nakayama TK. 2007. Intercultural communication
in context. 4th edition: New York: McGraw-Hill.
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1
Study unit 1:
The study and history of
intercultural communication
Christo Cilliers
Introduction
As students in the discipline of Communication Science it is important that we un-
derstand and have a knowledge of intercultural communication. In South Africa we
have diverse cultures and 11 official languages and constantly come into contact with
people who are similar and different from us. Think of how people migrate from other
countries to South Africa, bringing with them different classes, cultures and religions. As
communication scientists we also use technology and come into contact with people
globally it is therefore important that we understand, respect and have a knowledge
of the diversity of cultures. Think, for example, of how we can be self-aware of our own
location, South Africa, and be sensitive towards economic disparities (inequality) and
racial, ethnic and religious differences. The question we will try to answer in this study
unit is: what can I as an individual do to be more open to enhance my understanding of
the universalist, relativist and dialogic approaches and ethical issues?
Once we have looked at reasons for studying intercultural communication we will

consider ways in which we study intercultural communication. We will also examine
the historical and philosophical foundations of the field.
The focus of this study unit is why we study intercultural communication and a brief
overview of the history of the study of intercultural communication. This unit is based
on chapters 1 and 2 in the prescribed book (Martin and Nakayama (2007)).
KEY QUESTIONS
. How do electronic means of communication (Internet, e-mail, cell phones, fax and
so on) differ from face-to-face communication?
. How do these communication technologies change intercultural communication/
interaction?
. What are some of the possible challenges organisations face as they become more
diverse?
. Why is it important to think beyond ourselves as individuals in intercultural
interaction/communication?
. How do economic (financial/monetary/fiscal) situations shape intergroup relations?
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. How have the origins of the study of intercultural communication in South Africa
shaped (affected) its present focus?
. How did business and political interests influence what early intercultural
communication researchers studied and learned?
. How have the worldviews of researchers influenced how they studied intercultural
communication?
. How have other fields contributed to the study of intercultural communication?
. What are the adantages (benefits) of a dialectical approach to intercultural
communication?
In this study unit you will come across words like global village, identity management,
diasporic groups, identity tourism, demographics, heterogeneity, diversity, immigrants,
Anglocentrism, melting pot, nativistic et cetera. The prescribed book gives us definitions
of these words in the margins of the different pages.
1.1
Why study intercultural communication?
Through intercultural communication we can learn a lot about other people and their
cultures, and about ourselves and our own cultural background. We will also experi-
ence challenges. Intercultural communication can involve barriers like discrimination
and stereotyping. An important goal of this section in the study guide is to increase our
understanding of the dynamics at work in intercultural interaction.
Activity
1.1
1. Study read chapter 1 in Martin and Nakayama (2007).
2. You will need two clean pages (spread out) or an A3 page for this activity.
3. Draw six broad columns over the width of the pages and identify the six
imperatives for studying intercultural communication.
4. Under the technological imperative (column 1) describe how technology can
impact on intercultural interaction.
5. Under the demographic imperative (column 2) describe how demographics are
changing in South Africa. Briefly focus on heterogeneity and diversity, relationships
with new immigrants and religious diversity.
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6. Under the economic imperative (column 3) describe how domestic and
economic conditions influence intercultural communication.
7. Under the peace imperative (column 4) explain how studying intercultural
communication can facilitate resolution of intercultural conflict.
8. Under the self-awareness imperative (column 5) explain how studying
intercultural communication can lead to increased self-understanding.
9. Under the ethical imperative (column 6) differentiate between a universalistic, a
relativist, and a dialogic approach to the study of ethics and intercultural
communication. Also identify and describe three characteristics of an ethical
student of culture.
10. We encourage you to try to use bullets and pointers to make lists in the different
columns.
11. Use different colours for your lists in the different columns.
Our comments
global village When we say that we live in a global village we are using a term coined by Marshall
McLuhan in the 1960s that refers to a world in which communication technology unites
people in remote parts of the world. It connects us to people that we may never meet
face to face.
technological In discovering the role of the technological imperative we realise that we are using
imperative technology (using the Internet, sending photographs on our cell phones, writing letters
to friends in other countries by e-mail) used more and more to communicate with each
other. The Internet provides information about and access to other people and other
cultures. The World Wide Web gives us access to increasing amounts of information
about what is happening in South Africa, but also in the rest of the world.
Communication technology brings us in contact with people we might never have the
opportunity to know otherwise. But, technology (e-mail or chat rooms) can make
communication more difficult as we are not in a face-to-face communication situation
to ``read'' the other person's nonverbal communication (facial expressions, tone of
voice or gestures). On the other hand communication technology also allows us to have
more contact with people who are similar to ourselves. In this sense the Internet helps
us to strengthen our sense of identity, for example with diasporic groups. Advances in
communication help us to think differently about ourselves and our identity. Gergen (in
Martin & Nakayama 2007:10) says that with the removal of traditional barriers to
forming relationships, technology lead to multiphrenia (a splitting of the individual into
many different selves).
Also think of how people who do not have the skills or knowledge to use technology, or
people who do not have access to the Internet, can feel marginalised and even dis-
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connected. A critical question for us as students of intercultural communication should
be: what are the implications for intercultural communication when it comes to the
``digital divide''?
demographic Under the demographic imperative we observed that our world is increasingly be-
imperative coming more diverse. Think of people studying or working with us. How do they differ
from our ethnicity, race, religion and/or nationality? How have demographics changed
in South Africa for example (or your country of origin?) Think here of the work force that
is becoming older as the baby boomers are aging, has more women in it and is
ethnically and racially more diverse. Another change is the different immigration pat-
terns and how heterogeneity presents us with many opportunities and challenges. What
are our relationships with new immigrants? Think of the recent media coverage of
Zimbabwean residents coming to South Africa it has often been filled with tension
and conflict. Some of the conflict has to do with economic disparity (inequality/dif-
ferences). To enable us to understand these economic differences we have to look at
issues of economic class. It is well known that in South Africa there is a view that the rich
are getting richer and the poor are getting poorer. Immigration also contributes to
religious diversity. The diverse ethnic, racial, economic and religious groups come into
contact mostly during the day in schools, business and other settings, bringing different
languages, histories and economic statuses together.
economic imperative When it comes to the economic imperative, the question for us as intercultural
communication students is: what is the ultimate impact on the average person? How is
South Africa, for example, competing in a global market? Do we understand how
business is conducted in other countries? We need to realise that cultural differences in
business practices have implications where people from different companies do busi-
ness with each other and where people from different cultures work on the same team.
Globalisation means that some businesses have international teams and the latter can
be a big challenge when it comes to intercultural communication. Even with good
language skills employees interpret written and verbal communication through the filter
of their own culture. Business changes, like buy outs by multinational corporations, can
lead to lost jobs or closing facilities. In such cases domestic diversity requires business to
be attentive to cultural differences.
the peace imperative Under the peace imperative, the critical question for us as intercultural commu-
nication students is: can individuals of different genders, ages, ethnicities, languages,
races, cultural backgrounds and socioeconomic statuses co-exist on this planet? Some
racial and ethnic struggles are tied to histories of colonialism while others are tied to
economic differences influenced by technology and media. Some conflicts have roots
in past foreign policies. It would be nave of us to think that simply understanding issues
involved in intercultural communication would end war and conflict. It is also important
for us to remember that individuals are often born into and caught up in conflicts that
they never started or chose to be part of.
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the self-awareness In summarising the self-awareness imperative we realise that intercultural learning is
imperative not comfortable or easy. But the main question is: how can studying intercultural
communication help us to raise awareness of our own cultural identity and back-
ground?
the ethical imperative Martin and Nakayama (2007:31) see ethics as principles of conduct that help govern
the behaviour of individuals and groups. One needs to consider the various issues in a
discussion of ethics in intercultural communication. When do you ``do the right thing''
to contribute to a better society? If we try to be flexible when it comes to cultural
behaviour and try to ``see'' no cultural pattern as right or wrong, questions that arise
are:
. Is there any universality in ethics?

. Are any cultural behaviours always right or always wrong?
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Another way of viewing ethics is to look at the dialogical approach. When we try to
judge cultural patterns as ethical or unethical we need to consider the following three
issues:
. developing self-reflexivity
. learning about others
. developing a sense of social justice
Enrichment activity
Try to find other students who are also enrolled for this subject. Individually contact
and interview the oldest member of your family. Answer the following questions:
. When did your ancestors come to South Africa, or the country where you are
living?
. How did your immediate family come to the province where they live now in
South Africa/or your own country?
. What were the reasons for your family moving to South Africa/the province where
you are currently living? Did they move voluntarily?
. What language(s) did they speak? Did these languages develop from another
international (or African) language?
. What difficulties did they experience?
. Did they changes their names (or surnames) and for what reasons?
. What kind of work did they do? Did they take new jobs on their arrival?
. How has your family status changed through the generations?
Compare your family history (experience) with those of fellow students (if possible).
Did most immigrants (or migrants) come to South Africa for the same reasons? Did
they come from neighbouring countries/other provinces? What are the differences in
the various stories? (Adapted from Martin & Nakayama 2007:3940.)
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1.2
The history of the study of intercultural communication
The development of some aspects of intercultural communication has been influenced

by world-views. To understand a cultural worldview we will distinguish between three
world views in South Africa:
. The Afrocentric world-view can be described as personalistic or people-centred,

intuitive (spontaneous/perceptive), collective (communal/groups), based on experi-
ence and sometimes traditional in nature.
. The Eurocentric (Westernised) world-view is materialistic, individualistic, rational
and goal oriented in nature.
. The Asiocentric world-view sees materialism as an illusion and claims that reality is
linked to the spiritual.
Activity
1.2
1. Under the early development of intercultural communication as a discipline
Martin and Nakayama (2007:4447) identify its early foci (foci is the plural of
focus).
2. See if you can list these four foci and try to identify the early development of
intercultural communication as a discipline.
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Cultural world-view
by Lynne Parry (Faure, Parry & Sonderling 2000)
Cultural world-view can be seen as a cultural variable and refers to the most
fundamental assumptions held by people in a particular culture. This includes a
particular culture's explanation and interpretation of the universe and how it works.
The belief of world-view also includes how people function, and how their lives are
influenced by lack, fate, interpersonal relationships, the age in which they live and
their natural surroundings and resources. For example, in South Africa some cultures
that have an Afrocentric world-view see persistent illness or bad luck as the result of
evil supernatural forces. To deal with these forces, which they have no power over or
understanding of, they will consult a sangoma, because they believe that sangomas
possess the power to counter evil supernatural forces (sangoma is a Zulu term used
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to refer to people who possess spiritual powers). Cultural groups that consult a
sangoma may, in addition to this, consult trained medical doctors. For other cultural
groups, for instance people who belong to a Eurocentric culture and do not share an
Afrocentric world-view, this manner of dealing with illness and bad luck may seem
strange and unfamiliar.
Our cultural world-view is thus seen as a set of more or less systematised beliefs and
values in terms of which our group evaluates and attaches meanings to the reality
that surrounds it. We accept our world-view without questioning it, because for us it
is ``the way things are''. It is sometimes difficult to articulate (express) our world-view
as it is learnt throughout the socialisation process and tends to be unconscious.
Elements of a cultural world-view refer to deep-seated belief structures within a

cultural group and include concepts like fatalism. Fatalism is the belief that one need
not try to change a particular negative situation, because one has no control over
one's future. Often poverty-stricken groups will follow a communication pattern
reflecting fatalism, using expressions such as ``why bother'' or `ìt's no use trying''.
Another element of cultural world-view is the relationship of the dead to the living.
For example, in South Africa many cultures attach as much value to the dead as to
the living, hence their belief in and respect for ancestors. They have ceremonies and
rituals to appease the dead and their burial grounds and tombs are sacred. Often this
cultural world-view is not understood by other cultural groups, or they are insensitive
to it, which can cause a barrier or misunderstanding.
There are many more elements of a cultural world-view. For instance, is humankind
perceived to be good, evil or a combination of good and evil? Another element
concerns a cultural group's view of humankind and nature. Are humans subject to
nature, or should human beings be in harmony with nature? Yet another element of
a cultural world-view is whether a culture's world-view is sacred. Does the cultural
group accept the notion of a ``cosmos filled with spiritual beings and forces''?
Conversely, a culture's world-view can be secular, which means that the members of
the culture do not accept a spiritual dimension. When we consider these different
elements of cultural world-views, we understand how easy it is for cultural groups to
misunderstand each other. It also means that our cultural world-view has a powerful
influence in intercultural communication, because as a member of a culture, each
participant in the intercultural communication process has a world-view that is so
deeply embedded in the unconscious that we take it for granted. We should
therefore try to get to know more about the cultural world-view of others, by asking
questions, observing and listening.
In understanding how intercultural communication developed we need to consider the

various world-views (above) and Language and Intercultural Communication (see
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chapter 6 in Martin & Nakayama 2007) as well as Nonverbal Codes and Cultural Space
(see chapter 7 in Martin & Nakayama 2007). Like language, nonverbal communication
varies from culture to culture. We use language to transmit our values, beliefs, world-
views and norms. Not many South Africans are proficient in more than two or three
languages and not all the cultural groups will attach the same meaning to the same
words. How do you think this affects intercultural communication in South Africa (or in
your country)?
nonverbal communica- Nonverbal communication is spontaneous, ambiguous and at times beyond our con-
tion scious awareness and control. As our nonverbal communication is mostly unconscious it
is often misinterpreted and cannot be corrected easily.
The United States government passed the Foreign Service Act in 1946 and established
Edward Hall the Foreign Service Institute (FSI). The latter institute hired Edward T Hall to develop
courses for overseas workers. Hall (together with Ray Birdwhistell and George Trager)
developed their own material. The FSI developed a need to apply abstract anthro-
pological concepts between 1946 and 1956. The outcome was that these theorists
formed new ways of looking at culture and communication (Martin & Nakayama
2007:4445). The early emphasis was on the training of diplomats in the practice of
intercultural communication (Parry in Faure et al 2000:5).
Edward Hall's (1959) book, The silent language, is regarded as a leading work in in-
tercultural communication. The term `ìntercultural communication'' was first used in
this book. Hall's book focuses on the practical applications of intercultural commu-
nication as he explains anthropological insights into cultural differences.
The scholars (linguists, psychologist and anthropologists) at FSI drew on various theories
from their disciplines. Linguists help us understand the importance of language and its
Saphir-Whorf role in intercultural communication and highlighted the Sapir-Whorf hypothesis
hypothesis (language shapes our ideas and views of reality). They pointed out that learning a
second or third language can enhance our intercultural competence by giving us insight
into other cultures. The anthropologists focused on the role that culture plays in our
lives and the importance of nonverbal communication. It was however important for
these theorists to work from an integrated point of view to develop an interdisciplinary
focus enabling us to acquire and interpret information.
Enrichment activity
Describe and analyse a recent intercultural interaction. This may include talking to
someone of a different sexual orientation (gay, lesbian, transgender or bisexual),
different age, ethnicity, religion, race, a person with a disability et cetera.
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. Describe this interaction (encounter). What made it `ìntercultural''?
. Explain how you initially felt about the communication. Could you address this
person in your mother tongue? If you used another language (not your mother
tongue), how did it feel for you? Could the other person understand you? Did you
have the necessary vocabulary to start (or initiate) a conversation with the person?
. Describe how you felt after the encounter, and explain why you think you felt as
you did.
. Did you for example have any fixed ideas (stereotypes) or other barriers (internal
feelings of nervousness) about the person that you started the communication
with?
. Describe any challenges in trying to communicate. Think of nonverbal
communication (or language) for example. If there were no challenges, explain
why you think it was easy.
. Based on this interaction, identify characteristics (or issues) that may be important
for successful intercultural communication. (Adapted from Martin & Nakayama
2007:40.)
Activity
1.3
1. Study-read the three approaches to studying intercultural communication in
Martin and Nakayama (2007:4969).
2. View a feature film (video or DVD) like Brokeback Mountain, Priscilla Queen of the
Desert, Crying Game, Crash or Boys don't Cry and assume the position of a
researcher.
3. Analyse the cultural meanings in the film from each of the three perspectives:
social science, interpretive and critical.
4. What cultural patterns (related to nationality, ethnicity, sexual orientation, gender
and class) do you see?
5. What does each perspective reveal (disclose/expose)?
6. What does each perspective fail to reveal (disclose/expose)?
Our comments
The perceptions and world-views of scholars have an impact on the study of intercultural communication and led to
three contemporary approaches: the social science, interpretive and critical approaches. See Martin and Nakayama
(2007:4969) for a detailed discussion of these approaches.
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Activity
1.4
1. Study-read the dialectical approach to understanding culture and communication
in Martin and Nakayama (2007:6975).
2. Write a three page speech for the Minister of Arts and Culture in which you debate
the advantages of a dialectical approach to intercultural communication.
3. Your speech has to be persuasive and must include an introduction (introduce the
topic of dialectical approach), a body (the emphasis of the dialectical approach
and the six dialectics of intercultural communication) and a conclusion (viewing
the dialectical approach as a lens through which to view the complexities of the
topic).
Our comments
Martin and Nakayama (2007) advocate a dialectical approach that combines the social science, interpretive and critical
approaches. The dialectical approach emphasises a processual (how interaction happens), relational and holistic view of
intercultural communication. It also requires a balance of contradictory views. You need to include the six dialectics of
intercultural communication in your speech and need to highlight that intercultural communication is both cultural and
individual, personal and contextual, characterised by differences and similarities, static and dynamic, oriented to both
the present and the past, and characterised by both privilege and disadvantage.
Enrichment activity
One way to understand your cultural position or to become culturally conscious in South Africa (or your own
country) and examine your own cultural values, norms and beliefs is to think about the way you were brought up.
Answer the following questions:
. What values did your parents (grandparents or foster parents) attempt to instil in you?
. Why were these values considered important?
. What were you expected to do (after school) when you grew up?
. How were you expected to contribute to family life?
. What do you know about your ethnic background?
. What was your neighbourhood (town, school, university, sport fields, art facilities) like?
. Which newspaper did you read (or your parents) and why?
. Which media did you use (radio stations, television stations/programmes) and do you know why?
. What was church like (if any) when you were in the process of being shaped as a child to a teenager to an adult?
Try to discuss your answers with fellow students/colleagues. Analyse your own cultural position and how it is similar
to that of others (adapted from Martin & Nakayama 2007:7576).
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1.3
Conclusion
In this study unit we started by looking at why should we study intercultural commu-
nication and by giving a brief overview of the six imperatives for studying intercultural
communication. We also looked at the history of the study of intercultural commu-
nication where it started, how it developed, perceptions and world-views and at
the three approaches (social science, interpretive and critical) to intercultural com-
munication. Lastly we looked at a dialectical approach by focusing on six dialectics for
understanding culture and communication.
Test yourself
1. Identify the six imperatives for studying intercultural communication.

2. Describe how technology can impact on intercultural communication.
3. Describe how global and domestic economic conditions influence intercultural
relations. Include a self-reflection on how these conditions have an influence on
your life in the community where you are living.
4. Explain how understanding intercultural communication can facilitate resolution
of intercultural conflict.
5. Explain with examples the difference between a universalistic, a relativist and a
dialogic approach to the study of ethics and intercultural communication.
6. Identify and describe three characteristics of an ethical student of culture. Illustrate
the three characteristics with examples from your own culture.
7. Discuss the concept ``global village'' and identify the role of technology in human
communication. Explain the role of advances in communication technology and
highlight the issue of access to communication technology and the influence of the
``digital divide'' (Martin & Nakayama 2007:512).
8. Do research by reading three main newspapers over three weeks. Also surf
Internet websites and write a newspaper article (an opinion piece) on the
immigration patterns and diversity of new immigrants and the relationships of
South Africans (or people in your country of origin) with new immigrants. Highlight
the issue of immigration and economic classes as well as religious diversity (Martin
& Nakayama 2007:1524).
9. Write an article in which you discuss and disclose your own role in the self-
awareness imperative from an intercultural point of view.
10. The ethical imperative calls for an understanding of the universalist, relativist and
dialogic approaches to ethical issues (Martin & Nakayama 2007:3539). Discuss
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this statement critically by focusing on your own view on and the role (in your own
culture) of:
. self-reflexivity
. learning about others
. developing a sense of social justice
11. William Gudykunst (in Martin & Nakayama 2007:53) found that ``strategies varied
depending on whether people were from individualistic or collectivistic cultures''.
Discuss this statement critically by
. defining individualistic and collectivist cultures
. giving South African examples (or examples from your own country) of
individualistic and collectivist cultures
. discussing your opinion on the advantages and disadvantages of both
individualistic and collectivist cultures
12. Stella Ting-Toomey (in Martin & Nakayama 2007:53) views conflict as a ``face
negotiation process''. Briefly debate this view (in not more than one page) from
your own intercultural communication point of view by explaining why it is
important for people from your culture to save face.
13. Min-Sum Kim (in Martin & Nakayama 2007:53) discovered that people from
individualistic and collectivistic cultures place different forms of importance on
conversational concerns. Briefly debate this view (in not more than one page) from
your own intercultural communication point of view by explaining why it is
important for people from your culture to put importance on conversational
concerns.
14. In the communication accommodation theory ``researchers attempted to
identify how and when individuals accommodate their speech and nonverbal
behaviour to others during an interaction'' (Martin & Nakayama 2007:5356).
. Discuss this statement (in not more than one page) critically by explaining the
theory.
. Illustrate your discussion with examples from your own culture.
. Have you experienced overaccommodation from an individual from another
culture?
. In your culture how do you in your culture give compliments and offer
apologies, for example?
. What is your own view (or opinion) on self-disclosure in your culture?
. How would you translate the word ``self-disclosure'' into Afrikaans or an
African language/your mother tongue?
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15. Discuss the theoretical principles of the interpretive approach by discussing/
debating the theory and giving examples of the following from your own culture
(Martin & Nakayama 2007:62):
. human experience is subjective
. human behaviour is creative rather than determined or easily predicted
. culture is created and maintained through communication
. identifying patterns and rules
. interviewing people
. the view of oral culture
. language patterns
. Afrocentricity (if any)
. emergence of identity
. strengths and limitations
16. Give a descriptive overview of the critical approach by critically reviewing the
applications, postcolonialism, hybrid identity and the strengths and applications of
this theory (Martin & Nakayama 2007:6269).
17. List, define and describe the six dialectics of intercultural communication by
illustrating them with detailed examples from your own culture (Martin &
Nakayama 2007:6975).
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Study unit 2:
Culture, communication, context,
power and history and intercultural
communication
Christo Cilliers
Introduction
How do I ``see'' (or experience) my own culture? As humans we have different cultural
backgrounds, but we engage in the same daily activities and have many of the same
wants and desires. ``We all eat, sleep, love, pursue friendships and romantic relation-
ships, and want to be respected and loved by those who are important to us'' (Martin &
Nakayama 2007:81). There are also some real differences between cultural groups.
Culture can be defined in many ways and communication can be symbolic. Culture
influences communication and always happens within a context. Power is pervasive in
communication interactions it is not always evident how power influences com-
munication or what kinds of meaning are constructed. There is also a relationship
between power, history and intercultural communication.
The focus of this study unit is on the dialectical approach and understanding the four
interrelated components of intercultural communication: culture, communication,
context and power. We will also look at the various histories that provide the contexts in
which we communicate: political, intellectual, social, family, national, and cultural-
group histories. We pay particular attention to two identities diasporic and colo-
nial and the role of narrating our personal histories.
This unit is based on chapters 3 and 4 in Martin and Nakayama (2007).
KEY QUESTIONS
. How have notions of high and low culture influenced people's perceptions of
culture?
. How do the values of a cultural group influence communication with members of
other cultural groups?
. What techniques do people use to assert power in communication interactions?
. How is culture a contested site?
. What are some examples of hidden histories, and why are they hidden?
. How do the various histories of South Africa (or your country of origin) influence our
communication with people from other countries?
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. What factors in your experience have led to the development of positive feelings
about your own cultural heritage and background? What factors have led to
negative feelings, if any?
. When can contact between members of two cultures improve their attitudes toward
each other and facilitate communication between them?
. How do histories influence the process of identity formation?
. What is the significance of the shift from history to histories? How does this shift
help us understand intercultural communication?
. Why do some people in South Africa prefer not to talk about history? What views of
social reality and intercultural communication does this attitude encourage?
In this study unit you will come across words like culture, ethnography, cultural values,
power distance, communication ritual, diasporas and colonial histories. The prescribed
book gives us definitions of these words in the margins of the different pages.
2.1
Culture and communication
The relationship between culture and communication is the key factor in understanding
intercultural communication.
Culture and communication

by Lynn Parry (Faure, Parry & Sonderling 2000:1011)
Culture provides the context in which communication takes place. Communication

does not occur in a vacuum. Communication is what allows a culture to develop,
maintain and perpetuate itself and is the process through which culture is
transmitted. Communication, like culture, covers a multitude of definitions ranging
from, for example, a linear model of communication illustrating the recipient as
passively accepting the message, to the view that communication is not merely the
response but essentially the relationship determined by the transmission of stimuli
and the evocation of response. Another view of communication is that it is a
transnational process of exchanging messages and negotiating meaning to establish
and maintain relationships.
Communication involves people and their culture. Thus culture is an important

factor in communication. Particularly when people have different cultural back-
grounds, culture has an important influence on communication. ... [W]e view both
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culture and communication as dynamic processes. That is, they should be the result
of the creative, mutual adjustment to different circumstances. For example, in a
multicultural society like South Africa, where there is daily contact between African,
Western and Eastern cultures, it is evident that although this diversity may lead to
misunderstanding between the cultural groups, it also allows for an interesting and
stimulating community life.
Culture is a term that is used in many ways. More than one hundred definitions of
the term have been suggested by scholars from disciplines such as anthropology and
communication. Because culture is multidimensional and all-pervasive, scholars of
intercultural communication have defined culture in various ways. Culture can be
defined as ``the total accumulation of beliefs, norms, activities, institutions, and
communication patterns of an identifiable group of people''. Culture can also be
defined as the `èveryday activities practised by its members'' (Dodd 1991:41).
Another definition refers to culture as `à shared system of symbols'' (for instance,
language, nonverbal communication and group identity) which are linked to a
specific culture. For instance, both Americans and the British use the English
language, however in the United States a lift is called an elevator and petrol is known
as gas whereas in England it is a lift and petrol respectively.
A useful definition of culture could be that culture includes ``verbal and nonverbal
language, attitudes, values, belief systems, and behaviours'' (Singer 1987:34) that are
accepted by an identifiable group of people. This definition highlights some of the
most important cultural variables in intercultural communication.
If we use the term ``culture'' to refer to beliefs, values, attitudes, behaviours and
symbols that characterise the members of a society or nation, we need a term to
refer to the subdivisions of national cultures. The term used for this purpose is
subculture. A subculture involves a set of shared symbolic ideas held by a collectivity
within a larger society. In South Africa we can, for instance, talk about subcultures of
poverty and affluence, male and female subcultures, a senior citizen subculture, a
gay subculture, a youth subculture and a subculture of the disabled.
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Activity
2.1
1. Read the section What is culture? in Martin and Nakayama (2007:8191).
2. On a sheet of paper, identify and discuss the three approaches to culture.
3. Provide your own examples of each characteristic based on your own experience.
Our comments
The three approaches to culture can be viewed as:
. learned patterns of group-related perceptions

. contextual symbolic patterns of meaning
. heterogeneous, dynamic, and a site of contestation
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Activity
2.2
1. Study-read Martin and Nakayama (2007:91105).
2. In a three page article/mind map/guide (for an education supplement in a
newspaper of your choice) explain to grade nine learners the relationship between
culture and communication.
3. Make your article visually attractive by using colourful blocks. The article should be
easy to read and function as a mind map or a ``quick guide to understanding''.
Refer to examples from your own culture. Ensure that you include the following
information:
. communication as a symbolic process
. cultural values
. human nature
. living in harmony with nature
. relationships between humans
. activities
. orientation in time
. value orientations
. value frameworks
Our comments
. In the article (mind map/guide) how did you illustrate that communication is symbolic which symbols do we use
to communicate?
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. How did you explain the process by which we negotiate meaning and the importance of understanding cultural
values?
. Looking at human nature, do you agree/disagree that human nature is essentially evil?
. What is the view in your culture on living in harmony with nature?
. Did you explain that some cultural groups value individualism whereas others are more group oriented?
. What is the position (individualist/collectivist) in your culture? Why is it like this? What are the advantages/dis-
advantages?
. What is your view on cultural values (in your community/culture) that may influence the patterns of communication?
. Did you explain to the learners the difference(s) between those who ``do'' and those who ``think'' in your culture?
. What are the beliefs in your culture about emphasising the present or emphasising the past?
. What is the role of orientation in time in your culture?
. Did you share that although problems are shared by different cultural groups, solutions vary from culture to culture?
. Did you include the problem types (see Martin & Nakayama 2007:101) in your article?
. Did you focus in some way on identifying cultural values that help us to understand cultural differences?
. Did you remind your readers to remember that not everyone in our society holds the dominant value?
. Did you, for example, illustrate that not all South Africans living in rural communities may be collectively oriented, or
not all people living in the cities ignore those around them?
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Activity
2.3
2. Read the three newspaper articles: When culture gets the chop, Taking the bull by
the HORNS and Yengeni's dead bull is ring of hot debate.
Study how communication reinforces culture within a specific context and the re-
lationship between communication and power and then answer the following ques-
tions:
. Why do you think was it necessary for Tony Yengeni to be cleansed?

. What is your opinion (or view) on the cleansing ritual and cultural identity?
. Would you say the event in the article was a communication ritual?
. What would you say are the cultural norms and forms that construct cultural
identity in the article?
. Do you think that cultural values show how culture influences communication?
. Do you think communication reinforces cultural values?
. Do you think that Tony Yengeni resists or integrates the dominant cultural system?
What are your reasons for your answer?
*
19
Star, 24 Januarie 2007:1
*
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Saturday Star, 3 Maart 2007:17
*
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Saturday star, Januarie 2007:27
*
22
. Explain the relationship between communication and the context in which the
cleansing event took place.
. Do you think the context is social? Give reasons for your answer.
. Do you view the context as political? Give reasons for your answer.
. Do you think one can read the context as historical? Give reasons for your answer.
. What is your view on the power of the media that covered this event?
. What (in your opinion) was the role of the media in reporting on this event?
. What is the power of the religious views (Jewish and Islam) as quoted in the article?
. Explain the powers of the celebrities' views as quoted in the article.
. Consider the views of religion, readers and celebrities who has the most power?
Why would you say that?
. What is your view (opinion) on Phathekile Hlomisa saying that the media is
disrespecting `òur culture''?
. Think about the SPCA and the Congress of Traditional Leaders in South Africa.
. What are your views on the power of these two organisations?
. What is your view of the dialectical perspective in reviewing the article?
. What is your view of the communication perspective in reviewing the article?
. What is your view on the historical perspective in reviewing the article?
Our comments
In discussing these questions that relate mostly to the articles it is important that you read the relevant sections in the
book. You will also have to read the articles thoroughly. We recommend that you first read the section in Martin and
Nakayama (2007) and then the articles. After that you will have to work through the sections in the book together with
the articles. Opinions are not necessarily right or wrong, and try to relate examples to your own culture.
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Activity
2.4
1. Study read Martina and Nakayama (2007:117124).
2. Make a mind map (over two A4 pages). Identify the six different types of history.
Put brief pointers under each type. Give examples from your own culture and
country.
Our comments
You will see that culture and culture identities are intimately tied to history as they have no meaning without history. Also
keep in mind that we do not have one single version of history. The past has been written in many different ways. This
means that different kinds of history influence our understanding of who we are.
*
23
The six types of history that can be identified are:
. political, intellectual and social histories

. family histories
. national histories
. cultural-group histories
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Activity
2.5
2. Write an opinion article for a newspaper in which you sketch the power of your
histories as they happened to you.
3. Explain in layman's language the role of the ``grand narrative'' in telling your own
story as it fits into South African (or your own country's) history.
4. Interview grandparents and parents, historians and archivists and write your own
story on how you grew out of apartheid in South Africa.
5. Do you think/agree that a new narrative is emerging in your life in South Africa or
your own country?
Our comments
grand narrative The grand narrative refers to the overarching, all-encompassing (surrounding/encircling)
story of a nation or humankind in general. The grand narrative helps us to organise
history into a story that we can understand. This story will bring some ``truths'' that may
predominate over other conclusions.
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Activity
2.6
2. Choose a cultural group in South Africa (or your own country) that is familiar to
you.
3. Study the history of the group and describe significant events in their history.
Answer the following questions:
. What is the historical relationship between this group and other groups
(particularly the dominant cultural group)?
*
24
. Are there any historical incidents of discrimination? If so, describe them.
. What are common stereotypes about the group? How did these stereotypes
originate?
. Who are the important leaders and heroes of the group?
. What are notable achievements of the group?
. How has the history of this group influenced the identity of group members
today?
Our comments
The development of cultural identity is influenced largely by history. We can use history and stories to make sense of our
everyday lives. There are mainstream histories (ethnic and racial) as well as hidden histories (gender, sexual orientation,
racial, ethnic, diasporic, colonial and socioeconomic class histories).
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Activity
2.7
2. Write an opinion piece for a newspaper of your choice on intercultural
communications and history. Write the opinion piece (article) from your own
point of view/your own frame of reference. Address the following issues:
. How you recommend in a light-hearted way people of South Africa can
negotiate history.
. Recognise that you bring your own childhood experiences into the
interaction.
. Make recommendations on how communication can be facilitated by
bringing groups together.
. Highlight the eight conditions by advising readers with examples of how these
conditions can help us to negotiate interactions (Martin & Nakayama
2007:142144).
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By doing this activity you probably became aware of how contact with other cultural
groups can help us to negotiate aspects of history in interaction. It is important to
recognise how we bring our personal histories to each intercultural interaction. Myths,
language and events are all issues that come into the interaction. The eight conditions
can help us to understand how contexts differ and vary. Once we recognise that we
bring our own history into the interaction we can try to evaluate the role history plays
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for those with whom we interact. In each case it is important to negotiate the dialectical
tensions between the past and the present, and between the present and the future.
``Who we think we are today is very much influenced by how we view the past, how
we live, and what culture we believe to be our own'' (Martin & Nakayama 2007:146).
2.2
Conclusion
In this study unit we looked at the four building blocks for understanding intercultural
communication: culture, communication, context and power. Communication is
viewed as a symbolic process whereby reality is produced, maintained, repaired and
changed. The relationship between culture and communication is complex in the sense
that culture influences communication and is endorsed and reinforced through com-
munication. Communication also may be a way of challenging and resisting the main
(dominant) culture. The context also influences communication: It is the physical and
social setting in which communication occurs or the larger political, social and historical
environment. Power is pervasive and plays an enormous, although often hidden, role in
intercultural interactions (Martin & Nakayama 2007:113114).
Secondly we looked at the relationship between history, power and intercultural

communication. We identified the relationship between history and identity, four types
of hidden identity, and four antecedents (past histories/experiences) that influence in-
tercultural contact. The importance of negotiating personal histories was highlighted.
Test yourself
1. Identify three approaches to culture.

2. Briefly discuss the view of communication as symbolic and give examples of
symbolic communication from your own culture.
3. Identify and describe with examples nine cultural value orientations.
4. Using examples, describe how cultural values influence communication.
5. Using examples, explain how cultural values influence conflict behaviour in your
own culture.
6. Describe using examples from your own culture how communication can
reinforce cultural beliefs and behaviour.
7. Explain how culture can function as resistance to dominant value systems. Give an
example from your own life, community or country.
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8. Discuss Hofstede's value orientations (in Martin & Nakayama 2007:101104)
critically. Give a theoretical discussion and illustrate it with examples (or views and
opinions) from your own culture.
9. Cut out an advertisement from a men's (Men's Health or Blink) and a women's
(Cosmopolitan or True Love) magazine. Using examples from these advertisements,
discuss masculinity-femininity as a two-dimensional issue (see Martin & Nakayama
2007:103104).
10. Write an opinion piece for a newspaper in which you reflect on your own life and
culture. Give specific examples of the relationship between communication and
power (see Martin & Nakayama 2007:108114).
11. Define the ``grand narrative'' and explain how the master narrative in South Africa
(and in your own life) is changing to many new emerging narratives.
12. Choose two topics from the hidden histories (gender, sexual orientation, racial and
ethnic or diasporic and colonial). Interview a person who has had any two of these
historical experiences. Write a feature article/opinion piece in which you try to
reflect the historical experience of the person (see Martin & Nakayama 2007:132
140).
13. Discuss the eight conditions of the contact hypothesis critically. Explain in detail
the meaning of each and argue with examples from your own life/culture on why/
why not interaction can be negotiated (see Martin & Nakayama 2007:142145).
14. Discuss the importance of a dialectic perspective in negotiating personal histories.
Relate it to your own life/culture by illustrating with examples.
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Study unit 3:
Identity and intercultural communication
Celeste Shackleton
Overview
Have you ever wondered what defines you? Is it the language that you speak or your
biological characteristics? Is it the level of education that you have achieved, your
religion or the people around you? Taking this a step further, have you ever asked these
questions about a person from another culture?
This study unit introduces you to the concept of identity and what role it plays in
intercultural communication. You will get to understand what theory we apply to un-
derstanding identity, how a person goes through the process of forming an identity, what
kinds of identities there are, and what you need to be careful of, especially in your
perceptions of other people. All this will help you learn how to be effective and more
tolerant in your intercultural communication.
KEY QUESTIONS
. What did you learn about yourself after reading the chapter on identity?
. Can you describe your identity to your friend?
. Do you see how other people express their identity or how it is forced on them?
. What are the most important things to avoid in your own perceptions when you
conduct intercultural communication?
3.1
Introduction to identity and intercultural communication
To answer the key questions above, this study unit (Martin & Nakayama 2007:153206)
focuses on the three approaches to identity and investigates the processes that people
go through when developing their own identity. We then see how identity is expressed
through language and investigate social and cultural identities. Lastly we look at the
dangers of stereotypes, prejudice and discrimination and how you can become a more
effective intercultural communicator.
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In this study unit you will come across words such as identity, minority and majority
identity, labels, gender, age, racial, ethnic, religious, class, national, regional and per-
sonal identity, stereotypes, prejudice and discrimination. The prescribed textbook
provides you with definitions of these words in the margins on the different pages.
Please familiarise yourself with these terms.
Activity
3.1
1. Read your prescribed textbook (Martin & Nakayama 2007:154161).
2. Using table 5.1 in Martin and Nakayama (2007:155), draw a table as shown below
and provide your own example or mention a person that you know that is best
suited in each perspective. Your example should help you to understand what is
meant by each term.
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TABLE: Three perspectives on identity and communication and relevant examples
Social Science Interpretive Critical

Identity Self but culture Communication with Social, historical
created by: bound (static) others (dynamic) forces (dynamic)
Emphasises: Individualised Avowal: Contexts:
identity:
Familial identity: Ascribed: Resisting ascribed

identities:
Spiritual identity: Dynamic nature of

identities:
Our comments
When choosing your own example for the social science perspective, ask yourself if the person you have identified is
very independent, family oriented or spiritual and whether this person's culture has influenced the way they see
themselves.
For the interpretive perspective think about how you see yourself. Is it different from the way that another group of
people might see you? Does their viewpoint change the way you see yourself? If it does, then your interaction with them
has shaped your identity.
Your example for the last perspective should focus on what contexts have influenced your (or another person's) identity,
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and whether you (or they) are happy to be associated with an identity that other people have given you. The final
example should indicate how your (or another person's) identity has changed over time.
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Activity
3.2
1. Read the section in your prescribed textbook on identity and language (Martin &
Nakayama 2007:162163) and pages 230231 on the power effects of labels.
2. Consider your own workplace and describe what you should be aware of when
communicating with a colleague who speaks a different language to your own.
Our comments
In answering the above questions, did you bear the following in mind?
. Identity is expressed through language.
. The concept of labels and how it effects identity.
. Why it is important to remember change.
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Activity
3.3
1. Read identity development issues (Martin & Nakayama 2007:163171).
2. Identify minority and majority identities in your own context (at work, at home, in
your community, in any of your social clubs etc).
3. Go to someone in a minority identity and ask them how they feel about their
identity be sensitive in your questioning. Establish which developmental stage
that person is in and if they have worked through all four stages.
4. Do the same with someone from a majority identity.
5. Write down what you have discovered. Did it help you understand that person a
bit better?
Our comments
Remember that the minority or majority identities will differ from context to context. In the prescribed textbook, Martin
and Nakayama (2007:164) speak about an American context where white males are seen as a majority identity. The
identities that you identify in your context might differ considerably depending on the contextual factors. If you look at a
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soccer club, then the majority identity might be the goal scorers while the people who look after the grounds might be
seen to have a minority identity.
Another thing to consider is that people in a minority identity do not need to become a victim of domination but can
put themselves in a position of power by embracing their identity. Without the soccer club's groundsman who is
proud to do what he/she does, and does the job properly the goal scorers can't practise and play matches. Similarly,
someone in a majority context should realise that they are not necessarily more privileged than someone in a minority
identity, and their communication with each other should reflect this.
Additionally, people live with many identities (eg age, gender, ethnic, religious), which brings different dynamics to the
picture. The significant point to understand in this section is that while you are conducting intercultural communication,
you should not fall into the trap of thinking that someone else is more privileged than the other.
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Activity
3.4
1. Read the section on social and cultural identities on pages 171177 and 182 to
189 (Martin & Nakayama 2007).
2. After reading this section, match columns A and B.
TABLE: Match columns A and B: Social and cultural identities
Social and Cultural Identities Descriptions

1 National identity A. Women wear hair extensions and
men have big muscles.
2 Gender identity B. `Ì am 70 years old and proud to be
it.''
3 Regional identity C. The shared sense of origin and
history.
4 Age identity D. Based on physical characteristics
and fluid social contexts.
5 Racial identity E. Imbeleko, Baptism, Circumcision,
Bar Mitzvah, Initiation, Namakarna.
6 Class identity F. `Ì am a student at UNISA.''
7 Religious identity G. `Ì'm proudly South African.''
8 Personal identity H. Eating lobster and playing golf. Or
living in a certain suburb of a city or
township.
9 Ethnic identity I. The people living on the mountain
behave differently from the people
living in the valley.
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Our comments
Match the examples with the identities after finding the clues in the prescribed textbook. If you really cannot complete
the table, you can contact the module coordinators for the answers.
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Activity
3.5
1. Read the section on identity, stereotypes, and prejudice in Martin and Nakayama
(2007:189196).
2. Write down two examples of stereotypes in your context; one should be positive
and one negative. Think about how stereotyping forms labels and write down
what the label is for each of your two examples of stereotypes.
3. Now think back to where you learnt about these two stereotypes and write it
down.
4. Search for examples of people that you know (including yourself) that hold
prejudices for reasons described as a utilitarian function, an ego-defensive
function, a value-expressive function and a knowledge function. How does this
affect their communication?
5. Think carefully about how you have allowed stereotyping and prejudice to lead
you to discriminate against someone even if the person has an illness, is
disabled, or is old. How can you go about being more sensitive to the situation to
improve your intercultural communication?
6. Explain to a friend how stereotyping, prejudice and discrimination are different
from each other.
Our comments
It is important to understand why people stereotype other people, and that some people don't mind being categorised
into a stereotype while others do. Think about some South African Blue Bulls rugby supporters who are proud to be
stereotyped into that category. There are however other Blue Bulls rugby supporters that don't want to be associated
with the stigma of the Blue Bulls supporter stereotype.
It is also important to identify where you learn stereotypes from (the media, your family, or an experience), to be able to
distinguish whether the descriptions are accurate or misleading. Another reason for identifying the source of the
stereotype is because the messages might be reinforced in certain media which may make it very difficult to change
perceptions. If restoration is to take place, then you need to stop the message before you allow it to breed in your head.
The most important thing to remember when communicating between cultures is to avoid stereotyping and allow the
person to be his/her own person.
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Being prejudiced is not a good quality of an effective intercultural communicator. Identifying why people are prejudiced
will facilitate communication between cultures and hopefully overcome the negative beliefs.
. In a place such as South Africa where many cultures live in the same environment with different levels of power,
prejudicing might be rewarded by the community because communal prejudicing of one culture against others
attempts to preserve their own culture. Stories, rituals, myths and the like often reinforce these prejudices.
. Secondly, where people refuse to see their own faults, prejudice is an easy way out of refusing to change. Here the
old apartheid regime of South Africa is an example. The danger of such an extreme case is that the correction of
such prejudice could result in overcorrection and develop into another form of prejudice.
. Another reason for becoming prejudiced is to reinforce a value that is important to you. When someone who
doesn't feel the same way disagrees with you, it might frustrate you to the point of developing a prejudice against
that person. A working woman, for example, may value a man that helps in the house, but if another man doesn't
agree with this value, then the women could develop a prejudice against that man (or even men in general).
. Finally, people may even develop such an attitude of prejudice to some cultures that they interpret everything they
see and hear into a means to support their prejudice. Victims of this type of prejudice are often prominent people
(celebrities) who have had something happen in their lives. From there, everything they do after that is translated
into information that supports other people's prejudice against them.
Although discrimination seems extreme and you might think that you have never discriminated against anyone, Martin
and Nakayama (2007:193) explain to us how easy it is to discriminate by even the smallest nonverbal gesture. People
are very sensitive to gestures and notice them quickly even if you think you are being discrete. For this reason, as an
effective communicator you need to identify your areas of discrimination and deal with them. Be sure to realise that
discrimination doesn't only occur between cultures but in other areas such as against a person who has HIV/Aids or a
person who is old.
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Activity
3.6
1. Read the section on multicultural people in Martin and Nakayama (2007:197
203). If you are a multicultural person, why don't you keep a journal of your
experiences in learning about other cultures? See if your notes can help you
become a successful culture broker.
2. Study the section on identity and communication in Martin and Nakayama
(2007:203205).
3. The next time you talk to someone who is from a different culture to your own,
see if you unconsciously make assumptions about the person based on their
culture and physical appearance. Write down how you can correct yourself.
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4. Do a performance study on someone from a culture you are not familiar with and
write down your findings to learn more about the culture.
Our comments
Monitoring your own intercultural communication is the first place to start implementing successful intercultural
communication. This can only be done by keeping an open mind and practising to be an effective communicator. You
need to know and feel secure in your own identity and stay away from stereotyping, prejudicing, or discriminating
against other people's identity. Using the theory learnt in this section of the study unit, make sure that you avoid
assumptions and base your knowledge on the truth about the people that you are communicating with.
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3.2
Conclusion
This study unit introduced you to the concept of identity and helped you understand
the three approaches to identity. In these approaches, we had a look at the dialectical
view of identity where it can take the form of static and dynamic perspectives. We
investigated labels and how dangerous they can become. We focused on minority and
majority group membership of identities and how people go through the phases of
developing their own identity. We then saw how identity is expressed through social
and cultural identities and lastly we looked at the dangers of stereotypes, prejudice and
discrimination.
Test yourself
1. Differentiate between the three communication approaches to identity.

2. Describe what is meant by the term `ìdentity''.
3. Explain how language and identity influence each other.
4. Describe the phases of minority identity development.
5. Describe the phases of majority identity development.
6. Name and discuss the nine social and cultural identities and provide your own
examples of each.
7. Discuss the difference between stereotyping, prejudice and discrimination.
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8. Provide a debate on how you can avoid stereotyping, prejudicing and
discriminating.
9. Explain the relationship between identity and communication.
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Study unit 4:
Language, nonverbal and intercultural
communication
Celeste Shackleton
Overview
Imagine you are visiting a foreign country where you don't understand their language
and they don't understand yours. Do you think you would be able to communicate?
Maybe you could try to point at things or even draw things on a piece of paper, but in
many cultures, these forms of nonverbal communication have different meanings from
how we understand our own nonverbal communication.
This study unit introduces you to the concept of language and nonverbal commu-
nication, and the role that it plays in intercultural communication. By the end of this
study unit you will have learnt how to be sensitive and effective in your intercultural
communication by considering these two variables.
KEY QUESTIONS
. Why is it important to consider language from a discourse point of view?
. What is the relationship between our language and how we perceive our reality?
. What will you do differently in your nonverbal communication the next time you
engage with a person from a different culture?
. What nonverbal behaviours are universal?
4.1
Introduction to language and intercultural communication
This section of this study unit focuses on chapter 6 of the prescribed textbook (Martin &
Nakayama 2007:210248). You will come across words such as la langue, la parole,
discourse, semantics, syntactics, pragmatics, phonetics, International Phonetic Alphabet
(IPA), semiotics, semiosis, signs, nominalist position, relativist position, qualified posi-
tion, honorific, communication style, metamessage, high and low context commu-
nication, co-cultural, bilingual, multilingualism, interlanguage, translation,
interpretation, equivalency, and language policies. The prescribed textbook provides
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you with definitions of these words in the margins on the different pages. Please fa-
miliarise yourself with these terms.
Before you turn to the prescribed textbook, read this section on language.
Language
by Lynn Parry (Faure, Parry & Sonderling 2000)
Language is often the most problematic cultural variable in intercultural commu-

nication. We use language as the primary means by which to transmit beliefs, values,
norms and worldviews. Language develops in the context of a particular culture and
therefore reflects the culture. Language also influences perception, transmits
meaning and moulds our patterns of thought. Think about the different languages
in South Africa. We have 11 official languages as well as 12 or more other languages
spoken in our country.
It is clear from the above that language has a great impact on our communication with
each other. The issues of language and intercultural communication do extend further
than speaking and understanding different languages. Misunderstandings occur even
when the same language is spoken by different cultural groups.
Activity
4.1
1. Read your prescribed textbook from pages 211215 (Martin & Nakayama
2007:211215).
2. Look at the image below and explain from a dialectical approach why there is a
misunderstanding between the Zulu-speaking person and the English speaking-
person.
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Our comments
Your answer should discuss the situation by including all the components of language mentioned in Martin and
Nakayama (2007:211215). Here are some guidelines:
. Phonetically, ``Hau'' and ``How'' sound the same, but from a semantic point of view the meaning of the words
``Hau'' and ``How'' is very different in the two languages.
. Looking at the syntactics, ``Hau'' can be a complete sentence in isiZulu that communicates a specific meaning (or
reaction). In English, however, ``How'' is seldom used on its own in a sentence.
. The pragmatic viewpoint would suggest that ``Hau'' spoken differently could mean many things in isiZulu which
would be totally unknown to the Englishman.
. Looking at semiotics, you can see that the Zulu person looks astounded and says ``Hau'', but this could be
interpreted by the Englishmen as the beginning of a question that the Zulu person is confused about.
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Activity
4.2
1. Read the section on pages 215218 of Martin and Nakayama (2007:215218).
2. What position on language and perception do you think applies to your life? Tell
your friend why you feel this way and write it down. See how your own views
correspond with what the theories say in the prescribed textbook.
Our comments
To answer this question, you need to ask yourself whether you feel that your perception of the world is affected or not
affected by the language that you speak. In other words, if I am a Sotho person, does the fact that I speak siSotho
influence the way that I perceive a Zulu person or an Afrikaans person, even if I can speak isiZulu and Afrikaans? To help
you remember the theories, find people who would disagree or agree with you and write down examples to debate
your viewpoint.
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Activity
4.3
1. Read the section on pages 218226 f Martin and Nakayama (2007).
2. In your cultural language do you make use of the honorific? If so write down your
example.
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3. Think of situations where your excessive use of words or your lack of words
created an opportunity for a misunderstanding.
4. For your own benefit read the section on pages 226229 in Martin and Nakayama
(2007). Can you see how someone moving through the development issues of
identities will make use of the different assimilation, accommodation and
separation strategies?
Our comments
In South Africa, the Afrikaans culture considers it respectful to say `ù'' rather than ``jy'' in a formal conversation and/or
out of respect to an older person or person of greater status. Both of these words translate as the pronoun ``you'' but the
first word carries more respect than the second. In many languages and cultures these types of rules may or may not
apply. As an intercultural communicator you need to be mindful of the cultural rules that apply to the use of the
language in different cultures. You might for example find that the French spoken in the Congo is different to the French
spoken in France. The use of honorific, for example, might therefore be different from culture to culture.
Another form of honorific is seen in the speaking style of the younger generation as compared to the speaking style of
the older generation in the same cultural language. Think of a situation where you have spoken to a friend and how
your style of communication would differ if you were speaking about the same thing to an older person.
Martin and Nakayama (2007:219224) state that Western cultures tend to rely on words in their communication style,
and the opposite is true for other cultures. In South Africa this suggestion is not as clear cut. Look at the example on
page 244 of Martin and Nakayama (2007:224) do you agree with it? Communication styles in this country have
changed due to macro influences. Since the fall of the apartheid regime, South African cultures have been engaging in
intercultural communication more abundantly and with less prejudice. Metamessages from black, coloured and Asian
people have adapted to include an increase in verbal messages while the white people have become more reliant on
other aspects of the message. This whole process has positively affected the intercultural communication in the country
as there is a stronger tolerance and a tendency to adapt to the different communication styles.
Another example of metamessages can be seen in the communication between a husband and wife or two best friends.
In communicating over time the parties often become less reliant on words and are able to communicate with each
other without saying a word to each other.
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Activity
4.4
1. Read Martin and Nakayama (2007:232242). In South Africa we have many
people who speak numerous languages. What do we call these people?
2. Identify what forms of interlanguage have developed in South Africa.
3. What is the difference between translating and interpreting, and have you ever
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had to translate or interpret something for someone before? What did you have to
think about? Was it the same things as mentioned in Martin and Nakayama
(2007:234239)?
4. What is code switching and why do multilingual people tend to do it?
Our comments
An example of interlanguage in South Africa that differs from the one mentioned in Martin and Nakayama (2007:234),
is the language developed by people who worked on the mines. Called Fanagalo, this language is a blend of many
different South African languages and is understood by all mineworkers. Have you come across an interlanguage like
this? If you have, find someone who can speak it and ask them if it assisted them in their intercultural communication on
the mines.
It is important to understand that there is a difference between translating and interpreting languages. As languages are
structured differently, translation and interpretation are very difficult. This is especially true if there are words in the one
language that do not exist in the other. There are many other pitfalls that translators and interpreters need to be aware
of can you think of them?
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Activity
4.5
1. Read the sections on language politics and policies and language and globalisation
in Martin and Nakayama (2007:244247).
2. What do you think the language policy goals are in South Africa?
Our comments
The goals of language policy could be to encourage assimilation under a language and national identity. In other cases it
may be to provide protection for minority languages or regulate the language use in different parts of a nation. In South
Africa instituting the 11 official languages not only preserved and increased the use of these languages but also
reinforced our national identity of the ``rainbow nation'', thereby cherishing diversity. There are however many chal-
lenges surrounding this dream especially when it comes to education, media communication, public sector services and
the like. What are you thoughts on this?
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4.2
Introduction to nonverbal codes and cultural space
This section of this study unit focuses on chapter 7 of the prescribed textbook (Martin &
Nakayama 2007:253278). In this section of the study unit you will come across words
such as relational messages, status, deception, facial expressions, proxemics, contact
cultures, noncontact cultures, eye contact, chromenics, monochromic, polychromic,
cultural space, regionalism and postmodern cultural spaces. The prescribed textbook
provides you with definitions of these words in the margins on the different pages.
Please familiarise yourself with these terms.
Before you turn to the prescribed textbook, read this section on nonverbal commu-
nication. Then read the prescribed textbook from pages 253 to 256 (Martin & Na-
kayama 2007).
Nonverbal communication
Closely related to language is nonverbal communication. While language is mostly

explicit and processed through our cognition, our nonverbal communication is
spontaneous, ambiguous, often fleeting and at times beyond our conscious
awareness and control. Because our nonverbal communication is largely
unconscious, it is often misinterpreted and cannot be corrected easily.
Activity
4.6
1. Read the section on the universality of nonverbal behaviour in Martin and
Nakayama (2007:256265).
Study the six nonverbal codes and look at the pictures below. Identify which group
of pictures belong to which nonverbal code (namely facial expressions, proxemics,
gestures or kinesics, eye contact, chronemics and silence).
2. Based on the prescribed book, highlight which of these codes are universal.
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AND
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AND
3. Explain why we need to be careful not to generalise and stereotype nonverbal

behaviour.
Our comments
Although the universality of nonverbal communication has been researched and the approach to the study of nonverbal
communication requires a degree of generalisation, it is dangerous to categorise certain nonverbal behaviour as
belonging to a specific culture. Consider this example:
The Botswana people have a respectful gesture when they give something of value (like money) to someone. They
hold the money in one hand and put their other hand underneath the wrist of the hand passing the money. This
communicates to the person receiving the money that the giver will not attack the receiver or try to take the money
back because both hands are visible to the receiver.
I am from a different culture and have decided to adopt this gesture because I believe it to be beautiful. If there are
others like me, then there will be many other cultures practising this gesture, which will not make it specific to
Botswana people anymore. It can therefore not be generalised to the Botswana people only, but it can be said that
it is generally practised by Botswana people.
There are many of these kinds of gestures that are shared amongst different cultures, therefore it is dangerous to
stereotype people based on the gestures they perform. Similarly, cultures may include people who have formed
different identities (as discussed in the beginning of this study unit). For this reason these people may adopt or let go of
various forms of nonverbal communication that are not specific to their own culture.
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Activity
4.7
1. Read the section on defining cultural space in Martin and Nakayama (2007:266
278).
2. In each row of the table below, write an example of how your cultural space
communicates something about you nonverbally.
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TABLE: Examples of nonverbal influences from culture spaces
Your own example

Home
Neighbourhood
Regionalism
3. In the next table, fill in an example of how your cultural space has changed
because you have travelled or moved to a different area. If you haven't done that
then think of someone you know that has travelled or moved and write down how
it has affected them.
TABLE: Examples of changes in culture spaces
Changes in cultural spaces

Travel
Migration
4. What postmodern cultural space are you currently involved with and how has it
changed with new people joining the group? Have you enjoyed and accepted the
change or have you tried to maintain the previous state of the cultural space?
Our comments
It is clear that nonverbal communication does not only include a person's body language, but can include symbols, signs
and many other things. The authors, Martin and Nakayama, are trying to explain how the cultural space that you
operate in can influence your identity and become a nonverbal means to communicate something about you to other
cultures. Amongst other things, nonverbal cues from a home often communicate status levels. The neighbourhood
provides clues on the racial or ethnic groups that live there. Regionalism is a form of nonverbal communication that
communicates where you come from and your level of satisfaction with being associated with that region.
Travelling alters the above views because you are exposed to different ways of doing things. Where the effects are
temporary in travelling, migration makes effects more permanent.
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Your boss is explaining something to you, and out of respect you look at the ground. You can't understand why he/she is
getting frustrated by your behaviour but by the end of the conversation your boss walks away in a temper. What do you
think happened here? Can you ascribe both your and your boss's behaviour to the communication style?
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4.3
Conclusion
In this study unit we focused on the importance of language and nonverbal commu-
nication as variables of intercultural communication. We learnt that language refers to
the system of language where all the language components need to be considered
when understanding how a language is utilised within a particular culture. We explored
the relationship between language and our perceptions and how these perceptions can
vary depending on whether we are arguing from a nominalist, relativist or qualified
relativist position. We saw that communication styles differ from culture to culture, and
we established that we make use of our language from our social and power positions,
which gives rise to labels. We learnt that bilingual and multilingual people may engage
in code switching or changing languages and how translation and interpretation are
different. We also discovered that language policies are instituted with different goals.
From a nonverbal communication perspective, we learnt that nonverbal communica-

tion is different to verbal communication and we identified the reasons why we make
use of it. We investigated the universality of nonverbal behaviours and identified the
different nonverbal codes. Lastly we investigated cultural spaces and how these can
change.
Test yourself
1. Explain how language and discourse differ especially in your own context.
2. Describe what the components of language are and provide examples of each.
3. Explain the nominalist, relativist and qualified relativist positions on language and
perception.
4. Give examples of different communication styles in your own context.
5. Debate the power of labels and provide your own contextual examples.
6. Highlight the difference between translation and interpretation.
7. Describe the challenges of multilingualism.
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8. Examine language policies and present your argument on them.
9. Explain how verbal and nonverbal communication differs and what types of
messages are sent nonverbally.
10. Indicate what nonverbal messages are universal.
11. Explain why it is not good to stereotype nonverbal behaviours.
12. Describe what cultural space is and how it is formed.
13. Why is it important to understand cultural space in intercultural communication?
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Study unit 5:
Understanding intercultural
transitions
Stefan Sonderling
Overview
This study unit and chapter 8 of the prescribed book introduce you to the situations in
which people from different cultures encounter one another and interact. Such situa-
tions are created through the movement of people from place to place by migration or
travel. Understanding the reasons why people migrate can help us improve our un-
derstanding of different cultures and develop intercultural communication skills.
KEY QUESTIONS
. What is migration?
. What are the motives for migration?
. What different types of migrants can be identified?
. What types of relationship develop between migrants and their hosts?
. How do migrants and the host community adapt to each other?
. How do migrants and host experience their interaction?
. How does a person develop a multicultural identity?
5.1
Introduction
This study unit will guide you through your study of chapter 8 in your prescribed book
(Martin & Nakayama 2007). In this study unit we learn about the movement of po-
pulations, that is, movements of groups of people or individuals across borders. Such
movements are known as migration and travel. Throughout history people have mi-
grated from one place to another and the population of most countries is made up of
different groups of people who settled in one place or territory they now call home.
Over time the original settled group of people becomes a community. The character-
istics of the people living in one territory are called the demographic characteristic of
the country. Later the settled community may be joined by individuals or other groups
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of immigrants, migrants, tourists or refugees. Through such movements people of dif-
ferent cultures come into contact with each other and engage in intercultural com-
munication.
Activity
5.1 You have already encountered the idea of demography and migration in your study of
chapter 1 in the prescribed book (Martin & Nakayama 2007). Before you proceed with
your study of this study unit and chapter 8 of the prescribed book please revise your
knowledge by reading pages 1224 in the prescribed book (Martin & Nakayama 2007)
and working through the activities in the book and those in study unit 1 of this study
guide.
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Activity
5.2 On page 286 of the prescribed book you will find three migration stories. Read the
stories and identify the reasons why the people telling the stories or their ancestors
migrated from their place of birth and settled in the United States of America. You will
find the answers on page 287.
NB: While the stories you are reading are told by people living in the United States of
America, similar stories can be told by people living in South Africa or in any large city in
the world. We are all immigrants who settled in a city or a country. To hear such stories
go out and ask your friends to tell you where they came from and why they came to live
in the city or in the country.
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Activity
5.3 Read pages 288289 in the prescribed book on six trends in international migration.
Identify the trends in international migration and the reasons for such migration. While
you are reading the section in the prescribed book answer the following questions:
. What is global migration?

. What are the reasons for the increase in migration?
. What is meant by differentiation of migration?
. Why do women migrate?
. What are the political motivations for migration?
. What does commodification of migration mean?
You will find the answer on pages 288289 of the prescribed book.
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*
48
5.2
Thinking dialectically about intercultural transition
One of the problems of migration is the difficulty experienced by the migrants and their
hosts when they encounter one another, for example, how immigrants experience their
new environment and how the local population reacts to the new immigrants entering
their communities. According to the authors of the prescribed book we can use the
dialectical approach to understand these problems. The first task in understanding these
problems is identifying the types of migrant groups.
Activity
5.4 Read pages 287288 and answer the following questions:
. Why are some migrants more advantaged in their new environment?

. Why do some people find the experience of moving from one place to another
easier than others?
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5.3
Types of migrant groups
In this section of the prescribed book the authors suggest that one way to understand
migration is to classify migrants on the basis of their motivation or the reason that made
them migrate. Two motivations are identified: being forced to leave one's place of birth
or freely deciding to move to another place. Based on this we can identify two types of
migrants:
. voluntary migrants
. forced migrants
Given this distinction, you can understand that a person that migrated of his or her own
free choice will be more positive and adapt more easily to the new cultural environ-
ment as opposed to a person that was forced to leave his or her homeland and move to
another place.
*
49
Activity
5.5 Read pages 288295 on voluntary and involuntary migrants and answer the following
questions:
Voluntary migrants:
. What is a voluntary migrant?

. What is an immigrant?
. What is a sojourn?
. What motivates the immigrant to move to another country?
. What is the meaning of ``migrant labour''?
. What are the reasons for the migration of women?
Involuntary migrants:
. What is an involuntary migrant?

. What is a long-term refugee?
. What is a short-term refugee?
. What is an international refugee?
. What is a domestic refugee?
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5.4
Migrant-host relationships
A migrant-host relationship is the relationship that develops between the migrant and
the local community. The authors of the prescribed book suggest the use of the dia-
lectical method to explain the migrant-host relationship. The dialectical method means
that we need to consider the tension between the migrant and the host community and
how they adapt to each other. Five relationships are identified by the authors of the
prescribed book:
. assimilation
. separation
. integration
. marginalisation
. cultural hybridity
*
50
Activity
5.6 Read pages 295302 of the prescribed book and answer the following questions:
. What is the meaning of assimilation?

. What is forced assimilation?
. Why do some migrants value the host's culture more than their own culture?
. What is separation?
. What are the reasons that cause separation?
. What is segregation and how it is experienced?
. What is integration?
. What is marginalisation?
. Why are some people marginalised?
. What is cultural hybridity?
. How does religion influence the migrant's adaptation to the new environment?
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5.5
Cultural adaptation
Cultural adaptation refers to the process of adjustment experienced by an immigrant as

he or she gradually adapts to the host community and culture. In the prescribed book
the authors provide three approaches to describe and understand the cultural adap-
tation process. On page 302 of the prescribed book the authors list the main emphasis
of each of the three approaches to cultural adaptation.
Social science approach

The social science approach looks at how the individual adapts to the host culture and
studies what characteristics of the individual immigrant influence the process of
adaptation. For example, how characteristics such as the immigrant's age, gender,
preparation levels and expectations will determine how well the migrant will adapt to
the new host community. The social science approach provides a number of models to
explain the process of interaction and adaptation of the immigrant to the host en-
vironment. The models include the following:
Anxiety and uncertainty reduction model
*
51
The uncertainty reduction theory
At the base of this theory is the assumption that in intercultural communication, at

least one of the communicators is a ``stranger'', a member of an `òut-group'', and
experiences some anxiety or uncertainty in his or her interaction with the `ìn-
group''. This theory assumes that members of the `òut-group'', being conscious of
cultural differences, approach the `ìn-group'' at a high level of awareness; that
interpersonal factors, as well as intergroup factors, influence intercultural commu-
nication; and that the influence of group partisanship is often overestimated by the
participants. According to this theory, the `ìn-group'' (a new culture) is superior and
the `òut-group'' (strangers to the new culture) is inferior.
The uncertainty reduction theory focuses on two poles of cultural variability, namely
individualism and collectivism, which influence intercultural communication. In
individualistic cultures, individuals care for themselves and their immediate families,
while in collectivistic cultures, individuals care for, and are cared for by the group in
exchange for loyalty. The following factors will cause collectivistic influences to
increase, which will result in uncertainty and the avoidance of uncertainty:
. strong ethnolinguistic identity

. poor second-language competence
. negative expectations
. minimal group similarity
. different networks
. low interpersonal importance
. ambiguity intolerance (Gudykunst 1988:123157)
The reduction of anxiety is, therefore, a basic tenet of this theory. For example, if
your home language is English, how well do you speak or understand Sotho or Zulu?
On the other hand, if your mother tongue is Zulu, how well do you speak English, or
Tswana? If you belong to a Western culture, do you know what nonverbal
communication is used to stop a mini-bus taxi? An important notion in this theory is
the role of stereotypes. This theory assumes that it is easier to understand a
stereotypical picture of an `ìn-group'' than to understand an individual.
The uncertainty reduction theory views the two major goals of intercultural
communication as (1) the adaptation to new intercultural communication situations,
and (2) effective communication. This adaptation to new intercultural communica-
tion situations depends on the attributional confidence or desire of the `òut-group''
to communicate.
*
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Transitional model
The transitional model explains intercultural adaptation as a process of change that
includes some loss and some gain for the individual involved in the adaptation process.
In other words, if you desire to become part of a new community you need to give up
on some of your old cultural habits and biases in order to gain acceptance by the new
host community. The main assumption of the transition model is that we have two main
attitudes to our encounter with the new host community. In the ``flight approach'' we
want to escape and limit our contact with them and remain in the safety of our own
friends and family. Another approach is the ``fight approach'' in which we actively enter
the new community and become involved and try to participate in their life and
activities.
Integrative model
The integrative model emphasise the role of communication in the adaptation process.
Adaptations occurs through communication; the migrant communicates with members
of the host community and gradually gains knowledge and learns new ways of thinking
and behaving that are acceptable to the host community. Migrants who communicate
more with their new hosts may at first experience ``cultural shock'' but will be able to
adapt faster than those that do not communicate freely with the new host community.
All cultural contact has outcomes or results: by adapting to the new situation we start
feeling more comfortable and self-confident in the new environment and can function
well. When one feels well one is able to work and find one's way in the new host
community and hopes to develop a new intercultural identity. Intercultural identity
means that our identity combines aspects of our own culture and the new cultural
environment in which we now live and work.
Activity
5.7 Read pages 302309 of the prescribed book and answer the following questions:
. List the three approaches to cultural adaptation.

. Explain the main points of emphasis of the three approaches to cultural adaptation.
. What is the main focus of the social science approach to cultural adaptation?
. How do individual characteristics influence cultural adaptation?
. Describe the anxiety and uncertainty reduction model.
. What is uncertainty reduction?
. What is predictive uncertainty?
. What is the role of communication in the cultural adaptation process?
*
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. Describe the main assumptions of the transitional model.
. Explain the ``fight approach'' and the ``flight approach''.
. Describe the integrative model.
. What are the possible outcomes of cultural adaptation?
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Interpretative approach
The interpretative approach focuses on in-depth description of the intercultural process.
In other words, by describing the interaction in intercultural situations we are better
able to understand what happens during the adaptation process. Another name for the
interpretative approach is the phenomenological approach. Different methods may be
used to describe and understand the intercultural adaptation process, such as partici-
pant observation in which the researcher him or herself enters an intercultural adap-
tation process and describes his or her experiences. Other methods that are used are in-
depth and detailed interviews with the people involved or questionnaires.
The main difference between the social science approach and the interpretative ap-
proach is that the social science approach tries to describe the process by using ob-
jective criteria such as age and gender and how they influence the process of
adaptation, while the interpretative approach attempts to understand what happens
during the process by looking at the subjective experience of the people involved.
The interpretative approach describes adaptation by using three models:
. U-curve model
. W-curve model
. phenomenological model
The U-curve and W-curve models suggest that there are fairly predictable stages in the
intercultural adaptation to a new cultural environment. For example, according to the
U-curve model the first stage in the intercultural process is an experience of excitement
and expectation, this is followed by a period of shock and disorientation and a feeling of
being down at the bottom of the U-curve. The next stage is a slow process of recovery
and gradual improvement when the migrant adapts to the new situation.
In addition to the first adaptation process described by the U-curve, the W curve
describes what happens when the migrant returns to his or her home country and
culture. This is a similar experience of adaptations to one's own culture after having
been exposed to another culture.
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The phenomenological approach is simply an approach that seeks to understand the
intercultural experience by asking the participants detailed questions about their ac-
tions, reactions and feelings during the process of adaptation.
Activity
5.8 Read pages 309318 in your prescribed book and answer the following questions:
. What are the aims of the interpretative approach?

. Describe the stages of the U-curve model. If you have yourself experienced
intercultural adaptation, do you think that the model describes the stages of your
experience?
. Explain the stages in the W-curve model.
. Why do migrants have difficulty when they return and re-enter their own culture
after having been exposed to another culture?
. Explain the aims of the phenomenological model.
. Describe and explain the three stages of the phenomenological approach.
. What are some of the main experiences people have during the adaptation
process?
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Critical approach: Contextual influences

The critical approach considers the importance of the environment in which cultural
interaction takes place. The environment is the social and cultural context of inter-
cultural interaction. Understanding the intercultural encounter requires that we look
not only at the way people from different cultural backgrounds interact as individuals
but also the wider social and cultural environment of the interaction and how this
environment influences the way individuals interact.
By environment we mean how some communities are more open and receptive to
immigrants and easily accept outsiders while other communities are more closed to
outsiders. One of the reasons for a community being more open or closed may be its
historical experience of outsiders, or the way its cultural beliefs and practices welcome
or exclude outsiders.
Activity
. What is the context for intercultural encounters?

. What is the role of communication in the cultural adaptation process?
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. What is the meaning of in-group and out-group?
. How do social institutions influence intercultural assimilation?
. How can the school help immigrants to adapt to their new culture?
. How do religious institutions influence adaptation?
. How do differences of statutes and power influence adaptation?
. How does social class influence adaptation?
. What is the relationship between old immigrants and new immigrants?
. What is a ``guest-worker''?
. What are the issues that influence the way an immigrant develops intercultural
identity?
. Explain what is meant by ``living on the border''.
. Explain how people develop multicultural identity.
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5.6
Conclusion
In this unit we dealt with the dialectical perspective on intercultural transition, social
adaptation, the type of migrants, host and migrant relationships and the approaches we
can use to understand cultural adaptation.
Test yourself
On page 326 of the prescribed book you will find discussion questions and activities.
Please answer the discussion questions and do the activities and provide examples from
your own experience of intercultural adaptation.
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Study unit 6:
Popular culture and intercultural
communication
Stefan Sonderling
Overview
In this study unit we look at popular culture and its importance for understanding
intercultural communication. We concentrate on the nature of popular culture, how it
differs from high culture and folk culture and how people experience, use or consume
popular culture. We look at how most people interpret and enjoy popular culture while
others resist and object to popular culture. We look at how popular culture represents
or portrays people from different cultural groups, in particular how popular culture
represents or portrays people as stereotypes. We also consider the influence and power
of popular culture and in particular American popular culture and the way it spreads
across the world by being sold as a commodity or commercial product. The spread of
American culture and its availability in almost every country of the world means that it
now dominates over local culture; such domination is termed cultural imperialism.
In order to orient yourself to the study material for this unit, we suggest that you first
read chapter 9 in the prescribed book (Martin & Kakanyama 2007). After you have read
the chapter in the prescribed book you can return to this study unit and begin a more
detailed study of chapter 9 of the prescribed book. In this study unit we discuss the most
important parts from the prescribed book and guide your reading and study by pre-
senting you with questions and activities. You should do all the activities and illustrate
them with your own examples from your community and culture.
KEY QUESTIONS
. What is popular culture?
. What are culture industries?
. How do we learn about different cultures through popular culture?
. Why do some people enjoy popular culture and some resist it?
. How does popular culture represent different cultural groups?
. Who dominates the global production of popular culture?
. What is cultural imperialism?
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6.1
Introduction
In the previous study unit and chapter 8 of the prescribed book we discussed how
people from different cultural groups come into contact with each other through mi-
gration and travel. In this study unit and chapter 9 of the prescribed book we will learn
that people experience and have knowledge about other cultures without having to
travel. Instead, cultural products travel from one part of the world to another. The
encounter with the products of popular culture, such as films, television programmes,
music, videos, books and newspapers, allows us to gain knowledge and experience and
learn about intercultural communication.
6.2
Learning about culture without personal experience
Learning about other cultures by personal experience means that we have to meet
people from other cultures personally when we travel in other countries or when
travellers from other countries come to visit us. There is another way we learn about
and come into contact with people from other countries without having to travel. Such
learning about culture through personal experience is acquired from the movements of
products of popular culture.
Activity
6.1 Read pages 331336 in the prescribed book and answer the following questions:
. How do we gain knowledge about other cultures?

. Why do we study popular culture?
. How do you define high culture?
. Where do you encounter high culture?
. What is low culture?
. How do you define popular culture?
. What are the four characteristic of popular culture?
. What is folk culture?
. What are culture industries?
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. Why is it difficult to avoid popular culture?
. What can we learn from popular cultures?
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6.3
Consuming and resisting popular culture
Popular culture is found everywhere around us. Examples of popular culture are films,
television programmes, music and videos. Popular culture is a form of communication
because it disseminates a message. Because popular culture communicates we can
consider popular culture as if it were a text. The use and interpretation of such texts, for
example watching a film or a television programme, is called consuming popular
culture. In other words, popular culture is made in order to be sold as a commercial
product and therefore when we use such product we are called consumers of popular
culture.
Activity
. What is a cultural text?

. What are encoding and decoding?
. Describe how people decode cultural texts.
. What does ``readers' profile'' mean?
. What is the importance of the readers' profile?
. How do magazines respond to the needs of their readers?
. How do reader negotiate their consumption of popular culture?
. Why do some people resist popular culture?
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6.4
Representing cultural groups
People are introduced to other cultures through popular culture, for example we learn
how people from other cultures dress and behave, play music and dance by watching
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documentary films or television programmes about them. But there are other popular
culture programmes such as soap operas that represent fictional narratives. How people
from other cultures are represented in popular culture can therefore be positive or
negative and such representations influence our attitudes and ideas about them. Ne-
gative representations of other culture are known as stereotypes.
What are stereotypes?

(Faure, Parry & Sonderling 2000)
Stereotypes refer to beliefs about people, or generalisations that people make about
others, that ignore or give insufficient attention to individual differences among
members of a group. Often we make remarks like ``women are bad drivers'' or
``men are chauvinists''. The list goes on and on. These types of remarks are
stereotypical because no attention is given to the differences among individuals in
the group that is being stereotyped.
Stereotypes develop as a way of organising our world and at the same time help us
to simplify our complex reality. During intercultural communication we come into
contact with people who have characteristics that we are not familiar with, and who
are different from ourselves. Because we cannot respond to all the information to
which we are exposed, we develop categories that help us to classify people. In the
development of categories, we select only certain characteristics according to which
we can categorise people, while ignoring other characteristics that are inherent in a
person. Categories in general and stereotypes in particular summarise information
about other people. Stereotypes are labels that we attach to a certain group, and
these labels give us guidance on our communicative behaviour toward that group or
an individual from that group. However, stereotyping of people is often misleading,
since not all people within one category are alike (Gudykunst & Kim 1984).
Stereotyping often has negative consequences, which can hamper future interaction
with a negatively stereotyped group or individual. In the South African multicultural
society, stereotyping plays an important role in our intercultural communication.
When groups from different cultures are in conflict they will in many cases refer to
the other groups in terms of stereotypes. For example, groups may be branded as
racists or lazy or untrustworthy.
Stereotypes are sometimes confirmed by the mass media. Television programmes,

films and cartoons often make use of stereotypes to portray certain groups. After the
Gulf War the ``bad guys'' in American films were mostly people of Middle Eastern
descent, for example in ``True Lies'' with Arnold Schwartzenegger. When you next
watch television, see a film or read a newspaper, be on the lookout for the use of
stereotypes in the way the message is conveyed.
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The stereotypes we have of people from other groups have a direct impact on our
communication with others. Our initial predictions about the communicative
behaviour of others must, of necessity, be based on the stereotypes we have of the
other's culture, race, or ethnic group. To the degree that our stereotypes are valid,
we can make accurate cultural-level predictions about the communicative
behaviour of others who differ from us. But, if our stereotypes are incorrect, we
cannot make correct attributions about the communicative behaviour of others.
Activity
. In popular culture people can be portrayed or represented in a negative or positive

light. Which of these types of representation has a stronger influence on our view of
other people and cultures?
. How do Americans and non-Americans interpret a popular television soap opera?
. Do you think that television soap operas or dramas represent real life situations or
are they simply fictional stories?
. How do migrants learn about their host cultures from watching television?
. What is a stereotype?
. How do stereotypes affect our ideas about other cultures?
. How do stereotypes influence people's behaviour?
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6.5
US popular culture and power
The United States of America (USA) is the largest producer of popular culture and is the
most important exporter of popular culture. The domination of the market for popular
culture products means that people in countries outside the USA see more American
films and television programmes than any others. In fact, in many countries people see
more American popular culture product than products of their own culture. Such
domination by one culture over is known as ``cultural imperialism''.
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Activity
. Which country dominates the world market for popular culture?

. What is cultural imperialism?
. What is the role of the English language in spreading popular culture?
. Could a South African television programme dominate the international popular
culture market?
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6.6
Conclusion
In this unit we looked at the way popular culture provides experiences about inter-
cultural interaction and how we can learn about other cultures through our use of
popular culture texts. Popular culture is widely available to many people through the
mass media. Popular culture is a product of the cultural industries. People accept or
resist popular culture. Popular culture represents people of other cultures as stereo-
types. Migrants can learn about their new culture through exposure to popular culture.
Most popular culture is produced in the United States of America and dominates the
international markets. Such domination is known as cultural imperialism.
Test yourself
On page 356 of the prescribed book you will find discussion questions and activities. By
answering these questions you will be testing your knowledge about the material we
have studied in this study unit. Do the activity in the prescribed book and provide
examples from your own experience of the popular culture in your country.
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Study unit 7:
Culture, communication and
intercultural relations
Stefan Sonderling
Overview
This study unit will guide your study of chapter 10 of the prescribed book. In this study
unit we explain how individuals from different cultures develop intercultural relation-
ships with people who are different from them. This study unit looks at the role of
communication in intercultural relationships, identifies different intercultural relation-
ships, and explains how the social, historical and political context influences inter-
cultural interaction, how intercultural relationships develop and how they are
maintained and the benefits and challenges of intercultural relationships.
KEY QUESTIONS
. How do we form intercultural relationships?
. What are the different intercultural relationships?
. What are the benefits and challenges of intercultural relationships?
. Where do we form intercultural relationships?
. What are the challenges facing people in romantic and permanent intercultural
relationships?
. What are the contextual influences on intercultural relationships?
7.1
Introduction
How do you enter into an intercultural relationship? Do you have friends from a
different culture? If you have been part of such a relationship, think about your own
experience: how did you meet, how did you develop the relationship? What were your
expectations of such a relationship? What problems did you encounter? These are the
types of questions that are discussed in chapter 10 of the prescribed book and this study
unit.
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Activity
. What are the reasons that people from different cultures enter into a relationship
with one another?
. What different types of intercultural relationship can an individual have with people
from a different culture?
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7.2
Thinking dialectically about intercultural relationships
To understand intercultural relationships, chapter 10 in the prescribed book presents

some dialectical models to explain the dynamics of such relationships. The models are
based on the idea of tension (dialectics) within such relationships. The main tensions
identified are the tension between novelty and predictability, autonomy and connection
or belonging to a group, and openness and closeness. Such tensions are presented by
the authors of the prescribed book in the following categories:
. Personal-contextual dialectics. Personal and contextual dialectics refer to the

differences between the way you feel about your own intercultural relationship with
a person from another culture and how your family, friends and your community
may feel about your relationship with that person.
. Differences-similarity dialectics. We can be attracted to people that are different
from us or we are attracted to someone who is very similar to us.
. Cultural-individual dialectic. This kind of tension explains how our individual
expectations are in conflict with our cultural demands.
. Privilege-disadvantage dialectics. Some people are more privileged because they
have more powerful social positions or have more knowledge, such as a knowledge
of and ability to speak another language, while other people are less advantaged.
. Static-dynamic dialectic. Relationships develop and change as both people in an
intercultural relationship grow. In some relationships one person changes while
another does not.
. Historical/past-present/future dialectic. A tension that refers to the ways the history
of your culture is related to the history of your friend's culture and how such a
history influences your relationship.
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Activity
. Explain the personal-contextual tension in intercultural relationships.

. What is the similarity principle?
. What is a balance between novelty and predictability?
. What is cognitive consistency?
. What is meant by the statement that communication is both cultural and individual?
. Why are knowledge and ability to speak the same language as your friend an
advantage in intercultural relationship?
. What is the influence of the historical legacy of culture on intercultural relationship?
. Describe how the South African historical experience of a black person can
influence that person's relationship with a white South African.
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7.3
Benefits and challenges of intercultural relationships
Intercultural relationships are relationships between two individuals from different

cultures. People in such relationships experience difficulties and also gain some rewards
from such a relationship. For example, you may enter into a relationship with a person
from another country who does not speak your language. The challenges you will
experience is the communication problem between the two of you, but the long-term
benefit will be that both of you may learn each other's language.
Activity
. What are the possible benefits from intercultural relationships?

. If you are in an intercultural relationship, list some of the benefits or rewards you
have gained from such a relationship.
. What is relational learning?
. What are the challenges of intercultural relationships?
. What is a negative stereotype?
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7.4
Intercultural relationships
The study of intercultural communication provides a good way to understand inter-

cultural relationships. In this section of the prescribed book three approaches to the
study of intercultural communication are identified. Using these approaches inter-
cultural relationship are described and explained.
. Social science approach. The social science approach looks at the cross-cultural
differences that exist in intercultural relationships. It identifies the different ideas
people have about relationships such as friendship and intimate and romantic
relationships, and how relationship develop.
. Interpretive approach. The interpretive approach looks at how people from
different cultures communicate with each other. Intercultural communication
between people from different cultures is in many ways similar to intracultural
communication. Intracultural communication is communication between two
people from the same culture. For example, if people have difficulty with language
in intercultural communication such difficulties can also be experienced in
intracultural communication: people of the same culture sometime misunderstand
each other even when they are using the same language.
Not all people have the same opportunities to enter into intercultural relationships.
In many places people live in communities that do not have contact with migrants
or strangers from other cultures. Opportunities to meet people from other cultures
are usually found at the workplace where people from different cultures work
together and have to adapt to each other. Because many business organisations are
international and have offices or factories in other countries, people working for
such organisations have opportunities to move from country to country and meet
people from other cultures.
Another opportunity for intercultural communication is provided by the develop-

ment of technology such as computers and the internet. The internet is an
opportunity to meet people online. We can use a computer connected to the
internet to send messages to people in other parts of the world. The use of
computers and the internet is called computer mediated communication.
Computer mediated communication differs from real life communication because
in this form of communication we send text messages such as e-mails and we
usually do not have direct contact with the other person or much personal
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information about them. Sometimes even when we ask them for information about
themselves, we cannot be sure if the information they provide is true. For example,
if I am a male, in online communication I can pretend to be a woman and
communicate more freely with other women because they assume that I am a
woman.
Computer mediated communication offers new possibilities to meet people and

also to develop more personal and intimate contact through dating online, for
example. Such contacts can lead to people meeting each other in real life and
forming more permanent relationships such as marriage.
. Critical approach. The critical approach looks at the contextual influence on
intercultural relationships and communication. Such contexts refer to family and
neighbourhood, religious and educational contexts and the historical and political
contexts and how these influence our attitudes and communication with members
of other cultures.
Activity
7.4 Read pages 370390 in your prescribed book and answer the following questions.
. What are the main issues that the social science approach identifies in intercultural
relationships?
. Explain how different cultures explain the idea of friend.
. Do different cultures have different ways of developing relationships?
. How do we develop intimate relationships?
. How do people develop romantic relationships?
. What language problems can one encounter in an intercultural relationship?
. What is self-disclosure?
. What are the problems encountered in intercultural work relationships?
. What is computer mediated communication?
. How do people communicate on the internet?
. What is line of sight?
. What are low context and high context communication?
. How do people begin intercultural dating?
. What are the challenges facing people in permanent intercultural relationships?
. Explain the different styles of interaction in an intercultural marriage.
. What are the challenges in same-sex intercultural relationships?
. How do the family and neighbourhood influence intercultural relationships?
. What influence do religious and educational institutions have on intercultural
relationships?
. Explain how historical and political contexts influence intercultural relationships.
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7.5
Conclusion
In this unit we looked at the dialectical tensions in intercultural relationships, the

benefits and challenges of intercultural relationships and examined three commu-
nication approaches to intercultural relationships. Different types of relationships were
identified and the influence of politics, social institutions and history was discussed.
Test yourself
On page 395 of the prescribed book you will find discussion questions and activities. By
answering these questions you will be testing your knowledge about the material we
have studied in the study unit. Do the activity in the prescribed book and provide
examples from your own experience of intercultural relationships in your country.
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Study unit 8:
Conflict and the future of intercultural
communication
Corrie Faure
Overview
In this study unit, we look at the characteristics of intercultural conflict as well as

important orientations or theoretical assumptions that resulted from scientific research
on the topic under discussion. We concentrate, in general, on the viewpoints and
approach developed by Martin and Nakayama (2007), namely the dialectical approach
to intercultural conflict situations. The dialectical approach is primarily a combination of
the other approaches, including the social science, interpretative and critical ap-
proaches to intercultural conflict situations. We conclude this study unit with an
overview of possible future developments in the processes involved in intercultural
communication.
To orientate yourself to this study unit you have to read chapters 11 and 12 of your
prescribed book (Martin & Nakayama 2007). This exercise will give you an overall idea
about the general content of these chapters. We discuss important and relevant parts
from the book in some detail in the various sections. We also expect you to do all the
activities which are based on the content of your prescribed book. It is also important,
when asked for examples to illustrate the activities, that you draw these from your own
personal experiences or happenings in your community or country. The type of ex-
amples you use will depend on the specific activity and should be deduced from the
appropriate examples or illustrations in your prescribed book.
Next we give you some of the important key concepts for this study unit. Make sure that
you are, after you have mastered the study unit, able to define or describe the meaning
of these concepts.
In this study unit you will come across words like conflict, conscious, (in)competence,
intercultural conflict, empathy, avoiding, linguistic knowledge, compromising, judg-
mentalism, confrontation, self-knowledge, dominating, dialogue, integrating and
mediation. The prescribed book gives us definitions of these words in the margins on of
the different pages.
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8.1
Introduction
Intercultural conflict happens at many different levels: interpersonal, social, national

and international. On all these levels, apparently simple disagreements may lead to
serious conflict situations that seem difficult to resolve. Often the reason for such a
situation is that the different parties do not understand or do not want to understand the
reasons behind certain culturally induced viewpoints. The culture to which we belong is
usually strongly embedded and is an important part of how we see our life world. Many
factors influence the way we see our country, communities, groups and interpersonal
relationships. How we see our life world is influenced by our socialisation process. We
are influenced, for example, by our parents and institutions such as schools, religion,
mass media, customs and politics. All these factors which influence us determine who
we are and also how we view other cultures. If we are, for example, inclined to
stereotype other cultures, this situation could have a profound influence on the way we
communicate and interrelate with people from different cultures. This is apparent on all
the levels of communication: interpersonal, social, national and international. Much
research is being done on how to improve intercultural communication and under-
standing of the different cultures. It is knowledge and willingness in particular on the
part of the various parties that could help resolve (mostly inevitable) intercultural
conflict.
For us to be able to understand the basics of intercultural conflict we first have to look at
some of its important characteristics.
8.2
Characteristics of intercultural conflict
Scientists have identified some basic and general ideas about and some specific char-
acteristics of intercultural conflict. Some general ideas or viewpoints are that inter-
cultural conflict is inevitable on all the different levels, that conflict happens due to
mediated communication and that it is not easy to resolve. To understand intercultural
conflict sufficiently it is important to review existing research and the attempts to apply
the research to intercultural conflict situations and to think about ``some new ways'' to
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review and solve conflict situations (Martin & Nakayama 2007:400). Martin and Na-
kayama's (2007) research and viewpoints are mainly based on existing theoretical
approaches which they extend to a new approach, namely, the ``dialectical perspec-
tive''. The dialectical perspective emphasises that intercultural conflicts are `òften more
complicated than they first appear'' (2007:401) and are a ``layered process in which
individual, dyadic, societal, and historical forces are recognized'' (2007:404).
Intercultural conflict is complex because various aspects of culture might simultaneously

have a dialectical influence on the conflict situation. The various combined and often
related situations or inherent beliefs (learned as a child during the socialisation process)
influence cultural identities and as a result increase the possibility and the seriousness of
conflict situations, which makes the resolution or general management of conflict on all
levels more difficult and complicated. We are referring here mainly to common dif-
ferences such as differences resulting from poverty and wealth, different religions and
different languages.
Activity
8.1 Read pages 400404 of your prescribed book and identify the various characteristics of
intercultural conflict. Provide your own examples, based on the examples in your
prescribed book.
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You will find the answers to the above activity in your prescribed book.
8.3
Two theoretical approaches and the dialectical perspective
There are two opposite ways in which scientists and cultural groups regard ``conflict'':
conflict as opportunity and conflict as destructive. Conflict as opportunity is a Western-
based approach, also viewed as a ``neutral-to-positive'' orientation, whilst conflict as
destructive represents a viewpoint more or less shared by Asian cultures. According to
these cultures, conflict is viewed as a destroyer of harmony. According to your pre-
scribed book, these two approaches to conflict should be approached from a third
perspective: the dialectical perspective. This means that the answer to an intercultural
conflict situation may be a combination of these approaches. Martin and Nakayama
(2007:404) write: ``Neither orientation is always the best approach, nor does any
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culture only utilize one approach to conflict.'' The two approaches are basically
founded on underlying cultural values. The third perspective is founded on the idea that
``no one approach to conflict is appropriate in all situations'' and that ``these ap-
proaches are in dialectical tension with each other'' (Martin & Nakayama 2007:408).
The best solution therefore seems to lie somewhere in between the two approaches,
namely the dialectical approach.
Activity
8.2 Read pages 404409 of your prescribed book and answer the following questions on
the two orientations to conflict and the dialectical perspective. Substantiate your an-
swers.
. Do you think conflict is good or bad? Why?

. Do you think conflict should be welcomed to strengthen relationships or should it
be avoided? Why?
. According to you, what is the best way to solve a conflict situation? Why?
. Should people deal with conflict directly or indirectly, or keep silent and therefore
avoid it? Why?
. What has culture to do with conflict? Explain.
. Do you think the use of a mediator or intermediary is a good or bad idea? Why?
. Do you think change in a society's beliefs and other cultural aspects should be
gained through conflict and/or violence in one form or another? Why?
. Do you think the dialectical approach is more acceptable than the other two
approaches: conflict as opportunity and conflict as destructive? Why?
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You will find possible answers to the above questions in your prescribed book.
8.4
Social science approach to conflict
According to the social science approach the reasons for conflict situations are manifold
and religious difference is one of the main causes of intercultural conflict. In many
cases, in personal situations as well as in broader communities, parents do not teach
their children how to deal with conflict or to voice their own opinions. The avoidance of
conflict that results in ``harmony'' is usually an important part of a community's so-
cialisation process, taught by various institutions. However, sometimes individuals are
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very much aware of different styles of conflict resolution and tend to adapt to other
cultures' general ideas and customs and to resolving a conflict situation by staying calm
and accommodating.
According to the social science approach there are several types of conflict as well as
different strategies and tactics for dealing with conflict situations.
Activity
8.3 Read pages 409415 of your prescribed book and identify and illustrate with your own
examples, the following:
. the different types of conflict

. strategies and tactics for dealing with conflict
. influence of gender and ethnicity on conflict
. value differences and conflict styles
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You will find possible answers to the above activity in your prescribed book.
8.5
Interpretative and critical approaches to conflict
According to the interpretative and critical approaches to intercultural conflict, the

situation is more complex than interpersonal conflict could ever be. It is more a
characteristic of a national or international type of conflict and often results in drastic
measures and drastic changes might follow. The balance in a society or between
countries is disturbed and in dispute. Intercultural conflict is very much a part of
inequality or unjust situations blamed on factors such as unjust social, economic and
political contexts. This type of conflict often develops over a long time and is therefore
the result of the historical contexts of groups, communities and countries. Long lasting
inequality in comparison to other cultural groups within a society causes protests and
serious conflict and in some cases this situation results in violence. These communities
wish to change the status quo urgently and drastically.
Activity
8.4 Read pages 416420 of your prescribed book and briefly describe, in your own words,
or illustrate with your own examples, the way in which your community or country has
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resolved conflict situations and brought about drastic changes with regard to unjust
social, economic and political contexts.
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8.6
Managing intercultural conflict
There are five different approaches to the management of intercultural conflict situa-
tions. These five approaches (productive versus destructive conflict management,
competition versus cooperation and the dialectic approach to manage conflict situa-
tions) clearly describe the differences in how people deal with conflict situations. To
counter these views, your prescribed book also suggests the dialectic approach to
intercultural conflict management. This approach concentrates on dialogue and
maintaining contact between the parties and recognising different styles in the man-
agement of intercultural conflict situations. People tend to use the same style in most
conflict situations while the dialectical approach suggests that people should be creative
and not static in dealing with conflict situations. They should recognise the importance
of the context of the conflict situation and be willing to forgive. If people cannot resolve
conflict situations, they often ask an intermediary to assist in conflict resolution.
Activity
8.5 Read pages 420430 of your prescribed book and identify the seven ways in which the
dialectic approach suggests we should attempt to manage conflict situations. Illustrate
with your own examples, based mainly on the discussion (or examples) in your pre-
scribed book.
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8.7
The future of intercultural communication
Your prescribed book discusses some specific ideas and suggestions to improve com-
munication skills across cultures. According to Martin and Nakayama (2007:435) and
other scientists, such as Chen and Starosta (1996) and Collier (1998), communication
skills and/or intercultural competence can be approached in several ways: a social
science perspective (individual competence), an interpretative and critical perspective
(intercultural context) and a dialectical perspective (individual and context). Individual
competence includes aspects such as motivation, knowledge, attitudes, empathy, be-
haviour and skills (Martin & Nakayama 2007:435445). Contextual components in-
clude the importance of understanding intercultural contexts, the realisation that there
are many contexts, and that a competent communicator should be sensitive to contexts
in general. The understanding of contexts can be constrained by various factors, such as
political, historical and economic factors and these will probably influence our views on
various contexts we encounter in our lifetime (Martin & Nakayama 2007:445447).
Activity
8.6 Read pages 435447 in your prescribed book and identify individual competencies and
characteristics of contexts. Illustrate your discussion with your own examples, based
mainly on the examples in your prescribed book.
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Martin and Nakayama (2007:447) suggest that we follow the dialectical approach to
improve our intercultural relations. If we follow the dialectical perspective we con-
centrate on improving individual skills and trying to understand the various contexts that
may constraint our relationships with people from other cultures. According to this
approach people should recognise the importance of maintaining true dialogue by
firstly listening to others and secondly being aware of the importance of and individual
competence in dialogical skills in intercultural communication. People also should be
aware of different contexts, such as the historical, economical and political contexts
which should be taken into account when interacting with people from other cultures.
Martin and Nakayama (2007:452) emphasise that ``many identities and contexts give
meaning to who you really are''. Identities and contexts refer, among other things, to
sexual orientation, gender, race, religion, region, age and social class.
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Activity
8.7 Read pages 447458 in your prescribed book and do the following:
. Explain the listening process in intercultural communication.

. Discuss the application of knowledge about intercultural communication in the
dialectical approach.
. Identify and briefly explain new ways to think about cultural differences.
According to the dialectical approach, how could you apply some of the new ways of
thinking about cultural differences?
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You will find possible answers to the last two activities and questions in your prescribed
book.
Martin and Nakayama (2007:459463) conclude their discussion on intercultural re-

lationships with examples of the probable or possible future of intercultural commu-
nication.
Activity
8.8 Read pages 459463 in your prescribed book. Explain the possible or probable future
of intercultural communication with reference to the examples in your prescribed book.
Given your contexts, what do you think the future of intercultural communication
holds?
The most important part of the above activity is the question we ask. Being able to apply
what you have learned in this section will show your general understanding of the
processes involved in intercultural communication.
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8.8
Conclusion
In this study unit, we dealt with some of the important characteristics of intercultural
conflict, three of the broad orientations or theoretical assumptions that have resulted
from scientific research on the topic of intercultural conflict, and the possible future of
intercultural communication. In general, you had to concentrate primarily on the
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viewpoints and approach developed by Martin and Nakayama (2007), namely the
dialectical approach, as a combination of the other two approaches in intercultural
communication studies. We concluded this study unit with an overview of possible
future developments in the processes involved in intercultural communication.
Test yourself
1. How does conflict as opportunity differ from conflict as destructive? Explain.

2. Why is it important to understand the context in which intercultural conflict
occurs? Explain.
3. How are conflict strategies used in social movements? Explain.
4. Does an attitude of forgiveness help in conflict resolution? Explain.
5. Can you identify some general suggestions or solutions for dealing with
intercultural conflict situations? Explain.
6. In your own context, does the idea of intercultural competence seem valuable or a
restraint in intercultural communication situations? Explain.
7. In your view, why is it necessary to form alliances with people from another
culture? Explain.
8. How can you assess your unconscious competence and unconscious
incompetence? Explain.
9. How does your own context influence your intercultural communication
competence?
10. Does your intercultural communication competence change according to
intercultural contexts?
List of sources for Part A

Faure, C, Parry, L & Sonderling, S. 2000. Intercultural, development and health
communication: only study guide for COM2048. Unisa: Pretoria.
Martin, JN & Nakayama, TK. 2007. Intercultural communication in contexts. 4th
edition. New York: McGraw-Hill.
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PART B:
Development communication
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Study unit 9:
The modernisation theory of
development
Stefan Sonderling
Overview
This study unit provides you with an introduction to the study of development com-
munication. We discuss the historical context of the emergence of the current concern
with the development of the Third World and provide you with the concepts you need
to talk about development communication. You are introduced to the development
problems facing the Third World and to theories that explain social change. We outline
the modernisation theory, which was considered to be the dominant paradigm in
development. We discuss the role of communication in development and introduce the
mass media approach and the diffusion of innovations approach and discuss com-
munication models for development communication.
KEY QUESTIONS
. What is development and development communication?
. What are the development problems facing the Third World?
. What are the differences between traditional and modern societies?
. What does the process of modernisation entail?
. What are the theoretical assumptions of the dominant paradigm in development
communication?
. What are the principles of the diffusion of innovations approach to development?
. What is the role of the mass media in development?
9.1
Introduction
Almost every day, television broadcasts and newspapers tell tragic stories about the
sufferings and hardship of the people living in the poorest nations of the world: famine
and hunger in Sudan; malnourished and starving children; refugees fleeing from famine
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in Ethiopia; refugees in transit camps in the Sudan where they live without running water,
sanitation or clinics; the plight of homeless people in South African cities, and so on.
Stories of poverty and hardship in Africa stir public opinion in the more developed
countries in Europe and the United States and attempts are made to help poor and
disadvantaged communities by sending them money, food, medicines and personnel
trained in development assistance. Feelings of pity for the sufferings of poor people lead
to the concern that ``something needs to be done'' to relieve the sufferings of these
``wretched of the earth''. Such a concern for the plight of the poor people of the world
moved the President of the United States of America, Harry S Truman, in 1949. Looking
at the conditions in the world after the end of World War II, President Truman observed
that:
More than half of the people of the world live in conditions approaching misery.
Their food is inadequate. They are victims of disease. Their economic life is
primitive and stagnant. Their poverty is a threat both to them and to the more
prosperous areas of the world. For the first time in history, humanity possesses the
knowledge and skills to relieve the suffering of these people (Melkote 1996).
President Truman believed that the more prosperous and developed countries of the
world possessed the knowledge and skills to relieve the sufferings of the poor people of
the world, and such knowledge needed to be communicated and transferred to them.
He therefore proposed his Point Four Programme for solving the problems:
We must embark on a bold new programme for making the benefits of our
scientific advances and industrial progress available for the improvement and
growth of underdeveloped areas. ... What we envisage is a programme of de-
velopment based on the concept of democratic fair dealing (Melkote 1996).
development Truman's proposal was based on the belief that the poor, underdeveloped nations could
underdevelopment become prosperous if they followed the example of the more developed nations such
as the United States. The United States would provide them with scientific and tech-
nical knowledge so they could improve their economic production, which was the key
to prosperity and peace. The result of this proposal became known as development
(Escobar 1995:3; Esteva 1992:6; Melkote 1996:21; Packenham 1973:43).
The Point Four Programme is considered the beginning of modern development aid
and assistance programmes for the Third World. In his inaugural address as the newly
elected President of the United States of America in 1949, Harry S Truman proposed
four main points or elements on which to construct American foreign policy:
1. support for the United Nations
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2. European recovery programme for rehabilitating the damage and destruction
caused during World War II
3. providing military defence assistance to countries friendly to the United States
against the expansion of Communism
4. a bold new programme for providing development aid to the underdeveloped
areas of the world
Point Four Programme The fourth point of Truman's 1949 policy speech, or simply the Point Four Programme,
marks the formal beginning for American, European and the United Nations pro-
grammes for the development of the Third World (Pakenham 1973:43).
Activity
9.1 Read president Truman's observations about the living conditions of poor people in the
Third World. Do you think that charity and pity for the sufferings of the poor were the
main motives for proposing to develop the Third World? What other motives were
behind Truman's proposal?
Our comments
Feeling pity for the plight of the poor was only one reason for proposing development. Other reasons were political and
economic. Development was part of American foreign policy.
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cold war From 1949 a date that is considered as signalling the beginning of modern attempts
to develop the Third World development was placed on the social, economic and
political agendas of most of the rich nations of the world for whom it became a
universal duty. However, charity was not the only motive for developing the Third
World. Political interests of the United States played an important role in development.
During the 1950s and 1960s many colonised nations in Africa were gaining in-
dependence from their colonial oppressors and their development made political sense
for the United States and its European allies during the ``cold war'' rivalry with the
Soviet Union, because it gave them access and influence in the new states and kept
them from joining the communists. Development also made good economic and
commercial sense as it provided new markets for goods and media products for the
industries of the highly developed nations of the West.
Development became a new language in international politics to describe the re-

lationship between the West and the poor countries of Africa, Asia and Latin America. It
also provided countries in the Third World with an identity: to be called a ``developing''
country is a badge of honour, because it means that a nation has undertaken to lift itself
up by its own strength out of the stage of underdevelopment and to do in a few decades
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what in earlier history had usually taken centuries (Schramm 1964:10). In turn, the poor
and underdeveloped nations adopted development as a matter of national policy.
Whether dictatorships or democracies, whether their regimes were communist or ca-
pitalist, almost without exception, after independence all African states adopted na-
tional development programmes and received development aid from the West or from
the communist bloc.
RDP For example, one of the first acts of the newly elected South African government in
1994 was to make the Reconstruction and Development Programme (RDP) the cor-
nerstone of its policy. Such a Reconstruction and Development Programme was es-
sential because:
Our history has been a bitter one dominated by colonialism, racism, apartheid,
sexism and repressive labour policies. The result is that poverty and degradation
exist side by side with modern cities and a developed mining, industrial and
commercial infrastructure. Our income distribution is racially distorted and ranks
as one of the most unequal in the world lavish wealth and abject poverty
characterise our society (ANC 1994:2).
The Reconstruction and Development Programme gained support from international

development agencies, such as the United Nations, the European Union and the World
Bank, and funding for development became available to solve the problems of the poor
and disadvantaged communities in South Africa.
9.2
Basic concepts in development communication
development Broadly defined, development is a particular type of social change that is aimed at
Third world improving the material and human conditions of the people and societies of the Third
World by helping them to gain greater control over their environment.
While it is generally agreed that development of the poor countries is necessary, the
question of how to achieve such an objective and make these improvements has been
under constant debate and redefinition since 1949. In this study unit and in the fol-
lowing study units, 10 and 11, you will encounter some different definitions of de-
velopment.
social change While the concepts of development and social change are sometimes used inter-
changeably in discussions and in the literature on development, it is useful to distinguish
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between and contrast the two concepts. A distinction can be made on basis of the
source that motivates the change.
Social change is change that happens from within a society such as when members
of a society create a new idea with no outside influence. Every human society changes
over time because people have the capacity for independently increasing their ability to
live a more satisfactory life through exploiting natural resources. Every society changes
in one way or another, and to a lesser or greater extent. Social change also implies an
evolutionary and continual adaptation of existing social conditions through a progres-
sion of small steps and stages.
Development is a type of social change that is directed or planned and caused from
outside the society by people or agencies that intentionally seek to introduce new ideas
in order to achieve predefined goals. Development also implies a break from tradition
and disruption of existing social conditions and their replacement with new ideas,
practices and technologies that are communicated and imposed on a society or a
community from the outside (Horowitz 1972:2425; Rogers & Shoemaker 1971:8).
The Third World Development provides a way of dividing and classifying the countries of the world. The
developed countries of the world exist in a hierarchy of affluence, which ranges from utter poverty
underdeveloped to immense wealth. Such division means that different societies exist at different levels
of development and underdevelopment. The highly developed and prosperous in-
dustrial nations are the United States of America, Western European countries and the
United Kingdom. The poor and underdeveloped countries are found in Africa, Asia and
Latin America (Rodney 1980:11, 21). Since 1949 the poor and underdeveloped nations
have gradually gained their independence and have become known collectively as the
Third World.
Third World The concept of Third World is another way to describe the underdeveloped nations. It
First World is used to describe these nations in contrast with the more developed and industrialised
Second World nations such as the United States of America, the United Kingdom and Western Eur-
opean countries, which are known as the First World. The First World and Third World
are also contrasted with the communist block, which was known as the Second World.
The North Since the fall of the communist bloc in the 1990s, the terms ``Third'', ``Second'' and
The South ``First'' worlds are being replaced with the geographical terms the ``North'' and the
``South''. In terms of their geographical location on the world map, the most developed
and rich countries are found in the Northern hemisphere while the poor and under-
developed countries are found in the Southern hemisphere (Harris 1993:1).
Today the North/South division is changing again as China, India and other `Àsian
tigers'' have joined the group of developed nations.
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Development Development and social change depend on contact and communication between
communication developed and underdeveloped societies. Development communication can be de-
fined as communication that promotes development, by promoting education and
literacy, improved health care through information, family planning, agricultural prac-
tices and better industrial production, and so on. Just like the definition of development,
the definition of development communication has been under constant revision and
has been defined and redefined a number of times since 1949.
9.3
Development problems of the Third World
The underdeveloped and poor countries of the Third World in Africa, Asia and Latin
America are different from each other, have different climates, different resource po-
tential, and different cultures. However, they share many common problems.
Knowing what these problems are can be important because such knowledge is the first
step in finding solutions. In this sense, development can be considered as a process for
finding solutions to the problems of the Third World (Agunga 1997:55). In general, the
problems of the Third World are based on the following (Agunga 1997:5584; Fourie
1994:49; Harris 1993:7499): poverty, population growth, health, literacy and edu-
cation, inequality, economics, and inadequate knowledge, information and commu-
nication.
Poverty problem
It is estimated that 20 percent of the world's population live in poverty: they do not
have enough of the basic necessities of life, such as food, shelter, clothing, medical care
and educational facilities.
per capita income Poverty is usually measured in terms of economic indicators: ``per capita income'' (the
term ``per capita'' means ``per head'' or per person), per capita Gross National Product
(GNP), and per capita Gross Domestic Product (GDP).
Gross National Product The Gross National Product (GNP) is calculated by adding the value of the economic
GNP output resulting from the use of resources such as labour, land and capital owned by
members of a society. The GNP per capita (or per head) is calculated by dividing the
total GNP by the total number of people in the country.
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Gross Domestic Product The Gross Domestic Product (GDP) is calculated by adding together all the economic
GDP activities taking place within the country. The GDP per capita is calculated by dividing
the value of GDP by the total number of the population.
The GNP and GDP provide an indication of the average income of each member of the
population. For example, in many underdeveloped countries in Africa, the per capita
GNP is less than R3 000 ($500) per annum (or year), in South Africa it is R8 500
($1 400), while in developed countries such as the United States or Switzerland it is
R120 000 ($20 000) per annum.
The low per capita income in the underdeveloped countries means that many people
are very poor and do not have enough money to buy food and cannot afford to buy a
newspaper or a book.
Population problem
Many underdeveloped countries have a large number of inhabitants and their popu-
lation grows fast due to a high birth rate. For example, the population in Africa was
estimated at 650 million people in 1990, and is expected to grow to 900 million people
by the year 2010.
An increase in population usually implies a decrease in the per capita GNP or GDP,
because the same resources are divided among more people, and there is less wealth
available for each member of the population. Many development programmes concern
themselves with reducing the size of the population by providing family planning in-
formation to reduce the birth rate.
Health problem
The wellbeing of a society is measured by the physical state of its people. In many of the
underdeveloped countries people suffer from ill health as a result of malnutrition
caused by their poverty. Such conditions also result in a high level of communicable
diseases such as Aids.
In most underdeveloped countries there is a general lack of health care facilities such as
clinics and hospitals, and a shortage of doctors and medicine. Lack of health facilities
and lack of sanitation, such as the lack of clean drinking water, is the reason for high
infant mortality (the number of children who die in their first year of life) and maternal
mortality (the number of mothers who die during pregnancy or after giving birth).
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Literacy and education problem
Many underdeveloped countries have a poor educational system and a large number of
illiterate people. Together with illiteracy, many underdeveloped countries also have a
shortage of media, such as books, newspapers and magazines, and lack the technology
for producing printed material.
Inequality problem
In many underdeveloped countries there is a growing inequality between rich and poor
people. There is inequality between the people in rural and urban areas. There is an
unequal distribution of resources because governments spend less on the development
of rural areas, and the rural people are economically worse off than people in the cities.
There is also gender inequality with women being worse off in terms of education and
income opportunities than men. There are also other inequalities based on age and
differences in ethnic affiliations and social class membership.
Economic problem
Many underdeveloped countries have economic problems because they lack natural
resources and do not have a developed industrial sector.
There is also a problem of external debt: many underdeveloped countries are repaying
debts to international institutions. These debts have been accumulated through heavy
borrowing of finance for development projects by the national governments of the Third
World. Further financial aid to underdeveloped countries in Africa is also decreasing
because developed countries have been cutting back on their support for development
programmes.
Knowledge, information and communication problem

Poor countries and poor people differ from the rich not only because they have less
capital but also because they have less knowledge. There is an imbalance between
countries that are information rich and countries that are information poor. Knowledge,
information and means of communication are essential for development, but their
limited availability in the Third World is an obstacle to development. To promote
development, new information and communication technologies, such as computers,
computer networks, mobile telephone receivers and telecommunication systems, are
transferred to Third World countries. These technologies have the potential to stimulate
development (World Development Report 1998/99).
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Case study 9.1
South Africa as a Third World country
South Africa shares many problems that are typical of Third World countries. These
include the following:
. Approximately 40 percent of the adult population are illiterate.
. 44 percent of the population live in remote rural areas.
. Seven million people out of approximately 40 million are homeless squatters.
. 30 percent of the black population have no electricity.
. The majority of the black population cannot afford access to the mass media.
However, South Africa has also been classified as a First World industrialised country
together with countries such as the United States, Western Europe, New Zealand, Japan
and Israel. This is because it shares many characteristics of a developed First World
country, for example, modern industry and infrastructure and a modern mass media
and telecommunications systems (Melkote 1996:20; Schramm 1964:11).
South Africa could be considered to be a partially underdeveloped Third World
country, where wealth and poverty, development and underdevelopment, and tradi-
tional and modern communities exist side by side.
Activity
9.2 On a sheet of paper discuss and make a list of the development problems of the Third
World. Take your list and visit an underdeveloped community and compare the items
on your list with the development problems facing the community.
Our comments
How many development problems could you identify in the community?
Did you identify development problems that were not on your list?
What, in your opinion, is the most important development problem facing your country or your community?
Keep the list and notes you made until you have completed your study of this unit. Then see if you can resolve the
development problems you have identified in your community.
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9.4
How societies change and develop
In the previous section we outlined the problems and difficulties facing the poor
countries of the Third World. The question that faced social scientists concerned with
development was how to explain the underdevelopment of the Third World and the
fact that Western societies were highly developed.
The difference between the rich and poor countries was believed to have been the
result of the different ways in which these societies have developed throughout history.
Knowing how societies change and develop would be useful for the development of the
poor countries of the Third World.
It was believed that all societies change and go through a historical progression in which
they develop from simple, undifferentiated systems to more complex, modern and
industrialised societies.
At some time in the past, estimated at about 20 000 years ago, people lived in primitive
hunter-gatherer societies. People in these societies collected fruit and vegetables that
grew naturally and hunted animals to provide food for their survival. Gradually people
gained more control over the environment and societies began to develop and change.
However, change was uneven because not all societies developed at the same pace. For
example, the societies of Europe advanced faster, while those of Africa, Asia and Latin
America advanced more slowly. The European societies developed through clearly
identifiable historical periods of change or revolutions (Harris 1993:410) known as the
agrarian revolution, the commercial revolution, the industrial revolution and the in-
formation revolution.
The agrarian revolution

The early hunter-gatherer societies were nomadic because people were obliged to
travel in their search for food. Gradually groups began to settle in more fertile areas
where they could grow crops and tamed (domesticated) animals and provided them-
selves with food rather than being entirely dependent on nature. Such development
brought stability and improved quality of life.
Advances in agricultural techniques made it possible to produce more food and to

generate profit. Towns and villages emerged and a whole new economy based on the
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exchange of goods developed. The development of agriculture also resulted in an
increase in the value of land land became an important resource and a commodity,
and society was divided into groups of land owners and non-owners.
The commercial revolution

In the 15th and 16th centuries, explorers and adventurers made voyages into far-off
lands. The spirit of adventure was also reflected in the search for knowledge, and the
development of science and technology. During the 17th and 18th centuries, im-
provements in transport and communication techniques lead to accelerated innovation
and promoted new economic ideas. Merchants and entrepreneurs began to expand
trade and commerce on an international scale and powerful European states began
their conquest and colonisation of other parts of the world.
The industrial revolution

urbanisation During the 18th century, great technological innovations began to transform the eco-
bourgeoisie nomic and social structures of society. Small farming communities that were dependent
proletariat on small-scale agriculture production were replaced with large-scale factory production
systems. The decline in the demand for labour in agriculture and the increase in
demand for labour in the factories resulted in a rapid growth of towns and cities. This
process is called urbanisation. New social groups or classes emerged: the bourgeoi-
sie comprising rich capitalists and the professional middle class, and the proletar-
iat the new industrial working class consisting of the landless people who depended
on earning wages. The new industrial system made production possible on a large scale.
Mass production of goods at low cost for large markets was on the increase. Mass
production improved the overall living conditions of many people.
The information revolution

During the 19th and early 20th centuries the mass media, such as books, newspapers,
and magazines, expanded. Telecommunication systems developed and radio and tel-
evision became popular. During the second part of the 20th century new development
in communication and information technology such as computers, telecommunication
satellites, and new forms of media began to transform the social and economic struc-
tures of the highly developed societies. Information became a central commodity that
was produced, sold and used in the commercial and industrial sectors of the economy.
Occupational roles began to change as more people were employed in the information
and communication industries. The increase in availability of information and com-
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munication technologies began to transform the culture and politics of many countries
(Webster 1997).
Given such a history of social change, social scientists developed theories to explain
these social changes. Early theories of social change emerged during the 19th century.
9.5
Early theories of social change and development
The rapid social changes and upheavals in European societies during the 18th and 19th
centuries were of interest to philosophers and social theorists who tried to understand
and explain what was happening. Their ideas and theories about the causes of social
change laid the foundation for the scientific study of human society that became known
as the social sciences.
Organic view of society

Social theorists in the 19th century assumed that all societies progressed from simple
systems to more complex and developed systems. They suggested that human society
resembles a living organism such as a plant or animal. Just like the living organism that
grows and develops during its lifetime, so societies grow, progress and evolve over
centuries of their existence. This organic view of society was based on the biological
evolution theory of Charles Darwin. For Darwin the diversity of living species was due
to a process of natural selection, a process whereby a living organism adapts to its
environment. Those species that best adapt to their environment survive and flourish,
while those that do not adjust become stagnant or die out. Extending this view to
explain human society, social theorists such as Marx, Durkheim, and Weber assumed
that European societies adjusted to their environment successfully and progressed,
while societies in other parts of the world remained in a more primitive stage of
development (Harris 1993:19; Webster 1988:43).
Auguste Comte (17981857), who is considered to be the founder of modern so-

ciology, suggested that Western societies evolved through a series of fixed transforma-
tions and that such progress and evolution were the result of intellectual effort by the
members of these societies. That is, through the force of ideas, people adjusted to their
circumstances and improved their living conditions (Harris 1993:2021).
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Gemeinschaft Emile Durkheim (18581917) extended Comte's speculation about how society de-
Gesellschaft veloped, and provided an early theory of development, which also explained why
social change took place. Durkheim believed that societies evolved from simple, pri-
mitive or traditional societies to become more complexly organised modern societies.
A similar idea was also proposed by Ferdinand Tonnies (18551936), who suggested
that modern society was transformed from a Gemeinschaft, which is a traditional, close-
knit community, to a Gesellschaft a modern society characterised by the impersonal
associations of its members.
For Durkheim, people in traditional societies performed limited tasks simple agrarian
or agricultural activities based on groups of families or clans in village settlements. Social
cohesion was based on a simple, common lifestyle and beliefs that formed an un-
changing tradition. Each group or village was self-contained and its members performed
the required duties within a system of fixed division of labour, whereby each member
had a particular role such as farming, child rearing, social control or defence. Traditional
society was changed when different people began to congregate in larger settlements
such as cities and towns. People began to compete for scarce resources and had to
acquire specialised roles. These changed conditions resulted in a gradual increase in
specialisation and social division of labour. A more complex society developed and
people became more dependent on each other. New social institutions replaced the
traditional family and tribal cohesion (Harris 1993:2324; Webster 1988:44).
Karl Marx (18181883), like other thinkers of his time, also saw social change as an
evolutionary process in which a society passed through several stages, each stage
marked by specific modes of production. Marx identified distinctive stages in the de-
velopment of Western societies from slavery, through feudalism, capitalism, socialism
and finally resulting in communism. Each stage was a reflection of the various economic
relationships or modes of production that existed within these societies. For Marx, social
change was founded upon, and determined by, the system of material economic re-
lations that exist in a society at a particular time in history and the class conflict that
these relationships bring into play. Marx was also one of the first social theorists to
consider relations between Western and non-Western societies and suggest that the
spread of capitalism throughout the world would result in the economic growth and
development of the stagnant non-Western societies (Harris 1993:3539).
traditional society Max Weber (18641920) considered development as a transition from traditional
modern society society to modern society, which was caused by the rise of industry. According to
Weber, such a process of industrialisation brought new modern forms of social orga-
nisation based on rationalism and replaced traditional customs and superstitions that
hindered development. The development of the modern capitalist manufacturing in-
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dustry was based on the rational organisation of industrial production and business that
established a steady profit and accumulation of capital. Rationalism was a particular
cultural characteristic that developed in Western European societies. Rationalism was
further encouraged by the religious ideology of Calvinism, which urged its followers to
commit themselves to hard work, discipline and diligence, which were essential for
success in business and steady accumulation of capital through careful investment. As
European societies developed, an increasing number of their members began to act in
ways that were guided by the principle of rationality (Webster 1988:4649).
The ideas of the 19th century thinkers formed the foundation for an approach to
modernisation theory development that is known as modernisation theory and is considered to be the
dominant paradigm dominant paradigm in the study of development. A paradigm is a grand theory or a
common view that is shared by a group of theorists and directs research and practice in
a particular field of scientific inquiry.
Activity
9.3
Identify and discuss the two basic assumptions about the process of social change that
were shared by all the early theories of social change.
Our comments
All the early theories considered social change to be an evolutionary process and
assumed that societies progress from traditional to modern societies.
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9.6
Modernisation theory and economic growth: the dominant
paradigm in development
During the 1950s and 1960s American social scientists used the ideas of Comte,
Durkheim, Weber and Marx to construct a theory to explain development. The result
was the modernisation theory of development.
Based on their reading of the early theories discussed in the previous section, social
scientists made the following assumptions about social change:
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. All societies change and progress in ways that are similar to Western societies, that
is, they develop from simple, primitive systems to more complex, modern and
industrialised societies.
. Third World societies are underdeveloped but are moving gradually toward
modernity.
. Economic growth is the basis on which all other cultural and social development
takes place. In other words, economic growth is the engine that drives all other
social developments.
. The lack of development is the fault of Third World countries because of some
internal condition within these countries that prevented development. The
internal condition was identified as traditionalism. Traditional cultural, social and
political structures were seen as obstacles to the growth of efficient economic
development and modernisation.
tradition The underlying idea of these assumptions was a distinction between tradition and
modernity modernity (Webster 1988:5051):
Tradition and modernity
Traditional society does not change for the following reasons:
. The value of traditionalism dominates: people are oriented toward the past and lack
the mental ability to adjust to new conditions.
. The kinship system is the primary means through which social, economic and
political practices are regulated. A person's position in the society is determined by
that person's status in the family, clan or tribe and does not change.
. Members of a traditional society have an emotional, superstitious and fatalistic view
of the world.
A modern society develops for the following reasons:
. People are not enslaved by tradition but discard traditional beliefs and customs that
prevent progress.
. Kinship is less important, family and tribal ties are loosened as people become
geographically and socially mobile. A person's position in society, economy and
politics is earned through hard work and motivated by a desire for achievement.
. Members of modern society are forward-looking, innovative and free from
superstition.
Development was a transition or change from a traditional to a modern society. For the
modernisation theory the ideal modern society was the Western society and American
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society, in particular, was presented as the ideal image. In order for the Third World to
develop it needed to acquire the characteristics of such a modern society.
The characteristics of a modern society were the following:
. The modern society was the Western industrialised society, and therefore, the Third
World needed to become Westernised.
. Modern society was industrialised society: therefore, the Third World needed to
develop its economy by developing big industry and become industrialised.
. Modern society was urban society where industry and economic activities usually
develop around big cities: therefore, the Third World needed to become
urbanised.
. Modern society was democratic capitalist society: therefore, the Third World
needed to develop capitalist economy and Western-style democratic politics and
government.
Westernisation
. Through this process the Third World would become modernised. Therefore,
development was considered to be synonymous with modernisation and
Westernisation. In other words, without modernisation or Westernisation there is
thought to be no development.
For the individuals of the Third World, modernisation promised to bring the material
benefits and joy of a better life, as Daniel Lerner explained (1967:113114):
I have seen joy among the impoverished fellaheen (peasants) in Egypt when they
were able to offer me a bottle of Pepsi Cola. I have seen the bliss of an Iranian
father wearing, in the presence of his wife and children and neighbours, the first
store-bought suit to be seen in his walled village.
For a traditional society to become modern it was assumed that both the social structure
and individual human beings must be changed. Modernisation theory envisaged two
kinds of changes by which a society becomes modern:
1. Change in the structure of society. Social structures and economic practices need
to change from traditional to the more complex relationships of a modern society.
2. Psychological change in individuals. Characteristics of the individual's psychological
character, such as traditional values, attitudes and norms, need to be replaced with
modern ideas.
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Activity
9.4
List and discuss the four assumptions made by modernisation theory about the process
of social change in the Third World. Provide your own examples to illustrate your
discussion.
Our comments
1 All societies progress in similar ways to Western societies.
2 Third World societies are moving towards modernity.
3 Economic growth is the main cause of social change.
4 Third World traditionalism is an obstacle to development.
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9.6.1
Changing social structures and institutions: social and economic
modernisation
Internal structures of society could be changed only when the economy developed:
economic development was thought to be the engine that would drive all other social
development and modernisation. Economic development could be induced by a
massive diffusion of capital and technology into Third World countries from the West.
An American economist, Walter Rostow, claimed to have identified five stages of de-
velopment that all nations must go through in their progress to modernity, and proposed
a model to explain how a simple, traditional, agrarian society could be helped to
establish a modern industrial economy (Agunga 1998:143; Harris 1997:31):
1. The traditional society. This is the initial stage of a poor society with subsistence
agriculture and a simple system of social organisation.
2. The precondition to take-off. In this stage there is an increase in population due to
advances in agriculture, more people are freed from work in agriculture and
become involved in other economic activities such as the development of
transport and power supply.
3. Take-off into economic growth. There is a rapid accumulation of capital,
manufacturing industries grow and more workers enter industry. Traditionalism
begins to lose ground and the economy is placed on the road to modernisation.
4. The drive to maturity. The wealth produced from the industrial system stimulates
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further growth. More capital becomes available to develop the health care and
education systems.
5. The stage of high mass consumption. The highly developed industry produces
fewer basic commodities such as steel, machinery and textiles and now produces
more consumer goods such as washing machines and luxuries for mass
consumption.
For the theorists of modernisation, while change in social structure was essential, the
real key to development was the individual human being. These theorists assumed that
any development and modernisation ultimately depended on changing the attitudes
and habits of the individuals who constitute a society.
9.6.2
Making people modern: changing individuals' psychological
attitudes and values
Modernisation theory explained that Third World nations are poor and under-
developed because the character of their people does not allow development to take
place. To develop and modernise, the psychological orientation of the people, their
values, attitudes and norms need to be changed.
The traditional values of the peasants who constitute the majority of the population of
the Third World were identified as the obstacles to modernisation. The characteristics of
the peasants that prevented development were identified as the following (Melkote
1996:5859):
. Mutual distrust: The peasants were suspicious, evasive, uncooperative and

distrustful of others.
. Perceived limited good: Peasants believed that all good things in life are available in
limited quantities, and therefore, a person could improve one's position at the
expense of another.
. Dependence and hostility toward government authority: Peasants depended on the
authorities to solve their problems, but at the same time they distrusted the
government.
. Family-oriented: The family played an important and dominant role in the life of
peasants.
. Lack of innovativeness: Peasants did not like to adopt new ideas and had a negative
attitude towards change.
. Fatalism: Peasants believed that their destiny was predetermined and could not be
changed.
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. Limited aspirations: Peasants had a low level of motivation for achievement.
. Lack of deferred gratification: Peasants lacked that ability to postpone satisfaction of
immediate needs in anticipation of better rewards in the future.
. Limited view of the world: Peasants were not time conscious and were bound to
their place and community and had no orientation to the wider world beyond their
immediate localities.
. Low empathy: Peasants could not imagine themselves in new situations or places.
Changing these attitudes and values was a prerequisite for creating a modern society.
This was so because modern science, technology, and other modern institutions could
not be successfully grafted onto a traditional society whose members were uneducated,
superstitious, irrational and unscientific in their thinking.
David McClelland and other social scientists identified the individual's desire for
achievement, innovation, rationality and entrepreneurship as important impulses for
modernisation.
empathy Daniel Lerner identified empathy the ability of a person to imagine himself or herself
as being in another person's position or role as important for modernisation. For
Learner, empathy could be acquired through cultural diffusion or exposure to mod-
ernity from more advanced and developed societies. More specifically, empathy could
be learnt through the mass media. For such exposure and diffusion the role of com-
munication was considered by the modernisation theorists as the most important
means for development and modernisation (Webster 1988:5152; Melkote 1996:44
47).
Activity
9.5
1. List and discuss the characteristics of a traditional society that prevent
development. Can you identify some of these characteristics in your country or
community? Do you think that these characteristics are responsible for
underdevelopment in your country or community?
2. List and discuss the characteristics of a modern society. Provide your own
examples of each characteristic.
Our comments
1 According to the modernisation theory, traditional society was characterised by
. traditionalism and orientation to the past

. domination by a rigid kinship system
. superstition and a fatalistic view of the world
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2 According to the modernisation theory, a modern society has the following characteristics:
. It is Westernised: there is an abundance of Western goods, clothing, media programmes and lifestyle.
. It is industrialised
. It is urbanised.
. It has a capitalist economy.
. It has a democratic government.
Other characteristics that you could add to your discussion are: technological development, telecommunication net-
work, mass media, extensive roads and railway systems, hospitals and schools. You could also discuss the modern
characteristics of individuals, such as motivation, empathy, attitudes and behaviour.
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9.7
Development communication: the communication approach
of the dominant paradigm
Communication is at the centre of any society. The modernisation theorists saw the role
of communication as having central importance for development. Communication and
society are interdependent: new developments in communication affect and change
society, and new developments and changes in a society affect communication
(Schramm 1964:41). In development and modernisation, communication had to fulfil
three main functions (Schramm 1964:4243):
. A watchman function. Communication provides information on the events

associated with development within the country and at international level.
. A policy function. Communication is used to inform and persuade people to decide
to become modern and accept new ideas.
. A teaching function. Communication channels are used for teaching new skills and
for education that is needed for development.
In particular, the role of the mass media was considered crucial for preparing in-
dividuals for change by establishing a climate for modernisation. Once such a climate
was established, communication could be used to infuse new ideas.
In the next section we look at two main approaches to communication in moder-

nisation: the diffusion of innovations approach and the mass media approach.
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9.7.1
Diffusion of innovations approach
Evert Rogers introduced the diffusion of innovations approach to Third World de-
velopment in the early 1960s. According to Rogers, diffusion of innovations is a com-
munication process by which innovations spread to members of a social system.
Modernisation depends on the ability of members of a traditional society to accept new
and modern ideas. Innovations are new ideas, such as modern methods to improve
agriculture or health, that are communicated to a traditional society and accepted and
adopted by its members.
innovation The diffusion of innovations process goes through a number of stages: (1) an innovation,
which is any new idea, practice or object that is considered as new by its recipients, (2)
is communicated through some communication channels, (3) over time, and (4)
spreads among members of a social system (Melkote 1996:77). In such a process we
can identify four stages through which a recipient accepts or rejects an innovation:
1. Knowledge. An individual is exposed to the innovation and gains knowledge or

information about it.
2. Persuasion. The communication process through which an individual forms a
favourable or unfavourable attitude toward the innovation.
3. Decision. The individual forms a decision on whether to adopt and make full use
of the innovation, or reject the innovation.
4. Confirmation. The individual confirms the decision and seeks further confirmation
and reinforcement regarding the decision.
During the first stage when an individual becomes aware of an innovation and gains
knowledge, the mass media are influential. The mass media were believed to be
important in the modernisation process as they have the power to create awareness of
new ideas, and transmit information to create a climate that is favourable for devel-
opment.
However, at the persuasion, decision and confirmation stages interpersonal com-

munication seemed to be the dominant mode of influence. In other words, at the local
community level, interpersonal communication from opinion leaders or experts on
development such as agricultural extension officers or change agents facilitated further
dissemination of ideas and persuaded members of a traditional community to decide
to adopt new ideas or innovations (Melkote 1996:78, 81; Rogers & Shoemaker
1971:13; Servaes 1999:24).
The acceptance or rejection of an innovation depended on the nature of the innovation
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itself, and the rate of adoption of an innovation was related to the following char-
acteristics of the innovation (Rogers 1990:264):
1. Relative advantage of the innovation compared with the existing conditions. For
example, the financial profits that could be gained from adopting an innovation.
2. Compatibility of the innovation with existing values and past experiences of the
recipient. For example, the introduction of birth control in a Catholic community
would be rejected because it conflicted with existing values and attitudes.
3. Complexity or degree of difficulty of the innovation. For example, television is
easier to use than a computer.
4. Trialability or the degree to which an innovation can be tried out and tested. For
example, an innovation involving less risk would be accepted more readily than
one that has higher risks.
5. Observability or the degree to which the results of the innovation are apparent to
the recipient. For example, an innovation that produces results in short time would
have an advantage over one that produces results after a number of years.
Thus, an innovation that is beneficial, compatible with existing practices, tradition and
past experiences will be adopted more quickly that an innovation that does not.
Innovations are not adopted by every member of a society simultaneously; some

people adopt ideas earlier than others. The adopters of innovations within a community
were classified as the following:
. innovators, who are the first to adopt an innovation

. early adopters
. early majority
. late majority
. laggards, who are the last to adopt an innovation
It was suggested that adoption was dependent on the following characteristics of the
individual adopters:
1. Personal traits of the individual such as age and status of the recipient. For
example, early acceptors of innovations were usually younger people.
2. Media behaviour of the individual. For example, the type of message selected by
the recipient and the degree of media exposure.
3. The individual's status in the community. For example, people of relatively high
social and economic position were more inclined to adopt new ideas.
opinion leader Most people evaluated an innovation not on its scientific truth or research evidence but
on subjective feelings and were influenced by their peers or opinion leaders in the
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community who had already adopted the innovation. The opinion leader was a person
of some standing in the community and was able to influence other members. The
innovative behaviour of the peer or opinion leader was often imitated by other
members of the community. Person-to-person influence was essential in the diffusion of
innovations process. The task of the change agent was to identify opinion leaders in the
community.
change agent The diffusion of innovations approach attributes an important role to the change agent.
A change agent is a professional person associated with a development organisation
who influences decisions about innovations in a direction that the change agency
chooses (Rogers & Shoemaker 1971:227). For example, a change agent is the technical
assistance worker, agricultural extension officer, teacher or health worker who works in
the field and is in direct interpersonal contact with the traditional people of the Third
World. With the help of a local opinion leader the change agent promotes the diffusion
of new ideas through interpersonal communication. Social change was the con-
sequence of the diffusion of innovations and their acceptance or rejection by in-
dividuals and the community. Innovations could cause desirable and also undesirable
change. The desirable consequences are the anticipated and predicted social changes
that result in development and modernisation. The undesirable change is often the
unanticipated and disruptive consequence of the diffusion of innovations.
The communication strategy for an effective diffusion of innovations that would benefit
and develop most of the poor people of the community should be to formulate ap-
propriate messages, according to the following criteria (Rogers 1990:266267):
. Focus on the needs of the lower socioeconomic section of the population. Provide
messages that are redundant to people of higher socioeconomic status, but are
appropriate to the needs of the lower classes. For example, agriculture programmes
were designed that focused on topics already familiar to larger farmers but that were
of interest to small farmers. This would close the knowledge gap between the large
and small farmers.
. Focus on late majority adopters and laggards. The development programme should
concentrate on the late adopters and those that are lagging behind, rather than on
the innovators in the community.
. Tailor messages to the audience. The messages should be constructed for people of
lower socio-economic status in terms of their particular characteristics such as
education level, attitudes and communication habits.
. Use high-access media channels. Use media channels that are accessible to the
majority of the audience and are able to get through to the people of lower socio-
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economic status. For example, television is not available to many people in the rural
areas, so radio should be used to reach them.
. Select appropriate innovations. Priority should be given to innovations that are
appropriate and useful to the audiences.
. Use the personal touch. Organise people into small groups in which they can learn
about the innovations from each other and share resources for adopting them.
. Use opinion leaders. Identify the opinion leaders in the community and
concentrate the development efforts on them. The opinion leaders will diffuse
the message among others in the community.
. Use participative planning. Provide means for people to participate in the planning
and execution of diffusion of innovations programmes.
The diffusion of innovations approach emphasises the communication of new ideas

from external sources and their acceptance by people at community level.
While the diffusion of innovations approach established the importance of inter-

personal communication, other social scientists focused attention on the role of the
mass media.
Activity
9.6 A development organisation invites you to be their development communication
consultant to promote the diffusion of a new idea into your community. On a sheet of
paper, discuss the steps that you would take to implement a diffusion of innovations
development project in your community. Give specific examples of a project that is
relevant to your community.
Our comments
In your discussion you could include, for example, an explanation of the diffusion of innovations approach: ``The
diffusion of innovations is concerned with introducing new ideas into a community to be accepted and adopted by the
community in order to improve its health or increase agricultural production''. You could explain the four stages of
diffusion of innovations: knowledge, persuasion, decision and confirmation. Discuss the media you would use. For
example, for the diffusion of innovations you would make use of the mass media in order to provide information and
make the idea known to the community and create an atmosphere for development. In the second stage you would use
interpersonal communication to persuade people to adopt the idea. Factors to consider when trying to introduce the
idea are the advantages it provides, its compatibility, complexity, trialability and observability. The main activity for the
diffusion of innovations consultant would be to identify the opinion leaders in the community and persuade them to
adopt the idea and then diffuse it among the people. A good strategy to use when trying to get an idea accepted among
late adopters and laggards is to select an innovation that is appropriate to the needs of poor people, encourage and
persuade the late adopters and laggards, create messages that are appropriate to the audiences and use media that are
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accessible to them, and organise small groups to discuss the idea and learn from each other. You should provide your
own examples.
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9.7.2
The mass media and modernisation approach
The role of the mass media in the modernisation process was first emphasised by the
American sociologist Daniel Lerner (1965) in his book The passing of traditional society.
empathy According to Lerner, in order to move a traditional society to modernity, the people in
that society need to change their attitudes and become modern. The key to such a
process was empathy: the ability to see oneself in another person's situation. Empathy
enabled the person to operate efficiently in a modern society and provided motivation
for the individual to want to discard tradition in expectation of the rewards that
modernity would bring.
People could learn empathy through vicarious encounter through the mass media.
Vicarious encounter is the ability of the mass media, such as newspapers, radio, tele-
vision and cinema, to provide the viewers, readers or listeners with experiences of other
people. Through their own imagination the viewers, readers or listeners could experi-
ence the feelings, thoughts, attitudes and so on of other people.
It was assumed that the mass media such as the newspaper, radio, film and television
had the power to affect large numbers or masses of people directly by opening them up
to new ideas and attitudes. Such attitudes were essential for development because they
created a core of mobile individuals with the appropriate psychological orientation to
accept rapid change in their personal life and in their society.
According to Lerner, it was important to develop an extensive mass media system that
could reinforce and accelerate social and individual change by infusing new ideas.
Therefore, a combination of urbanisation, exposure to the mass media, and economic
and political participation were necessary for development. According to Lerner, there
is a correlation, or a cause and effect sequence between the existence of the mass
media and modernisation.
Everywhere increasing industrialisation has raised urbanisation; rising urbanism has

tended to raise literacy; rising literacy has tended to increase media exposure; and
increasing media exposure has tended to increase popular participation in economic
and political life (Lerner 1967:114).
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For Lerner, urbanisation the transfer of people from rural to urban centres is the
first phase of modernisation. Urbanisation further stimulates the spread of literacy and
the growth of the mass media. Once urbanisation, literacy and the mass media have
been established, the mass media in turn can stimulate urbanisation and the spread of
literacy and trigger a rise in political and economic participation that is characteristic of
a modern society (Faure 1996:183; Melkote 1996:8285; Stevenson 1993:1922).
Optimism about the ability of the mass media to contribute to modernisation was high.
The role of the mass media in development was further supported by the growing
popularity of the theories of Canadian scholar, Marshall McLuhan, who suggested that
technology and, in particular, communication technology had the power to create a
new human environment and change society (Servaes 1999:25).
The first attempt to define systematically the role and power of the mass media to
promote development came from the United Nations. In 1958 the United Nations
called for a programme to help the newly independent nations of the Third World
develop their mass media systems and proclaimed the 1960s the `Ùnited Nations
Decade of Development''. Unesco (United Nations Educational, Scientific and Cul-
tural Organisation) took the initiative and commissioned American communication
scholar, Wilbur Schramm, to produce a scientific study on how the mass media could
be used for national development. Schramm's study, Mass media and national devel-
opment, was published in 1964.
Schramm's research found that the underdeveloped nations had less developed mass
communication systems and suggested that the power of the mass media needed to be
mobilised for the development of the Third World.
For the Third World the mass media could function as a bridge to the wider developed
world. According to Schramm (1964:127132), the mass media could
. widen the horizons of traditional people

. focus attention on development issues
. raise aspirations to achieve the benefits of development
. create a favourable climate for development
The mass media of information and new media of education can speed up develop-
ment and mobilise human resources behind national modernisation efforts. The mass
media could prepare individuals for change by establishing a climate for modernisation,
and on a national level the mass media could be used by national leaders as a one-way
channel to disseminate modern ideas to the public. The strength of the mass media was
their ability to communicate and effectively disseminate information to a mass audience
at a low cost.
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For Schramm, the mass media were magic multipliers of development and the gov-
ernments of Third World countries were the main forces in directing national devel-
opment, and it was their task to develop the mass media systems. Schramm and
Unesco suggested a minimum standard for mass media availability in the Third World
(Melkote 1996:88). Every nation should aim to provide the following for every 100 of its
inhabitants:
. 10 copies of daily newspapers

. five radio receivers
. two television receivers
. two cinema seats
Such a minimum of mass media availability would provide information, and stimulate
the expansion of education, commerce, economic growth and all other development
activities.
Schramm's suggestions for the extensive use of the mass media for development were
adopted and put into practice in the Third World by the development agencies of the
United Nations, the World Bank, and the United States (Melkote 1996:8590; Ste-
venson 1993:2227).
Radio, television and film were used in many development projects to provide in-
formation to rural communities on agricultural improvements and health and family
planning campaigns, and to teach literacy to adult learners, and were incorporated into
the formal education systems (Schramm 1964:149174).
Case study 9.2

Example of the use of mass media in development
A report of the Central Health Education Bureau of India indicates how that organi-
sation goes about applying information to speed up community development in health
practices. The Bureau uses all the media of mass communication to reach health
workers, health educators, and the general public. It maintains a film library on health
subjects, previews new films to advise other users, and helps the Ministry of Information
in the production of films on health problems. It also stocks filmstrips. It arranges radio
talks and publishes pamphlets, carefully pretested with a target audience; issues press
releases; places advertisements; publishes posters. It has participated in a number of
health exhibits. Now it plans a new nontechnical health journal in a vernacular lan-
guage for people with minimum education. In a typical campaign, such as the one
aimed at smallpox vaccinations, it produces brochures and pamphlets for popular use;
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posters on the need for vaccination for six different target groups; handbills, bus panels,
and chalk boards, explaining about vaccination; feature articles and press conferences
for newspapers' ``talking points'' and technical background material for the field staff;
special numbers of journals; some radio features, advertisements, and a group of slo-
gans for campaign use (Schramm 1964:155156).
Activity
9.7
1. Read case study 9.2. Identify the various mass media and communication activities
used by the Central Health Education Bureau. Can you classify all the media used
by the bureau as mass media?
2. Do you agree with the statement that ``the bureau uses all the media of mass
communication to reach health workers, the health educators and the general
public''?
Our comments
1 The mass media used were film, radio, newspapers and journals. Other media such as posters, exhibitions, film
strips, handbills, bus panels, and chalk boards and slogans are not mass media but media that reach small audiences.
2 The bureau used a combination of mass media and ``little'' media for interpersonal communication situations.
The combination of mass media and interpersonal media seems to be best suited for development communication as
had already been suggested by the diffusion of innovations approach.
The importance of the mass media for the development of the countries of the Third World was again emphasised in
1976 by Unesco, when it appointed the McBride Commission to study the communication problems in the world. The
commission's findings were published in 1980. According to the commission, most countries of the Third World lack the
technology and skills for an effective mass communication system. In order to use the mass media for national
development, the mass media system itself needed to be developed. The mass media should be considered a major
development resource and national governments were urged to incorporate communication policies into their national
development planning and strategies (Servaes 1999:125127).
In the next section we examine briefly the role of the various forms of the mass media in development.
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9.7.3
The use of mass media in development
The press and development

Many underdeveloped countries of the Third World that achieved independence after
World War II had an established press that operated according to the colonial tradition.
During colonial rule the press was mainly used as a vehicle for providing news to the
European community. In most African countries the press consisted of one daily
newspaper that was published in the big city and lacked penetration into the rural
areas.
At independence, the new governments in the Third World took control of the press
and harnessed it to promote nation building, economic development and education.
The press was used to create a feeling of nationhood among the diverse people of the
country, to explain to them the goals of the new society, to obtain their cooperation for
community and national development projects, to provide information on better ways
of life and to promote the ruling political party. The press was expected to publish news
on the positive aspects of development and praise for the government.
In China, for example, government controlled newspapers published special articles on

development issues and also reported on the concerns of the people. In South Africa,
commercial newspapers such as Sowetan, The Star and Sunday Times and other
newspapers publish special supplements on education, offering crash courses written by
teachers to help school children with their studies and examination preparation. In
many poor areas where school books are in short supply, newspapers are used by
teachers as reading material.
The radio and development

Given Africa's great oral tradition, the radio is an important medium for development.
Radio is also accessible to the many illiterate people in the remote rural areas.
The radio has been used effectively to stimulate development in a number of countries.
Moemeka (1983:10) identified a number of strategies for the use of radio in devel-
opment:
. Open broadcasting. Broadcasting (to general audiences) programmes that include

information to improve the wellbeing and quality of life of the people, for example,
information regarding nutrition, agriculture and health. The use of drama, humour
and quiz shows could easily attract listeners and motivate them. Advertising is also
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used to promote development issues such as campaigns to promote Aids
awareness.
. Instructional radio. Radio broadcasts are used for formal education and serve as a
substitute teacher. Many countries use radio to teach language and numeracy skills,
and radio is also included in the classrooms of remote rural schools.
. Radio schools. The use of radio directed at non-formal learning groups of illiterate,
rural adults to provide basic literacy training. The aim of these programmes is to
bring together small groups that meet to listen to the lessons being broadcast, talk
about the material and support one another.
. Radio rural forums. The use of radio to broadcast farming news, information on
farming issues, lectures by experts and response to listeners questions. Farmers or
villagers gather in groups to listen to the programmes, discuss them and put the
lessons learnt into practice. The groups are guided by a discussion leader who may
also provide feedback on the programmes to the radio station and the sponsoring
development agency and assist the local people with their projects.
. Community radio. A community radio is a radio station that broadcasts to a specific
geographically located community, and serves and promotes the interests of the
local community. Since 1995 some 60 community radio stations have been
introduced in South Africa. Many serve previously disadvantaged and under-
developed rural communities.
Television and development

The spread of television in the Third World provides another medium to stimulate
development. General television programmes, such as news and entertainment, pro-
vide information and informal learning experience. In addition, educational television
(ETV) or instructional television (ITV) programmes have been designed and broadcast to
schools in a number of underdeveloped countries. Educational television can reach the
population in remote rural areas and help overcome the shortage of teachers, facilities
and instruction materials. However, television in the Third World is mainly available in
the large cities and does not have a wide penetration in the rural areas. For example, in
South Africa, some 12 million people do not have access to electricity and cannot use
television receivers.
Film and development

Historically, commercial film was used in Africa as a means to propagate colonial
ideology, and for the communication of propaganda. In South Africa, the former
apartheid government produced news and documentary films and a large mining
corporation produced labour recruitment and instructional films (Tomaselli 1989).
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Contemporary feature films produced by Hollywood studios still promote the ideas of
modernisation and the benefits of development to the audiences of the Third World
(Mytton 1983:29).
Documentary films were used with limited success in education, skills training and in
health and nutrition information campaigns in many countries in Africa. However, to a
large extent the use of film in development has been replaced by the use of television
and video (Jowett & Linton 1980).
The use of film for development is also restricted because it is distributed and exhibited
mainly in urban areas, and there are few cinemas in the rural areas.
9.8
Communication models for development: the dominant
approach
The use of communication for development, as we have seen in the sections above,
was based on certain assumptions, scientific theories and models of communication
that were popular during the 1950s and 1960s.
The study and practice of development communication within the dominant paradigm
(the modernisation approach) was based on two main assumptions:
1. Communication is a mechanical process of transmitting messages or information

from a sender (communicator) to a recipient.
2. The mass media are means of communication that have a powerful effect on their
recipients and the ability to influence their opinion and behaviour directly.
9.8.1
Transmission of information model of communication
The early scientific studies of communication described the process as a mechanical
one-way transmission of information or messages from a source or communicator to a
receiver. A simple S-M-C-R model described communication as a process in which a
source (S) sends a message (M) through a channel or medium (C) to the receiver or
individual (R). This simple model was popular among development communication
scholars, who assumed that the source or communicator is an active agent of in-
novations, communicating information to a passive receiver.
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The introduction of a mass medium such as the newspaper, radio or television was able
to multiply the messages and transmit them to large audiences consisting of millions of
people. It was assumed that the basic mechanical transmission of messages became
more powerful when communicated through the mass media.
9.8.2
Mass media effects models
The assumption that the mass media are a powerful means of communication first
emerged during the 19th century. After World War I it formed the basis of a scientific
theory of mass communication. Such a view of communication was based on the
psychological stimulus-response theory. According to the stimulus-response theory,
every act of communication, such as sending a message, always triggers a response in
the recipient. Accordingly, it was assumed that a stimulus (S) such as a media message
produced a response (R) in a recipient.
The expansion of book printing and the rise of mass circulation newspapers during the
Industrial Revolution of the 19th century attracted the attention and concern of poli-
ticians, philosophers and social scientists. They feared that the mass media could ne-
gatively influence the attitudes and behaviour of the masses of people in the newly
industrialised urban centres.
mass society The Industrial Revolution caused large-scale destruction of established rural commu-
nities as people were uprooted and migrated to the new urban industrial centres in
search of work and new opportunities. Through migration, people were uprooted from
their communities and traditional ways of life, family ties, old loyalties and accepted
norms and values were eroded. The strong interpersonal bond that existed between
people in the pre-industrial rural community was replaced by impersonal relations and
a tedious life in industrial centres. These changes created the modern mass society.
Social scientists assumed that the mass society consisted of an aggregate of atomised
individuals, that is, a collection of unconnected people, all acting according to their
unrestrained personal interests and desires without social restraint. It was believed that
in such a society the mass media had great power to influence the behaviour and
opinion of these isolated individuals to the detriment of the whole society, because the
mass media bypassed the control of traditional institutions such as the family, church
and state.
The American political scientist, Harold Lasswell, is credited with being the first scholar
to theorise the effect of the mass media in his model of communication. According to
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Lasswell, the nature of communication could be described by answering the following
questions:
WHO says
WHAT
in which CHANNEL
to WHOM
with what EFFECT
Lasswell's model is based on the simple stimulus-response theory and considers com-
munication as a one-way flow of information from sender to receiver.
bullet theory Other social theorists, extending on Lasswell's idea, described the powerful effect of the
media effect mass media as if the media were guns and their message bullets: the mass media
supposedly shot messages like bullets at passive and defenceless audiences. This idea
was known as the bullet theory of media effect.
hypodermic needle Another similar explanation for the effects of the mass media described the media as a
theory hypodermic needle. According to the hypodermic needle theory, the mass media were
like a needle that injected ideas into the veins of passive and defenceless audiences.
These early conceptions of mass media effects on isolated individuals can be re-
presented by the following one-way flow model of communication.
Direct effect model

In this model, messages from the mass media reach individuals who were isolated from
one another, but were dependent on the mass media for information and ideas. These
individuals were defenceless against powerful media messages and allowed the mass
media to manipulate their behaviour and opinions.
9.8.3
Two-step flow of communication: diffusion of innovations model of
communication opinion leader
Research on the effects of the mass media in the late 1940s and 1950s conducted by
Lazarsfeld using voting behaviour and the political decision-making process during
elections in the United States suggested that the mass media did not have a powerful
effect as was suggested by the early theories. The studies by Lazarsfeld found that
individuals were not influenced by the mass media directly, but media messages were
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mediated by opinion leaders. Opinion leaders were influential people in the com-
munity who were held in high esteem by other members of the community.
two-step flow of commu- This research suggested that there is a two-step flow of communication with the mass
nication media. First the mass media influence the opinion leaders in the community, and then
trickle-down the opinion leaders influence other members of the community through interpersonal
persuasions. In other words, messages are diffused by the mass media to selected
recipients such as the opinion leaders and from them the messages trickle down and are
diffused to wider circles. This view of the communication process underlies the diffu-
sion of innovations approach.
selective exposure The reason that the mass media do not have a powerful effect and do not influence
people directly is that people do not usually accept every persuasive message from the
mass media, but defend themselves against such persuasion. They defend themselves
against direct media effects through selective exposure: people tend to accept messages
that agree with and support their preconceived ideas, beliefs and values, while rejecting
messages that contradict such views.
Activity
9.8 Do you think the mass media, on their own, have the power to influence people to
change their attitudes and habits? Discuss and support your view with your own ex-
amples.
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9.9
Conclusion
The dominant paradigm in development known as the modernisation theory and

development communication approaches to the use of mass communication and the
diffusion of innovations were popular during the 1950s and the 1960s and are still used
in development. Modernisation theory inspired many development programmes and
the use of development communication in the Third World has produced a large body
of research. During the late 1960s and the 1970s it became evident that the as-
sumptions of the dominant paradigm did not fit the reality of the underdeveloped
countries, because most of the programmes failed to develop the Third World. Instead
development seemed to increased poverty and inequality. The dominant paradigm was
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criticised and re-evaluated, and new approaches to development began to emerge in
some Third Would countries. The limitations of the dominant paradigm and alternative
explanations for the cause of underdevelopment of the Third World are discussed in the
next study unit.
Summary
In this study unit we discussed the beginning of the idea of development of the poor
countries of the Third World. Development began after World War II and was initially
part of the foreign policy of the United States of America. The development problems
facing many of the countries of the Third World were outlined. The history of social
change in European societies and the early theories about social change were ex-
plained. In the 1950s, on the basis of the early theories of social change, American
social scientists constructed a theory of modernisation and economic growth for the
development of the Third World. The modernisation approach known as the
dominant paradigm in development explained underdevelopment by reference to
social and psychological obstacles to development that were internal to the Third
World. The dominant paradigm suggested that the Third World was to be modernised
and become westernised through economic growth and industrialisation. Development
was seen mainly as a transition from a traditional to a modern society and development
depended on changing social structures and institutions and individuals' psychological
orientations. We outlined the role of communication in development, the use of mass
media, the diffusion of innovations, and the models of communication of the dominant
paradigm.
Test yourself
1. Discuss the objectives of development in the Third World.

2. Analyse and provide your own examples of the development problems facing the
Third World and your community.
3. Explain the differences between traditional and modern societies.
4. Discuss and explain the modernisation process.
5. Discuss the theoretical assumptions of the dominant paradigm in development
communication.
6. Apply the principles of the diffusion of innovations approach to a development
problem in your community.
7. Explain and evaluate the use of the mass media in development situations in your
country and community.
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Study unit 10:
Dependency theory: critical issues in development
communication
Stefan Sonderling
Overview
In this study unit you are introduced to critical issues in development communication.
We begin with a critical evaluation of the limitations of the dominant paradigm
(modernisation) and introduce you to the new dependency paradigm and its alter-
native explanation for the cause of underdevelopment of the Third World. We explain
the role of media imperialism and the demands for a New World Information and
Communication Order (NWICO) and discuss the aims and strategies of development
journalism and mass campaigns as alternative Third World development communica-
tion. We conclude with a critical evaluation of the dependency paradigm.
KEY QUESTIONS
. What are the limitations of the modernisation paradigm?
. What are the differences between the modernisation and the dependency
paradigms?
. How are development and underdevelopment interrelated on a global scale?
. How does development cause underdevelopment in the Third World?
. What is the role of mass media imperialism in the underdevelopment of the Third
World?
. What are the principles of development journalism?
10.1
The failure of modernisation theory and criticism of the
dominant paradigm
The dominant paradigm, or modernisation paradigm, prescribed that the Third World
follow the example of the West. It emphasised economic development, massive transfer
of technology and the use of the mass media to disseminate information in support of
development. But during the late 1960s and throughout the 1970s it became apparent
that most of the development projects had not led to the desired development of the
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Third World. On the contrary, poverty was not eradicated and inequality between rich
and poor nations and between the rich and poor people inside the Third World in-
creased.
Modernisation in the Third World destroyed traditional ways of life, but did not pro-
duce the expected material and political benefits. Development created more under-
development and the people in the Third World were worse off than before.
Development thus proved to be a contradiction. For example, in countries in Latin
American, Africa and Asia, development resulted in an increase in the per capita GNP
income that seemed to indicate positive economic growth, but at the same time the
number of people living in poverty had increased. This proved that diffusion of in-
novations and the expected trickle-down effect of development had not happened.
The rich were getting richer and the poor were sinking deeper into poverty.
The failure of development demonstrated that the conditions in the Third World did not
fit the assumptions of the modernisation theory. The dominant paradigm's approach to
development came under increased criticism and a number of Latin American scholars
proposed a dependency theory or paradigm to explain the state of underdevelopment
of the Third World (Agunga 1997:145146; Melkote 1996:9798; Servaes 1999:32).
10.2
Critical evaluation of the modernisation approach to
development
The modernisation paradigm failed to contribute to the development of the Third

World because it made wrong assumptions about the Third World. Modernisation
theory was based on certain prejudices or preconceived ideas. The shortcomings of the
dominant paradigm were exposed by evaluation and criticism from different scholars.
The following is a summary of some of the main criticism against the modernisation
theory.
Abstractness of the theories of social change and the modernisation

process
The dominant paradigm of modernisation was criticised for being theoretical and ab-
stract. Modernisation theory described the history of development of Western European
societies and, therefore, had little relevance because it did not fit the conditions of the
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Third World and could not provide usable guidelines for predicting development. The
prediction that every society must pass through a fixed number of stages proved to be
incorrect in the newly independent former colonies in Africa and Asia. At best, mod-
ernisation theory and its model of development provided an understanding of devel-
opment in general. However, it had limited application to the development of the Third
World because it did not take into consideration the existing inequalities and political
situation in many Third World societies (Melkote 1996:135).
The ahistorical nature of the assumptions about development

ahistorical Modernisation theory was criticised for being ahistorical. The historical experience of
development in Western societies did not match the existing conditions in the Third
World. The dominant paradigm attempted to apply ideas about economic develop-
ment from the history of a small number of countries in the Western world to a different
historical situation in the non-Western world. The belief that it was possible to identify
distinct stages in the history of Western development also presented a distorted view of
history because it only looked at Western development during the past two centuries.
For example, Rostow's model compressed complex historical changes (which took a
long time to unfold) into a neatly drawn, simple, five-stage model (Melkote 1996:98).
Limited consideration of the indicators of development

trickle-down The dominant paradigm considered economic growth to be the most important in-
dicator of development. However, economic indicators such as Gross National Product
(GNP) did not reflect the economic inequalities that existed within a particular country.
While these indicators show a general economic growth, this was not a true indication
of development because such growth was not evenly distributed among all members of
the population and did not benefit the poor. Therefore, the prediction that economic
development would begin with a small section of the population that adopted modern
ideas and then trickle down to the rest of the people was not realised. For example in
South Africa, according to the Reconstruction and Development Programme (ANC
1994:14):
Poverty is the single greatest burden of South Africa's people, and is the direct
result of the apartheid system and the grossly skewed nature of business and
industrial development which accompanied it. Poverty affects millions of people,
the majority of whom live in the rural areas and are women. It is estimated that
there are at least 17 million people surviving below the Minimum Living Level in
South Africa, and of these at least 11 million live in rural areas. For those intent on
fermenting violence, these conditions provide fertile ground.
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With a per capita gross national product (GNP) of more than R8 500 South Africa
is classified as an upper middle income country. Given its resources, South Africa
can afford to feed, house, educate and provide health care for all its citizens. Yet
apartheid and economic exploitation have created the gross and unnecessary
inequalities among us. Unlocking existing resources for reconstruction and de-
velopment will be a critical challenge during the process of reconstruction.
Overemphasis of the distinction between tradition and modernity

The modernisation approach blamed the traditional way of life in the Third World as
the cause of underdevelopment and disregarded external obstacles such as the unequal
power relations between nations. It was realised that tradition does not necessarily
prevent development, but could co-exist with development and modernisation.
Western or ethnocentric cultural biases in the assumptions

ethnocentric The dominant paradigm was ethnocentric because it regarded its own Western cultural
values as superior to those of the Third World. For example the United States of
America was considered to be the ideal image of a perfectly developed nation and it
was assumed that capitalism was superior and the only economic system that could
bring development to the Third World. All development programmes in the Third
World were aimed at making the Third World countries look like little Americas. It was
taken for granted that communication technologies and communication strategies that
proved effective in the development of the West could be easily transferred to Third
World settings.
Activity
10.1 Discuss and explain, in your own words, why the prejudices of the modernisation
paradigm contributed to its failure to develop the Third World.
Our comments
The failure of the modernisation paradigm was caused by its wrong assumptions or prejudices. This paradigm provided
an abstract theory of change but could not explain how development should take place in situations in the Third World.
The modernisation theory was ahistorical because it was constructed on old theories that explained change in Western
societies in the past and not development and change in the present. It overemphasised the negative role of tradition
while promoting only the positive aspects of modernisation. The assumptions were based on ethnocentric prejudice that
considered the West as being superior to the Third World, that the Third World could not contribute to its own
development and, therefore, that everything in the Third World needed to be replaced with Western ideas, habits,
institutions and technology.
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10.3
Critical evaluation of the modernisation theory approach to
development communication
The assumptions of the dominant paradigm about the role of communication in de-
velopment were also based on a number of preconceived ideas, such as those dis-
cussed below.
10.3.1
Mass media prejudice
magic multipliers The modernisation paradigm considered the mass media to be the main instrument for
creating awareness and providing the right climate for modernisation. The mass media
were considered to be ``magic multipliers'' of development messages because the mass
media could spread a single message, at high speed, to a large number of people in
different locations at a low cost. It was believed that the mass media had great potential
to persuade people to accept modern ideas and innovations. These assumptions
proved wrong and overemphasis of the power of the mass media created the following
problems:
Neglect of traditional media

The overemphasis of modern media resulted in the rejection and neglect of traditional
forms of communication, such as oral communication, and cultural practices that en-
joyed popularity in the Third World and which could have been used to promote
development.
Neglect of message content

selective exposure The overemphasis of the effects and power of the mass media to persuade resulted in
lack of attention to the content of the messages and the quality of the information that
was conveyed. It was assumed that any exposure to the media would have the desired
effect. But this ignored the fact that people sometimes could not understand the
messages communicated to them by the media, or that they misinterpreted the in-
formation in a way that was detrimental to development. Furthermore, the dominant
paradigm also neglected to consider that people could expose themselves selectively to
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mass media messages. For example, people may prefer to listen to entertainment
programmes or music on the radio and ignore development related educational pro-
grammes.
Limited access
The overemphasis of the use of the mass media to carry development messages ignored
the fact that the mass media were mainly available to the people in the cities and were
not available to the majority of people living in the rural areas.
Ideology of technological determinism

The dominant paradigm overemphasised the importance of modern mass media
technology. Such emphasis resulted in the Third World spending large sums of money
to acquire expensive technology, rather than using more appropriate and cheaper
means of communication. For example, implementation of new expensive commu-
nication technologies resulted in African nations finding themselves in debt as a result of
international loans they received to buy new technology (Boafo 1991:112113). The
promotion of media technology was also ideologically biased, because many devel-
opment specialists and development communication researchers were funded by
American government institutions, which desired to develop mass communication
systems in the Third World for the diffusion of American political propaganda.
Inappropriate use of media and message content

In many instances the media selected for development were wrong for the purpose.
The promotion of particular mass media such as daily newspapers and television for
speedy modernisation in the Third World was a mistake. For example, priority was
given to establishing daily newspapers in the Third World, but magazines would have
been a better option (Melkote 1996:146).
The use of inappropriate media content was another reason that development mes-
sages failed to achieve their objectives. Leonard Doob, who studied the use of the mass
media in Africa, found that it was essential to consider the local conditions, language
and culture when using media for development. For example, an educational film
produced in Nigeria to teach mothers how to bath a baby offended women in Uganda.
A child, they said, should not be shown naked, and its hair must be washed first, not
last. Even what appears to be universally acceptable can cause problems. For example,
during World War II, when meeting Donald Duck for the first time, some Congo
soldiers threw stones at the screen because they though they were being ridiculed.
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`Ànimals don't talk,'' they shouted. ``Whoever saw a duck in uniform?'' (Schramm
1964:52).
10.3.2
Problems caused by mass media exposure: a revolution of rising
expectations
The use of the mass media for modernisation in the Third World created a ``revolution
of rising expectations''. The mass media first exposed the people of the Third World to
modern values and inspired them to believe that they could achieve the lifestyle and
affluence of the people living in a Western society. The mass media presented images of
the ``good life'' of a modern society, but the material goods and benefits were not
available to most people in the Third World. As well as raising the aspirations of people
in the Third World, development information and the mass media created another
``revolution of rising frustrations'' and disappointment when these demands and ex-
pectations could not be satisfied (Melkote 1996:151152). For example, through ad-
vertising, poor people were encouraged to drink Coca-Cola or eat McDonald's
hamburgers, but they could not afford to buy these products because they were un-
employed.
Case study 10.1

Problems and dangers of mass media exposure
Through advertising, the people of the Third World are encouraged to buy many of the
consumer goods marketed by affluent nations. This has a harmful effect on their quality
of life in two ways:
1. The individual is living in an illusion of affluence with, say, a television set amid the
squalor of a shanty town.
2. Far more serious is the fact that individuals may sell wholesome food that they
produce locally in order to purchase processed foodstuffs from the affluent
nations. For example, a person in the Third World may sell eggs in order to
purchase artificial baby food in the belief that she is giving her baby a better start in
life.
Third World women, especially in Africa, have been subjected to much advertising of
powdered milk for bottle feeding. The advertisers try to discourage the mothers from
breast feeding by creating an image of ``modernity'' in relation to the ``scientifically
prepared'' baby food. If this fundamentally safe product is mixed with water from a
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polluted source, as it frequently is in the underdeveloped world, this creates a serious
potential risk to health (Harris 1993:93).
Activity
10.2
1. List and explain the two dangers of exposure to inappropriate mass media
development messages. Provide your own examples.
2. Explain why, in your opinion, some people select entertainment programmes on
television or radio and ignore educational development programmes. What could
be done to make people choose to pay attention to development messages in the
mass media? Provide your own examples.
Our comments
1 The danger of media exposure to inappropriate messages is that they create an illusion of development and could
have serious effects on health, for example when products are advertised that are wrong for the context. Give your
own example.
2 There are many reasons why people expose themselves selectively to the mass media and neglect development
messages. For example, they may not understand the difficult technical language of the programme; the programme
may not be presented in their own language but in an official language such as English which they find difficult to
understand; the presentation of the programme may not be interesting enough to hold their attention; the messages
may not have any relevance to their situation or experience; or the content of the programme may offend them.
Give your own examples.
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10.3.3
Ideology of individualism and psychological prejudice
The dominant paradigm assumed that development depended on changing people's
traditional attitudes and values, and it was thought that mere exposure to new ideas and
innovations would motivate people to take action. For communication to aid devel-
opment it was assumed that all you had to do was distribute technical information and
people would make their own decisions automatically. The failure of development was
blamed on the individual's psychological state of mind, such as fatalism, peasant
mentality, and stubborn and negative attitudes to change. However, such assumptions
did not take into account the position of the individual in the social structure and the
influence of the social context in which communication took place on the individual's
attitudes and behaviour. The influence of contextual factors were ignored, such as the
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class division that existed in a society, and different social, political and religious groups
that individuals belonged to.
It was realised that while communication was indispensable to every development

attempt, the provision of information about development to individuals without con-
sidering their social situation would not lead to successful development. Communica-
tion was only one of several factors that could bring about change in a society. For
example, it would be meaningless to begin campaigns for better nutrition if people had
nothing to eat, or to urge people to go to health centres or hospitals if such facilities did
not exist or the people were unable to pay for the services. As Hedebro (1984:92)
explains:
Farmers will not adopt new ideas and products if they do not have a real possi-
bility to do so or if they will not benefit from it, no matter how cleverly the
information has been designed. In many developing nations farmers are tenants
or the land is divided into small plots. The farmer may own small pieces of land
scattered over a large area. What is needed to improve living conditions and
efficiency of farming in such situations is land reform, not information. A change
in the structure of society is needed, not technical know-how. This can be put in
another way: information can never substitute for structural changes, no matter
how ambitious the effort.
As the result of the failure of development to improve conditions in the Third World and
the criticism of the dominant paradigm and its faulty assumptions, a new approach to
development and new explanations for the state of underdevelopment of the Third
World were proposed by the dependency paradigm.
Activity
10.3 Discuss and provide examples of what the emphasis on individualism in modernisation
theory neglected to consider as the cause for underdevelopment.
Our comments
The most important point that was neglected in emphasising individualism and the idea that people could make their
own decisions regarding development was the role of society, the inequality based on relations of power, and the
inability of individuals to access land, money and other resources that were essential if they were to decide to
modernise. Give your own examples.
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10.4
Development and underdevelopment in international
perspective: dependency theory
A new approach to development, known as dependency theory, rejected the as-

sumptions of the dominant paradigm that there were characteristics inside the Third
World that obstructed development and contributed to underdevelopment. From their
studies of the historical evidence on social change, dependency theorists concluded
that the underdevelopment of the Third World was caused by factors outside these
societies.
For the dependency theorists, or dependistas, development and underdevelopment

were interlinked. Basing their theory on the views of Karl Marx, the dependistas ex-
plained the causes of underdevelopment by reference to the history of conquest and
exploitation of the natural resources and people of the Third World by European
imperialism, and the global unequal distribution of power among nations. In other
words, Europe and the West were the cause of underdevelopment in the Third World.
In order to understand the dependency theorist approach and their criticism of the
dominant paradigm, we need to take a brief look at Karl Marx's ideas on social change.
10.4.1
Marx's theory of underdevelopment
modes of production Karl Marx (18181883) was one of the first theorists to link development to relations
between societies on an international scale. He maintained that social change was a
process by which a society passed through several historical stages of development: this
was a progression from slavery to feudalism, capitalism, socialism and finally com-
munism. Each stage was a reflection of the material and economic relationships
modes of production that existed within the society at that particular historical
moment. The change from one stage to another was determined by transformation in
the modes of production, and driven by class conflict. For Marx, all societies must
undergo the same stages of change as those of the European societies. As he put it:
``The country that is more developed industrially only shows to the less developed, the
image of its own future'' (Marx in Roxborough 1990:43).
According to Marx, the capitalist system had the ability to modernise the stagnant non-
Western traditional societies. By its nature, capitalism was compelled to seek greater
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and greater profits and in order to do so it needed to expand into non-Western so-
cieties. Such expansions resulted in domination and exploitation (Harris 1993:3539).
The intrusion of capitalism into the backward non-Western societies, through colonial
conquests and imperialist rule, would bring them to the stage of modern capitalism and
would result in their economic growth and development.
Marx was optimistic about the progressive nature of capitalism and its ability to mod-
ernise traditional societies and transform them into modern industrial societies. Ac-
cording to him, the expansion of capitalism contributed to the modernisation of
traditional societies, as was the case with British domination of India in the 19th century.
Marx explained (Barratt Brown 1972:4647) that England had to fulfil a double role in
India:
1. A destructive role the annihilation or destruction of the old traditional Asiatic

society
2. A regenerating role laying the material foundation for a Western-type society in
Asia. The foundation for modernisation of the society consisted in
. political unification of the country

. establishing a free press as an agent for the reconstruction of the old society
into a modern capitalist society
. creating an educated native elite that was endowed with the required skills for
government and imbued with European science
. building an industry and a railway network
Traditional societies had no defence against the pressure of capitalist expansion. Marx
and Engels explained it as follows:
Through the rapid improvement of the instruments of production and vast im-
proved communications the bourgeoisie forces all nations, including the most
barbarian ones, into civilisation. The low prices of goods is the heavy artillery with
which it shoots down all Chinese walls, and the means by which it forces the
capitulation of the barbarians' stubborn hate of foreigners. All nations are forced
to adopt the bourgeoisie mode of production unless they want to be ruined.
... In other words: the bourgeoisie creates a world in its own image (Kazan
1993:2122).
imperialism Extending Marx's ideas on capitalist expansion, Lenin named the international re-
lationships of exploitation, imperialism.
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10.4.2
Dependency theory and underdevelopment
Other theorists used Marx and Lenin's ideas to analyse development and under-
development as a relationship between societies. It became evident that Western ca-
pitalist societies achieved and maintained their development through their conquest
and exploitation of the less developed societies.
neo-Marxists While Marx and Marxist theorists considered underdevelopment from the European
perspective of capitalist expansion, and were optimistic about the ability of capitalism to
modernise traditional societies, neo-Marxists transformed Marx's thinking and focused
on imperialism as it was experienced by the Third World and emphasised the de-
structive role of capitalism and how it enslaved the Third World (Hettne 1995:88).
One such neo-Marxist analysis of the problems of development and underdevelopment

was proposed by Latin American economist, Andre Gunder Frank. According to Frank,
underdevelopment was not some traditional condition of the Third World, but was the
result of the historical expansion and development of the capitalist system on a global
scale. The capitalist system simultaneously generated underdevelopment in some parts
of the world and development in others (Frank 1984:99). Thus, development and
underdevelopment should be understood as the relationship between countries on an
international scale.
periphery Within such a global system of capitalist exploitation, the underdeveloped countries
centre were described as being on the periphery, and the developed countries were con-
sidered as being at the centre of the world's economy. The developed centre de-
termined events at the underdeveloped periphery, and the more the centre developed,
so the periphery was left further behind (Servaes 1999:34).
The underdevelopment of the Third World was seen as the result of deliberate ex-
ploitation of market forces of the global economy. Through the domination of the Third
World by their colonial masters, the Third World was made to produce cheap raw
material for the factories of the developed nations. Such an export-based economy
prevented the dominated countries from developing their industrial resources and
made them dependent on the economies of the developed nations.
According to the dependency theory, the most important obstacle to development was
the continuous external domination of the Third World by the West. The collapse of
British and European imperialism during the 20th century and the political in-
dependence of the former colonies in the Third World did not free them from Western
domination. For the dependency theorists, the modernisation development pro-
grammes sponsored by the West were another attempt to dominate and exploit the
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Third World. This was a new form of colonialism or neo-imperialism. Said (1994:341)
explained this as follows:
`Ìmperialism did not end, did not suddenly become `past', once decolonisation
had set in motion the dismantling of the classical empires. Imperialism or neo-
imperialism is still the most powerful force in economic, political, and military
relations by which the less developed countries are dominated by the more
developed.''
Foreign aid for development was seen as a method by which the United States and its
European allies maintained a position of influence and control around the world. Such
domination began after the end of World War II when First World nations began to
compete against Russia for the political loyalties of the newly decolonised Third World
nations and their raw materials and markets. Old British and European imperialism was
replaced by modernisation. Modernisation was an American ideology and consisted in
military interventions in the affairs of Third World countries and investments in the
development of these underdeveloped nations.
`Àlmost without exception, the Third World seemed to American policy-makers

to be ùnderdeveloped', in the grip of unnecessary archaic and static `traditional'
modes of life, dangerously prone to communist subversion and internal stagna-
tion. For the Third World `modernisation' became the order of the day, so far as
the United States was concerned. ... Huge sums were poured into Africa and Asia
with the aim of stopping communism, promoting United States trade, and above
all, developing a cadre of native allies whose expressed raison d'etre (purpose)
seemed to be the transformation of backward countries into mini-Americas. In
time the initial investments required additional sums and increased military
support to keep them going. And this in turn produced the interventions all over
Asia and Latin America which regularly pitted the United States against almost
every brand of native nationalism'' (Said 1981:27).
American involvement in the Vietnam war provided further justification for the accu-
sation that development and modernisation were disguises for a new-style Western
imperialism. Imperialism was also reflected in the practice of the development in-
stitutions of the United States and the World Bank (Harris 1993:57). For example,
research into the development policies of the World Bank found that development aid
is,
`ìn general, available to countries whose internal political arrangement, foreign

policy alignments, treatment of foreign private investment, debt-servicing record,
export policies and so on are considered desirable, potentially desirable, or at
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least acceptable, to the countries or institutions providing aid, and which do not
appear to threaten their interests. ... Supporters of aid argue that promoting
economic development in poor countries is in the long-term interests of the
developed countries'' (Hayter in Harris 1993:57).
New political situations in Latin America and Africa also provide inspiration for criticism
of the Western model of development. The success of the Cuban revolution, and
China's and Tanzania's successful socialist development provided inspiration and hope
that countries of the Third World could develop themselves without Western assistance
and interference. The dependency theory promoted the idea of an alternative devel-
opment. The Third World was encouraged to disengage, de-link or free itself from the
global capitalist system and proceed with revolutionary self-development (Stevenson
1993:7).
Tanzania's development strategies provide a good example of the application of de-

pendency theory in Africa. Tanzania, formerly known as the British colony Tanganyika,
gained independence in 1961. For the first few years after independence the govern-
ment led by Julius Nyerere followed a capitalist modernisation development strategy.
But this strategy encountered problems such as increased inequality in the rural area
due to capitalist agricultural production, costly imports of raw materials and machinery
for industry, and insufficient foreign aid and capital for development. In 1967 Tanzania
adopted a socialist development policy based on self-reliance. The government made
efforts to reduce inequalities. These efforts included nationalisation and state control of
the economy, and extensive expansion of health and education services in the rural
areas. In the rural areas peasants were encouraged to follow a socialist agricultural
policy, and to adopt the ujamaa village concept where everyone worked on a large
communal farm rather than cultivate their own small plots. However, by middle of the
1980s Tanzania was facing an economic crisis and was forced to return to capitalist
development.
Having outlined the assumptions of dependency theory, let us examine the dependency
theory views on the role of communication in the underdevelopment of the Third
World. We then examine the possible positive contribution of the mass media to the
alternative development of the Third World.
Activity
10.4
1. Explain the difference between Marx's view and the dependency theory's view of
the consequences of capitalism for the Third World.
2. Explain the differences between the modernisation paradigm's and the
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dependency paradigm's explanations of the cause of underdevelopment in the
Third World.
3. Discuss how the dependency theory explained the relationship between
development and underdevelopment.
Our comments
1. The main difference is that Marx was optimistic and considered capitalism to be a progressive force. He thought
that as capitalism expanded into the traditional societies it would transform them into modern industrial societies.
The dependency theory was more pessimistic and proposed that capitalism is a destructive force and causes
underdevelopment in the Third World as it makes the traditional society dependent on the capitalist centre. Give
your own examples.
2. The modernisation paradigm considered underdevelopment to be a state internal to the Third World and caused
by a lack of development. The dependency paradigm explained that underdevelopment was caused by forces
outside the Third World, such as capitalist expansion and imperial domination. Can you give your own examples of
dependency in your own country?
3. Dependency theory maintained that there was a close relationship between the development of the modern
Western societies at the centre of the world economy and the underdevelopment of the Third World countries at
the periphery. Development, therefore, was the ``cause'' of underdevelopment.
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10.5
The role of communication in the underdevelopment of the
Third World
multinational The dependency theory viewed the world as a single economic system in which the
transnational developed centre controlled the underdeveloped periphery. While the old imperialist
control was based on the brute power of military and economic domination, the new
imperialism was based on ideological manipulation by multinational or transnational
corporations that controlled the means of communication. Transnationals and multi-
nationals are large businesses usually based in one of the developed countries of the
West but which operate in many other countries across the world.
Modern imperialism was maintained by persuasion, communication and the power of

the mass media. Of course, cultural and media imperialism was not a new invention; it
had already been used during the 19th century by European countries in their conquest
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of Africa, as Jomo Kenyatta (Mazrui 1990:6) explained: ``When the white man came to
Africa he had the Bible and we had the land. And now? We have the Bible and he has
the land. For the West it was a case of offering culture in exchange for material goods.''
cultural dependency The dependency theory considered communication and the mass media to be an
important external component by which the developed nations dominate the Third
World. Communication, the mass media and cultural and educational institutions were
of great importance in keeping the underdeveloped nations dependent on the devel-
oped nations. The invention and spread of new communication and information
technologies and the expansion of transnational communication industries contribute to
renewed cultural dependency. Such dependence is described as media imperialism
(Servaes 1999:35; Stevenson 1993:6).
10.5.1
Media imperialism
media imperialism Media imperialism can be defined as a process in which the ownership, structure,
distribution or content of the media in any one country is subject to substantial external
pressures from the media interests of any other country or countries, without propor-
tionate reciprocation of influence by the country so affected (Boyd-Barrett in Servaes
1999:35). In other words, media imperialism refers to the one-directional flow of
international communication from the developed to the underdeveloped nations. For
example, there is a heavy flow of communication and export of media products such as
news, films, television programmes, books and magazines from the United States to
Africa, while there is very little exchange of exported media products between Africa
and the United States. The media markets in the Third World are dominated by a small
number of countries that produce most of the communication and media content for
international consumption. For example, international film production and distribution
is dominated by Hollywood and other transnational corporations in the United States
(Boyd-Barrett 1984:117).
The unbalanced flow of communication is the result of inequality of power between

countries and keeps contributing to such inequality. Media imperialism manifests itself
in the following ways (Boyd-Barrett 1984:119128; Servaes 1999:3637):
. The developed world dominates the market for communication and media
technology. Third World countries are dependent on expensive imports of media
technology.
. The control of the financial and organisational structure of the media. For example,
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the control of the international distribution of films by Hollywood, or the control
and distribution of news by American news agencies.
. The export and imposition of values of practice. For example, the idealisation and
use of Western journalistic values such as `òbjectivity'', ``balanced reporting'' and
so on in Third World countries. The imposition of values is also reflected in
encouraging the adoption of a particular communication technology.
. Media content and market penetration, for example, the export of American
television entertainment programmes to the Third World, or the extensive use of
English in computing. Such market penetration prevents the development of local
programmes.
After exposing media imperialism and other shortcomings of the dominant paradigm,
dependency theory proposed new ideas about the use of communication for the de-
velopment of the Third World.
Activity
10.5
1. Give your own definition of media imperialism.
2. Discuss the manifestation of media imperialism. Give your own example of media
imperialism in your country or community.
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10.6
Alternative development communication in the Third World
Dependency theory criticism of the dominant paradigm and the critical analysis of
media imperialism combined with the Third World's frustration with failed moder-
nisation gave rise to demands for restructuring the world's economic and commu-
nication systems and for alternative development in the Third World.
10.6.1
New World Information and Communication Order (NWICO)
nonaligned During the 1960s, in response to the Cold War rivalry between the United States and
NIEO the Soviet Union, Third World countries formed a nonaligned movement to assert their
neutrality. The nonaligned movement began to address the problems of development
and the unequal distribution of economic benefits. They took up these concerns at the
United Nations and Unesco. In 1975 Unesco called for a New International Economic
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Order (NIEO). Unesco resolved to redress the gap between the wealth of the West and
the poverty of the Third World, and eradicate the legacy of colonialism by suggesting
the transfer of more resources from rich to poor countries.
NWICO It was also realised that information was becoming a new medium for the creation of
wealth, and demands were made for a New World Information Order (NWIO), or New
World Information and Communication Order (NWICO). At a meeting of the non-
aligned countries in Algiers in 1973 attention was focused on issues of communication.
These issues included the following:
. the West's domination over the means of international communication and

information
. the imbalance in the international flow of information
. the West's monopoly over news about the Third World
. the Western media's negative and distorted reporting on the Third World
All the above undermined development efforts and presented a distorted image of the
national identity of Third World countries. For example, Western mass media reports on
the Third World were ideologically distorted and usually expressed in cliches and
stereotypes such as the following (Van Dijk 1988:4445):
. They described Third World countries as a homogeneous block despite their

differences.
. Politically, Third World countries were considered primarily in terms of their
deviance from the Western parliamentary system and as being undemocratic.
. Economic problems of the Third World were primarily described as being a
problem for the West, and economic successes were usually neglected.
. International debt was portrayed as a problem for Western banks, and starvation
and poverty were dealt with in terms of what it would cost the West and how the
West could help, rather than trying to create conditions for change.
Activity
10.6
1. Collect about five newspaper or magazine reports on events in the Third World.
How many of the stereotypes and cliches about the Third World listed above in
this study unit can you identify in the reports?
2. What impression do these media stories and stereotypes give of the problems of
Third World development?
Our comments
1. The media describe the countries of the Third World as if they were all the same; Third World countries are
undemocratic; Third World rulers oppress their people; the Third World is a problem and burden to the First World
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countries; there is no economic progress in the Third World; the Third World is in debt to the World Bank and does
not want to pay; charity is needed to help the poor.
2. Obviously these news reports give a negative impression of the Third World because they emphasise the negative
aspects of the Third World and neglect to tell us about positive developments.
Because such ideologically distorted mass media images of the Third World influence development policy decisions,
these issues and concerns were taken up at a Unesco meeting in Nairobi in 1976 and incorporated in a declaration for a
New World Information and Communication Order (NWICO). Because media imperialism contributed to under-
development, there was a corresponding obligation to strengthen the resources, technological infrastructure and pro-
ductive capacity of underdeveloped countries in the Third World. These resources should be used to create
communication systems that are appropriate for authentic national development in the Third World (Stevenson 1993:8,
4049).
In 1976 Unesco also established the International Commission for the Study of Communication, also known as the
MacBride Commission, to examine international communication problems. The commission report was published in
1980 and recommended that the Western media provide more positive information on the Third World.
According to the MacBride Commission, most countries of the Third World lack the technology and skills for an effective
mass communication system. The mass media should be considered as a major development resource for national
development, and governments were urged to incorporate communication policies into their national development
planning and strategies (Servaes 1999:125127).
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Activity
10.7 In a short paragraph describe the aims of the New World Information and Commu-
nication Order (NWICO).
Our comments
The ideas and recommendations of the MacBride Commission were taken up by many Third World governments who
subordinated their journalists and the mass media to promote nation-building, economic growth and cultural identity.
Many Third World governments use such an authoritarian approach to control the media and limit the freedom of the
press and force the media to promote their political goals. This approach is known as development journalism,
development news or development media theory (McQuail 1987:119; Stevenson 1993:143).
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10.6.2
Development journalism
The idea of development journalism was first envisaged in the 1960s at the Free Press
Foundation of Asia in Manila. Development journalism was to have been independent
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journalism that provided constructive criticism of government and development and
informed readers about how development affected them. However, the idea of de-
velopment journalism was taken up by Third World leaders as a justification for con-
trolling the mass media (Shah 1996:143).
The idea of a press committed to nationalist ideals is not new in Africa. Many African
journalists were political figures active in the anti-colonial movement and struggle for
independence. The pre-independence political activism of the press was within living
memory for most journalists and politicians, and the successful contribution of the press
to the nationalist liberation struggle was a tribute to the potential power of the mass
media (Golding 1984:301).
After independence, African leaders demanded a totally committed press and mass
media because they did not want their media to be a replica of those in the West and
reflect the ideology of impartial and objective reporting (Mytton 1983:143). African
leaders argued that given the continent's subservient position in the global economic
system, its colonial legacy and the fragility of newly independent African countries, a
free, Western-style press could too easily lead to instability, hinder government func-
tions and cause internal chaos. Therefore, press control was necessary for national
development and political stability (Ogbondah 1994:3).
Development journalism also fitted well with the existing power structures in the Third
World where the mass media operated in an extremely centralised manner with the
concentration of power, resources and services in the hands of the ruling urban elites.
The mass media in Africa served the needs of the ruling elites in the urban areas who
transmitted information and ideology to the majority of the people (Boafo in Mda
1993:1).
The basic principles of development journalism were identified as the following

(McQuail 1987:121):
. The mass media should make a positive contribution to the national development
process.
. The state or government should be able to restrict the freedom of journalists and the
mass media. The freedom of the media should be subordinated to their
responsibility to contribute to nation-building and promote economic growth and
the development needs of the society.
. The mass media should give priority to information about national, cultural and
language issues and encourage national autonomy.
. The media should give priority to news and information about other developing
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countries and encourage solidarity among the underdeveloped or developing
nations.
. Journalists and other media workers have a responsibility to their countries in their
information gathering and dissemination tasks.
. In the interest of national development, the state has the right to intervene in or
restrict media operations, impose censorship and use state subsidies to directly
control the mass media.
The control of the mass media by governments and the demand that the mass media
report on ``positive'' development only were supported by many African leaders who
suggested that without such control the free press might confuse the people.
Many journalists in Africa were committed to the idea of development journalism.

Some journalists suggested that bad news, such as the failure of development projects,
should not be published. For example, in Tanzania in 1968 when information became
available about a village settlement scheme that had failed very badly, involving the loss
of large sums of money, and villagers who had been brought to live at the settlement
had left, development journalists argued that such a story should be ignored by the
media because the government had only recently launched its policy of ujamaa or
socialist village development whereby peasants were first encouraged and later forced
by the government to move to large rural settlements where they worked on a com-
munal farm rather than on their own small plots. The concept of ujamaa was difficult to
put across to the people and many peasants were suspicious or afraid. Reporting on the
failure of the attempt at village settlement would therefore not have helped to persuade
the peasants that moving to a new village was a good idea. Such reports would only
reinforce doubts and resistance. Journalists had a duty to report on important events,
but their reporting should always take into consideration the likely effects produced by
the publication of the information. Media reporting about failure of development
programmes would only spread confusion at a time when the government was
launching a political education campaign through the mass media to encourage positive
attitudes toward living in the new villages (Mytton 1983:144145).
Government-controlled development journalism provided ``positive'' news stories and

information that promoted and reflected development. Development news and in-
formation usually consisted of stories such as the opening of a fertiliser factory, the
graduation of a doctor from a remote and poor village, and any reduction in illiteracy or
infant mortality, however slight. Because the mass media in most Third World countries
were under direct government control, news about development was often manipu-
lated to provide a kind of public relations for the doings of governments and state
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officials and mobilise support for the ruling political party (Stevenson 1993:145). Be-
cause of such bias, development journalism did not enjoy credibility among the people.
Case study 10.2

Examples of government-controlled development journalism
The following are some typical examples of ``positive'' development news reports
written by development journalists under direct government control (Stevenson 1993):
Belgrade President Petar Stambolic, on behalf of the Presidency of Yugoslavia, has

sent President of the Democratic Socialist Republic of Sri Lanka Junius Richard Jaye-
wardene a telegram on the occasion of his being re-elected President. In the telegram
cordial congratulations and best wishes are expressed for success in carrying out of this
responsible duty for the wellbeing of the friendly people of non-aligned Sri Lanka.
Beijing The Nantong fermentation factory, China's largest citric acid producer, lo-
cated in Jiangsu Province, reports completion of the first stage of its expansion project,
doubling its annual output of product to 4,000 tons.
Dar es Salam Representatives of five friendly political parties which are attending
the on-going second ordinary conference, today inspected development projects in the
coast region where they commended Tanzania's policy of socialism and self-reliance as
the only alternative to the country's development.
Activity
10.8
1. Collect samples of development journalism from newspapers and magazines.
Establish whether these are similar to the government-controlled press reports in
the examples above.
Our comments
Did you find similar reports in media in your country or community? What does the existence of such reports in the
press tell you about the relationship between the government and the press?
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Development journalism could make a positive contribution to the development of the

Third World and South Africa. However, before the mass media in the Third World can
play the role of a ``change agent'' in support and promotion of development, there are
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certain problems that need to be addressed (Addison 1993; Faure 1996:203204;
Fourie 1994; Shah 1996):
. For the mass media to be accepted as credible agents of change, media workers and
journalists should establish their independence from the ruling political party. Any
direct government control of the media would lead to biased and ideological
messages being communicated and development messages would be rejected by
the public as mere propaganda.
. For journalists to become agents of change they need to acquire specialised
knowledge about development. Development journalism demands that journalists
explain the aims of development, mobilise support and act as channels of
communication between the developers and the people.
. Development journalism could be emancipatory when journalists report critically
about development, provide relevant information, become activists and challenge
and help change oppressive social structures.
. Democracy and the freedom of the press should be guaranteed, and development
journalists should strive to be independent observers, critics and advisers.
. The mass media need to be accessible to most of the people. The development role
of the media would fail if large numbers of the people did not have access to the
media. In many instances access to the media is expensive and the less privileged
cannot afford it.
The press and other mass media could contribute to national development only if they
were free and responsible. A free press would enjoy the trust of the people, promote
efficient government, and forestall corruption (M'bayo Nwokeafor & Onwumechili
1995:50). Press freedom is vital for development in Africa because a government-
controlled press is incapable of uncovering fraud, theft and corruption among the ruling
classes: ``For example, corruption and these other illicit economic ventures by the
dominant African bourgeois class have been identified as part of the reasons for the
failure of development projects in Africa'' (Ogbondah 1994:1).
Activity
10.9 Discuss and give examples of what would be needed for development journalism to
make a positive contribution to development in a free society such as South Africa.
Our comments
For the media to contribute to development some of the following are needed: media need to be independent of
government; journalists need to learn about development and have the kind of knowledge that you have acquired while
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studying the study units in this study guide; the media need to provide relevant information and journalists should be
activists and supporters of development in their communities; the media must be accessible. Give your own examples.
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10.6.3
Alternative communication for Third World development
The dependency theory inspired alternative self-development for Third World countries
that was independent of Western influence. The models for the development of many
African countries were inspired by socialist development in the People's Republic of
China, Cuba and Tanzania. Most of these self-development projects in Africa and
elsewhere were directed and controlled by national governments. However, their ideas
about the power of the mass media to promote development were the same as those of
the modernisation paradigm.
Mass campaigns and mass movements

Communist and socialist countries such as China and Tanzania assigned great im-
portance to communication as the means for the ruling party to mobilise the masses for
revolutionary change and the rapid development of society.
For example, in China the emphasis was on mass mobilisation of the people and on
communication between the party and the masses. The Chinese communication sys-
tem combined the use of mass media such as the radio, newspapers and mass public
meetings with interpersonal channels in small groups.
At national level the mass media radio and the press were under the direct
control of the communist party's central committee and promoted the ruling party's
ideas. In the provinces the provincial committees exerted the same control. A national
news agency provided government-approved information.
mass campaign Since 1949 the Chinese have also made extensive use of mass campaigns and mass
wall newspaper movements to mobilise the masses. These mass campaigns or cultural revolutions tar-
geted issues such as land reform, liberation of women, increasing production and
propagation of communist ideology. The people's involvement and support for the
campaign was publicised in easily accessible wall newspapers called ``tatzepaos''. The
wall newspaper consisted of a large sheet of paper or a poster that was posted in a
public place and included political slogans, essays, cartoons and workers' opinions. The
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wall newspaper was simple in form, lively in style, attracted attention and was con-
venient for mobilising the people.
In addition to the mass media China had a highly developed system of group gatherings
from the national level right down to the village level. The average Chinese was a
member of several such groups: at work, in the commune or village, or at neigh-
bourhood political study groups. These groups were under the guidance of local party
officials and discussed and explained party policy that was communicated through the
mass media. These small groups created consensus among the people on party policy
and also provided literacy and skills training (Hedebro 1984:7484; Yu 1967).
Case study 10.3

Communication tactics of Chinese mass campaigns
The Chinese mass campaigns or mass movements were undertaken to guarantee that
the socialist revolution and development could be carried out thoroughly and speedily.
The revolutionary mass movement and mass campaigns consisted of four distinct stages
(Yu 1967:202205):
Stage one: Attracting attention

The objectives were to get the masses acquainted with the campaign topic. Those who
were being mobilised needed to understand the basic issues involved.
. Local party leaders went out to speak to the masses, and staged mass public
meetings and made extensive use of radio broadcasts.
. All local cadres and propagandists explained the policies of the government and the
ruling party to the people in their own areas, through public meetings and personal
house-calls.
. All forms of mass media such as newspapers, radio, pamphlets, wall newspapers,
bulletin boards, plays, operas, movies and traditional media such as magic lanterns
were used to focus attention on the campaign.
. Local activists in the different communities lent their support and gave testimony to
the campaign.
Stage two: Ideological preparation

More meetings were held aimed at the following:
. Studying policies. Study the directives, announcements, speeches and newspaper

reports regarding the campaign. Local cadres or party officials lead study groups,
consisting of newspaper reading groups, workers' groups and so on.
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. Sharing ideas and feelings. The people in the study group were encouraged to talk,
express grievances and arrive at correct interpretations of the campaign.
Stage three: Taking action

This was usually the climax of the mass movement. The masses were mobilised behind
the campaign and committed to its aims, and action was taken to achieve the objectives
of the campaign. For example, these actions included the execution of guilty landlords
or enemies of the state, or staging public ceremonies where workers made pledges to
work harder and improve production.
Stage four: Review and the struggle

This stage begins after the masses have taken the desired action in the campaign.
Newspapers and magazines published reports of the experiences gained and re-
commended the use of such experiences in other areas and future campaigns. The
major aims of the closing stage of the campaign are
. to study possible remaining problems

. to study the level of political consciousness achieved by the masses
. to study the strength of the masses in carrying out the campaign
. to study the appropriateness or correctness of the policies concerning the campaign
The campaigns also identified new aspiring political activists among the communities
who could be used by the party in later campaigns.
Activity
10.10
1. Make a list of the media and communication activities used in the Chinese mass
campaigns described above.
Our comments
Both campaigns make use of the mass media, mass meetings, public gatherings, film, theatre, posters, speeches, group
discussion, and so on.
The main differences are the size of the campaigns and the level of people's participation. The Chinese campaign is
coordinated by the government and forces the mass of people to participate, the modernisation campaign is supported
by a government but cannot force people to attend mass meetings: people need to participate on a voluntary basis.
In socialist Tanzania, the radio, mobilisation campaigns and organised group discussions were under the control of the
ruling party (Hedebro 1984:7484).
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In South Africa large resistance campaigns against the apartheid regime were launched by the African National Congress
(ANC) in the 1950s. During the 1950s these campaigns, big rallies and various gatherings were centrally organised and
controlled from the ``top down'' by the ANC, but after the banning of the ANC and state repression during the 1970s
and 1980s, the mass campaigns were directed from the ``bottom-up'', grassroots levels and democratic participation of
various black communities (Louw 1989:2627). While these mass campaigns were informed by dependency theory
and directed by the political ideology of the ANC, the campaigns were inspired by and in turn inspired new ideas about
development and community participation and open democratic dialogue.
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10.7
Critical evaluation of the dependency paradigm
While modernisation theory considered the obstacles to development to be inside the

Third World, dependency theory considered these obstacles to be outside and beyond
the control of the Third World. However, dependency theory's emphasis of the external
obstacles and analysis of international constraints on development did not pay enough
attention to the internal obstacles to development, such as the inequalities within the
Third World and the internal exploitation of the people by the ruling elite.
Despite the differences between the modernisation and dependency theories, both
have important similarities:
. Both theories considered economic growth to be the magic key to development.

. Both theories attributed development or the lack of development (ie under-
development) to a set of factors such as human attitudes and values or economic
market factors.
. Both theories considered centralised use of mass communication from the top
down as the means for development.
The most important contribution of the dependency theory of development commu-

nication has been to improve our understanding of the role of communication by
showing that communication, mass media and technology have political significance,
and to alert researchers to the dangers of uncritical acceptance of Western assumptions
about development and communication. The dependency paradigm forces researchers
not only to think about the internal constraints on and obstacles to development but
also to consider the international and global context and interdependence within which
any development takes place. Dependency theory's emphasis of national identity and
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the need for mass mobilisation also brought new insight into the need for people to
participate in development.
Activity
10.11 In your opinion, did the dependency paradigm have different assumptions to those of
the modernisation paradigm about the role of communication in development?
Our comments
Both the modernisation and dependency theories made similar assumptions about the role of communication in
development. The most valuable contribution of the dependency paradigm was to expose the role of communication as
contributing to underdevelopment through media imperialism.
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10.8
Conclusion
In conclusion, the dominant paradigm of development has failed to address the de-
velopment problems of the Third World and worsened underdevelopment. The de-
pendency paradigm, based on Marxist ideas, has also failed to achieve development in
countries in the former Soviet Union and Africa.
Because of the failure of both paradigms of development, new ideas and models for
another development paradigm have been suggested. These new approaches to
development are based on the insights gained from both the modernisation and de-
pendency paradigms. The new approaches are based on participation and dialogue and
are discussed in study unit 11.
Summary
In this study unit we discussed critical issues in development communication that arose
during the late 1960s and the 1970s when it was realised that many of the moder-
nisation development programmes initiated in the Third World under the guidance of
the dominant paradigm had failed. Development did not improve the living conditions
of poor people in the Third World. On the contrary, poverty and inequality were
worsening and the dominant paradigm came under criticism. A new dependency
theory or paradigm emerged in Latin America. Dependency theory explained that
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underdevelopment was the result of external causes and not due to some internal
characteristics of the Third World. The dependistas as the dependency theorists
were known suggested that development and underdevelopment were part of the
same process of global capitalist exploitation and unequal distribution of power among
nations. Communication and mass media imperialism were considered to be crucial
aspects of a Western domination that ``caused'' underdevelopment in the Third World.
Political leaders in the Third World began to demand a New International Economic
Order (NIEO), for a more equitable distribution of material goods between the rich and
poor countries, and a New World Information and Communication Order (NWICO),
for a more balanced flow of information between information-rich and information-
poor countries. In Africa and other Third World countries new ideas emerged regarding
an alternative development that was not linked to the dictates of the West. The mass
media and development journalism were used for nation-building and political uni-
fication. An evaluation of the dependency paradigm showed that it provided important
insights into underdevelopment and the role of the media in underdevelopment, but it
was not a real alternative to the modernisation paradigm because it also failed to
address the internal causes of underdevelopment in the Third World.
Test yourself
1. Explain the limitations and prejudices of the dominant paradigm.

2. List and explain the differences between the modernisation and dependency
paradigms.
3. Discuss the dangers of exposure to inappropriate messages in the Third World.
4. What is the relationship between development and underdevelopment?
5. What are the assumptions of the dependency paradigm?
6. What is the role of the media in the underdevelopment of the Third World?
7. What is media imperialism?
8. What are the aims of NWICO?
9. What are the principles of development journalism?
10. What is the role of media in your community?
11. How can the media and communication strategies be used in development
campaigns?
12. What are the similarities between the modernisation and dependency paradigms?
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Study unit 11:
Another development: the multiplicity-in-one-world
paradigm for participatory development
Stefan Sonderling
Overview
In this study unit we introduce a third paradigm in development communication,
namely, the ``multiplicity in one world'', `ànother development'' or ``participatory
development'' paradigm. We discuss reasons for the emergence of the new partici-
patory development paradigm and contrast the new paradigm's assumptions with both
the modernisation and dependency paradigms. You are introduced to two approaches
to participatory development communication: the principles of development support
communication and grassroots community journalism. You will analyse the potential of
new information and communication technologies for participatory development and
apply the methods of participatory research in development communication.
KEY QUESTIONS
. Why have approaches to development communication changed?
. What are the differences between the participatory approach to development
communication and the modernisation and dependency paradigms?
. What are the principles of participatory development communication?
. What are the assumptions of the two interpretations of participation in
development communication?
. What is the importance of Freire's dialogical participation model for development in
Africa?
. What is grassroots community journalism?
. What is the role of folk media and theatre in development?
. What is the potential of the new information and communication technologies in
development?
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11.1
Another development: the multiplicity-in-one-world paradigm
for participatory conceptions of development
Thinking on development has changed since the idea of development of the Third
World emerged in 1949. During the 1940s and 1950s most modernisation theorists
concerned with development suggested that the problem of underdevelopment was
one of backwardness of traditional societies and could be solved by mechanically
transferring the economic, social and political systems of the West to the Third World.
During the late 1960s and 1970s the ethnocentric perspective of the dominant para-
digm was challenged by Latin American scholars and the alternative dependency
paradigm was born. The dependency theory suggested that development and under-
development were interrelated and needed to be understood in a global context. The
dependency paradigm focused on the effects of dependency at the periphery of the
world system and on the role of media imperialism in underdevelopment. The de-
pendency paradigm argued that obstacles to development were external to the de-
pendent society; development at the centre increased the gap between developed
societies and the underdeveloped countries on the periphery.
However, the modernisation and dependency paradigms gave development commu-

nication a similar role. The modernisation paradigm viewed communication as a
transfer of messages from sender to recipient, and the mass media were assumed to
have powerful means for sending messages about development from the `àctive'' and
innovative communicators to the mass of ``passive'' recipients or, alternatively, in a two-
step flow process to opinion leaders who then diffused the messages among their
followers. The dependency paradigm considered how capitalist ideology from the West
dominated the cultures of the Third World. As an alternative to modernisation, the
dependency paradigm proposed that governments in the Third World promote their
own form of development independently of the West.
However, in practice neither paradigm produced the desired development results and
poverty and underdevelopment worsened. The high cost in human sacrifice and suf-
fering where the dependency theory was applied raised ethical questions about the
objectives of development, for example under centralised, state-controlled socialist
systems, such as in China, Cuba, and Tanzania, or under capitalist and totalitarian state-
controlled countries such as Brazil or under the apartheid system in South Africa. Here
``development'' was sometimes effected through the use of state-organised terror and
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forced resettlement of people. Questions were asked about who gains from develop-
ment and the rights and wrongs of development. These questions led to the realisation
that there was a need for more just development to benefit the majority of poor people
in the Third World. During the 1980s and 1990s it was realised that development
should not be equated with the narrow perspective of economic growth. The objectives
of development should include material benefits, and also the cultural and spiritual
development of individuals in a free society (Berger 1976; Melkote 1996:178182).
From the critical evaluations and questioning of the objectives of development, the
following new priorities were identified (Melkote 1996:189192):
. A more broad-based definition of development was required that would

incorporate attention to the development of the physical, mental, social, cultural
and spiritual needs of individuals.
. Greater importance should be given to the positive role of local cultures and
traditions.
. Broader support was needed for development through the effective participation of
people at grassroots levels.
egalitarian . There was a need for a more egalitarian or equal distribution of the benefits of
development across all economic and social classes in society.
New ideas that were critical of the modernisation and dependency paradigms while
also combining and synthesising what were seen as their good points focused attention
on a human-centred approach to development. These ideas were proposed by social
scientists and adopted by international development agencies. Some of the following
theories and approaches contributed to this human-centred perspective on develop-
ment (Agunga 1997:151164):
. The growth-with-equity theory. Proposed interdependent development as a

compromise between modernisation and dependency paradigms. Economic
growth should be distributed more equally among all members of society.
. Basic needs approach. Placed development priority on meeting the basic needs of
the poor before attention could be given to other development programmes.
. Integrated rural development approach. Promoted by the World Bank and United
States Agency for International Development (USAID); identified the need to
develop agriculture and rural areas as essential for national development.
. People-centred approaches. Variety of approaches and theories such as ``human
development theory'', ``human resource development approach'' and ``capacity
building''. Emphasised the need to develop the human potential in each society
through investment in education and communication systems. People were
considered to be the key to development.
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. Empowerment and emancipatory theories. More revolutionary theories that stress
liberation, self-esteem and education as the basis for freedom, aim for justice and
the elimination of oppression and emphasise the need for the people to take
control of their lives.
. Sustainable development. The rise of concerns about the ecology and the
environment put the emphasis on development that meets basic human needs
but does not endanger or destroy natural resources and ensures that the
environment will be able to meet the basic needs of future generations.
. Women and development. Inspired by women's liberation movements and
emancipation approaches, the emphasis is on what should be a central but which
in fact is the neglected role of women in development.
Together, these new approaches, the re-evaluation of the objectives of development

and the changes in global political and economic relations provide the ground for a
third development paradigm that has been named `ànother development'', the
``multiplicity-in-one-world'' or participatory development paradigm (Servaes
1999). The central idea of the new paradigm is that there is no universal path to
development; development should be seen as integral, multidimensional, inter-
dependent and as a participatory process that is different for each society, because
each society must find its own way to development.
Development must be seen as a multidimensional process involving major changes in

social structures, popular attitudes and national institutions as well as the acceleration of
economic growth, the reduction of inequality and the eradication of absolute poverty.
Development, in its essence, must represent the entire gamut of changes by which an
entire social system, tuned to the diverse basic needs and desires of individuals and
social groups within that system, moves away from a condition of life widely perceived
as `ùnsatisfactory'' towards a situation or condition of life regarded as materially and
spiritually ``better'' (Todaro in Servaes 1999:7677).
According to Servaes (1999:7879), the new paradigm is based on the following re-
quirements that development needs to fulfil:
. Basic needs. Development is geared to meet basic human, material and non-
material needs. The basic needs such as the need for expression, creativity, equality
and the ability of the majority of the dominated and exploited people to understand
and muster their own destiny must be satisfied first.
Endogeny: from within . Endogeny. Endogeny stems from the heart of each society and defines its values and
the vision of its future. There is no universal model for development, only plurality
of development that applies for each society.
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. Self-reliance. Each society relies on its own strength and resources and its natural
and cultural environment. Self-reliance is expressed at international, national and
community levels.
. Ecology. Rational utilisation of natural resources and understanding of the local
ecosystems. It implies the equitable access to resources by all and the use of socially
relevant technologies that do not damage the environment.
. Sustainability. Development should be sustainable and consider the interdepen-
dence of resources both for present and future generations and in national and
international contexts.
. Participative democracy. Development should be based on a true form of
democracy that includes full participation of the people at all levels.
. Structural and sustainable changes. Structural changes in economic, social and
power relations are required in order to provide conditions for self-management
and participation in the decision-making process by all people.
These changes in thinking about development imply that the multiplicity paradigm
considers development to be a democratic process aimed at creating a just society. Such
development can be described as development for the people, by the people, and of
the people. This can be contrasted with the modernisation paradigm, which attempted
to do everything for the people, and the dependency paradigm, which attempted to get
everything done by the people.
Activity
11.1 In one paragraph discuss the reasons that lead to the emergence of a new paradigm in
development.
Our comments
There are a number of reasons for the rise of a new approach to development. Some of the points you could include in
your discussion are the following:
. failure of both the modernisation and the dependency paradigms to promote development
. increasing poverty in the Third World
. realisation that economic development was not benefiting the poor
. ethical issues raised by development projects in both socialist and authoritarian countries
. need to distribute the benefits of development among the poor
. revolutionary responses from the people at grassroots levels against oppression
. importance of local culture and diversity
. re-evaluation of the modernisation and dependency paradigms
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. new theories about development
. women's liberation movements
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11.2
New role for communication in development
In the new paradigm, development is seen as a participatory process aimed at self-

development of people and communities in which people have to discuss together,
identify their needs and problems, decide on a plan of action and then use specific
communication media and access information that is the most appropriate for them.
Such changes in the priority of development and the new and more inclusive con-
ception of development have also introduced new perspectives on the role of com-
munication for development.
A new perspective on development demands different communication strategies for

participatory development. The hierarchical, bureaucratic and sender-oriented model
of the modernisation and dependency paradigms was replaced by a model of com-
munication that is suitable for the envisaged democratic and participatory society. That
is, development communication is now defined as a process that is taking place hor-
izontally among equal participants and is sensitive to the needs of the recipients.
Communication is thus interactive, participatory and a two-way process at all levels of
society. The aim of such communication is not persuasion or a simple exchange of
information but exchange of meaning and sharing of information (Servaes 1999:83).
dialogue The emphasis is on a bottom-up flow of communication from the grassroots community
level upward, and on communication between people. The communication model for
the participatory paradigm is a dialogue. Through dialogue people come together to
discuss a problem and freely exchange knowledge and meaning and come to mutual
understanding.
indigenous knowledge The idea of participatory dialogue and sharing and exchange of information has been
accepted by international development institutions such as the World Bank. It has been
realised that local people in underdeveloped countries have important knowledge
about development to exchange with others. For example, an initiative on Indigenous
Knowledge for Development has been launched by the World Bank and other partners
with the aim of encouraging the process of learning from clients and integrating that
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knowledge into projects and programmes. This will be done by increasing the dis-
semination of information on successful indigenous practices, by increasing the
awareness of the importance of indigenous knowledge and by fostering its exchange
within and across local communities (World Development Report 1998/99).
culture The new paradigm has also focused renewed interest on the positive and necessary role
of culture and tradition in development. Culture is the total way of life of a community,
a totality of human expression and manifestation of a community. Culture includes art,
music and dance, beliefs, values, attitudes, habits, lifestyle and tools and artifacts.
Culture and tradition are no longer seen as obstacles to development but as a dynamic
context that mediates all human action and understanding. The interest in local cultures
has also focused attention on the role of traditional means of communication such as
folk media and community journalism in development.
11.3
Communication for participatory development
The idea of participation as sharing in joint action in development is a central

concept in the new paradigm. However, there are two main ways of interpreting the
idea of participation in development: participation as involvement and collaboration,
and participation as emancipation and empowerment (Melkote 1996:237; Servaes
1996:17; Servaes 1999:8485; Sonderling 1997; Swanepoel & De Beer 1997:129
130).
11.3.1
Participation as involvement and collaboration
co-option Participation as involvement, collaboration or as a means-to-an-end approach refers to
cooperation and co-option of communities and their mobilisation to help in putting a
predetermined development project into practice. Community participation by co-
option means that elected representatives from the community participate in decisions
about development. The emphasis is on development projects that are initiated by
governments and aid agencies that identify the needs, plan the intended action and
control the management of the development project. The communities or groups are
made aware of the benefits of the development project, mobilised to become involved
and co-opted into a development project that was not initiated by them. This idea of
participation implies that the public is presented with a development project and is
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asked to express its reaction to the planners. This is a more conservative view of
participation and is propagated by organisations such as Unesco and various interna-
tional development agencies and is also favoured by national governments in the Third
World. In this form of participation, development is still centrally controlled by the
government and the people participate in a passive process because they are required
to provide information for the implementation of development decisions already taken
by bureaucrats. An example of this approach is Development Support Communication
(DSC), discussed in more detail further on in this study unit.
11.3.2
Participation as emancipation and empowerment
confrontation Participation as emancipation, empowerment or as-an-end-in-itself approach is
conflict based on the radical pedagogic dialogue concept of Paulo Freire and was strongly
influenced by the dependency paradigm. This revolutionary people-centred process is
aimed at liberation and emancipation. Development projects are initiated, controlled
and managed by the people or a community and aim to transform and empower the
people and to make them self-reliant. For the people to participate in development
decisions, there are times when the people need to confront and conflict with the
authorities, in order to make their voices heard. This more radical approach is un-
popular with elites and governments who consider it to be subversive. Indeed, this
approach was used by various communities in South Africa in their resistance to the
oppression of apartheid and manifested itself in participatory grassroots community
journalism.
In the following two sections we discuss how these two different interpretations of
participation have been used in development. The two approaches are development
support communication (DSC) as an example of participation as involvement, and
Freire's dialogic education and grassroots community journalism as an example of
participation as emancipation.
Activity
11.2
1. In one paragraph discuss the differences between the two approaches to
participation. Give your own examples of each approach.
2. Which participatory approach would you prefer to use to empower your
community? Give reasons for your choice and provide examples to support your
argument.
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Our comments
Participation as involvement operates on the basis of representation. People are elected by a community to cooperate
with the authorities. Participation for emancipation is action oriented and suitable in situations where the authorities do
not allow democratic representation. Give your own examples.
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11.4
Development support communication (DSC)
In the participatory and democratic development approach the participation of the

people at grassroots level, such as small communities of rural farmers or poor people in
shanty towns, is essential for the success of any development project. However, it was
found that a major obstacle to development is the lack of a common language between
the target group of people for whom development is intended and the administrators,
technical experts and change agents. As Agunga (1997:223) points out, research in-
dicates that, in general, development funds are abundant, the best technical expertise
and knowledge are available, but the major obstacle is lack of communication. The
people need to be told what the governments, donors and development agencies have
in store for them.
In order to bridge this communication gap, a new profession of development support

communication (DSC) experts or practitioners has been formed. The objective of de-
velopment support communication is to make the development messages more easily
understood by the recipients. Development support communication has the task of
bridging the gap between the technical experts, such as health professionals and agri-
culture specialists, and rural people in the Third World. The development support
communicator is expected to mediate between the specialists and the people and
translate the difficult jargon of technical language into messages that are easily under-
stood and are relevant to the local people.
Case study 11.1

Lack of communication results in development failure
International development agencies and governments in the Third World were high-
handed in making assumptions about what poor peasants and other under-privileged
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people needed. In the minds of many officials the people were far too ignorant, con-
servative, fatalistic and stubborn to have any worthy ideas. Therefore, planners made
assumptions about the needs of the people without consulting the people for whom the
development projects were intended.
As a result of such official attitudes many development projects met with apathy from
their beneficiaries. Local people never identified with the projects and did not become
involved. They did not see the projects as relevant to their needs; they appeared to be
something that belonged to the government and some foreign organisations, whose staff
were running around busily promoting strange ideas or building things for unknown
purposes.
Consultations and dialogue are essential to determine the people's real needs (Fraser &
Restrepo-Estrada 1998:4041).
As a mediator, the development support communication practitioner's role is also to

communicate the wishes, ideas and knowledge of members of the community to the
development planners and experts. Development support communication experts as-
sist in the sharing of knowledge, and make both experts and the rural people participate
in dialogue that leads to mutual understanding and guarantees successful development.
Development support communication is envisaged as operating at two main levels:
micro level
1. At the micro or small-scale local community level, the aim of the DSC expert is to
develop appropriate messages and strategies such as creating posters, pictures and
symbols in order to translate technical messages to the community.
macro level
2. At the macro or broader national level the DSC specialist is involved in the
planning and overall organisation and administration of development programmes
and the specific communication needs of the community and planners.
holistic Development support communication involves a holistic approach that incorporates all
aspects of development programmes. An important objective of the development
support communication specialist is to integrate communication into every aspect of the
development programme. Obviously, such a expert needs wide knowledge and mul-
tidisciplinary training. For example, the DSC expert needs to understand development,
have knowledge about the Third World, its politics and cultures, have specific knowl-
edge about agriculture, health, family planning and commerce, and needs to be trained
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in social sciences disciplines such as political science, economics, development ad-
ministration and communication (Agunga 1997:262263).
The DSC specialists' main development tasks are the following (Agunga 1997:257
262):
. advising governments and donor agencies on development communication policy

. promoting participation and mobilisation of the beneficiaries of development
. providing communication training for technical personnel involved in development
projects
. producing multimedia and audiovisual material
. promoting networking and coordination among development professionals
. planning and conducting communication campaigns
. promoting coordination and linkages among development agencies
. promoting communication research, information generation, storage and sharing
The development support communication professional is a ``jack-of-all-trades'', com-

mitted to making development projects succeed (Agunga 1997:262).
Activity
11.3 A development organisation invites you to be their development support commu-
nication consultant for a new development project in your community. You are given
the task of supporting the change agent in his or her communication with members of
the community.
On a sheet of paper, discuss the steps that you would take in implementing a devel-
opment support communication plan to promote the project and obtain community
participation. Give specific examples of a project that is relevant to your community.
Our comments
When you write about your plan, you need to consider the following:
As a development support communicator you will operate at both micro and macro level. At the macro level you will be
involved in the organisation and coordination of the project and you will consult with the development agency,
planners, government agencies and community leadership, and coordinate the communication activities. You will need
to familiarise yourself with the objectives of the development project and establish what information is needed from the
community. You will have to obtain information about the needs of the community and ensure that the project meets
these needs. At the micro level you will consult with the change agent and other specialists working in the field. You
need to gain knowledge about the requirements of the change agent and provide communication training. You will
need to inform the change agent about the needs of the community. To get the community to participate in the project
you will have to consult community leaders, organise meetings with members of the community to explain the aims of
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the project and find out the real needs of the community. In your work you will translate technical information given by
the change agent into a language that is understood by the community. You will prepare speeches, plan media
campaigns, organise exhibitions, prepare posters and exhibitions, produce multimedia material, organise press con-
ferences, issue press releases and write reports. You will also conduct research on the progress of the project and
promote exchange of knowledge among communication specialists.
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11.5
Participatory development communication: dialogue for
emancipation and empowerment
The idea of participatory communication emphasises the self-management of devel-

opment by the people at grassroots community levels and making use of decentralised
communication strategy. Such tasks demand authentic participation of the people to
deal directly with issues of redistribution of power the need to challenge domination
and oppression and change the existing power structure in society. If development is to
benefit most of the people, then social structures that are responsible for oppression
must be challenged and changed to enable the people to take part in the political and
economic decision-making process and to receive the material and cultural benefits of
development.
Paulo Freire, a Brazilian educator who was involved in providing an alternative adult
education, provides a radical perspective on authentic participatory communication for
empowerment. According to Freire, people must be treated as human beings and have
the capacity to make their own decisions in planning development to change their
situation. To enable them to do this he suggests that there is a need to make people
literate and awaken their consciousness about their social conditions. Freire's method is
dialogue conscientisation and dialogue.
conscientisation For Freire, conscientisation is a learning process whereby one develops critical
awareness to perceive social, political, and economic contradictions and to take action
against the oppressive elements of the situation. That is, one becomes aware of one's
disadvantaged situation in society and such a realisation leads to action to transform
society or development. People are able to organise themselves, understand the
challenges that face them, change their attitudes and recognise the possible responses
available to them and take appropriate action to change the situation.
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For Freire, education is the key to critical consciousness and liberating action. Critical
thinking develops through critical education in the form of a dialogue between
teacher and student.
banking concept Freire identifies conventional education as an obstacle to development. Conventional

functional literacy education works on the principle of the banking concept. Conventional education is
like depositing money in the bank, a mechanical depositing process: the teacher issues
statements and the students patiently memorise and repeat them. Examples of such
conventional education can be seen in development projects that are aimed at pro-
viding illiterate people with functional literacy. Functional literacy means that the
learners acquire basic literacy skills such as being able to fill in official forms, read
instructions and gain vocational skills that are work-oriented. Such skills are defined by
the ruling elites in a society and are thought to be sufficient to make a person a
productive citizen and a more efficient worker. Thus conventional education is an
instrument of domination and oppression and creates a ``culture of silence'' because
people are taught to accept what is given to them by the elites or governments without
questioning. It also denies people the power to think for themselves, and recognise their
true social conditions (Nyirenda 1996:1011).
For Freire, before people learn to read and write they need to be helped to overcome
their passive understanding of themselves and their world and need to develop critical
understanding. This is done through dialogical education. First the content of what is
being taught needs to be made relevant to the learner's situation so that the learner's
own experiences become part of education. Secondly, the learner enters into dialogue
with the teacher as an equal human being. This type of education is not imposed from
the top where communication is a top-down transmission of information. Dialogue is
an exchange of ideas and open investigation; it involves problem raising and critical
analysis of social reality.
Critical dialogue in education is liberating because it challenges and disrupts the

structures of domination and leads to development and change in the structure of
society, or to revolution, if no other ways are open to create a just society. Obviously
such an approach, which attempts to promote the basic needs of the people, is not
favoured by many Third World governments and traditional leadership because it re-
presents a threat to their position of power.
Case study 11.2

The relevance of Paulo Freire's theory to education and development in Africa
In contemporary Africa, illiteracy contributes to poverty and is an obstacle to devel-

opment. Illiteracy rates are very high in many countries, especially in the rural areas.
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These conditions provide the context in which Freire's concept of conscientisation and
literacy education could be applied to raise the critical awareness of the rural illiterate
people and the urban workers. This would help them to understand why they and their
countries are poor and how they could act in order to change the situation for them-
selves.
Freire's educational method could encourage many illiterate people to participate in

literacy classes because the learning content is relevant to their present social realities
and, therefore, meaningful to them.
However, for this method to work, teams of educators would have to be trained in a
new attitude toward dialogue and critical study for conscientisation as part of the
education process. Such educators would need to change their existing paternalistic
attitudes and adopt critical dialogical education.
At present, it seems that the elements of dialogue and conscientisation are absent in the
traditions and education systems of many countries in Africa. The curriculum and
methods of teaching determined by governments and the elite still dominate the
education system. And the governments in power would need to accept Freire's
method and not regard it as subversive (Nyirenda 1996:78).
Activity
11.4
1. In one paragraph, explain why conventional education could be an obstacle to
participatory development.
2. In one paragraph, explain why Freire's dialogical participation is considered to be
``subversive''.
Our comments
1. Conventional education makes people accept their situation without questioning or challenging their oppression.
Conventional education aims to provide skills to help people cope with their existing situation, but it does not
provide them with the means to change the situation. Give your own examples.
2. When you answer the second question, think about what a government's reaction would be to a revolution or what
people in positions of authority feel when their power is challenged.
Freire's ideas are particularly relevant for development communication. The present role of the development expert,
agricultural extension officer, technical specialist and literacy teacher is to extend their technical knowledge to people
who they believe are ignorant. In Africa many development programmes are imposed on rural communities without
regard to their culture or knowledge of their real problems. Everything is done to persuade peasants to accept pro-
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paganda and preconceived ideas about development. However, the local people's own knowledge and experience can
help with their development. Therefore, they need an opportunity to engage in dialogue and exchange of ideas with the
developers. Dialogue is the key to any development.
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11.5.1
Grassroots community journalism for participatory development
The application of Freire's concept of dialogue for liberation was demonstrated in
revolutionary grassroots community journalism during the struggle against apartheid in
the 1980s.
During the 1980s the South African government imposed censorship and exerted
control over the mass media; newspapers were prevented from reporting on the ac-
tivities of the African National Congress (ANC) and on political development among the
black communities. Most major newspapers were white-owned and catered for their
white readers and had no interest in publishing information on black communities. A
small alternative press emerged during this time but was constantly repressed by the
regime.
Left with a communication vacuum, opposition leadership made an effort to create

new means of communication to direct the political struggle and social change. As most
channels of the mass media were inaccessible to the people engaged in the struggle,
leaders used alternative popular communication such as graffiti, posters, popular per-
formance, community video, and cultural forms such as mass meetings, funeral oration,
song and dance, and military style chant rituals such as toyi-toyi.
A significant development during the 1980s, which greatly boosted the capacity to build
alternative press and provided means for alternative communication, was the emer-
gence of new media technologies such as photocopiers, audio cassettes, portable video
cameras, personal computers and laser printers, which made desktop publishing ac-
cessible, easy and affordable. These technologies made possible the production of
newsletters, pamphlets and stickers, to spread the voice of the people (Louw 1989:29;
Pinnock 1991:143147; Tomaselli 1991:163).
In the early 1980s these new technologies provided the means for a group of journalists,
academics and community leaders opposed to the government to establish a com-
munity newsletter called Grassroots in the Western Cape.
Grassroots was started as an experimental project in non-profit community publishing,

and rejected the conventional Western values associated with newspapers and jour-
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nalism. It defined its role as `àdvocacy journalism'' for direct participation in the on-
going political resistance (Johnson 1991a:191).
The newsletter defined itself as part of the alternative press and had the following
characteristics (Johnson 1991b:24):
. It was non-commercial because the profit motive was not a primary criterion for its
establishment.
. The reason for its existence was to fulfil a role within the resistance to the regime
and provide alterative views.
. It considered the established mainsteam media as not reflecting the aspirations of
the majority of people.
. It was aimed at audiences that were mainly disenfranchised and black.
The newsletter was born out of the need for a communication medium to be used for
community organisation and publishing items of community news because these were
increasingly omitted from the major newspapers. The mainstream media operate on a
capitalist system of profit and essentially contribute to the maintenance of the existing
social order, and could not serve as agents for change. An alternative non-commercial
community journalism could become an agent for social change. Indeed, the newsletter
considered itself to be an agent of change and defined its objectives as the following:
. to articulate the views and aspirations of communities and workers

. to assist grassroots organisations in developing skills in the field of communications
. to produce a publication that would act as a catalyst in assisting communities and
workers in the process of getting organised, and to improve the organisational
capacity of community and workers' organisations
. to provide workers and communities with basic information in the fields of
alternative education, community and industrial health, social services and legal
matters
. to promote the concept of alternative media, aiming at grassroots involvement in
the organisation, writing, production and distribution of the newsletter
. to serve as a vehicle for the coordination of worker and community organisational
efforts, and to promote the idea of challenging common problems and formulating
joint strategies
Although the newsletter was begun by intellectuals and journalists, attempts were made
to encourage community grassroots participation. Some 50 community organisations,
civics and worker groups were consulted before the project began.
Community involvement was carried into the actual operation of the newsletter.
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Grassroots was managed and controlled by a board of trustees consisting of community
leaders, community workers, academics and journalists and introduced a democratic
production process. Rather than leave the running of the newsletter in the hand of
`èxperts'', operations were spread among a news-gathering committee and a pro-
duction committee, while distribution was done through a network of volunteers who
distributed the newsletter door-to-door and made further contact with the community.
The intellectual origins of the newsletter were de-emphasised and interpretation and
analysis of important events were presented in a simple manner that the people could
understand. The opinion of the community was constantly canvassed, and community
perspectives and experiences were reflected in the articles. In selecting articles for
publication, the concern was with presenting a community perspective and questions
such as the following served as the main selection criteria (Johnson 1991a:196):
. How can this article contribute to initiating organisation or strengthening it?

. Does it expose injustice in society?
. How can it best be written from the people's point of view, at a level at which it
relates to their experiences?
. Will it inform and educate, and raise the critical level among the oppressed?
The newsletter operated on a democratic participatory principle and supported the

development of democratic organisations in the community.
The newsletter also became a catalyst for developing skills among members of the
community. By involving the community in its operation, the newsletter helped sti-
mulate and develop media and communication skills and provide general organisation
skills (Louw 1989:30).
Activity
11.5
1. On a sheet of paper discuss the strategies used by the newsletter Grassroots to
promote community participation and development. Refer to specific examples.
2. Formulate a plan to start a participatory community newsletter in your community.
On a sheet of paper discuss the steps that you would follow to define the
objectives of your newsletter and obtain community participation in your project.
Our comments
1. The strategies used by the newsletter were: consultation with the community before the project began, forming
committees for news gathering and production, establishing a door-to-door distribution network, involving people
by preparing reports that reflect their point of view, and organising training workshops in the community.
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2. In your discussion you should pay attention to the following needs: identifying the development problem; defining
the aims of the newsletter; consulting your community on what they consider to be an important development
problem. Does the community share your view of the problem or does it have a different idea? Does everyone
agree on what the development problem is, or are there different opinions within the community? You also need to
get the community involved in your newsletter project. How will you collect information for publication? How will
you organise the production process? How will you evaluate the articles for publication? How will you organise the
distribution of the newsletter? Will the community help with funding for the project? What skills will the project
develop in the community? What other contributions will the project make to the development and empowerment
of the community?
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11.6
Media for participatory communication in development
The idea of self-development and participation refers to activities initiated by people

within their communities. Successful development depends on the initiative of local
people. It was realised that such participation could be made more effective by the use
of indigenous media that are appropriate and culturally acceptable within a community.
11.6.1
Folk media
Folk media are a product of the local culture, are rich in cultural symbolism, and are
intimately known by the people at grassroots levels. Folk media are, for example,
theatre, puppetry, story-telling, folk dances, ballads and mime. The traditional use of
folk media is primarily for entertainment, social communion and religious rituals.
However, folk media are flexible and can be used to communicate development
messages and can also be combined and integrated with the use of modern mass media
(Melkote 1996:210211).
The advantage of using folk media in development can be summarised as follows:
. Folk media are part of the rural environment and the traditional way of life of the
people and are credible sources of information.
. Folk media are ``living media'' and demand audience participation.
. Folk media are relatively cheap to use.
. Folk media represent actuality and consist of a large variety of forms and themes.
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Although folk media have advantages there are also limitations and problems that need
to be taken into account:
. Knowledge of folk media. Before folk media can be used, it is essential that the
communicator has a good knowledge of the traditional media that are familiar to
the people in a particular area.
. Integration with mass media. A combination of folk and mass media can be very
effective, for example, a folk dance production could be recorded on video-tape
and broadcast to the community on television.
. Community control. Folk media are controlled by the community and make for
ideal participation.
11.6.2
The ``little'' media
The ``little'' media (``little'' when compared with the mass media) are often the most
appropriate means of communication for transmitting development messages. The little
media are exhibitions, posters, filmstrips, cassette audio tapes, slides, wall newspapers,
bulletin boards and puppets shows. These media are not as glamorous as the con-
ventional mass media such as television, films and newspapers, but are less costly and
their use is more flexible in rural development settings. For example, change agents can
use portable and battery-operated slide projectors to show visual images, and use an
audio cassette recorder to play sound. Lectures could be made more effective by the
use of overhead projectors.
Generally the little media are neglected by development administrators who lack
knowledge about the potential of the little media or consider them to be inferior,
outmoded and less prestigious than the mass media.
Activity
11.6 List the characteristics of folk media and discuss their use for development. Provide your
own example of folk media.
Our comments
Folk media are part of the local culture and tradition; they are made for participation, and are inexpensive to use.
Important issues that need to be considered when using folk media in development are: the communicator needs to
know the folk media well and be able to combine folk media with the mass media and other media technology. You
must also remember that the communicator is limited because the audience have control over folk media.
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11.6.3
Theatre for development
Traditional cultural forms such as drama, song and dance are excellent media to
communicate feelings and beliefs. These media are entertaining and have an im-
mediacy with their audiences and can effectively initiate a dialogue between the actors
and the audience. Theatre is a form of interpersonal communication and can be
considered as a bridge between the individual and the mass media. Theatre can be an
effective medium for participatory development communication for the following
reasons:
. It is entertaining and can hold the interest of a large number of people.

. It is an oral medium using local languages and can involve people who are illiterate.
. It is a means of cultural expression which is understood by the community.
. It is a public ritual or social activity that brings people together and creates a context
for thought and discussion.
Theatre has long been used in Africa for education and development programmes.
Theatre for development was used by theatre experts who helped development spe-
cialists to construct theatre productions that would carry specific development messages
on themes such as nutrition, health, literacy and agriculture. The objectives of these
programmes were planned and the script was prepared by government employed
development experts in the cities. Teams of development workers travelled from village
to village and staged performances before an audience. The theatre programmes were
effective because actors were able to give advice about sensitive issues in a way that
would not have been possible in direct conversation. The staged performance was
followed by a discussion with the audience about the topics raised by the play. How-
ever, such government sponsored theatre was not very effective because the commu-
nities did not have control over the choice of topics and performance but were mere
spectators (Mda 1993:1113).
Case study 11.3

Sarafina II controversy: Theatre against Aids in South Africa
The South African Department of Health commissioned a large theatre production to

bring Aids awareness to the youth. Sarafina II, written and produced by award-winning
playwright Mbongeni Ngema and performed by his company, Mbongeni Ngema and
Committed Artists, premiered in KwaZulu-Natal on World Aids Day, on 1 December
1995. However, controversy developed around the play and the seemingly excessive
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amounts of money spent. For example, an editorial in the Weekly Mail & Guardian takes
issue with the government:
The expenditure itself was self-evidently and grossly excessive. The purchase of a
R1-million bus, complete with toilet, to cart the cast about, represents extra-
vagance even in the lavish realms of showbiz; in the context of a public works
programme, it is little more than a grotesque distortion of spending priorities.
Some of it is downright foolish: travelling theatre has, of necessity, to be small and
simple, able to adapt to any venue; this should make it relatively cheap.
The Minister of Health Nkosazana Zuma defended her decision to spend R14,27
million on the production of the Aids awareness play, despite criticism from non-
governmental organisations (NGOs). The expenditure was part of the government's R70
million allocated to anti-Aids campaigns.
The Department of Health dismissed the accusations that too much money had been
spent on the production. The department claimed that no taxpayers' money went to
the project, and that the entire amount was donated by the European Union.
According to government supporters, the play made a positive contribution to the

development of the country. The production costs were also justified because in the
rural areas where information on Aids was lacking, there were no facilities such as halls,
electricity or transport. The play was an innovative way of getting the message to groups
of young people who were more susceptible and more at risk from the spread of AIDS
(Weekly Mail & Guardian, 9 February 1996).
Activity
11.7 Do you think that a theatrical production such as Sarafina II could promote develop-
ment and reach audiences in the rural areas?
Our comments
When you answer this question, think about the lack of electricity to power the stage lighting and the equipment
needed to stage the play, or the lack of a theatre hall and a stage that is large enough to accommodate the actors and the
set. Sarafina II seems to be a large and elaborate production consisting of many actors. Could such a group of actors
engage in a dialogue with the audience?
A more effective use of community theatre was demonstrated in Botswana's Laedza Batani (translated as ``community
awakening'') non-formal education projects founded in 1974. The project was started by a group of adult educators and
community leaders and its aims were to motivate people to participate in development and overcome the indifference
to previous development efforts by the government.
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community theatre Community theatre is participatory popular theatre and involves development workers
and the community who decide how to use the theatre and stage their own produc-
tions. The theatre performance presents problems in the way that they are seen and
experienced by the community and the critical perspective of drama challenges people
to become aware of their conditions and find solutions for themselves. The use of
community theatre does not require sophisticated technology and the actors do not
have to memorise long scripts. The actors improvise their words, react and enter into
dialogue with members of the audience and clarify the message of the play.
According to Mda (1993:177), community theatre is an efficient instrument for con-

scientising the people and for the propagation of development messages in the com-
munity's own language, idioms and art forms. Such theatre serves the following
functions (Mda 1993:178):
. Mobilisation in support of national development. People are motivated into

effective participation in programmes designed for them.
. Conscientisation. The play stimulates the community to question the contradictions
in their society.
. A two-way communication process with built-in feedback. Through the play a
dialogue develops among the members of the community and between the
community and the change agents.
. Community discussion and community decision making. The play gives members of
the community an opportunity to discuss their problems, decide on solutions and
implement their decisions.
. Revitalisation of the people's own forms of cultural expression. The play provides a
stimulus for the community's cultural activities.
11.6.4
New information and communication technologies
ICTs During the 1990s, new information and communications technologies (ICTs), such as
computers, computer networks like Internet and World Wide Web, new tele-
communications, and mobile telephones, began to change the character of developed
societies. These new information and communication media are used to provide
education and entertainment, and are a means of linking people across the world.
There has also been a shift from agricultural and industrial production to the production
of information. The production of information is becoming the main foundation for the
new `ìnformation economy'' of a global ``post-industrial society''. As the cost of in-
formation and communication technologies drops, so their potential grows for pro-
moting development in the underdeveloped countries.
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The enormous potential of the new information and communication technologies for
the development of the Third World has been emphasised by the United Nations.
Between 1995 and 1997, the United Nations Commission on Science and Technology
for Development (UNCSTD) investigated the usefulness of the new information and
communication technologies and recommended that these technologies should be
diffused into Third World countries to enable them to develop and join the new
`ìnformation economy'' and ``global information society'' (Mansell & When 1998:1
6).
International organisations that support Third World development, such as the United
Nations, Unesco and the World Bank, have also shifted their emphasis in development
assistance and now urge Third World governments to formulate national policies to
develop their information and communication infrastructures, acquire new information
technologies from the developed countries and train people to be able to function in
the new information environment.
For example, the World Development Report 1998/99 issued by the World Bank sug-
gests that most countries in Africa could greatly improve their development prospects by
expanding their knowledge base, investing in education, and taking advantage of the
new technologies for acquiring and disseminating knowledge.
Poor countries and poor people differ from rich ones not only because they have
less capital but because they have less knowledge. Knowledge is often costly to create,
and that is why much of it is created in industrial countries. But developing countries
can acquire knowledge overseas as well as create their own at home. Forty years ago,
Ghana and the Republic of Korea had virtually the same income per capita. By the early
1990s Korea's income per capita was six times higher than Ghana's. Some reckon that
half of the difference is due to Korea's greater success in acquiring and using knowledge
(World Development Report 1998/99:1).
According to the World Bank, knowledge is critical for development and the countries
of the Third World need to increase their capacity to use knowledge. The Third World
needs to address its knowledge problem and narrow the knowledge gap between the
information-poor and information-rich countries. For this purpose, the poor countries
can acquire and adopt knowledge already available in the rich countries, and with the
low cost of communication, transferring knowledge is cheaper than ever. Such a flow of
information and knowledge is essential for development (World Development Report
1998/99:117).
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Case study 11.4
Knowledge for development in Africa
The key message of the World Development Report (WDR) 1998/1999 for Africa is that
most countries on the continent need to do much more, much faster, to increase their
knowledge base, to invest in educating their people, and to take advantage of the new
technologies for acquiring and disseminating knowledge. Countries that postpone this
will fall behind those that move faster, and the unhappy effect on their development
will be hard to fix.
At the Africa Telecom `98 Forum held in Johannesburg, South Africa in May 1998, the
participating African Communications Ministers observed that the lack of ``policies that
promote equitable public participation in the information society as both producers and
consumers of information and knowledge'' makes it difficult for African countries to
share the benefits of the global communication revolution currently taking place. Given
that more than 60 percent of the people of Africa live in rural areas, the Ministers
identified the development of telecommunications infrastructures in rural areas as one
of the biggest challenges facing Africa and one that deserves priority treatment. The
WDR, which underscores this assertion, contains many examples of challenges for
Africa, as well as achievements in the effective use of knowledge for development.
In health, for example, the report praises the effective use of knowledge for develop-
ment in West Africa, where epidemiological and pharmaceutical knowledge made
possible the near total eradication of river blindness.
In agriculture, the report observes that extension programmes are more likely to suc-
ceed if they use existing channels of information transmission. Kenyan farmers have
traditionally organised themselves into groups to market their crops, obtain credit, and
improve their farming techniques. Women in a South African community, with the help
of one of their peers with the equivalent of two years of high school education,
download information about adult-education programmes that they would otherwise
not be able to afford. With on-line advice on vegetable farming, they recently harvested
their first crop.
With regard to the World Bank's knowledge-related activities in Africa, the Africa Re-
gion of the Bank is assisting in several initiatives aimed at closing the knowledge gap and
giving more meaning to the term `Àfrican Renaissance''. The African Virtual University
(AVU) is training Africans in a number of professional areas to be world-class scientists,
technicians, engineers, business managers and health care providers. It presently offers
undergraduate and remedial courses to 16 universities in Africa.
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The World Links for Development programme connects secondary school students and
teachers around the world via the Internet. Its objective is to improve education, de-
velop information technology skills, broaden cultural understanding and promote
economic development. The programme includes 130 schools in some 10 African
countries that are linked to schools in the US, Europe, Japan, India, China and Australia.
The Africa Live Data Base (LDB) is a powerful, user-friendly computer-based tool de-
veloped to become the linchpin of a major effort to build local capacity in statistical
data collection and analysis. This tool has met the demand from African countries for
reliable data on Africa. Through the LDB, policymaking can be based on up-to-date
data as never before. Partners in this initiative include the Economic Commission for
Africa, the African Development Bank and some African countries such as Mozambi-
que, Ethiopia and Rwanda.
An initiative on Indigenous Knowledge for Development has also been launched by the
Bank and other partners with the aim of encouraging would-be developers to learn
from clients and to integrate that knowledge into projects and programmes. This will be
done by spreading information about successful indigenous practices, by increasing the
awareness of the importance of indigenous knowledge and by encouraging the ex-
change of this kind of information within and across local communities. (World De-
velopment Report 1998/99)
Activity
11.8 After you have read case study 11.4, write about the potential of new information and
communication technologies to contribute to development and exchange of informa-
tion and knowledge. In your discussion try to answer questions such as: What needs to
be done so these technologies can be used for development in Africa? How can
knowledge benefit development? What are the obstacles to knowledge sharing? What is
the role of indigenous knowledge? Provide examples to illustrate your argument.
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The Internet and development

New information and communication technologies such as computers linked to the
Internet are being used on the African continent to further development in many areas.
The Internet (also known as the Net or Information Super Highway), is a system of
computers that are linked to each other through a vast array of networks consisting
mainly of telephone lines, satellite communication, optical fibre lines and office com-
puter networks.
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It is estimated that 1.5 billion users are connected to the Internet worldwide. No one
person or group controls the Internet, and it enables many people in different time
zones and different places to interact. Some of the elements on the Internet that are
most widely used are the following:
. E-mail (electronic mail) is probably the most widely used facility of the Internet.
Through this facility users can send text, graphic images, sound clips, computer
progams and video images to other users across the world who have access to the
Internet.
. Internet phone and picture (video) phone take e-mail a step further. Users who are
on line at the same time can either talk to each other via the Internet or, if they have
the necessary facilities, view each other on their computer monitors as they talk.
This usually costs much less than normal telephone calls. However, these facilities
do require sophisticated computers with sound cards and miniature video cameras
at both ends.
. The World Wide Web (WWW) is based on hypertext, which means it combines
elements of both print (text) and audiovisual media (images, sound and video). The
WWW is the more glamorous section of the Internet allowing companies and
individuals to have web pages which are accessed by users of the WWW.
. Electronic news and electronic newspapers many press groups and newspapers
maintain home pages and news facilities on the Internet. The advantage of
electronic newspapers is that they can be updated literally as the news breaks. This
can be done as frequently as two to three updates within one hour. However, the
cost of the equipment needed restricts access to the Internet.
The Internet is also being used increasingly by governments (in their role as institutions
of development) to provide services. The following are some of the main uses of the
Internet for development efforts: telemedicine, distance education and telecentres.
Telemedicine
Telemedicine is a system that uses information and telecommunications technologies to
provide medical information and services irrespective of distances.
In 1999, the South African Telemedical Resources (TMR) opened South Africa's first
telemedicine website, aimed at improving primary healthcare in South Africa. Tygerberg
Hospital is now linked to Grootte Schuur Hospital to provide radiology and pathology
expertise, with links to Frere Provincial Hospital in East London for pathology and
haematology cases. Telemedicine, a stated government priority for 1999, enables the
remote diagnosis of patients at a distance through the transmission of the patient's
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medical data via telephone lines, microwave or satellite. As long as the tele-
communications technology is available, it will be possible to link up patients from the
most rural part of South Africa to any urban health centre.
Distance education
Educators say that distance education via the Internet is the way to go for education in
the 21st century. It will offer rural communities a chance to get decent education
without their having to leave their villages and trek to urban learning institutions. For
example, the African Virtual University (AVU) is a first-of-its-kind interactive-instruc-
tional telecommunications network established to serve the countries of Sub-Saharan
Africa.
Telecentres
telecentre Telecentres that employ information and communication technologies (ICTs) are a re-
latively recent phenomena. The first telecentres were built in Denmark and Sweden in
1983. More recently, they have been established in developing countries and were
introduced in South Africa in 1998.
Telecentres employ a number of types of ICTs and offer services such as access to
telephones and fax machines, photocopiers, printing equipment, e-mail, the Internet
and electronic networking. The Internet is a relatively cheap, powerful and potentially
an ideal platform to build a flexible and powerful environment for sharing knowledge
and learning. The Internet is the first communication tool that allows every user to be a
sender and a receiver, on a global sphere.
Case study 10.5

Telecentres in South Africa
In South Africa telecentres could unite people living in poor communities with the
technologies that enable them to communicate, access information and exchange ideas
with their neighbours and potential partners all over the world.
A telecentre may be a simple telephone shop. Or it may be a community centre

equipped with a telephone, fax machine, copier and access to the Internet. A telecentre
may be located in a school or a clinic. This means that communities can be linked to
education and health networks, opening many opportunities for gaining knowledge and
information.
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The motivation for the telecentres is the need for a practical and cost-effective way to
bring the community of Africa into contact with itself and with the world.
Telecentres help develop the community by providing the following:
. a way to obtain urgent medical advice in areas where there are no doctors or other
ways of getting information about community health care
. a means of access to open schools and universities, enabling people to study in
areas where there are no facilities
. a way to get support and information on agricultural projects, natural resource
management and small business development
. access to books, which can be downloaded and printed
. a way of sending personal messages
. a way for government to provide services, like pensions and welfare payments
. a means for the people to connect with government and other institutions to ask
questions, raise concerns and send complaints
Ownership of telecentres
Anyone may own a telecentre. They may be owned by entrepreneurs (either in-
dividually or as part of a franchise) or by community organisations. Because they re-
present an important part of community development, they are subsidised. Telecentres
are a cost-effective alternative to putting in costly infrastructure, like telephone lines and
post offices. Governments that do not have large revenues and cannot afford to put in
telephone lines or post offices in remote areas can often find or raise the money to fund
a telecentre. For example, in South Africa, the body responsible for setting up tele-
centres is the Universal Service Agency, which is currently developing a number of
private and public sector models. Donors like IDRC, UNDP, UNESCO, ITU and the
World Bank are all funding pilot centres in countries like Egypt, Tanzania, Mali, Benin,
Mozambique and South Africa.
The benefits of telecentres

Communities benefit from telecentres because they give access to information and
communication technologies. This access has the potential to empower communities so
that they can play a part in their own development and make their voices heard.
Governments benefit because communication technologies can help reduce poverty by

empowering communities. Governments can also use telecentres to deliver many
services, such as pensions. Telecentres also enable governments to stay in touch with
people in remote areas.
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The private sector benefits because information and communication technologies meet
development objectives, and integrate isolated communities into the mainstream
economy and society in a sustainable way.
Opportunities for development

There are many opportunities for the private sector to develop new infrastructures,
technologies and tools and to adapt them for community use. The private sector may
decide to develop initiatives on its own, as part of a private sector consortium or in
partnership with donors and governments. Opportunities include the following:
. the design of secure physical facilities, new approaches to delivering the

communications infrastructure, hardware, software and content
. the joint development of pilot projects, including infrastructure development
related to telecentres, multipurpose community centres or other similar models that
use information and communication technologies to increase community access to
information and selected services
. developing and marketing technologies and tools to facilitate community use of
Internet communication technologies, especially those that are locally developed
(eg decision-support systems for community planning, graphic and touch-screen
interfaces, text/voice conversion, computer-assisted translation)
. developing and marketing locally defined applications, content, services and
networks to address specific development problems at the community level (eg
distance education, packaging of government information, corporate learning
partnership centres)
. market research related to innovative pilot initiatives in selected areas which
demonstrates the effective use of information technologies in African development,
with a view to promoting and marketing their application in other communities
. the development, adaptation and management of training programmes on
network operation, software, Web site creation, information packaging to
increase the independence of community-based telecentre operators
. the development of business planning and marketing tools, which can be used at
the community level to increase the sustainability of telecentre programmes (http://
www.africanconnection.org/telecomms/index.html)
Activity
11.9 Read and study about telecentres in South Africa in case study 11.5 above.
After you have work through the case study, write down an evaluation on the potential
of telecentres to contribute to participatory development in rural areas. How could a
telecentre promote development and participation in your community?
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11.7
Participatory research in development communication
The new approach to development and its emphasis on people's participation has
brought with it new ideas about the role and methods of scientific research in devel-
opment communication.
participatory research Participatory research differs from conventional scientific research, which considers the
objectivity and neutrality of the researcher to be a central factor. Scientific research is
thus non-participatory and anti-participatory. Participatory research rejects the objec-
tivity of scientific research and instead emphasises the participation of the researchers
and their involvement with the community and the human subjects they study.
Participatory research also gives a greater role to the people being studied. This has
often been described as giving the poor those who have been the object of scientific
research the opportunity to do their own research. As Servaes (1999:109) puts it:
why shouldn't the ``researched'' do their own research? Why is it that the poor have
always been researched, described and interpreted by the rich and educated, but never
by themselves? Participatory research may not be considered ``good social science
research'' but it may have more benefits for development.
The assumptions of participatory research can be summarised as follows (Faure

1996:192; Servaes 1999:116117):
. Participatory research is an interactive learning process for both the participants and
the researcher.
. The researcher is involved with the subjects being researched and attempts to see
and understand the world from their perspective.
. Participatory research is not neutral and detached but is value-laden because it is
committed to direct social purpose. That is, participatory research is ideological
because it is biased in favour of those being researched.
. The research process is a dialogue between the researcher and those being
researched. As such it is not controlled and manipulated by the researcher.
. Participatory research is a problem-solving process. It is aimed at identifying
problems and needs, gaining awareness about the obstacles to solving the
problems, analysing the causes of the problem and using the creative potential of
the community to formulate and implement relevant solutions to the problems.
. The knowledge created in participatory research is shared with the community.
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The process of participatory research is described as cyclical, continuous, local, and
accessible. Three basic steps can be identified in such a process (Servaes 1999:114):
1. collective definition and investigation of the problem and needs by a group of

people struggling with how to deal with the problem
2. group analysis of the underlying causes of their problem
3. formulation of a solution and taking group action to solve the problem
Activity
11.10 Discuss how you would conduct participatory research in your community.
Our comments
In conducting participatory research you could follow the three steps discussed above. First you discuss the problem
facing the community. Not everyone has the same idea about the problem. Different people may have different ideas
about other problems. In the discussion and dialogue, different views about the problem are exchanged and a clear
understanding and definition of the problem will emerge. In the second stage the group will identify and analyse the
possible causes of the problem. Again, different explanations will be given. In the third stage a plan of action is discussed
and formulated and the group decides on the best way to implement the decision and what action should be taken.
Give your own example.
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11.8
Conclusion
Ideas about development have been constantly changing. From the shortcomings of
both the modernisation and dependency paradigms, a new paradigm has emerged. The
new paradigm is human-centred and based on the idea of participation in the devel-
opment of a just society for the benefit of all the people. However, the new paradigm
has not entirely replaced the ideas of the modernisation and dependency paradigms.
The modernisation paradigm and insights of the dependency model are still influential
among development agencies and policy makers.
Summary
In response to the disappointment with the ability of both the modernisation and
dependency paradigms to further development, a new paradigm for a development
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model known as ``multiplicity in one world'' was proposed by development scholars.
The new paradigm suggests that there is no universal road to development but each
society must decide on its own priorities. The new paradigm is human-centred and
emphasises the need for people's participation in development through a dialogue in
which meaning is exchanged and information shared. Two interpretations of partici-
pation were introduced: the development support communication (DSC) approach and
Paulo Freire's critical participatory dialogue approach and its application in grassroots
community journalism in South Africa. With the need to get communities participate in
development, we looked at the role of culture and the use of traditional forms of
communication such as folk media and the theatre. Then we analysed the potential of
new information and communication technologies to promote participation in devel-
opment. We also discussed and applied the principles of participatory research invol-
ving both researcher and community in a dialogue of discovery to create relevant
knowledge.
Summary of the three development paradigms

The main characteristics of the three development paradigms can be summarised as
follows (Servaes 1996:8384; Servaes 1999:269271):
Modernisation theory: the dominant paradigm

. Development is a unilinear process of social change that happens naturally in every
society.
. Development is a process that can be divided into distinct historical stages that
reflect the level of development achieved by each society. Underdeveloped
societies are at an earlier stage of development.
. Underdevelopment is mainly the result of internal social and cultural obstacles.
. Development can be stimulated from outside a society by infusion of capital and
technology to establish an industrial base. Economic growth is the main criterion by
which to measure development.
. Development or modernisation means that traditional societies are becoming
Westernised.
The dependency paradigm: Third World alternatives

. The process of development is considered in terms of relations between countries,
between nations at the centre and at the periphery of the world's economy.
. The most important obstacles to development are external to the underdeveloped
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nations. The main external obstacles are the expansion of capitalist domination and
economic and media imperialism.
. Because the countries at the periphery are exploited by the countries at the centre,
the development of the centre implies underdevelopment at the periphery.
. For the periphery to develop it must dissociate itself from the world market and
strive for self-reliance.
. Both the dependency and modernisation paradigms consider economic growth and
technological progress as indicators of development.
Multiplicity paradigm: another development

. There is no universal model for development. Each society must develop its own
development strategy.
. All nations are interdependent. Internal and external factors influence the
development process.
. Development must be studied in the international context and attention must also
be given to internal division within countries.
. Development is based on providing for the basic needs of the people, and on
empowerment of the oppressed. Development must benefit all sections of a society.
Test yourself
1. Why have approaches to development changed?

2. Explain the difference between the participatory approach and the modernisation
and dependency paradigms.
3. Discuss the principles of participatory development communication.
4. Explain the differences between the two approaches to participation.
5. What are the goals of development support communication?
6. Discuss the importance of Freire's dialogical participation in development in
Africa.
7. Explain the principles of grassroots community journalism and how they apply to
development problems in your community.
8. Explain how can we use folk media and theatre for development.
9. Explain the use of the new information and communication technologies in
promoting participation in development.
10. What are the aims of participatory research in development?
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Hettne, B. 1995. Development theory and the three worlds. 2nd edition. London:
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PART C:
Health communication
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Study unit 12:
Health communication: an introduction
Corrie Faure
Overview
Study unit 12 introduces you to health communication. We explore the meaning of
relevant concepts and definitions related to health communication and the field of
health communication. Next, we discuss two more or less opposing theoretical ap-
proaches to the management of healthcare, namely the traditional biomedical ap-
proach and the more recent outcomes approach. The outcomes approach is reflected
in the basic model of health communication and in all the models of health commu-
nication that we discuss in subsequent study units.
In order to orientate yourself, skim read study unit 12 now by concentrating on only the
headings and subheadings. Thereafter do your first activity.
Activity
12.1 Identify the main topics that are discussed in this study unit.
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By underlining the main headings and subheadings in the study unit you would have
been able to identify the most important themes or topics. It is a good idea to list these
topics or to display them in a mind map. It does not matter how you did this, the most
important outcome of this activity is that it gives you an idea about the contents of this
study unit. By underlining the main topics you probably also identified some of the key
concepts of this study unit.
Please repeat this activity in all the subsequent study units of part C.
Next we give you the most important key concepts for this study unit. Make sure that
after you have adequately mastered the study unit, you are able to define or discuss the
meaning of these concepts.
KEY CONCEPTS
health communication health communication settings
health communication contexts health professional
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patient client
significant other paradigm
biomedical approach outcomes approach
relationships transactions
culture multicultural
holistic approach ethnocentrism
proselytising norm of reciprocity
12.1
Introduction
The overall aim of this study unit is to help you to gain insight into the complexities of
multicultural relations in healthcare contexts and to help you become effective multi-
cultural communicators. Multicultural communicators interact sensitively and can apply
strategies to overcome the complexities of the healthcare system and thus accomplish
personal and professional goals. In other words, the main topic of this study unit is:
How we should use our knowledge of health communication to overcome any cul-
turally induced obstacles in the path of effective healthcare.
Next, we elaborate on the above general statement by giving you some relevant and
necessary background information on the different worlds we live in.
12.2
The different worlds we live in
Underdeveloped countries are collectively known as the Third World. These countries
are underdeveloped relative to countries in the First World (or the West) and in the
Second World (or the East). They are underdeveloped in most areas of life and pre-
dominantly characterised by a weak physical infrastructure, poor agricultural and
economic performance, social and healthcare problems as well as political unrest or
conflict. Most of these underdeveloped countries are found in Africa, Asia and Latin
America. South Africa, however, is often categorised as both a First World country and a
Third World country (Melkote & Steeves 2001). It is categorised as a First World country
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due to many First World characteristics such as a modern infrastructure and modern
mass media systems. South Africa is also viewed as partially underdeveloped because it
shares some of the characteristics that are typical of Third World countries. These
characteristics include high illiteracy levels; poverty, especially in remote rural areas; the
existence of many squatter camps or informal housing settlements; lack of electricity in
many areas; and the inability of the majority of the black population to afford the mass
media in any or some of its forms. All these factors, as well as limited human and
financial resources, are reflected in poor and inadequate healthcare facilities in South
Africa. The lack of facilities in turn reflects in statistics that indicate a high percentage of
child and infant mortality due to HIV/Aids and malnutrition. There has also been a
significant increase in the mortality rate among adults due to HIV/Aids and related
diseases such as tuberculosis (Jackson 2002; The impact of ... 2007).
Healthcare in South Africa is furthermore very much related to the financial situation of
the clients of healthcare (patients and their significant others) and whether or not you
belong to a medical aid scheme. This determines whether you receive healthcare in a
private setting or in a government-sponsored setting. It is well known that there is a
huge difference between these settings in healthcare (A state of emergency 2006). But
whatever the situation, patients are always entitled to effective healthcare and this
includes effective health communication. Health communication is however influenced
by many factors, such as the different world views on how health professionals ap-
proach health-related matters. Health communication is further influenced by the fact
that the population or the clients of healthcare in South Africa are multicultural.
The above discussion of the different worlds we live in reflects in different world views
on healthcare. The main world views on healthcare represent healthcare based on
Western ideas on the one hand and healthcare based on more traditional views or ideas
and beliefs. The main difference is that the practice of healthcare and scientific research
into healthcare are viewed from different cultural contexts. The Western view em-
phasises thorough scientific research before certain medicines or healthcare practices
(for both psychological and physical diseases and illnesses) are used to cure these
diseases and illnesses. A scientific approach is important and a more traditional ap-
proach is often dismissed as unscientific (linked to, for example, the power of religion,
natural products, ancestors and witchcraft). Traditional approaches to healthcare em-
phasise, among other things, that socio-cultural factors are often as important as the
correct medicines or the correct healthcare practices. It is generally accepted that
cooperation between these two world views is necessary for a holistic approach to
helping the client. Prejudices on both spectrums remain main stumbling blocks, how-
ever, but they can be overcome in time by means of effective and sensitive health
communication.
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We identify the ideas reflected in the basic principles of the outcomes approach (see
subsection 12.5) (Kaplan 1997, Verwey & Crystal 1998a, 1998b) as an important means
for health professionals to bring these worlds together and to deal with problems that go
hand in hand with a society that is multicultural.
Read the next scenario before doing activity 12.2.
There are no easy answers to the many problems that hamper effective healthcare in
a multicultural society such as South Africa. Our population is comprised of
individuals from different combinations of national, regional, ethnic, racial,
socioeconomic and occupational cultural orientations. As a health professional in
South Africa you will encounter many different people who need healthcare. With
11 official languages in South Africa you sometimes will have to look after people
whom you do not understand and who do not understand you. Many different
languages in one country is usually an indication of many different cultures which, in
turn, is an indication of many different health beliefs, attitudes and behaviours.
Now, do the activity by applying the above general introduction on health commu-
nication to your own life world.
Activity
12.2 In your discussion, when you relate health communication to your own life world, you
should answer questions such as the following:
1. Do you experience South Africa as a First World country? Explain and illustrate
with your own examples.
2. Do you experience South Africa as a Third World country? Explain and illustrate
with your own examples.
3. Describe briefly the type of community in which you live. Is there a hospital or
clinic in the vicinity? Is there easy access to a hospital or clinic in your vicinity?
How would you describe the general treatment you or your family have received
in this hospital or clinic or in any other healthcare-related centre?
4. Did the health professional(s) you encountered explain carefully and in
understandable language your problem(s) and the possible solutions to your
problem(s)?
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The above questions were meant to make you think about your own situation in South
Africa, especially with regard to the accessibility to healthcare in general and the type of
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treatment (physical as well as psychological) you received. In other words, were you
treated with respect and empathy and was everything explained to you in a way you
could understand?
Lastly, before we can study the field of health communication effectively, we must
understand the meaning of the various concepts that scientists use and why they use
these specific concepts in scientific research. In the next section, we therefore explain
some of the unfamiliar concepts you encountered in the above discussion as well as
other concepts that you will find useful when you study the importance of effective
health communication in multicultural societies.
12.3
Definitions and basic concepts
In our daily lives we communicate continuously. We use everyday language and

symbols to talk with people about our experiences, our knowledge and our thoughts.
However, everyday language is often subjective. Subjectivity means that the words we
use do not necessarily have the same meaning for everybody. For example, the meaning
we ascribe to adjectives such as ``large'', ``big'', ``fat'', ``beautiful'', ``rich'', ``poor'' and
``healthy'' often differ according to circumstances (personal, social, economic and
political), cultural diversity and ethnicity. In other words, the meaning of language is
often individual or group related where you live, how much you earn, the way you
were raised, individual emotions and other feelings influence the meaning you attach to
words. Thus, two or more individuals often understand the same events, ideas or things
entirely differently. Because of the subjective meaning of everyday language, it is not
precise enough for us to use it as scientific language. In scientific language, we strive for
objectivity (the suspension of individual feelings and emotions) and accuracy. The use
of concepts helps scientists to be more objective. Therefore, in scientific language, we
use concepts (specific terms that have a similar meaning for all scientists) to describe
reality or the world in which we live. In other words, scientists assign more or less the
same meaning to concepts that is, they agree with one another on the meaning of
concepts. Concepts form the building blocks of theories or explanations of reality and
aspects of reality. They also form the building blocks of models (a visual or graphical
presentation of theories, eg a basic health communication model that describes the
processes of communication between health professionals, patients and significant
others).
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In communication science and also in health communication there are specific con-
cepts we use to describe and explain processes. For a meaningful study of health
communication it is important that you get to know the meaning and definitions of
certain concepts. We also refer to key concepts or key terms. These are the most
important or relevant words in a text or sentence. We explain most key concepts
throughout the text.
Activity
12.3 Identify the main key concepts in the previous two paragraphs and explain the meaning
of each one.
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You had to study read the paragraph carefully and identify key concepts such as
``subjectivity'', `òbjectivity'', ``concept'', ``theory'' and ``model''. Of course, you could
have identified more than these concepts.
12.3.1
Defining health communication and related concepts
Before we can explain the synergistic nature of health and communication (the joining
of the characteristics of two elements into one), we emphasise that contemporary
researchers confirm that there is sufficient evidence that effective health communica-
tion can have a direct impact on a patient's pain and recovery (Tjale & De Villiers
2004). In other words, to effectively cure a patient, the body as well as the mind is
important in the healing process. The traditional Western medical world declares
someone healthy by ``ruling out'' a particular disease, disorder or illness in the quest to
make an accurate diagnosis. Today we know that being healthy means to be free from
illness in both body and mind. This is reflected in the World Health Organisation's
(WHO) official opinion that ``health'' means a state of optimum physical, psychological
and social welfare (World Health Organisation 2007). Health does not therefore only
mean the absence of illness or ill health. For people ``to be healthy'' they must also be
mentally well and socially adjusted. The role of communication in health-related
matters refers to meaningful interaction between two or more people. The people
involved in the interaction process are communicators (in this context health profes-
sionals) and recipients or clients. The roles of communicators and recipients are in-
terchangeable because both parties are actively involved in the sending and
interpretation of messages (Steinberg 2007).
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12.3.1.1 Health communication defined
A formal definition of health communication reflects the characteristics of commu-

nication in general but also narrows the scope of communication in that the message is
primarily focused on the promotion of health and the prevention of physical and mental
illness or discomfort. Health communication can be very briefly defined as human
interaction in the healthcare process or as health-related transactions. It is important to
notice, however, that it should always involve reciprocal influence between partici-
pants. In most definitions of health communication the content of messages as well as
the specific participants are considered important. The participants of the commu-
nication process are the persons involved with health-related issues the health
professionals and the patients and their family members. Therefore, we define health
communication as the dissemination and the interpretation of health-related messages
by participants in the healthcare process. It is an ongoing and dynamic interaction
process, which may lead to mutual understanding between the participants in the
healthcare process (Steinberg 2007).
12.3.1.2 Different concepts, similar meanings
Sometimes in the literature about health communication, different concepts are used
for more or less the same things. These concepts are related with differences only in
degree. The meanings of these concepts are therefore similar. For example, ``health-
related transactions'' is a synonym for ``health communication'', ``disseminator'' is si-
milar to ``communicator'' and `ìnterpreter'' means more or less the same as ``re-
cipient''. Sometimes, and for various reasons, concepts such as ``health consumer'',
``client'', ``survivor'', ``partner'' or ``health citizen'' are used instead of ``patient''.
``Healthcare settings'' and ``healthcare contexts'' are also used interchangeably
(Northouse & Northouse 1998; Tjale & De Villiers 2004). For unity in our discussion
about health communication, we use the following main concepts: ``health profes-
sional'', ``patient'', ``significant others'', ``client'', ``healthcare settings'' and ``healthcare
contexts''. We briefly explain these concepts as follows:
. ``Health professionals'' refer to a great variety of professional people who are

involved in the provision of healthcare. They include workers such as doctors,
pharmacists, dentists, sangomas, nurses, physiotherapists, radiologists, pathologists,
administrators and social workers.
. ``Patients'' refer to the people who in one way or another make use of the services
in the healthcare system. They include people who need physical and/or mental
healthcare.
. ``Significant others'' refer to a patient's ``care-takers'' such as his or her family and
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support groups. They are what we call the `'non-professional participants'' in
healthcare services.
. ``Clients'' refer to everybody on the receiving end of healthcare. We view this
concept as a combination of the concepts ``patients'' and ``significant others''.
. ``Health-communication settings'' refer to the physical environments of healthcare
such as hospitals, doctors' consulting rooms, nursing homes and clinics. Each
particular healthcare setting affects the dynamics of health transactions that take
place within it.
. ``Health-communication contexts'' refer to the relationships that exist in health
communication settings. These relationships are influenced by the number of
participants within a particular healthcare setting (eg interpersonal and small group
contexts).
Next, based on the above discussion, do activity 12.4.
Activity
12.4 Define health communication and related concepts. Explain each of these concepts
briefly in your own words.
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This activity is a mere repetition of the information given in the previous few sections.
You should not have had any problems with the identification of the main ideas behind
each definition. By identifying the key terms specific to each concept you should have
been able to formulate your own version of the meaning of each concept. For example,
when defining or describing the concept of health communication, you should have
referred to the ``content'' of the message and the ``participants'' in the health com-
munication process.
In the next section we explain the scientific field of health communication. In other
words, we explain the main topics in the field of health communication that are of
interest to scientists and researchers (Jackson & Duffy 1998).
12.4
The field of health communication
Communication scientists who concentrate primarily on health communication are

interested in topics such as the development of
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. healthcare related relationships
. healthcare related communication skills
. healthcare related theoretical viewpoints
. healthcare related campaigns
In the next subsections, we elaborate briefly on each of these fields of research.
12.4.1
Development of relationships
The scientific field of health communication begins with the study of relationships. This
type of research is attempted primarily by observing health professionals who com-
municate with each other and with their patients in various healthcare contexts and
settings. Health professionals include all professional healthcare workers involved with
patients (this also includes social workers, administrators and voluntary workers). All
these people depend on their ability to communicate effectively with colleagues and
patients in the performance of their healthcare duties. The clarity, timeliness and sen-
sitivity of communication in healthcare are often critical to people's physical and
emotional wellbeing.
Communication builds relationships between people, and therefore in the study of

health communication we concentrate on the development of the following relation-
ships (Northouse & Northouse 1998:79121):
. health professional-patient relationships (relationships between the person who

provides healthcare and the person who receives the care)
. health professional-health professional relationships (communication events that
occur when health professionals need to cooperate with one another in order to
help patients resolve complex healthcare problems)
. health professional-significant others relationships (interactions between health
professionals and the family or friends of the patient)
. patient-significant others relationships (encounters between patients and their
family and friends)
12.4.2
Development of health communication skills
The field of health communication involves exploring ways to identify and improve
communication skills to assist health professionals in their daily work. We refer here to
skills such as the application of important intrapersonal and interpersonal skills, such as
empathy, engaged listening, the interpretation of verbal and nonverbal communication,
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counselling and interviewing skills, as well as how to act ethically in healthcare. A
valuable ``tool'' used by researchers in health communication is focus groups. The use
of focus groups is important in both exploratory research and programme planning and
evaluation. According to Du Plooy (2001:178182) a focus group is a qualitative
technique used to obtain data about feelings and opinions of small groups of partici-
pants about a given problem, experience, service or other phenomenon. Researchers
seek open and in-depth discussion of feelings, motivations and subjective reactions in
an attempt to experience the `èxperience'' and to clarify the everyday perspectives of
the population (ie sample) they investigate. Although focus groups were traditionally
associated mostly with marketing research (often as a means of gaining insight into
consumers' thinking or their reactions to particular products or advertising concepts),
today they are used extensively in health-related research and programme planning for
health promotion campaigns.
12.4.3
Development of theory
The field of health communication develops theory and general paradigms (a domi-
nant way of thinking by prominent scientists which might find its way into appropriate
theories). In order to understand the process of health communication better, scientists
have developed various approaches or paradigms, theories and models. These ap-
proaches, theories and models are sometimes adapted to provide for changes in the
healthcare process or new ideas about the healthcare process. For example, the recent
shift in approach from a biomedical to an outcomes or more patient-centred approach
(Bennett & Irwin 1997; Kaplan 1997; Tjale & De Villiers 2004) resulted in adaptations
in theories and models to incorporate the influences that cultural differences may have
on the physical and mental health of patients.
12.4.4
Development of health campaigns
Another area in the field of health communication is research into the role of com-
munication in the prevention of illness and the promotion of general health (by urging
people to look after their health). In other words, health communication also caters for
healthy people by developing programmes and campaigns to promote health and
prevent illness. This aspect of research is especially important in developing countries
such as South Africa where many people still live in Third World conditions. To reach
this very important goal of preventive healthcare, various forms of communication (eg
interpersonal and/or small group and/or mass communication) are used in health
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promotion. Most people are regularly exposed to health campaigns in the media and a
scientific approach based on valid research on how to conduct such campaigns ensures
that participants (the planners or designers of health campaigns) do it effectively. Re-
search in health communication is therefore relevant to health campaign aspects such
as message content, the selection of appropriate media, audience analysis and the
timing of messages. Experts in health communication should take the lead to ensure
that educational health information is communicated efficiently, ethically, and effec-
tively to the public. It is understandable that health professionals focus mostly on cures,
treatment and vaccines but there should be a concerted effort to encourage them to
work closely with health-communication experts to the benefit of patients.
Next, read the following scenario and then try activity 12.5.
When John started to suffer from serious respiratory problems he became a patient,
and entered the world of healthcare, health communication and health research.
His way of life changed dramatically, and he as well as his wife and children had to
adapt to new circumstances. This was not an easy process, but professional people
were available to assist him and his significant others. For him, being a patient was
difficult and stressful. An important factor for both John and the health professionals
involved with him was the development of effective communication. He and his
family had to understand why various courses of action were prescribed. John's
health professional, Dr Nkoe, had effective health communication skills and
explained everything to him in a language he could understand. Dr Nkoe had
obtained these skills by, among other things, attending seminars based on research
done through focus groups. These focus groups helped to identify effective ways of
communicating with patients. Based on knowledge obtained through seminars,
academic journals and practical experience by communicating with John and other
patients, Dr Nkoe developed new insights. These new insights ultimately culminated
in a new theory or model on how to communicate effectively with patients in certain
circumstances or with patients with respiratory problems. Dr Nkoe also gained some
new ideas on how to prevent the same or similar illnesses in others. He then
approached some professional people to design a health campaign to try to prevent
a similar situation to John' s from happening to others. The campaign he wanted
designed was an anti-smoking campaign.
Activity
12.5 Discuss the field of health communication by applying the different areas of research to
your own life world.
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When you discussed the field of health communication, you had to think about five
main areas of research, namely research into
. effective communication between the participants in health communication

. the identification and improvement of health communication skills
. programme planning and evaluation using focus groups
. the development of theoretical approaches to guide practical application
. health promotion and disease prevention
Based on the above scenario, you had to explain the above five aspects by relating them
to your own life world. You could, for example, have imagined yourself as a patient
discussing your problems with a health professional.
In the next section we discuss the importance of a free flow of communication between
health professionals and patients, by identifying two main theoretical approaches to
health communication. We also emphasise a basic model of health communication that
is based on the outcomes approach.
12.5
Two opposing paradigms in health communication
Two more or less opposing approaches to the management of healthcare are re-
presented in the traditional biomedical approach and the more recent outcomes ap-
proach (Kaplan 1997; Verwey & Crystal 1998a, 1998b). The biomedical approach
represents a one-way flow of communication from the health professional to the pa-
tient, whereas the outcomes approach emphasises the empowerment of patients
through an effective two-way flow of health communication.
12.5.1
A biomedical approach
Traditionally, the role of the health professional was to diagnose illness and provide
medicines and surgeries. The importance of two-way health communication had not
yet been researched. The biomedical approach to healthcare represents a mechanistic,
one-way type of communication where the emphasis is on the transfer of information
from the health professional to the patient. The biomedical approach is viewed as an
illness-centred model. According to this approach, diagnosis and remedies are im-
portant and health professionals ``know'' what is in patients' best interest without
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much input from patients themselves. Scientists and researchers who support the
biomedical approach regard health communication mainly as a one-way flow of in-
formation in order to change patients' illness into health. Socio-cultural characteristics
of patients have no place in healthcare. This approach highlights the power of the
health professional, and relegates patients' experiences and interpretations to a sec-
ondary place.
12.5.2
An outcomes approach
According to the outcomes approach, also referred to as a bio-psychological model,
patients' health behaviours can only change when they are empowered through the
exchange of information and meanings. This approach is viewed as a patient-centred
model. Being healthy implies physical, mental and social health. Health outcomes are
influenced by quality of life, respect, physical and psychological wellbeing, attention to
individuals' preferences, values and decision making. Health professionals and patients
are the interactional partners in the healthcare process. Health is created and sustained
in interaction, and health behaviours are the result of those interactions.
According to the outcomes approach, the power that is ascribed to health professionals
should be shared with patients. However, one-way communication may be sufficient in
acute healthcare. For example, when accident victims are admitted to a hospital they
need medical treatment immediately lives are in danger and there is no time to
engage in meaningful communication. But, two-way communication is always central
to the treatment of chronically ill patients. In chronic illnesses, the exchange of in-
formation will influence outcomes as much as medicines.
Health professionals should be aware of the importance of building relationships with

their patients through transactional communication. They should be aware that direct
and indirect factors shape individuals' health. This means that they should not focus
only on patients themselves, but also on their broader circumstances. An exclusive focus
on patients means that the responsibility for change rests only with them. Social and
cultural circumstances that might inhibit change are ignored. Those people who do not
practise healthy behaviour are therefore seen as irresponsible, unmotivated or in-
competent. In other words, ``victims'' may be blamed unfairly if the constraints of their
environments are not taken into account.
The view that one-way communication from health professionals to patients is the only
correct means of communication inhibits dialogue and causes feelings of uncertainty
and inadequacy. Such a view represents the paternalistic idea of ``doctor knows best''.
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Health professionals should acknowledge patients' roles and influences in health-re-
lated interactions. By recognising the importance of patients, health professionals create
more active, knowledgeable and informed patients. This means that they can make
informed decisions about their own health.
Activity
12.6 Identify the differences between a biomedical approach and an outcomes approach to
the field of health communication.
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An effective way to do this activity is to list, in the form of a table, the differences
between the two approaches. Underlining key concepts in the above discussion makes
it easy to identify the characteristics that distinguish these theoretical approaches.
Next, we discuss one of the most basic models of health communication. This basic
model reflects the main principles of an outcomes approach to health communication.
12.5.3
A basic health communication model
Meaningful transactions (health-related interactions) between health professionals, pa-
tients and their support groups (significant others) play a key role in healthcare. The
primary focus of our basic model is on health communication that occurs within various
kinds of relationships in healthcare contexts. The model also emphasises a series of
factors that can influence interactions in healthcare contexts. The basic health com-
munication model (figure 12.1) illustrates the three major factors in the health com-
munication process: relationships, transactions, and contexts (Northouse & Northouse
1998:1721).
The main idea that is communicated by the model is the importance of a reciprocal or
two-way communication process between participants in health communication. This
process, as indicated by arrows and a circle from which an unending spiral emerges,
culminates in a ``relationship'' between the participants. A further important idea that is
communicated by the model is that there are many variables that influence participants
and their messages. In order to explain the basic health communication model in more
detail, we discuss it under the following headings:
. relationships
. transactions
. contexts
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FIGURE 12.1
A basic health communication model (adapted from Northouse & Northouse 1998:17)
health professional Cultural & health professional

3 "
Intrapersonal variables
~ ~
Cultural &
Cultural &
! !
Patient Cultural & Significant

3 "
Intrapersonal variables Other
12.5.3.1 Relationships
The health communication model illustrates four main types of relationships that exist in
healthcare settings:
. professional E professional
. professional E patient
. professional E significant other
. patient E significant other
Although the contexts may differ according to the number of persons involved, health
communication always involves one of these four types of relationships. The model also
indicates that these relationships can influence other types of relationships in healthcare
settings. For example, communication about a specific health-related issue between
health professionals can affect how a health professional communicates about the issue
with patients. Similarly, patients' interactions with members of their social network can
influence later interactions between patients and health professionals. For example a
patient thinks: ``My cousin says he is a good doctor. I trust my cousin, therefore I trust
my doctor.'' Each participant in the healthcare process brings unique characteristics,
beliefs, values and perceptions (cultural and intrapersonal variables) to healthcare
contexts and these elements will affect health communication. For example, the per-
ceptions or health beliefs of a patient can affect whether or not that person even seeks
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the help of health-care professionals. Similarly, whether or not a patient's values are
oriented more towards quality of life or towards quantity of life will influence decisions
and interactions with others. These are only a few of the numerous intrapersonal factors
that can affect patients' perspectives according to the model of health communication.
A factor that becomes more and more important in healthcare transactions is the role of
the patient's significant others. These social networks include family members (spouses,
sisters, brothers, and other relatives), roommates, friends, co-workers, and other in-
dividuals connected in a significant way to patients who use health services. In other
words, patients' social networks are composed of all those individuals who are sig-
nificant in their lives, but who are not health professionals. Health professionals should
be aware of the important role these people play in their patients' lives and involve
them in the healthcare process, for the benefit of patients.
Activity
12.7 Think about your relationships in healthcare contexts. Do you yourself have specific
health beliefs or have you encountered any cultural beliefs that others have that in-
fluences these relationships? In what way could these cultural factors hamper effective
health communication and ultimately healthcare?
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To do this activity you had to explain your own personal experiences as a health
professional or as a patient in a healthcare situation. If you could not think about
anything relating to this matter, perhaps you could have asked family or friends about
their experiences.
12.5.3.2 Transactions
Transactions refer to health-related interactions that occur between the participants in

the health communication process. We can identify the following characteristics of
transactions in health communication:
. Transactions always include both verbal and nonverbal communication behaviour.

Both types of communication are equally important.
. Transactions are most effective when verbal and nonverbal aspects of messages are
compatible with each other (eg you do not tell patients that they are terminally ill
with a big smile on your face).
. Transactions include both content and relationship dimensions of messages. This
deals with health-related content (how a patient seeks to attain and maintain health
over her lifespan) and the relationship dimension as established within the various
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relationships represented by the model. The relationship dimension influences how
the content of the message should be interpreted.
. Transactions may be represented by a circle from which an unending spiral
emerges. This illustrates the ongoing, transactional nature of health communication.
Health communication is not a static event but an interactive process that occurs at
various points in the course of a person's life.
. Transactions include continuous feedback (indicated in the model by arrows that
point both ways), which allows participants to adjust and readjust their
communication.
. Transactions are influenced by many communication variables that influence the
participants and their messages (eg empathy, engaged listening, control, trust and
self-disclosure).
12.5.3.3 Contexts
A third major element of health communication is healthcare contexts. We have al-
ready distinguished between the two levels of meaning that we assign to the concept of
``contexts'', but we emphasise the following:
. It is important to realise that contexts at the first level of meaning (healthcare
settings) such as hospitals and clinics may have a profound influence on the
interaction process. For example, an intensive care unit, with its accelerated pace
and lack of privacy, will affect patterns of communication in a different way from a
normal hospital ward where the pace may be less hectic. Each particular healthcare
setting affects the dynamics of health transactions that take place within it.
. Contexts at the second level of meaning refer to the contexts in which relationships
develop. In other words, these healthcare contexts refer to the number of
participants within a particular healthcare setting. Health communication takes
place in a one-to-one situation, in triads, in small groups, and among larger
collections of individuals (organisational and mass). The number of persons present
within a given context also influences interactions in the context.
In the next section, we concentrate on the second level of meaning. We discuss the
ways that multicultural contexts of health communication can influence various aspects
of health and healthcare.
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12.6
Multicultural contexts in health communication
The culture in which people are socialised influences them profoundly. People's en-
vironment family, churches, schools and friends reinforces cultural rules in such a
way that they become part of people's personal life worlds (Tjale & De Villiers 2004;
Martin & Nakayama 2007).
In order to explain the above statement adequately, we have to look briefly at various
related concepts. Firstly, we explore the concept of ``culture''; secondly, we describe
the concept of ``multicultural'' health communication; thirdly, we emphasise the im-
portance of a holistic approach in healthcare; fourthly, we discuss the problem of
ethnocentrism and prosetelysing; and fifthly, we explain the value of cultural diversities
and the importance of the ``norm of reciprocity''.
12.6.1
The influence of culture
The concept of ``culture'' refers to collective sense-making (shared meanings and ways
of experiencing reality). Culture consists of shared beliefs, values, attitudes and beha-
viour. The main aspects that are linked to culture are people's occupations, language,
friendships, and customs such as eating habits, communication practices, tastes in
music and economic and political activities. In the healthcare system there are many
cultural influences that affect people's ways of working, ways of communicating and
interpretations of messages. In other words, health professionals and patients represent
different values, ages, educational levels, socioeconomic standards and sexual or-
ientations, and all these differences have an influence on communication and inter-
pretation. Even different health conditions and health beliefs are linked to cultural
groups. Examples of these conditions are blindness, deafness, paralysis, diabetes, cancer
and Aids. We talk about disabled people as a group with their own limitations and goals
and some people even believe that some illnesses are a punishment for sins committed
in the past. It is therefore very important that participants in healthcare should be aware
of the various cultural orientations that influence the communication process in
healthcare settings. People are what we call multicultural beings. This means that every
time people communicate, multiple influences affect the interaction process.
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12.6.2
Multicultural health communication
We use the concept of ``multicultural'' to describe the multiplicity of cultural influences.
The concept of `ìntercultural'' (between two or more cultures), which is frequently
used in literature, is somewhat restricted with regard to our views of the healthcare
process. By using ``multicultural'' we are emphasising that there are no limits to cultural
perspectives in health communication it illustrates the complexity of influences of
multiple cultural orientations on behaviour and it confirms the multicultural nature of
human communication (Martin & Nakayama 2007).
12.6.3
A holistic approach
The health and treatment of patients depend on sensitive and effective communication
between health professionals and between health professionals and patients. Effective
health communication is essential for saving lives and promoting health, whether
physical health or mental health healthcare is for the individual as a total person. An
individual cannot be divided into parts: a physical part, a mental part and a cultural
part. All the parts are interdependent and influence each other and we cannot separate
them in effective healthcare. Health professionals must therefore follow a holistic
approach (the whole person is important including his or her cultural background
and beliefs) (Tjale & De Villiers 2004).
12.6.4
Ethnocentrism and proselytising
However, the holistic approach in healthcare often fails because of ethnocentrism, for
example (the conviction that your cultural perspectives are the only correct ones)
(Martin & Nakayama 2007:35). Ethnocentrism is the result of too effective a sociali-
sation process and that often leads to proselytising (an attempt to convert people to
your cultural perspectives) (Martin & Nakayama 2007:38). The health professional must
be aware that urging colleagues and patients to forsake their own cultural and health
beliefs as well as patterns of behaviour may lead to unhappiness and even anger. We
regard an ethnocentric attitude as a general cause of ineffective communication in
healthcare.
The health professional must also be aware of the value of cultural diversities. The
showing of interest, respect and cultural tolerance are important virtues when com-
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municating with people from different cultures. The norm of reciprocity (treating
someone as you wish to be treated yourself) is a general rule in human behaviour.
12.6.5
The value of cultural diversities
People often forget the many advantages of multicultural communication and they
forget that these advantages represent an important characteristic of the healthcare
system. New information obtained from communicating with people from diverse
cultures is often more valuable than information from people who share similar cul-
tures. People from different cultural backgrounds are inclined to see their life worlds
differently and consequently they develop different solutions to the same problems.
The integration of solutions and an open discussion about them often leads to really
feasible solutions.
To summarise the above sections, note that the concept of ``multi-culture'' recognises
the complex influences of multiple cultural orientations on behaviour and commu-
nication. With this statement in mind, do the next activity.
Activity
12.8
1. Identify cultural descriptors that describe who you are.
2. Describe briefly the socialisation process that influenced you.
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When doing this activity you had to keep in mind that every person has a unique
combination of different cultural orientations and every person belongs to many cultural
groups (eg student, parent, researcher, feminist, disabled, nature lover, white or blue-
collar worker, housewife, artist, gay/lesbian and citizen of the world). Based on our
heritage and life experiences, we each develop our own cultural identity. Your list of
cultural descriptors would therefore differ greatly from another student's list. But, in
your list you had to at least include relevant cultural influences such as gender, age,
race, religion, national origin, health status, socioeconomic status, educational level,
and occupation. However, each one of the cultural descriptors you identified influences
who you are, how you perceive the world, and how you behave. It is important to
recognise that in the course of time your cultural descriptors will change. You will gain
new cultural influences and former cultural descriptors will become less influential in
your life.
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Looking back
Study unit 12 introduced you to the field of health communication. We explored the
meaning of relevant concepts and gave you some important definitions. Next, we
discussed two opposing theoretical approaches: the biomedical approach and the
outcomes approach. We then linked the outcomes approach to a health commu-
nication model. In order to be able to explain the model adequately we concentrated
on concepts such as ``relationships'', ``transactions'' and ``contexts''. We concluded this
study unit with a discussion of multicultural contexts in health communication.
In the following study unit, we examine the various ways that the effectiveness of health
communication can be influenced by the different contexts in healthcare situations.
Test yourself
1. Discuss the ``different worlds we live in'' and relate them to your own life world.
2. Define ``health communication'' and other related concepts.
3. Discuss the field of health communication by referring to the five areas of research.
4. Differentiate between two opposing paradigms in health communication.
5. Draw and discuss the basic health communication model. In your discussion refer
to ``relationships'', ``transactions'' and ``contexts''.
6. Discuss multicultural contexts in health communication. In your discussion refer to
the influence of culture, the importance of a holistic approach, and the problem of
ethnocentrism. Do you think cultural diversities between people could be a
positive experience? Substantiate your answer with relevant examples.
List of sources
Bennett, KC & Irwin, H. 1997. Shifting the emphasis to ``patient as central'': sea of
change or ripple in the pond? Health Communication 9(1):8393.
Du Plooy, GM. 2001. Communication research: techniques, methods and applications.
Kenwyn: Juta.
Jackson, LD & Duffy, BK. 1998. Health communication research: a guide to
developments and directions. London: Greenwood.
Jackson, H. 2002. Aids Africa: continent in crisis. Harare: SAfAIDS.
Kaplan, RM. 1997. Health outcomes and communication research. Health Commu-
nication 9(1):7582.
A state of emergency. 2006. Mail & Guardian, 2531 August:13.
Tjale, A & De Villiers, L. 2004. Cultural issues in health and health care. Lansdowne:
Juta.
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Martin, JN & Nakayama, TK. 2007. Intercultural communication in contexts. 4th
edition. London: McGraw Hill.
Melkote, SR & Steeves, HL. 2001. Communication for development in the Third World.
2nd editon. New Delhi: Sage.
Northouse, LL & Northouse, PG. 1998. Health communication: strategies for health
professionals. 3rd edition. Norwalk, Conn: Appleton & Lange.
Steinberg, S. 2007. An introduction to communication studies. Cape Town: Juta.
The impact of HIV/AIDS on Africa. http://www.avert.org/AIDSimpact.htm Accessed
2007/07/17.
Verwey, S & Crystal, A. 1998a. A patient-centred approach to healthcare: the role of
health communication. Communicatio 24(2):3142.
Verwey, S & Crystal, A. 1998b. Setting new standards for health communication in
South Africa. Communicare 17(1):117142.
World Health Organisation (WHO). http://www.who.int/about/en/ Accessed 2007/07/
17.
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Study unit 13:
Contexts in multicultural health communication
Study unit 13:

Corrie Faure
Overview
Study unit 13 introduces you to the various contexts in multicultural health commu-
nication. In this study unit, we describe the ways in which multicultural contexts such as
the intrapersonal, interpersonal, group and organisational contexts in health commu-
nication can influence various health transactions. We explain the contexts by relating
them to various health communication models and by emphasising how important it is
to be aware of and sensitive to cultural differences in the healthcare environment. We
conclude this unit by explaining the role of the mass media which through the process
of mass communication influences numerous recipients in multicultural healthcare
contexts.
Next we give you the most important key concepts for this study unit. Make sure that
after you have adequately mastered the study unit, you are able to define or discuss the
meaning of these concepts (including approaches and models).
KEY CONCEPTS
health belief therapeutic model
empathy positive regard
congruence
King' s interaction model healthcare teams
ethics committees social support groups
leadership culture shock
cognitive dissonance theory meta communication
rules (as a means of communication) cycles (as a means of communication)
cultural climate charismatic leaders
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13.1
Introduction
We introduce this study unit with a scenario that explains the importance of contexts in
communication science in general and their importance in health communication
specifically.
It is seven o'clock in the morning. You have to wake up and go to work. However,
you don't want to get up, get dressed and make breakfast for the whole family. You
feel the same anxiety as you have every other morning for the last month or so. You
know something is wrong with you and your family is at their wits' end. They don't
know how to help you and get you going. Your family thinks that you should get
outside help they also feel continually stressed because without you, the mother
of the house, they cannot function properly. You feel that in a way you have to get
some help otherwise your family structure will collapse. Your husband decides to
make a doctor's appointment for you.
The next day, you discuss your problems with a health professional. You trust him,
because he shows empathy and seems to understand what the problem might be.
He sends you to a hospital for some testing. In the end you are diagnosed with
serious depression, due to a chemical imbalance in the brain. The doctor prescribes
medicine, but emphasises that you also should go for therapy sessions.
You follow the doctor's and therapist's recommendations to the letter. Things are
much better and at least you are able to get up in the morning and start the day. You
keep busy, but you feel something is missing. You still feel as if you can't cope as well
as before your illness. You phone a friend and she suggests that you join a support
group for people with depression. You think this is perhaps what you need and you
decide to go. In the mean time you also decide to learn more about your illness by
going to the public library for some health magazines and some books about ``how
to live with anxiety and depression''. The library personnel will also help you with an
Internet search on the latest developments and research on the topic.
With the above scenario in mind, do your first activity.
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Activity
13.1 Identify and briefly describe the various contexts of health communication displayed in
the above scenario.
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We are sure that you didn't have any problems identifying contexts as intrapersonal,
interpersonal, small group, group, organisational and mass communication.
13.2
Intrapersonal communication and health beliefs
The most basic level of human communication is intrapersonal communication. This

type of communication refers to interaction within ourselves when we think about
something or interpret a message we receive or when we create messages in our minds
to communicate with others. Although intrapersonal communication is a mental pro-
cess we cannot see, hear, touch, or smell it it is also a central process. We refer to
this process as the encoding and decoding of messages. Encoding and decoding are
translation processes whenever the thought about something ``translates'' into
meaningful messages. Communication is not possible without these two processes.
Through encoding, we translate our own thoughts into messages and decoding is the
process of translating messages we receive into personal meaning. In other words, we
link messages and meaning we use our meanings to create our own messages and
we make sense out of messages (meanings) we receive from others (Steinberg 2007).
When we talk about intrapersonal aspects of health and illness, we are referring to non-
physical conditions such as ideas or beliefs that influence physical health. For example,
people tend to assign certain meanings to their own health status and to the health
status of other people. Also, people often have strong (mostly unfounded and negative)
ideas or beliefs about tragedies such as suicide, or illnesses such as sexually transmitted
diseases. Health beliefs or ideas are strongly influenced by cultural backgrounds (eg
some religions forbid blood transfusions) and experiences (eg hospitals are bad ``my
father died in one'') as well as a lack of knowledge about certain illnesses (eg HIV/Aids).
The problem is that health beliefs influence healthcare choices and decisions. For
example, for many years many patients depended on traditional medicines to help
them (and many people still do) and they may feel that they have no confidence in
modern medicines and health professionals. The result of this belief is that they do not
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trust modern health professionals and modern treatment methods and may refuse the
treatments proposed by health professionals. Healthcare choices and decisions based
on (unfounded) health beliefs may therefore eventually have a profoundly negative
effect on people's physical health or even physical responses to treatment. What then is
the solution to this problem?
The primary way of treating physical aspects of illness is well known (eg medicines,
surgical procedures and other healthcare therapies), but the primary method that in-
fluences harmful health beliefs is effective health communication.
In order to counteract negative aspects of health beliefs, health professionals must be

sensitive to different culturally based health beliefs, values and attitudes that influence
patients' interpretations of health and healthcare. Health professionals must therefore
make an effort to
. learn about their patients' interpretations of their health condition

. provide relevant information and feedback to help them to make sense of their
healthcare
. make sure that their own interpretations of different health conditions do not
influence treatment (eg patients with culturally stigmatised health conditions such as
HIV/Aids must not be discriminated against in healthcare)
Research has shown that personal aspects such as stress can seriously threaten the
human body's immune system and therefore increase vulnerability to psychological and
physical diseases. It has been proved that there is a significant correlation between stress
and mental diseases as well as physical diseases such as cancer. In other words, there is
interdependence between psychological variables (eg control) and people's physical
health. A special type of stress culture shock (Martin & Nakayama 2007:310
312) can occur when people use too much mental and physical energy in adjusting
to changes and uncertainties relating to a new cultural group. This new cultural group
may be a professional, ethnic, organisational, local, national or international cultural
group. Culture shock can lead to ``frustration'', `ànger'', ``depression'' and other such
reactions. In the South African healthcare system, participants are regularly forced to
adapt to a wide range of different national, ethnic and professional cultures. Health
professionals and clients are likely to experience high levels of stress and too much
stress can be physically and mentally destructive. People therefore want to avoid culture
shock. How do they do so?
People avoid unpleasantness caused by culture shock by doing the following:
. being sensitive to cultural differences
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. learning about different cultural norms and values
. adapting to culturally distinct individuals in healthcare systems
. developing communication skills and attitudes that demonstrate an appreciation of
and sensitivity to cultural diversities
Other ways to counteract harmful health beliefs are features of the health-belief model
that we discuss next.
13.2.1
A health-belief model
Rosenstock's (1974) health-belief model emphasises patients' perceptions of health and
preventive actions to maintain health and avoid illness. The model explains that pa-
tients' perceptions and beliefs can be altered positively by using different means of
communicating information about health-related topics. The following important ele-
ments feature in this model:
. perceptions of the severity of the illness

. perceptions of benefits of / barriers to preventive health action
. the influence of factors such as demographical or socio-psychological characteristics
. cues available to engage in preventive health action
FIGURE 13.1
A health-belief model (adapted from Northouse & Northouse 1998:14)
Individual perceptions 3 Modifying factors " Likelihood of action
! ! !
Perceptions of severity Demographic and Perceptions of benefits

3 "
of illness sociopsychological and barriers
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"
3
Cues to action
3 campaigns
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advice
lectures
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The model is about perceptions individuals have of the severity of their illness. Perhaps
they believe, for example, that cancer is incurable. It is also about the perceptions they
have of what is ``good'' (benefits eg herbal treatment) and what is ``bad'' (barriers
eg any treatment such as chemotherapy) in terms of their health situation. Their per-
ceptions are influenced or modified by their cultural and personal variables (demo-
graphic and sociopsychological). In other words, the model is about perceived threat
and perceived benefit based primarily on ignorance. In order to combat ignorance,
effective communication is essential to motivate them to take health-related action. The
available means of communication to change health beliefs include:
. interpersonal communication (eg advice from others)

. group lectures or workshops (eg about basic hygiene or how to look after your baby)
. mass communication campaigns or folk media such as theatre (eg how to avoid
getting Aids or how to stop smoking)
. mass media messages (eg educational television programmes or newspaper articles
about how to avoid becoming a rape victim)
To be able to relate the development and changing of health beliefs to your own life
world, you must develop a scenario by doing the next activity.
Activity
13.2 Develop a scenario in which you explain how you could change some of the health
beliefs of people you know or know about. Relate your scenario to the aspects of the
health-belief model that we have discussed.
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You had to keep in mind that when explaining something in terms of a scenario you
have to relate it to a specific person or group of persons you are familiar with. You had
to explain the context, in other words the background or demographic particulars and
any emotional problems that seemed to be involved. Could you have changed a certain
person's view on treatment that might have helped by getting him or her to discuss the
problem with you or someone who conquered a similar problem and benefited from
treatment? Could you perhaps have organised a talk with an expert in the field? Could
you have taken this person to attend a seminar or watch a television documentary that
might have influenced him or her positively? Was it difficult to change any health
beliefs? Why was this so? Did it perhaps relate to the age (or other demographic factors)
of the person in question?
Lastly, take note that there are many ways to explain attempts to influence someone to
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change a specific health belief and that your scenario will differ from scenarios de-
veloped by other students.
In the next section, we discuss interpersonal communication and the development of

relationships. We suggest ways on how to develop proficiency in the establishment of
sensitive and effective multicultural health professional-patient relationships.
13.3
Interpersonal communication and relationships
In the interpersonal context of health communication, a two-way relationship can be

established between two or more people (Steinberg 2007). Strong interpersonal re-
lationships are based on the fulfilment of needs and expectations by the partners in the
relationship. In effective relationships, expectations must be made clear. Effective re-
lationships are similar to contractual agreements, although they are less formal than
legal contracts we refer to these contracts as unspoken implicit contracts. Such a
contract implies that participants should act in certain ways towards one another. For
example, a friendship relationship between two nurses working together in the emer-
gency room of a hospital is based on an informal and implicit contract. The relationship
is informal and not formally required by the organisation or formally agreed on by the
nurses.
Communication that occurs in interpersonal settings is affected by the roles each person
plays and by the expectations that they have of one another (eg the roles played by
health professionals, patients and patients' significant others). We have selected two
models that are especially important in understanding the relationship between health
professionals and patients: Rogers' therapeutic model and King's interaction model.
13.3.1
A therapeutic model
The Rogerian model, also referred to as a therapeutic model developed by Carl Rogers
(1951), emphasises the important role of relationships in helping patients to adjust to
their circumstances and to move in the direction of health, away from illness. Ther-
apeutic communication is a skill that helps people to overcome stress, to get along with
others, to adjust to problems that cannot be changed, and to overcome mental pro-
blems which stand in the way of a normal life and self-realisation. For example, if a
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therapist communicates honestly and caringly with patients it will help them to adjust to
their circumstances. The model is a patient-centred model, because the focus of the
interaction is the patient. The health professional is encouraged to communicate with
empathy, positive regard and congruence. These three qualities will help patients face
their problems. In other words, this model emphasises an honest interpersonal trans-
action between health professionals and patients.
FIGURE 13.2
A therapeutic model (adapted from Northouse & Northouse 1998:12)
Necessary conditions " Health communication " Patient outcomes
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" Health professional

Empathy Feels understood
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Congruence and
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Positive regard copes effectively
Patient "
For Rogers, empathy is the process of communicating to patients the feeling of being
understood; it refers to ``standing in the patients' shoes'' by trying to feel what they feel.
Positive regard refers to the process of communicating support to the patient in a
caring and non-judgemental way. It is communication that is genuine, unthreatening
and unconditional.
Communication congruence involves the honest expression of the health professio-

nal's own thoughts and feelings. Congruence therefore requires that health profes-
sionals will respond to patients honestly and attempt to be ``true'' in their relationships
with them. This model is about the importance of honest interpersonal transactions
between health professionals and patients.
Although therapeutic communication appears to be a concept that describes com-

munication in traditional psychotherapeutic settings (settings where psychological
problems are treated), it also describes communication between health professionals
and patients in other healthcare contexts.
13.3.2
King's interaction model
King's interaction model emphasises the communication process between nurses and
patients. King (1981) describes how health professionals (nurses) help patients to
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maintain their health. Although she describes the interrelationships of three systems
the personal, interpersonal, and social systems King gives particular emphasis to the
interpersonal systems in healthcare. The model suggests that in a nurse-patient re-
lationship, both the nurse and the patient simultaneously make judgments about their
circumstances and about each other. These judgments are based on their perceptions
of the situation. Judgments also lead to verbal or nonverbal actions that stimulate
reactions in the nurse and the patient. Thereafter, new perceptions are established and
the process repeats itself. Interaction is the dynamic ongoing process that includes the
reciprocal interplay between the nurse's and the patient's perceptions, judgments, and
actions. Transactions are the result of the reciprocal relationships established by nurses
and patients as they participate together in determining mutual health-related goals
(Northouse & Northouse 1998:1517).
FIGURE 13.3
An interaction model (adapted from King 1981:92)
feedback
Perception
Nurse Judgment
Action
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Reaction " Interaction " Transaction
! Action
Patient Judgement
Perception
feedback
King's model is particularly valuable for explaining communication between a health

professional and patient. It represents the nurse-patient interaction process. This model
encompasses the important dimensions of relationship, process, and transaction that
are crucial elements in any communication process. The feedback loop in the model
also indicates the importance of shared meaning between the nurse and patient.
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To finalise this subsection, we next discuss the processes involved in the development of
multicultural interpersonal relationships.
13.3.3
The development of multicultural interpersonal relationships
The basic expectations that people have are largely determined by cultural norms for
role performances (how we are expected to behave in certain situations). In different
cultural milieus or cultural settings there are likely to be different expectations for
behaviour. An understanding of the fundamental cultural norms in different social
settings is therefore essential (eg when we meet people for the first time we should be
sensitive to the various culturally determined ways that people greet one another).
When we meet people regularly we learn in the course of time to fulfil the many, often
subtle, expectations we have for each other. When expectations are met and implicit
contracts are established, the intimacy of an interpersonal relationship grows. However,
when people fail to meet relational expectations, the relationship suffers and might
come to an end.
The development of relationships is a dynamic process. In other words, expectations

and cultural norms for role performances are emergent phenomena (people change,
often due to changes in their circumstances, and thereafter expectations also change).
This makes periodic updates of implicit contracts necessary. This is a two-way process;
both partners must be equally involved to let an interpersonal relationship flourish. An
important challenge to the development of effective healthcare relationships is the
ability to bridge cultural differences between health professionals and their patients. We
implicitly understand communication rules if we share the same culture, and the job of
decoding and interpreting the other person's message is significantly easier. The am-
biguity increases dramatically when we are interacting in a multicultural way. Skills and
proficiency in developing multicultural relationships are the key to productivity as a
health professional. Ultimately, multicultural proficiency is affected by two essential
elements, namely, message content (verbal and nonverbal) and relationship. Our re-
lationship with the person with whom we are communicating affects how the message
is interpreted. Conversely, message content could also change relationships positively or
negatively. To enhance this dual-purpose building block of multicultural communica-
tion, one must develop a personal style of interpersonal communication that
strengthens the relationship and is mutually empowering.
Activity
13.3 Discuss the two models that explain interpersonal relationships in a healthcare context.
Add your own examples that illustrate the specific characteristics depicted in the
models.
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To complete this activity successfully, you had to discuss all the elements of the models.
To add examples you had to relate the core meaning of these models to your own life
world. In this way you would have known that you understand the meaning of these
models in terms of interpersonal communication.
In the following subsection, we discuss the importance of group forming in reaching
modern healthcare goals.
13.4
Communication in multicultural groups in healthcare
We should not underestimate the role of the group or small group in healthcare (a
collection of three or more people whose relationships and behaviours make them
interdependent to some degree) (Steinberg 2007). Group forming has been an im-
portant element of social organisation since people learnt that working together towards
reaching a goal could be beneficial. Specialised groups, such as healthcare teams, ethics
committees and social support groups, are used in modern healthcare to gather, process
and disseminate relevant health information as well as trying to reach many complex
healthcare goals through the coordination of group members.
We view communication as the primary means by which group member coordination
and goal attainment is accomplished. According to Steinberg (2007) communication
. enables individual group members to establish and maintain important group roles
(eg leadership)
. is used to manage group conflicts
. is the means by which group members give one another social support
. is the primary mechanism for facilitating effective group decision making
In healthcare settings there are many different kinds of group. We have selected three
important healthcare groups to discuss in some detail, namely, healthcare teams, ethics
committees and social support groups. We examine several of the important roles
performed by these groups in healthcare and illustrate the powerful influences of
communication on group performance.
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13.4.1
Healthcare teams
Healthcare teams are important work units in modern healthcare systems. These teams
consist of groups of people involved in the delivery of healthcare, often representing
different healthcare disciplines and perspectives. These people work together, share
relevant health information and coordinate the delivery of healthcare services. The
effectiveness of healthcare teams depends on the quality of communication between
team members of one group and between different groups. However, communication
across different professional groups can often become strained because of cultural
barriers. Culturally based constraints may include differences in educational back-
grounds, career patterns, language use, socio-economic status, gender, race, values and
lack of interprofessional respect. These interprofessional cultural barriers must be
minimised for healthcare teams to work together effectively.
Problems caused by, for example, bad experiences, value differences, status inequal-
ities, competition, misunderstandings within a healthcare team and between healthcare
teams can all be reduced or solved by effective communication.
Effective communication guarantees that the members within a group and the members
of different groups (Roseman in Thornton & Kreps 1993:8487)
. get to know each other and appreciate each other's problems (eg by distributing
regular feedback reports on the issue that needs solving)
. build trust by making sure that intentions are known
. create goodwill (eg by volunteering assistance and by showing genuine concern)
. are reasonable and flexible (eg to listen to and consider other people's viewpoints)
. consider consequences of actions (eg ask yourself, ``Will I hurt other people in my
own or in other groups?'' or ``Would alternative steps cause less harm without
compromising my objectives?'')
. act constructively (eg try to satisfy others' needs so that other group members and
groups will follow your example).
Also remember that no group member or group as a unit can afford to alienate itself
from other group members or other groups. We function in an interdependent en-
vironment; group members need one another and groups should cooperate with other
groups. Strong relationships within and between groups strengthen effectiveness in
healthcare.
In addition to effective communication in healthcare teams, another point that also

deserves our attention is the usual exclusion of patients from healthcare teams. Ac-
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cording to Kreps and Kunimoto (1994:62) clients of healthcare must be recognised as a
central part of any healthcare team. Interestingly, research has shown that patient
involvement in the healthcare decision-making process improves physical response to
treatment. Patients should therefore be encouraged to participate actively in making the
decisions concerning their care.
In the model of relational health communication competence, the patient is at the

centre of the healthcare wheel (team), represented by the hub of the wheel. The
different health professionals are illustrated as the different spokes of the wheel that
surround the patient. Lines of communication connect the health professionals to one
another and to the patient. The more competent the communication is between these
members of the healthcare team, the more likely the team is to promote therapeutic
communication, social support, satisfaction, information exchange, and cooperation.
FIGURE 13.4
A model of health communication competence (adapted from Kreps & Kunimoto 1994:63)
ro fe ss io n a
ce alt h p ls D
He
en
ec
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re
et
mp
as
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co
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co m
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p e te
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e te n
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Patients !
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therapeutic pathological
social support ~
lack of social support
~
satisfaction dissatisfaction
!
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information ~ barriers
cooperation lack of cooperation
!
He ls
a lth p
r of es si on a
The tendency to exclude patients from healthcare teams may be due to unresolved
intercultural barriers between health professionals and patients. Such exclusion may
reflect the following (Kreps & Kunimoto 1994:6465):
. a lack of respect for the important role patients can perform in team activities
. stereotyping and ethnocentrism (eg health professionals may underestimate the
level of healthcare knowledge that patients possess)
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. assumptions that patients are unlikely to be able to comprehend the healthcare
issues examined within the team
. a failure to recognise the importance of patients' personal experiences in
diagnosing, selecting and evaluating treatment strategies
The primary focus of healthcare services is to serve the patient. Health professionals
should use the opportunity to interact with patients within healthcare teams to learn
more about their needs and experiences. Also, health professionals should help patients
to access the relevant health information they need to make well-informed choices
about their treatment.
According to Kreps and Kunimoto (1994:66), the most effective healthcare teams are
egalitarian groups, in which all members are treated as equals. The following steps will
help to promote egalitarianism in healthcare teams:
. information about the specialised expertise and contribution each team member
can offer to the team
. team-building and orientation training sessions (eg the importance of cooperation
between team members and the development of interprofessional respect should
be emphasised)
. flexible leadership rather than fixed leadership (eg leadership can be alternated so
that the member with the greatest expertise on an issue under consideration can
direct goals and tasks)
Developing interprofessional respect, coordination and egalitarianism can help the

healthcare team to utilise group members' expertise to the full, and work together to
deliver effective care.
Activity
13.4
1. Define the meaning of the concept of healthcare teams.
2. Discuss the problems healthcare teams may encounter that hamper the successful
functioning of these teams.
3. Draw and explain in your own words the model of health communication
competence.
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Next, we discuss another very important group that is specific to the healthcare context.
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13.4.2
Ethics committees
Ethics committees are interdisciplinary small groups, usually in hospital or institutional
settings, that assist individuals or institutions in addressing the ethical dilemmas of
healthcare. To address ethical dilemmas, ethics committees have to make decisions
concerning complex moral and bioethical issues. The committees are generally com-
posed of an interdisciplinary group of health professionals, administrators, social
workers, priests, patient representatives, lawyers and, at times, selected members of a
relevant public (Tjale & De Villiers 2004:231; Martin & Nakayama 2007:3134). Ethics
committees may help health professionals to evaluate moral issues and to make deci-
sions about many different situations, such as the following:
. when to provide treatment to or withhold it from a terminally ill patient

. when to use or discontinue using certain drugs
. which patient among many seriously ill applicants on a waiting list for a transplant
operation should receive the next available donated organ
Modern healthcare is faced with tough decisions every day. Ethics committees carefully
debate and consider healthcare issues and identify available options and their possible
implications. Ethics committees have to provide healthcare administrators with eva-
luations of healthcare issues and act as guides in the decision-making process. Policies
for future actions are often the result.
However, members of an ethics committee should be sensitive to the fact that culture
directly influences ethical standards and behaviours. Ethical values are established by
cultures, and courses of action must take relevant cultural orientations into account.
Right and wrong are intimately tied to the cultural groups to which we belong, and the
different cultural orientations of health professionals and patients create a situation in
which a wide range of moral and ethical positions are often in competition with one
another. To counteract misunderstanding, ethics committees should do the following
(Kreps & Kunimoto 1994:67):
. seek relevant information from sources external to the committee

. take into account the relevant cultural perspectives of all individuals involved in
particular issues
. fully evaluate bioethical decisions and courses of action
Effective multicultural relations are therefore essential between ethics committee

members and between these members and their relevant publics.
Ethics committees are a very recent phenomenon in South Africa. Usually doctors
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together with patients and their families decide on ethical issues. Sometimes, in cases of
disagreement, the issue is decided by a court of law. But some private hospitals now
realise the necessity of such committees and are in the process of establishing them or
have already established them.
Activity
13.5 Explain in your own words the importance of ethics committees in a democratic society
such as South Africa.
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In your explanation of the importance of ethics committees in democratic societies, you

had to refer to the equality of people and basic human rights to healthcare.
Next, we discuss the importance of social support groups. In general, these groups
reach the goal of helping people in similar situations mainly through effective com-
munication.
13.4.3
Social support groups
Social support groups use communication to help individuals work through the anxiety
and uncertainty of difficult and stressful life events. Members of the group have similar
problems and by sharing these problems with other members overcome problems such
as alcoholism. In these groups honest and straightforward communication is very im-
portant.
Social support is provided informally in everyday life by friends and family members, as
well as formally by counsellors and self-help groups. Although the family is the principal
informal group setting for social support, in recent years many self-help groups have
emerged. Self-help groups are important formal settings for the provision of social
support, helping individuals cope with such diverse issues as bereavement, divorce,
epilepsy, cancer, HIV/Aids, terminal illness, old age, and mental illness. Social support
groups help their members cope with life stress through communication. These groups
provide the following (Kreps & Kunimoto 1994:69):
. relevant information about healthcare methods and services

. problem-solving interaction
. referral services
. friendly visits
. assistance in making choices about the available healthcare options
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. new cultural norms for handling difficult life experiences
. new cultural frameworks for viewing the world and responding to it
These groups help members to feel good about themselves and help them to assert
control over their own healthcare. Social support groups use communication to em-
power their members. For example, one of the oldest and best known self-help groups,
Alcoholics Anonymous (AA), provides its members with a very strong cultural frame-
work that guides member behaviours. This cultural framework revolves around group
rituals and rules that socialise members into the group's culture. Primary group rituals
and rules include the following (Kreps & Kunimoto 1994:6970):
. the self-identification of members as recovering alcoholics

. the expectation that recovering or recovered members will support other members
to help them refrain from drinking alcohol
The strength of this self-help group's cultural socialisation process has made it a very
influential social support group and one of the most successful long-term treatments for
alcoholism.
However, cultural sensitivity should be an important element of any effective support

group. Fortunately, members of support groups often share similar cultural experiences
that promote mutual acceptance and identification. Group members should be sensi-
tive to the fact that it is particularly difficult for new members to enter support groups.
New members often feel (Kreps & Kunimoto 1994:71):
. particularly vulnerable
. a lack of confidence
. confused
. desperately in need of help in coping with their problems
Culturally sensitive communication can help support-group members reduce un-

certainty, regain their confidence, and identify new strategies for handling their pro-
blems.
Lastly, groups can perform important functions in healthcare if group members work
together cooperatively and synergistically. Member cooperation depends on the de-
velopment of multicultural respect, so group members feel comfortable enough to
develop meaningful implicit contracts to follow advice and guidance. Now, do the next
activity to ascertain that you have understood the above discussion.
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Activity
13.6 Define or describe the concept of social support group in your own words. Add an
example about how a social support group you know about operates.
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To complete this activity successfully you had to use the basic information provided in
this section to describe the characteristics and meaning of a social support group. To
find examples to illustrate your discussion you could have asked people about various
social support groups or perhaps you could have read up on these groups in the media.
Also, see our case study about a specific social support group at the end of this study
unit.
In this section we have described the important healthcare functions performed by
healthcare teams, ethics committees, and social support groups. Sensitive multicultural
communication is essential to the effective operation of all these healthcare groups. In
the next section we discuss a bigger group, namely the healthcare organisation, as the
primary setting for healthcare practice.
13.5
Communication in multicultural organisations in healthcare
Healthcare organisations (such as hospitals, medical centres, clinics, hospices) are pri-
mary settings for formal healthcare delivery. These organisations provide both health-
care services and relevant information to patients. It is impossible to provide effective
healthcare without effective communication. Communication enables health profes-
sionals and patients to coordinate their activities to accomplish healthcare goals. We
must realise that organisational healthcare communication encompasses each of the
three levels of communication we have already discussed: intrapersonal, interpersonal
and group communication. But, organisational communication also goes beyond these
three levels of interaction and includes intergroup relations (communication between
representatives of different groups) and interorganisational relations (communication
between representatives of different but related organisations) (Robinson 2002; Tjale &
De Villiers 2004).
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13.5.1
How to accomplish healthcare goals in organisations
Healthcare goals in health organisations are always directed to providing relevant
healthcare information (eg information about the most appropriate treatment for an
illness) and services (eg the actual treatment of an illness) to the public. Effective
communication is the main ``tool'' that groups of people who work together use to
coordinate their information inputs in order to accomplish healthcare goals. To be able
to accomplish healthcare goals, organisation members should share important in-
formation about the following (Steinberg 2007; Kreps & Kunimoto 1994:7475):
. goals (eg to save a little girl whose parents refuse a life-saving operation because of
religious convictions)
. options (eg considerations by ethics committees and discussions with the family of
the little girl)
. problems (eg intensive discussions about the case with the family and prominent
members of the church or leaders in the community might lead to a conflict
situation)
. strategies (eg after trying to persuade the family, a court of law might have to decide
on the fate of the little girl and overrule the decision of family members)
Many people have to work together to accomplish what are sometimes complex
healthcare goals. In practice, however, ineffective communication often blocks the
fulfilment of organisational goals and further complicates the healthcare delivery system
by distorting information, blocking the exchange of important messages and alienating
health professionals from one another. Important causes of ineffective communication
in healthcare organisations are the following (Kreps & Kunimoto 1994:7475):
. Culturally based differences in the backgrounds, orientations, strategies and goals of

the participants (including the patients) this means that the same healthcare
situations and treatments might be viewed quite differently by participants.
. Health professionals often fail to encourage full participation for example, they
tend to communicate to other health professionals and especially to their patients
(``You must follow these guidelines otherwise ...'') rather than communicate with
them (`Ì would like you to follow these guidelines, what do you think''?).
. The bureaucratic nature of healthcare organisations intensifies communication
problems by reinforcing status differences and distance between health profes-
sionals and between health professionals and patients for example, in many
hospitals a doctor who treats a patient, often has the last word about the patient's
treatment.
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In order to develop an effective multidisciplinary holistic treatment (treating the whole
person and not just one aspect, such as the respiratory system), effective interprofes-
sional relationships should be developed, especially when organisation members are
members of different and often competing professional cultures. It is not uncommon for
health professionals (usually people with the highest professional status within the or-
ganisation) to dictate their own ethnocentric decision without consulting other pro-
fessionals, and in doing so limit the exchange of relevant diagnostic information and
thus the potential for effective holistic healthcare for the patient.
Activity
13.7 Discuss the following statement: ``Many people have to work together in healthcare
organisations to accomplish what are sometimes complex healthcare goals.'' Add ap-
propriate examples.
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To be able to discuss the above statement, you had to firstly study-read the given
information again carefully. Then you had to describe the meaning of the key concepts
in the statement, namely ``healthcare organisations'' and ``healthcare goals'', and you
had to refer to who the people are who have to work together in the organisation. Next
you had to identify specific goals and explain how positive results could be obtained.
You had to discuss the statement in your own words and use examples from your own
life world or from the life world of others.
13.5.2
Internal and external organisational communication
Two distinctive ``tools'' of multicultural organisational health communication are
communicating internally and externally in effective and sensitive ways. Internal
communication refers to communication among members of the same organisation
within the boundaries of a single organisation. External communication refers to
communication among members of an organisation and individuals who are not part of
that organisation communication outside the boundaries of the organisation. Ex-
ternal communication often occurs with individuals who are representatives of groups
within the organisation's relevant environment (ie all individuals, groups and organi-
sations that influence and are influenced by the healthcare organisation, including
patients, suppliers, competing organisations and media representatives). Through ex-
ternal communication (eg health education publications) the organisation establishes
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good public relations with members of the relevant environment by promoting co-
ordination between them (Steinberg 2007).
The strength of multicultural relations influences the quality of both internal and ex-
ternal communication in healthcare organisations. Both internal and external in-
formation will be ineffective unless it is culturally sensitive. As a result we need to
identify relevant publics by means of an audience analysis so that we can divide au-
diences into relatively homogenous segments. In other words, people with the same
cultural background should be grouped together for the sake of analysis. Relevant
cultural information, needs and orientations must be established for each group before
providing these groups with healthcare information. (See one of the following study
units for a discussion of external communication campaigns and audience analysis.)
Activity
13.8 Explain in your own words the differences between internal and external organisational
communication. Illustrate your discussion with appropriate examples of the two forms
of organisational communication.
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13.5.3
Multicultural relationships in organisations
According to Kreps and Kunimoto (1994:86) `èvery organisation develops its own
cultural identity''. This means that organisational cultures establish norms for members'
behaviours and these norms influence the way they see the world. People who work for
a healthcare organisation often develop similar beliefs, norms and values that help them
to make sense of their environment. However, organisational cultures are also com-
prised of many subcultures. These subcultures consist of several cultural groups re-
presented in the healthcare organisation, such as members who share the same racial,
ethnic or socio-economic backgrounds. Each subculture within the organisational cul-
ture also has a unique set of norms that directs members' beliefs, attitudes and values.
Each subculture has its own identity and has its own relative status within the organi-
sation.
Unfortunately, competition for status and influence among subcultures often leads to
interprofessional antagonism and even conflict in healthcare organisations. However,
effective multicultural relationships can counteract the tendency toward ethnocentrism
and competition in healthcare organisations. The organisational culture has to establish
norms for guiding unhealthy competition between subcultures and help to create a
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climate (the emotional tone present within the organisation) that directs the way the
organisation responds to different cultural groups. Communication can be used to guide
the development of norms that promote multicultural sensitivity and receptivity.
Activity
13.9 Why is a tendency to ethnocentrism harmful for multicultural relationships in health-
care organisations? Explain.
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All the information you required to answer the question is in the above section.
However, you also had to give some personal input by using examples that relate to
your own experience or the experience of others.
Next we discuss the importance of effective official means of communication within

healthcare organisations and the possibilities open to the members of the organisations
to provide feedback and also to criticise previous communication strategies used by the
organisation.
13.5.4
Meta communication in healthcare organisations
Meta communication (messages that provide for feedback about the acceptability of
previous communication strategies) can be used to establish norms that encourage
members to respect one another and that demonstrate respect for cultural diversity. A
primary goal of organisations is to develop the ability and organisational intelligence
(interpretative resources, such as policies, procedures and strategies) to enable mem-
bers to interpret and respond to a broad range of information inputs. In hospitals, for
example, health professionals must give appropriate feedback on the broad range of
health problems presented by other health professionals, and to the many different
patients who seek healthcare. Hospitals develop organisational intelligence based on
past experience, to guide healthcare treatment for the many different patients.
Members of healthcare organisations use two main communicative responses to make

sense of the different information situations that they encounter (Kreps & Kunimoto
1994:9092):
. the use of rules as a means of response or feedback

. the use of cycles as a means of response or feedback
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13.5.4.1 Rules
Rules are pre-established strategies for directing responses to frequently encountered

situations, such as the use of ``form'' letters (eg admission forms) to respond to in-
formation requests that recur often. Because rules are pre-established strategies that
provide members with specific guidelines for responding to different situations, re-
sponses to rules are usually less complex than responses to cycles.
13.5.4.2 Cycles
Cycles refer to the use of communication patterns for processing responses. Cycles
include the following:
. problem-solving interaction among members of decision-making groups (eg ethics

committees)
. the asking for and receiving of advice and counsel (eg interviewing and counselling
of patients, or discussions with other health professionals)
Responses to cycles are equivocal or uncertain. In cycles, it is uncertain how a com-

municative interaction will develop and what kind of responses to expect. Each cycle
removes some uncertainty from complex information and eventually reduces the un-
certainty enough for members to develop new rules to guide their responses. Therefore,
uncertainty can only be reduced through communication.
Issues concerning cultural diversity and multicultural relations are often highly complex
and uncertain. Cycles help to reduce these complexities and uncertainties to a man-
ageable level. It is important to demystify multiculturalism for members through the
following activities (Kreps & Kunimoto 1994:9192):
. healthcare conferences about multicultural relations

. workshops in which members actively participate in identifying and solving
problems in multicultural relationships
. training sessions in multicultural health-communication skills
. public lectures to involve people outside the healthcare organisation
. attending and supporting discussion groups such as ethics committee meetings and
social groups
To ensure that conferences, workshops and so on have the required impact, written and
audio-visual educational materials about multicultural sensitivity and cooperation
should be part of the activities.
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Activity
13.10
1. Describe the meaning of meta communication in healthcare organisations (page
312).
2. Distinguish between the use of rules and cycles as a form of communication in
healthcare organisations.
Next, we discuss the importance of good leadership in multicultural healthcare orga-

nisations (page 313).
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13.5.5
Leadership in multicultural healthcare organisations
Good leadership is perhaps the most important factor in promoting effective multi-
cultural relations in healthcare organisations (Steinberg 2007). Leaders usually set the
tone for cultural sensitivity. They are important role models who set examples of how
healthcare professionals are supposed to communicate with culturally different patients.
This is especially important in interaction with patients who often receive prejudicial
treatment in healthcare, such as people diagnosed with HIV/Aids, the poor, minority
groups, women and the elderly. For example, in healthcare the elderly are often
confronted with the following:
. loss of social status within the healthcare system

. loss of personal independence and control over their healthcare treatment
. limitations in the availability of healthcare services
. growing alienation and loneliness within the healthcare system
Leaders can help to overcome these problems by
. communicating their respect for elderly healthcare patients and their commitment
to providing them with the best possible healthcare services
. proposing and instituting specific policies and training programmes to promote
sensitive and effective healthcare for all patients
According to Kreps and Kunimoto (1994:9394) effective leadership communication

strongly influences the development of organisational cultures. Charismatic leaders
(engaging leaders who dramatically communicate a vision of organisational life that
followers believe in) establish and communicate clear organisational values and goals
that become norms within organisational cultures. Leaders who make it clear that they
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value cultural diversity and will not tolerate prejudicial and ethnocentric communica-
tion in their organisations enhance multicultural relations by setting recognisable stan-
dards for communication. In addition, by communicating in a caring and sensitive
manner with organisation members, leaders can help establish supportive commu-
nication climates that discourage cultural competition and encourage cooperation.
Activity
13.11 Discuss the importance of good leadership in multicultural healthcare organisations.
Illustrate your discussion by identifying important characteristics of a leader you know
about.
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Note that many characteristics of leaders are universal and not only specific to the role
of a leader in a healthcare organisation. This means that you could have chosen any
leader with leadership abilities and applied these to illustrate necessary leadership
qualities in healthcare organisations (Steinberg 2007).
Next, we briefly discuss some aspects relating to health communication in the mass
media.
13.6
Health communication in the mass media
Health communication occurs in all the contexts we have discussed in this study unit. At
the level of mass communication, health communication refers particularly to areas
such as health promotion campaigns and public health planning, but also to the pro-
vision of information about controversional health issues and problems (eg the pro-
blems encountered with regard to state sponsored hospitals, strikes for higher salaries
for nurses and corruption in the management of healthcare organisations). In other
words, the mass media concentrate on problem areas in healthcare that may be of
interest to the public (this includes of course problems encountered with regard to the
publication of sponsored campaigns).
According to Kar, Alcalay and Alex (2001:351) modern communication media (tele-
vision, radio, newspapers and the Internet) support existing programmes such as on-
going health campaigns (eg the Arrive Alive campaign), influence public policy and
mobilise public opinion or public pressure when something out of the ordinary happens
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and inform or educate the public about health matters (eg how to prevent cholera by
boiling all drinking water in affected areas or special ``health'' sections or addendums in
newspapers). The mass media often give prominence to a particular organisation or
movement concerned with health matters by publishing a newsworthy event or relaying
an organisation's message through media campaigns, press conferences, and press re-
leases. For example the Treatment Action Campaign (TAC) drives home its message by
drawing attention to alarming facts or serves as an expert source of information for the
media. In this way the TAC as well as the media may shape public opinion, generate
material support for programmes, and bring about desired policy reforms as well as
public action and participation. The media often supply information and in the process
educate recipients with regard to healthcare. The information and ultimately the
educational aspects are strengthened by advocacy techniques, such as emphasising
news items as the main news in television broadcasts and follow-ups in panel discus-
sions, in newspaper editorials and feature articles, through comments on the radio and
discussion forums by experts, and through other forms of emphasising news such as
large photographs with bold headings on front pages of newspapers. For example, the
newspaper media reports on strikes in hospitals, but also in the form of editorials on the
reasons behind these strikes and the possible influence these strikes could have on
patients. By emphasising certain aspects, and also regularly repeating the issue (follow-
ups), the media accept the role of an advocate (advocacy journalism) to influence
public opinion.
It is well known that the mass media, including the Internet, have developed as an
important source of information about health. All possible ailments and diseases are
discussed in detail on the Internet. There is virtually no aspect pertaining to prevention,
care and treatment which cannot be accessed by the public (Geist-Martin, Berlin-Ray &
Sharf 2003:285; Kar, Alcalay & Alex 2001:3440). There are truly many positive and
necessary developments in this area. There are also, however, various problem areas.
Think, for example, in terms of accessibility. Large numbers of South Africans and others
in Africa are unable to access much of this information: many are illiterate and there are
costs associated with accessing the information (Melkote & Steeves 2001:247. In terms
of accessibility, however, the radio and television play an important role. The problems
associated with illiteracy are virtually overcome through radio and television (Melkote
1989:1730; Melkote & Steeves 2001).
It is important to note that the media can play an important role in health-related issues,
such as the fight against HIV/Aids. By making the public aware of specific organisations
and movements' activities and actions on a regular basis, and by conducting interviews
with the representatives of these organisations and movements, the media is able to
convey their views and problems to the public. Kar, Alcalay and Alex (2001:350353)
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assert that effective media support plays an important role in the success and em-
powerment of movements concerned with healthcare in South Africa. The topics or
themes that journalists choose to write about, the manner in which they write about
them, and where they place them as well as their use of graphics, colour photographs
and larger headlines, attract readers' attention and influence public and private dis-
course the media brings attention to specific issues and in this way can set the
agenda for policymakers and the public.
Activity
13.12 Discuss the role and possible influence of the mass media in health communication.
Illustrate your discussion with examples from any mass medium that you regularly use
or consult for information on health or health-related topics (eg poverty as one of the
main causes of poor health or polluted drinking water as a main cause of cholera or
views on HIV/Aids-related research or events).
The next section is a case study based on study unit 12. It is a practical illustration of
how the various contexts of health communication are applicable in real life situations
and can be analysed by researchers.
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Case study 13.1

Obsessive-compulsive disorder (OCD): an application of the various commu-
nication contexts
Introduction and background
Obsessive-compulsive disorder (OCD) is a distinctive and often disabling illness char-

acterised by unwanted thoughts that recur (obsessions) and unwanted repetitive acts
that the person realises are foolish but is unable to resist (compulsive rituals). In this
disorder obsessions and compulsions, which may be resisted initially, cause marked
distress, and are time-consuming and usually interfere with social, academic and vo-
cational functioning (cf Obsessive-Compulsive Disorder ... 2007; Obsessive-Compul-
sive Behaviors ... 2007).
Over a decade of clinical research suggests that the symptoms of OCD can be best
managed by a combination of medicinal and psychological interventions or, in other
words, a combination of the biomedical and the outcomes approach. The medicinal
treatment of OCD involves the use of a group of antidepressants whilst the psycholo-
gical treatment of OCD utilises primarily behaviour therapy. The behaviour therapy
involves exposing the person with OCD to a situation that gives rise to the obsession,
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and then preventing the OCD person from engaging in the compulsive ritual that he or
she uses to reduce distress, anxiety and doubt. Regular therapy of this nature will in
many instances result in a marked decline in the amount of distress the person with
OCD experiences. He or she will eventually come to realise that these obsessions are
just harmless thoughts and that there is no need to be afraid of them.
The OCD Association of South Africa resulted from the need of one particular person
with OCD to break out of the isolation and despair that was the consequence of living
with the effects of this disorder. He or she believed that through association with others
who have OCD, as a collective, sufferers could support each other and find ways to
overcome the disorder. Today, the OCD Association of South Africa is a national or-
ganisation, run by people with OCD, which assists people with OCD from all walks of
life. The objectives of the OCD Association of South Africa include the following:
. support and educate people with OCD and their families

. gain access to appropriate methods of treatment on behalf of people with OCD
. raise funds toward improving services for people with OCD
. raise public awareness of OCD
. encourage research into OCD
. find better methods of treatment
Different health communication contexts

In order to achieve its objectives, the OCD Association of South Africa communicates in
a number of different health communication contexts. These include the interpersonal,
small group, organisational, mass-communication or public contexts. However, the
intrapersonal context is of course also involved and may differ from person to person.
Intrapersonal context
The most frequently occurring obsessions include a fear of contamination (by house-
hold cleaners, disease and environmental pollutants), doubt (the feeling that they can
never be sure that something terrible won't happen), need for symmetry, and aggressive
thoughts. The most frequently occurring compulsions include checking, hand-washing,
counting and rituals related to the need for symmetry and hoarding.
Interpersonal context
People who think that they are suffering from OCD or who have been diagnosed as
having OCD initially contact the OCD Association of South Africa by telephone. Most
will be experiencing a great deal of distress, anxiety and may well be depressed. These
individuals or their families will know nothing or very little about OCD and its treat-
ment. The lay counsellor who will deal with their inquiry is a person with OCD or a
family member of someone with OCD. After the initial contact by telephone, the
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person with OCD and/or their family may need to speak to the lay counsellor on
numerous occasions and it may be necessary for the lay counsellor to visit the person
with OCD in his or her home.
The purpose of this interaction is to provide the person with OCD with as much
information as necessary to empower him or her to make informed decisions about
treatment and how best to handle the OCD symptoms. More importantly, the person
with OCD is made to feel that he or she is not alone, that there are others out there who
have had similar experiences and that these people will be there for him or her during
this difficult period.
Small group context

It is not only through interpersonal communication that the OCD Association of South
Africa attempts to educate and support people with OCD. It is also through the self-help
or social support group that small group communications occur and where people with
OCD can support each other and learn how to cope with the effects of OCD on their
lives. The self-help group as an expression of small group communication provides a
secure environment where self-disclosure is encouraged, acceptance is unconditional
and group members can empathise with each other's experience of OCD and the pain
that it causes. The self-help group also has a therapeutic function, especially when
combined with a behaviour-therapy oriented self-help group format like GOAL (Giving
Obsessive-Compulsives Another Lifestyle). Self-help group members are taught how to
apply behaviour therapy techniques to their particular obsessions and compulsions and,
with the group's support and encouragement, they practise these techniques between
group meetings. Should they encounter difficulties when practising these techniques,
members can call on each other's support and advice to overcome these difficulties.
Organisational context
Small group communication is not restricted to the OCD Association of South Africa's
self-help groups. In fact, small group communication outside the self-help groups
themselves is essential to the continued survival of the OCD Association of South Africa.
For it is through small group communication that the management committee com-
posed of 10 individuals develops the OCD Association of South Africa's organisational
strategy and ensures its everyday operation. For instance, small group communication
occurs when the publication subcommittee plans and produces the OCD Association of
South Africa's publication OCD News. When meeting with potential sponsors (eg
multinational pharmaceutical companies), representatives from the two parties engage
in small group communication. Both sides try to negotiate the best deal for their party.
Without effective organisational communication, the OCD Association of South Africa
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cannot operate efficiently. The OCD Association of South Africa is dependent on vo-
lunteers in the localities to implement its projects and assist people with OCD. The
OCD Association of South Africa has to ensure that people with OCD throughout the
country are kept abreast of new developments in OCD treatment and new project
initiatives.
When the membership needs to be made aware of time-sensitive information, then a

special mail shot or circular will be sent out. Where possible, this urgent information will
be communicated via electronic mail (e-mail). If the information applies only to a
specific locality, for example, then the members will be contacted by telephone.
However, it is not unusual to communicate new information, especially regarding
treatment and new research findings, to members at large formal information evenings
held in halls and university auditoriums. The information is communicated by an expert
in a certain aspect of OCD, using audiovisual aids.
Mass communication context

So far the main emphasis has been on communication within the OCD Association of
South Africa. However, if the OCD Association of South Africa is to achieve its ob-
jectives of increasing public awareness and raising funds to support its services and
projects, it must create a presence for itself in the broader community. This is achieved
by communicating to the general and specific segments of the population about what
OCD is and what the negative consequences are if people suffering from OCD are not
identified and, therefore, do not receive appropriate treatment. The OCD Association
of South Africa communicates information through its quarterly publication OCD News
and campaign pamphlets such as Understanding Obsessive Compulsive Disorder.
The OCD Association of South Africa utilises different types of media to communicate
its message. The type of medium used depends on the target audience the association is
trying to reach. When targeting the general public they usually use the mainstream print
media, for example daily newspapers' health and trends sections and women's ma-
gazines as well as electronic media such as television actuality and magazine pro-
grammes. This may be supplemented by placing pamphlets and posters in health-
related localities, for example, doctors' consulting rooms.
Often the OCD Association of South Africa wants to communicate a specific message to
a specific target audience, for example, healthcare professionals. In this instance,
specially commissioned OCD-related articles will be published in journals catering for
the healthcare professions. This will often be done in collaboration with a pharma-
ceutical company that will pay for advertising space, thus encouraging the publication
to print the article. However, communicating a specific message to a particular target
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audience need not be expensive. Setting up an exhibition stand at a medical con-
ference or delivering an audiovisual presentation to high school educators can be a very
cost-effective means of communicating one's message.
Evaluation
The success of healthcare-related organisations is judged by their ability to effect po-
sitive change in the lives of individuals with specific health problems, whether through
increasing awareness, education, support or treatment. The ability of the OCD Asso-
ciation of South Africa to achieve its objectives and hence alleviate the suffering caused
by OCD is influenced by the effectiveness of its communication, whether interpersonal,
small group or within the organisation, or conveying its message via the mass media to
the broader community.
To conclude this study unit we provide the next activity to test your ability to apply this
case study to similar support groups or cases that involve the application of healthcare
contexts to practice.
Activity
13.13 Identify any social support group of your choice and apply the main ideas of the OCD
support group to the group you have identified.
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When doing the activity you could have concentrated on aspects such as the following:
1. the nature of the problem (the reason why a social support group is necessary)
2. how the support group came into being
3. how the support group communicates with its members
4. how the support group communicates with the public
Looking back
Study unit 13 introduced you to health communication in multicultural contexts: in-
trapersonal, interpersonal, group, organisational and mass communication contexts.
We explained these contexts by relating them to relevant health communication
models and by emphasising the importance of being aware of and sensitive to cultural
differences in healthcare settings. We concluded this study unit with a case study on
OCD to show you how the various contexts of health communication are applicable in
real life situations and can be analysed as such by researchers.
In study unit 14 we look at the meaning of nonverbal communication in multicultural
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health communication contexts. A knowledge of the meaning of these variables is
important for all participants in healthcare situations. A knowledge of these nonverbal
skills is also important in communication situations in everyday life. In other words, it is
important that you can apply these life skills in everyday multicultural encounters.
Test yourself
1. Explain how you could change some of the health beliefs of people you know or
know about. Relate your discussion to the health belief model.
2. Discuss the two models that explain interpersonal relationships in the healthcare
context.
3. Discuss the concept of healthcare teams and some of the problems that healthcare
teams may encounter that hamper the successful functioning of these teams.
4. Explain in your own words the importance of ethics committees in a democratic
society.
5. Describe the concept of a social support group. Illustrate your description with an
example of a social support group.
6. How do healthcare organisations accomplish what are sometimes complex
healthcare goals? Add appropriate examples.
7. Explain the differences between internal and external organisational
communication.
8. Why is a tendency to ethnocentrism harmful to multicultural relationships in
healthcare organisations? Explain.
9. Describe the meaning of meta communication in healthcare organisations.
10. Discuss the importance of good leadership in multicultural healthcare
organisations.
11. Discuss the role and possible influence of the mass media in health
communication.
12. Identify any social support group of your choice and apply the main ideas of the
OCD support group to the group you have identified.
List of sources
Geist-Martin, PE, Berlin, R & Sharf, BF. 2003. Communicating health: personal, cultural,
and political complexities. Belmont, USA: Thomson, Wadsworth.
Kar, SBR, Alcalay & Alex, S (eds). 2001. Health communication: a multicultural
perspective. London: Sage.
King, IM. 1981. A theory for nursing: systems, concepts, process. New York: Wiley.
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Kreps, GL & Kunimoto, EN. 1994. Effective communication in multicultural healthcare
settings. London: Sage.
Martin, JN & Nakayama, TK. 2007. Intercultural communication in contexts. London:
McGraw-Hill.
Melkote, SR. 1989. Effectiveness of development-radio programming among poor
farmers: a case study. Gazette 43(1):1730.
Melkote, SR & Steeves, HL. 2001. Communication for development in the Third World.
2nd edition. New Dehli: Sage.
Northouse, LL & Northouse, PG. 1998. Health communication: strategies for health
professionals. 3rd edition. Norwalk, Conn: Appleton & Lange.
Obsessive-Compulsive Disorder. http://www.health24.com/mind/Psychology_A_Z/
1284-1307,25972.asp Accessed on 2007-07-15.
Obsessive-Compulsive Behaviors and Disorders: symptoms, treatment, and support.
http://www.helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm Ac-
cessed on 2007-07-15.
Robinson, M. 2002. Communication and health in a multi-ethnic society. Bristol: Policy.
Rogers, CR. 1951. Client-centered therapy. Boston: Houghton Mifflin.
Roseman, E. 1993. How to overcome intergroup conflict, in Perspectives on health
communication, edited by BC Thornton & GL Kreps. Ill: Waveland.
Rosenstock, IM. 1974. Historical origins of the health belief model. Health Education
Monographs 2(4):354386.
Steinberg, S. 2007. An introduction to communication studies. Cape Town: Juta.
The impact of HIV/Aids on Africa. 2007. http://www.avert.org/aidsimpact.htm Accessed
13/ 07/ 7007.
Tjale, A & De Villiers, L. 2004. Cultural issues in health and health care. Lansdowne:
Juta.
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Study unit 14:
Nonverbal, intrapersonal and interpersonal skills in
healthcare
Corrie Faure
Overview
In study unit 14 we discuss nonverbal communication and some of the skills involved in
coping with multicultural healthcare situations. It is about practical ways of improving
communication between health professionals and their clients and colleagues. There is
no right way, no single method of ensuring that health professionals will be understood
by others, but there are many straightforward methods of helping them to communicate
more effectively in healthcare situations. In this study unit we highlight some of those
methods and point out some obstacles that may get in the way of effective health
communication. Of course, many of these skills are not restricted to specific health
communication settings and contexts. Even if you are not part of the health profession,
you could benefit from this study unit. After all, all of us are sometimes, in one way or
another, clients of the healthcare profession.
KEY CONCEPTS
nonverbal communication kinesics
proxemics paralinguistics
touch (haptics) environmental factors
empathy engaged listening
control personal control
relational control trust
self-disclosure confirmation
14.1
Introduction
For health professionals to provide effective healthcare they need to communicate

effectively with their patients. Effective communication focuses on understanding pa-
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tients' explicit and implicit health needs. This means that health professionals at all
levels should pick up and understand both overt (or obvious) and hidden messages from
patients and communicate messages competently. In other words, health professionals
must be able to recognise and understand the meanings of the messages they receive
from patients and they must convey messages that patients can understand and relate
to. However, we cannot assume that health professionals will automatically be good at
all appropriate forms of communication in the various situations they are likely to
experience.
Study unit 14 introduces you to various nonverbal health communication dimensions.

We describe the role of nonverbal aspects in health communication by applying five
major communication dimensions to various healthcare situations: kinesics, proxemics,
paralinguistics, touch and environmental factors. We also introduce you to specific
intrapersonal and interpersonal skills that will help health professionals to communicate
effectively in multicultural healthcare settings. In this study unit, we show you that
intrapersonal attitudes and knowledge influence interpersonal communication skills
dramatically. Because it is not possible to discuss all the skills that health professionals
might need to communicate effectively with their clients, we select a few skills that are
especially important in multicultural healthcare settings. The skills we discuss are em-
pathy, engaged listening, control, trust, self-disclosure and confirmation (Martin &
Nakayama 2007; Northouse & Northouse 1998).
Read the following scenario that illustrates some of the intrapersonal (nonverbal) and
interpersonal skills that we discuss in this study unit.
Mary is devastated. Her two-year-old little boy drowned in a swimming pool. Mary's
doctor knows exactly what she is going through because his sister's little boy died last
year in a motor car accident. The doctor comforts her and shows that he
understands her feelings of despair and also of guilt. He listens to her story of how it
happened with full attention. He gives her ample time to sort through her innermost
emotions and tries to answer her questions truthfully and honestly. Obviously Mary
trusts her doctor otherwise she wouldn't tell him how she really feels about her
terrible loss. His attitude and patience shows her that he takes her feelings seriously
and that he will prescribe the best possible treatment to help her to take the first
steps in the long healing process. She will never be able to forget her son, but she will
be able to live her life again and in the end move on.
Next, do your first activity. You are still at the beginning of this study unit and therefore
we only expect you to use your basic intuition and basic life skills to recognise some
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implied nonverbal communication and some of the health communication skills the
doctor displayed in dealing with the bereaved patient.
Activity
14.1 Explain how you experience the above scenario by identifying and discussing some
basic nonverbal communication and health communication skills.
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After studying the remainder of this study unit, you could go back to this activity and try
to improve on your discussion.
14.2
Nonverbal communication in healthcare
Nonverbal communication is the opposite of verbal communication (the words and

phrases we use when we speak or write). Nonverbal communication is communication
without words, which can be vocal (eg sobbing sounds) or nonvocal (eg facial ex-
pressions) as well as intentional (eg gestures) or unintentional (eg staring). Nonverbal
communication has many different purposes in the communication process: to express
feelings (eg frowning), to regulate interactions (eg yawning, which implies that the
interaction should end, or vocal sounds such as `àh'', which could encourage more
interaction), to validate verbal messages (eg a nod of the head to emphasise that you
agree), to maintain self-image (eg wearing a formal suit) and to maintain relationships
(eg hugging). Verbal and nonverbal communication work closely together. In fact, there
is no way that we can use verbal communication without using some form of nonverbal
communication. Nonverbal messages always surround and influence the meaning of
verbal messages. However, be aware that there is no dictionary that explains nonverbal
behaviour. Generally, nonverbal messages are more ambiguous than verbal messages.
This means that nonverbal messages do not always mean what people think they do
(Steinberg 2007). In other words, nonverbal behaviour has multiple rather than single
meanings.
In healthcare settings health professionals have to learn to really listen to their patients
and this involves not only noting the things patients say verbally. Health professionals
have to be aware and conscious of the fact that in healthcare situations in particular, the
things patients do not say the nonverbal messages are sometimes more important
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than the things they do say. For example, when a patient says `Ì don't have pain'' but
his body posture shows a back problem, the health professional should be aware that
the patient is perhaps trying to be brave or is generally not inclined to complain. In
other words, health professionals have to be attentive to the nonverbal messages that
patients unconsciously convey. In this subsection we apply five major nonverbal
communication dimensions to various healthcare settings: kinesics, proxemics, para-
linguistics, touch and environmental factors (cf Northouse & Northouse 1998:127158;
Tjale & De Villiers 2004:115; Martin & Nakayama 2007; Steinberg 2007).
14.2.1
Kinesics
Kinesics is the study of body motion as a form of communication. This includes such
areas as gestures, body movement, posture, facial expressions and eye movement.
Gestures are one of the most obvious and common forms of nonverbal communication,
and they are often used instead of words. For example, a nurse uses a hand gesture to
show a patient's significant others where his or her ward or bed is, or colleagues greet
one another with a handshake. We often combine nonverbal messages such as ges-
tures, facial and eye expressions. For example, together with the hand gesture the nurse
also smiles and her eyes radiate friendliness or goodwill. Through facial and eye ex-
pressions we communicate powerful emotional messages either unconsciously or
consciously (eg goodwill, mood, anxiety, pain, tiredness, misunderstanding). Often our
deepest feelings show in our eyes (eg love and hate). Eyes are what we call ``mirrors of
the soul'' in other words, our eyes show what we feel or think. We also can convey
meaning through direct eye contact (eg `Ì am listening and what you say interests me''),
staring (eg `Ì don't understand what you are saying'' or `Ì am bored''), as well as
blinking behaviours (eg `Ì am nervous''). In other words, kinesics can tell us about a
person's emotional state and level of interest in a situation or in another person. Facial
and eye expressions are major sources of emotional information in healthcare settings.
Activity
14.2 Define kinesics and discuss, in the form of an example, a situation where you ex-
perienced confusing nonverbal communication or a situation where you experienced
complementary nonverbal communication. It is necessary that you relate your example
to a healthcare context.
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Lastly, health professionals should be aware of their own facial expressions as well as the
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facial expressions of their patients. For example, health professionals should be careful
that they do not show disgust or disbelief in their eyes or facial expressions when
patients tell them of `ùnmentionable'' experiences in their past. If patients become
aware of any negative reaction on the part of the health professional they will stop
talking and opportunities for health professionals to help such patients will be lost.
Health professionals must remain professional and hide their personal feelings in such
cases. In general, thoughtful and considerate use of eye contact can help patients to feel
more at ease in healthcare settings.
14.2.2
Proxemics
Proxemics is the concept we use when we refer to how people use and interpret
personal and social space. In healthcare settings proxemics deals primarily with things
such as the importance of and also the lack of personal space that patients experience.
Space communicates strong messages and influences healthcare in an important way.
Let us explain.
Personal space, or one's own territory, is important because it provides us with a sense
of identity, security and control. Individuals feel threatened when others invade their
territory; it creates anxiety and produces feelings of loss of control.
Before you attempt the next activity, read the following scenario that aims to explain the
importance of proxemics in healthcare settings in simplified terms.
In healthcare settings patients always experience invasions of their personal space.
For example, when Selina Khumalo was admitted to a hospital she had to give up
the personal space and privacy of her own home. She was required to stay in an
entirely new setting and had to live with strangers in the same room strangers she
had never met before. In addition, she had to undergo many tests and other
diagnostic procedures that further invaded her sense of privacy and personal space.
She had to share her room, dining area, lounge area and bathroom with unfamiliar
faces. In other words, she had little space to call her own. As a result she
experienced anxiety and even aggression. The result was that she withdrew herself
socially. In this way she tried to cope with the loss of personal space.
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Activity
14.3
Explain, by means of a scenario, how you could help patients overcome problems
related to proxemics.
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Take note that when you do the activity that although health professionals may not be
able to eliminate problems related to proxemics, they can help to reduce the anxiety
that patients experience as a result of intrusions and loss of space. Health professionals
can help patients by doing the following for example:
. Show respect. Health professionals must recognise patients' hospital territory, their
belongings and their right to privacy.
. Allow control. Health professionals must allow patients to make decisions about
their territory, for example whether the door should be open or closed, whether the
shades should be up or down, and where the bedside table should be placed.
. Supply information. Health professionals must recognise patients' individuality
and provide explanations for activities and procedures that directly or indirectly
affect them.
. Recognise the need for privacy. If possible, protect patients against unnecessary
body exposure and minimise the discomfort involved in procedures that require the
invasion of privacy.
Next, we focus on paralinguistics or paralanguage on how the voice plays a role in

the interpretation of messages.
14.2.3
Paralinguistics
Paralinguistics refers to vocal sounds such as `àh'' and `ùm'', for example. It also refers
to the volume, pitch, tone and rate of someone's speech and expression in their voice.
All these affect how we interpret messages. These clues often give a clear indication of
the emotional feelings of the communicator. Paralinguistics is the vocal form of non-
verbal communication and, therefore, closely tied to verbal communication.
The tone of voice that health professionals use when speaking to patients has a sig-
nificant effect on the patient's level of compliance and how they experience an in-
terview with health professionals, for example. It is easy for patients to detect from the
tone of voice when health professionals are in a hurry or relaxed. Patients can often
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determine the level of sincerity and concern from the way that the health professional
speaks to them rather than from what is said. Loud, rapid, forcefully spoken words can
intimidate patients and communicate aggressiveness and even contempt. On the other
hand, soft, slow, expressionless speech may communicate lack of interest to the patient.
Activity
14.4 How do you think health professionals should communicate with their patients? Answer
this question by relating it to paralinguistics and to your own experiences or other
people's experiences that you know about.
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When answering the above question, take note that health professionals should pre-
ferably use a clear speaking voice. In other words, health professionals should speak
loud enough for patients to hear all the words, but not so loud as to frighten them. They
also should speak with enough expression to hold patients' interest and attention. They
should establish a relaxed communication climate by trying to limit environmental
sounds (eg by closing the door of the consulting room).
14.2.4
Touch
Haptics or touch is a kind of nonverbal communication that can convey a variety of
meanings. For example, a firm handshake can convey self-confidence, a gentle squeeze
can mean ``please pay attention'' or an enveloping hug can convey friendliness, warmth
and love. These are all forms of touch. Touch has particular relevance for health
communication and health professionals use touch for many different purposes. For
example, touch can ease patients' sense of isolation and can provide comfort. Touch is
also an important tool that health professionals have for diagnosing health problems (eg
patients have all heard health professionals asking: ``Where does it hurt most here or
here?'' while touching problem areas on their bodies).
Various factors influence the meaning of touch. For example, in healthcare settings, the
gender of patients and the gender of health professionals can affect the receptivity to
and the meaning of touch. Social cultural factors and background also influence our
reaction to touch. In other words, our family environment and early experiences in-
fluence our preferences and how comfortable we are with touch as adults. Some
cultures are what we call ``contact'' cultures while others are ``noncontact'' cultures. For
health professionals it is important to understand that individual differences exist within
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each culture and that the type and location of touch, the duration of touch and the
nature of the relationship influence interpretations.
Activity
14.5 How do you think health professionals should use the often necessary skill of touch or
haptics? Answer this question by relating it to your own experiences or other people's
experiences you know about.
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Generally, health professionals should use a functional-professional type of touch (for

diagnostic purposes or a gentle squeeze to give comfort and show empathy). Un-
fortunately there is no precise formula for determining whether or not to touch patients,
and there is no universally accepted meaning that can be given to a single touch. But
there are some general guidelines that can be used to increase the likelihood that touch
will be perceived positively in therapeutic relationships:
. Appropriateness of touch. Health professionals should use a form of touch that is

appropriate to the particular situation. For example a person who has just been told
distressing information (eg that a son has been injured in a car accident) may
respond positively to the health professional who places his or her hand on the
distressed person's arm.
. Intimacy needs of patients. Health professionals should not use touch to impose
more intimacy on patients than they desire. Touch gestures must adapt to the
intimacy needs of patients.
. Reactions of patients. Health professionals must observe patients' responses to
touch. This is especially important when touch is used in initial meetings with
patients and the health professional has no prior knowledge of how a patient will
respond. If a patient pulls away, appears frightened, or displays tense facial muscles
or other anxious body gestures, health professionals should know that these are
negative responses to touch. But if patients, after a touch gesture, appear to relax or
seem more comfortable then it is likely that the touch is being received positively. It
is important that health professionals should be aware of potentially negative
responses to touch, of situations in which the meaning of touch can be
misunderstood, and of situations in which the message conveyed by a particular
type of touch is not compatible with the nature of the relationship. However, in
healthcare situations in which both the health professional and the patient are
comfortable with touch, and the use of touch is assessed for its therapeutic effects,
touch can be a very valuable means of communication.
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Next, we discuss the influence and importance of environmental factors as a health
communication variable that has an impact on health and healthcare.
14.2.5
Environmental factors
Environmental factors such as formal and informal healthcare settings, privacy, various
forms of constraint, environmental sounds as well as physical and psychological dis-
tance communicate powerful messages and can have a major impact on patients and
their significant others in healthcare settings. All these factors influence the type of
messages that health professionals communicate to patients. These factors also influ-
ence interpretations of messages and the degree of comfort or discomfort patients feel
with messages. Let us explain.
. Formal and informal healthcare settings. Patients react differently to formal and
informal healthcare settings. Large healthcare settings in urban areas seem more
formal than clinics in rural areas, for example. In formal healthcare settings
communication will also be more formal (superficial, less relaxed, more hesitant,
and generally more difficult) than in more informal healthcare settings. Formality is
emphasised by factors such as the smell of disinfectants, colour of the room, white
uniforms and the position of furniture. Think about stark white examination rooms
and bright fluorescent lights that give an impression of coldness while
psychologically warm environments encourage patients to feel relaxed and
comfortable.
. Degree of privacy. Partitioned or enclosed environments, where interactions
cannot be easily overheard by others, are associated with privacy, for example.
Think about patients confined to a six-bed ward this offers little personal privacy
even with curtains drawn around patients' beds. Although this offers visual privacy,
the patient in the next bed can still hear everything that is said.
. Constraint. A further environmental factor that influences health communication
has to do with freedom of movement a lack of freedom (eg patients who are not
able to leave their beds) causes constraint. Patients who can move freely about their
rooms would probably perceive the environment as less constricting than the
patient who is anchored to a bed because of monitors and equipment. In
environments where physical and psychological constraint seems high, people will
be slower to share and initiate personal disclosures.
. Sounds or noise. The clatter of trolleys, the beep of monitors, the click of
respiratory equipment and the rattle of equipment trolleys are all familiar hospital
noises that influence health communication and the degree of anxiety that patients
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experience. Health professionals are accustomed to these environmental sounds
and do not notice them, but these sounds often cause patients and significant others
distress. These `'normal'' sounds can interfere with rest and recovery, for example.
Environmental sound is therefore another irritant for patients who are already in
pain.
. Physical and psychological distance. Hospital rooms at the end of a long hallway
may seem both physically and psychologically distant from other patients' rooms
and the nursing station, for example. There is limited possibility of communication
with other patients and health professionals and little chance of getting sufficient
attention (dying patients are often placed at the end of hallways).
In general, healthcare settings represent unfamiliar surroundings for patients espe-

cially for patients and family members who have never been there before. This often
causes cautious and hesitant behaviour.
The above examples represent only some of many possible dimensions that influence
effective health communication. Many of these dimensions overlap and interrelate with
one another. Generally, more personal communication is associated with informal,
unconstrained, private, familiar, close, quiet and warm environments.
Activity
14.6 Write a scenario which describes how you think stress factors that are caused by
negative environmental factors in healthcare settings could be lessened. Think about
this mostly unavoidable situation and try to find some answers to the problem. For
example, why should hospital patients be woken up at five o' clock in the morning for a
bed bath? Could hospital routine perhaps be changed in some cases?
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In general, health professionals should be aware of and sensitive to environmental

factors that influence health communication. Solutions are not always in the hands of
health professionals. However, many suggestions have been made on, for example,
how to reduce noise in healthcare environments. These suggestions include health
professionals
. using normal voice tones when talking

. limiting unnecessary interactions during night hours or at times when patients are
sleeping
. placing equipment (when possible) away from patients' bedsides
. being provided with conference areas
. becoming involved in designing better noise-limiting structures
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To combat the problem of psychological and physical distance new hospitals should be
designed with nurses' stations in the middle with rooms forming a circle around them.
This design would replace older designs where the nursing station is the midpoint
between two long wings. Other structural changes could include more lounge areas for
patients and significant others, and various kinds of open and closed areas in the units in
which staff can interact with patients as well as with other staff members.
From the above it is clear that the healthcare environment does not have a neutral role
in health communication. It can facilitate or inhibit communication within a particular
setting, and environmental components require close attention from health profes-
sionals.
To conclude, do the next general activity to make you more aware of the importance of
most of the nonverbal health communication skills we discussed in this section.
Activity
14.7 Watch a television situation comedy and/or drama series and/or film depicting medical
or healthcare settings. Try to find examples of kinesics, paralinguistics, touch or haptics,
proxemics and environmental factors that influence communication in that particular
healthcare or medical environment.
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When doing this activity, you must remember that verbal and nonverbal communica-
tion should be treated as a total and inseparable unit. Nonverbal behaviour can repeat,
contradict, substitute for, complement, accent, or regulate verbal behaviour. You also
have to remember that nonverbal communication is culturally oriented, and that you
have to be sensitive to the fact that one culture might not use or view nonverbal
behaviour in exactly the same way as another. Nonverbal communication is particularly
important in the healthcare setting.
Next, we discuss the various health communication skills in detail. We illustrate these
skills with examples and provide activities for your benefit. By doing these activities you
can make sure that you understand the discussion on which the activities are based
satisfactorily.
14.3
Intrapersonal and interpersonal skills
In this section, we show you that intrapersonal and interpersonal skills can influence
effective health communication dramatically. We concentrate on a few skills that are
especially important in multicultural healthcare settings.
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14.3.1
Empathy
Empathy affects all types of communication relationships from our everyday social
relationships to intense therapeutic health communication encounters. It plays an im-
portant role in all effective interpersonal communication. But what do we mean when
we speak about empathy? Essentially we are referring to the concept of `ùnder-
standing'': the understanding of someone else's thoughts and feelings. Rogers (1975:4)
defines empathy as a process that involves `èntering the private perceptual world of the
other and becoming thoroughly at home in it''. In simple terms, this involves being
sensitive to the feelings of others, to the fear, anxiety, rage, tenderness, happiness or
confusion or any other feeling that the other person experiences during a commu-
nication encounter.
Empathy is not the same as sympathy. Although these two concepts are frequently used
interchangeably, their meanings are quite different. Sympathy is ``the concern, sorrow
or pity shown by an individual for another individual'' (Northouse & Northouse
1998:24). It is the expression of one's own feelings about another person's problems,
whereas empathy is the sharing of another's feelings and not the expression of one's
own feelings about a problem someone else is having.
To help you to understand the meaning and importance of empathy in healthcare

settings we give you the following scenario and then the next activity to do. Relate the
activity to your own life world by writing a brief scenario.
We find ourselves in a hospital ward where a patient receives bad news from his
doctor. The doctor announces with a big smile that his diagnosis of Hodgkin's
disease is correct and he sounds quite pleased with his achievement. However, the
patient is shocked, fearful, horrified and devastated. The doctor is preoccupied with
the diagnostic process and fails to be sensitive to the patient's feelings. On the other
hand, the nurse, who is also present, has tears in her eyes. Although she does not say
anything, she is the only one who shows that the patient's feelings of horror and fear
are justified. The patient receives some consolation from the nurse's reaction.
Activity
14.8 In your view, what does the above scenario show us? Explain your views in the form of a
brief scenario about the lack of empathy as well as the display of empathy. Relate your
views to your own life world or the life world of your significant others.
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The scenario shows that empathy is an essential personal quality that a health profes-
sional must have. Health professionals must be able to make patients' perspectives their
own they must understand their patients' feelings. If you can convey empathy to
patients, they are more likely to feel reassured and understood. According to Williams
(1997:90) one way of doing this is by showing patients that you are paying attention to
them. This means that you
. must make eye contact

. have an appropriate facial expression
. nod your head
The above three forms of nonverbal communication show that you are interested in
them and in their problems. These nonverbal signs together with a warm, friendly tone
of voice will encourage patients to make contributions to the discussion.
Byrne and Byrne (1996:31) write that `àccurate empathy is an active skill that must be
acquired through sensitive training, and then maintained by relentless practice over a
whole professional career. It is rare for any person to know just how another person is
experiencing the world. Usually, a person can achieve that knowledge only through a
laborious process of listening, adjusting guesses and listening some more''. Empathy
means, among other things, learning a patient's private language, both verbal and
nonverbal. Without this, signs both important and trivial may be missed by the health
professional, with the result that communication becomes confused and the patient
loses trust in the health professional. For the skill of empathy you therefore need the
intrapersonal qualities of patience, sensitivity and understanding and must apply these
qualities in interpersonal communication with patients.
14.3.2
Engaged listening
Engaged listening is a very important part of being a health professional. Kreps and
Kunimoto (1994:53) write that engaged listening involves `à critical representation of
concern that one person can communicate to others in any setting, but particularly in
health settings''. Before we can listen to someone we have to truly focus on the other
person. It involves consciously making ourselves aware of what the other person is
saying and what they are trying to communicate to us. A good listener makes space for
the other person to reply. Burnard (1992:25) writes: `Ùnfortunately, most of us feel
obliged to talk! Unfortunately, too it is òvertalking' by the healthcare professional that is
least productive.'' We have to learn to give our full attention and really listen to other
people then we can do much to help them. Engaged listening is therefore an es-
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sential skill, and just as important as any verbal communication. It is necessary for each
person to listen before they are able to respond appropriately. How you can develop
effective listening skills that are essential in health communication is the topic of the
next few sections.
14.3.2.1 How to develop your listening skills
We first identify some essential elements for developing effective listening skills and we
then discuss them briefly (Burnard 1992:5861; Williams 1997:4649).
For effective listening we need to do the following:
. Be private and the environment must be distraction free.

. Sit at right angles to or opposite the other person.
. Maintain an open position.
. Lean slightly toward the other person.
. Nod our head now and then.
. Maintain reasonable eye contact with the other person.
. Relax.
Next, we briefly explain some of the essential elements for effective listening skills
in healthcare contexts from the viewpoint of a health professional:
Privacy and a distraction-free environment create the right atmosphere for effective
health communication interruptions are reduced and health professionals are able
to concentrate on their patients. The right atmosphere will, for example, communicate
to a patient that the doctor's attention is focused on him or her.
Sitting at right angles to or opposite patients, rather than next to them, allows health
professionals to see all aspects of communication, both verbal and nonverbal, that
might be missed if they sat next to their patients.
Maintaining an open position is the opposite of having crossed legs and folded arms.
This body posture (folded arms, etc) can convey a defensive feeling to patients and
counselling is often more effective if healthcare professionals sit without either crossing
their legs or folding their arms.
Essential elements that encourage patients to keep on talking are when health pro-
fessionals show they have empathy by leaning slightly toward patients, maintaining
reasonable eye contact with them and nodding their heads. These are strong nonverbal
signals of attentiveness. Using body language in this way will show patients that health
professionals are prepared to listen to them.
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It is lastly also very important that health professionals relax while they listen. This
means that they should refrain from ``rehearsing responses'' in their heads. In other
words, they must give themselves up completely to the task of listening and trust
themselves to make appropriate responses when they have to.
According to Williams (1997:47): ``listening is a mental activity (or intrapersonal) that

requires effort and concentration''. Sometimes, although we think we have listened, our
attitudes, preconceptions and prejudice distort the message. Here is a scenario of how
assumptions about the patient have prevented the health professional from ``hearing''
the patient's real concerns:
Patient: `Ì would like to try to come off the tablets and see what
happens.''
Health professional: `Ìt is important that you continue with the tablets. We know
that any recurrence of the inflammation is usually worse.''
Patient: `Ì would still like to try.''
Health professional: ``There is no need to worry if you are thinking about getting
pregnant. We know that this type of drug has no effect.''
Patient: `Ì will stop the tablets for a few months and see what hap-
pens.''
Health professional: ``That's up to you then.''
Activity
14.9 What do you think the above scenario shows us? Explain your views by rewriting a
similar dialogue that clearly displays the skill of engaged listening.
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Take note that the patient's real concerns were not about getting pregnant, but about
the long-term effects of taking the medication. The health professional had assumed
from his previous knowledge of the patient's medical history that she was anxious about
having a baby. Look at the same situation where the health professional listens and
responds to what the patient is trying to say. (Your dialogue could of course differ from
our version, but that is irrelevant as long as you emphasised in one form or another that
the health professional was seriously practising `èngaged listening'' techniques.)
Patient: `Ì would like to try to come off the tablets and see what
happens.''
Health professional: ``You would like to stop the medication. Are you having any
problems with the tablets?''
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Patient: ``No. The tablets are okay. It's just that I don't like the idea of
taking tablets forever.''
Health professional: ``You don't like the idea of staying on long-term medication.''
Patient: ``No. It can't do your body any good taking all this stuff all the
time. And it's quite a drag carrying them round and making
sure I take the right dose.''
Health professional: ``There are few side-effects with this drug. They usually show
up fairly soon after people start taking them. You have no
signs of any of these side effects, so you are unlikely to de-
velop them in the future. However, we will be regularly
monitoring you.''
Patient: ``What happens if I stop taking them?''
Health professional: ``We know that people usually have a flare up of the condi-
tion fairly quickly. Unfortunately the symptoms are usually
worse. My advice is to continue with the medication.''
Patient: `Ì suppose I had better carry on taking them.''
Health professional: ``We could try you on a reduced dose and see what hap-
pens.''
Patient: ``Yes. I would like to try that.''
Health professionals have to follow patients' leads rather than imposing their own
interpretations. By matching their verbal responses to what patients are saying, they
show that they have listened. Although the second exchange is longer, the patient is far
more likely to comply with the health professional's advice.
14.3.2.2 How to sharpen your listening skills
It takes practice to sharpen your listening skills. You have to ask yourself questions such
as the following (Williams 1997:47):
. What is the person saying?

. Do you know why they are saying it?
. Are they consistent in what they are saying?
. How does what the person is saying compare with what you know already?
. In what order do they say things? (This will give you some clues as to their priorities.)
. How do they convey their message? (Do they talk too quickly? Do they make
themselves clear? Are they hesitant?)
Watching and listening go together. These elements complement each other. When you
are listening to a patient compare what you observe with what you are hearing. For
instance, when you ask a patient ``How are you today?'' and he or she answers `Ì'm
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fine'' but looks away in discomfort you need to be alert and attentive to a ``hidden''
problem.
14.3.2.3 Engaged listening in multicultural health communication
Listening and acting on the information reduces uncertainty. Uncertainty or feeling
unsure is a primary barrier to effectiveness in multicultural communication. Research
has shown that surgical patients who are told, in detail, of the nature of the post-
operative discomfort they can expect will recover as much as one-third faster than those
left in the dark (not given information). Providing patients with accurate information, in
their own language or in a language they can understand, and allowing them to make
knowledgeable choices about their treatment is moral or ethical (doing the ``right''
thing) as well as a legal requirement (enforced by the laws of a country). The legal
requirement of healthcare practice is known as informed consent. Failure to provide
patients with full treatment information leads to surprises that can be discomforting to
patients. In contrast, providing full and accurate information helps them to prepare for
treatment and its side-effects.
Activity
14.10 What do you think could happen if patients do not receive sufficient information from
the health professional about their health condition? Explain by way of an example that
relates to your own or your significant others' experiences.
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If, for example, a patient is told that he or she will suffer from severe shortness of breath
for a few days after the operation then the patient knows what to expect and can deal
with it. If kept in the dark, patients might think that something is seriously wrong and
that the operation was a failure. Unfortunately, no amount of explanation will help at
that stage. It will be too late; patients will assume that the health professional is lying
and that they are dying. This causes emotional stress and could delay recovery.
Everybody seeks predictability. In fact, the more uncertain, frightening and complex the
situation, the more we grasp for predictability. Listening to patients and considering their
input in the decision-making process is crucial in healthcare, and in multicultural health
situations health professionals must make a special effort to help their patients to
understand their treatments and their side-effects.
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14.3.3
Control and empowerment
Control influences empowerment in healthcare settings (Tjale & De Villiers 2004). This
means that when you as a health professional are in control of a communication
encounter with a patient (eg you dominate the communication by giving guidelines),
you must learn when you need to listen to the patient to share control with the
patient and listen to his or her contribution. In other words, you must develop the skill
of empowering the patient by giving him or her a share of the control you had during
the encounter (you make a conscious decision about it). Empowering patients means
showing your willingness to:
. be more culturally sensitive (eg by asking the patient whether he or she understands
a specific guideline) or a healthcare worker who is more sensitive to what the
patient believes is causing her mental ill health even if the patient's beliefs are
culturally very different from the psychologist's.
. increase your understanding and empathy (eg do not rush the patient when he or
she tries to explain his or her views or give nonverbal cues that your time is
limited)
. convey the importance of meaningful multicultural relations (eg make an effort to
take the patient's views into account)
It follows that it is important for you as a health professional to understand what patients
are saying as well as to understand patients' cultural differences. Empowering means
that you take the other person seriously, and you demonstrate this by the action you
take based on what you hear (Tjale & De Villiers 2004). In other words the sharing of
knowledge leads to mutual respect and empowerment.
Control is an integral part of most communication encounters. This means that

whenever an individual is influenced by or influences another person or event, ele-
ments of control are present. We distinguish two types of control: personal control and
relational control.
14.3.3.1 Personal control
Personal control is the perception (understanding or idea) that people have that they
can influence the way in which circumstances affect their lives. The perception of being
in control minimises feelings of powerlessness. It is important for people to see their
environments as being controllable and predictable. Control does not need to be ex-
ercised to be positive; it is sufficient to feel in control.
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14.3.3.2 Relational control
Relational control refers to the perceptions individuals have about their relationship
with others, and the degree to which they feel able to influence these relationships.
Issues involving personal and relational control constantly confront both patients and
health professionals in healthcare settings. Control is important to patients primarily
because they are experiencing the loss of it. For health professionals, control is im-
portant because it is through the negotiation or sharing of control that they are able to
work effectively with patients and with other health professionals. Most people need to
experience some sense of control over their destinies. Through a sense of control
people make sense of themselves and their surroundings.
However, patients often have no control over their destinies or surroundings. Read the
following scenario and try to understand the anxiety patients must feel when they are
admitted to a hospital ward for the first time.
Yesterday, Sibogile was admitted to a hospital ward. She discovered that a variety of
unfamiliar behaviours and attitudes were expected of her. After she undressed she
was expected to sleep on a narrow bed and had to hand over most of her personal
possessions: her money and other valuables were locked up in a cupboard (she did
not know where). She discovered that there are many, very detailed hospital rules
and regulations including visiting hours, availability of food, restrictions on
recreational opportunities and the use of toilet facilities. She realised with a shock
that her individual freedom had been severely reduced. The next day she was
subjected to invasive physical examinations, many of which she experienced as
quite embarrassing, but she got the impression that she was expected to be passive.
She just tried to answer the many questions she was asked. She was questioned in
detail about areas of her life which, under any other circumstances, she considered
very private and not open to probing. She did not understand why all these
questions were necessary and what the answers had to do with her condition the
actual reason why she was in hospital. It was also difficult for her to respond
accurately to the questions because she did not understand English very well.
Within the first few days Sibogile underwent numerous tests she sometimes
missed her meals because of them. Three times a day she had to drink unpleasant
medicine and experienced considerable discomfort and pain. Sibogile's tests were
scheduled at the convenience of hospital personnel and she was `òn call'' to the
entire staff.
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The above scenario sketches a patient's loss of personal and relational control. What are
the options to help Sibogile to accept the inevitable?
Activity
14.11 Illness leads to a feeling of powerlessness, uncertainty and insecurity. Patients feel that
they no longer have any control over their lives. With this statement and the above
scenario in mind, do the following:
1. Explain how effective multicultural health communication could ease Sibogile's

plight. Before you do this read the following hypothetical situation:
Imagine that you as a health professional are one of Sibogile's caretakers. You are a
sensitive and caring person and you realise that she is experiencing fear,
uncertainty and a loss of control. Now, rewrite the scenario and explain how you
would help Sibogile to make her stay in hospital a more pleasant experience.
2. How would you make other health professionals involved with looking after
Sibogile aware of how she is experiencing her hospitalisation? Explain this briefly in
one paragraph.
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Loss of control causes feelings of fear, anger, helplessness and incompetence. Health
professionals should be sensitive to and aware of this and help patients cope by ad-
dressing not only the problem of the loss of control, but also help them to restore their
sense of control. The health professional should attempt to do this by taking into
account the patient's environment, the patient's illness and other factors that may affect
the amount of control that is realistically available to the patient. Patients should be
assisted in gaining free control over areas they can manage alone, and the health
professional should offer help in the areas they cannot manage alone.
Health professionals should share control with patients as much as possible. This is not
easy and there are no simple prescriptions for how control should be shared. However,
being aware of patients' need for control is a first step in this sharing process. This
awareness, coupled with flexibility and a willingness to share control, will result in better
interpersonal health communication and more productive healthcare relationships.
14.3.4
Trust
Trust involves accepting others without evaluating or judging them. We define trust as
`àn individual's expectation that he or she can rely on the communication behaviours
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of others'' (Northouse & Northouse 1998:41). Trust gives relationships a special, un-
ique, positive quality that sets them apart from other relationships. Trust is a highly
desirable element in relationships; it creates feelings that events are predictable and that
people are basically sincere, competent and accepting. In healthcare relationships, trust
is particularly important to patients because they often feel helpless, extremely vul-
nerable and in need of support. Patients want to feel that they can depend on health
professionals to behave in predictable ways and that they can rely on health profes-
sionals' knowledge and integrity.
Two positive outcomes emerge when trust is present in relationships (Northouse &
Northouse 1998:4147):
1. Trust helps individuals to experience a sense of security, to feel that they are not
alone and that others care about them.
2. Trust creates a supportive climate in relationships which reduces defensive
communication.
These outcomes make individuals more open and honest about their attitudes, feelings
and values. In healthcare settings, the first outcome security is particularly im-
portant to patients. The second outcome a supportive climate is important to
both health professionals and patients.
All the different types of communication behaviours that health professionals use will
have a major impact on the development or lack of development of trust be-
tween patient and health professional, and on trust between health professionals.
Health professionals cannot automatically assume that others will immediately trust
them and grant them credibility just because they occupy a particular position. By
attending to others' needs and communicating in ways that create positive reactions,
health professionals can foster trust and credibility.
Imagine the following scenario:
A pregnant woman who is obviously in strong labour is admitted to the labour ward.
After a quick examination the nurse knows the patient needs an emergency
caesarean to save the baby. After much running around and a few telephone calls,
the nurse and a few helpers lift her onto a trolley and whisk her off to the operating
theatre. The gynaecologist has been notified and he is on his way. The patient does
not know this and feels confused and bewildered she expected a normal labour.
She is in the theatre and ready to be prepared for the operation. The gynaecologist
hurries in (wearing his theatre cap and mask) and gives the instruction to begin the
anaesthetic. Although the patient is in a lot of pain and discomfort she refuses any
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further treatment. She cries out `Ì will wait for my doctor!'' and demands that
everybody leave her alone. The gynaecologist immediately understands what is
happening and takes off his glasses and pulls off his theatre mask! With a sigh the
patient smiles and tells him to go ahead ``Do whatever you need to!''
Activity
14.12 From this scenario we deduce that the patient trusts her doctor, and only him the
moment she recognises him, she feels satisfied and starts cooperating. Rewrite the
above scenario and explain how you as a health professional (eg a nurse) can help the
patient to remain calm and sure of her situation despite the pain she has to endure.
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Patients and especially pregnant mothers are inclined to trust only their own
doctor the doctor they have come to know and trust during their months of preg-
nancy. You as a health professional (eg a nurse) must understand this, and the best way
to avoid a situation such as in the above scenario is to communicate with your patient.
You have to hold her hand and explain what is happening to her, why it is happening
and what will probably be happening in a little while. You have to reassure the patient
continuously and tell her that you have contacted her doctor and that he is on his way.
Tell her that she will see her doctor before the operation and that he as always
will take good care of her. You could also add that the theatre staff will look very
different in their anonymous uniforms and masks, but add that this is only to protect her
and the baby from any contamination. The doctor knows his patient very well and he
immediately spots her confusion in not recognising him. He rectifies this and the patient
starts cooperating quite happily. However, the doctor made one serious mistake; he did
not acknowledge the patient when he entered the theatre. Before giving any orders for
an anaesthetic, he should have greeted her and reassured her first.
14.3.5
Self-disclosure
Self-disclosure refers to open communication, which is essential in the development of
healthy interpersonal relationships. We view self-disclosure as any message about the
inner self that one person communicates to another. It is a process whereby an in-
dividual communicates personal information, thoughts and feelings (verbally and
nonverbally) to others. According to Northouse and Northouse (1998:49) ``people can
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attain health only in so far as they gain the courage to be themselves with others, that is,
to self-disclose''.
Self-disclosure, however, is not easy to accomplish in healthcare situations or in any

other communication situation, for that matter. Why is it so difficult in healthcare? Part
of the answer lies in the feelings of vulnerability and uncertainty experienced by pa-
tients who may wish to share their feelings with health professionals. For example, we
(as patients) often wonder if our reactions to illness and stress are normal. We worry that
if we disclose our feelings about our illness, others will evaluate us and find us to be
responding in weak, excessive or strange ways. Other problems, specifically applicable
to the South African health environment, may be the following:
. Patients are not able to express their feelings because of language problems (they
cannot make themselves understood verbally).
. Intercultural communication problems (eg caused by a negative attitude toward
people from other cultures).
. Influences from the environment (eg the role of the traditional belief system and
poor conditions in health services in South Africa).
The traditional belief system still influences healthcare relationships in South Africa. The
traditional healer is the most important role player in this regard. According to people's
belief system, ancestors and the spiritual world influence their lives, illnesses and
deaths. Previously, formal South African healthcare denied the importance of the tra-
ditional belief system, but the latest approach is to acknowledge the importance of this
system and to cooperate with it.
14.3.5.1 How to help patients with self-disclosure
There are three points that health professionals must take into consideration when they
want to make patients' self-disclosure easier. These points are:
. the existence or development of trusting relationships between health professionals

and their patients and/or significant others
. insuring the privacy of healthcare settings in which self-disclosure can be
encouraged
. an awareness of the individuality of patients which reflects in their different needs
for self-disclosure
Activity
14.13 Explain in your own words why self-disclosure would be difficult in any or in most
communication situations, but especially in healthcare contexts.
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In your answer to the above activity you must also note the following explanation:
For health professionals to be able to help patients to talk about their inner fears and
feelings there must be a trusting relationship as well as privacy. Without these aspects
self-disclosure is almost impossible. Healthcare settings are known for a lack of privacy
(eg large four-bed wards and crowded waiting rooms make disclosure of personal
information very difficult). If health professionals accept the importance of self-dis-
closure for patients and their significant others, they must work towards creating con-
texts in healthcare settings in which self-disclosure can be fostered, and then nurture
trusting relationships in which patient disclosure can be made easier.
Another aspect that health professionals should be aware of is that patients vary in their
preference for self-disclosure. Some people are comfortable sharing personal in-
formation with many people without any hesitation. Other people disclose personal
information only to one or two close family members and, even then, do so with great
difficulty and restraint. Because of this, health professionals need to assess patients'
readiness and preferences for self-disclosure. Expecting immediate self-disclosure from
patients who seldom self-disclose to anyone or who have not yet developed a com-
fortable relationship with the health professional may be unrealistic.
By becoming more sensitive to the concept of self-disclosure, patients as well as health

professionals can begin to relax some of their defensive attitudes and exchange some of
their true concerns and feelings. Such exchange may well result in increased co-
operation and understanding among all role players in the health-care setting.
14.3.6
Confirmation
We describe confirmation as communication that focuses on the importance of ac-
knowledging other people (Northouse & Northouse 1998:6071). This means that by
communicating effectively the other person knows that he or she is acknowledged,
validated and understood. All individuals wish to be confirmed and accepted for what
they are and what they can become. The meaning we establish for our lives, and our
actions and responses, all become more meaningful when they are acknowledged and
validated by others. When health professionals' communication is confirming, it helps
patients and colleagues in a variety of ways:
1. Health professionals provide recognition of patients as unique persons with real

problems. (Patients often feel that they are objects rather than people.)
2. Confirmation is essential for patients, but it is also important for nurses and other
health professionals.
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3. Health professionals assist other health professionals and patients to cope with
feelings of depersonalisation, rejection and even alienation.
14.3.6.1 How to apply the skill of confirmation
Imagine the following scenario that often happens in many hospitals.
A patient with a rare disease is visited by her doctor and 10 medical students in a
hospital ward. The doctor gives the students some background on the case and
explains the origin of the disease. He also explains the patient's progress over the last
few weeks. He shows them the patient's record and the results of numerous tests.
He then asks one of the students to examine the patient thoroughly and discuss
findings while doing the examination. He also asks the other students to give a
running commentary and advice.
Activity
14.14 The outcome of the above scenario was that the patient became agitated she loudly
voiced her desire to be treated as a person and not as an object to be studied! Why did
she react that way? Rewrite the above scenario or explain how such a situation could be
changed through the skill of confirmation.
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PART A: INTERCULTURAL COMMUNICATION

Study unit 1: THE STUDY AND HISTORY OF INTERCULTURAL

Study unit 2: CULTURE, COMMUNICATION, CONTEXT, POWER

Study unit 3: IDENTITY AND INTERCULTURAL COMMUNICATION 28

Study unit 4: LANGUAGE, NONVERBAL AND INTERCULTURAL

Study unit 5: UNDERSTANDING INTERCULTURAL TRANSITIONS 47

Study unit 7: CULTURE, COMMUNICATION AND INTERCULTUR-

Study unit 8: Conflict and the future of intercultural communication 69

PART B: DEVELOPMENT COMMUNICATION

Study unit 9: THE MODERNISATION THEORY OF DEVELOPMENT 80

Study unit 10: DEPENDENCY THEORY: CRITICAL ISSUES IN

Study unit 11: ANOTHER DEVELOPMENT: THE MULTIPLICITY-IN-

PART C: HEALTH COMMUNICATION

Study unit 12: HEALTH COMMUNICATION: AN INTRODUCTION 182

Study unit 13: Contexts in multicultural health communication 204

Study unit 14: NONVERBAL, INTRAPERSONAL AND INTERPERSO-

Study unit 15: The skill of interviewing in health communication 265

Study unit 16: Multicultural communication in health campaigns 281

Study unit 17: Ethics in multicultural health communication 308

This module consists of three parts:

Part A: Intercultural communication (compulsory)

The case studies are descriptions of a communication situation in the context of

The prescribed book for part A: Intercultural communication is:

Martin, JN & Nakanyama, TK. 2007. Intercultural communication in context. 4th

. This study guide.

Once we have looked at reasons for studying intercultural communication we will

. Is there any universality in ethics?

The development of some aspects of intercultural communication has been influenced

. The Afrocentric world-view can be described as personalistic or people-centred,

Elements of a cultural world-view refer to deep-seated belief structures within a

In understanding how intercultural communication developed we need to consider the

1. Identify the six imperatives for studying intercultural communication.

This unit is based on chapters 3 and 4 in Martin and Nakayama (2007).

Culture and communication

Culture provides the context in which communication takes place. Communication

Communication involves people and their culture. Thus culture is an important

of the creative, mutual adjustment to different circumstances. For example, in a

stimulating community life.

communication. Because culture is multidimensional and all-pervasive, scholars of

intercultural communication have defined culture in various ways. Culture can be

defined as ``the total accumulation of beliefs, norms, activities, institutions, and

communication patterns of an identifiable group of people''. Culture can also be

defined as the ``everyday activities practised by its members'' (Dodd 1991:41).

language, nonverbal communication and group identity) which are linked to a

as gas whereas in England it is a lift and petrol respectively.

accepted by an identifiable group of people. This definition highlights some of the

most important cultural variables in intercultural communication.

symbols that characterise the members of a society or nation, we need a term to

subculture. A subculture involves a set of shared symbolic ideas held by a collectivity

gay subculture, a youth subculture and a subculture of the disabled.

The three approaches to culture can be viewed as:

. learned patterns of group-related perceptions

. Why do you think was it necessary for Tony Yengeni to be cleansed?

. political, intellectual and social histories

Secondly we looked at the relationship between history, power and intercultural

1. Identify three approaches to culture.

TABLE: Three perspectives on identity and communication and relevant examples

Social Science Interpretive Critical

Familial identity: Ascribed: Resisting ascribed

Spiritual identity: Dynamic nature of