Title: Assistant Professor of Technical and Professional Communication
University: Georgia Southern University
Email: mcarrion@georgiasouthern.edu
Twitter: N/A
Website: N/A
Description of Work:
Broadly speaking, my research lies at the intersection of rhetoric, health communication, and women’s studies. I’m especially interested in how individuals come to make sense of and decisions about health controversies, and how gendered discourses shape that sense-making process. My present research is focused on maternal vaccine refusal—what are the common messages and experiences that influence this decision, how are they bound up with particular social constructions of motherhood, and how can we design communication to successfully address concerns? To answer these questions, I draw from feminist, rhetorical, and social scientific theories, as well as from both written texts and interview data.
This symposium submission is based on a study involving semi-structured interviews with fifty mothers who refused vaccines for their child(ren). Results suggested that mothers’ concerns were based less in specific misconceptions about vaccine safety (e.g., a link between vaccines and autism) and more in meanings constructed intertextually in relation to other related health discourses (e.g., prenatal nutrition). This paper uses the interview data as a jumping off point to identify and map these health discourses, proposing a model for and specific example of a risk ecology—a network of intertextual messages which shape and constrain sense-making about risk as it emerges within a particular moment and bio-social community. This ecology becomes a way to visualize the many discourses influencing public understanding about vaccines, and can help to identify texts for analysis as well as points of rhetorical intervention.
I am currently working on two additional, related projects. The first draws from semi-structured interviews with registered nurses to identify the common themes, barriers, and challenges that emerge in their communication with vaccine hesitant patients and/or parents. The second analyzes public documents from the National Vaccine Injury Compensation Program in order to explore how risk and causation are rhetorically constructed. Collectively, I’m hopeful that this research can contribute theoretically but also guide the design of effective vaccine messages and campaigns.
Symposium Submission:
“I don’t understand how these two things go together”: Toward a vaccine risk ecology
“I’m going, ‘I don’t know,’ ‘cause all the doctors are telling me that I’m only supposed to give my baby breast milk—like ‘breast milk is the be all end all, don’t give formula to your baby, don’t do this, don’t do that.’ And then I’m gonna inject all these things into my baby? And it was just kind of this—I don’t understand how these two things go together.” – Claire, 33 year-old mother of one
Rates of vaccine refusal, also called intentional under-vaccination, have risen steadily in the United States for the past two decades (Omer, Richards, Ward & Bednarczyk, 2012). A recent study found that 15% of parents reported refusing one or more recommended vaccine (Gilkey et al., 2016), and vaccination rates in some communities are well below the thresholds required to maintain herd immunity (Dredze, Broniatowski, Smith & Hilyard, 2016). The medical, economic, and social costs of this trend are significant, and calls to better understand and respond to vaccine concerns (e.g. National Vaccine Advisory Committee, 2015) have prompted a significant body of research and interventions spanning approaches from the perspectives of public health (e.g., Kennedy, Brown & Gust, 2005; Yang, Delamater, Leslie, & Mello, 2016), public policy (e.g., Parasidis & Opel, 2017; Omer et al., 2006), sociology (e.g., Berezin & Eads, 2016; Reich, 2014), and communication (e.g., Goldstein, MacDonald & Guirguis, 2015; Krieger & Sarge, 2013), to name a few.
From a health communication perspective, vaccine refusal is especially frustrating because it doesn’t seem to matter whether misconceptions about safety—a prime motivator of vaccine refusal (Salmon, Dudley, Glanz & Omer, 2015)—are corrected. Indeed, a 2014 study published in the journal Pediatrics found that successfully refuting participants’ vaccine safety concerns—in this case, debunking a link between vaccines and autism—nevertheless left them less inclined to vaccinate their children (Nyhan & Reifler, 2014). This evidence points to the inadequacy of current deficit models of vaccine communication. That is, as the quote above from Claire suggests, successfully responding to vaccine refusal also requires attending to the discursive field in which messages about vaccines are embedded.
Certainly, communication scholars have documented the ways in which risk is discursively constructed (e.g., Grabill & Simmons, 1998; Katz & Miller, 1996). Drawing from that recognition, this paper calls upon the notion of rhetorical ecologies (Edbauer, 2005; Jensen, 2015) in order to analyze semi-structured interviews with mothers (n = 50) who refused vaccines for their children. Doing so enables identification of the intertextual discourses that exist surrounding vaccine risk perception and communication; in particular, I argue that, for participants in this study, sense-making about vaccine risk is inextricably bound up with messages about prenatal and infant nutrition, pregnancy, fertility, childbirth, and breastfeeding, and especially the discourses of scientific and intensive motherhood (Apple, 2006; Liss, Schiffrin, Mackintosh, Miles-McLean & Erchull, 2012) that permeate these messages. Using this interview data as a jumping off point, this project then explores the related texts identified by participants in order to construct what I call a risk ecology—a network of intertextual messages which shape and constrain sense-making about risk as it emerges within a particular moment and bio-social community. This framework offers both a theory and method for understanding and responding to risk-related concerns in the context of vaccination.
Theoretically, this project builds upon existing scholarship that has utilized rhetorical ecological frameworks to examine health discourses (e.g., Jensen, 2015; Johnson). However, whereas much previous work in this vein has focused on rhetorical histories—tracing rhetoric as it progresses through time—this project focuses instead on multiple messages that exist contemporaneous to each other in a given moment. Because such ecologies can be difficult to bound (indeed, they span the boundaries of multiple argument spheres and discursive spaces), I argue that this is one place where field methods— such as interviews and participant observation—offer an important source in the identification of texts that can further elucidate the ecology. In this sense, what I propose draws from a rhetorical/qualitative mixed-methods approach, both in terms of data collection and analysis. In terms of data collection, these were rhetorical field methods—examining vernacular rhetorics through interviews, but also identifying written texts for analysis. In terms of data analysis, this was part thematic analysis (e.g., analyzing interview data to identify discussion of related risk messages—this was itself an inductive code) but was rhetorical insomuch as it examined how those different messages were deployed—how they work—in terms of enabling certain kinds of sense-making.
Overall, this project is in line with Keränen’s (2014) call to “identify places and strategies for rhetorical intervention in matters of public health” (p. 105) and offers pragmatic implications for the design of effective vaccine communication, especially with regard to the need to identify and cross-test messages that can reasonably be assumed as part of the related risk ecology.
References
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Parasidis, E., & Opel, D. J. (2017). Parental Refusal of Childhood Vaccines and Medical Neglect Laws. American Journal of Public Health, 107(1), 68-71.
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