Category / Culture and Health

by Lu Tang

Sharing Experiences of Depression on Douyin

Social media provides a new platform for the public, patients, and health professionals to communicate about health and illness and potentially improve health outcomes. One specific type of social media influencers extensively shares their experiences with health, fitness, and illness with their followers through autobiographic videos or posts.

Autobiographical accounts on social media could play an essential role in shaping the public’s understanding of illnesses and dispelling illness-related stigma.

In this study, we examined how people living with depression describe their illness experiences on Douyin, China’s leading video-sharing platform. Here are some of the main findings:

  • Most videos were created by young women who have lived with the illness for over three years.
  • The top three topics were patient psychology, experience sharing, and knowledge and medical advice.
  • These videos provided an overall non-stigmatizing portrayal of depression, with more than 80% of the influencers using challenge cues.
  • However, stigma cues contributed to the virality of the videos. In other words, highly negative videos adopting stereotyping descriptions of depression are more likely to generate more likes and comments.

Li, J., Tang, L., & Pu, Y. (2023). My story of depression: A content analysis of autobiographic videos on Douyin. Health Communication. DOI: 10.1080/10410236.2023.2191887 [Full text]

by Lu Tang

Are HPV vaccine interventions targeting racial and ethnic minorities doing a good job?

Image by vectorjuice on Freepik

Racial and ethnic minorities in the United States face higher risks of human papillomavirus (HPV) and are less likely to benefit from HPV vaccines. Effective HPV vaccine promotion efforts need to acknowledge and adapt to the cultural characteristics of these minority groups. 

We conducted a systematic review of all the published journal articles between 2010 and 2019 and found 26 studies reporting HPV vaccine intervention among minority populations. We further analyzed these studies to see whether and how they incorporated cultural adaptation in their interventions. Here are some of main findings:

  1. Almost all of these interventions involved some cultural adaptation. (Yeah!)
  2. Very often the adaptations were quite superficial, including community outreach and involvement or delivering the intervention in a location or through a venue convenient to the community.
  3. There is a lack of theoretically driven intervention or cultural adaptation.  Only 6 out of 26 studies mentioned behavioral or communication theories in guiding the intervention. Even though many of these studies discussed the concepts of social behavioral theories, such as efficacy, beliefs and attitudes, the majority of the researchers did not use theories to guide the design of the interventions and merely measured the aforementioned theoretical concepts as outcome variables. Consequently, it was difficult for the authors to explain why the intervention was successful or unsuccessful in creating significant improvements in the outcome variables.

Overall, we call for more comprehensive and better-designed cultural adaptations.

Zhang, X. & Tang, L. (2021). Cultural adaptation in HPV vaccine intervention among racial and ethnic minority populations: A systematic literature review. Health Education Research. Published online first. https://doi.org/10.1093/her/cyab034 [Full Text]

by Lu Tang

The Stigmatization of Suicide

Image by wirestock on Freepik

Suicide is the leading cause of death among people between 14 and 35 years in China. The suicide rate of adolescents in China is 1.5 times higher than the world average, with 16.1% of Chinese adolescents ranged from 10-19 years reporting suicide ideation and 2.94% reporting suicide attempts in the last year. Among college students, 10.7% reported suicidal ideation, and 2.8% reported suicidal attempts. The suicide rate of the 14–35-year-old group in rural areas is twice that in cities.

Suicide stigma is a mark or stereotype associated with suicide. For example, people with suicidal ideation/behaviors are sometimes seen as attention-seeking or “crazy”. Suicide stigma leads to prejudice and discrimination and is a significant barrier to effective suicide prevention since such stigma hinders people’s help-seeking behaviors.

We studied how suicide stigma is communicatively constructed by examining the stories told by college students in China. Here are some of the main findings:

  • Our participants portray those who attempt or die by suicide as “familiar strangers” through the practice of othering. Participants believe that those who have suicidal ideation/behaviors are fundamentally different from themselves in terms of personality and circumstances. People who attempt or die of suicide are usually described as irresponsible, fragile, impulsive, or attention-seeking.
  • Taking one’s own life is mostly framed as a betrayal of one’s parents and family.
  • Finally, subtle differences in the suicide stigma of people of different ages and gender were also revealed. Women’s suicides are less likely to be taken seriously.

Zou, W., Tang, L., & Bie, B. (2022) The stigmatization of suicide: A study of stories told by college students in China. Death Studies, 46(9): 2035-2045. https://doi.org/10.1080/07481187.2021.1958396 [Full Text]

by Lu Tang

‘Picture me heart disease free’: understanding African Americans’ cardiovascular disease experiences through a culture-centered approach

African Americans have a disproportionately high risk of premature death caused by cardiovascular diseases (CVDs) and related risk factors such as hypertension, high cholesterol, diabetes, and obesity.

In this study, my advisee Felicia and I used the photovoice method. Participants took pictures for a period of time about how they live with CVDs and then are were interviewed about these pictures. We asked them what each of their pictures was about, why they were important, what these pictures say about their lived experiences with CVD. Photovoice is a super interesting research method that allows participants, especially members of the marginalized group, to voice their view of the world and their experiences. Very often a picture is worth a thousand words.

Here are a couple of pictures.

This study was informed by the culture-centered approach to communication’s (CCA), which call for community-based health solutions for marginalized populations.

Here are some of the findings of the study:

Participants demonstrate tremendous agency in their efforts to adopt a healthy lifestyle and manage their heart diseases. Structural factors such as socioeconomic status, insurance, discrimination, and knowledge enable and constrain their agency. Several cultural factors, such as food culture, reluctance to see doctors, consumerism, and religiosity, mediate the relationship between structure and agency. Public health professionals and researchers can capitalize on our findings in promoting cardiovascular health among the African American communities.

York, F. & Tang, L. (2021). “Picture me heart disease free”: Understand the cardiovascular disease experiences of African Americans through a culture-centered approach. Journal of Applied Communication Research. (Published online first.) https://doi.org/10.1080/00909882.2021.1912377

by Lu Tang

Gay men’s wife and LGBTQ communication in China

While working on the previous study about how gay men in China come out, I learned about the existence of gay men’s wife. Around 13.6 million heterosexual women in China are married to gay or bisexual men, and they call themselves tongqi 同妻. Tongqi belong to both co-cultural groups (as women and wives) and a dominant group (as heterosexuals).

Through a narrative analysis of 51 stories told by tongqi, this study examines how tongqi make sense of their husbands’ communication behaviors and the co-cultural strategies tongqi use.

The study identifies two novel co-cultural strategies: self-blaming and enduring. Self-blaming means that co-cultural group members blame themselves for their situations. Enduring (or ren) refers to the practice of putting up with the oppression from the dominant group without protest for an extended period of time.

It also examines how tongqi narratively construct their husbands’ co-cultural strategies and finds that tongqi often internalize the ideologies (of gender, sexual orientation, marriage, and family) in their sensemaking process and in their communicative responses to their husbands.

Tang, L., Meadows, C.Z., & Li, H. (2020). How gay men’s wives in China practice co-cultural communication: Culture, identity, and sensemaking. Journal of International and Intercultural Communication, 13(1), 13-31. doi: 10.1080/17513057.2019.1569252 [Full article]

by Lu Tang

Chinese gay men’s coming out narratives and co-culture communication

LGBTQ communication is not my primary research interest. But I find the overlap in theoretical constructions and research methods between the study of LGBTQ communication and the study of minority health (which is my research interest.)

My interests in LGBTQ communication in China and co-culture theory started during a conversation with a doctoral student at Alabama many years ago. We talked about the fact that unlike in the US, the Chinese society is generally more “resistant” toward the LGBTQ communities and some even think being gay is a mental illness. [See our prior study about it]As a result, we studied the coming-out stories of gay men in China. We found the co-culture theory developed by Dr. Mark Orbe was perfect for such a study as the theory describes how marginalized group members (what he calls “co-culture group”) communicate with dominant group members.

We examined Chinese gay men’s coming-out experiences through a narrative analysis of 60 self-reported stories online. It finds that Chinese gay men’s decision to come out, their communication orientations, and the outcomes of their coming out are influenced by traditional Chinese cultural values such as family, marriage, and duty. Assertive assimilation, assertive accommodation, and nonassertive accommodation are the most used communication orientations. The study adds to co-cultural theory by demonstrating that types of social relationships affect the communication orientations adopted, at least in the context of China.

Bie, B., & Tang, L. (2016). Chinese gay men’s coming out narratives: Connecting social relationship to co-cultural theory. Journal of International and Intercultural Communication, 9(4), 351-367. doi: 10.1080/17513057.2016.1142602 [Full article]

by Lu Tang

Mental illness Stigma II

Answering the calls of Anderson and Bresnahan (2013) and Weiss, Ramakrishna, and Somma (2006) to explore the gender and cultural dimensions of illness-specific stigma, we examined how popular magazines targeting women and men in the US portrayed mental illness between 2009 and 2013 through a theory-driven content analysis.

The magazines we examined include:

Women’s magazines: Vogue, Cosmopolitan, Marie Claire, Shape, Self.

Men’s magazines: GQ, Esquire, Details, Men’s Health, Men’s Fitness

We found that women’s magazines tend to present a more positive coverage of mental illnesses by citing patients, adopting human interest discourse, and using challenge cues such as hope than men’s magazines. 

  • In terms of major topics covered, both women’s and men’s magazines paid most attention to depression, stress, and anxiety,
  • Both men’s and women’s magazines were more likely attribute mental health issues to individual causes rather than social causes.
  • Women’s magazines are more likely to give a human face to mental illnesses than men’s magazines.
  • Women’s magazines are more hopeful than men’s magazines in coving mental illness, even though both project a lack of optimism, social inclusion and fight.

Yang, Y., Tang, L., & Bie, B. (2017). Portrayals of mental illnesses in women’s and men’s magazines in the United States. Journalism and Mass Communication Quarterly,94(3), 793-811. doi: 10.1177/1077699016644559 [Full article]

by Lu Tang

Mental health and mental illness stigma I

Another research interests I shared with some of my doctoral students (former and current) was mental illness stigma. Mental illness is a serious health risk around the world, especially among young people. At the same time, mental illnesses are often highly stigmatized. In several studies, we examined the discourse around mental illness through interviews as well as analysis of media contents.

My first study on mental illness stigma explores the cultured understanding of mental health and mental illnesses among members of Generation Y in China. We conducted interviews with college students in China to collect stories about people with mental illness. A narrative analysis of more than 100 stories identified five narratives featuring the tragic genius, the psychotic criminal, the fragile victim, the antisocial recluse, and the homosexual. These narratives are gendered, in that women are the primary protagonists in the narrative about the fragile victim, while men are featured prominently in the narratives about the tragic genius, the psychotic criminal, and the antisocial recluse. Our study demonstrates that these narratives are based on, and will further reinforce, highly cultural-specific stereotypes and biases about mental illnesses in China.

Tang, L., & Bie, B. (2016). Narratives about mental illnesses in China: The voices of Generation Y. Health Communication, 31(2), 171-181. doi:10.1080/10410236.2014.940673 [Full article]

by Lu Tang

Doctor Patient Communication in China II

This study examines the doctor-patient communication in China through the perspective of patients. Patient satisfaction is an important intermediate outcome of patient-provider encounters, linking face-to-face interactions between patients and medical professionals with patients’ well-being after consultations.

Today, physician review websites provide a new venue for the study of patient satisfaction, as patients are utilizing such websites to evaluate their encounters with physicians. This study examined how parents of pediatric patients in China evaluated their pediatricians and factors associated with patient satisfaction through a qualitative content analysis of reviews (n = 7230) on the “Good Doctor Website” (haodf.com), China’s largest physician review platform.

Three dimensions of patient satisfaction were identified:

  1. pediatricians’ interpersonal manners (including friendliness, listening to patients, heartfelt encouragement, and clear explanation)
  2. ethics (including rejecting red envelopes and kickbacks and cost awareness)
  3. medical competence/overall health outcome.

This study contributes to a culturally sensitive understanding of patient satisfaction and further explains the tense physician-patient relationship in China. Practically, our findings can inform the training of pediatricians in China.

Wu, Q. & Tang, L. (2021). What satisfies parents of pediatric patients in China: A grounded theory building analysis of online doctor’s reviews. Health Communication. https://doi.org/10.1080/10410236.2021.1888437 [Read full text here]

by Lu Tang

Doctor Patient Communication in China I

The physician-patient relationship in China is highly strained. According to the latest survey conducted by the Chinese Medical Doctor Association (CMDA, 2015), 60% of medical personnel had suffered verbal abuse, and 13% had suffered physical violence in 2014. Initially, mainstream news media often blamed physicians for being irresponsible, immoral, or simply incompetent. Lately, the tide has been reversed and patients were often portrayed as being too demanding, too greedy, and too unreasonable. China’s medical schools start to teach courses in physician-patient communication based on western textbooks and theories. However, attributing the problematic physician-patient relationship to individual stakeholders’ competence or morality does not address the root of physician-patient conflicts in China: the rise of health consumerism and the change in the culture of health.

In this study, we examined the professional identities of physicians and their perceptions of the physician-patient against the backdrop of the rise of health consumerism in China. We conducted in-depth interviews with physicians in China during the course of two years to create a new theoretical perspective for the study of physician-patient communication in China. We argued that because of the marketization of healthcare in China in the last two decades, the traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm’s length relationship characterized by self-interest, opportunism, and mistrust. This is the cause of many communication problems and conflicts between physician and patients in China.

Tang, L., & Guan, M. (2018). Rise of health consumerism in China and its effects on physician’s professional identity and physician-patient relationship. Health Communication, 33(5), 636-642. doi: 10.1080/10410236.2017.1290015. [Read full text here]