2. Literature Review

2.3. Alternative Development

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

18

ostracized by their families and communities. Rural women are especially vulnerable to the disease because they do not have equal access to social and economic resources as men, which leads to lower knowledge level and less freedom of making their own sexuality-related decisions.

Although the number of AIDS-related deaths in Kenya has dropped drastically by 32% to 58,000 in 2013, compared to 2009 (AVERT, 2014), rural areas remain a concern, with potential for a further rise (Guwatudde et al., 2009; Tumushabe, 2006).

The challenges for uncircumcised men living in the Africa’s AIDS belt increase greater risks for women suffer from infectious diseases, raise the impacts of HIV/

acquired immunodeficiency syndrome (AIDS). AIDS belt indicates areas with highest percentages of HIV cases: Botswana, Burundi, Central African Republic, Kenya, Malawi, Rwanda, Southern Sudan, Uganda, and Zambia. The UN Human Development Report (2014) indicated women make up more than half of the nearly 37 million people worldwide living with HIV, most of them in hard-hit Africa.

2.3 Alternative Development in Kenya/ Africa

Alternative development, redefining the goals of development, is people-centered and participatory as mainstream development is originally identified with the growth of gross national product, rise in personal incomes, industrialization, technological advances, or social modernization. However, high inequality and the restrictions among people lead to the concept of “alternative development.” As Sen (1999) mentioned, removal of major sources of confinement is what alternative development can offer. It can be caused by “poverty as well as tyranny, poor economic opportunities as well as systematic social deprivation, neglect of public facilities as well as intolerance or over activity of repressive states.” Inclusive of public participation, social welfare, benefits for community and minority come first before economic growth (Sen, 1999). Rather than conventional development agents such as

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

19

the state or multilateral institutions, the agents of alternative development are usually considered to be grassroots associations and NGOs, and local people themselves (Bebbington and Bebbington, 2001) Alternative development primarily looks at development from the local and grassroots’ viewpoint; it “looks at development along a vertical axis, from a bottom-up point of view” (Pieterse, 1998).

In Africa, ever since its decolonization in the 1960s and 70s, the region has struggled economically. Previous studies have shown that some of the ethnically diverse societies have slower economic growth and are more prone to corruption and political instability than ethnically homogeneous societies due to political conflict and lack of cooperation across ethnic groups, in which hinders national growth (Mauro, 1995; Knack and Keefer, 1997). In sub-Saharan Africa, ethnic diversity has had a particularly negative impact on economic outcomes which has suffered from a series of destructive ethnic conflicts in recent years and is the most ethnically diverse and the poorest region in the world, argued by Easterly and Levine (1997). The resource-poor regions suffer from this cause are facing ill health, which deepen the rural dwellers believe in religion that studies of health communication strategies need to be culturally constructed for its appropriateness (Kreuter et al, 2003, p.139). It is encouraged that health educators should recognize and build on the specific religious or spiritual aspects that caters to each individual or community interests and needs (ibid). Another impediment of advent alternative development is language and cultural barriers interfered with respectful engagement (DeCamp, 2007; Pinto

&Upshur, 2009; White &Cauley, 2006). Since this study is related with the Western Kenyan women’s menstrual management, McMahon (2011) has concluded influential factors are mainly culturally affected (see Figure1). Without an understanding of the cultural context, evidence in Pinto &Upshur (2009) proves that misunderstanding may

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

20

end up with offense, mistrust, or misdiagnose (e.g. a volunteer recommends the use of condoms or sex education without knowing the cultural context).

Figure1. Factors affecting Menstrual management by schoolgirls in western Kenyan (McMahon et al., 2011)

In the face of alternative development through volunteer tourism; an immerging spectrum of global citizens embark on the health service group as Butcher and Smith (2010, p.30) mentioned voluntourism, and it becomes the product of contemporary

‘life politics’ and the making of “morally justifiable lifestyles.”

2.4 Voluntourism, the power to do good and harm

Volunteer-tourism, often at short duration, is an increasing form of alternative travel that attracts research attention in recent years. Combining volunteer and tourism, it refers to activities in which “tourist…volunteer in an organized way” and

“undertake holidays that might involve aiding or alleviating the material poverty of some groups in society, the restoration of certain environments or research into

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

21

aspects of society or environment” (Wearing 2001, p.1). As Guttentag (2009) mentioned, the practice of voluntrouism has multiple functions and purposes since voluntourists may arrange an alternative trip with assistance from a range of organizations (i.e. private companies, charities, schools, religious organizations, and NGOs). Many associations, especially NGOs, depend heavily on volunteers to facilitate their operations and as a means of cost down since voluntourism insinuates paying to volunteer abroad. Therefore, carefully constructed media campaigns of delivering sensational, exciting, and exotic are developed in the content of these voluntourist programs, from the travel brochure, news specials, to the websites.

Voluntourism is portrayed as only available to the elite who can not only afford the luxury of paying everything, but also exclusive to ‘truly altruistic people’ aspiring to

‘make differences’ in the world (Kass, 2013).

Volunteers’ work performances, compared to paid employees, require fewer skills or specialized training and are more efficient in completing assigned work in gaining proper recognition for the good work they have done (Dunn, 1986). Philip Kotler (1982) contends that “training and work experience is a major motivation for many types of volunteers, especially students and women volunteers who have been homemakers but intend to reenter the workforce.” The main reason of volunteers volunteering others typically involves altruism to improve the lives of others and potentially notice the opportunity for personal growth and development can be offered (Sin 2009; McIntosh and Zahra 2007). Furthermore, the desire for self-gratification, to travel, and to build a resume are additional motives for voluntourism activities as well (Guttentag 2009, Fischer 2013).

Counter arguments for voluntourism have been proposed that voluntourists can be positioned of potentially doing good but create harm to the recipients. Jessye Kass

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

22

(2013) vividly elucidates the ethical challenges of being the voluntourist in Kenya after successfully creating an HIV-positive support group within one week:

…there were several problems with its creation in the first place. First of all, as a volunteer, an outsider, what right or authority did I have in creating such a group? Though my intent was to help, I could have done more harm.

I was in a position of power where people listened to me because I was a guest, was white and held knowledge of western culture that was idealized by locals in many ways (primarily in being a white savior with wealth). Yet, by reinforcing western norms, such as support groups, I was using my power to preach what I believed was best for the Kenyans I was working with, a notion which could definitely do harm to both their culture and tensions between foreigners and locals. Additionally, after beginning the group, patients continuously asked me for money. The help they needed more than a support group was most likely financial, but that was not what I was able or willing to give. Yet, they knew I had money, in order to be there, and I could have potentially been reinforcing stereotypes of greedy, rich, whites not giving money to the needy and thus further jeopardizing mutual understanding. Though on the outside an HIV-positive support group sounds nice, it was not without concerns. Where some could argue I created positive social change, others would argue it was not my place to do so, and that I could have or did harm the community. Though this example happens to be outside of Ghana, it still holds the same relevance in terms of an ability for volunteers to harm communities, even if intents are to do good (Kass, J., 2013, p42).

Similar to the volunteerism model, voluntourism is more episodic, dynamic,

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

23

task-based, with high turnover rates (Hustinx, 2010) and “loose connections”

(Wuthnow, 1998). In such context, recruitment for similar projects mostly takes place online and participants receive little orientation in acquiring practices in the local cultural or health context before performing their mission to improve the health conditions in the served communities. In previous research, cross-border voluntouring faces difficulties toward:(1) ambiguity resulting from discrepancies between volunteers’ own ideology and those of the organization; (2) frustration when the organization lacks the necessary resources for ongoing activity; (3) problems in coping with beneficiaries’’ suffering; (4) a sense of being unable to help the beneficiaries (Fisher & Schaffer, 1993; Kulik, 2007). Guttentag (2009, p537) further explains the concerns as a neglect of locals’ desires caused by lack of local involvement; a hindering of work progress and the completion of unsatisfactory work caused by volunteers’ lack of skills; a decrease in employment opportunities caused by the appearance of volunteer labor; a reinforcement of conceptualizations of

‘othering’ and rationalizations of poverty caused by the intercultural experiences; and an institution of cultural changes caused by the demonstration effect and actions of short-term missionaries. The impacts of voluntourism on both the tourist and the host community in Table 1 are addressed from literature in abundance depicted by Wright (2014).

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

24

Table 1. Impacts of volunteer tourism (Wright, 2014).

A proper learning planning and facilitate in communication between the organization and voluntourists is mandatory; moreover, the collaboration with local communities to decide which needed services will be valuable as well as ensure the volunteers see

the experience in the proper sense, i.e., as an exploratory process (Guttentag 2009).

2.5 Health Communication in Perspectives

Communication in health can be defined in much the same way as communication has generally been defined: a transactional process (Corcoran, 2013).

Communication plays a critical role in promoting healthy choices through message delivery. However, what health communication is most dissimilar from the traditional communication is it being issue-specific, integrating fields from mass media, interpersonal network, public health, social psychology and development, medical science ( , 2008). Centers for Disease Control and Prevention (CDC, 2007) and The National Cancer Institute (2002) define health communication as ‘‘the study and use of communication strategies to inform and influence individual and community decisions that enhance health.’’

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

25

Kreps (2003) summarizes that adding ‘health’ into communication definition as a

‘resource’ allows health messages, such as prevention, risk or awareness, to be used in the education and avoidance of ill health. It is also important to remember that health communication always takes place in a social and cultural context. Hence, health communication should be understood as a process viewed as a chain from the sender to receiver, with different situations within that may amplify or attenuate risks. Such situations can be social (e.g., news media), individual (e.g., attention filter), or institutional (e.g., political and social actions).

Imposing public health challenges, the studies by scholars and practitioners in a wide range of science and disciplines find the common goal of health communication and social marketing practices is creating social change by altering peoples’ attitudes, external structures, and/ or modify as well as eliminate certain behaviors if necessary (2007). What distinct health communication from other communication research is that field experiments are applied as a basic research design that include field experiments and focus group interviewing (Rogers, 1994). Health communication targets to improve not only understanding health problems, but also health improvement. This main discipline guides schools of researches of health communication promotions and practices, specifically in fighting AIDS, conduct effective strategy within multiple perspectives: human rights, governmental diplomacy, interpersonal network and community based studies.

In UNICEF’s human rights approach to programing, communication is explicitly acknowledged both a right and a means to claim other rights. Health communication from a human rights perspective is especially relevant to HIV/AIDS programming (Ford & Chorlton, 2003). The change could benefit local people (claim holders) in taking less risky ways of sex or safer means of parental care for infants. To Ford&

Chorlton (ibid), dialogues are chosen by claims holders for effective health

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

26

communication process. And all the conversations should be continued extending to level up national forums for greater influences. Another way to fortify health communication in a diplomatic perspective is foster government’s health diplomacy.

Rely heavily on medical and monetary aids caused by political conflicts, Kenya has received HIV/AIDS care, treatment, and education from the United States (Cook, 2006). The WHO provided reports to help identify countries in need for help since determining what countries are in need and which countries could support the help sending country’s interests for good diplomatic relationship establishment is also important to boost health communication (Kumar & Karl, 2009). All levels of implementing and monitoring such activities are crucially important by involving communities, nongovernmental and civil society organizations and individuals in the planning.

The United Nations Population Fund (UNFPA) stressed that “it is men who usually decide on the number and variety of sexual relationships, timing and frequency of sexual activity and use of contraceptives, sometimes through coercion or violence.” To form a healthier and gender-equal society, ensuring women and girls’

access to sexual and reproductive health services and protection from gender-based violence can be facilitated more efficiently by involving men and boys. Sexual and reproductive health topics can be highly stigmatized and charged with emotion, shame, and fear among families or couples (Kumar, Hessini, & Mitchell, 2009) In Kenya, women have little to no decision-making power with their lives and health historically;

the use of family planning rest mainly with husbands and in-laws; let along women’s perceived nature “to give birth to children” by men. Henceforth, Rao and Svenkerud (1998) listed six concepts that are most relevant to prevent HIV/ AIDS in interpersonal network lens: Communication (channels of how message is transmitted from one to another), the innovation-decision (an over-time sequence process of how

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

27

target audiences adopt the change), homophily (the extent of the two or more people who communicate perceive themselves to be similar), an attribute (characteristic of the innovation either to be positive or negative), adopter categories (classifying groups based on relative time they spent on adopting a new idea, technique, or process), and opinion leaders (people being respected for their knowledge and reputation on certain topic).

Health communication involves modifying cultural tradition, which may differ from each community, including ways of thinking, behavior, and practices-social, economic, and political-that are deeply ingrained in the vast majority in the culture, whereas villagers or political leaders do not think of anything goes wrong (Pillsbury, Mayer, 2005). Limitations NGOs faced in community-based health communication are limited capacity to communicate effectively about the problems. “Grassroots and community-based organizations have relied on a various form of “traditional”

media-from posters, brochures, and newsletters to folk drama and t-shirt, to get their messages out to local and rural audiences” (Pillsbury, Mayer, 2005). Insufficient and imprecise research is conducted to understand what people in different communities believed or the reasons of their behaviors. This leads to the failure of evaluation for how well the target group understood or changed with the desired effect. A given example explained the abovementioned circumstance well,

If a donor gave money for work on HIV/AIDS, an organization might design a poster or brochure telling people not to have unprotected sex. Often this poster or brochure was printed without finding out what people really knew and thought about AIDS or pregnancy, and without studying what would convince people to accept new information or think about changing their behavior. As such, these materials were not relevant and did not resonate with the local community.

Far too often they ended up stacked on shelves in clinics or used for everyday

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

28

needs such as wrapping purchases in a market (Pillsbury, B., & Mayer, D. 2005).

Appropriate means to design media campaigns, referred in communication research, can affect knowledge, attitudes, and behavior (Graeff, Elder, & Booth, 1993). Thus, to know what the target audience believes is critical of making a persuasive argument.

Having target communities participate in the design and implementation of campaign matters much as well since the authoritative top-down campaign activities is often ignored by the target communities (2005).

The collaboration between health communication scholars and marketing specialists has provided important ideas in communicating health and numerable research topics in its health applications. Social marketing (SM), the most widely used strategy, is a planning framework that ‘‘applies commercial marketing technologies to the analysis, planning, execution, and evaluation of programs to improve the personal welfare of intended populations’’ (Andreasen, 1995). By providing tailor-made marketing plan in a systematic way, SM is applied by plenty of NGOs, NPOs’ health promotion campaign to boost attitude or behavior changes in preventing diseases. The frequently used social-marketing strategy in health communication is segmentation, partitioning a total audience into sub-audiences that are each relatively homogeneous in the segmentation variable (Evans, 2006). The core concept of SM contained 4P:

Product, Price, Place, and Promotion, (Positioning or Partner) is also borrowed into health communication applications (Corcoran, 2013), like the testimony of an experienced voluntourists shared in supporting HIV-positive sufferers accepted in the Kenyan community:

We put flyers around town and called patients of the clinic who were HIV-positive. Within a week, our free HIV-positive support group was up and running. I would speak in English and my supervisor would translate into Kiswahili so that discussions were held in Kiswahili in order to increase

立 政 治 大 學

N a tio na

l C h engchi U ni ve rs it y

29

participation and comfort. I ran the meetings similarly to a group-therapy model, geared toward fostering support. To relieve stress and cultivate friendships between group members, we played a game of volleyball.

Laughter and smiles filled the courtyard and at the time I was very pleased with the results (Kass, J., 2013, p41).

More effective health messages can be created for each audience segment than for the entire audience. In recent years, health communication scholars have used focus groups to pretest communication messages, to design health communication interventions, and to evaluate the effects of health campaigns. Furthermore, Africa’s health systems are designed with a bias toward primary care leading to the difficulties of coping with the cost and complexity of AIDS treatment, especially in rural communities. To mitigate and overcome the barriers socially, culturally, and legally allows more Kenyans, especially women and girls, the key affected groups from accessing correct information, to increase the provision of HIV prevention via efficient and effective health promotion. Hopefully in the near future, more efforts of sustainable methods will be developed for reaching both the top-down and bottom-up communicative channel that could also reduce the country’s reliance on keep exhausting international donating funding.

2.6 Research Settings

Settings of promoting health are first explained in the Ottawa Charter for Health Promotion, WHO (1986). Besides from stressing the nature of caring, holism, and ecology in developing strategies for health promotion by saying “health is created and lived by people within the settings of their everyday life; where they learn, work, play

Settings of promoting health are first explained in the Ottawa Charter for Health Promotion, WHO (1986). Besides from stressing the nature of caring, holism, and ecology in developing strategies for health promotion by saying “health is created and lived by people within the settings of their everyday life; where they learn, work, play

在文檔中 台灣赴非志工旅遊之健康促進與反思-愛女孩計畫個案研究 - 政大學術集成 (頁 18-0)