“It’s the Implications!”

Improving graphic health communication tools to increase health literacy in marginalized populations

“The burden to reveal privilege falls on those who lack it.” (Walten, Moore, & Jones, 2019, p. 101)

As technical communicators and professionals of the field, we are the curators of messages. We control the conversation. As the field of health communication shifts towards a movement of graphic storytelling, more responsibility falls to us. Presentation of visual health information is more than just words on paper, images, graphs, and charts. The presentation of visual health information should create a sense of empowerment and promote a strong sense of self-efficacy as a blueprint for better decision-making regarding health and well-being. But where does this blueprint begin? It begins with how the message is designed, the rhetoric of the text, and the context in which the two work together cohesively and independently when analyzed apart.

Garrison-Joyner and Caravella (2020) illustrate the excruciating importance of inclusivity and culturally representative graphics as health communication tools for vulnerable populations. The authors explore the current presentation of health information through graphics and comics as health education tools for patients. They have concluded that the lack of representation and inclusivity has created barriers to health literacy in vulnerable populations. This lack of health literacy is believed to cause the same health issues in vulnerable populations as their more privileged counterparts, but has also led to higher mortality rates (Garrison-Joyner & Caravella, 2020).

The gap in the existing literature regarding how graphic health information is presented to adults drove the authors to question how we as technical communicators can shift the focus of existing health education tools from working for marginalized populations to working with them, all while increasing their ability to make the right decisions about their health. How can we assist them in improving health literacy without forcing our privilege, power, and positionality on theirs? Though the answer is not labeled here in black and white, there is a clear direction of what must change to achieve the authors’ presented goals. The direction is guided in technical communication theory and puts a large weight on the shoulders of those of us representing the field.

The authors frame this article around the idea of what is known in technical communication theory as “the three Ps: privilege, power, and positionality” (Garrison-Joyner & Caravella, 2020). The three Ps provide a lens for us as technical communicators to never get lost in our unspoken privilege of just being allowed to tell the story. This lens offers insight into the struggles of those who are not offered the same affordances due to their environment, social determinants, and demographics. By allowing traditionally marginalized populations to offer direct insight into how this information directly impacts their lives, we as technical communicators can take a step back and evaluate our technical documents regarding health from another dimension; one that currently suffers from the way information is being presented through childish comics and white-washed representations of problems heavily impacting those most vulnerable.

The current practice of using comics in health graphics offers depth and dimension only at face-value, according to the authors. The implications that are associated with viewing information through comics are obvious: they are childish, low-level, and barely begin to scratch the surface of the issues at hand while poking a little fun along the way. By merely representing one-dimensional facets of a three-dimensional problem, those with less privilege (i.e., experiencing lack of health care coverage, low socioeconomic status, bottom-tier vocational status, geographical barriers, etc.) are not actually influenced by the graphics and their representation of what is quite literally killing them. This compromises their ability to internalize their interactions with the technical document and the health problem, which then affects their health. Cultural competency and being mindful of representation in the curation of health-related messages are important concepts to understand as technical communicators. If we are designing the messages, we are controlling the conversation, and we have the power to disseminate information to large audiences. 

Why have we not been as involved in the conversation as we should be? According to Garrison-Joyner and Caravella (2020), technical communicators have controlled the conversation by creating the technical documents, including comics and graphic depictions of situations involving health, but there is practically no existing literature presenting this social justice dilemma from the technical communicators’ perspective. By holding the power to rebrand the presentation of health-related comics as educational tools, we have the power to fill this gap in literature, and we should begin by listening to the vulnerable populations and their specific cultural and communal needs regarding their health. 

We must perform usability testing and community-based participatory research on the educational materials we create, as well as approach them from not only the viewpoint of stakeholders (doctors, physicians, technical communicators, etc.), but also of the population of interest. By continuously breaking down our work and contextualizing it from multiple perspectives, we can truly begin to see where the “lapses in literacy” lie, and how to fill them with materials that will increase confidence and the ability to make important decisions that can be the difference between life and death.

Those in the fields of health communication, technical communication, and the professional world where this is a daily facet of a vocational role, should take a step back and dissect the messages and visuals that are presented to your audiences. Are they appropriate? Are they inclusive? Are they culturally relevant? Are they just? Do they empower your audience, or do they just barely scratch the surface? Asking these questions will not resolve the dilemma, but rather further the movement of inclusivity and positive health outcomes as a result of the educational materials that we work so hard to create. 

Lapses in Literacy: Cultural Accessibility in Graphic Health Communication, by Veronica Garrison-Joyner and Elizabeth Caravella


Viewpoint Written by Kimberly N Uzzel, Texas State University

Edited by Gabriella Garcia, East Carolina University


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