Updated final paper draft

Hi all,

Below is what I have so far for the final paper. It’s still a draft and might be a little choppy and abrupt. I am also yet to write the DISCUSSION section and I did not included a bibliography at the end in the interest of space (they’re there in-text, though). The in-text reference links also don’t seem to be working for some reason – so please ignore those. Other than that, I welcome your feedback via comments and questions. Thanks for reading!!! 🙂 🙂

Priyanka

Digital Culture, Identity, and Participation: Bridging the Health/Development Digital Divide in India

Since its inception, the field of development communication has been understood and operationalized through various approaches such as the dominant paradigm (where health is largely a matter of individual responsibility), diffusion of innovations (health as function of adopting certain innovations), social marketing, cultural sensitivity (merely using local culture to tailor health messages), cultural-centrism (building theories and applications organically from within a culture), entertainment education, organizational communication, information communication technologies (ICTs), and recently, participation-based communication. No matter how health communication is understood, however, in its simplest form, it is the process by which communication theories and strategies are used to stimulate social change and/or development. It is also geared toward some form of positive social growth that is intended to help people improve their quality of life and empower them with knowledge and agency.

The new paradigm or what is referred to as the participatory approach to development communication, shifts the agency of development from the researcher or the outside expert to the people who constitute the target for development communication programs. This shift is premised upon the belief that it is the community that knows best about the problems it faces and hence should be included in any development communication efforts that target the community (Dutta, 2007). This is held to be a reasonable assumption for development-related aspects such as health practices, attitude change, resource allocation, power distribution, and even family dynamics. A significant body of research has been aimed at investigating the factors that prevent people from adopting certain health behaviors or seeing value in an attitude change. Scholars have also investigated how certain power mechanisms operate at a global scale to deliberately subordinate certain parts of the world or certain groups of people in every part of the world. Further, Rogers (2003) theorized specific adopter characteristics that encourage some categories of people to adopt innovations while others are driven by several factors to not subscribe to them. While most of these research efforts have focused on Western society and conventional media, little attention has been paid to the types of barriers (structural/cultural) that development/health efforts have faced (or are likely to face) in India – a  society deemed conservative, collectivistic, traditional, and yet making giant strides in technology. Recently, considerable research has demonstrated that health and development campaigns are increasingly going digital as new media formats such as blogs, mobile technology, and social networking are being deployed in developing nations in order to disseminate health/development related information. Scholars such as Berg, Aarts, & van der Lei (2010) have therefore urged for a greater understanding ICTs by means of analyzing the relationships between social environments and the technology being used to spread health-related information. Further, scholars like Haux, Ammenwerth, Herzog, & Knaup, (2002) have made several lofty predictions about how ICTs are going to facilitate advanced yet affordable healthcare and information in the near future. However, most of these predictions and recommendations are for the Western world and they usually refer to technologies such as the internet.

Therefore, in this paper, I focus my attention on India and the potential reasons why developmental and health efforts might be difficult to conceptualize, mobilize, and implement in the country. First, I will briefly trace the historical trajectory of development communication efforts in India – this is akin to mapping the communicative ecology as suggested by Horst and Miller (2006) in the context of proliferation of mobile technologies, and the ecosystem approach to development presented by Chung & Pardeck (1997). Second, I will identify the gaps that exist between traditional development ideologies and realities in the Indian scenario. Third, I will attribute these gaps not only to certain structural barriers but also to some intrinsic cultural and psychological barriers within the communicative ecology, at the individual, community, and even at the nation-state level which health and development scholars will likely need to overcome before a developmental effort can fructify in India. Lastly, I will use a development communication campaign in India conducted via the digital media (undertaken by the BBC World Service Trust in association with the Bill and Melinda Gates Foundation) from 2006 to 2009, as an example of how culture and new technologies can be successfully incorporated into development messages and how the barriers and challenges outlined in this paper can be worked with. As I will illustrate, this campaign also served as an excellent example of how digital technology is being utilized in order to bridge the digital divide between the information-rich and the information-poor from a health communication perspective.

Mapping the communicative ecology: India’s development trajectory

India has historically presented several contradictions and formidable challenges for development communication efforts. Overall development efforts in India are undertaken through five-year plans, conceived, implemented, and monitored by the Planning Commission of India. The first of these five-year plans was presented in 1951 and as of today, India is in its 11^th five-year plan. Taken collectively, these 11 plans have focused on a plethora of areas such as agriculture, industry, energy, transport, communication, information technology, economic reform, and modernization of agriculture and industry[1]. It was only in the later five-year plans (after 1974) that the Planning Commission of India began to focus on developmental issues such as unemployment, low literacy rates, infant mortality, affordable health care, impoverished living conditions, sex ratio, and the environment.

The fact that the initial five-year plans did not really focus on these issues is surprising, given that origins of developmental efforts in India can be traced back to the 1940s when the Gandhian model of development was conceptualized with an intention to attain individual- and community-level empowerment and self-sufficiency. The Gandhian model was aimed at preserving Indian values and culture rather than substituting them with the Western paradigms of development that were in vogue around the 1940s and 1950s (Khoshoo, n.d.). The focus was on rural reconstruction based on Gandhi’s ideal of ‘villageism’ which emphasized participatory communication as a means to attain self-reliant villages. Gandhi envisioned the Indian village as the most basic unit of social planning and conceptualized the philosophy of ‘Sarvodaya’ (meaning development for all) as the backbone of an economy that would be able to provide food, clothing, shelter, justice, political power, and education to its members.

For a long time, the Sarvodaya model was considered the ideal model of development in India because it suggested that development is inextricably enmeshed with social transformation which would allow people to realize their ethical and spiritual potential. In the decades that followed, political instability and an ideological vacuity led to the lack of a cohesive vision for the country’s developmental goals. This, coupled with the government’s promise of attaining quick results for the masses, meant that there was significant chaos in choosing the developmental model that would be best for a country like India. This chaos was apparent in the second, third, and fourth five-year plans proposed by the Planning Commission where little or no resources were allocated toward alleviating the conditions in which the majority of Indians lived.

By the 1990s, the focus of development shifted drastically from what was proposed by Gandhi to three developmental models implemented by the Planning Commission: The Basic Minimum Needs Model, Technological Model, and the Participatory Model. Under the Basic Minimum Needs Model the government is the change agent responsible for providing the basic necessities of life to the people of the country. The relationship here is thus akin to that between a parent and child where authoritarian agent would tell the dependent party what to do and how to do it. Under the Technological Model of development, science and technology were seen as the agents that will improve the living conditions of people even at the grassroots levels. This is consistent with Lister, Dover, Giddings, & Grant’s (2009) argument that in every era, there exists a technological imaginary whereby each new technology brings with it a “positive’ ideological charge”. Lastly, the Participatory Model, which is in keeping with the Western ‘new’ paradigm of development communication, suggests that people can only live better if they are given the power and agency to improve their own lives. Ideally, these three models should be implemented concurrently so that various sections of society may benefit from one or all of the development models. This, however, is far from the development realities in India where the gap between the haves and the have-nots is ever-widening. In the next section, I seek to identify some of these gaps.

Development ideologies and realities in India – the chasms

For a developmental effort to attain intended results, there needs to be successful and effective interaction among all units involved in that developmental effort. Usually, these include the government, development planners, sponsors, change agents, and of course, the targeted community which could be as small as a village or as big as the whole country. It is fair to assume that during this interactive process, an ‘image of development’ arises that might be different for each of these development units depending on where they are situated. From a phenomenological perspective (Griffin, 2008), one may argue that each unit’s experience of the self and of other units can only occur here through effective dialog and the thoughtful scrutiny of everyday life from the point of view of the person living it. Politicians, planners, sponsors, change agents, and the masses might agree that development is always good and ethical but it is possible (and in most cases, probable) that each of these units has preconceived notions of what constitutes development and how it can be best attained for the population in question. For instance, the development planner’s perception of what a target community’s problems and needs are, might not be synchronous with what the target community itself perceives as its problems. What then ensues is a veritable mismatch of expectations driven by differing visions and aspirations that politicians, bureaucrats, sponsors, social leaders, and the people have for their country’s development. These fault lines are largely where much of the meaning making of Indian realities takes place. The complexity of overlapping and/or contradictory visions for development along the development continuum means that eventually, each node (unit) of development struggles to define and coherently put forth its notion of development because it runs into opposition from other nodes’ conceptualization of development. In the process, no real development takes place.

For true development to be attained, therefore, each participant in the development process needs to seek some amount of congruence and co-orientation in the meaning-making of development. This is in keeping with Pavitt’s (1981, cited by Papa, 1995) argument that “successful co-ordination is more likely to occur when communication increases each member’s ability to make…predictions relevant to the particular task at hand. Members would then make judgments as to whether their knowledge about each other is adequate for the task and if further information acquisition would be advantageous.” This leads to the conclusion that the conceptual chaos pertaining to development can be clarified significantly through an interactive process where dialog and acceptance take precedence over lofty visions. In an Indian context, this conceptual chaos is further problematized by nation-state level variables such as bureaucracy, political ideology, culture (individualistic/ collectivistic/combination thereof), type of society (modern/traditional/transitional), as well as demographic-level variables such as gender, age, and regional diversity.

Evidently, it is hard to reach a consensus on the meaning, processes, and goals of development because of these variables which in turn determine the definition of what constitutes development. This becomes especially problematic in a country as diverse as India where there is an overwhelming plurality of political parties, ideologies, and religion, among other variables. This multiplicity eventually culminates into complex realities that defy generalized conclusions and create several chasms along the development process.

Barriers to development communication in India

It is evident from the above discussion that the development scenario in India is one where all involved entities agree that there is something intrinsically wrong with the way development is being understood and undertaken in India. Naïve realism (Ross, 2004) might even lead to each of these entities into believing that while their actions are responsible and pro-development, other entities are responsible for the developmental disarray in India. In this section, I proceed to identify three possible causes behind the development gaps mentioned in the previous section. Previous scholarship (Kar, Alcalay, & Alex, 2000; Servaes, J., 1999; Singhal & Rogers, 1999; Singhal & Rogers, 2001) in this field has attributed these gaps to several structural barriers. My emphasis in this section, however, will be on barriers that may be considered cultural and psychological in nature. These barriers are, what I argue, challenges and factors that development planners and/or change agents need to bear in mind and purposively consider when planning health and development programs in India.

The culture of inculcated dependency

India’s economic fabric has previously been comprised of socialism, communism, extreme protectionism, state-ownership, and excessive regulation. Because of these factors development and growth have taken place at a slow pace in India, punctuated in large measure by rampant corruption and the infamous ‘license raj’ (red tapism).  In fact, for about three decades after its independence, India continued having a mixed economy, where the government monitored and dictated private domestic businesses, stopped imports, and made the purchase of official licenses (hence ‘license raj’) mandatory for any entrepreneurial initiative in India. The goal of this system was to ensure economic self-sufficiency but the policies led to the production of low-quality, outdated products that had no demand. The result of this restrictive mixed economy was that while the GDP of nations such as Korea and Singapore grew at a rate of 9% from the 1960s to the 1980s, India’s GDP grew by a paltry 4-5%[2]. With little or no agency in the hands of people to better their own lives and procure the means necessary to live comfortably, Indians have therefore traditionally looked to the government for provision of food, clothing, shelter, social justice, and even self-fulfillment. India has witnessed economic liberalization only since the 1990s and is expected to embrace “compassionate capitalism’[3] in the years to come with a focus on entrepreneurial efforts and ethical distribution of wealth. In spite of what may be considered a vast improvement in terms of economic freedom and permissiveness, even today, India ranks 122^nd in the World Bank’s Doing Business 2009[4] report in which countries are ranked in terms of how conducive their “regulatory environment” is toward the operation of business. The reason why India’s entrepreneurial permissiveness is being discussed here is because development (especially in rural areas) has been often linked to entrepreneurship and its concomitant factors such as innovation, risk taking, agency, decision-making, change, and even uncertainty (Petrin, 1994). This is further substantiated in an Indian context if the mission statement of the Entrepreneurship Development Institute (EDI) of India is taken into consideration. According to EDI[5], some of its primary objectives are to create “a multiplier effect on opportunities for self-employment, promoting micro enterprises at rural level, and inculcating the spirit of entrepreneurship in youth”.

Clearly, entrepreneurial efforts and development are enmeshed with each other to an extent that limiting the former in the past has led to sluggishness in the latter today in India. Because of the historical nature of entrepreneurship in India (outlined above), I argue that people were culturally ‘trained’ to depend on the government for fulfillment of their basic needs. This cultivated passivity, coupled with a fatalistic attitude toward life (Bhattacharji, 1982) is the main reasons for this culture of learned dependency – the primary barrier.

The ‘why me’ ethos

Historically, there has been a lack of initiative-taking among Indians due to their over-reliance on the government. The chances of taking initiative diminish further when an individual perceives that other people will benefit unfairly from his/her actions. Thus, everyone waits for another to take action first before they will join in. In the process, no one does anything about an issue and things remain as they are – a fact which is then justified via reciprocal blame. This rationale keeps individuals and communities from taking action that will serve collective purposes. I argue that the ‘why me’ ethos originates in an individual from a sense of feeling exploited when others benefit as a result of action taken by that individual. The same could also hold true for entire communities where one community will not take action if it means other surrounding communities will also benefit from their having taken that action.

While this might make individuals and communities look selfish and short-sighted, it is crucial to bear in mind that the government’s assumed parental role precludes these people from realizing that what when an action benefits one person, it begins to benefit others, and eventually has a ripple effect.

This is almost akin to the concertive control system that Papa et al. (1995) identify as one of the reasons behind the Grameen Bank’s success. I argue that the benefits of concertive control, where the locus of immediate control rests with the people and not the government, need to be established and even demonstrated in a health/development program for people to see how one person’s right action can and should have a multiplier effect on the community.

Psychological fears and dilemmas

In this section, I use Hofstede’s cultural dimension scale[6] as a theoretical framework to substantiate some possible psychological barriers to development in India. Hofstede’s conclusions about cultural dimensions were originally aimed at garnering a better understanding of cultural differences specific to international business. However, I extrapolate Hofstede’s conclusions about Indian culture to explain people’s psychological dilemmas when it comes to development communication in India. Specifically, I use two of Hofstede’s cultural dimensions – ‘avoidance of uncertainty’ and ‘individualism’ – as the theoretical underpinning of this section. While Hofstede’s arguably prescriptive approach and functionalist characterization of uncertainty avoidance and collectivism-individualism does not do justice to the diverse Indian demography, these concepts may be implicitly associated with the psychological dilemmas that I discuss in this section.

India is ranked 45^th and 40^th on Hofstede’s cultural dimension scale of individuality and avoidance of uncertainty respectively[7]. A score of 45 on the individuality scale, according to Hofstede, indicates that the social fabric is closely knit, with a high emphasis on extended families, loyalty, and importance of the group over the individual. However, it seems contradictory that a culture can be collectivistic and yet have the ‘why me’ ethos at the same time since each of these concepts indicate the presence of inherently opposed social characteristics. While the collectivism-individualism might not be a binary continuum, there is an amount of validity to Hofstede’s conclusions about India. Individuality, as characterized by autonomy, independent thinking and judgment, self-responsibility, and the pursuit of one’s goals/happiness, is not necessarily considered a good thing in India. Instead, people (the vast majority, anyway) do not want to act or think in a manner that makes them stand out or be different even if that means the attainment of the common good – an essential principle of collectivism. In other words, the fear of being perceived as an ambitious elitist, much like the theory of the spiral of silence (Noelle-Neumann, 1974), which explains why people would refrain from voicing an opinion or taking specific actions if such opinion or action runs contrary to prevalent social trends.  Thus, someone adopting a new health behavior based on a health communication campaign (for example, testing for STDs), might be seen as an elitist who would run the risk of social reprisal from others.

India also ranks low (40) on Hofstede’s avoidance of uncertainty scale compared to the global average of 65. This, according to Hofstede, indicates that a culture is relatively more comfortable with unstructured ideas and ambiguous situations. Further, such a society will also have fewer rules with which unexpected events can be tackled and will be “more phlegmatic and contemplative.” It follows logically from this theorization that there might be a pervasiveness contentedness with the status quo as well as resentment toward the government (the failed parent). The concurrence of such contentedness and resentment leads to two things – people voice their needs and grievances but do not take alleviative action. This in turn breeds a cynical frustration and an overall climate of skepticism among people toward any developmental or health-related efforts since they have learned to accept their condition as inevitable and pre-ordained.

So far, this paper has attempted to map India’s communicative ecology, and presented cultural factors (inculcated dependency and the ‘why me’ ethos) and psychological factors (such as fear of isolation, indifference, and inertia) as the reasons responsible for causing the gaps between the image of development and the reality of it in India. In the next and final section of this paper, I use an ongoing development campaign in India to demonstrate how the above-mentioned barriers were worked with, not just by incorporating Indian culture as we know it so far, but by shifting the identity of what it means to be an ‘Indian’ today.

Using digital culture for health communication

The employment of culture is crucial to any health/development program not just in order to increase receptivity of the program or message but also to make sure that theories and applications pertinent to a campaign originate from within that culture, thereby situating culture as a pivotal core of health- and development communication practices.  Development scholars such as Dutta (2007) recommend a culture-centered approach to development communication as opposed to a culture-sensitivity approach that usually works toward maintaining the status quo and for the most part simply uses culture in order to increase the receptivity and identifiability of social/health messages. The culture-centered approach, however, uses culture as a theoretical lens and employs it at a deeper, structural level (Dutta, 2007). Under this approach, the researcher and the researched are collaborators who engage in dialog in order to not only identify health/social problems but also conceptualize solutions to those problems. Further, the culture-centric approach is aimed at challenging the status-quo through dialog with the target community (cultural members), thereby creating discursive spaces for subaltern voices that have been traditionally marginalized by dominant development programs that reflect “Eurocentric biases of individualism” (Airhihenbuwa, 1995).

I argue in this section that an ongoing health communication effort in India has been able to successfully incorporate popular digital culture into a campaign that urges the youth to use condoms and to talk about contraception without embarrassment. This campaign is being chosen for analysis here primarily because of its unique utilization of technology (which has become an intrinsic part of the Indian lifestyle) and for the way in which it managed (as opposed to ‘solved’) the development barriers identified earlier in this paper.

On World AIDS Day 2006, the BBC World Service Trust in association with the Bill and Melinda Gates Foundation, implemented a mass media campaign in India that seeks to “normalize” condoms in India. Indian men of varying ages were surveyed in order to find out existing knowledge, practices, and attitudes toward condoms. The aim of the campaign was to encourage men to talk about condoms since research suggests that “men who talk about sex are more likely to use condoms consistently.”[8] The campaign was also geared at projecting condom-use as a positive health practice – something that should be done if Indian men want to be perceived as responsible and caring toward themselves as well as their partners and families. The campaign was estimated to reach about 125 million people through media that encompasses television, radio, movies, music, and print, and was lasted until 2009. Given its fairly long-term focus, the campaign was implemented in phases. The aim behind making this campaign multimedia-based as well as multi-phased was possibly to ensure that by the end of the campaign’s life cycle, most people will have witnessed one or more health message about condom-use. The campaign, in each of its phases, relied on one form of media and employed specific aspects of nouveau ‘Indianness’. For instance, the first phase capitalized heavily upon the Indian youth’s preoccupation with mobile phones. The first phase played on people’s curiosity – they were asked to solve a riddle, the primary clue being – “It’s a sign of manhood…but it’s not a moustache.” Free mobile phones with paid minutes were offered as incentives.

In the second phase of the campaign, a mobile phone ringtone (an ‘a Capella’ arrangement called ‘Condom Condom’) was used to spread the word about protection and its benefits and also bring the word ‘condom’ itself out of the closet to which it is confined in India. In a country where sex is not discussed and sometimes not even acknowledged, BBC’s campaign, and particularly the ringtone phase, demonstrates a dexterous nexus between tradition (where sex is taboo) and modernity (where mobile phones are ubiquitous and a quirky ringtone is a sign of being ‘with it’).

Music has always been a popular medium for delivering health-related messages. For instance, rock music videos promoting teenage sexual responsibility have been successfully used everywhere from Mexico and South American countries to the Philippines and Nigeria (Singhal & Rogers, 1999). However, the ringtone campaign seems to be the first time that a mobile phone ringtone has been used to deliver a health-related message. Yvonne Macpherson, Country Director, BBC World Service Trust (India), argues that “…with one in four people in India having a mobile phone, and ringtones being, for some, statements of personal style, it’s a new way to reach people.”[9] Radharani Mitra, Creative Director, BBC World Service Trust (India) argues that “ringtones have become such personal statements that a specially created condom ringtone seemed just the right way of combining a practical message with a fun approach[10].”

The campaign obviously exploited the mobile-phone revolution in India where the subscriber base grew from a mere 3.2 million in 2000 to 508 million in 2009¹². By 2013, India’s mobile phone market is expected to surpass that of China’s with an estimated subscription base of 1.15 billion![11] Indeed, affordable prices and low recurring costs have made it possible for mobile phones to be used extensively, regardless of age, gender, and socio-economic status. Having the latest model of phones launched by popular phone brands is quite the fashion trend among the youth. Offering a free mobile phone with paid minutes and disseminating condom-use related messages via the cellphone indicated a clever employment of popular digital culture.

According to BBC World Service Trust, the campaign website got over 65,000 hits a day and the ringtone was downloaded close to 300,000 times within a few months of its launch (MacPhersen, 2008). Although it is not clear yet if the campaign has been able to effect attitudinal and behavioral change regarding condom use (although BBC World Service Trust claims that condom purchase has increased in India by 5% since the airing of the campaign), these numbers indicate that the campaign raised significant awareness about safe sex practices despite the strong taboo pertaining to anything sexual. This is interesting since health communication campaigns in India, particularly HIV/AIDS related campaigns have traditionally been top-down, informative, and educational in nature with implicit, indirect content. The popularity and apparent success of this campaign which mobilized popular discussion and encouraged interactivity indicates that there has been a positive shift in the manner in which HIV/AIDS related campaigns are planned and implemented in India. Further ‘being Indian’ vis-à-vis attitudes toward sex-related topics have also come a long way in the last decade or so. From a sexually repressive climate to an atmosphere where people proudly flaunt a condom-themed mobile ringtone – the leap has been significant. It is therefore interesting to analyze what cultural definitions and shifts the campaign employed to attain its goals.

On the one hand, this campaign retained some elements of the cultural-sensitive approach (asking questions such as “Will the ringtone concept work in India?”, “How can we make a ringtone that has international appeal and is yet undeniably Indian?”, and “How can you encourage Indian men to talk about and use condoms?” On the other hand, strains of the culture-centered approach were also evident (asking questions such as “What are the existing beliefs and attitudes about condom use in India and why do they exist?”, “How can we get Indian men to talk about condoms without feeling awkward?”, and “How can we centralize the voices of the people and engage them in active participation?”). The campaign also relied heavily on redefining what it meant to be an Indian male by undertaking cultural maneuvers. It modeled condom-use as a positive behavior for Indian men, the practice of which makes one attractive to women and leads to one being seen as a role model. It further projected that condom use indicates that a man is responsible toward himself, his partner, and to his family. Thus, it was no longer ‘cool’ to be reckless and irresponsible; rather, to be the new Indian male – sensible, prudent, and sensitive – one must use protection and be proud of it. By and large, therefore, this campaign employed a tectonic shift in the national and cultural identity of masculinity in order to promote a health behavior. We know that the cultural identity of a country is “a complex and dynamic web of meaning” (Dutta, 2007), subject to several cross-currents originating from myriad sources, usually social, economic, or religious in nature. In this case, a health campaign challenged the status quo of Indian masculinity and engaged the ‘with-it’ youth in order to relocate the Indian male and his notions of masculinity.

The campaign reinforced the notion that it was up to the individual to protect oneself and that one need not depend on external factors to ensure protection from HIV/AIDS and other sexually transmitted diseases. The transfer of agency from the conventional parent (government) to the individual was made clear by catchy slogans such as “you win when you understand” – with verbal emphasis on the second person singular pronoun. The campaign was also ready with an answer in case people asked “why me?” – it said “your family, your choice” – reiterating that it is up to the man to practice this health behavior because he is confident, smart, and responsible for his family’s well-being, and that no one else but him should have to shoulder a responsibility that is his.

Psychological barriers such as fear of isolation and indifference were also addressed by showing the campaign mascot (a typical middle-class Indian male, often accompanied by an animated talkative parrot or a puppy called Condom) flaunting the condom-ringtone at public gatherings such as weddings and games, thereby sending the message that there is no stigma or shame associated with talking about condoms.

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