digital, research, cycle, content, audience, culture, technology, textual, style, health, care, Web, development, Uganda, survey


It has been estimated that one third of the world's population does not have access to "adequate" health care. Some 1.6 billion people live in countries experiencing "concentrated" acquired immune deficiency syndrome (AIDS) epidemics. Many countries in Africa--and other low-income countries--are in dire need of help providing adequate health care services to their citizens. They require more hands-on care from Western health workers--and training so more African health workers can eventually care for their own citizens. But these countries also need assistance acquiring and implementing both texts--the body of medical information potentially available to them--and technology--the means by which that information can be conveyed. This dissertation looks at these issues and others from a multi-faceted approach. It combines a survey of the developers of Web sites designed for use by health workers in low-income countries and a proposal for a novel approach to communication theory, which could help improve health communication and other social marketing practices. It also includes an extensive review of literature regarding a number of topics related to these issues. To improve healthcare services in low-income countries, several things should occur. First, more health workers--and others--could visit African countries and other places to provide free, hands-on medical care, as this researcher's group did in Uganda. Such trips are ideal occasions for studying the cultural differences between "mzungu" (white man) and the Ugandan people. A number of useful medical texts have been written for health workers in low-income countries. Others will be published as new health information becomes available. But on what medium will they be published? Computers? Personal digital assistants? During the past 10 years the Internet became an ideal venue for conveying information. Unfortunately, people in target countries such as Uganda encounter cultural differences when such new technologies are diffused. This dissertation looks at cultural and technological difficulties encountered by people in low-income countries who attempt to diffuse information and communication technologies (ICT). Once a technology has been successfully adopted, someone will look for ways to use it to help others. There are hundreds of sites on the Internet--built by Web developers in Western countries--that are designed for use by health workers in low-income countries. However, these Web developers also experience cultural and technological differences, based on their knowledge of and attitudes toward best practices in their field. This research includes a survey of Web developers which determined their attitudes toward best practices in their field and tested this researcher's hypothesis that there is no significant difference among the developers' attitudes toward the content on their sites, their audience's cultural needs and the various technological needs their audience has. It was found that the Web developers agree with 17 of 18 perceived best practices and that there is a significant difference between Web developers' attitudes toward their audience's technological needs and their attitudes toward quality content and the audience's cultural needs. Creation of the survey herein resulted in this researcher generating a new way of thinking about communication theory--called digital research cycles. The survey was based on a review of literature and is rooted in the belief that any successful communication of a computer-mediated message in the information age is a behavior which is influenced by the senders' and receivers' attitudes and knowledge about textual style, the audience, technology and the subject matter to which the message pertains.


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Graduation Date



Saper, Craig


Doctor of Philosophy (Ph.D.)


College of Arts and Humanities



Degree Program

Texts and Technology








Release Date

May 2009

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)