Abstract
Informed by Communication Infrastructure Theory (CIT), this article explores the ways community organizations and ethnic media serve as communicative resources and form into storytelling networks with different health-enhancing purposes for Filipina household service workers (FHSWs) in Hong Kong (HK). Using key informant interviews with print and broadcast media, non-governmental organizations, and faith-based organizations in HK, it found that cancer, stroke, and depression were shared concerns among FHSWs. Community organizations and ethnic media explained these concerns based on work and labor conditions. As communicative resources, they provided health information, offered tangible support, and campaigned to employers and governments. In discussing social media for health, community organizations highlighted accessibility, whereas ethnic media focused on journalistic practices. Overall, this article highlights ethnic media and community organizations as key but often overlooked publics in health communication and the importance of further incorporating temporality in CIT-informed research for migrant health. Implications to public health campaigns and health reporting are discussed.
Keywords
Introduction
This article explores the role of community organizations and ethnic media to advance migrant health in countries of destination. It pays attention to the ways print and broadcast media, non-governmental organizations (NGOs), and faith-based organizations serve as communicative resources and form into storytelling networks with different health-enhancing purposes. In so doing, it frames ethnic media and community organizations as critical publics in health communication in three ways. First, it focuses on organizations as resources for health among Filipina household service workers (FHSWs) in Hong Kong (HK). It engages with previous work on meanings and experiences of health by migrants in countries of destination (e.g. Dutta et al., 2018). Second, this article builds on Communication Infrastructure Theory (CIT; Kim & Ball-Rokeach, 2006; Wilkin et al., 2010) to explore the role of ethnic media and community organizations per se in communicating health to FHSWs. Together with Bernadas and Jiang (2016) and Oktavianus and Lin (2023), it highlights a network of print and broadcast media, NGOs, and faith-based organizations offering different solutions for migrant health. Third, it emphasizes the perceptions of and experiences with social media by ethnic media and community organizations working and serving FHSWs. After outlining a context of FHSWs in HK and its implications to migrant health, this article articulates the research questions and elaborates on CIT as theoretical anchor.
Labor migration and women’s health: a context of FHSWs in HK
The overseas deployment of FHSWs commenced as the Philippine government launched a labor export policy that aimed “to ease the worsening problem of unemployment and the tight balance of payment situation in the country caused by the structural adjustment policies of the IMF (International Monetary Fund)” (Pascual, 2017, p. 14). Coincidentally, HK opened the doors for household service workers from other Asian countries to address labor shortage in various industries (Ignacio & Mejia, 2008). At present, HK remains to be among the top five destination cities of FHSWs (Philippine Statistics Authority, 2017). In 2018, there were around 386,000 foreign household service workers in HK, representing close to 10% of the city-state’s population, with FHSWs comprising 55% of migrant population followed closely by Indonesians (43%) (Census and Statistics Department Hong Kong, 2018). Other than coming from countries that are top exporters of domestic work in Southeast Asia, FHSWs and Indonesian household service workers have been in solidarity with each other, especially in collectively safeguarding their rights as migrant workers in HK (Plucinska, 2015).
In HK, foreign household service workers’ economic contribution is felt beyond their roles filling in the care gap and freeing around 110,000 mothers from their domestic obligation that allow them to participate in the city-state’s economic activities (Carvalho, 2019). Even though FHSWs are seen as necessary supplement to the economic prosperity of both the Philippines and HK, a significant number of them are subjected to exploitative conditions such as working for more than 100 hours per week, some without weekly or monthly days off, for less than US$500 per month (Amnesty International, 2013). Their precarious working environment is made worse by mandatory live-in arrangement that results in various types of abuse (Mission for Migrant Workers, 2013). According to Hall et al. (2019), foreign household service workers’ physical and mental health issues like “hypertension, chronic pain, diabetes, poor sleep, depression and anxiety” (p. 10) are related to structural conditions of their occupation. Moreover, their access to medical services is also tied to their work visas. Once their work contracts are terminated, they are also barred from seeking free health care services entitled to citizens. The nature and length of work visas and work contracts available to foreign household service workers only reinforce their status as temporary in HK which impacts their health (Oktavianus & Lin, 2023).
Although FHSWs and Indonesian household service workers in HK have shared concerns, they also have differences. First, they have different networks before going to and while in HK (Oktavianus & Lin, 2023). Compared with their Indonesian counterparts for example, FHSWs had larger overseas migrant networks (Paul, 2019). Second, they have different histories and cultures including languages and religions (Paul, 2019). While Indonesians in HK were commonly affiliated with Islam, FHSWs were usually affiliated with Christianity (Liao & Gan, 2020; Yap, 2015). Third, differences in networks and histories also shape the ways into which they differ in terms of political organizing in HK (Rother, 2017). Overall, these differences are important as they suggest that FHSWs and Indonesian household service workers have unique experiences and these experiences shape and can be shaped by what is available and accessible for them. Likewise, these differences afford opportunities to focus on a specific community and their health.
Foreign household workers’ health-related media habits and their interactions with community organizations
Foreign household service workers acquire health information across interpersonal sources and media. While in countries of destination, they purposefully seek treatment- and prevention-related health information from medical professionals, non-medical professionals, and the Internet. While doctors and nurses were frequently cited as interpersonal sources, FHSWs in HK also referred to their peers, family members in the Philippines, and employers (Bernadas & Jiang, 2016). Reliance on social networks for health information and care is well documented, especially among foreign domestic workers who are not fully integrated in their countries of destination (Baig & Chang, 2020; Oktavianus & Lin, 2023; Piocos et al., 2021). The importance of fellow foreign household service workers as health information sources was emphasized by Oktavianus and Lin (2023), that is, Indonesian household service workers in HK relied on their peers for health advice. In their work with both Filipino and Indonesian household workers, Baig and Chang (2020) found that both groups sought health-related information from friends in HK. Social networks, specifically employers and peers, may serve not just as direct sources of health information but can become “access points to health institutions and services” (Piocos et al., 2021, p. 95). Beyond medical concerns, access to interpersonal network via technologically mediated communication, primarily media, also helps in addressing mental health issues and general well-being of many FHSWs in HK (Cheng & Vicera, 2022; Zhong et al., 2022).
Recently, there is a growing number of research about media use for health among foreign household service workers. During a health crisis, for example, Indonesian household service workers sought pandemic-related information from Indonesian ethnic media in HK (e.g.
The COVID-19 pandemic has only exacerbated the health-related vulnerabilities of FHSWs as HK reels from its fifth wave of outbreak. Early in 2022, around 80 FHSWs were fired by their employers for contracting the highly transmissible omicron variant of the virus (Sun et al., 2022). Given the restrictive and expensive mandatory quarantine for those who tested positive, many of these FHSWs find themselves stranded and homeless as their employers refuse to house them in the same accommodation until they fully recover from the virus. The news of these illegal dismissal of COVID-positive FHSWs, which spread among migrant groups in social media, has mobilized NGOs like HELP for Domestic Workers and Mission for Migrant Workers (MFMW) to extend their services to either house the dismissed migrant women or aid them with relief packs as they isolate toward recovery (Davidson, 2022). Similar to Bernadas and Jiang (2016) and Oktavianus and Lin (2023), these instances show how important community media and organizations respond to health-related crises of vulnerable migrant women in the city. In HK, community organizations are critical sources of health information for both FHSWs and their Indonesian counterparts. While FHSWs approached
Situated in the growing engagement of community organizations and ethnic media working for migrant health in countries of destination yet limited theoretical explanations and empirical evidence, this article raises the following research questions (RQs):
CIT and migrant health: community organizations and ethnic media in HK
Originally proposed to explain civic engagement, CIT argues for the importance of “integrated connections to the ‘storytelling neighborhood’ network” (Kim & Ball-Rokeach, 2006, p. 189). Guided by ecological approach, it focuses on “communication ecologies” (Wilkin, Ball-Rokeach, Matsaganis, & Cheong, 2007, para. 1) or the layers of interpersonal and/or mediated communication linking organizations and people in particular context. It emphasizes connections among organizations and between organizations and individuals, and the extent to which these connections facilitate communication and belongingness critical for building and improving community (Hayden & Ball-Rokeach, 2007; Kim & Ball-Rokeach, 2006; Matei & Ball-Rokeach, 2003; Wilkin, Ball-Rokeach, Matsaganis, & Cheong, 2007). Central to CIT are the concepts of “storytelling network” (Kim & Ball-Rokeach, 2006, p. 174) and “communicative action context” (p. 174). Storytelling network is characterized as links among community organizations, ethnic media, and residents and the ways into which these links generate messages for enabling communities to identify and act on their problems (Hardyk et al., 2005; Kim & Ball-Rokeach, 2006; Lin & Song, 2006; Wilkin, Ball-Rokeach, Matsaganis, & Cheong, 2007).
Meanwhile, communicative action context (CAC) refers to cultural, social, economic, and physical spaces into which a storytelling network exists and the extent to which these spaces shape the connectedness (or lack thereof) of community organizations, ethnic media, and residents (Kim & Ball-Rokeach, 2006; Wilkin, Ball-Rokeach, Matsaganis, & Cheong, 2007). Examples of CAC may include healthcare resources, ethnic/cultural diversity, street/safety fear, transportation, public spaces, schools, social control, area appearance, goods and services, work conditions, and resources for families/children (Kim & Ball-Rokeach, 2006). While Oktavianus and Lin (2023) did not directly explore CAC, they found that Indonesian domestic workers faced additional challenges during COVID-19 because of limited physical space and contact. Similar to Oktavianus and Lin (2023), this article did not directly examine CAC but focused on the storytelling network, specifically meso-level storytellers per se—community organizations and ethnic media. Given its relatively unique orientation toward community organizations and ethnic media, as well as the context into which their connections are situated, CIT has been applied to health communication research and programs, specifically for hard-to-reach populations and low-income communities (Oktavianus & Lin, 2023; Villanueva et al., 2016; Wilkin et al., 2010).
When extended to health communication, CIT has focused on explaining and addressing health disparities encountered by African-Americans (e.g. Kim et al., 2011; Matsaganis et al., 2014) and Latinos and Hispanics (e.g. Cheong, 2007; Wilkin & Ball-Rokeach, 2006; Wilkin et al., 2007; Wilkin et al., 2015) in the United States and Indonesian household service workers in HK (Oktavianus & Lin, 2023). The work of Oktavianus and Lin (2023) is pioneering because it was the first to use CIT to provide answers to question of “Who were the story-telling agents that Indonesian MDWs connected to during the COVID-19 pandemic, and how did they connect to these agents?” (p. 3). Through interviews, Oktavianus and Lin (2023) found that interpersonal networks of Indonesian household service workers had favorable and unfavorable consequences on their health, depending on the quality of health information they provide. These interpersonal networks included fellow Indonesian household service workers in HK, left-behind families in Indonesia, and employers (Oktavianus & Lin, 2023).
Drawing insights from CIT in general and storytelling network in particular, Wilkin and Ball-Rokeach (2006) focused on ethnic media or “mediated media . . . targeted toward a specific ethnicity and/or community” (p. 300) and the ways they assist Latinos in addressing health concerns. Compared with mainstream media and the Internet, local Spanish-language TV and radio shows and newspapers were reported by Latinos as their most common sources of medical and health information (Wilkin & Ball-Rokeach, 2006; Wilkin et al., 2015), specifically for those who were uninsured (Cheong, 2007). To illustrate, ethnic TV shows communicated information critical for preventing and/or managing diseases and addressing barriers to health recommendations (Wilkin et al., 2015). The availability of ethnic media in HK especially during the pandemic was important for Indonesian household service workers who were not proficient in English or Cantonese (Oktavianus & Lin, 2023). The relevance of ethnic media for health can further be illustrated among migrants with long-term temporary status who are not completely integrated in countries of destination (Oktavianus & Lin, 2023). In addition, local Spanish-language TV shows were likely to have health-enhancing effects, that is, entertainment-related programs were found to improve breast cancer knowledge and heighten intention for screening behaviors (Wilkin, Valente, Murphy, Cody, Huang, & Beck, 2007). Overall, extant literature on CIT points to the following about ethnic media as part of storytelling network: (1) they have health information acquisition function, (2) they contain multiple health messages, (3) they have health-enhancing effects, and (4) they facilitate identification between characters and audiences. To date, however, the role of ethnic media in the context of migrant health and the production of health messages are underexplored, and this article is an attempt to partly address this shortcoming.
Compared to ethnic media, community organizations and their positive contributions to health and well-being have been given more attention. As part of the health storytelling network, NGOs and faith-based organizations function in at least two ways (Wilkin & Ball-Rokeach, 2006). First, they serve as sources of health information for preventive and/or management or treatment purposes. To illustrate, African-Americans and Latinos who belonged to sports/recreation, cultural/ethnic/religious, neighborhood/homeowners, and political/educational also reported high knowledge related to breast cancer and diabetes (Kim et al., 2011). Second, community organizations organize and connect to other parts of the storytelling network such as ethnic media to address structural barriers to health. When linked to African-Americans, for example, community organizations enable access and use of underutilized reproductive health care services (Matsaganis et al., 2014). Described as part of a communication asset, community organizations and faith-based organizations served as “comfort zones” for promoting health among residents of multi-ethnic communities in Los Angeles (Villanueva et al., 2016, p. 2713). In the context of communities that Villanueva and colleagues (2016) worked with, community organizations and faith-based organizations become “comfort zones” (p. 2713) for health promotion largely because they enable connections built on trust and comfort.
Although the role of community organizations for promoting health has been explained in terms of CIT, it has been limited in some ways. First, CIT has rarely been used to explain the growing importance of NGOs and faith-based organizations in promoting the health of migrants outside the United States and the United Kingdom. While CIT has been extended to other contexts such as Japan (e.g. Jung & Maeda, 2018) and even among foreign household service workers in HK (Oktavianus & Lin, 2023), it was used to explore individual or personal storytelling networks but not community organizations and ethnic media per se. Second, community organizations have largely been homogenized, that is, unique meanings and experiences of NGOs and faith-based organizations have not been given much attention. Extending the work of Villanueva et al. (2016), this article highlights the individual solutions and collective actions of NGOs and faith-based organizations for promoting migrant health. Third, other potential conditions for which community organizations and ethnic media may form, maintain, or even disconnect from a storytelling network need to be explored. Motivated by the work of Matsaganis and colleagues (2014), this article attempts to document other ways into which NGOs and faith-based organizations may connect with each other and connect to ethnic media. Fourth, understanding the strengths and opportunities of social media use by community organizations to link with other members of the health storytelling network warrants further attention. Although CIT focuses on available interpersonal and mediated sources in the community (Kim & Ball-Rokeach, 2006), it has been limited to understanding the importance and shortcomings of the Internet (e.g. Hayden & Ball-Rokeach, 2007; Matei & Ball-Rokeach, 2003) and not so much on social media. Given the restrictions for physical contact during COVID-19, social media, for example, enabled Indonesian household service workers to maintain connection to their storytelling networks (Oktavianus & Lin, 2023). Exploring the opportunities and limitations of social media in a health storytelling network is warranted given that foreign household service workers use social media for acquiring health information.
Methods
Study design and ethics
To explore how community organizations and ethnic media serve as communicative resources for FHSWs in HK, this article employed face-to-face key informant interviews (KIIs). Broadcast program hosts and journalists from ethic media and officers/leaders from community organizations in HK served as key informants. To complement the KIIs, field notes were generated by observing and participating in formal activities (e.g. meetings) and informal gatherings (e.g. parties) of ethnic media and community organizations. Before data collection, ethical approval was obtained from the Institutional Review Board of the affiliated university.
In selecting ethnic media and community organizations, this article used theoretical sampling informed by CIT (Kim & Ball-Rokeach, 2006; Wilkin et al., 2010) to highlight the breadth of experiences, programs, and services offered to FHSWs in HK. For ethnic media, it included three broadcast programs and two print newspapers (Organizations A, B, C, D, and E). These programs and newspapers have been in operation for at least an average of 16.4 years. All ethnic media exclusively catered to Filipinos are run and operated by Filipino journalists and broadcasters. They are sustained by advertisements or support of businesses in HK that are catered to Filipinos. These community media, which include Filipino community print newspapers and radio stations, can also be accessed through their websites or social media accounts. For community organizations, it included four NGOs and four faith-based organizations (Organizations F, G, H, I, J, K, L, and M). These NGOs and faith-based organizations have been in operation for at least an average of 26 years. The NGOs served migrant household workers from different nationalities, whereas the faith-based organizations catered to Christian/Catholic FHSWs. It is worth noting that these NGOs were either organized by Filipino organizers collaborating with NGOs from other nationalities or were first established as welfare support groups for FHSWs before expanding their service to foreign household service workers from other countries (Lopez-Wui & Delias, 2015). Faith-based Christian organizations, meanwhile, were organized around communal gatherings and church-based activities, and have become important avenues for support and socialization among many Filipinos in HK, majority of which are Roman Catholics (Yap, 2015).
Key informants were recruited based on (1) affiliation with ethnic media and community organizations and (2) firsthand knowledge and direct experience with programs and services for FHSWs. Names of ethnic media and community organizations were anonymized to promote confidentiality. Prior to the interviews, the study purpose was again explained to key informants. If they agreed to participate and to audio-record the interviews, key informants were asked to sign informed consent forms. Interviews were conducted using English, Tagalog, or other Philippine languages—depending on the key informant. With the exception of Organization I, all ethnic media and community organizations told their stories in English, Tagalog, or Taglish. Organization I narrated their stories in English only. Similar to previous studies on migrant health (e.g. Baig & Chang, 2020; Bernadas & Jiang, 2016; Oktavianus & Lin, 2023), the use of local languages during interviews established trustworthiness, made the participants comfortable, and offered further opportunities to probe. At the end of the interviews, a token of appreciation (amounting to US$7.00) was given to key informants for their time and effort. Overall, the interviews lasted for an average of 87 minutes and ranged from 53 to 110 minutes.
Interview guide
The guide is organized into three interrelated parts consisting of semi-structured and open-ended questions. The first part inquired about the goals and clients/audiences. The second part focused on the ways in which ethnic media and community organizations problematize the health of migrants. The third part encouraged the key informants to share how their organizations envision the state of migrant health. The overall interview guide resulted from iterative and ongoing consultations with key informants.
Procedures for data analysis
Before data analysis, the authors read all transcriptions while listening again to the original audio recording of KIIs for data accuracy. The audio-recorded KIIs generated 218 pages of single-space, 12-font size, and double-column transcriptions. Names and other possible identifiers were removed from the transcriptions. The first part of data analysis started by building a meta-matrix that included verbatim answers to questions from the interview protocol. Rows of the meta-matrix referred to questions, whereas columns referred to answers of broadcast hosts, journalists, and NGO and faith-based organizational leaders working with ethnic media and community organizations. Guided by the research questions, the second part of data analysis involved the merging of and comparing and contrasting answers. Answers of broadcast hosts and journalists were merged under ethnic media, whereas those from NGO and faith-based organizational leaders were merged under community organizations. After the answers of ethnic media and community organizations were placed side-by-side with the corresponding research questions, they were compared and contrasted largely based on CIT literature (Kim & Ball-Rokeach, 2006; Wilkin et al., 2010). The third part of data analysis was guided by grounded theory for health research (Starks & Trinidad, 2007) to look for emergent themes that were not identified in previous literature. Although this article did not directly focus on CAC, it also attended to some salient features of CAC in HK that emerged from the interviews. Across three phases of data analysis, the authors consulted each other and their field notes for validation.
Results
Definitions of and explanations for health
RQ1 focused on how ethnic media and community organizations define and explain the health of FHSWs in HK. They consistently referred to cancer as the most serious and widely shared concern among FHSWs. For instance, Organization D shared “We are seeing it because we already have a number of OFWs [overseas Filipino workers] with stage 4 cancer sent home . . . There are a lot of people with stage 4 cancer here.” Organization C elaborated on the challenges of being diagnosed and coping with cancer while in HK by saying “. . . it’s hard to be a domestic worker. Imagine the life of a domestic worker suffering from cancer?” Aside from cancer, stroke and depression were identified by ethnic media and community organizations as shared health concerns among FHSWs.
When asked to explain why cancer, stroke, and depression were widely shared health concerns, ethnic media and community organizations indirectly implicated the CAC. The salient communication contexts mentioned were (1) work conditions and (2) healthcare resources. In terms of work conditions, for example, Organization B discussed “. . . employers start early morning then go home by 8 [PM] or 9 [PM] and they still awake by midnight, so the domestic workers are expected to be up all night and attend to the needs of the employers . . .” Organization E also shared “. . . we get feedback that it is really related to long working hours. What can they do when they sleep at 1 am and wake up at 5 am?” The problem of work conditions was echoed by Organization M by saying: the work here also has no limit. If there is a law that states that work should only be for 8 hours or 12 hours then I think our fellow countrymen can have more rest. I think this is work related.
One of the most substantive references to work conditions was offered by Organization F: they [FHSWs] are also overworked. On a day-to-day basis, a regular person in any country follows standard working hours. For every day of their work, it is double the work for domestic workers. In one day, they take two more jobs. Based on our own survey statistics, as well as other institutions, the average working hours is 12-16 hours. However, the domestic workers here are working for 20 hours so they only have four hours to relax. So that is the stress that the domestic workers are facing.
Organizations likewise pointed to access to affordable healthcare resources. Access to affordable healthcare was first tied to employers, such that, “. . . if you do not have the job here, you will be charged like a tourist. You cannot be a beneficiary of a public hospital” (Organization G). FHSWs accessing healthcare resources may also signal to employers that they were unfit to work and may have serious economic consequences. Organization J shared “. . . if there is something they do not want to talk officially, it is health issue. But it’s very common. They [FHSWs] feel that when they talk about their health issues to their employers, their contract might get terminated.” Access to affordable healthcare was also connected to employment contracts as FHSWs with terminated employment contracts do not have access to public healthcare. To illustrate, Organization D said, “. . . [FHSWs] will not be able to afford it. They won’t be able to pay for the hospital bills, and they will not get paid because they are sick and will be asked to go back to our country.”
Although differentiated from each other, work conditions and healthcare resources were related to the community organizations and ethnic media. Work conditions of and healthcare resources available for FHSWs were tied to migration in general and domestic work in particular. Domestic work in HK is characterized as temporary. Organization H shared, “Before they say they can only work here for two years and then they will return to the Philippines. It is difficult for them to be separated from their families.” Even if 2-year employment contracts can be renewed, FHSWs are prohibited from obtaining residency status in HK.
Solutions for health, illness, and disease
RQ2 focused on solutions offered by ethnic media and community organizations to address the health concerns of FHSWs in HK. The first commonly shared solution they had was direct and indirect provision of health information. On the one hand, they served as direct sources by talking about health issues with examples and warnings. Organization B, which is an ethnic media, provided an example by saying “. . . I give myself as an example on not to neglect their health . . . We always give advisory or reminder or warning that if they don’t act on their concerns, they might die.” On the other hand, they served as indirect sources by inviting healthcare professionals and organizations in their broadcast programs and medical missions. As a faith-based organization, Organization K mentioned, “Two or three months ago, since we have a member who has cancer, we invited someone to talk about cancer.” Interestingly, community organizations reach out to workplaces of employers to promote health of FHSWs. For example, an NGO like Organization I shared, . . . we go to the corporations to make us part of their HR or initiative to talk to their staff because this is impacting a lot of their staff. They do not want to get a headache with these things. We come in as an information source. We do a one-hour session that is very practical.
The second commonly shared solution among ethnic media and community organizations to address the health concerns of FHSWs was in terms of tangible support—from giving wheelchairs and organizing exercise programs to providing food and shelter to fundraising. Organization L, which is a faith-based organization, discussed the way it offers tangible support to FHSWs: Once a year, there is a cancer awareness program where we do fund raising activities like selling tickets, t-shirts. We also have solicitation in different companies here but also in the Philippines. It is a great help to us because without financial support, we do not run as well because patients do not really care about spiritual and emotional if there is no money. They especially struggle with their salary.
While community organizations offered health information and tangible support, they also designed and implemented campaigns and advocacies. Unlike health information and tangible support that targeted individual FHSWs, campaigns and advocacies were for employers and governments (i.e. HK and the Philippines). When asked to talk about their advocacy targeting governments, Organization G said, “Our campaign is wage, working hours, and worker’s right. It is part of a more broad-based campaign against modern day slavery and neo-liberal policies affecting migrants.”
Perceptions toward and use of social media for health
RQ3 inquired about how ethnic media and community organizations perceive and use social media for health. For ethnic media and community organizations, social media were advantageous because of the extent to which they reach audiences. Organization A explained, “We are live on
Unique with ethnic media was their discussion of the favorable and unfavorable consequences of social media on journalistic practices. Organization D mentioned “. . . to strike a balance between being able to give the information as comprehensively as we used to and giving it out as fast as social media now demands it.” On the one hand, social media pointed ethnic media to popular health issues confronting FHSWs. For Organization E, a health issue is covered when it is widely shared and becomes viral in
Particular to community organizations was their elaboration of the advantages and disadvantages of social media on their accessibility to FHSWs. When asked to talk about the positive side of accessibility, Organization L said, “social media is a big help. For example, someone can message and refer patients to us.” Although accessibility enabled community organizations to address immediate health concerns of FHSWs, it also became a problem in terms of workload. Given the limited resources and volunteers, they were expected to respond to different messages even after office hours. Accessibility heightened stress among volunteers from community organizations who also happened to be FHSWs.
Discussion
This article focused on communication infrastructure for health among migrants in countries of destination. Through a series of KIIs with broadcast media hosts, journalists, and NGO and faith-based leaders, it particularly explored how ethnic media and community organizations enable a storytelling network serving as communicative resources for FHSWs in HK. Overall, it situates ethnic media and community organizations as key but rarely examined publics in health communication by discussing (1) ethnic media as key player in health storytelling network, (2) structure-oriented community organizations in the health storytelling network, and (3) tensions in social media use by community organizations and ethnic media.
Ethnic media as key players in health storytelling network
By knowing how ethnic media may play different roles in a health storytelling network, this article reinforces previous literature in at least two ways. First, it aligns with health information acquisition literature in migrant health (e.g. Cheong, 2007; Cohen et al., 2010; Wilkin & Ball-Rokeach, 2006; Wilkin et al., 2015) by validating that ethnic media were sources of health information. In particular, it shows that FHSWs who acquired health information from ethnic media were strategically targeted by broadcast programs and newspapers in HK. By pointing to a potential communicative juncture (Matsaganis et al., 2014) between ethnic media and FHSWs, this article suggests that continuous coverage and reporting of widely shared health concerns (e.g. cancer) is warranted for broadcast programs and newspapers. Second, it illustrates the ways ethnic media become part of a health storytelling network for FHSWs in the context of Hong Kong. Specifically, it highlights how different population and context may benefit from the health-promoting functions of ethnic media. Similar to Latino and Asian media (Wilkin & Ball-Rokeach, 2006; Wilkin et al., 2015), radio stations (Hardyk et al., 2005), and Black newspapers (Cohen et al., 2010) in the United States, it shows how broadcast programs and newspapers connect FHSWs to local resources and additional health information. Ethnic media point FHSWs to qualified individuals (e.g. healthcare professionals) and established organizational health storytellers (e.g. community organizations and government) from both Hong Kong and the Philippines. Compared to what has been found by Lin and Song (2006), broadcast programs and newspapers primarily focused on health concerns of FHSWs in HK. Knowing some shared health concerns of FHSWs also allows ethnic media to provide personalized health information. To a large extent, this article offers partial evidence for the appropriateness of CIT (Kim & Ball-Rokeach, 2006; Wilkin et al., 2010) to argue for the importance of ethnic media in promoting health among migrants while in countries of destination.
To date, however, this article is one of the few to shed some light on the production of health information by ethnic media especially for FHSWs. Broadcast programs and newspapers produce health information by bringing healthcare professionals to speak live in their shows. Likewise, they produce health information by allowing FHSWs to ask questions from healthcare professionals who are interviewed directly either from studios in HK or from the Philippines. By producing health information with healthcare professionals and allowing FHSWs to ask questions, ethnic media heighten their trustworthiness and comfort as channels for correct and relevant information. Overall, this article may have broader applications to health campaigns directed to hard-to-reach populations (Wilkin et al., 2010). To reach migrants in countries of destination, health campaigns may target ethnic media as one of the channels for communicating health information. More importantly, health organizations and professionals may work with ethnic media as co-creators of culture-centered (Dutta et al., 2018) solutions for enhanced migrant health. A step toward that direction is for healthcare professionals, medical associations, and public health organizations to build media relations with broadcast hosts and journalists in voicing out health concerns of migrants in countries of destination.
Structure-oriented community organizations in the health storytelling network
Consistent with extant literature, this article reinforces that community organizations serve as health information sources for migrants in countries of destination. Similar to their counterparts in Singapore (Dutta et al., 2018), faith-based organizations and NGOs were sources of health information and tangible support. Although focused on meso-level storytelling networks per se, this article adds to the work of Oktavianus and Lin (2023) by confirming the importance of community organizations as health information sources. This article further clarifies how faith-based organizations and NGOs become direct and indirect health information sources. Direct sources refer to how NGOs and faith-based organizations communicate health information based on their knowledge and experience in working with FHSWs, whereas indirect sources point to bringing healthcare professionals when organizing medical missions. Partly new in this article, however, is the framing of health by community organizations. Faith-based organizations and NGOs emphasize structural explanations, that is, they point to work conditions and healthcare resources. Formal policies by the government and informal rules by employers serve as backdrop to understand the experiences of FHSWs in HK. Knowing that community organizations frame health of FHSWs as structural, this article has three potential implications to migrant health and CIT.
First, it makes governments and employers visible audiences for promoting migrant health. It shifts the responsibility for better health from FHSWs to governments (e.g. HK and the Philippines) and employers. While NGOs and faith-based organizations have other solutions for promoting health of FHSWs, they engage in campaigns and advocacies to dialogue with other stakeholders. To some extent, it legitimizes the accountability of governments (e.g. countries of origin and destination) and employers for health concerns of migrants. When community organizations frame health as structural, they also offer solutions that directly engage with work conditions and healthcare resources. In other words, this article highlights that definitions of and explanations for health are critical in explaining the ways community organizations structure their solutions for illness and disease.
Second, it clarifies some potential conditions upon which health storytelling may be established and maintained in a particular context. In conversation with CIT (Kim & Ball-Rokeach, 2006; Wilkin et al., 2010), it raises the following questions: “How do we characterize the meso-level health storytelling network per se? In what ways can it start and persist over time?” Based on the experiences of community organizations working for health of FHSWs in HK, a meso-level health storytelling may be informal and expertise-based. To address some health concerns of FHSWs, community organizations rely on their informal relationships with each other. As expertise-based, the meso-level health storytelling network links other organizations (e.g. ethnic media) to community organizations that have experience and competence in handling a particular health concern. In the context of FHSWs, a meso-level health storytelling may be formed and maintained via shared definitions and explanations for health concerns. Community organizations work with each other as well as ethnic media, albeit informally, because they share a belief that health concerns of FHSWs is tied to structural (e.g. work conditions and healthcare resources) factors. For a meso-level storytelling network to exist and function, there must be some ties that will bind community organizations and ethnic media, and one promising “bind” is a shared belief that migrant health is complex and goes beyond individual responsibility.
Finally, it offers another opportunity to revisit CIT in relation to temporality. This article continues the work of Oktavianus and Lin (2023) by incorporating temporalities of migration (Boersma, 2019) into CIT to explain migrant health. Compared with other migrants (e.g. professionals), foreign household service workers have temporary status, and this status is reinforced by the kind of work visa and work contract granted to them (Paul, 2019; Rother, 2017). While their 2-year contract can be renewed, which enables them to become long-term temporary migrants, foreign household workers do not have the right to abode or apply for residency status (Baig & Chang, 2020; Paul, 2019).
While much is known about “permanent temporariness” (Boersma, 2019, p. 273), it has rarely been connected to migrant health, especially foreign household workers, until the work of Oktavianus and Lin (2023). This is further reinforced by the Philippine government’s policy preference for circular migration (Calzado, 2007) which encourages completion, return, and further renewal of contract, thereby prolonging a temporary sojourn or even facilitating “permanence” in the host state. The non-inclusion in countries of destination and temporary status of migrants impacted their health storytelling networks, that is, foreign household service workers rarely relied on local health information sources in HK since they do not cater to their nationality and language (Bernadas & Jiang, 2016; Oktavianus & Lin, 2023). Instead of relying on official sources, these migrants obtain information and referrals from their peers who have been staying longer than them. Nonetheless, their status as temporary migrants has also reinforced “substantial temporal restrictions of migration” (Boersma, 2019, p. 274). Thus, temporariness has further enforced denial of family reunion and lack of opportunity to obtain permanent citizenship. Furthermore, the temporary status often results in inequality, deprivation of rights, and even the experience of precarity. Goldring (2014) focuses on the precarious status and the areas of conditionality which indicates how the surrounding presence and access play out in various aspects, including healthcare. This article confirms the work of Oktavianus and Lin (2023) by showing that the consequences of temporalities of migration is not just illustrated at the level of individual or personal storytelling networks but also at the meso-level. The experiences of community organizations and ethnic media reinforce that the temporary status of foreign household service workers impact their access to health information and care. As a result, solutions offered by community organizations recognize temporalities of migration or even advocate against the disciplining function and exclusionary effects of temporary status on migrant health. In addition, community organizations are widely involved in addressing issues caused by negotiating arenas of conditionality imposed against temporary migrants.
Tensions in social media use by community organizations and ethnic media
In line with CIT (Kim & Ball-Rokeach, 2006), this article shows that community organizations and ethnic media rely on multiple communicative modes to talk about a particular referent and a local community. While this article does not discount the multiple communicative modes, it shows the ways the Internet and social media are embedded in the health storytelling network. Consistent with health information acquisition literature in migrant health, for example, this article validates that the Internet serves as a critical channel for scanning and seeking health information. In particular, it shows that ethnic media and community organizations use social media to communicate health information. Together with the work of Hayden and Ball-Rokeach (2007) and Matei and Ball-Rokeach (2003), this article broadens literature that problematizes the Internet in general as communication infrastructure linking different levels of health storytelling network. To some extent, similar to communication technology centers (Hayden & Ball-Rokeach, 2007), social media serve as sources of content for health concerns of FHSWs and enable connection within meso- (e.g. community organizations and ethnic media) and between meso- and micro-levels (e.g. ethnic media or community organizations and FHSWs). By pointing to circulation of health disinformation, this article adds to the discussion on how social media may reinforce “magnifying glass effect” (Matei & Ball-Rokeach, 2003, p. 642), such that, social media may only benefit FHSWs who have resources for identifying problematic health information and access to quality healthcare.
A contribution of this article is to encourage reflection about advantages and limitations of social media use for health storytelling in the context of migration. On the one hand, they may positively contribute to health by promoting accessibility of NGOs and faith-based organizations to FHSWs who need health information and tangible support. They are also beneficial for ethnic media, that is, social media enable new ways of identifying and producing relevant health-related content to FHSWs. On the other hand, accessibility afforded by social media also requires availability and presence all the time and may have unfavorable consequences on limited resources of community organizations and well-being of volunteers. They may also become challenging for ethnic media, that is, broadcast programs and newspapers need to confront a new set of ethical challenges in reporting health. Overall, this article has applications to health campaigns for FHSWs and social media policies of community organizations and ethnic media. For instance, health campaigns for enabling FHSWs to identify health disinformation or talking about the risks of sharing and posting health disinformation in
Conclusion
Although it contributed to understanding some of the ways by which community organizations and ethnic media per se are engaging with conversations about migrant health, this article has several limitations. First, the health storytelling network in this article is limited by the following contexts: “meso-level,” population, and territory. It focused solely on FHSWs and excluded other nationalities with a sizable number of household service workers in HK. A step in the right direction is to compare and contrast storytelling networks and CACs of FHSWs and their Indonesian counterparts not just in HK but also Singapore. A collaboration between Filipino and Indonesian researchers is much needed to address this recommendation. Second, the focus on production in “meso-level” storytelling networks has excluded health messages directed to FHSWs as well as CAC. A step in the right direction is to bring CAC further into CIT-informed migrant health research. For instance, comparative research can be done between FHSWs in Singapore and HK not just in terms of healthcare resources and work conditions but also public spaces and ethnic/cultural diversity. Third, data were limited to officials and leaders of community organizations. Future research may include members (volunteers) of faith-based organizations and NGOs to understand their direct experiences of working with FHSWs. Overall, this article has shown that ethnic media and community organizations function as health-enhancing communicative resources by offering health information, providing tangible support, and campaigning to employers and stakeholders. Despite the limitations mentioned, this article engaged with theory and offered evidence to argue for the importance of community organizations and ethic media as publics for advancing migrant health in countries of destination.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article was supported by De La Salle University Interdisciplinary Research Grant (DLSU-IR.001-2017-2018.T3.CLA).
Ethical approval
This article secured an approval from the Research Ethics Office before data collection (REO PROTOCOL CODE: DLSU-IR.001.2017-2018.T3.CLA).
