Читать книгу Medical Communication: From Theoretical Model To Practical Exploration - Tao Wang - Страница 17

The deficit model was proposed by John Durant, a Professor of Public Understanding of Science at Imperial College of Science, Technology and Medicine. He was also the Editor-in-Chief of Public Understanding of Science and the first professor of public understanding of science appointed by Royal Society of England. Durant thought that the public was short of scientific literacy and interest in science, so it was necessary to popularize and educate scientific knowledge to the public. In short, the main characteristic of deficit models was the public education by scientists. For example, since the 1970s, the National Science Council of the United States had regularly measured the level of scientific knowledge of the public. The Committee was disappointed to find that only 10% of Americans could define a “molecule”, while more than half believed that humans and dinosaurs were present on Earth at the same time. Based on these findings, the Committee concluded that only 5% of American citizens were scientifically literate and only 20% were interested in science, while others were referred to as “the rest of the population”. The deficit model confirms that when the public’s scientific literacy improves, it will support the development and application of science and technology in the country. Therefore, the early deficit model had a strong government-oriented color.

However, critics of the deficit model believed that this model presupposes some ideas: scientific knowledge was absolutely reliable, playing a supreme role in modern life; scientific knowledge could only flow from top to bottom; the improvement of scientific knowledge level was the only way to solve the problem of public alienating, doubting or even rejecting science, and so on.⁵ More scholars pointed out that the deficit model did not take context into account. Learning theory shows that only when facts and theories were meaningful in life could people grasp them best. For example, residents in water-polluted areas could quickly grasp complex terminology related to water pollution. Some scholars pointed out that the fatal weakness of the deficit model was that it tried to impose the cognitive model of occupational science onto the public’s understanding of science. Durant himself also realized that the deficit model accused the public of not taking their place in the relationship between science and society, and it also did not realize that the inconsistency between experts and the public in understanding might be due to the redefinition or reestablishment of science in specific contexts. It produced a one-way propagation process between science and the public, which is of no value or even of destruction, so, the public is skeptical about science in the process.

We assumed that the deficit model was applied to medical communication, then it was top-down propaganda of medical knowledge. Just as the deficit model in scientific communication characterized by scientists educating the public, the deficit model in medical communication was characterized by professional medical personnel educating the public. However, if only through education, it was very questionable whether the public was interested and how much they can be accepted. Figuratively speaking, the deficit model was similar to spoon-feeding education in primary and secondary school. I forced the transfer or education of medical knowledge to you in a variety of ways, regardless of whether this method was effective or whether the content was appropriate. Not to mention how effective it was for the public to acquire medical knowledge in this mode. Under the cramming education, even if the public acquired some medical knowledge, he might not understand the knowledge he had acquired very well. Such education is deficient congenitally. Let us take iodine supplementation for example. Iodine is one of the essential trace elements in human body. If iodine deficiency occurs, it may cause abortion, stillbirth, congenital malformation, neuromotor dysfunction in the fetus, hypothyroidism and goiter in the newborn, goiter in the childhood, hypothyroidism, subclinical cretinism, mental retardation and physical development disorder in adolescence, and goiter and its complications, hypothyroidism, and mental retardation in adulthood. If iodine is excessive, it may cause hyperthyroidism and other problems. In China, there are many iodine deficiency areas where iodine needs to be supplemented. Many authoritative media often propagated that the residents of our country should use iodized salt. In the Reform Plan of Salt Industry System, it was also stipulated that the coverage rate of qualified iodized salt should be over 90%. That is the deficit model in medical communication if we do not consider the regional issues of whether all regions are iodine deficiency areas, and the reason why iodine supplement should be used to publicize the whole population, and advertise for those to supply iodine, but not to tell them how to supply iodine scientifically and what harm iodine deficiency has and does to people. On the one hand, the public was told to supply iodine. But it was not clear how many people cared about the importance of iodine to the human body. Many of the public might think that iodine deficiency had nothing to do with themselves, so they did not care about it. On the other hand, some of the public may take iodine actively as required, but some of them might not be suitable for iodine supplementation. Excessive iodine supplementation may also lead to other diseases; thus this kind of medical communication is undoubtedly useless and may even be harmful.

Applying the deficit model to medical communication, as it has presupposed its supremacy, it shows its absolute authority when it spreads and propagates, but ignores whether the public is concerned about it and how much knowledge can be accepted. Therefore, even if the content of dissemination is very reliable, the effect of dissemination is also debatable. For example, hypertension is a very common chronic disease. According to the 12th Five-Year Plan sample survey of hypertension published by the State Health Planning Commission in 2017, the prevalence of hypertension among adults in China was 23%, and the number of adults was 243 million, which meant that one in four adults suffered from hypertension. The awareness rate, treatment rate, control rate, and treatment control rate of hypertension were 42.7%, 38.3%, 14.5%, and 38.0% respectively. The awareness rate, treatment rate, and control rate of hypertension in rural areas were lower than those in urban areas. From this survey, we can see that the prevalence of hypertension in Chinese population is high and the awareness rate is low. It is very urgent and necessary to improve people’s awareness of hypertension. In order to improve the prevalence rate of hypertension knowledge, local students in the school were popularized the knowledge of hypertension through books. Let’s see how it works. First of all, primary school students are generally not concerned about the common diseases of adults such as hypertension because they are not high-risk groups of hypertension and have low incidence of hypertension. Secondly, pupils’ cognition and cognitive ability are still at a developmental stage, and they cannot reach the adult’s cognitive level. Because of their limited understanding ability, the degree of understanding will not be very high. And If only books are used to popularize medical knowledge, the effect will not be very good. If the communication was carried out in the form of image cartoons or interactive lectures, the effect might be increased significantly.

Based on the defects of the deficit model, the following three models have been proposed successively.