Constructing women’s heart health and risk: A critical discourse analysis of cardiovascular disease portrayals on Facebook by a US non-profit organization

Abstract

Women’s cardiovascular disease portrayals were explored on Facebook by the US non-profit organization Women’s Heart Alliance and public users in February 2017. Portrayals were explored using critical discourse analysis which also identified subject positions. Women’s cardiovascular disease was constructed within two central discourses: achieving health equity and healthism, with the following subject positions: altruistic fighters, health activists, and compliant patients and consumers. These findings affirmed and resisted problematic forms of cardiovascular disease risk reduction. Recommendations are made using discursive resources and subject positions within social media forms as concrete entry points of resistance and change to raise women’s cardiovascular disease awareness.

Keywords

coronary heart disease health promotion qualitative methods social media women’s health

Cardiovascular disease (CVD) is the leading cause of death among White, African American, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander women in the United States (Centers for Disease Control and Prevention, 2017). Women with income below the poverty level, less than 12 years of education, and of racial and ethnic minority groups are at greater risk for CVD (Mozaffarian et al., 2016). While 45 percent of US women are unaware that CVD is the leading cause of mortality, those at greatest risk have reported less awareness about CVD risk (Bairey Merz et al., 2017). Furthermore, 48 and 21 percent of women with at-risk and high-risk profiles did not believe themselves to be at risk (Kling et al., 2013). US women reported limited awareness of symptoms of cardiac events (e.g. 17% identified chest tightness as a heart attack symptom) and limited engagement in risk-reducing behaviors (e.g. 53% reported doing regular physical activity) (Mosca et al., 2013). Risk reduction barriers included time constraints, lack of disease prevention knowledge, and confusing media messages (Mosca et al., 2013).

Critical discursive studies have shown problematic implications for social, political, and ideological meanings surrounding subjectivity and feminine identities through the identification of discourses in media portrayals of women’s health and disease (Clark et al., 2018; Gibson et al., 2015). When breast cancer was portrayed within a discourse of biomedicine in newspapers, women’s roles as good medical consumers were constructed as moral imperatives, which positioned with gatekeepers with power over women’s bodies (McGannon et al., 2016). Patriarchal meanings surrounding women’s health portrayed women with limited control over their risk, and benefits of lifestyle changes within their means were minimized (Gonsalves et al., 2017b; McGannon et al., 2016; Stampfer et al., 2000).

There is a gap in critical health psychology literature regarding socially constructed health meanings, ideologies, and subjectivities in large-scale US women’s cardiovascular health promotion through social media and user engagement with health organizations’ social media messages (Clarke, 2010; Gonsalves et al., 2017b). Social media platforms are discursive sites that (re)produce cultural health meanings and provide opportunities for users to support, resist, and/or reshape self-identities constructed within dominant narratives (Lupton, 2015). Discursive resources circulated by national institutions through social media for US women to make sense of their CVD risk has not yet been examined (Gonsalves et al., 2017b).

This study is the first to address the gap in the literature about US institutional use of social media in the discursive construction of women’s CVD risk and how risk can be reduced. The aim of this study was to conduct a critical discourse analysis (CDA) of Facebook messages to explore how knowledge of US media messages (i.e. print media of the early-mid 2000s) have carried forth into institutional power dynamics in the interactive digital era. How Facebook users may have provided novel meanings to women’s CVD in the current era was also of interest. User negotiation of women’s cardiovascular health identities through electronic discussions within cultural discourses and the implications for behavior modification was also of interest. The following research questions guided the study: (1) What discourses are drawn upon by the Women’s Heart Alliance (WHA) and public Facebook users to construct cardiovascular health, disease, risk, and health-related identities? and (2) What identity/subject positions are constructed within particular discourses for women at CVD risk and social agents accountable for women’s cardiovascular health maintenance?

Methodology and methods

WHA

The Facebook page of the WHA offered an opportunity to answer the research questions given its mission to raise awareness of US women’s leading cause of death, encourage risk-reducing behaviors, and fund women’s CVD research through cross-industry collaborations (Facebook, 2017; WHA, 2017a). The WHA was co-founded by Barbra Streisand, a recording artist, and Ronald Perelman, the Chairman and CEO of a diversified holding company titled MacAndrews & Forbes Incorporated (WHA, 2017a). Streisand and Perelman are philanthropic supporters of the following medical institutions: Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute in Los Angeles, CA, and the Ronald O. Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, NY (WHA, 2017a). February 2017 was a symbolic month for exploring power relations in discourse and language used to convey women’s cardiovascular health promotion by the WHA. On 2 February 2017, US President Donald Trump issued a proclamation declaring February as American Heart Month in memory of those who sustained fatal CVD events. The purpose was to raise awareness of the leading cause of death and to encourage CVD prevention on the 14th National Wear Red Day on 3 February 2017 (American Heart Association, 2017). The Love Project campaign was launched on 26 February 2017, a partnership between the WHA and cosmetics company Revlon for which WHA co-founder Streisand described women’s cardiovascular health with her perceptions of the concept of love (Revlon, 2017). The WHA initiative entitled Cities and Community with Heart was launched on 27 February 2017, in Nashville, TN, to promote women’s cardiovascular health through a collaborative effort between entertainment, political, academic, and medical institutions (WHA, 2017b).

Media context

The WHA Facebook page received 25,824 “likes” by Facebook users with 25,552 “followers” and constitutes a far-reaching discursive site of women’s cardiovascular health messaging (Facebook, 2017; WHA, 2017a). Facebook is the most popular social networking site among US adults (68% of all US adults and 79% of US adults with social media accounts are active on Facebook) which continues to garner users with an increase of 7 percent from 2015 (Greenwood et al., 2016). Frequency of user engagement is also high with 63 percent of Facebook users visiting the site at least once a day and 40 percent of users visiting Facebook multiple times a day (Duggan and Smith, 2013). A majority of US Facebook users are female (83% of female Internet users have Facebook accounts) with large percentages of women across age groups reporting Facebook usage (Greenwood et al., 2016). Larger percentages of US Facebook users are low-middle income adults earning < US$49,999/year, which is one female demographic group that is at greater risk of CVD (Mozaffarian et al., 2016). US Facebook users also disclosed their identification with various racial backgrounds with 71 percent identifying as White, 76 percent Black, and 73 percent Hispanic (Duggan and Smith, 2013). The following pieces from the February 2017 WHA Facebook data were analyzed; 31 Facebook posts, 120 comments, 23 replies to comments, 22 links to external webpages, 82 images, 11 videos, 1 audio file, and 1 GIF.

CDA

CDA is a broad form of analyzing the production and consumption of texts through identification of interpretive resources and ideologies within which texts are situated (Fairclough, 1995). The form of CDA used was grounded in social constructionism, which supports the assumption that taken-for-granted “truths” and social actions occur through language use within cultural, historical, and political contexts (Wetherell, 2008). Given that we were interested in the socially constructed meanings of health, risk and health-related identities within discourses made available on digital platforms (Lupton, 2015), CDA was an appropriate methodology to answer the research questions.

Within CDA, the term “subject position” refers to particular perspectives for social actors, to make sense of identities made available in discursive resources (Wetherell, 2008). Individuals exert agency by resisting subject positions in accordance with certain discourses to take up contradictory subject positions afforded by competing discourses (McGannon et al., 2016; Wetherell, 2008). Within health psychology, CDA has been used to investigate print and electronic media (re)presentations of women’s CVD (Clark et al., 2018) and breast cancer (Gibson et al., 2015; McGannon et al., 2016).

CDA methods were employed from previous health psychology research analyzing women’s CVD and breast cancer messages in newspaper, magazine, and electronic media (Clark et al., 2018; McGannon et al., 2016). Facebook data posted during February 2017 were collected manually and saved as screenshots in PDF format to aid intertextual contextualization across text, images, audio file, videos, and GIF (Millington and Wilson, 2016) and Microsoft Word format to facilitate line-by-line coding. Analysis began with immersion in positions over multiple readings and noting how images, rhetorical strategies, concepts, and narratives (i.e. storylines) were indicative of ideological categories. For example, the ideology that medical industry leaders have power in controlling women’s CVD risk was identified through the following rhetorical strategy: metaphors of medical specialists fighting a “ladykiller,” quoting medical experts about their humanitarian convictions, and requests for public donations to fund a medical “calling” to redeem women from death (Clark et al., 2018; McGannon et al., 2016). Next, the content and context of categories were linked across data items to identify overlaps, similarities and contradictions within and across categories (Clark et al., 2018; McGannon et al., 2016). An example of this analytical stage was noting how the medical industry and agents were portrayed as beneficial and problematic to women’s health through tensions surrounding levels of presumed expertise, rhetorical strategies to categorize medical staff within hierarchical structures, and “othering” of non-endorsed and non-affiliated professionals. Discourses and subject positions were identified from the frames and patterned themes of meaning in the health promotion messages through a recursive process of linking findings with media work in health psychology (Clark et al., 2018; McGannon et al., 2016). Although links to the literature guided the initial coding and interpretation of data, the analytic process was driven by the researchers by reflexive and higher order analysis within and across data items.

Quality and rigor was enhanced through methodological, theoretical, and epistemological coherence, which included using CDA grounded in social constructionism and making analytic choices that aligned with CDA steps. We also used pluralistic interpretive perspectives and data meanings through reflexive dialogs between the authors acting as critical friends (Smith and McGannon, 2018). Interpretations were also connected with compelling data illustrations and links to social constructionist literature, allowing for theoretical generalization (Smith, 2018). We conducted the study using social media ethics recommendations put forth for critical, naturalistic document analysis of open-access Facebook data. This process included exclusion of names and demographics to ensure privacy; deletion of identifying information in Facebook posts (e.g. residence and health conditions) when presenting data illustrations; and no interaction by the researchers with users or tracing data back to users during or after analysis (Roberts, 2015).

Results and discussion

In order to show the critical analysis phase of CDA the results and discussion and presented together (McGannon et al., 2016). Meanings associated with women’s cardiovascular health, disease, and risk reduction were constructed through two primary discourses: achieving health equity and healthism. These discourses intersected to construct three subject positions: altruistic fighters, health activists, and compliant patients and consumers. Each discourse and the associated meanings will be outlined, followed by the subject positions to show how these were made available within discursive resources, as afforded and limited by the WHA and other Facebook users.

Discourse of achieving health equity

A discourse of health equity was the one in which women’s CVD risk was portrayed as a social justice issue to reduce women’s health disparities through medicalized humanitarian efforts to raise women’s awareness of risk, and advance scientific knowledge and advocacy, healthcare delivery and access changes, and political leadership changes (Higgins et al., 2006; Roy, 2008). Women’s disparities were medicalized by the use of the following rhetorical strategies: positioning the female body as different and atypical against the male frame of reference and excluding meanings about social, political, and economic considerations in influencing women’s CVD risk to promote CVD as biology “gone wrong” (Clarke et al., 2007).

Facebook users personalized their inequitable medical CVD experiences in comparison to that of men and positioned pregnancy as a rhetorical device to further “feminize” meanings of what it meant to be a woman with CVD. An implication was the detailed WHA focus on sex-differences, as demonstrated in following user comments: “When a women goes to the ER with complaints it’s a panic attack go home. When a man of the same age goes in its lots if tests and a […] overnight stay. I know. I’ve been there,” “They cut my husbands […] jeans off and had him in the helicopter. Me? They’d send me home,” “Heart problems affect women in very different ways from men. I had a [information withheld] attack and I was an enigma,” “Equality??? Women have a lot more to stress about then any man will ever!!!,” “One of my dear friends passed away 7 days after the birth of her 3rd child due to [information withheld]. I spent 5 days in the ICU after the birth of my son with [information withheld], which wasn’t diagnosed until I crawled into the ER after the birth center released me. There is such a lack of knowledge about these heart conditions related to pregnancy!,” and “My [information withheld] was after a hysterectomy. My ob gyn had never heard of that.” The WHA further drew on a discourse of achieving health equity to construct and portray which women were worthy candidates for equitable health, contextualizing comparisons against the (so-called) male standard and gendered norms and expectations for CVD risk meanings (Clark et al., 2018). Acceptable femininity was limited to caregiving mothers who conceived and breastfed their infants, as demonstrated in the following from an article in US newspaper Miami Herald that Facebook users were to read:

“We don’t have enough money given to us by the NIH [National Institutes of Health] and the government to do the research, and we need to do it because women are different than men,” Streisand said. “They have different size hearts. Different size arteries. And the research has to be done on women in the labs on female mice.” When I said, “How come you don’t use female mice?” They said, “They are more expensive.” Why are they more expensive? Because they are more complex. They have different hormones. Duh! You can’t do research on women’s heart disease on male mice or on males—and in the last 50 years it has been on males. Can you imagine? We are physiologically different. We have different plumbing. We have babies. We nurture. We feed babies. We are different.

In the above quotation, women’s reproductive capacity and gender roles as mothers were linked with sex-differences between female and male cardiovascular systems (e.g. “different size hearts,” “different plumbing,” and “we are different”). This example further shows the use of biological difference and physiology to reinforce and legitimize moral responsibility, divisions between female and male health, and political ramifications of gender equity in research funding (Clarke, 2010; Clarke et al., 2007). These patriarchal meanings grounded in biology contributed to the construction of women’s CVD through cultural ideals of prestige, celebrity, morality, and nobility, for social agents in power and supported by the public (Glenn et al., 2013). An example of this is seen in the construction of WHA Medical Advisor Dr Holly Andersen, in terms of her morality and nobility in achieving women’s cardiovascular health equity, while garnering prestigious medical titles and cross-industry accolades, in the following post, linked quotation, and user comment, respectively, on 7 February 2017:

The doctor’s tireless efforts continue through her work with major health groups. She is a member of the Board of Overseers for the Geisel School of Medicine at Dartmouth College and the International Women’s Health Coalition, among others. She also serves on the Leadership Council of the American Heart Association’s Go Red campaign, working to ensure that women have the know-how to keep their hearts healthy for years to come … We’re thrilled to share that WHA’s Medical Advisor, Dr. Holly Andersen NewYork-Presbyterian Hospital will be honored tonight at the Woman’s Day Magazine Red Dress Awards for her commitment to raising awareness of gender differences in heart disease and educating women about their heart health. Congrats, Dr. Andersen!, … Congratulations, Holly! You are so deserving of this honor after decades of fighting for the heart health of women.

Acceptable femininity was also tied to heteronormative ideals in women’s first-person stories advocating for greater medical knowledge, as demonstrated in the following linked quotation on 16 February 2017, regarding spontaneous coronary artery disease (SCAD) tied to identities as heteronormative wives:

… while vacationing with my husband … celebrating our 5-year wedding anniversary, I felt an uncomfortable tightening in my chest and tingling down my left arm … My husband insisted we go to the ER—a decision that undoubtedly saved my life. … In that moment the thought of losing my consistent health shattered my vision of our future. … My husband begged doctors to wake me so he could say all the things he wished he had said before I went in for that final test. After 13 days in the hospital kept alive by machines, we received news of a matching heart. I wanted to shout from the mountain tops that God had answered our prayers. There was still a future for me here, for us here.

Women at CVD risk were distinguished from WHA leaders and affiliated figures which contextualized “images” of those who experienced health inequity (e.g. due to lack of health insurance), to support the WHA as responsible for achieving health equity—a novel finding in comparison to prior media portrayals (Higgins et al., 2006). Physicians and specialists were described having superior clinical expertise compared to male counterparts. Women were also portrayed as medically knowledgeable enough to know when and how to advocate for equitable services, as demonstrated in the following user comment:

Don’t allow a doctor to just dismiss your symptoms either. I was hospitalized for some issues I was having with my heart. When I was discharged the 1st cardiologist I was referred to dismissed my symptoms as indigestion even though my EKG was not normal and my primary care doctor had requested a stress test. … I asked my primary for a new cardiologist and he referred me to a woman who has such compassion and shows such care. … Know your body and advocate for yourself, your life could depend on it.

WHA Facebook posts catered to women employed in the medical industry, ultimately holding up the WHA’s ties/allegiances to corporate interests/partners. An example of this is shown through a story noting that four out of five Cities and Communities with Heart Initiative (CCHI) program goals catered to maintaining the cardiovascular health of medical and political industry employees, and further medical focusing on maternal identities (e.g. Nashville hospitals and health systems and Office of the Mayor employees). This construction was promoted despite noting that Nashville residents experience high CVD risk given their minority backgrounds, and WHA paternalistic “first-of-its-kind effort” to “stop women in Nashville from needlessly suffering from CVD” through cross-industry collaboration.

Discourse of healthism

A discourse of healthism is one in which women at risk were positioned as active health seekers and individually responsible for health maintenance through self-governance and self-surveillance practices (Gibson et al., 2015). The concept of neo-liberal healthism (i.e. individual responsibility over one’s own health) promoted medical consumerism (i.e. medical services through monetary means) as a form of health promotion. The role of the medical industry in this discourse was to facilitate women’s CVD risk reduction. Women were positioned as social agents with power to maintain their health through self-care and surveillance practices versus being in need of policing or “cures” (Gibson et al., 2015).

The WHA and Facebook users drew upon particular plotlines, rhetorical strategies, and visual imagery to construct two dimensions for women’s identity profiles based on social categories of age, employment and socio-economic background, education, and gender roles. The first profile for women at risk comprised an older demographic of affluent, educated, employed women in high social standing. These women’s identities were closely tied to their social networks and heteronormative social roles. In the following video quotation, Katie Couric, a 60-year-old US news anchor, was shown as the “face of typical women” at risk, with her risk and health identity tied to Streisand and high social standing in accessing medical services of WHA Scientific Advisor and Director Dr Noel Bairey Merz:

People aren’t really sure what they should be doing when it comes to monitoring their heart health. So, I decided to come here to the Barbra Streisand Women’s Heart Centre at Cedars Sinai and find out because everyone I know wants me to get my heart checked; my daughters, my husband, even Barbra herself.

Couric was then shown engaging in a face-to-face conversation with Streisand, in which Streisand articulated her desire for Couric to receive health screens for CVD. Couric then walked into the check-in desk at Streisand’s Heart Center at Cedars Sinai where she asked for and was screened by Bairey Merz. Couric’s roles as an entertainment industry leader, wife, and mother show a positive link to encouraging women to attend to their heart health. These roles may also undervalue social identities of diverse female populations (e.g. women from minority racial backgrounds, who are unemployed, work in general labor, and unmarried), whose first-hand messages were absent in WHA posts (Clark et al., 2018; Gonsalves et al., 2017b). In addition, risk reduction for this older, affluent women’s profile focused on consumerism of WHA medical services through health screens. Such focus limited opportunity for other forms of healthism such as lifestyle changes. The second demographic profile of women within the discourse of healthism comprised younger women with a focus on preventing CVD and ensuring the health of other women in their families and networks. This was accomplished using rhetorical strategies, images, and videos shown in a WHA video quotation posted 3 February 2017:

What we do today will determine the chronic disease that develops later on in life. The time you have now is what you invest in your health because when you get to that point or stage when you’re older and you haven’t put in the investment kind of like insurance, you can’t get it when you need it. … Be a change agent for your families, for your Moms, for your grandmothers, for your sisters, because you want them to be around for a really long time.

In the above illustration, “investment kind of like insurance” within a discourse of healthism was used as a metaphor to construct risk reduction as an intentional goal-oriented activity in which women in their 20s and 30s must consistently engage. Younger women were positioned as role models for older generations of fragile, morally irresponsible women who failed to take care of their health when younger. In turn, the responsibility of their failed health care rested on granddaughters, daughters, and sisters, a finding for CVD media portrayals not yet identified in research. Neo-liberal healthism for younger women comprised some diversity in race and ethnicity through imagery (e.g. Ohio State College students appeared to belong to White, Black, South Asian, East Asian, and Hispanic backgrounds in a link posted 23 February 2017), but less-so in terms of gender and sexuality (e.g. construction of their identities exclusive of heteronormative roles).

Subject positions

The subject positions of altruistic fighters, health activists, and compliant patients and consumers were created through meanings within the intersection of the discourses of health equity and medicine, and healthism.

Subject position one—altruistic fighters

Through drawing on personal stories, and particular metaphors, the WHA leaders, entertainment celebrities, and affiliated political figures were constructed within the discourse of achieving health equity as altruistic fighters. Altruistic fighters fought “tirelessly” to change women’s cardiovascular health disparities and volunteered to use medical, political, and celebrity platform for public health education. Women were positioned as “subjects” for scientific discovery with “atypical” traits against the male frame of reference for CVD risk because of their biological capacity to give birth, and the social expectations surrounding motherhood and caregiving. Within the discourse of healthism, expert gatekeeper fighters were positioned as role models for how to perform healthy behaviors (due to social status), while receiving scientific, medical, and humanitarian accolades for professional accomplishments. Seeking medical services of these WHA medical experts was systematically positioned against medical professionals not affiliated or endorsed by the WHA to support the “Fight the Ladykiller^TM” campaign and enlisting a pool of potential donors by linking messages to the online donor portal (Gonsalves et al., 2017a). These meanings and focus on medical consumerism within healthism limited risk-reducing behaviors to women with social and financial means and promoted dependence on medical gatekeepers (McGannon et al., 2016). A further implication was a lack of trust in the physicians whose services to which most women have access and potential break-down of beneficial patient–physician relationships (Roy, 2008). These points are shown in two user comments to a WHA post dated 19 February 2017. In this post, users expressed desire to receive medical services from Bairey Merz despite receiving medical testing and diagnoses and being scheduled for appropriate follow-up (i.e. surgery):

I would love to see her as I am a [information withheld] patient with horrible heart disease and having 23% of my heart removed on my lower left lobe. I wonder how long it takes to get a […] appointment with her, And

Wish I could go to Cali […] to be tested by Dr Bailey Merz as I have heart issues in my immediate family. I’ve had two angiograms both normal but they say that most women have heart attacks in the smaller vessels. I just want to make sure nothing was missed.

Subject position two—health activists

Within the discourse of achieving health equity, the subject position of health activists was constructed for medical and political leaders in leading structural, institutional changes in women’s and health practitioners’ knowledge of risk. The meanings ascribed to medical leaders who were positioned as health activists within the discourse of healthism differed from meanings for altruistic fighters within the discourse of achieving health equity. Health activist’s messages promoted meaningful lifestyle changes such as “moving more,” which may be within some women’s means. However, these messages excluded older women prominent within the discourse of healthism as they were used as medical instruction to young women in universities rather than including wider age ranges engaged in other roles.

Novel gender roles for health activists included lesbian, gay, bisexual, and transgender (LGBT) women at risk for CVD and positioning them as resisting industries in power (Clark et al., 2018; Clarke et al., 2007). Through the use of personal stories and videos, Facebook users resisted corporate health ideologies by promoting a grass-roots advocacy approach to achieve women’s health equity and make known the problematic implications of corporate-generated CVD risk for women of lower incomes and power within the discourse of healthism (Zoller, 2017). These contrasting meanings surrounding health activism within the discourse of healthism are shown in a video posted 24 February 2017. This post featured two YouTube videographers portrayed as advocates of LGBT culture and low-income women to resist problematic linguistic use of the term “pride” by tobacco companies (The Truth, 2018).

Subject position three—compliant patients and consumers

In contrast to the health activist subject position, women’s roles were constructed as compliant patients in the discourse of achieving health equity. In turn, ideologies of gatekeeper control over women’s physical bodies by WHA leaders for scientific research and surveillance were supported (Roy, 2008). In prompt willingness to hand over control for experimental manipulation, women’s participation as subjects was constructed as the means by which to eliminate health inequities due to incompetent non-affiliated medical professionals. This subject position worked to reinforce the meanings associated with the altruistic fighter subject position by financially and professionally benefiting the WHA (Gonsalves et al., 2016). The construction of compliant patients and experimental subjects was shown by WHA postings calling for volunteers for clinical trials and user comments/experiences:

I have participated in two studies at Streisand’s center in the hopes of identifying non-invasive ways to diagnose heart attack symptoms in women. They administer a drug that makes you feel like you are having a heart attack while in a CT scanner.

WHA calls for volunteers and user comments did not contextualize these messages with meaningful knowledge exchange about women’s risk factors or risk reduction, despite the WHA goal to increase risk awareness. Within the discourse of healthism, the rhetorical strategy of portraying a culture of consumerism as a form of empowerment problematically portrayed women at risk as limited to those with the financial means and/or inclination to purchase cosmetics (Gonsalves et al., 2016). The #Lovein3Words campaign for which WHA partnered with cosmetics company Revlon contextualized CVD risk by associating this hashtag with the term “empowerment” (Revlon, 2017). This campaign was cross-referenced on WHA social media platforms (e.g. Twitter), which reinforced idealized appearance and aligned with heteronormative norms such as being wives to men and mothers, excluding identity diversity (Clark et al., 2018; Gonsalves et al., 2016).

Conclusion

This study made empirical, methodological, and practical contributions in relation to media portrayals of women’s CVD through a critical reading of discourses that constructed US women’s CVD with subject positions for social agents. New empirical insights were provided into the use of Facebook by public users to give meaning to institutional health promotion messages that supported and resisted corporate agendas. These findings enhance understanding concerning corporate social responsibility in shaping public perception of risk within social and health realities. In turn, there were actionable consequences for risk reduction placed in the hands of social agents as responsible for women’s health. This study answered calls to analyze women’s CVD campaigns from a critical qualitative perspective to explore how power and assumptions marginalize those at greatest CVD risk (Clarke, 2010; Gonsalves et al., 2017b). Intertextual utilization of this form of CDA with social media data sources and multiple data formats was also advanced through our analysis and findings.

Moving forward, several considerations are recommended for health communication: inclusion of demographics at greatest CVD risk in corporate health agendas versus catering to donor demographics, inclusion of culturally relevant health practices to promote agency in risk reduction, and inclusion of diverse vantage points to enhance agency through lifestyle behaviors. Given that political leaders were positioned as lending credence to health messages and WHA leaders in conducting public health promotion initiatives, future research might explore the use of social networking sites by the US government. US women’s consumption of the WHA hashtag “#getHeartChecked” may be tracked on Twitter and Instagram to explore the meanings of health screens. Health psychology researchers may conduct community-based participatory research to develop programming using more inclusive discursive resources and subject positions within virtual “communities of practice.” Such work holds potential for circulating culturally relevant forms of CVD awareness, prevention, and management for women.

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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Kerry R McGannon

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