Issues of representation,reflexivity,and research-participant relationships: Doing feminist cultural studies to improve health campaigns

Abstract

I reflect upon findings from a feminist cultural study uncovering teen girls’ and parents’ perceptions of the Gardasil HPV/cervical cancer vaccine media campaign. I consider issues important to feminist researchers such as representation, reflexivity, and researcher–participant relationships as they relate to public relations research. Topics discussed are seeing the dark side of meeting our publics, renegotiating feminist ideals, and balancing strategic and feminist goals. I propose considerations for doing feminist cultural studies to inform campaign production.

Keywords

Qualitative methods feminist research cultural studies teen girls campaign vaccine

Introduction

The purpose of this article is to illuminate the importance of feminist cultural research in the development of public health/risk communication campaigns. Specifically, feminist methods rely on the researcher’s act of reflecting on her role in relation to the participants (Pillow and Mayo, 2007). I argue that this reflection is necessary for public relations practitioners to better know how publics’ cultural experiences affect their communication behaviors. Thus, I reflect on the complications of conducting feminist cultural studies with marginalized publics, particularly according to values of commitment to systematic change, recognition of positional and partial knowledge, attention to representation, and reliance on reflexivity.

This study is an analysis of a previous feminist cultural study conducted to learn about teen girls’ and parents’ perceptions of the Gardasil HPV/cervical cancer vaccine media campaign. The current study considers issues important to feminist ethnographers such as representation, reflexivity, and researcher–participant relationships as they relate to public relations research. To inform the analysis, the literature review identifies characteristics of feminist research and the dearth of cultural studies in public relations research. Next, feminist cultural studies are positioned as necessary in health/risk public relations research and practice. Then I discuss the original study, which explored girls’ and parents’ perceptions of how Gardasil was communicated to them through a media campaign. The findings of this analysis suggest that seeing the dark side of meeting publics, renegotiating feminist ideals, and balancing strategic and feminist goals are fundamental issues applied communication scholars and practitioners must consider when attempting to promote social change among marginalized publics. I conclude with suggestions for a feminist cultural studies approach to campaign production.

Literature review

Cultural studies and public relations

Few cultural studies of publics – which often employ ethnographic methods – have been conducted in public relations research. L’Etang noted the ‘strange’ absence of such work in public relations research because ‘public relations is a profoundly cultural activity’ (2010: 148). Recent calls for more anthropological perspectives have been made because of increasing intercultural communication emerging from globalization (Vujnovic and Kruckeberg, 2010); integration of technology with public relations, which ‘straddles economics, politics, and culture’ (McKie and Munshi, 2009: 63); and the ‘active nature of audiences’ and the practitioners’ ‘job of creating meanings with which audiences will identify and of documenting the efficacy of their efforts’ (Curtin and Gaither, 2007: 140). A sect of public relations studies has emerged that considers how public relations contributes to the ‘everyday life’ of praxis and practitioners (Hodges, 2006; Pieczka, 2006).

Cultural studies can uncover the cultural meanings publics give to relationships, processes, and objects that are publicized and affected by public relations organizations, practitioners, and campaigns. The methods would explore the impacts public relations products (e.g. messages, services, mergers, community programs, policies) make on society. The methods would be conducted with explicit purposes to change social and environmental ills that influence marginalized publics. Furthermore, feminist cultural studies would bring to light the cultural meaning-making and factors driving decision-making among groups that have been historically neglected in applied communication programming.

Feminist cultural studies of health/risk campaigns

Feminist cultural studies differ from the general ‘cultural studies’ moniker in their purposes to uncover how the gender of girl/women is marginalized in ‘feminine’ media representations (Acosta-Alzuru, 2003; Bobo, 1995; Press and Cole, 1999; Radway, 1984; Schwichtenberg, 1989). However, this study is positioned at the nexus between media representations of girls/women, public health initiatives for girls/women, and girls’/women’s perceptions of those representations to identify variations among the discourses. Studying the dominant and subaltern knowledges among health public relations discourse is important for the fact that medicine and public health are cultures that have historically marginalized women patients as the ‘other’ to the traditional knowledge based on the male body (Martin, 2001). However, as women are the primary decision-makers of health for not just themselves but for families (US Department of Labor, n.d.), women’s intimate, cultural knowledge of medicine, health, and their bodies are relevant as the site of interrogation for how health messages are constructed by media and campaign producers.

However, very few public relations-based feminist cultural studies of women’s health have been conducted to question how women perceive their health, based on gendered media representations of health threats. The findings from these feminist cultural studies of health/risk public relations (Aldoory, 2001a; Vardeman-Winter and Tindall, 2010) suggest that women’s perceptions of their health are often reflections of inaccurate media portrayals. Specifically, these studies found ‘cultural misses’ in the campaign messages. Non-White and low-income women do not often see themselves reflected in health media messages, despite health communicators’ attempts at culturally competent campaigns (Aldoory, 2001a). The effects are of an essentialism of culture, a neglect of intersectional lived experiences, incongruent understandings of ‘common sense’, and an emergence of counterhegemonic practices (Vardeman-Winter and Tindall, 2010). These conclusions confirm propositions that the impact of culture is underestimated, and cultural cues are misappropriated in campaigns (Aldoory, 2009a; Dutta, 2007; Lupton, 1994).

To identify the root of these misappropriations of culture, our discipline needs better reflection of the formative and evaluative research that informs public health campaigns. Some reflective public relations work has examined how the researchers’ cultures and identities affect the questions and answers of research (Aldoory, 2001b; Pompper, 2010; Vardeman-Winter et al., 2013) and how practitioners’ cultures and identities influence the programming goals and tactics implemented with publics (Edwards, 2010; Vardeman-Winter, 2011). Moreover, feminist cultural studies inherently examine the intertwining of identities, particularly those of race, class, and gender. Specifically, gender does not exist alone without identities such as race and class; therefore, as feminist cultural studies examine the conflicting meanings constructed about gender, they inherently question the role race, class, and other identities play in the construction of such gendered representations (Martin, 2001). Therefore, my intersecting identities – of being White, middle-class, and a woman – affected the research process: my reflection below will demonstrate the assumptions I made about participants’ feelings about their peers, the narrow-ness through which I accessed the research setting, and the violations to my pro-health and pro-success expectations (defined according to my cultural meanings). The richness of the importance of gender, class, and race in the processes of public relations is recognized because of the act of cultural interrogation inherent in feminist research.

Feminist research

Feminist studies are grounded in feminist standpoint epistemology, which involves research conducted by women, for women (Olesen, 2003). The advocacy of feminist research reflects long-term, structural negligence by political, economic, legal, academic, and biomedical systems of women’s particular knowledge (Harding, 1991). Feminist studies alike represent: (1) commitment to systematic change; (2) recognition of positionality and partial knowledge; (3) attention to representation; and (4) reliance on reflexivity (Pillow and Mayo, 2007).

Commitment to systematic change

As feminism is grounded in exposing power differentials to enact change (Olesen, 2003), the ontology of feminist research is finding ‘what is missing, what is passed over, and what is avoided’ (Pillow and Mayo, 2007: 164). Feminist researchers find ways to improve the conditions for marginalized groups (Collins, 2000; Wolf, 1996). Researchers, thus, often have a relationship with multiple constituencies, like participants, the surrounding community, the funding/grantor agencies, and students (Pillow and Mayo, 2007). Thus, feminist researchers hold themselves personally accountable for how their findings can change power relations and how their findings may unintentionally re-inscribe the participants into the dominant paradigm they are working to change (Bhavnani, 2007; Collins, 2000).

Recognition of positionality and partial knowledge

Feminist critiques challenge traditional, positivist research with questions such as, which groups have the power to make knowledge, and to what extent does gender affect power differentials in knowledge production? (Harding, 1991). Feminism works to reduce power differentials and emancipate women from oppressive structures; contrastingly, ethnographies require a researcher to enter a site, observe, question, probe, and evaluate participants, make assumptions in analysis and writing about participants’ lives, and leave the site (Stacey, 1991). These are freedoms research participants do not have. These real dilemmas constitute discourses about positionality and partiality (Ellis, 1995).

Feminist researchers deny the ‘God trick’ (Haraway, 1988), the assumption that researchers can influences phenomena from un-tethered, removed positions. This takes for granted the influence researcher and participant have on one another. Thus, feminists argue for subjective understandings of science and culture by analyzing the situated positions and partial knowledges they bring to the research (Hawkesworth, 2007). In practice, positionality has come to mean that ‘the researcher analyze[s] the micropolitics of the research situation … that researchers explore, in public, what power dynamics come into play and when, how they shift, and what their consequences might be in the many different parts of their research’ (Bhavnani, 2007: 643).

Attention to representation

Representation is considered each time a researcher asks themselves, what is – and is not – a feminist topic? Typically, feminist topics manifest as ‘women’s work’ in efforts to highlight the centuries-long neglect of the dailyness of women’s roles and perspectives of the topics traditionally viewed from men’s perspectives (Pillow and Mayo, 2007). Issues emerge of being the ‘insider/outsider’ or the ‘outsider within’ when researchers work to uncover the essential-ness of their cultures, or cultures close to them (Hesse-drive and Piatelli, 2007; Naples, 2003). Since personal identity and experience often drives feminist work, feminist cultural work has increasingly required self-reflexivity from the researcher. As ‘all researchers are political subjects’ (Kauffman, 1992: 188), identities should be written into the cultural study as sites for ‘local politics’ (e.g. gender, sexuality, race, class).

Reliance on reflexivity

Representation and reflexivity are intricately linked because ‘attentions to the specificities of identity and power relations are primary to the research methodologically and epistemologically’ (Pillow and Mayo, 2007: 158). Research processes such as choosing which data to highlight in reports, how to code and compare data, and how to represent participants’ experiences in writing are all political acts. To liberate feminist work from the strictures of traditional writing norms, feminist researchers have experimented with ways of presenting data, such as through fiction, poetry, art, and performance. But, reflexivity becomes an act that feminist researchers fall back on as the validating security blanket. This warning constitutes the meaning-making of feminist work, as ‘reflexivity of discomfort … makes the work of reflexivity visible and interrupts the ethnographer’s desire to know. To name, to claim, asserting that not knowledge is often as powerful as knowing’ (Pillow and Mayo, 2007: 166).

Context of original study: Discussing the benefits of Gardasil with teen girls and parents

Vaccines are now available to protect young girls and boys, and young adult women and men against HPV infection by the HPV strains that most commonly lead to cervical cancer. Gardasil, produced by Merck and Co., was approved by the US Food and Drug Administration (FDA) in early June 2006 (Centers for Disease Control & Prevention (CDC) Morbidity and Mortality Weekly Report, 2007), to protect against four HPV strains that commonly lead to cervical cancer (PATH, 2007). The CDC formally added Gardasil to its recommended vaccination schedule beginning in early 2007, recommending that girls aged 11–12 years old receive the vaccine (Manning, 2007).

Advertising around Gardasil provides a timely health media campaign in which to investigate vaccine risk communication. This campaign – which bears the slogan, ‘I wanna be one less woman to battle cervical cancer’ – is particularly salient as it is one of the first direct-to-consumer pharmaceutical campaigns targeting teen girls about sexual health and part of a rising trend of marketing to teens about prescription drugs (Kritz, 2008).

This case study is relevant for exploring the theoretical and methodological implications of feminist cultural studies in public relations because of the opportunity to observe decision-making by two distinct publics: teen girls and parents. The health media used to advertise and promote the vaccine provided a relevant cultural artifact upon which to access these publics’ interactions, norms, and factors influencing their symbiotic decisions. Finally, asking teens’ opinions about media, technology, health, and their relationships offers fertile ground to intricately explore the cultural nuances and idiosyncrasies of public decision-making that often is glossed over in traditional marketing-based research.

Method

Research question

The purpose of the original study was to uncover how two related publics make meaning together of mediated communication about a health risk. The research question (RQ) driving the current analysis utilizes an essential element of feminist research, the reflection of the researcher to her study and participants. In reflection, communicators learn dominant and latent meanings about the cultures being studied. Thus, the RQ is: How do the subjectivity of the researcher and the interactions with participants affect the research process and findings in a feminist cultural study of teen girls and parents about a public health issue?

Summary of methods

I triangulated three qualitative methods to gather and analyze data to explore the nature of the topic. Qualitative in-depth interviews were particularly useful for feminist research because therein lies an intimacy between research and participant that can be neglected in survey research (DeVault and Gross, 2007). Qualitative dyads were important for de-centering power around the researcher in relation to the participant (Kashy and Kenny, 2000). Focus groups were also important emancipatory methods because the power is held primarily among the participants instead of the researcher (Wilkinson, 1998). Furthermore, the triangulation of data is important to understand the multiple perspectives on how knowledge is produced, and which knowledges are privileged (Hawkesworth, 2007; Hesse-Biber and Brooks, 2007).

Summary of participants and procedures

I recruited from two consumer publics of the campaign: 14–17-year-old girls and parents of teen girls. These girls were interviewed because this age group is being targeted by Merck and government agencies as the recommended ages for vaccination. The parents of teens were recruited because they permit their minor children to be vaccinated (Stinchfield, 2001). I interviewed a total of 54 participants for this study: 40 teens and 14 parents (see Table 1).

Table 1.

Teen girls’ and parents’ demographics and details of interviews.

	Teens	Parents
Gender
Girls/Women	39	13
Boys/Men	1¹	1
Race
White	25	13
African American	7	1
Latina	6	0
Biracial	2	0
Age
13	1²	n/a
14–17	38	n/a
18	1	n/a
Geographic location
Maryland	23	3
Texas	13	7
Virginia	2	2
New York	1	1
Iowa	1	1
Location of interviews
Participant’s home	23	11
Students’ high school	12	0
Parent’s workplace	4	2
Telephone	1	1
Interview composition
Teen individuals	2	n/a
Teen dyads	8	n/a
Teen small (3–5) focus group	16	n/a
Teen large focus group	12	n/a
Parent individual	n/a	6
Parent dyads	n/a	6
Teen–parent dyads	2	2
Teens’ parenthood status
Not pregnant or parenting	28	n/a
Currently pregnant	2	n/a
Currently parenting	10	n/a

Parenthood status

Twelve of the teens interviewed were also parents or expecting mothers (and therefore, emancipated from their parents). Through the Agency for Pregnant Women (APW),³ I conducted a focus group with teen girls in a parenting class at a local high school in a lower socio-economic area with a high percentage of students from racial minority groups. This group interview lasted 75 minutes, and consisted of 12 Black and Latina girls – two of which were pregnant and 10 who were postpartum.

Socioeconomic status

I did not ask teens or parents for their incomes because teens likely could not accurately provide this information. I also find asking for income a sensitive subject for both participants and me. For these reasons, I relied primarily on whether participants explicitly said income was a barrier. If participants believed that they could not afford the vaccine, I felt this was a more accurate signal to their cultural meaning-making of economics and health than the traditional method of asking participants to classify their income levels. Various comments I received from parents about their ability to pay were, ‘money is super tight right now’, ‘we would not have been able to get the vaccine had it not been for insurance/clinics’, and ‘does insurance cover this?’ In some cases, participants were shocked when they learned the cost of the vaccine (~$360 for a series of three injections).

Recruitment

I used maximum variation, convenience, and snowball sampling strategies to recruit participants (Rubin and Rubin, 1995). Informal contacts put me in touch with people they knew with daughters between the ages of 14 and 17. I also used some social media to recruit such as Craigslist.org, MySpace, and Facebook. If the teen was interested, I asked her to ask a friend of hers to participate in the study with her. This constitutes the dyad method, which I believe engaged the girls in the discussion because they have a same-aged and same-gender friend that they trust with them (Kashy and Kenny, 2000).

Interview guide

An interview guide helps an interviewer through the discussion and generally outlines the main points the interviewer would like to explore (Rubin and Rubin, 1995). An interview guide ‘consist[s] of groupings of topics and questions that the interviewer can ask in different ways for different participants’ (Lindlof and Taylor, 2003: 195). The interview guide for this study was framed using theories/concepts from three different disciplines. First, I used the situational theory of publics to design questions to explore girls’ and parents’ decision-making factors around the cervical cancer vaccine based on the communication they have received (Grunig, 1997). Second, the cultural studies approach helped me explore cultural meaning-making concepts such as symbols, relationships, use of cultural texts, conflict, and preferred representations (Hall, 1997).

I wrote two different interview guides: one for the teen girls and one for the parents. The guide for the teens was adapted to ensure the language used suited their apprehension level. Questions included, ‘What health topics do you talk about with your mom/daughter?’; ‘Do you feel like you are doing what the commercial is asking you to do in order to avoid (or help your daughter avoid) getting cervical cancer? If so/not, why?’; and ‘How do you think girls/parents of different races than yours think about the vaccine media differently?’.

Procedures

I held the interviews in girls’ homes for their convenience, to observe them in their natural environment, and to promote their comfort with the research, especially given the potentially sensitive subject (Press and Cole, 1999). The interviews/groups lasted on average between 45 and 90 minutes. I reviewed the Assent Form (a modified Informed Consent Form for minors) with the girls. All participants agreed to be audio recorded. When the interviews and focus groups finished, I thanked the girls, answered questions they had for me, and distributed information from the CDC about HPV, cervical cancer, and the vaccine.

The cultural artifact

Halfway through the interviews, we watched the Gardasil ad on YouTube (n.d.) so I could obtain participants’ real-time perceptions and feelings about the ad. Questions such as, ‘Do you think this commercial is important for you to know? Why?’ and ‘Do you believe you are doing what the commercial is asking you to do to avoid getting cervical cancer? Why?’ solicited diverse responses girls had about the media representations of HPV/cervical cancer and their experiences with such health risks. To learn about their behavioral intentions with the vaccine, I asked, ‘After seeing this commercial and reading this information, what can you do to stay healthy over the next couple of years?’ After watching the ad, I asked participants how they would change the ad, if they could, to make it ‘talk’ to them better.

Data analysis

Transcribing

All interviews were audiotaped for purposes of transcribing later details from the dialogue and personal narratives. During transcription, I inserted observer comments (OCs) (Miles and Huberman, 1994) into the documents. OCs are personal notes I made about emerging themes throughout the interviews, linkages to other interviews, my interactions with the participants, and ideas I had for future interviews.

Coding

Data analysis began during transcription. I used analytical techniques derived from grounded theory, such as constant comparison of data (Glaser and Strauss, 1967). During the transcription process, for example, I used open-coding procedures to look for emerging themes. Then I used axial coding to determine how responses and themes relate to each other as well as how the responses relate to the variables and concepts informed by the literature review.

Reflection

After most interview sessions, I spoke into a digital recorder as a form of journaling my initial reactions and feelings. In these journal entries, I spoke about the success of each interview, prevalent themes I noticed, and any areas I needed to examine more closely or interview techniques to improve upon for the next interview/focus group. As I transcribed each interview, I also transcribed the journal entries and wrote down themes and ideas, which translated into initial data analysis as well as points for my discussion section. These are ‘reflective remarks’ to ‘strengthen coding, in pointing to deeper or underlying issues that deserve analytic attention’ (Miles and Huberman, 1994: 66). In the journal entries, I also reflected upon my fears, judgments, stereotypes, and anxieties about the study, topic, or participants. I used this as a way to clearly organize and understand my relationship to the topic, the study, and the participants, and to ensure that participants had the room to speak for themselves instead of my leading their comments, a goal of feminist standpoint research (Reinharz, 1992). These OCs and reflective remarks serve as the units of analysis for this study.

Results

The purpose of conducting this analysis of reflections contributes to feminist goals to reduce politics of representation and expose differences in positionality and partial knowledge. Three major effects of feminist-cultural studies emerged. First, in seeing the dark side of meeting our publics, I learned my limitations in experiencing anxiety over keeping ‘safe’ information and regret of complicity. I then found myself renegotiating feminist ideals when confronted with my hesitance to critique and teach the health information and the issue of participants ‘cramming’ for interviews. Finally, I found a need for compromise when balancing strategic communication and feminist goals at the end of data collection and analysis when ending research without discrimination and bargaining between essentialism and division of participants.

Seeing the dark side of meeting our publics

I tended to romanticize members of the publics: I often believed my marginalized participants could ‘do no wrong’ because of the plights they experience with discriminating media and public health. Occasionally, I found myself confronted with comments or situations in which I felt a range of mild discomfort to deep anxiety. I term this experience ‘seeing the dark side of meeting our publics’ as an epiphany in getting a more cogent view of participants and publics – due to the ethnographic purpose – than I would with less exploratory, culturally centered methods. The dark side of meeting publics manifested in perspectives on my anxiety over keeping ‘safe’ information confidential and my regret of complicity. Although the worst-case scenarios I prepared for in interviewing minors about sex-related topics did not occur (e.g. asking for sex-related advice, panicking about sex topics, revealing risky behaviors), several less ‘hot’ (Fine et al., 2003: 118) methodological quandaries emerged from which feminist researchers can learn.

Anxiety over keeping ‘safe’ information confidential

Related to the presence of parents was the issue of interviewing teens, then interviewing their parents. My dedication to confidentiality slipped a few times when I revealed to parents – in the context of the discussion – that their daughters had told me they were abstinent. At the time, I did this because some parents expressed obvious concern regarding this subject. In an attempt to reassure them, a few times I made comments like, ‘well, [your daughter] said she is nowhere near wanting to have sex right now’. My need to reassure and comfort participants is my limitation as a researcher, and I do question whether my need to reassure and actually doing so is not consonant with the commitments set forth in feminist epistemology. To what extent is it unethical to share a minor’s information with the parent when the researcher has information that may ease a participant’s mind – even momentarily – from some anxiety of uncertainty she may be experiencing? To what extent is one participant’s empowerment (the parent’s) more ‘valid’ than another’s (the teen’s)?

I predict if teens had revealed to me they were sexually active, I would have guarded that information more carefully, because that revealing is the sort of information I was expecting I would have to keep confidential from the parents. I did not anticipate that the ‘safe’ information – or the information that parents would approve of anyway – is as important to keep protected by confidentiality. What if a parent stopped talking to their daughter about sex, based on my confirming with her that the daughter is not having sex? What if the parent mentioned to the daughter that I indicated she wasn’t having sex, and then the daughter loses trust in talking to other adults like researchers and school nurses? The consequences of revealing even ‘safe’ information are significant and should not be dismissed or underestimated.

Regret of complicity

I was confronted several times in interviews with the realities of racism, othering, and bullying. Several groups of teen girls often talked about their negative feelings toward pregnant girls at school, and they often associated parenthood status with non-White girls. They made derogatory comments about girls they thought were promiscuous and ‘gross’. Some girls used derogatory words to describe girls of different races than them.

I was extremely uncomfortable during these conversations: should I try to change their opinions about difference and race and show them a more empathic perspective? I found myself frozen at times, and in some moments, I did nothing. I listened to them, did not laugh at their jokes, and either refocused the discussion back to the commercial, or asked about their feelings about the differences they perceived (e.g. ‘How do you feel that there are pregnant girls at your school?’). In some instances, I asked whether they had thought about what conditions led girls their age to be pregnant or to feel they need to have sex with multiple partners at their age.

In hindsight, I assume they perceived that my race gave them permission to make these othering comments. Although I cannot confirm now with the participants, I think the White participants (those who mostly made these comments) felt safe to say their feelings in the company of a White, middle-class researcher and assumed that I agreed with them because I shared their racial and class background. To this point, the participants transcended other differences they had with me like age and educational attainment to express their feelings about other girls’ behaviors through a racial lens. These perceived common values based on shared identities illuminate the importance of feminist cultural studies: without the interrogation of representations of gender, the important presence of intersecting identities and power differentials in participant–researcher relationships may remain hidden.

I regret that I did not intervene and ask them to re-evaluate their comments, for this signals complicity to bullying and othering. ‘Working-the-hyphen’ of the Self–Other framework negotiates the messy-ness of research and teases out the commonalities and the divides (Fine et al., 2003). Considering the problem with intervening feels cold and calculated: if I intervene, I may lose rapport, and the interview may end. I decided that either way, the process of intervening would yield meaningful data about the cultural members’ perspectives on difference, power, and communication. It also would be telling of the extent to which these participants perceive authority and how to interact with authority during disagreement, which is another representation question in feminist cultural studies.

Renegotiating feminist ideals

There were many points in this project when factual information was requested, and I felt the need to educate. I had never realized the tricky relationship between feminist researcher and public health educator. In fact, I was taught in my methods courses to give short affirmative responses to participants’ comments so as not to persuade them either way (of whether the researcher confirms she is getting the data she wants or whether she signals the information is not interesting, valid, or useful). I was not prepared for the significant testing of my skills as a researcher, and each interview was a new lesson of balancing my conflicting ideals of feminist empowerment with the lessons of ‘old’, traditional notions of objectivity. Two salient tests emerged in my hesitance to critique and teach the health information and the issue of participants ‘cramming’ for interviews.

Hesitance to critique and teach the health information

In every interview or group with teens, girls asked whether I had received the vaccine. I said no because I was too old to receive it. Girls also asked whether I would, if I could receive it. This question was tricky, partially because I did not know if I would get the vaccine if I could, and partially because I did not want to influence their attitudes toward the vaccine by giving my opinion. For example, one teen, Mia, asked for my opinion on the vaccine. Below is the OC I wrote during transcription:

I told them that I don’t know if I endorse the vaccine … I felt like I need to take a side; I’m not sure why I feel I need to; do I? Can I continue to say, I am not sure – I see both sides? Or, do I also have to be a public health advocate? What does it mean to be a public health advocate – that the public’s health is more important than an individual’s health? Perhaps I can agree with the vaccine and disagree with the way it’s being marketed and disagree with the way the pharmaceutical companies forge relationships and persuade governmental regulation bodies to endorse the scheduling of the vaccine.

The dilemma of revealing is related to the dilemma of whether to teach. Again, in nearly every interview, girls and parents alike asked numerous questions about cervical cancer, HPV, and the vaccine as well as related topics such as Pap smears, reproductive biologies, and sex. At first, I was apprehensive about educating participants about the facts, for I worried I may contaminate the research process. However, the purpose of doing feminist work is to help participants empower themselves and grow in ways that lead to autonomous, informed lives (Naples, 2003). In this case, knowledge about how cervical cancer-related topics work together is one way to help girls and parents empower themselves.

Issue of participants ‘cramming’ for interviews

I realized during the study that some parents helped their daughters ‘cram’ for the interview. For example, in one focus group of girls, one participant said that her mom told her and her friend information about cervical cancer as she drove them to the interview. In another instance, a mother said that she had talked to her daughter about cervical cancer prior to the daughter’s interview because she did not want her daughter to be ‘blind-sided’ during the interview. I initially considered that this ‘cramming’ tainted the evidence. I wondered if parents do this because the daughter questions why she is going to do this interview, what is it for, what is HPV, etc. I also wondered if possibly parents do it because they are embarrassed that their kids may not know facts about the disease.

Then I reconsidered that this act is perhaps some parents taking the opportunity of the interview to talk to their daughters about a potentially sensitive health issue. (For example, two mothers said it was easier to talk about sex when either the daughter asked about it or when the school needs a sex education release signed by the parent. Those ‘interventions’ give parents a catalyst to initiate the ‘awkward discussion of sex.’) In terms of the validity of the data collected post-’cramming’ sessions, it is something over which I had little control. Also, I doubt I had any ethical ground to stand on to say that parents should refrain from talking about this with their daughters for the sake of getting their real-time, honest reactions and knowledge of the topic. When I consider the feminist empowerment piece, the point is to give girls information through the process of the study (Fine et al., 2003), and perhaps parents sharing information with their daughters prior to the interview (for whatever motivation) is simply part of that empowerment process.

Balancing strategic and feminist goals

This study illuminated a basic characteristic of public relations culture. Our work has loyalties to two often-conflicting groups: to the publics we hope the information will lend some empowering insight, and to the practitioners, who have a need to conduct business with strategy and efficiency. This problem plagues the discipline (Dutta, 2007; Lupton, 1994), one that I hope public relations scholars continue to problematize and remedy. Difficult issues were ending research without discrimination and bargaining between essentialism and division of our participants.

Ending research without discrimination

Near the end of data collection, a pattern emerged of knowledge levels, attitudes, and behavioral intentions toward the vaccine media. The vast majority of White, middle- and upper-class girls interviewed had seen the Gardasil ad prior to the interview, knew the jingle by heart, and had or planned to receive(d) the vaccine. These girls did not feel they needed the vaccine because they expected to remain abstinent until marriage. After marriage, they believed they would not be at risk because they would be monogamous. However, these girls knew little about cervical cancer and HPV.

Differently, the non-White girls from the pregnant/parenting class had more knowledge about sexual health (they were all already sexually active) than did the White girls. But they had not heard of the vaccine, and none of them had seen the Gardasil ad. These girls felt the vaccine was very important for them, and they said they needed the vaccine because of issues such as doubts about their partners’ monogamy.

Surprised with the findings, I questioned the acute differences in knowledge and awareness of the media along racial, class, and parenthood status identities. According to epidemiological statistics, low-income women of color are more likely to have and die from cervical cancer (US National Cancer Institute, 2009; Rothman and Rothman, 2009). This suggests that Merck divided public health disparities victims (low-income women of color) from likely consumers with access (White women with health care). Merck avoided customizing messages and utilizing media that would reach publics likely to benefit from the product more and, instead, commoditized a less salient risk among publics with the means to purchase the remedy.

By the time I drew this conclusion, I was near the end of data collection, as I was hearing redundant answers to my questions about the culture of teen girls. Reflecting on my data, I questioned the extent to which my data were even ‘valid’, as the limitation of a relative lack of representation by girls, parents of color, and low-income publics distracted me. I questioned whether it was truthful to claim that I reached a saturation point when I found this demarcation caused by a discriminating media campaign. Had I not done enough formative secondary research to predict I might find this differential? Perhaps I should have pursued a quota sample of low-income publics of color rather than attempting to achieve maximum diversity.

These questions contribute to the ‘endings’ conversation feminist ethnographers have about when we should be ‘done’ with our project (Ellis, 1995; Pillow and Mayo, 2007): have I learned enough about the cultural environment of this topic to take the data and enact change in policy and campaign development? How could I possibly have learned enough if I did not hear from more affected girls, particularly those more likely to need vaccine information? Can I truly say I am done with the study merely because I reached saturation among one group of girls?

Although I did not exclusively interview the group that perhaps needs the most voice in the campaign, what I found contributed largely to the cultural studies goals of the study, which were to find how media representations affect the multiple cultural groups involved in the public health intervention. Had I only interviewed the privileged group of teens and parents, I would have learned that the media was well-received and that the media reified girls’ health as objects to be managed for fear of some over-exaggerated risk. I would not have learned about the potential discriminatory practices of the media campaign according to intersectional identities.

Conversely, had I only interviewed low-income girls of color, I would have learned only about the lack of communication that Merck conducted with already-marginalized publics. I would have suggested that Merck’s campaign flopped because the girls did not know about the media campaign or the product. In fact, I would conclude that Merck’s campaign was largely effective, if I were to take only the middle- and upper-class girls’ perspectives. Instead, by getting at these disparate groups – by interviewing both the ‘dominant’ public as well as the ‘subaltern’ public – I was able to see how the campaign negatively impacts both groups because of its discriminatory segmentation strategies. In fact, Fine et al. (2003) argued that learning both privileged and marginalized perspectives are required for creating actionable policy.

Bargaining between essentialism and division of our participants

Finally, the data revealed that teen talk consists largely of gossiping about other girls, peers, boys, and teachers. This study provided interesting data because of the opportunity to visit the class of pregnant teens/teen mothers. These were the same type of girls that some of my White, middle-class participants othered and bullied. I thought in data analysis, how do I stay true to the data without essentializing all girls for their commonalities and diminishing important and powerful differences, or other any of the girls (for their parenthood status or their gossip/bullying behavior) and thereby perpetuating divisive dialogue among teens?

My inclination is to avoid essentializing. Instead, I committed othering of the gossiping girls. My rationale relied on their privilege to access the vaccine and their perceived lack of involvement because they believe their abstinence protects them from risk. I sympathized with the teen mothers who felt the vaccine could help them but they did not have access to it. To negotiate these equally challenging tensions in feminist studies, I decided that revealing my position and my dilemma would help readers contextualize how I report and interpret the findings. It was also important for me to situate these stark differences in the context of cultural studies, which illuminate negative, hegemonic meanings in media. Furthermore, an important lesson here is that despite a researcher’s bias toward particular participants, it is our responsibility to explore that bias, to question the racist/othering/mean comments in our writing and, when possible, with our participants, and to write about these tensions to continue the dialogue around managing these dilemmas.

Discussion and conclusion

This study demonstrated that many important overlaps exist between feminist qualitative research, cultural studies, and public relations. First, public relations relies increasingly on the relevance of feminist critiques to the future make-up of public relations practice and the reliance on feminist ideals for empowering publics (Aldoory, 2009b). Also, the inherent overlap between public relations and ethnographic methods at the site of human behavior and collective action is under-explored and fertile (L’Etang, 2010). Finally, feminist cultural studies excavate power differentials in mediated texts and provide a basis for exploring not only which groups systematically maintain dominant knowledges, but which groups can resist and are resisting marginalization by finding ways to apply their local, tacit knowledges (Schwichtenberg, 1989).

Using a feminist cultural studies approach in campaign production

These feminist reflections highlight the particular feminist ideals and the methods of feminist cultural studies that are important for health researchers and practitioners to consider and employ in their interventions and campaigns. Thus, this study’s data inform a developing feminist cultural studies approach to campaign production, which encompasses three major premises: the publics’ positionality imperative, the health practitioner’s obligation to change, and the researcher’s essential ethnography with local members.

The publics’ positionality imperative

The reflections analyzed in this study provide evidence that researchers’ social positions are often vastly different from participants’ social positions. This inequality also manifests in the differences between communicators and publics. Thus, in the beginning of campaign development, publics’ everyday lives should be considered according to the complexities and difference they experience. I suggest we redefine the situation of publics to include the negotiated identities – such as the pregnant/parenting girls’ learning about Gardasil after becoming sexually active – of the group in addition to the physical, environmental, and temporal factors that may influence decision-making around an involving topic. Other factors such as socioeconomic status and racioethnic identity should not disappear from how practitioners understand publics’ perceptions and decisions around a topic; rather, they should be considered as incidental instead of motivational. Instead, the publics’ negotiated positionalities are considered first and foremost when campaigns are designed and implemented.

The health practitioner’s obligation to change

These implications also address ethical obligations assumed by the practitioner, particularly in the situation of practitioners’ dilemmas in compromising strategic and publics’ goals. Communicators should see their role in public health as unique from public relations’ roles in other industries. Health practitioners have a situated standpoint of their own: they work for their stakeholders, as any for-profit organization employee does, and they work for their publics, as ethical codes of the public relations practice suggests. However, an additional obligation public relations practitioners have is to society. In the case of the health communicator, the obligation is to work toward public health goals. In the case of Gardasil, campaign designers thus have the added obligation to make the option available to all teen girls and parents by (a) making the information available primarily to marginalized publics, and (b) helping them learn the extent to which they are eligible for free or discounted vaccine programs such as CDC’s Vaccines for Children Programs, Medicaid, and Merck’s Vaccine Patient Assistance program.

The researcher’s essential ethnography with local members

Imperative to a cultural-centric approach (Dutta, 2007) of campaign production is the effort to relearn how to give the reigns of campaign development completely over to publics. Using a feminist cultural studies approach to campaign design, communicators work to reduce power differentials in communication relationships by pursuing cultural meanings, languages, and norms more ethnographically. They should bring local cultural members into initial and ongoing decision-making rather than gloss over cultural competency as a factor to be checked off in the to-do list of the campaign. More importantly, health practitioners should instigate and develop campaigns from the onset with local publics who experience the issue from a marginalized standpoint. Health educators should promote emancipatory communication such that not only do campaigns start from the public’s perspective with the public (Dutta, 2007), but the campaign also starts with those in greatest need as a way for them to problem solve for themselves.

Practical applications

The current study expands upon previous critiques of campaigns (Dutta, 2007; Lupton 1994, 2003) by proposing a feminist cultural studies approach to campaign production. Such a critique is necessary to question the ethics of campaign goals, particularly when an organization’s marketing targets are different from public health targets. In several instances, the act of reflecting upon the power differentials throughout the study encouraged more rigorous study and enlightened opportunities for change. For example, as I was hesitant initially to ‘educate’ about health risks, I now feel ethically obligated that I should have taught more in previous health research I conducted. Also, when I became intellectually and emotionally stuck between my conflicting allegiances to strategic communication and the promise to ‘do good’ for society’s publics, the feminist commitment to change bridged the gap for me. Without that commitment, I likely would not have made the small attempts at action research. These attempts are now models in my classroom and community projects.

These tensions constantly invade data collection, transcription, and analysis and force a feminist researcher to re-assert her reasons for conducting a feminist cultural study: to uncover the cultural interactions of marginalized publics and to enact change among the power distribution among groups in dominant discourses. In fact, the act of formative data collection in health/risk public relations campaign development can actually serve as an intervention for at-risk publics. The impact of such an intervention is miniscule compared with the potential impact of a mass-mediated campaign. However, this grassroots experience may encourage more lasting impact than large-scale media campaigns do. Thus, these dilemmas in revealing my opinion and teaching open up opportunities for a number of innovations in public information campaigns: interpersonal teaching; active listening; co-creation through dialogue; uncovering taken-for-granted meanings in gendered media; utilizing partial, local knowledges in meaningful ways in the development of campaign goals; and initiating campaigns that are situated at the margins.

Limitations

Some limitations exist in the original study around sampling. More parents of color should be interviewed to understand how the parental themes persist among them compared to the predominantly White themes. More fathers and boys should be included to find out the extent to which they participated in vaccine decision-making. This would be particularly interesting given that many girls talked about discrepancies they felt in their responsibility to be vaccinated and their perceptions that boys did not need to be vaccinated. Furthermore, not having more parents from seemingly low socioeconomic backgrounds limited the ability of this study to truly understand factors and barriers to vaccine decision-making across a range of families.

Future research

To enable a feminist cultural critique of health/risk public relations, future research can investigate the extent to which practitioners are interested in these findings. Specifically, research can uncover factors motivating practitioners to develop better dialogues among their publics as well as barriers practitioners perceive in doing so. Furthermore, in efforts to bring to scholarship more frameworks to achieving culture-centered risk communication projects, case studies of grassroots, community-based organization in which publics are co-constructing the campaign from its onset should be investigated. Finally, to fully explore the feminist-cultural goals in such a study of publics, autoethnographic research – perhaps employing a content analysis of all reflective memos and OCs written throughout the study – would yield helpful data in teasing out even more feminist issues in public relations ethnography (Pompper, 2010).

Footnotes

Funding

The original research upon which this reflective analysis was done was funded by the James and Larissa Grunig Dissertation Fund and the Center for Risk Communication Research Fund from the University of Maryland’s Department of Communication.

Notes

Author biography

Jennifer Vardeman-Winter (PhD, University of Maryland, USA) is an assistant professor at the University of Houston’s Jack J. Valenti School of Communication and an affiliate faculty member in University of Houston’s Women’s, Gender, & Sexuality Studies Program. She teaches issues management, public relations theory, public relations management, crisis management, and critical and cultural public relations. Her studies are concentrated in public relations campaigns, health communication, and multicultural feminist research; specifically, using the theory of intersectionality and the situational theory of publics, she explores how underserved publics understand mediated information about health and risk, as well as how communicators can improve campaigns and messages with diverse communities. Her work has been published in public relations, health communication, and feminist journals. She is a former public relations practitioner from the high-tech field and continues to practice by working with groups in the public health and affordable housing fields.

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