【作者】 刘佳；

【导师】 陈华明；

【作者基本信息】 四川大学 ， 传播学， 2021， 博士

【副题名】基于四川大学华西医院的探索

【摘要】 健康是人民幸福和社会发展的基础,是人民对美好生活的共同追求。十九大报告中强调要进一步实施健康中国战略,将健康提升到前所未有的高度。毫无疑问,健康传播是提升国民健康素养、实践健康中国战略的重要进路之一。医疗机构作为社会公共服务的践行者,其专业权威身份价值在健康传播中发挥着日益重要的作用。社交媒体出现之前,医疗机构的健康信息和媒介印象大多是一种“被呈现”和“被建构”的状态,缺乏主观能动的话语表达。在转型期医疗体制深层结构性矛盾以及社交媒体传播情境下,健康信息生产由原来的专业化媒体生产演变为社会化大生产,医疗机构传播主体的话语权日益凸显,有利于健康知识的普及以及医疗机构社会形象和信任的重塑。但从目前的发展现状来看,医疗机构社交媒体的健康传播还处于探索发展期,存在新媒体传播理念滞后、传播内容良莠不齐、传播形式单一、话语方式亲和力不足以及互动对话功能匮乏等现实问题。四川大学华西医院微信社交媒体率先开辟出一条独具特色的健康传播路径,成就了新媒体健康传播的“华西模式”和“华西现象”。对华西医院个案的深入研究能为一般性医疗机构的健康传播提供理论关照和实践指导。本研究充分结合传播学、社会学、语言学及修辞学等多学科的理论知识,从学科交叉的视野丰富拓展医疗机构健康传播研究的理论和方法。全文以话语分析理论、健康信念理论、理性行为理论、社会认同理论作为主要的理论基础和支撑。并采用话语分析、内容分析、问卷调查以及深度访谈等方法展开研究。一方面历时性梳理健康传播媒介形态、话语范式、主体类型的生态变迁以及医疗机构健康传播的形态演化及特征。同时尝试以典型代表华西医院作为实践探索对象,考察其社交媒体健康传播的话语实践和特征以及公众基于健康信息的“知信行”接收效果和公众对医院医生形象的认同效果。最后从个案实践探索中总结出具有普遍性和公共价值的医疗机构社交媒体健康传播现实路径。全文采取理论分析与实践阐述相结合的研究思路,遵从“一般——特殊——一般”的问题研究进路。研究发现:第一,社交媒体情境下健康传播媒介形态、话语范式以及主体类型呈现出多元对话的生态格局,并且医疗机构健康传播经历了从现场到线上的融合传播形态演化,显现出专业性、精准性、公益性和互动性的传播优势。第二,华西医院微信社交媒体的话语实践呈现人格化、“网感”化、多模态化以及情感化的话语偏向和叙述特征,并且具有很强的互动性,重构了医疗机构及医生丰富多元的社会形象。依照新的网络话语规则,华西医院及医生身份形象不断从传统的社会结构单位中“脱嵌”,建构了幽默、娱乐、温情、亲民的多元身份意义和形象认同,形成了专业医疗机构与公众间的同质化话语体系。第三,华西医院微信社交媒体开展健康传播具有显著的传播效果,关注华西微信公众号对受访者的健康认知、医患关系认知及医院医生形象这三个维度有显著的正向影响,而是否关注华西微信公众号对受访者的健康行为并没有显著的影响。同时,华西医院通过微信社交媒体开展健康传播重构了公众健康观念和医学期许的个体认同以及医院医生形象和健康文化的社会认同效果。第四,提出医疗机构社交媒体健康传播的具体优化策略,主要包括:完善公共价值导向下的健康传播保障机制、创新与公众共通的意义空间和健康话语实践、构建公众健康需求为中心的精准传播体系、转换“民本框架”的新媒体传播思维模式以及建立“共情”理念下的医患情感互动机制。更多还原

【Abstract】 With the in-depth advancement of the Healthy China strategy,medical institutions,as practitioners of social public services,their professional and authoritative identity values are playing an increasingly important role in health communication.Before the emergence of social media,the information communication and media impression of medical institutions were in a state of being "presented" and "constructed",lacking the right of subjective and active discourse expression.Under the in-depth structural contradictions of the medical system during the transition period and the social media communication situation,the production of health information has evolved from the original specialized media production to the socialized mass production.The discourse power of the main body of the communication of medical institutions has become increasingly prominent,showing scientific and precise The communication advantages of sex,public welfare and interaction are conducive to the formation of the scope and effect of the cross-influence of mass communication and interpersonal communication.The health communication of medical institutions is not only the transmission of health knowledge and health information,but also the construction of the social identity,status and value identity of the main body of the medical institution’s communication.The We Chat social media of West China Hospital of Sichuan University took the lead in opening up a unique health communication path,achieving the "West China Model" and "West China Phenomenon" of new media health communication.Therefore,taking West China Hospital as a case to explore the practice and effect of social media health communication in medical institutions became the initial origin of this study.For a long time,the research on health communication in China has mainly focused on the health report and media effect of mass media,health education of government agencies,interpersonal communication between doctors and patients,the health transmission of specific diseases and the transmission of health crisis,etc.,but few studies have been conducted from the perspective of the main body of medical institutions and its communication effect.This study took West China Hospital as a case to explore the discourse practice and communication effect of health communication in the context of social media.This paper takes discourse analysis theory,health belief theory,rational behavior theory,and social identity theory as the main theoretical basis and support,and uses discourse analysis,content analysis,questionnaire survey,in-depth interview and other research methods.On the one hand,it has diachronically combed the changes in the form of health communication media,discourse paradigm,subject type,and the evolution and characteristics of health communication in medical institutions.At the same time,I tried to use the typical representative Huaxi Hospital as the object of practical exploration to examine the discourse characteristics and style of health communication in medical institutions on social media,as well as the public’s "knowledge,faith and action" communication effect based on health information and the public’s identification of medical institutions and doctors.Finally,it sums up the health communication path of general medical institutions with universality and public value from the case study.The full text adopts the research idea of combining theoretical analysis and practical exposition,and follows the approach of "general-special-general" problem research.The research found that: First,the forms of healthy communication media,discourse paradigms and subject types in the context of social media present an ecological pattern of multiple dialogues,and the health of medical institutions has undergone the evolution of integrated communication forms from on-site to online.Second,the We Chat social media discourse practice of West China Hospital presents personality,"networking",multimodal,and emotional discourse rhetoric and narrative characteristics,and has strong interaction,reconstructing medical institutions and doctors.Diverse social image.In accordance with the new rules of online discourse,the identity image of West China Hospital and doctors has been continuously "de-embedded" from traditional social structural units,constructing a humorous,entertaining,tender,and intimate identity and image identity,forming a homogeneous discourse system between professional medical institutions and the public.Third,the health communication carried out by West China Hospital’s We Chat social media has a significant communication effect.Paying attention to the West China We Chat official account has a significant positive impact on the respondents’ health perception,the perception of doctor-patient relationship,and the image of hospital doctors.,And whether to pay attention to the Huaxi We Chat official account has no significant impact on the health behavior of the respondents.West China Hospital carried out health communication through We Chat social media to reconstruct the individual identity of public health concepts and medical expectations,as well as the social identity of hospital doctors and health culture.更多还原