Rediscovering the communication engine of neighborhood effects: How the interaction of residents and community institutions impacts health literacy and how it can be leveraged to improve health care access

While the impetus for research that will help us understand what it is about the places we live in that matters when it comes to our health seems to be growing exponentially in the public health literature, our knowledge about the social mechanisms through which place or context-related effects manifest is still limited. The cross-pollination of public health research on the social determinants of health, on one hand, and, on the other, sociological investigation into the influences of various social processes on different facets of human life and behavior has been fruitful. However, important gaps remain unaddressed.;The primary objectives of this dissertation are to re-introduce communication as an elementary social process through which individuals and communities organize their lives, and to develop a communication-based model of neighborhood health effects that can be applied by researchers, communication campaign professionals, and policy-makers to improve health care access and health literacy in diverse ethnic communities.;Employing a multi-methodological and multi-level analytical framework, the author also addresses the question of how institutional resources available in a residential community operate as mechanisms of neighborhood effects, and investigates ways through which to gauge their impact as neighborhood actors in building health literacy and improving health care access.;The theoretical framework guiding this project extends prior research on communication infrastructure theory and neighborhood effects theoretical models developed in sociology.;The findings of the study indicate that the extent to which individuals are connected to other neighbors, local and ethnically-targeted media, as well as community-based organizations, is a critical factor in predicting prevention-oriented health literacy. Institutional community actors can amplify the positive effects of being part of such a neighborhood-wide storytelling network, even in circumstances where their independent influence may be small or negligible. The significance of the interaction effect between residents and institutional level actors is even larger in the case of predicting health care access. However, as the results indicate in this case, the influence of an integrated neighborhood storytelling network (STN) may be strongly and negatively affected by environmental factors. As an information resource, the storytelling network may be influenced by troubling developments in the community and breaking news, such as the closure of a medical facility. This type of 'bad stories' can impact residents' perceptions of vulnerability and capacity to deal with health problems. The more connected to the STN residents are, the more susceptible they are to these negative effects.