April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: The Effects of Message and Community Characteristics on Medical Crowdfunding Inequality: A Multilevel Investigation
Medical crowdfunding—the digital platform where people solicit donations to pay for medical bills or treatments—is profoundly inequitable. Campaigns for beneficiaries from disadvantaged communities disproportionately fail to reach their fundraising goals (Kenworthy & Igra, 2022). Two main perspectives characterize the extant research seeking to explain crowdfunding inequality. One perspective investigates social contextual determinants, such as community disadvantage, while the other emphasizes communication literacies, specifically focusing on the discourse of deservingness. Although communication scholarship consistently underscores that social contextual factors can moderate message effects, no studies have considered the message- and community-level determinants together to understand medical crowdfunding inequality. Responding to the repeated invitations in the field to investigate multi-level determinants of health inequality (Viswanath & Emmons, 2006), this study addresses two questions: 1) How do people from communities with varying levels of disadvantage construct messages to communicate deservingness? 2) How does community disadvantage moderate the message effects on campaign outcomes?
In pursuing these questions, we make theoretical and methodological innovations to health communication scholarship. At the theoretical level, we integrate framing theory (Entman, 1993) with social fragmentation theory (Fagg et al., 2008) to explore the varying use and effectiveness of message frames across communities with different levels of disadvantages. Specifically, we distinguish two message frames used to convey a beneficiary’s deservingness: 1) a human-oriented frame highlighting the beneficiaries’ unique experiences and personal characteristics and 2) a need-oriented frame emphasizing the beneficiaries’ health challenges and financial hardships. At the methodological level, we leverage multiple datasets, linking digital behavioral data consisting of over 270,000 GoFundMe campaigns from 2,800 counties in the U.S. with the census data assessing the levels of neighborhood disadvantages. Using large, behavioral data, along with census indicators, enables us to assess message effects and their contingency on community characteristics in a real-world setting.
Our results showed that fewer medical crowdfunding campaigns were launched, and fewer campaigns reached their fundraising goals, among the communities with greater disadvantages (e.g., higher levels of poverty and unemployment, and lower educational attainment). The findings suggested that communities with the greatest need of support were the least likely to access and benefit from medical crowdfunding. Further, communities varied in their messages to communicate deservingness and appeal for assistance. The need-oriented frame was more prevalent in campaigns from communities with greater disadvantages, while the human-oriented frame was more prevalent in campaigns from better-off communities. The differences in message frames are not inconsequential. Everything else being equal, the human-oriented frame was associated with more campaign donations, while the need-oriented frame was associated with fewer donations. Indeed, campaigns raised the least amount of donations when they were from the most disadvantaged communities and characterized beneficiaries with need-oriented frames.
This study is among the first to integrate message- and community-level theories, while leveraging extensive behavioral data and census records, to understand health inequalities on digital platforms. Our results demonstrate that campaign effects are inherently bounded by the social environment where the campaigns operate. The message strategy that benefits one community may inadvertently backfire in another community.
In pursuing these questions, we make theoretical and methodological innovations to health communication scholarship. At the theoretical level, we integrate framing theory (Entman, 1993) with social fragmentation theory (Fagg et al., 2008) to explore the varying use and effectiveness of message frames across communities with different levels of disadvantages. Specifically, we distinguish two message frames used to convey a beneficiary’s deservingness: 1) a human-oriented frame highlighting the beneficiaries’ unique experiences and personal characteristics and 2) a need-oriented frame emphasizing the beneficiaries’ health challenges and financial hardships. At the methodological level, we leverage multiple datasets, linking digital behavioral data consisting of over 270,000 GoFundMe campaigns from 2,800 counties in the U.S. with the census data assessing the levels of neighborhood disadvantages. Using large, behavioral data, along with census indicators, enables us to assess message effects and their contingency on community characteristics in a real-world setting.
Our results showed that fewer medical crowdfunding campaigns were launched, and fewer campaigns reached their fundraising goals, among the communities with greater disadvantages (e.g., higher levels of poverty and unemployment, and lower educational attainment). The findings suggested that communities with the greatest need of support were the least likely to access and benefit from medical crowdfunding. Further, communities varied in their messages to communicate deservingness and appeal for assistance. The need-oriented frame was more prevalent in campaigns from communities with greater disadvantages, while the human-oriented frame was more prevalent in campaigns from better-off communities. The differences in message frames are not inconsequential. Everything else being equal, the human-oriented frame was associated with more campaign donations, while the need-oriented frame was associated with fewer donations. Indeed, campaigns raised the least amount of donations when they were from the most disadvantaged communities and characterized beneficiaries with need-oriented frames.
This study is among the first to integrate message- and community-level theories, while leveraging extensive behavioral data and census records, to understand health inequalities on digital platforms. Our results demonstrate that campaign effects are inherently bounded by the social environment where the campaigns operate. The message strategy that benefits one community may inadvertently backfire in another community.