ORIGINAL RESEARCH
Constructing identities in the media: newspaper coverage analysis of a
major UK Clostridium difficile outbreak
Emma Burnett, Bridget Johnston, Joanne Corlett & Nora Kearney
Accepted for publication 12 October 2013
Correspondence to E. Burnett:
e-mail: e.burnett@dundee.ac.uk
Emma Burnett BN MSc RGN
Lecturer and Researcher Infection
Prevention
School of Nursing and Midwifery,
University of Dundee, UK
Bridget Johnston PhD PGCE(FE) RGN
Reader in Palliative Care
School of Nursing and Midwifery,
University of Dundee, UK
Joanne Corlett MSc PhD RGN
Head of Post Qualifying Division
School of Nursing and Midwifery,
University of Dundee, UK
Nora Kearney MSc RGN
Professor of Nursing and Cancer Care
School of Nursing and Midwifery,
University of Dundee, UK
1542
B U R N E T T E . , J O H N S T O N B . , C O R L E T T J . & K E A R N E Y N . ( 2 0 1 4 ) Constructing
identities in the media: newspaper coverage analysis of a major UK Clostridium
difficile outbreak. Journal of Advanced Nursing 70(7), 1542–1552. doi: 10.1111/
jan.12305
Abstract
Aim. To examine how a major Clostridium difficile outbreak in the UK was
represented in the media.
Background. Clostridium difficile is a serious health care-associated infection
with significant global prevalence. As major outbreaks have continued to occur
worldwide over the last few decades, it has also resulted in increasing media
coverage. Newspaper journalists are, however, frequently criticized for
sensationalized and inaccurate reporting and alarming the public. Despite such
criticisms, nothing is known about how the media frame Clostridium difficile
related coverage.
Design. Qualitative interpretive descriptive study.
Method. An interpretive analysis of newspaper articles from the national press
that reported about the outbreak from the first day of coverage over 3 weeks
(12 June–3 July 2008).
Findings. Twenty-eight newspaper articles were included in the study from
tabloids, broadsheets, a regional and a Sunday newspaper. Monster and war
metaphors were frequently adopted to portray the severity of Clostridium difficile
and the impact it can have on patient safety. In addition, the positioning of the
affected patients, their families, healthcare professionals and the Government
produced representations of victims, villains and heroes. This subsequently
evoked notions of vulnerability, blame and conflict.
Conclusion. The media are and will remain critical convectors of public
information and, as such, are hugely influential in risk perceptions and responses.
Rather than simply dismissing media coverage, further understanding around how
such stories in specific contexts are constructed and represented is needed so that
it can help inform future communication and management strategies.
Keywords: Clostridium difficile, media, multidisciplinary, newspapers, nursing,
outbreak, patient safety, risk communication
© 2013 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
Why is this research or review needed?
• Media representation plays a crucial role in shaping indi-
viduals’ risk perceptions and influencing how they respond
to risks or risky situations.
• The media are frequently criticized for inaccurate reporting
and scaremongering when reporting about health care-asso-
ciated infections by those without in-depth understanding
of representation.
• No previous study has examined how Clostridium difficile
infection has been represented in the media.
What are the key findings?
• In the media, Clostridium difficile is portrayed as very
‘dangerous’ and ‘deadly’ and is something that the public
should be fearful of.
• Specific identities of Clostridium difficile and key players of
an outbreak are created by the media, which encourage the
reader to contextualize and compartmental some very com-
plex issues.
• In outbreak situations, coverage represents identities as
those who are the victims, villains and heroes. This repre-
sentation is frequently bolstered by apportioning blame
and conflict.
How should the findings be used to influence policy/
practice/research/education?
• Understanding how media construct and report their stories
in specific contexts is crucial to help inform future Clos-
tridium difficile infection and other health care-associated
infection management and communication strategies.
• The findings of this study can help healthcare professionals,
the Government, external stakeholders, the media and the
public to engage more effectively with each other.
• The findings of this study can help inform further research
in gaining more insight into how the media influence risk
perceptions and also to identify influential factors around
media production.
Introduction
The media are a major source of information and commu-
nication about health care-related issues. They represent the
world in both textual and visual images and suggest to their
readers ways to make sense of the world. In doing so, they
present concepts about what is and what is not acceptable,
what is important and what is not (Redman & Taylor
2006). Consequently, they play a prominent role in ques-
tioning the authority of healthcare professionals’ knowledge
and practice (Seale et al. 2010). This has been illustrated
© 2013 John Wiley & Sons Ltd
Media coverage analysis of a major UK C. difficile outbreak
clearly in recent press in response to the publication of the
Francis report (Francis 2013).
As health care-associated infections have a major impact
on morbidity and mortality, they have the potential to
attract significant media attention. Clostridium difficile (C.
difficile) infection (CDI) is a common cause of health care-
associated diarrhoea worldwide (Davies et al. 2013, Mitch-
ell et al. 2013). As major outbreaks have continued to
occur over the past two decades, not surprisingly, CDI, spe-
cifically, has evoked a remarkable increase in media fascina-
tion (Healthcare Commission 2006, 2007, Boyce et al.
2009). However, when reporting about health care-associ-
ated infections, the media are frequently blamed for sensa-
tionalist reporting and causing irrational risk perceptions,
fear and confusion among the public (Collins et al. 2009,
Burnett et al. 2013). Indeed, journalists have also been
accused of pursuing such news as if they were reporting a
hostage crisis (Washer & Joffe 2006).
From December 2007–June 2008, it was reported that, at
the Vale of Leven Hospital, NHS Greater Glasgow and
Clyde, UK, 55 patients were diagnosed with CDI. Of those
55 patients, 18 patients died as either a direct result of CDI
or it was a contributory factor to their death (The Scottish
Government 2008). Not surprisingly, this outbreak gener-
ated significant media coverage, which inherently resulted
in major public interest. This media coverage analysis of
the outbreak provides a unique opportunity to examine
how CDI and key actors were represented in the media and
what strategies were used to convey information and mes-
sages. Consequently, it goes a long way in helping under-
stand how risk perceptions and responses may be shaped.
While this media coverage analysis focuses on an outbreak
in the UK, given that CDI is a major challenge worldwide
and continues to attract media attention, the implications
of this study are globally pertinent.
Background
The print media has become a major source of health infor-
mation and communication, thus influencing public under-
standing of science, medical practice and ethical
controversies in health care (Seale 2010). They represent
the world and suggest to readers ways to make sense of the
world. Moreover, the media have the potential to mould or
structure people’s consciousness in ways that are socially
and politically consequential (Bennett 1982). Accordingly,
the media have a significant amount of power through
which they can choose what they present as news to readers
and decide how they shape a story (Vilella-Villa & Costa-
Font 2008). Rather than simply reporting about the ‘real
1543
E. Burnett et al.
world’, they continually contribute to the creation and re-
creation of this world (Gamson et al. 1992). By employing
rhetorical devices, the news can be made interesting, dra-
matic and emotive to shape readers’ reactions and future
attitudes and behaviours. Media stories are therefore often
constructed using such dominant frames to define what
issues are viewed as important or more newsworthy (Hilton
2010). As a result, the media are often blamed for inaccu-
rate reporting, committing sins of omission and sensational-
ism (Moynihan et al. 2000).
In this respect, analysing print media is becoming increas-
ingly popular in qualitative health-related research world-
wide to understand better how important health issues are
represented. This in turn can help inform future manage-
ment and communication strategies (Clarke & Everest
2006, Metcalf et al. 2010). Such dominant health topics
include breast cancer (Atkin et al. 2008), HPV vaccination
(Hilton 2010), Measles-Mumps_Rubella (MMR) (Smith
et al. 2011), cervical cancer (Bell & Seale 2011), HIV/AIDS
(Kiwanuka-Tondo et al. 2012) and euthanasia (Rietjens
et al. 2013). In terms of health care-associated infection, to
date, following a structured literature search, the authors
were unable to locate any media coverage analysis research
about C. difficile. Rather, literature has only focused on
meticillin-resistant Staphylococcus aureus (MRSA) (Childs
2006, Washer & Joffe 2006, Boyce et al. 2009, Chan et al.
2010).
Washer and Joffe (2006) examined the social representa-
tion of MRSA and found that it was largely represented as
a potentially lethal superbug marking the end of a golden
age of medicine. Terms such as ‘killer superbug’, ‘doomsday
scenario’ and ‘impending health crisis’ were used in favour
of the correct scientific terms. In addition, coverage was
constructed around an ‘it could be you’ set of assumptions
reinforcing the ease with which it could spread to people.
Consequently, a blame culture was embedded in coverage
to show that the spread is often caused by poor hygiene in
hospitals and mismanagement of the National Health Ser-
vice. Chan et al. (2010) also reported a strong bias in news-
paper coverage of MRSA in an attempt to associate it with
representations of ‘the dirty hospital’. Childs (2006) con-
cluded that newspaper reporting of MRSA was frequently
inaccurate and sensationalized, thus having an impact on
public confusion and lack of understanding. Inaccurate
reporting, as explained by Boyce et al. (2009), could be
attributed to scientific articles having negligible influence on
MRSA newspaper coverage. Instead, journalists appear to
favour the use of celebrity stories in addition to fictional
programmes to portray wrongdoing and reinforce the seri-
ousness of MRSA. Such adverse media coverage may cause
1544
widespread panic among patients and public and have long-
term effects on perceptions. As a result, this can create sig-
nificant challenges for healthcare professionals in relation
to communication and management of strategies. Nurses
are frequently exposed to patient and public concern, worry
and fear in relation to the risk of infection. Therefore, if
such strategies are to be effective, it is essential to gain an
understanding of how the media works (Boyce et al. 2009,
Leask et al. 2010).
Taking into consideration ongoing outbreaks, evolving
global challenges, increased media coverage and reports of
fear among patients and the public, this study provides a
unique opportunity to gain further insight into how CDI
was represented during an outbreak. This can therefore
help inform future communication and management strate-
gies. In addition, it can help identify ways for establishing
and strengthening future engagement between healthcare
professionals, the media, public and wider stakeholders.
The study
Aim
The aim of this study was to examine how a major CDI
hospital outbreak in the UK was represented in the media.
Design
A qualitative interpretive description methodology was
used, which was purposively developed for nursing and
health-related research (Thorne 2008). This allows research-
ers to stay close to their data by providing a comprehensive
summary or description, yet also to move beyond that to a
higher level of interpretation (Oliver 2011). In doing so, it
generates credible and meaningful insights that occur in
nursing and health care (Thorne et al. 2004).
Sample and data collection
National and regional newspaper articles that wrote about
the CDI outbreak over 3 weeks were analysed. Analysis was
undertaken from the first day of coverage and continued for
a 3 week snapshot period: 12 June–3 July 2008. This period
was during the height of coverage.
Using the online database LexisNexisâ, a sampling pool
of all original UK national broadsheets and tabloid newspa-
pers, regional and Sunday newspapers that reported on the
outbreak was generated to allow for purposive sampling.
The following search terms were used: Clostridium difficile;
C. difficile; C. diff; healthcare associated infection; hospital
© 2013 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
acquired infection; superbug; Vale of Leven. From the sam-
pling pool, purposive sampling identified three national
broadsheet daily newspapers (Daily Telegraph; Guardian;
Times), three national tabloid newspapers (Daily Mail;
Daily Mirror; The Sun); a Sunday newspaper (News of the
World) and a regional newspaper (The Herald) were also
included. These reflected the broad political shades of opin-
ion, highbrow/lowbrow spread and readership of the news-
papers (Newsworks 2013).
Lynch and Peer (2002) acknowledge the confusion
around selecting what articles should be included in a
media analysis, as newspapers are composed of various
types of content. The inclusion criteria in this study sup-
ported their views in that the articles:
1 Must be longer than two inches in length
2 Must be written in complete sentences that include a cen-
tral theme (C. difficile and Vale of Leven Outbreak)
3 Must not be part of a paid advertisement
4 Must not be a promotional reference for a full story that
is contained elsewhere; therefore, they must be complete
stories
Data analysis
Newspaper articles were analysed thematically using Frame-
work (Ritchie & Spencer 1994). This involved some impor-
tant steps:
• Familiarization with the data through reading and
re-reading.
• Generation of categories, codes and sub codes from
significant features of the data.
• Identification of themes and collating the codes into
the themes.
• Reviewing themes by checking if the themes are
relevant in relation to the coded extracts and the
complete data set, thus generating a thematic map of
analysis.
• Defining, refining and naming of each specific theme.
• Production of the final report, which clearly reflects the
research questions and aims and aligns with the
reviewed literature and theoretical frameworks.
Information from each newspaper article was synthesized
onto a previously validated newspaper coding sheet (Kitzin-
ger 1999), which had been adapted specifically for this
study. Three very broad categories were initially developed,
each containing several codes and sub codes. From the cate-
gories, ten themes were then identified from each category
where the codes and sub codes were assigned to. Each
theme was given explicit identification by stating its name a
© 2013 John Wiley & Sons Ltd
Media coverage analysis of a major UK C. difficile outbreak
definition (clear statement of what it is) and a description
(how to know when it occurs), which were continually
revisited throughout the course of the analysis process.
Rigour
According to Crabtree and Miller (1999), the developing
of a coding form provides a comprehensive trail of evi-
dence, which enhances the credibility of a study. Follow-
ing coding of all included articles by one researcher onto
the coding form, two researchers independently checked
20% to test reliability. The final adapted coding sheet
was piloted on five newspaper stories, which were not
included in the study sample, and some minor revisions
were made. Differences of opinions were resolved through
in-depth discussion. The coding sheets and newspaper
articles were then entered onto NVivo 9 to strengthen
analytic rigour and enable in-depth analysis. The analyti-
cal process was discussed in-depth with two other experi-
enced researchers at regular periods of time throughout
the study.
Findings
A total of 28 newspaper articles were included in the study.
Six of the eight sampled newspapers reported on the out-
break for the 3 weeks of analysis, as shown in Table 1.
Constructing identities
From the matrices developed during analysis, emerging
themes were identified. These were contextualized into one
overarching concept of ‘constructing identities’. This was
further conceptualized into ‘constructing C. difficile’ and
‘constructing individuals’.
It was clear that journalists possessed a key source of
empowerment in the creation of these identities; first of C.
difficile, then of the individuals who were connected with
the outbreak. Notably, the individuals constructed were
not fixed and sometimes changed throughout the course of
coverage. The three main groups of identities created
throughout the coverage build on the theoretical and
empirical work of Clive Seale and included victims, villains
and heroes (Seale 2010).
Constructing C. difficile
Two main metaphoric constructions were prominent
throughout the coverage: C. difficile as a war and C. diffi-
cile a monster.
1545
E. Burnett et al.

difficile as a war

03/07
C.

/08
With a specific focus on death, the metaphoric descriptions

0
of C. difficile as a war signalled the seriousness of the situ-

02/07
/08
ation. C. difficile was often portrayed as the enemy that

0
deliberately caused death. This tone was set on the first

01/07
/08
day of coverage and was consistently maintained through-

0
out as further deaths continued to occur. Headlines por-

30/06
trayed C. difficile as being the ‘killer’, being ‘lethal’ and

/08

1
‘deadly’ (Sugden 2008) and the number of deaths were
29/06 often referred to as ‘the tragic toll’. In addition, the out-
/08

0
break was portrayed as a ‘crisis’ (Robertson 2008a,b) in
28/06

which it ‘claimed lives’ (Sweeney 2008) and deaths were

/08

0
reported as ‘fatalities’ (Grant 2008a,b).
27/06

Furthermore, The Times provided explicit detail of how

/08

the Vale of Leven hospital was initially built, so that

26/06

victims of a potential nuclear war could be treated. The

/08

story told how the hospital had built a ‘super-size mortu-

25/06

ary to accommodate hundreds of extra bodies’. The

/08

kitchen was also ‘three times larger than needed for a hos-
0

pital of its size to allow them to cope with the extra strains
24/06
/08

of feeding casualties and refugees’. It stated that the parti-

2

tions that separated the blocks to make them into wards

23/06
/08

could be ‘quickly knocked down to leave big open spaces

5
Table 1 Newspapers reporting the outbreak between Thursday 12 June and Thursday 3 July 2008.

where injured people could be brought in and laid on mat-

22/06
/08

tresses’. In addition, medical staff were ‘taught how to

1

catch, kill, skin and cook a rabbit so that they could pass
21/06

on the skill to survivors’, so that they could ‘live off the

/08

land’ (Reid 2008a,b).

20/06

Not all coverage, however, adopted such a negative

/08

war-related tone. Using the same metaphoric approach, an

19/06

idealistic stance was also portrayed whereby the Scottish

/08

Government (namely Nicola Sturgeon, the then Health

18/06

Secretary, and Alex Salmond, First Minister of Scotland)

/08

were reported to be taking positive action to ‘win the

17/06

war’, thus putting them back in control. Here, the meta-

/08

phors used imposed a situation of defence and counter-

2

attack, thus reflecting the physical strength of the political

16/06
/08

power. This was reported as the Scottish Government

1

planning to ‘defeat the scourge of hospital-acquired infec-

15/06
/08

tion’ (Nicolson 2008a,b).

0
14/06
/08

C. difficile as a monster
0

Terms frequently used throughout the coverage included

13/06

‘superbug’ (Sweeney 2008), ‘terrifying’ (McAulay 2008),

/08

‘horror’ (Bruce 2008), ‘aggressive’ (Robertson 2008a,b)

12/06

and patients ‘succumbed to C. difficile’ (Grant 2008a,b).

/08

This representation of C. difficile as a monster illustrated it

newspaper
Number of

as untouchable and having exemplary physical strength.

articles

Consequently, it conveyed the illusion that it is was uncon-

trollable and posed a significant threat to people.

1546 © 2013 John Wiley & Sons Ltd

JAN: ORIGINAL RESEARCH
Such terms were used alongside descriptions of the per-
ceived severity of C. difficile and how this deviated from the
norm. For example, articles stated that it was ‘20 times more
toxic than the normal form of illness’ (Nicolson 2008a,b)
and that ‘antiseptic washes used to keep MRSA under control
don’t work with C. diff’ (McAulay 2008). In addition, com-
pared with MRSA, it was ‘three times deadlier’ (McAulay
2008) and the number of cases reported were believed to be
‘just the tip of the iceberg’ (Bruce 2008). The emphasis on the
potential severity and strength of C. difficile also highlighted
that it did not only affect vulnerable patients. For instance:
Our mum was a hardy woman. She had never been to the doctor
in 40 years […] but it was as soon as she got diagnosed, that
her health went on a downward spiral […] she was struck down
by C. diff in the hospital ward and was dead within a week. (Bruce
2008)
The use of historical analogies on the first day of report-
ing enabled journalists to contextualize unfolding events
and to illustrate the severity and impact of C. difficile. A
previous highly publicized outbreak at the Maidstone and
Tunbridge Wells NHS Trust in 2007 (Healthcare Commis-
sion 2007), where 90 patient deaths were reported, was
referred to (Reid 2008a,b).
Constructing individuals
Victims
The construction of the victims largely focused on the fami-
lies affected by the outbreak. The victims were represented
as powerless, vulnerable and needed to be protected, yet
the ‘protectors’ had failed them. These protectors of course
were the villains. This was presented using emotive descrip-
tive references, such as ‘victims’ (Sweeney 2008), ‘vulnera-
ble’ (Nicolson 2008a,b) and ‘elderly’ (Reid 2008a,b).
Stories also reported personal profiles of affected people,
providing explicit accounts related to their death, thus
encouraging reader visualization. These mainly took the
form of personal testimonies, such as:
She (mother) went downhill almost overnight. She had been able to
talk and recognise everyone and had been getting better. She went
from drifting in and out of consciousness and it ended up that she
couldn’t even recognise us. I had not seen her for a couple of days
before she got C. diff and the difference was huge. She was in pain
all the time and had constant diarrhoea. She looked like death
warmed up. She had lost a lot of weight, her face was drawn and
you could see her bones […] The whole family is devastated. We
are all very close and could not believe my mother had died. (Bruce
2008)
© 2013 John Wiley & Sons Ltd
Media coverage analysis of a major UK C. difficile outbreak
An additional construct of the victim was a whistle-
blower at the hospital. Firstly, the whistle-blower wished to
remain anonymous, thus highlighting his/her professional
vulnerability in terms of being anxious about the conse-
quences of being identified. Secondly, the concept of victim-
hood in this sense was to explain that, despite voicing
concerns to management at the hospital, they failed to pro-
vide healthcare workers with adequate facilities to cope
with the number of infected patients. In addition, no
specialist support was provided to help them deal with the
complex issues they were faced with. Notably, the emotive
concepts used for this story may have also encouraged
anger towards those responsible for not taking appropriate
action, thus enhancing the identities of the villains (David-
son 2008a,b).
Villains
There were several villains constructed throughout the cov-
erage. These were individuals who were believed to be
responsible for the outbreak or for not taking action. They
included the Health Board, in particular, Tom Divers, the
Chief Executive of the hospital, the Health Secretary, Nic-
ola Sturgeon, and the doctors and nurses at the hospital.
Whilst constructing the identities of the villains, strategies
were also adopted by the media to bolster the conflict,
which arose between them.
Chief Executive
Right from the beginning of the coverage, the Chief Execu-
tive was portrayed as the main villain. This began by Ross
Finnie, the Scottish Liberal Democrat leader, implying that
the Health Board was not telling the truth. As the number
of deaths continued to increase, Wendy Alexander, the
Scottish Labour leader, also became prominent in the accu-
sations against the Chief Executive, indicating that the
deaths were being ‘covered up’ and that they were not
reported to the Health Secretary (Davidson 2008a,b). Expli-
cit details were then reported about the specific failings of
the Chief Executive, such as inadequate surveillance systems
in place, a lack of resources and facilities that were not fit
for purpose in the hospital and patient care equipment
not being fit for purpose. At this time, as the Scottish
Government was reported to be unaware of these issues, it
was not portrayed as the villain, but rather as the victims
(MacLeod 2008).
The Chief Executive’s responses to these allegations con-
tinued to enhance his profile as the villain as they presented
him as taking little responsibility for the situation. His lack
of accountability was further heightened when he denied
allegations that staff had been complaining about the
1547
E. Burnett et al.
conditions at the hospital for several years and attempted
to apportion blame onto others:
No doubt there have been shortcomings and I bitterly regret those.
If it turns out there have been fundamental shortcomings which
should have been acted on previously that had not been acted on
by senior management then, certainly, I will apologise. (Paterson
2008)
Consequently, coverage presented an array of angry
responses from individuals, such as the daughter of a
patient who had died and Margaret Watt, from the Scottish
Patient’s Association, stating his ‘patronising impertinence
is astonishing’, it was ‘obscene’ and a ‘disgrace’ and
demanded his resignation (Grant 2008a,b). Furthermore,
this story also provided explicit details of the Chief Execu-
tive ‘lucrative pay and pension packages while families were
left with the heartbreak of losing their loved ones’.
Health secretary
Early in the coverage, as conflict became apparent between
opposing political parties, details of the accusations made
towards Nicola Sturgeon were a significant feature, thus
portraying Nicola as one of the villains. Such accusations
included being aware of the problems prior to the outbreak,
yet not acting on them and being aware of the new C. diffi-
cile guidance in England, but not implementing it in Scot-
land (Robertson 2008a,b). In addition, despite the number
of deaths increasing, it was reported that Nicola Sturgeon
was reluctant to conduct a public enquiry, instead favour-
ing an official internal inquiry. This generated additional
anger by other opposing parties, external stakeholders and
families of those who had died. Enhancing this persona of
being the villain, especially in earlier coverage, it was the
allegations made towards Nicola Sturgeon that journalists
focused on most, especially in tabloid newspapers (Bruce
2008). Minimal coverage was given in terms of her
responses. While accusations were directly quoted in
lengthy sentences, when Nicola Sturgeon’s responses were
published, journalists mainly used their own words, rather
than her direct quotes. If quotes were used, they tended to
print only one or two words, thus not providing the whole
context.
Doctors and nurses
Doctors and nurses were also portrayed as villains in two
main ways. Firstly, journalists referred to a previous highly
publicized C. difficile outbreak, possibly in an attempt to
draw on similarities between the two, despite previous out-
breaks not being connected to the one being reported:
1548
After the outbreak in Kent […] the Healthcare Commission said
that an ‘itinerary of errors in infection control had caused the
‘avoidable tragedy’. It added that nurses at the trust were too
rushed to wash their hands and left patients to lie in their own
excrement. (Reid 2008a,b)
When providing information about the causes of C. diffi-
cile, references were made towards doctors’ and nurses’
practice. For example, doctors were blamed for overusing
antibiotics (Nicolson 2008a,b). This was further enhanced
by reports that ‘significant reductions in C. diff’ have
occurred elsewhere in the UK following changes by doctors
in the way antibiotics are used, as it demonstrated that
C.difficile is preventable (Reid 2008a,b). In addition, doc-
tors and nurses were held responsible for not decontaminat-
ing their hands (McAulay 2008). This accusation was also
reinforced when newspapers reported that a hand hygiene
expert had been assigned to ensure that standards were met
(Reid 2008a,b). One controversial article questioned
whether ‘lazy healthcare staff’ was actually responsible for
the outbreak:
Could it be the great untouchables of modern life, doctors and
nurses are so beyond criticism nobody publicly says they are the
real culprits in these appalling bug outbreaks? […] I think it’s time
we were told what’s actually going on in our hospitals and why
they have become so unsafe. It would be criminal if it was just
down to staff being too lazy to wash. (MacKenna 2008)
Heroes
The heroes in the coverage were illustrated as those expos-
ing and questioning the villains and taking action to deal
with the outbreak and stop the spread of infection. The key
heroes identified in the coverage were the politicians,
namely Nicola Sturgeon.
Paradoxically, while Nicola Sturgeon was portrayed as
the villain, as highlighted above, this was not the case in
all coverage. Davidson wrote a lengthy article about the
deaths being ‘hidden from Health Secretary’, how she had
‘uncovered’ the ‘tragic toll’ and outlined the action that the
Health Secretary was taking to address the problems
(Davidson 2008a,b). Further details of this were published,
which provided a positive story as to all the action Nicola
was taking (Dinwoodie 2008). In these accounts, Nicola
Sturgeon talked compassionately about ‘our patients’ and
being ‘determined to ensure lessons are learned’. In addi-
tion, she was also reported praising the Health Board for
the ‘concerted drive towards improving hand hygiene at
the hospital’ rather than solely criticizing them for wrong-
doing (Robertson 2008a,b). It was also at this time that
© 2013 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
reports stated that she believed the case for an independent
enquiry was ‘overwhelming’ (MacDermid 2008).
Discussion
This paper has provided an insight into the diverse and
complex strategies that were adopted by media profession-
als to represent this CDI outbreak in newspapers. In doing
so, it enabled ways of seeing how C. difficile was con-
structed and the identities that were created and re-created
over time as new information became available. Given the
power of media representation, having in-depth understand-
ing goes a long way in understanding how and why people
form and modify risk perceptions towards CDI and how
they may respond to risks. This can then help inform future
communication and management strategies.
Words, whether spoken or written, have power (Lyons
2000). The strategic use of metaphors allows journalists to
construct specific meanings about something (Harding &
Pilotto 2010). This, according to some, makes the story more
believable, understandable and interesting and aesthetically
pleasing (Gibson et al. 2001). There were several distinct
and prominent metaphors used throughout the coverage to
convey the severity and impact of the outbreak, who and
what was to blame and how the outbreak was responded to.
These were often associated with metonymies of death, war,
fight and battle. Battle and military metaphors triggered sce-
narios of the enemy (C. difficile) ‘attacking’, ‘invading’ and
‘killing innocent victims’ (Koteyko et al. 2008), while C. dif-
ficile was described as a ‘killer bug’, ‘lethal bug’ and ‘deadly’.
The use of sources, quotes and conflict allows journalists
to construct meanings and portray specific issues, people and
events in certain ways. Notably, however, if there are imbal-
ances in quotations and uses of sources, this can sway read-
ers’ opinions to one side of an issue or argument. In doing
this, journalists can reframe what sources say or do and
reproduce them to create a persuasive story, depending on
the ideological and political stance of the newspaper about a
specific situation (Archakis & Tsakona 2009). Personal testi-
monies are often used in newspaper articles, as they are more
likely to garner attention and interest by evoking sympathy.
In addition, they bring stories to life and personalizes them
to capture the reader’s emotions and enhance the portrayal
of wrongdoing (Petts et al. 2001, Taylor & Sorenson 2002).
In times of crises, communication can be a more convo-
luted, interwoven process, with the media assuming a cen-
tral place (Brossard 2009). However, it is too easy to pin
all the blame on journalists for dramatic reporting and
causing misperceptions and fear among readers. In addition,
Hughes et al. (2006) argues that the messages ‘decoded’ by
© 2013 John Wiley & Sons Ltd
Media coverage analysis of a major UK C. difficile outbreak
the reader are not always necessarily those intended by the
producer. People can select from media messages for their
own purpose; therefore, the media are more likely to rein-
force, rather than create, completely new perceptions or
change existing perceptions.
In view of this, in healthcare settings, appropriate com-
munication between healthcare professionals is absolutely
crucial. As nurses have an integral role in patient outcomes,
their communication skills are of utmost importance. How-
ever, to develop and implement effective communication
strategies so that a positive effect on outcomes can be
achieved, attention must be paid to the constituent elements
of patient and public perceptions. With regard to media
coverage, it is therefore vital that an understanding of what
is reported, how it is reported and why it is reported is
gained to be able to engage fully with patients and the pub-
lic. Rather than viewing media coverage of an adverse
healthcare event as potentially harmful, it can be used as an
opportunity for healthcare professionals, especially nurses,
to continually engage with patients and the public to
challenge unwarranted assumptions and promote basic
knowledge of infection risk and a more comprehensive
understanding (Boyce et al.2009). Moreover, as media cov-
erage has the ability to drive change and improvement, this
also affords great opportunities for healthcare professionals
and key stakeholders and the public to engage with the
media, so that negative messages can be challenged and
more balanced representations in future coverage can be
achieved (Kitzinger 2009, Hilton 2010).
Understanding media influence on risk-related healthcare
issues is only one element. Journalists do not see their job
to simply echo policy maker’s advice or become health edu-
cators. Their concern is to communicate to their readers as
to what is going on and to be seen to represent its audience
(Kitzinger 2009). To aid further understanding, future
research also needs to focus on audience reception of the
media as well as understanding the challenges and con-
straints that media professionals face when reporting about
health-related risks (Larsson et al. 2001).
Limitations
A limitation of this study is that analysis was conducted
only over 3 weeks. Considering the severity of the outbreak
and the longevity of media reporting, it may have been use-
ful to extend the period of analysis to explore further
changes in how C. difficile and identities were constructed
as new information became available. In addition, it would
have been interesting to note if previous statements or
assumptions made by the media altered following the pub-
1549
E. Burnett et al.
lishing of the outbreak report (The Scottish Government
2008).
Conclusion
The global impact of health care-associated infections is
devastating; therefore, the public has a right to know what
is happening and the risks that they may be potentially
facing (Kiernan 2013). However, the impact of media
coverage, on health issues, should not be underestimated.
Regardless of scientific flaws or inaccuracies, the media
remain powerful drivers of change. Individuals’ risk percep-
tions and responses to a health-related threat are context-
dependent, which is why, in specific situations, the media
can be a major influence (Loewenstein & Mather 1990,
Botterill & Mazur 2004). However, researchers, scientists
and healthcare professionals are quick to attack the media
when they believe they have been misrepresented and when
talking about public understanding, journalists are often
portrayed to be the problem. An editorial in Nature argued
that attacking journalists for inaccurate reporting and sen-
sationalism sounds bitter and can be seen as an easy way
out and the long-term benefits are little. Rather than ‘shoot-
ing the messenger’, it stated that scientists, researchers and
healthcare professionals should work with them to help
portray the real story (Nature 2002). To healthcare profes-
sionals and communicators to attempt to achieve their
goals, it is essential to understand the role of the media.
Media representation is a crucial part of this.
Funding
This research received not specific grant from any funding
agency in the public, commercial or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the author(s).
Author contributions
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/ethical_1author.html)]:
• substantial contributions to conception and design,
acquisition of data, or analysis and interpretation of
data;
• drafting the article or revising it critically for important
intellectual content.
1550
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