Escuchar hacia adentro barreras estructurales y potencial relacional en la comunicación de salud pública J. Law Epistemic Stud. (July - December 2025) 3(2): 1-6 https://doi.org/10.5281/zenodo.15905774 ISSN 3091-1575 ORIGINAL ARTICLE Listening within structural barriers and relational potential in public health communication  Yanara Aróstica yanara@suss.co.cu Universidad de Sancti Spiritus “Jose Marti Perez”, Cuba. Received: 10 March 2025 / Accepted: 06 June 2025 / Published online: 31 July 2025 © The Author(s) 2025 Yanara Aróstica Abstract Internal communication in public health institutions is a key operational axis and an essential space for the production and circulation of organizational knowledge. This study, from a crit- ical organizational perspective, diagnosed the internal communi- cation dynamics within a Cuban healthcare institution, identifying strengths, weaknesses, and opportunities for structural improve- ment. Using a qualitative, non-experimental, and descriptive de- sign, participant observation, semi-structured interviews, and doc- ument analysis were conducted, with thematic coding performed using Atlas.ti. A hierarchical structure was observed, characterized by limited feedback, strong reliance on informal channels, and a lack of strategic planning in communication management. These conditions hinder transparency, demotivate staﬀ, and limit the insti- tution’s responsiveness. However, spontaneous collaborative prac- tices and a willingness for interpersonal dialogue were also noted, representing valuable resources for bottom-up institutional trans- formation. It is necessary to professionalize internal communica- tion, institutionalize protocols, and democratize information ﬂows. Communication should be addressed as a transversal component of public management, constitutive of both power and organizational knowledge. The study provides conceptual and practical tools for rethinking the relationship between communication, institutional authority, and organizational epistemologies in the ﬁeld of public health. Keywords organizational communication, public health, internal communication, structural barriers, institutional culture. Resumen La comunicación interna en las instituciones de sa- lud pública es un eje operativo clave y un espacio esencial para la producción y circulación del conocimiento organizacional. Este estudio diagnosticó, desde una perspectiva organizacional crítica, las dinámicas comunicativas internas en una institución sanitaria cubana, identiﬁcando fortalezas, debilidades y oportunidades de mejora estructural. Mediante un diseño cualitativo, no experimen- tal y descriptivo, se aplicaron observación participante, entrevistas semiestructuradas y análisis documental, utilizando Atlas.ti para la codiﬁcación temática. Se observó una estructura jerárquica con es- casa retroalimentación, fuerte dependencia de canales informales y ausencia de planiﬁcación estratégica en la gestión comunicacional. Estas condiciones afectan la transparencia, desmotivan al perso- nal y limitan la capacidad de respuesta institucional. No obstante, se observaron prácticas colaborativas espontáneas y disposición al diálogo interpersonal, consideradas recursos valiosos para una transformación institucional ascendente. Es necesario profesiona- lizar la comunicación interna, institucionalizar protocolos y demo- cratizar los ﬂujos informativos. La comunicación debe abordarse como un componente transversal de la gestión pública, constitutivo del poder y del conocimiento organizacional. El estudio aporta he- rramientas conceptuales y prácticas para repensar la relación entre comunicación, autoridad institucional y epistemologías organizati- vas en el ámbito de la salud pública. Palabras clave comunicación organizacional, salud pública, co- municación interna, barreras estructurales, cultura institucional. How to cite Aróstica, Y. (2025). Listening within structural barriers and relational potential in public health communication. Journal of Law and Epistemic Studies, 3(2), 1-6. https://doi.org/10.5281/zenodo.15905774

J. Law Epistemic Stud. (July - December 2025) 3(2): 1-6 2 Introduction In the ﬁeld of public health, internal communication has evolved from being a functional tool to becoming a complex organizational phenomenon with epistemic and political im- plications. It is now acknowledged that communicative prac- tices not only enable the circulation of information, but also structure hierarchies, shape power relations, and conﬁgure institutional knowledge (Felt, 2023). This epistemological shift implies understanding communication as a constitutive dimension of public institutions, especially in sectors such as healthcare, where organizational eﬀectiveness and insti- tutional legitimacy largely depend on how decisions, norms, and knowledge are communicated. Recent research demonstrates that the quality of internal communication is directly related to organizational well-be- ing, staﬀ motivation, and the perception of institutional jus- tice. For example, Edmondson and Lei (2021) emphasize that the presence of psychologically safe environments in public institutions largely depends on the availability of open feedback channels, horizontal dynamics, and a culture of di- alogue. In their study, they identify that when communica- tion is authoritarian or fragmented, levels of stress, distrust, and employee turnover increase. This is especially problem- atic in healthcare contexts, where decisions must be shared, agreed upon, and understood by multiple actors in real-time. Likewise, the bibliometric analysis conducted by Puigvert-Santoro, Arimany-Serrat, and Tarrats-Pons (2025) indicates that after the COVID-19 pandemic, a signiﬁcant transformation occurred in the dynamics of internal commu- nication within public organizations. A clear trend emerged toward information decentralization and a renewed appreci- ation for informal channels of communication. Their study, based on more than 200 scientiﬁc publications, reveals that institutions with bidirectional communication strategies and a participatory approach achieved higher levels of cohesion, adaptability, and legitimacy. In this regard, the pandemic act- ed as a catalyst that exposed both the structural weaknesses and the opportunities for innovation in institutional commu- nication systems. In Latin America, studies consistently highlight the per- sistence of structural barriers, including hierarchical verti- cality, informality in information ﬂows, and inadequate stra- tegic planning of internal communication (Dollard & Bailey, 2021). However, emerging processes of communicative de- mocratization are also identiﬁed, driven from the grassroots by actors committed to organizational improvement. These tensions between structural rigidity and spontaneous innova- tion deﬁne a dynamic scenario in which institutional power and access to knowledge are conﬁgured. In the context of public organizations, internal commu- nication is structured as a key component that directly in- ﬂuences the production, legitimation, and dissemination of organizational knowledge. This perspective emphasizes that communication should not be viewed solely as a manage- ment tool, but as a critical dimension of institutional power. In the speciﬁc ﬁeld of public health, this dimension ac- quires particular relevance due to its impact on service qual- ity, organizational climate, and strategic decision-making. Recent literature has emphasized that deﬁciencies in com- municative processes can generate adverse eﬀects, including staﬀ demotivation, the breakdown of formal channels, and institutional ineﬃciency (Flick, 2022). The Pan American Health Organization (PAHO, 2022) warns that the absence of communication protocols in Latin American healthcare institutions limits the capacity to im- plement eﬀective public policies, especially in emergency contexts. These communication deﬁcits result in a loss of institutional trust, failures in interdepartmental coordination, and diﬃculties in maintaining collaborative and sustainable practices. In the Latin American context, persistent structural barri- ers have been documented that aﬀect communicative eﬀec- tiveness, such as hierarchical rigidity, limited formalization of internal channels, and dependence on informal networks (Creswell & Poth, 2018). Far from being circumstantial, these conditions stem from historical patterns that reproduce inequalities in access to information and the capacity of in- ﬂuence among diﬀerent organizational levels. In Cuba, these barriers are further complicated by an ad- ditional layer of complexity: the coexistence of highly cen- tralized regulations and informal mechanisms that compen- sate for institutional gaps. According to Morales and Landa (2022), this duality generates tensions that aﬀect both strate- gic planning and operational execution, while granting infor- mal communication an ambivalent role—it is simultaneous- ly an obstacle and a solution. These tension-laden dynamics compel a reevaluation of traditional analytical frameworks and the incorporation of perspectives that recognize communication as a ﬁeld of sym- bolic struggle, where organizational hierarchies, identities, and knowledge are constructed and negotiated. This article aims to analyze, from a critical qualitative ap- proach, how internal communication processes are conﬁg- ured within a Cuban public health institution. In particular, it examines how formal and informal channels are structured, their impact on organizational management, and their inﬂu- ence on the legitimacy of institutional knowledge. It is based on the premise that every public institution also operates as an epistemic community, in which communi- cative practices do not merely transmit information but act as devices for meaning-making, power legitimation, and knowledge distribution. Through this lens, the study seeks to

J. Law Epistemic Stud. (July - December 2025) 3(2): 1-6 3 provide empirical evidence and critical reﬂection that con- tribute to the design of more inclusive, strategic, and contex- tually grounded communication policies within the Cuban healthcare system. Methodology This study employs a qualitative, interpretive methodolo- gy to understand the deep and symbolic dynamics of inter- nal communication within the Cuban institutional healthcare context. The choice of this approach is based on the need to grasp the meanings that individuals attribute to their com- municative experiences, as well as the power structures and systems of meaning that emerge from such practices (Flick, 2022). A non-experimental, cross-sectional design was employed, allowing for a situational diagnosis without manipulating va- riables. The unit of analysis was a public health institution located in central Cuba, selected based on criteria of acces- sibility, strategic relevance, and willingness to collaborate. The methodological process was structured into three pha- ses: (1) empirical data collection, (2) thematic coding and analysis, and (3) interpretive triangulation. The data collection techniques included participant obser- vation, semi-structured interviews, and document analysis. Observations were conducted over a continuous four-week period, with structured sessions in various institutional spa- ces, including planning meetings, informal settings (such as hallways and waiting rooms), and oﬃcial events. This tech- nique enabled the identiﬁcation of relevant communicative situations, implicit information ﬂows, institutionalized silen- ces, and symbolic modes of interaction. The interviews were conducted with 12 key informants, selected through theoretical sampling, who represented ma- nagerial, technical, administrative, and operational levels. A ﬂexible thematic guide was used, based on the emerging categories of the conceptual framework, addressing dimen- sions such as communicative leadership, information chan- nels, informal practices, perceptions of eﬀectiveness, institu- tional legitimacy, and organizational culture. The interviews were fully recorded and transcribed, adhering to ethical standards of informed consent and participant anonymity. Data processing was carried out using ATLAS.ti version 23, following an open, axial, and selective coding protocol (Sal- daña, 2021). Results and discussion The document analysis encompassed internal regulations, procedural protocols, institutional reports, meeting minutes, administrative guidelines, and oﬃcial communications from management. This technique enabled the contrasting of the normative dimension of institutional discourse with the em- pirical communicative practices observed and reported by the participants. Additionally, the analysis was supported by the thematic analysis framework of Braun and Clarke (2021), which enabled the organization of ﬁndings across six phases: familiarization with the data, initial coding, theme identiﬁcation, theme review, theme deﬁnition and naming, and drafting of the analytical report. Methodological triangulation was used as a validation strategy, combining data from interviews, observations, and documents. This triangulation was complemented by an intersubjective category review conducted among peer re- searchers, which helped reﬁne interpretive biases. Further- more, a partial feedback technique was applied with the in- stitutional actors themselves, aimed at validating preliminary interpretations and promoting co-construction of knowledge. From an ethical standpoint, the principles of the Com- mittee on Publication Ethics (COPE, 2022) were adopted, ensuring respect for participants’ rights, data conﬁdentiality, responsible use of sensitive material, and the right to volun- tary withdrawal at any stage of the process. It is essential to emphasize that this methodological design aimed not only to describe the functioning of internal com- munication but also to analyze it in its structural dimension: as a device for organizing power, producing meaning, and le- gitimizing institutions. In this sense, internal communication is approached as a transversal process that shapes organiza- tional identities, deﬁnes symbolic hierarchies, and structures the relationship between knowledge, authority, and public action (Creswell & Poth, 2018). This methodology enabled the construction of a critical, situated, and empirically grounded perspective on institu- tional communicative processes within the Cuban context, thereby contributing to academic and technical debates on the contemporary challenges of public health management. The qualitative analysis enabled the identiﬁcation of six key emerging categories that reﬂect both the weaknesses and the potential of internal communication within the institution under study. These categories were ranked according to their frequency of occurrence in interviews and observations, as illustrated in the Figure 1. The graph shows a strong concentration of references around downward communication and the use of informal channels, reinforcing the perception that the communicative structure is hierarchical and poorly planned. However, sig- niﬁcant levels of willingness for dialogue and participation in collective spaces were also recorded, suggesting that con- ditions exist for an organizational transformation oriented toward strengthening internal communication. Most of the interviewed workers indicated that communi- cation ﬂows unidirectionally from managerial levels to oper- ational staﬀ. Vertical directives and announcements are pri-

J. Law Epistemic Stud. (July - December 2025) 3(2): 1-6 4 oritized, without systematic spaces for feedback or debate. This practice reﬂects a verticalist institutional culture, which hinders innovation, shared responsibility, and work motiva- tion (González & Moreno, 2021). Testimonies revealed that even important decisions are communicated without justi- ﬁcation or prior consultation, generating frustration and a sense of detachment. Figure 1. Frequency Polygon: Findings on Internal Com- munication in the Public Health Institution. Own elabora- tion. The document-based diagnosis conﬁrmed the absence of formal plans or guidelines for managing internal communi- cation. No institutional communication objectives or evalu- ation indicators were identiﬁed. According to Menéndez and Suárez (2023), this strategic void has a negative impact on operational coherence and staﬀ perceptions of transparency. The lack of planning hinders interdepartmental coordination, weakens institutional identity, and exacerbates internal con- ﬂicts. It was found that a signiﬁcant portion of the information circulates through unoﬃcial channels, including sponta- neous conversations, verbal announcements, and informal peer communications. While these channels compensate for speciﬁc gaps, they also generate asymmetries in access to information, rumors, and distortions (Bartoli, 2019). This re- liance on informal communication highlights a lack of trust in formal channels and reﬂects a culture that is more reactive than proactive. Operational staﬀ reported feeling excluded from deci- sion-making processes. The lack of spaces to express opin- ions, suggestions, or criticisms reduces their sense of be- longing and hinders continuous improvement. According to Pérez-Díaz et al. (2023), upward institutional feedback is a key factor in building psychologically safe environments. The absence of such mechanisms reinforces the distance be- tween management and frontline staﬀ. Despite the predominance of rigid structures, a favorable relational culture among workers was identiﬁed. Teamwork, mutual support, and interpersonal relationships based on trust are highly valued. This symbolic capital constitutes an internal strength that could be harnessed to build more participatory and horizontal communicative environments (PAHO, 2022). Peer recognition serves as a buﬀer against the wear and tear of institutional pressures. Although in a limited manner, there are collective practices in which workers engage in dialogue about their experienc- es, concerns, and proposals. Periodic meetings, celebrations, and community spaces serve as venues for symbolic and emotional expression, although their connection to formal institutional management remains weak (Morales & Landa, 2022). These practices show transformative potential if inte- grated into genuine deliberative processes. The results reveal a communicative paradox: while the in- stitutional structure privileges hierarchical and unidirection- al practices, spontaneous practices of collaboration, listen- ing, and participation emerge, which could be systematized and strengthened. From a critical perspective, these tensions reﬂect struggles over the control of meaning, authority, and knowledge within the organization. In line with Puigvert Santoro et al. (2025), it is proposed that improving internal communication requires a compre- hensive approach that combines technical tools (protocols, plans, indicators) with cultural processes aimed at com- municative democratization. According to PAHO (2022), strengthening institutional communication not only im- proves organizational eﬃciency but is also a strategic com- ponent for ensuring rights, equity, and legitimacy in public health systems. The critical analysis of internal communication in the examined public health institution revealed that it does not function merely as an operational mechanism, but instead constitutes a structuring dimension of organizational life. The ﬁndings indicate that, in public health contexts, internal communication operates as a transversal axis that directly in- ﬂuences strategic management, staﬀ well-being, knowledge circulation, and institutional legitimacy. A vertical and unidirectional organizational culture was identiﬁed, characterized by predominant top-down commu- nication and a lack of formal spaces for feedback and active staﬀ participation. This communicative structure reinforces rigid hierarchies and limits collective learning, institutional innovation, and the development of organizational trust. Fur- thermore, the absence of an internal communication policy was evident, reﬂected in the lack of strategic planning and the high degree of informality in information ﬂows. These conditions undermine functional eﬃciency, weaken employ-

J. Law Epistemic Stud. (July - December 2025) 3(2): 1-6 5 ees’ sense of belonging, and reduce institutional cohesion. Despite these limitations, the study identiﬁed emerging communicative practices with potential for democratization. Informal cooperation networks, a willingness for interper- sonal dialogue, and non-institutionalized collective spaces were observed. Although marginal, these practices serve as symbolic mechanisms of resistance to authoritarian manage- ment styles, opening possibilities for the development of a more horizontal and participatory communication culture. From an epistemic perspective, internal communication not only transmits information but also structures meaning, produces institutional legitimacy, and conﬁgures power rela- tions. The way an organization communicates—or remains silent—shapes the construction of valid knowledge, legiti- mizes certain discourses, and marginalizes others. In this sense, communication is positioned as a normative space that shapes the organization’s symbolic architecture. The results suggest the need to implement comprehen- sive strategies that frame communication as an institutional right rather than a concession. Developing structured inter- nal communication plans, fostering leadership attuned to dialogue, and institutionalizing participatory spaces emerge as fundamental actions to strengthen symbolic governance, ensure communicative justice, and advance toward more in- clusive and context-sensitive organizational epistemologies in the health sector. Conclusions The study highlights internal communication in public health institutions as a core organizational dimension that shapes strategy, staﬀ well-being, knowledge ﬂow, and legi- timacy. It reveals a dominant vertical communication model that limits feedback and trust, alongside a lack of structured communication policies, which weakens cohesion and eﬃ- ciency. However, informal networks and dialogical spaces emerge as resilient, democratizing forces pushing toward more participatory cultures. Communication is shown to be a political and epistemic process that constructs meaning and power relations, challenging traditional management views. Practically, the study calls for comprehensive communica- tion plans, participatory leadership, and institutionalized dialogue, rather than merely symbolic gestures. It positions communication as a fundamental institutional right and con- tributes to critical public management scholarship by advo- cating for context-sensitive, inclusive organizational episte- mologies in Latin America’s health sector. References Bąk, D., & Bąk, S. (2024). Change management in heal- thcare – a scoping literature review. e-mentor, 2(104), 23–33. https://doi.org/10.15219/em104.1652 Bartoli, C. (2020). La comunicación interna en las organi- zaciones 2.0: Prácticas informales y desafíos estraté- gicos. 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