_C_QMS751: Introduction to Health

C o m m u n i c a t i o n

1 0 - 6 : 0 0 , Lasher 209

;her 107 fh 1:00 - 2:30 (and by appointment)

As participants in a survey of health communication theory and research, students in C O M S 751 will read a wide variety of reviews, reports of original research, and editorial/critical commentaries. The class will start with a brief consideration of the nature of health communication and, following Robert Craig, varieties of (health) communication theories (differentiated not by variant epistemological commitments but by differences in basic conceptions of communication itself). But this will not be the major organizing scheme for the class. Rather, because health communication scholarship is driven by pragmatic concerns (as opposed to other domains in which there are basic interests in knowledge for its own sake or in aesthetics), the course is organized not by theory or theoretical tradition but by substantively meaningful questions about health communication. For instance: W e will ask about the meaning of illness (esp., the challenges t h a t bedevil meaning making) and the nature of important sensemaking practices (e.g., metaphor, narrative, interaction, spirituality). W e will also ask about the nature of relationships between the ill and their care providers, efforts to better educate care providers and patients, and layers of health communication beyond the patient-provider relationship (e.g., social support networks, health care teams, the broader organization and culture of medicine, and popular culture). Moreover we will ask questions about communication about risk from both a psychological and social constructionist perspective, a variety of efforts to limit risk and otherwise promote public health (e.g., campaigns, community organizing, policymaking), and the ethical considerations that accompany these efforts. By the end of this semester, participants will be able to (a) understand major theoretical, phenomenological, and practical issues in health communication scholarship, (b) apply several lenses, both at the same and different levels of analysis, to m a n y aspects of health communication, and (c) think critically about theory, research, and practice in this area. Students whose main interest is in health communication will have a broad and solid background for more focused studies. Students whose main interest lies in a related area of the field will have a substantial basis for a minor in health communication to augment work in their major area. Assignments, G r a d i n g , a n d R e l e v a n t Policy There are three forms of assignment-related grading in this course. The following is a bare-bones summary. (1) Three reaction papers (10% each for a total of 30% of quarter grade). See the syllabus Appendix A for assignment details.

(2) Quarter project (60% of quarter grade). The quarter project will be your choice of either a literature review, rationale for a research proposal, or rationale for an intervention or campaign proposal. See the syllabus Appendix B for assignment details. (3) General attendance and participation (10% of quarter grade). All students are expected to read and prepare carefully to discuss assigned readings. We all will enjoy and get more out of the class if we take this to heart! I will pay attention to w h o contributes not only quantity but quality of contributions, as well as missed classes and inadequate preparation. In addition, I will strictly enforce OU policies on academic integrity (study the relevant policy at http://www.ohio.edu/judiciaries/conduct_policy.cfm ). Be sure you understand and adhere closely to these regulations. If you have any questions, seek answers from me. Texts All readings are available in the content folder for the course on Blackboard. Course Outline and Calendar In the event of a major campus exigency, course requirements, deadlines and grading percentages will be subject to changes. To get information about changes in this course, please email me. Unit I: Theorizing About Health Communication What are some of the more important dimensions of communicating about health and illness? What are major alternatives for building theories of health communication? March 27 Babrow, A., S., & Mattson, M. (2011). Building health communication theories in the 21 s t Century. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 18-35). N e w York: Routledge. Unit II: Challenging Meanings/Communication Resources What does it mean to be ill? What are the challenges we face in making sense of illness? How do we use communication to make sense of illness? What are some of the basic communication resources for meaning making in the experience of illness? March 29 The meaning of illness and some challenges to making sense of the experience.

Cassell, E.J. (1991). The nature of suffering and the goals of medicine. N e w York: Oxford University Press. Ch. 3: The nature of suffering and Ch. 4: Suffering in chronic illness (pp. 30-65). Babrow, A. S., Kasch, C. R., & Ford, L. A. (1998). The many meanings of "uncertainty" in illness: Toward a systematic accounting. Health Communication, 10, 1-24.

April 3

Uncertainty reduction, management, coping, and information seeking

Brashers, D. E., Neidig, J. L., & Goldsmith, D. J. (2004). Social support and the management of uncertainty for people living with HIV. Health Communication, 16, 305-331. [ Q_,__ Babrow, A. S., Hines, S. C , & Kasch, C. R. (2000). Managing uncertainty in illness explanation: An application of problematic integration theory. In B. B. Whaley (Ed.), Explaining illness: Messages, strategies and contexts (pp. 41-67). Hillsdale, NJ: Erlbaum. Afifi, W.A., & Weiner, J.L. Toward a theory of motivated information management. Communication theory, 14, 167-190.

**April 5

Narrative sense-making. **NB: Qtr project topic statement due**

Charon, R. (2006). Narrative medicine: Honoring the stories of illness. N e w York: Oxford University Press. Ch. 2: Bridging healthcare's divides and Ch. 3: Narrative features of medicine (pp. 17-62). Harter, L.M., Patterson, S., & Gerbensky-Kerber, A. (2010). Narrating "new normals" in health care contexts. Management Communication Quarterly, 24, 465-473. Ellingson, L.L. (2009). Salvaging, surrendering, and saying goodbye to my leg. HealthCommunication, 24,112>-11A. Manoogian, M.M. (2011). My mother's bed. Health Communication, 26, 202-204. April 10 Metaphor and visual representation

Lakoff, G., & Johnson, M . (1980). Metaphors we live by. Chicago: University of Chicago Press, pp. 3-13. Lupton, D. (2003). Medicine as culture (2 nd ed.). London: Sage. Ch. 3: Representations of medicine, illness and disease in elite and popular culture (pp. 54-83). Boylstein, C , Rittman, M., & Hinoiosa, R. (2007). Metaphor shifts in stroke recovery. Health Communication, 21, 279-287'. Unit III: M a k i n g Sense of Health and Illness in Interactional and Cultural Context What is the nature of the relationships among the ill, their family and friends, and care providers? H o w do power dynamics structure and constrain these relationships? H o w have these relationships been changing through time, and what are the constraints on such changes? What can be done to enhance patient and provider communication skills? H o w is healthcare gendered, and what are some alternatives? H o w does culture shape experiences of illness and care? April 12 Patient-provider interaction and relationship Q C-,

Szasz, P. S., & Hollender, M. H. (1956). A contribution to the philosophy of medicine: The basic ] model of the doctor-patient relationship. Archives of Internal Medicine. 97. 585-592. Emmanuel, E.J., & Emmanuel, L.L. (1992). Four models of the physician-patient relationship. Journal of the American Medical Association, 267(16), 2221-2226. I Politi, M., & Street, R.L. (2011). Patient-centered communication during collaborative decision

1 making. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 399-413). N e w York: Routledge. Lupton, D. (2003). Medicine as culture (2 nd ed.). London: Sage. Ch. 5: Power relations and the medical encounter (pp. 113-141). April 17 Patient and provider communication skills training

Atkinson, P. (1984). Training for certainty. Social Science & Medicine, 19, 949-956. Brown, R.F., & Bylund, C.L. (2008). Communication skills training: Describing a n e w conceptual model. Academic Medicine, 83, 37-44. A sampler of Memorial Sloan-Kettering physician skills training modules: Discussing prognosis, breaking bad news, shared decision making about D N R orders, discussing the transition from curative to palliative care. Cegala, D.J. (2007). Patient participation, health information seeking, and communication skills training. In H.D. O'Hair, G.L. Kreps, & L. Sparks (Eds.), The handbook of communication and cancer care (pp. 375-386). Cresskill, NJ: Hampton. Cegala, D.J. (2006). Emerging trends and future directions in patient communication skills training. Health Communication, 20, 123-129. April 19 Culture in patient-provider interaction.

Dimou, N. (1995). Illness and culture: Learning differences. Patient Education and Counseling, 26, 153-157. Kagawa-Singer, M. & Kassim-Lakha, S. (2003) A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Academic Medicine, 78, 577-587. Street, R.L. (2002). Gender differences in health care provider-patient communication: Are they due to style, stereotypes, or accomodations. Patient Education and Counseling, 48, 201206. Suh, E.E. (2004). The model of cultural competence through an evolutionary concept analysis. Journal of Trans cultural Nursing, 15, 93-102. Clingerman, E. (2011). Social justice: A framework for culturally competent care. Journal of Transcultural Nursing, 22, 334-341. April 24 Health care teams

Real, K., & Poole, M.S. (2011). Health care teams: Communication and effectiveness. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 100-116). N e w York: Routledge. Gawande, A. (2010). The checklist manifesto: How to get things right. N e w York: Metropolitan Books. Introduction and Ch. 1: The problem of extreme complexity (pp. 1-31). April 26 Social support **NB: Revised project statement and bibliography due. * *

Goldsmith, D.J. (2004). Communicating social support. Cambridge, UK: Cambridge University Press. Introduction and Ch. 1: Puzzles in the study of enacted social support and Ch. 2: Conceptualizing enacted support as communication (pp. 1-51).

May 1

Gender and the culture of medicine

Scully, D., & Bart, P. (1973). A funny thing happened on the way to the orifice: W o m e n in gynecology textbooks. American Journal of Sociology, 78, 1045-1050. ~ Lupton, D. (2003). Medicine as culture (2 n ed.). London: Sage. Ch. 6: Feminisms and medicine (pp. 142-172). Matthias, M. S. (2009). Problematic integration in pregnancy and childbirth: Contrasting approaches to uncertainty and desire in obstetric and midwifery care. Health Communication, 24, 60-70. May 3 Culture in promoting health: "Beyond the western paradigm."

Airhihenbuwa, C O . (1995). Health and culture: Beyond the Western paradigm. Thousand Oaks, CA: Sage. Ch. 1: Culture, health promotion and development, Ch. 2: Communicating health within culture, Ch. 3: Developing culturally appropriate health programs, and Ch. 4: Health, healing, and medicine as cultural constructs (pp. 3-62). .

Unit IV: Psychological, Social Psychological, Social Constructionist, and Critical Views of Health Messages in the Media H o w do media messages shape perceptions of health risk? What are some of the major strategies for using mass communication to promote health? What are some alternatives to strategic campaigns for promoting community health? May 8 Communicating risk: Psychological and social constructionist perspectives

Turner, M.M., Skubisz, C , & Rimal, R.N. (2011). Theory and practice in risk communication: A review of the literature and visions of the future. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 146164). N e w York: Routledge. Strydom, P. (2002). Risk, environment and society. Buckingham, U K : Open University Press. Ch. 5: The societal production of risk: Society as laboratory and Ch. 6: Discursive construction of risk: The n e w public sphere. M a y 10 Campaigns: Health belief (reasoned action), the transtheoretical model, and social learning 0 n

Rosenstock, I.M. (1974). Historical origins of the health belief model. Health Education Monographs, 2, 328-335. Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of h o w people change. American Psychologist, 47, 1102-1114. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31, 143-164.

M a y 15

Campaigns: Emotion and sensation-seeking **NB: Outline of Quarter Project paper due**

Stephenson, M.T., & Southwell, B.G. (2006). Sensation seeking, the activation model, and mass media health campaigns. Journal of Communication, 56, S38-S56. Chadwick, A.E. (2012). Persuasive hope theory: A discrete emotion appraisal theory with implications for message design. Manuscript submitted for publication. M a y 17 Campaign alternatives: Communication Activism

Crabtree, R.D., & Ford, L.A. (2007).Community activist and communication consultant: Managing the dialectics of outsider-within status at a sexual assault recovery services center. In L.R. Frey & K.M. Carragee (Eds.), Communication activism: Volume 1: Communication for social change (pp. 249-285). Cresskill, NJ: Hampton Press. Campo, S., & Somjen Frazer, M.S. (2007). " I ' m glad you feel comfortable enough to tell me that': Participatory action research for better healthcare for w o m e n who partner with women. In L.R. Frey & K.M. Carragee (Eds.), Communication activism: Volume 1: Communication for social change (pp. 355-384). Cresskill, NJ: Hampton Press. M a y 22 Popular media

Kline, K.N. (2011). Popular media and health: Images and effects. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 n ed., pp. 252-267). N e w York: Routledge. Black, A.R., & Peacock, N. (2010). Pleasing the masses: Messages for daily life management in African American w o m e n ' s popular media sources. American Journal of Public Health, 707,144-150. Gill, E. A., & Babrow, A. S. (2007). To hope or to know: Coping with uncertainty and ambivalence in w o m e n ' s magazine breast cancer articles. Journal of Applied Communication Research, 35, 133-155. M a y 24 Health divide and health literacy

Cameron, K.A., Wolf, M.S., & Baker, D.W. (2011). Integrating health literacy in health communication. In T.L. Thompson, R. Parrott, & J.F. N u s s b a u m (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 306-319). N e w York: Routledge. Zarcadoolas, C , Pleasant, A.F., Greer, D.S. (2006). Advancing health literacy: A framework for understanding and action. N e w York: Jossey-Bass. Ch. Ch. 14: Guidelines for advancing health literacy (pp. 287-313). For more, go to http://healthvpeople.gov/2020/default.aspx and search "Literacy" on the site. Unit V: Transcending the material? What is the relevance of spiritual or religious meaning to health, illness, care, and healing? H o w can we understand health communication related to spiritual and religious meanings? M a y 29 Religion/spiritualities and health communication

Brown, K B . , & Bakos, A.D. (2007). Spiritual care. In H.D. O'Hair, G.L. Kreps, & L. Sparks (Eds.), The handbook of communication and cancer care (pp. 211-224). Cresskill, NJ: Hampton. Willis, M.A. (Ed.). (2009). Communicating spirituality in health care. Cresskill, NJ: H a m p t o n Press. We will read the following chapters: Willis, M.A. Introduction: Reclaiming the "spiritual" in health care (pp. 1-13). Jacobi. L.J. Ch. 3: Through the eyes of the nurse: Spirituality and well-being in health care (pp. 47-66). Ellingson, L.L. Ch. 4: Spirituality within the comprehensive geriatric assessment process (pp. 67-86). FYI UCSF lecture on spirituality and health: http://www.voutube.com/watch?v=A0ucsxP0vUk , and programs of study at http://www.csh.umn.edu/ , http://www.spiritualityandhealth.ufl.edu/, http://www.spiritualityandhealth.duke.edu/ Unit VI: Ethics What ethical theories have been applied to health communication? What are some of the most important ethical dilemmas and challenges in health communication? M a y 31 Guttman, N . (2011). Ethics in communication for health promotion in clinical settings and campaigns: N e w challenges and enduring dilemmas. In T.L. Thompson, R. Parrott, & J.F. Nussbaum (Eds.), The Routledge Handbook of health communication (2 nd ed., pp. 632-646). N e w York: Routledge. **Quarter project due by noon.**

**June 6

Appendix A: COMS 751 REACTION/POSITION PAPER ASSIGNMENT General Parameters and Substance You will be asked to sign up to write three separate reaction papers for three different days over the course of the quarter.JEach paper will convey your reaction to a single piece or to more than one reading assigned for that day. I will use the example of a reaction paper focused on a single specific assigned reading in the following, but please keep in mind that you can write about more than one reading for a given day. To prepare to write each paper, think about issues in the reading that have provoked your interest, puzzled, or bothered you. Among these issues, some will be central to the perspective or argument in the reading, and some will be tangential. Direct your thinking to the former, the central or critical issues that summoned you, and choose the one that most interests you. Do not merely "bump and run," or react to a single and noncentral idea that sends you away from the central issues in the paper. I want to know that you understand and can react meaningfully to the thrust of readings. To write the paper, think about the central issue from various standpoints: your personal understanding of it, theoretical analyses offered in the reading, methodological issues that are relevant to studying this issue, practical "" implications oi the issue.(Jpu may then crftique the author's argument and offer your own constructive refinement, extension, or reformulation /Alternatively, you may propose a study that would clarify question opened by the reading. /Another possibility is to explore practical and/or policy implications of your analysis. No matter what kind of reaction you choose to write, the bulk of your paper must clearly go beyond summary of the assigned piecefs"). When expressing your own position, you must back up your claims (e.g., with arguments, compelling examples, references to authoritative supporting literature). When you critique an article, anticipate your opponent's counterarguments and try to refute them. Alternatively, if you apply a theoretical principle to a concrete health communication situation, explain carefully how the principle helps us understand the situation. Your reaction papers must be concise. Tell your reader what you are planning to do in the first paragraph. In the remainder of the paper, implement this plan. Format Papers must be no more than 3 pages long, name on top of the first page (i.e., no wasted title page), pages numbered consecutively, using nothing smaller than 12-point typeface, and otherwise formatted according to any one of the three writing/formatting styles summarized in Hacker (2009). All papers are due by 9:00 a.m. on the morning of the day on which we are to discuss the relevant reading. In-Class Participation There will be no standing expectation that you will have to present your position paper in class, but we will want to hear your thoughts about the readings. Therefore, please be prepared to briefly summarize your thesis and argument or to present a question that might prompt class discussion related to your thesis. Offer this brief presentation or question whenever you think it would be relevant. Grading Each of these three papers will account for 10% of your overall grade. The papers will be evaluated for their depth of thought or insight, reasoning, and writing grammar and style.

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Appendix B: COMS 751 Quarter Project y You have several options for the quarter project. The following presents some major possibilities complete with detailed discussions of the components of these approaches. I have tried to be flexible; my goals are to help you figure out what would be most beneficial to you and do what I can to facilitate your work. If the following options are not as well suited to your interests as some other possibility, please discuss your interest with me. I am confident that w e will be able to work out a meaningful and satisfying project. Options Literature review. A literature review should be focused on a topic of significant interest to health communication scholars. In the ideal, a literature review should set out to answer some specific and manageable question or set of questions about a literature. Perhaps the m o s t important consideration is whether the questions guiding the literature review are sufficiently focused to promise meaningful answers. Well focused research questions guide us to insights or answers that are clear, specific, and practical for theory development, further research design, or application to concrete problems. A literature review should contain, at minimum, (a) a statement of the general topic/problem and justification of its significance; (b) specific questions that the review is intended to address; (c) a sketch of the specific literature search boundaries, terrain, and procedures (i.e., where and how you looked for pertinent writings); (d) a critical review and synthesis of the literature(this should be the bulk of the paper); (e) a reflective and self-critical discussion of answers to the research questions (pt. b, above) that guided the review; and (f) a brief consideration of directions for future inquiry. Rationale for a research proposal. A complete research proposal is essentially the first sections of what will ultimately be a research report. It will typically include a rationale (explanation and justification) for exactly what the researcher plans to do and a fully articulated research plan (i.e., methodological design), including proposed data analysis. By contrast, for this assignment, you might provide only the rationale for a research proposal (i.e., you would not include plans for data collection and analysis). This entails all of the steps noted above for the literature review, except that the typical rationale will have less to say about the boundaries of the literature search (see pt. c. above), and in place of the brief consideration of directions for future research (see pt. f. above), a study rationale will culminate in explicit research questions and/or inferences/hypotheses. Rationale for an intervention or campaign proposal. A fully developed rationale for a communication intervention or a fully developed campaign proposal will entail (a) a combination of practical and theoretical justification and (b) a practical plan. For the purposes of this assignment, you may construct the theoretical and practical justification for a health communication intervention or campaign and only the broadest outlines of a practical plan. That is, you may develop out of the health communication and related literatures the reasons and strategic aims for an intervention or campaign; you would not have to develop a detailed plan, but I would expect some discussion of the major elements that you believe would be m o s t relevant to implementation of your ideas. The intervention or campaign may be intended to promote action directly related to personal health (e.g., exercise, responsible sex, dietary modification), or it may promote political action designed to change policy related to health. The campaign or intervention proposal should include a: (a) statement of the practical problem and justification of its significance; (b) review of the pertinent theoretical and practitioner literature culminating in specific intervention/campaign goals and strategies (i.e.,

X % goals and strategies that are tied very carefully to your reading of the relevant scholarly and practitioner literatures); and (c) brief discussion of practical considerations (constraints and potential resources) that you think most relevant to implementation (these considerations will be most convincing if they are tied carefully to past writings by researchers and practitioners). General Logistics

Topics. Begin to think about potential projects immediately. To foster such thinking, take a look at topics and readings to come later in the semester and/or scan the contents of journals such as Health Communication, Journal of Health Communication, Journal of Applied Communication, Social Science & Medicine, Health Psychology, Qualitative Health Research, American Journal of Public Health, Health Education Quarterly, Patient Education & Counseling, etc. ' Timeline. To help you make progress and provide feedback along the way, I will ask you to meet the following interim timeline for preliminary work: April 5: Bring to class a clear and concise (a) statement of your topic, (b) a paragraph justifying your interest in the topic, and (c) specification of the which of the several options you will elect (i.e., the form the project will take, whether literature review, etc.). April 26: Bring to class a paper including all items that were submitted on April 8, revised as necessary based on my feedback, as well as (d) a list of sources you aim to consult for your project and (e) any other development of the project you have been able to accomplish by this date (for my feedback). May 15: Bring to class a carefully formulated outline that lays out the major sections of your paper as you currently envision them. To whatever extent you are able to sketch the subsectionsin outline form, pleaseinclude these details as well. The outline should use full sentences (so I can understand your intent) but clearly display the structure of the arguments you plan to build through the outline format. June 6: Quarter projects are due by noon. Please submit a paper copy of your work to my mailbox. I will not print papers unless doing so will help you avoid some unreasonable demand. Format. Papers must be formatted according to any one of the three styles summarized in Hacker, D. (2009), A pocket style manual ( 5 n ed.), although you are strongly encouraged to use APA publication style. Grading I will evaluate your work based on the depth of thought exhibited, reasoning, expertise (thorough use of appropriate literature), and professionalism (grammar, style, formatting, careful editing).