Health Communication in the

21 Century
st

Kevin B. Wright
Lisa Sparks
H. Dan O’Hair
Overview of Communication
and Health

Chapter One
 Overview of Communication and
Health
 Arguments for the need to study health
communication.
 U.S. spends over $1 trillion per year on
healthcare.
 Over half of all U.S. deaths can be attributed
to preventable behavioral and social factors
(e.g. diet, exercise, etc.)
 Lack of health maintenance behaviors in U.S.
linked to mortality rates.
 Overview of Communication and
Health
 Arguments for the need to study health
communication.
 The majority of health campaigns in the U.S.
have only had limited success in terms of
influencing health behaviors.
 The rise of global health issues, terrorism, and
other concerns.
 The increased use of new technologies in
health care.
 Overview of Communication and
Health
 Defining health communication.
 World Health Organization defines health is a state of
completed physical, mental, and social well-being.
 Communication is more difficult to define, but it
possess characteristics such as a sender, receiver,
message, channel. Health communication can be
assessed at many levels (interpersonal,
organizational, mass, etc.).
A Brief History of Health
Communication Research
 History of Health Communication
Research
 Early research in the communication
discipline began in the 1960’s
 Korsch & Negrete’s (1972) “Doctor-Patient
Communication” is often cited as the
founding article.
 ICA formed the health communication
division in 1975.
 History of Health Communication
Research
 The journal Health Communication was first
published in 1989.
 The Journal of Health Communication was first
published in 1996.
 Since the 1990’s health communication
continues to grow and diversify.
 There are now many regional, national, and
international health communication associations
and conferences.
Current Challenges to the U.S.
Healthcare System

Role of Health Communication

Research
 Current Challenges/Role of Health
Communication Research
 Aging population
 Cultural diversity and healthcare
 Tension between traditional and new
approaches
 Biomedical model
 Biopsychosocial model
 Current Challenges/Role of Health
Communication Research
 Funding for health research
 Changes to health insurance and managed
care
 The impact of new technologies on
healthcare
Provider-Patient Interaction

Chapter Two
 Provider and Patient Views of
Health and Healthcare
 Provider perspective
 Provider training
 Provider communication skills training
 Challenges providers face in healthcare
delivery
 Rising costs of healthcare and competition
 Impact of managed care on provider-patient
communication
 Provider and Patient Views of
Health and Healthcare
 Provider perceptions of patients and
communication
 General perceptions
 Assessing patient cues
 Patient Perspective
 Patient socialization
 Everyday experiences
 Mass media
 Patient perceptions and expectations
 Patient uncertainty
 Problematic integration theory (Babrow, 2001)
 Patient needs and goals
 Provider-Patient Interaction
 Communication accommodation theory
(Giles, Mulac, Bradac, & Johnson, 1987)
 Divergence
 Convergence
 Overaccommodation
 Underaccommodation
 Provider-Patient Interaction
 Characteristics of problematic provider-
patient communication
 Provider workload/time constraints
 Questions, directives, blocking
 Relational control/provider dominance
 Improving Provider-Patient
Communication
 Addressing patient concerns
 Recognizing provider perspectives and
needs
 Outcomes of Provider-Patient
Communication
 Satisfaction with healthcare
 Adherence to treatment
 Physical and psychological health
outcomes
 Communication and Medical
Malpractice Lawsuits
 Rise and cost of medical malpractice
litigation
 Provider-patient communication and
medical malpractice litigation
Caregiving and
Communication

Chapter Three
 Caregiving
 Caregiver roles
 Caregiving and changes in relationships
 Communication issues surrounding
symptom management
 Communication challenges associated with
caregiving
 Willingness to communicate concerns
 Communication of emotional support
 Hospice and Palliative Care
 History of hospice and palliative care
 Dame Cicely Saunders—founder of hospice movement
 Hospice services and care
 Barriers to hospice care
 Palliative care
 Palliation refers to any treatment, care, or support
that relieves symptoms and suffering
 Barriers to palliative care
Attitudes Towards Death and Dying

 Communicating with others about death

and dying
 Advanced care directives
 Coping with the death of a loved one
 Reactions to grief
 Organ donation
Social Support and Health

Chapter Four
 Types and Functions of Social
Support
 Types of support
 Instrumental support
 Emotional support
 Esteem or appraisal support
 Informational support
 Proactive and reactive support
 Positive and negative functions of support
 Models of Social Support and
Health
 Stress and health
 Physiological processes
 Stress and negative health outcomes
 Stress and social support
 Buffering model (Cohen & Wills, 1985)
 Direct effects model (Aneshensel & Stone,
1982)
 Models of Social Support and
Health
 Coping strategies and health outcomes
 Problem-focused coping
 Emotional-focused coping
 Avoidance-focused coping
 Perceptions of Support Providers

 Social comparison theory (Festinger,

1954) and social support
 Lateral comparisons
 Upward comparisons
 Downward comparisons
 Reciprocity and social support
 Underbenefitted
 Overbenefitted
 Strong Tie Versus Weak Tie
Support Networks
 Theory of weak ties (Granovetter, 1973)
 Communicating about illness in weak tie
vs. strong tie networks
 The Role of Communication in the
Social Support Process
 Cognitive complexity and support provision
(Burleson, 1994)
 Cognitive complexity and comforting messages
 Interactive nature of support provision (Barbee,
1990)
 Solve person’s problem
 Support person emotionally
 Dismiss person’s problem
 Escape from dealing with issue
 Support Groups for People with
Health Concerns
 Prevalence of support groups
 Reasons why people join support groups
 Difficulties communicating about illness within
traditional social networks
 Other factors influencing support group
participation
 Communication Processes within
Support Groups
 Use of narrative
 Being helped by helping
Culture and Diversity Issues in
Healthcare

Chapter Five
 Patient Diversity
 Increase in a variety of co-cultures in the
U.S. due to immigration
 Cultural and language barriers to
healthcare.
 Impact on healthcare system
Cultural Differences in Concepts of
Health and Medicine
 Cultural differences in attributions of
illness/health
 Acculturation
 Informed consent
 Cultural differences of people born in the
United States.
 Recognizing Cultural Diversity in
Health Beliefs
 Effectively communicating with patients
from diverse cultural backgrounds
 Barriers to providing culturally sensitive
health care
 Alternative Medicine
 History of alternative medicine in the U.S.
 Types of alternative medicine
 Perceptions of alternative medicine
 Benefits/limitations of alternative medicine
Spirituality, Culture, and Health
 Associations among spirituality, culture,
and health
 Religion and psychological/physical health
outcomes
 Religion and social support
 Social Implications of Illness
 Stigma and disease
 HIV/AIDS
 Cancer
 Alcoholism
 Mental illness
 Changing Social Perceptions of
Health Issues through Comm.
 Language usage
 Use of narrative
 Advocacy
 Provider Diversity
 Specialization and unique provider cultures
 Socialization processes and provider
diversity
Communication and Health
Organizations

Chapter Six
 Health Organizations as Systems

 Characteristics of systems
 Interdependence
 Homeostasis
 Equifinality
 Types of Healthcare Organizations
 Organizations concerned with financing and regulating
health services and products
 Centers for Medicare and Medicaid
 Insurance and managed care
 Organizations concerned with healthcare delivery
 Hospitals
 Nursing homes
 Pharmaceutical companies
 Professional organizations that influence other
healthcare organizations
 Accreditation organizations
 Communication within Healthcare
Organizations
 Organizational information theory (Weick,
1979) and healthcare organization
 Cycles
 Double interact loops
 Formal/informal communication networks
 Upward/downward communication
 Healthcare Organizational Culture

 Cultural belief systems of healthcare

organizations
 Promoting new healthcare organizational
environments
 Influences on Healthcare
Organizational Communication
 Pharmaceutical and biotechnology
companies
 Direct-to-consumer marketing
 Preceptorships
 HIPPA
 Patient Privacy
 HIPPA’s effect on medical research
 HIPPA’s effect on providers and patients
 Influences on Healthcare
Organizational Communication
 Medicare and Medicaid
 Insurance and managed care
 Traditional health insurance
 Health maintenance organizations (HMO’s)
 Preferred provider organizations (PPO’s)
 Effects of managed care on provider-patient
relationships
 Provider Stress, Conflict, and
Support within Healthcare
Organizations

 Stress and conflict

 Effects of job stress
 Social support and stress in the workplace
New Technologies and Health
Communication

Chapter Seven
Health Information on the Internet

 Health information access

 Credibility issues
 Literacy issues/underserved populations
 New Technologies and Patient-
Patient Communication
 Health-related web communities and
computer-mediated support groups
 Advantages and disadvantages of
computer-mediated support groups
 Advantages/Disadvantages
 Social information processing theory (Walther,
1996)
 New Technologies and Provider-
Patient Communication
 Email and wireless communication
 Satellite technology
 Wireless comm. devices
 Electronic records
 Disadvantages of new communication
technologies
 Telemedicine and Providers
 Advantages of telemedicine for providers
 New Technologies and Provider-
Patient Communication
 Potential for increased provider-patient
interaction
 Telemedicine and patients
 Managed care organization efforts to
reach patients via the Internet
 New Technologies and Health
Campaigns
 Tailoring health messages
 Advantages of message tailoring
 Process of message tailoring
Mass Communication and
Health

Chapter Eight
 Two Perspectives of Media
Influence
 Cultivation Theory (Gerbner, Gross, Morgan, &
Signorelli, 1982)
 Uses and gratifications theory (Katz, Blumler, &
Gurevitz, 1974)
 Needs fulfilled by the mass media concerning
health
 Information seeking
 Entertainment, diversion, and tension release
 Media use to fulfill social needs
 Convenience
 Media Usage, Health Portrayals,
and Health Behaviors
 Unrealistic portrayals of health situations
 Unhealthy role models and the promotion of
unhealthy behaviors in advertising
 The influence of media on eating habits
 Obesity
 Eating disorders
 Media content and cosmetic surgery
 Media content and acts of violence
 Media Usage, Health Portrayals,
and Health Behaviors
 The relationship between media and
substance abuse
 Alcohol
 Tobacco products
 Media and sexual behavior
 Direct-to-consumer advertising of
prescription medication
 Health News Stories in the Media

 Problems in the reporting of health news

stories
 Agenda-setting theory (Protess & McCombs,
1991)
 HIV/AIDS as an example
 Overreporting
 Underreporting
 Health News Stories in the Media

 Media bias and inaccuracies in reporting

health issues
 Framing
Risk and Crisis Communication

Chapter Nine
 Defining Risk Communication
 Risk communication versus crisis
communication
 Global and Large-Scale Health
Threats
 Environmental threats/world hunger
 Environmental injustice
 Natural disasters
 Hunger
 Pandemics
 HIV/AIDS
 SARS/Avian flue
 Terrorism
 At-Risk Communities with the
United States
 Risk factors
 Social status
 Social capital
 Human capital
 Communication strategies for dealing with
health risks
 Dealing with the threat of HIV/AIDS
 Dealing with the threat of terrorism
 Coping with the psychological effects of terrorism
 Other Health Risk Issues
 Community-based health initiatives for at-
risk or marginalized populations
 Risk communication strategies at the
provider-patient level
 Health Campaigns and
Community Health Initiatives

Chapter Ten
 Campaign Goals
 Health awareness and behavioral change
campaigns
 Public policy approaches
 Theoretical Approaches to Health
Campagins
 Social cognitive theory (Bandura, 1977)
 Cognitive processes influencing health behavior
 Environmental influences on health behavior
 Theory of reasoned action (Ajzen &
Fishbein, 1980)
 Health belief model (Becker, 1974)
 Extended parallel process model (Witte,
1992)
 Theoretical Approaches to Health
Campagins
 Stages of change models
 Transtheoretical model (Prochaska &
DiClemente, 1984)
 Multi-stage model of behavioral change
(Lippke & Ziegelmann, 2006)
The Process of Conducting a Health
Campaign
 Audience analysis
 Conducting audience analysis research
 Available data
 Surveys
 Interviews/focus groups
 Audience segmentation
The Process of Conducting a Health
Campaign
 Creating message content
 Gaining audience members’ attention and
motivating them to action
 Persuasive message appeals
 Other message considerations
The Process of Conducting a Health
Campaign
 Channel and message dissemination
processes
Formative Campaign Evaluation
 Pilot testing
 Launching the campaign, process
evaluation, and outcome evaluation
Interdisciplinary Health Teams

Chapter Eleven
 Interdisciplinary Health Teams
 Diversity of healthcare professional
 Importance of interdisciplinary teams
 Continuum of health care teams
 Unidisciplinary
 Interdisciplinary
 Transdisciplinary
 Model of Synergistic Healthcare
Teams
 Instilling a sense of ownership
 Building and maintaining trust
 Building commitment to team and mission
(vision)
 Sense of accomplishment
 Becoming performance based
 Prioritizing and setting goals
 Measuring results
 Decision-making procedures
 Model of Synergistic Healthcare
Teams
 Developing team synergy
 Role congruence
 Competent listening
 Participation and empowerment
 Conflict management
 Consensus building
Emerging Health Communication
Contexts and Challenges

Chapter Twelve
 Health Literacy
 Importance of understanding health
literacy issues
 Health literacy and health outcomes
 Health literacy and provider-patient
communication
 Breaking Bad News
 Defining bad news
 Demographic effects on bad news delivery
 Current provider education in breaking
bad news
 Health Communication and Older
Adults
 Getting older and experiencing health
problems
 Presbycusis
 Cognitive decline, Alzheimer’s disease, and
dimentia
 Physical activity/mobility
 Polypharmacy
 Provider-older patient interaction

 Stereotypes of older patients

 Companions and provider-patient
interaction
 Managed care influences on provider-older
patient interaction
 Institutionalized Older Adults
 Nursing homes
 Communication issues