The field of health communication is vast, always growing, and increasingly important. A combination of breakthroughs in science and technology set against the backdrop of rapid population growth and increased literacy rates corresponded to the rapid development – and acceptance – of health communication as a discipline in Communication Studies.
Perhaps more so than other areas of study within Communication, the tangible, real-world consequences of health communication are readily available and immediately felt. In the Encyclopedia of Health Communication, Teresa L. Thompson (2014) highlighted the importance of health communication to human society, writing that “research that affects how long people live, their level of health during their lifespan, how they cope with health problems, and how communication affects their health brings with it a level of human relevance that is not available in all areas of study.”
Outside the realm of academia, health communication’s presence, prestige, and importance continues to grow as well. Governments, health-care providers, and industry operatives increasingly rely upon research conducted by health communication experts to improve lives, disseminate new information and technology, and solidify healthcare’s standing in economies around the world.
Defining Health Communication
Given the interdisciplinary nature and the emphasis on the practical and pragmatic in health communication, a universally accepted definition remains elusive. While most definitions of health communication will highlight the communicative process that occurs in “advocating for and improving individual or public health outcomes,” the difference often appears in the overarching goals of the practitioner.
In other words, who is the targeted audience and what is the desired outcome? If the desired outcome is to “inform and influence” individuals and the community, then a good definition might come from the American Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), which define health communication as the “study and use of communication strategies to inform and influence individual decisions that enhance health.”
If the desired outcome is a change in behavior, Schiavo (2013) cited Clift and Freimuth (1995) in their comparison between health communication and health education as “an approach which attempts to change a set of behaviors in a large-scale target audience regarding a specific problem in a predefined period of time.”
For students new to health communication research and for those exploring various master’s in health communication programs, a thorough and encompassing definition that is widely accepted is: “the use of strategies to communicate information about health and to influence individuals and communities in health decision making” (Thompson, 2014).
History of Health Communication
Arguably, humankind has communicated about health since the very beginning. The timeline of human development can certainly be placed upon a corresponding timeline of health-related discoveries and advances in medicine. To that end, Judy Segal (2008) remarked that “the most salient narrative of medical history is the narrative of progress.” In practice, however, health communication is significantly more complicated than the simple narrative that is often told.
As an academic discipline, health communication’s history is more recent and significantly less complex than humankind’s relationship with health. The inception of health communication as a discipline began on two separate, yet interwoven tracks: research in public health “education” and physician-patient interactions.
Beginning in earnest in the 1940’s and 1950’s, scholars in the field that would eventually manifest into health communication studied early iterations of modern health campaigns. Utilizing a “sociological perspective,” which emphasized the “diffusion of health information” to the masses, scholars largely focused on the educational aspect to these campaigns (Thompson, 2014).
In the 1960’s, the seminal work in physician-patient communication launched, ultimately leading both scholars and health professionals to recognize the power of communication in health settings. Even a half century later, the physician-patient communicative context remains relevant and is still widely studied as different scholars continue to interrogate the various nuances of these interactions.
Health Communication Theories
Health communication researchers employ theories and concepts from other disciplines to great effect. Typically drawing from theories of persuasion, interpersonal, nonverbal, and organizational communication, scholars of health communication have added serious depth and context to theories and concepts like Inoculation Theory, fear appeals, and the Theory of Planned Behavior.
In addition to expanding already grounded theories and concepts in Communication writ large, health communication researchers have developed theories and concepts pertinent to the discipline specifically or have repurposed borrowed theories, so they are now almost exclusively thought of in the context of health communication. These theories include: The Health Belief Model, Theory of Planned Behavior, and Social Cognitive Theory.
The Health Belief Model: This model helps to predict the overall likelihood that an individual will adopt a health-related behavior by utilizing that person’s belief or perception of an illness coupled with their thoughts on the effectiveness of treatment for that illness. In other words, the Health Belief Model suggests that if an individual perceives themselves to be susceptible to, say, an upper-respiratory infection, and they hold a belief that upper-respiratory infections are both serious and preventable, that individual is more likely to adopt the recommended behavior to either prevent or treat the illness.
Of course, the Health Belief Model has been extended to many diseases, and has helped researchers and public officials craft messages to improve the health and wellness of communities around the world.
Theory of Planned Behavior: Over the last several decades, the Theory of Planned Behavior became an almost omnipresent concept in health communication. The theory places an individual’s intention to enact a behavior as the paramount factor in predicting whether that individual will or will not carry out the behavior. In addition to intention, the theory predicts that people will “act on their intentions when they have the necessary skills for performing the behavior” (Thompson, 2014).
Put differently, if an individual has the intention and the skill to do something, they will do it. This theory has helped researchers inform public health experts and doctors to craft messages, both community-wide and interpersonally, that are skills-based and with the assumption that an individual has the intention to engage in the desired health-behavior.
Social Cognitive Theory: This theory suggests that learning is not an exclusively internalized process but rather a function of socialization. In other words, Social Cognitive Theory proposes that human beings learn a behavior through observing others perform that behavior. Additionally, after observing someone else perform a behavior, an individual is more likely to recall past experiences or memories of that behavior and use these recollections to steer future interactions.
Social Cognitive Theory reifies the notion that human beings are influenced by their environment, thereby making social interactions, past experiences, and the media significant factors in an individual’s behavioral development.
Areas of Study and Other Concepts in Health Communication
From the two original and aforementioned tracks, health communication emerged as a well-respected discipline and significantly expanded its research both in focus and in depth. With many Communication scholars now working with professionals and scholars in public health and other areas, as well as working with governmental agencies and nongovernmental organizations, this expansion of health communication’s research resume cannot be overstated.
Similarly, given its vastness, highlighting areas of study and concepts in health communication is a difficult task. The following topics and concepts primarily stem from the original two tracks of the discipline and their inclusion should not be read as a promotion of the traditional over the burgeoning. Indeed, the following concepts and theories should be read as just a sample of the richness health communication has to offer in the realm of research.
Health Campaign Related Theories and Concepts
Popular connotations of heath campaigns tend to call forth recollections of D.A.R.E. (Drug Abuse Resistance Education) programs from elementary schools or the cheesy anti-drug commercials from the 1990’s and early 2000’s. While these health campaigns devolved into something of a trope, health communication scholars learned a great deal about message effectiveness and reach, resulting in renewed focus in practicality and audience-centered messaging.
Disease Prevention: In the domain of health campaigns aimed towards disease prevention, scholars employ several communication theories to bring to the fore more effective techniques and practices in behavioral interventions. These interventions are “guided by one or more” theories that include: “diffusion of innovations model, fear appeals/extended parallel process model (EPPM), health belief model, social cognitive theory, theory of reasoned action, and theory of planned behavior” (Thompson, 2014).
Many health campaigns in the 20th and 21st Centuries, both in the United States and around the world, employed tactics associated with these theories to varying degrees of effectiveness. For example, health campaigns geared towards reducing drunk driving fatalities primarily began with fear appeals. While many high schools and driving schools with young adult learners still rely upon fear appeals in attempting to prevent drunk driving, health communication research influenced campaigners to adopt more nuanced preventative techniques.
Public Service Announcements: Using a vast array of messaging mediums ranging from television and radio, to billboards and “viral” videos on the Internet, public service announcements (PSAs) are typically aimed at correcting an issue of public import. The frequency of health-related PSA’s increased significantly over the last few years, providing health communication scholars with another area of research.
As many other facets of health campaigns often do, PSAs rely upon theories of persuasion like fear and guilt appeals, normative appeals, and other “presentation tactics” that “enhance PSA effectiveness” (Thompson, 2014). Many anti-smoking and anti-texting while driving PSAs within the last decade have utilized a combination of the aforementioned persuasion-based theories. Health communication researchers are therefore tasked with finding out which communication theories help make PSAs better, while also working to solve why some PSAs fail, all through a communicative lens.
Message Design and Strategy: While PSAs are just one communicative vehicle to disease prevention and are a strategy in health campaigns, they are often the most visible or best remembered of health campaign communication methods. Because of this, questions regarding message design and strategy come to the fore. Health communication researchers examining health campaigns or working with a health campaign consider a litany of theories or concepts in crafting the best health message design.
Inoculation Theory, for example, aids message designers and health campaign strategists in making sure their message resonates as thoroughly as possible. Like immunization, Inoculation Theory in action “consists of giving subjects small doses of opposing perspectives, which allows these subjects to have greater immunity when facing these differing perspectives” (Thompson, 2014). In health campaigns, Inoculation Theory is thoroughly employed and often utilized in drunk driving prevention, sexual harassment prevention, and STD prevention campaigns.
Provider-Patient Theories and Concepts
Susan Sontag wrote in 1978 that “illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” In the 21st Century, humankind’s relationship with illness often involves seeing a physician and, at least in the United States, navigating a complex and needlessly bureaucratic healthcare industry – and the communication that occurs in these contexts can be life changing.
While health campaign related theories and concepts are typically derived from theories of persuasion, provider-patient theories typically borrow from interpersonal, nonverbal, and organizational communication. For Communication scholars, research rarely happens in isolation and usually builds upon work already in motion.
Provider-Patient: Among the “most researched areas” in health communication is physician-patient, or doctor-patient, communication. Similarly, nurse-patient communication is increasingly studied as the frequency of interaction between nurses and patients typically outnumbers that of doctor-patient interaction. In both instances, doctors and nurses talk to patients using verbal and nonverbal communication (i.e. interpersonal communication) in the context of a medical setting, like an office or hospital. Colloquially, people often refer to doctor-patient and nurse-patient communication as “bedside manner” or “people skills.”
As interpersonal communication is the backbone of doctor-patient and nurse-patient communication, research on these forms of communication is instrumental in improving health outcomes, and can be the foundation of initiatives that improve patient education and the effectiveness of health care teams. For example, research conducted by Elaine Wittenberg, Ph.D. of the California State University, Los Angeles identified health literacy indicators that health care providers can use to assess how well a patient and his or her family understand a medical issue or treatment (Wittenberg, 2019).
There is no singular theory for doctor-patient and nurse-patient communication. Rather, scholars use “several theories and models” that draw from interpersonal and nonverbal communication to help highlight the nuance at work within these interactions. “As long as there is some sort of identifiable health-related outcome that can result from the application of a certain communication theory, it can be considered within the realm of health communication,” noted Dr. Wittenberg. Researchers typically examine physician-patient communication through surveys, where quantifiable data can be obtained, or through observational studies and intervention-based experiments, where a mixture of numerical and qualitative data can be obtained through coding (Schiavo, 2013; Thompson, 2014).
Family Communication in Health Contexts: Communicating with family is an already difficult feat when health is not a factor. The dynamics of the context shift when the health of a family member changes, especially if it is for the worst. In the direst of health-related circumstances, when terminal illness makes death inevitable, family health communication becomes sacrosanct.
Family communication scholar Maureen P. Keeley coined the term “final conversations” in researching the communication that occurs between the living and the dying. Through this communicative lens, and over the course of her sustained research, Keeley (2004) and Keeley and Yingling (2007) applied theoretical frameworks ranging from religious and spiritual communication to interpersonal and nonverbal communication to this unique form of health communication.
Another example is how family communication plays a central role in preventative health care. This is apparent in the significant research and clinical work that has focused on the role of family communication in substance use and abuse prevention. Research conducted by Margaret Skeer, Ph.D. of Tufts University’s School of Medicine investigates the connection between having family meals and cultivating an open dialogue between parents and their children regarding drugs. These findings have helped to inform public health campaigns that center on improving family communication and reducing youth substance abuse (Skeer, 2019).
Health Insurance Communication Contexts: Healthcare in America is a business. The Centers for Medicare and Medicaid Services reports that the American healthcare system comprises over a sixth of our total economy, reaching to about $3.5 trillion in dollars spent. Navigating the murky, for-profit American healthcare system is complex, and often tragic. On an anecdotal level, it seems that many Americans have a story of a time that they or a loved one were denied a procedure, a medication, or a mobility device because their insurance company said no.
Additionally, many doctors continue to report facing “loyalty between the needs of patients and managed care plans” offered by health insurance conglomerates, as well as the emotional toll of seeing a procedure, medication, or device being denied to a patient they know needs it. The amalgamation of organizational bureaucracy, the stress of disease, and the nuance of interpersonal communication make this context particularly difficult to theorize and predict.
Health communication scholars are increasingly turning to theories in organizational communication to help explain the various communicative phenomena that occur in the American healthcare industry, and with findings that have profound implications on public health. Research institutions such as the Center for Communication and Health at Northwestern University focus on researching how health communication can help mitigate burgeoning health care cost concerns. “[Healthcare] consumes more and more of everything we earn, both individually and as a country. And it is unsustainable,” noted Bruce Lambert, Ph.D., Director of the Center, “There are so many inefficiencies, and we think that by applying design thinking and using new communication tools and social media influence and interaction design, we can improve the efficiency of many processes in healthcare. That is why I believe health communication is such an important field to study. It is, I believe, the most or one of the most important applied domains for the communication arts and sciences” (Lambert, 2019).
Researching Health Communication
With its magnitude and seemingly endless avenues of research, how does one actually conduct research in health communication? By and large, health communication is conducive to both empirical and qualitative research. Many researchers, both within and outside academia, contend that the discipline is trending towards empirically oriented methodologies as journals, health organizations, companies, and governments continue to see the benefits of replicable and verifiable data. The latest issues of Health Communication, The Journal of Health Communication, and several NCA sponsored journals certainly affirm this trend.
Without diminishing the import of social scientific approaches and results, it is important to remind readers that health communication, by nature, is persuasive, and therefore is open to rhetorical and other humanistic or qualitative approaches. Segal (2008) reiterated this, arguing that “medicine is not only rhetorical as it is reproduced in published texts; it is also rhetorical as a system of norms and values operating discursively in doctor-patient interviews, in conversations in hospital corridors, in public debate on health policy, and in the apparatus of disease classification.”
Moreover, visual communication and argumentation scholars continue to contribute to health communication through their inherently qualitative research. For example, while primarily writing to audiences of Argumentation and Advocacy, Birdsell and Groarke (1996) analyzed an anti-smoking poster created and distributed by the U.S Department of Health, Education, and Welfare in 1976 (since renamed and reorganized into the Department of Health and Human Services) that utilized both visual and verbal argumentative strategies. Blending research approaches, just as Birdsell and Groarke (1996) did, continues to yield significant knowledge in the communication of health, particularly in the 21st Century.
Sources and Additional Resources
To learn more about the field of health communication and health communication research, check out the following resources:
- Birdsell, D. S., & Groarke, L. (1996). Toward a theory of visual argument. Argumentation and Advocacy; River Falls, 33(1), 1.
- Centers for Disease Control and Prevention. (2019, March 8). Gateway to Health Communication | CDC. Retrieved from https://www.cdc.gov/healthcommunication/
- Keeley, M. P. (2004). Final Conversations: Survivors’ Memorable Messages Concerning Religious Faith and Spirituality. Health Communication, 16(1), 87–104. https://www.tandfonline.com/doi/abs/10.1207/S15327027HC1601_6
- Keeley, M. P., & Yingling, J. (2007). Final Conversations: Helping the Living and the Dying Talk to Each Other. VanderWyk & Burnham.
- Lambert, B. (2019) Interview with Bruce Lambert, Ph.D. – Director of the Master of Science in Health Communication Program in the School of Communication at Northwestern University. MastersinCommunications.com https://www.mastersincommunications.com/school-interviews/dr-bruce-lambert-northwestern-university.
- Medicare, C. for, & Baltimore, M. S. 7500 S. B. (2018, December 11). National Health Accounts Historical. Retrieved from https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical
- Schiavo, R. (2013). Health Communication: From Theory to Practice. John Wiley & Sons.
- Segal, J. (2008). Health and the Rhetoric of Medicine. Carbondale: Southern Illinois University Press.
- Skeer, M. (2019) Interview with Margaret Skeer, Sc.D., MPH, MSW from Tufts University School of Medicine. MastersinCommunications.com Interview with Margie Skeer, ScD, MPH, MSW – Tufts University.
- Sontag, S. (1978). Illness as Metaphor and AIDS and Its Metaphors. Macmillan.
- Thompson, T. L. (2014). Encyclopedia of Health Communication. SAGE Publications.
- Wittenberg, E. (2019) Scholarly Interview with Elaine Wittenberg, Ph.D. from California State University, Los Angeles on Health Communication. MastersinCommunications.com https://www.mastersincommunications.com/scholarly-interviews/dr-elaine-wittenberg-health-communication/.