About Angela F. Cooke-Jackson, PhD, MPH: Angela F. Cooke-Jackson is an Associate Professor of Health and Behavioral Science in the Communication Studies Department at California State University, Los Angeles (CSU-LA). Her research focuses on the connection between health, health-related messages, and behavioral science, and how memorable messages can be used to address health disparities amongst different demographics. In collaboration with Dr. Elaine Wittenberg, Dr. Cooke-Jackson helped to build the Health Communication concentration for CSU-LA’s Communication Studies Department.
Prior to her position at CSU-LA, Dr. Cooke-Jackson was an Associate Professor at Emerson College, where she taught classes in health and intercultural communication, and also taught as an Assistant Professor at Eastern Kentucky University. While at Emerson College, she founded and directed the Emerson Literacy Education and Empowerment Project, which empowered youth to teach their peers about healthy life choices.
She received her Ph.D. in Health Communication and Behavioral Science from the University of Kentucky, and her Master of Public Health in Health Behavior and Epidemiology from the same institution. She also holds a Master of Science in Student Personnel Counseling in Higher Education from the University of Dayton, and a Bachelor of Science in Organizational Communication from Cedarville University.
[MastersinCommunications.com] May we have an overview of your professional and academic background? How did you first become interested in health communication?
[Dr. Cooke-Jackson] I am currently an Associate Professor at Cal State University, Los Angeles. Prior to that, I was an Associate Professor at Emerson College in Boston, Massachusetts. I was there for eight years, teaching courses in intercultural communication and health communication. Before working at Emerson, I was an Assistant Professor at Eastern Kentucky University. My research specialization is Health Communication and Behavioral Sciences, and I have been teaching for about 20 years now.
I have always had an interest in health specifically, in Behavioral Sciences and Public Health. My Ph.D. is in Health Communication and Behavioral Sciences and I have a Masters of Public Health in Health Behavior and Epidemiology. I also have a master’s of science in Student Personnel Counseling in Higher Education. It’s interesting–I look back and there were points where I felt like I was a little bit all over the place. But all of my choices in education have really been instrumental in my classroom teaching.
For example, when I was earning my Master of Science in Student Personnel Counseling in Higher Education at the University of Dayton, I also worked as a Resident Director at Cedarville College. This position allowed me to interact with so many students, helping them make the transition from college to their career, and fulfilling residential director responsibilities, including providing crisis intervention and working with resident assistants and planning out the events for the resident hall. A lot of that involved understanding and optimizing communications between people, which helped me in my career.
Up to that point, I was on a professional career trajectory in higher education. This included working at the University of Vermont as the Assistant Director for the Office of Multicultural Affairs and at Northern Kentucky University as the Assistant Dean in the College of Professional Studies. When I took the job as an Assistant Dean I realized that the administrative track wasn’t my passion. I love working with students but realized I wasn’t able to spend quality time with them. My roles felt more punitive and disciplinary in nature. I was also teaching communication courses on the side—classes in public speaking and interpersonal communication. This is when I started to realize that I really was passionate about teaching, and that it would be a great avenue for me to pursue.
As a side note, I come from a family of educators: my mother was a grade school teacher and principal, my older sister was a Title IX Reading Specialist who recently retired. Finally, my older brother is a psychologist and professor in Washington DC and my eldest sister is an artist who also taught classes. I can remember at a young age saying “I’ll never be a teacher!” but the older I got the more I realized I had a natural proclivity to education and came out of a family environment that put emphasis on education and teaching.
I lost my mother to complications from Type II Diabetes in 1998 and I felt like her death was instrumental in my decision to get into the health field. At this time, I was trying to figure out where my interests lay–I was interested in public health, I was interested in individual health choices, and I was interested in communication, but I didn’t see an avenue to connect these interests. When my mom got really sick, I started really paying attention to how my family system communicated with each other about Type II Diabetes and chronic illnesses in general. I was fascinated by how we cared for my mom as she battled her illness and its many complications.
I knew I wanted to get my Ph.D., but I started having more clarity after my mother’s transition. I started looking for programs that would allow me to do a Ph.D. to look at family systems, health, and health behavior. I was so fascinated by these topics.
So that is what I wrote my dissertation on: Type II Diabetes among African-American women with adult daughters who are non-diabetic. The goal of my dissertation was to try to interview African American mother-daughter dyads to understand how their health behaviors translated through mothers’ oral histories and storytelling of her illness, and how this impacted adult daughters.
Now as a professor I am able to teach about health and chronic illness as well as other health constructs. My colleague Dr. Elaine Wittenberg and I recently had our Health Communication concentration approved at California State University, Los Angeles. This means offering our Communication Studies majors an opportunity to take courses like health narrative, health campaigns, and community health and media literacy.
In terms of theoretical and research models, I lean towards something called the socioecological model that says that when you’re caring for the individual, you must consider their communities, family systems, political structure and policies that impact their lives.
So if you live in a neighborhood where you don’t have walkable spaces, you can’t just walk out of your house and go for a walk, and that in turn impacts your health. And it’s not just that there’s no sidewalk, but the fact that you don’t even have peace of mind in going out to walk. Those things all frame your behavior, and they frame how you think about being healthy. As a researcher I’m always trying to think about, “How do we switch these paradigms? What do we need to change in a neighborhood to make it more accessible, especially in vulnerable neighborhoods? How do we make positive health behaviors more accessible for the people who are there?”
I believe if you’re not healthy in mind, body, spirit, then you’re not going to do healthy things to ensure that you can successfully lose weight or even successfully manage your diabetes or other chronic illness you might have. Public health is literally about the public health—and everything is considered, studied, and done in public health from a mass context. Basically, public health is about looking at the mass population whereas health communication to me is thinking about the messages. So I can think about the mass population, but if I’m looking at, for example, Los Angeles and I’m considering the HIV rates among gay males–who might not want to identify as gay males or men who have sex with men—I’m asking “What kind of messages do they want to hear?” If for instance, I don’t realize that they don’t like to be referred to as ‘men who have sex with men’ then any public health campaigns I want to use to promote safe sex practices will not reach my target population effectively.
So when I’m trying to promote something like PrEP, which is a medication that they can take after sexual interactions to make sure they don’t get HIV… if I don’t have a message that fits how they define themselves, then I could totally lose them in my attempt to help them negotiate this health issue.
When you’re in health communication, you are trying to think about messages, message dissemination, and how you make sure that a message is gendered, culturally sensitive, and specific to a target audience. So you might ask, “Does it speak to the LGTBQ community, or to the ethnicity of people and how they might think about dealing with their health issues?” The health communication content is crucial to the public health content.
Over the last ten to 15 years we’ve seen a trend whereby more public health specialists are taking health communication theories, research and curriculum and incorporating it into their public health campaigns or informational materials. They are giving more thought to the efficacy and effectiveness of the message in an attempt to foster more impactful outcomes.
Years ago, when I was completing my degrees in both public health and communication, a lot of people were asking me, “Why are you doing a master’s in public health? What are you thinking?” And I just happened to have some really good mentors who encouraged me to stay the course. They told me, “For one, these two things will pair well together. Secondly, if you can keep abreast of the scholarship in both fields, it will offer broader, more cohesive, and more comprehensive opportunities for you.”
And the more that I worked in health behavior, and saw all of the different ways that behaviors play out in different population groups, I began seeing how intimately connected communication and health behaviors and public health outcomes really are.
[MastersinCommunications.com] May we have more information on your areas of research expertise? What have been some of your principal findings regarding family dynamics when discussing health issues, sexual health and its relation to gender and racial disparities, health media literacy in urban communities, and health narratives and their impact on public/community health?
[Dr. Cooke-Jackson] As of late, I have been doing a lot of work with something called memorable messages, which is a construct that informs how people think about the messages that they receive over a lifetime and which messages, especially in their formative years, are most important to them, and finally how those messages end up impacting people as they move into their adulthood.
There has been a lot of research done in this area. It started with a scholar named Cynthia Stohl, and a couple of her colleagues, including Gary Kreps. They were looking at these memorable messages and trying to understand what was going on and how do these messages have an impact on people’s behavior both in the short-term and in the long-term future.
I really gravitated towards this because my interest is in behavior change. So I investigate content around behavior change and behavior change models. Memorable messages was something that really stuck with me, and therefore I’ve devoted a good amount of my research efforts to exploring and understanding it.
I have looked at memorable messages from different cultural perspectives, and examined memorable messages’ role in sexual health education. Right now I’m working with three other young people, whom I’m mentoring, and we’re writing several different pieces on memorable messages around reproductive health, contraceptive use and menstruation. And at a simplistic level, we are trying to understand: what are the messages young women receive about reproductive health and contraceptives, and what do they wish they had heard?
My previous research looked closely at media and health literacy and how it affected public health outcomes and social outcomes. I created and ran a program in Boston called ELEEP, which stood for the Emerson Literacy Education and Empowerment Project. At that time I was collaborating with the Boston Commission of Public Health program that worked with youth. In the program that we used a peer to peer mentoring model whereby Emerson college students worked with high risk teens to educate them about sexual health and about healthy dating relationships.
The amazing thing about this program was that after the teens learned and created a curriculum on these topics, they would teach what they learned to younger kids in the school system and after school programs.
There is an incredible amount of impact that is possible when you place youth in the position where they can actually engage in the process of creating the curriculum and/or creating the content that comes out of the curriculum. So this peer-to-peer mentoring program used a lot of human-centered design and participatory-learning to create an interactive and applied learning environment.
I hired college students to mentor and teach technology to younger students in the program and through that teaching process, which transpired over a six-week period, students were asked to create a video or other forms of content that were informative about sexual health.
Through a grant I was able to purchase cameras, video software, iPads, and other equipment so that the youth had up-to-date equipment to produce important content. So in addition to learning important concepts around safe sex practices, they also gained communication and technology skills that they applied to the education of their peers.
It was the most phenomenal thing–seeing these young kids learn, taking sometimes very academic and transferring it over to an applied, participatory design. For me, this is the core of the research that I do in health communication. I’m considering, “What is it that makes people change, adapt, and restructure their behavior? And are there tangible ways to get those things to happen?”
From my experience, and the literature bears this out as well, I’ve learned that a person has to have really thorough constructs that frame the behavior change in the context of their values, and help them understand why the change is important. And then they have to be able to, in a sense, melt down the information they’ve gained, make it their own, and really engage with it. And for me, that is something that I’m passionate about–how that transition happens that ends up impacting a person long-term.
[MastersinCommunications.com] For students just learning about the field of Health Communication, how would you recommend they explore the depth and breadth of this field, and how it intersects with other important disciplines such as social work, mental health counseling, public health, etc.?
[Dr. Cooke-Jackson] One of the things I tell my students is that when they think about health communication, they should also be asking themselves the questions, “What is the field of communication about? What is its purpose, and how is health care and well-being connected with that?” There is importance in them understanding that communication is about the way messages are constructed, disseminated, and modified to achieve certain goals. In my classes I start there, and then I have them think about the messages that they receive about health, as there is a broad spectrum of ways that these messages can play out.
The field of health communication originated with scholars really looking at the patient-physician communication dyad and trying to understand the interplay of the power between doctors and their patients. It also investigated the importance of a patient being able to hear his or her doctor and use that information to get better. The term that was used often is “adherence.” Why isn’t this patient adhering to the treatment plan?
There were many scholarly articles about adherence among patient-physician behaviors, but most of them were published in medical journals. So communication scholars said, “We need to see what happens when doctors talk to the patient and understand how doctors deliver medical information.” So that’s where the field started, and when I talk about health communication, I mention this because it was the beginning of communication scholars’ investigation.
There is also a large body of literature on cancer and cancer narratives as well as research on family communication in the field of health communication. Additionally, I’m seeing more and more scholars of color who are writing and publishing about different racial and ethnic issues in the field of health communication, like mental health and sexual health.
I tell students, if they’re interested in health communication, to ask themselves, “What really drives you when you think about your interest in doing research on health issues?” I encourage them to let that guide their decisions in their program because health and communication can be linked to so many different careers. If they find what their passion is, then they can find a niche in which to enter. The field is quite open to unique and interesting research ideas.
I have a former student with whom I still keep in touch. She is very interested in autoimmune issues because she was really sick for a year, and she wanted to see whether the challenges she encountered as a patient were more universal. She examined topics surrounding reproductive health, autoimmune issues and invisible illnesses.
Health communication is a field that intersects naturally with other communication disciplines. For example, the study of organizational communication dynamics applies to health communication organizations and the flow of communication between organizations, teams, and individuals. One of my students actually looks at this specifically—organizational communication in health care environments. She looks at medical error, memorable messages, and health communication through an organizational lens and an understanding of health communication scholarship. She has actually been very prolific, and has published studies about health communication’s role in Asperger’s syndrome, the VA, and memorable messages about health in university health centers, particularly for international students. She also has a piece on narrative among nursing students’ experiences with medical error during clinicals. She is a very qualitative scholar, and uses a lot of individual interviews and other qualitative methods to gather her data.
My colleague Elaine Wittenberg is also doing fantastic research on the role of health communication in palliative care. She worked at City of Hope, focusing on palliative care for cancer patients, their families, and the nurses who cared for them. She started out working with nurses and worked to understand how nurses and caretakers of cancer patients could have better conversations with their patients in the context of palliative care. She focuses mainly on interpersonal communication between patient and health care provider, but she also works on optimizing communications in an organizational environment.
Health communication is so interdisciplinary. For instance, research in health communication can pertain to health education or public health campaigns, health care policy, health marketing, family communications that influence personal health choices, high school or college programming to boost health literacy and agency… really, it runs the gamut. We have seen an increase in scholars investigating digital communication and technology and how that space has impacted health communication scholarship.
For example, there is a young lady at Tufts School of Medicine who runs a certification program in digital health communication, which looks at health literacy, social media and its relationship with health outcomes, and mobile health design. She’s interested in understanding how you create mobile health spaces that are embedded in technology which not only give people the information they need to make sound health decisions, but also help motivate these decisions.
Another program that is really cool is Columbia University’s certificate and master’s program in narrative medicine. It comes from the concept that doctors must understand the patient narrative to successfully help them manage illness. Much of this program centers on the patient and understanding each patient’s profound narrative. The program is very writing-intensive and is concerned with helping doctors, practitioners, and nurses pay closer attention to the narratives that are shared with them by their patients to understand the lived experiences of patients.
Finally, the National Cancer Institute now has a whole graduate program that you can do in health communication. Some government agencies now have health communication as a central part of the language they use on their website and in other media. Health communication gets paired a lot with social marketing and campaign development—how do we make compelling health campaigns, and make sure we are sending the right kind of messages to our target populations?
[MastersinCommunications.com] Do you have any advice or recommendations for students considering entering the field of health communication and/or earning a master’s degree in health communication?
[Dr. Cooke-Jackson] I would recommend that students work to build a record of work experience and have a set of skills in writing and communication technologies. I have a young man who is working at Harvard right now, in their Department of Public Health. And he got in the door because he had a lot of background in communication technologies. He’s been very dynamic there in helping them rewrite a lot of their curriculum and a lot of their material so that it is more culturally sensitive and can access a wider audience.
I would advise students go to a master’s program in health communication that teaches them interdisciplinary and particularly communication technology skills. I think technology has changed the field of health communication in a tremendous way—it has changed how we use medical systems and how we craft and disseminate health information to larger audiences. There is a profound need among medical institutions and other health organizations to have a Facebook site, as well as other social media sites like Instagram, LinkedIn, etc. So there are all of these different avenues now that require someone to know how to make those sites work successfully.
At Emerson, I had a lot of students coming out with numerous technical skills. A lot of them had Instagram feeds and knew how to build a following on that platform. They knew how to set up Facebook accounts and small group/business accounts and things like that.
Now that is not going to get you a job in and of itself, but pair that with a knowledge of health communication systems, organizational communication, and a drive to make health outcomes better within older, more antiquated bureaucratic systems like a medical hospital, and you have just opened up a lot of doors.
You also need to know how to write good content. Knowing how to write and how to create compelling messages is important in this field. And know how your readers will interact with your content—in other words, understand usability and how to make health education and health care engaging.
A huge area right now is game design. The game design folks are doing a lot of great work in game development for social change. One colleague I worked with at my prior institution was doing scholarship that worked to change water systems in Ghana. He was trying to find an innovative way to engage the population there to start safer water practices. The community did not see a need to change their eco-system but they were getting really sick because their water supply was toxic. His work involved creating games that he could take to the community, in which community members would have buy-in, and be more open to change their thinking about how to transport water through different villages.
So, as far as new technology goes, it still always comes back down to message construction and message impact. That for me is the essence of what communication is all about, and that core will not change.
Thank you, Dr. Cooke-Jackson, for your excellent insight into the field of health communication!