About Erin Donovan, Ph.D.: Erin Donovan is a Professor in the Department of Communication Studies at The University of Texas at Austin (UT Austin). Dr. Donovan’s interpersonal health communication scholarship explores the roles of social-emotional support and communicative labor in a variety of health contexts, from patient-provider communication to the supportive communication between young adults with cancer on online forums. Her research has earned Top Paper Awards from divisions of the National Communication Association (NCA), including the Training and Development Division, the Health Communication Division, the Family Communication Division, the Applied Communication Division, and the Interpersonal Communication Division. Additionally, she has received the Bill Eadie Distinguished Scholarly Article Award from the Applied Communication Division of NCA.
Dr. Donovan has served as Principal Investigator (PI) or Co-Investigator on a wide variety of grant-funded research projects conducted in collaboration with the Texas Health and Human Services Commission, the National Cancer Institute, the Texas Department of State Health Services’ Women, Infants and Children (WIC) Program, the Robert Wood Johnson Foundation, and more. Dr. Donovan’s projects have also focused on health communication pedagogy, training, and development for medical and pharmacy students and health-care practitioners.
At UT Austin, Dr. Donovan has been honored as a Provost’s Teaching Fellow, a position that enables faculty to pursue individual projects while engaging in peer mentorship. Previously, she served as Director of Interdisciplinary Education and Associate Director of the Center for Health Communication, a collaboration between the Moody College of Communication and the Dell Medical School. Dr. Donovan earned her Ph.D. and her M.A. in Communication from the University of Illinois at Urbana-Champaign. She holds a B.A. in French with a minor in writing from Hiram College.
Interview Questions
[MastersinCommunications.com] May we begin with an overview of your academic and professional background? How did you become interested in health communication and the important role that interpersonal communication plays in health communication contexts?
[Dr. Erin Donovan] I did my undergraduate degree in French. I was a language major, and I loved it. I loved learning about language, culture, and literature, and I minored in writing because I have always liked to write. I was very interested in graduate school. I had a sense that I wanted to stay in academia and become a professor. I asked a lot of my mentors for advice about what direction to go and took some time to reflect on that advice. I loved foreign languages, but the more I thought about it, the more I felt like that might be a little bit narrow for my interests.
I felt motivated by questions about relationships and social interaction that emerged in studying language. With some good advice from professors, that led me to communication. I originally thought that I might specialize in intercultural communication given my background in language and interest in culture, but I took a course on interpersonal communication in health communication contexts with Dale Brashers when I started at the University of Illinois, and I fell in love with it. I thought, “This is it. I would do this work for fun and for free.”
I stayed on that path, doing work in training and development in interpersonal communication and health communication contexts. That was a growing area in communication studies, which was helpful as I was developing my research pipeline. Still, looking back, especially when I am doing things like patient-provider communication training, I think that is intercultural communication in a sense. I get to satisfy that interest in helping people who come from very different backgrounds, languages, and points of view meet each other where they are and create meaning. I ended up doing what I thought I might but in a very different way.
[MastersinCommunications.com] A key thread of your research concerns communication as a means of social and emotional support, which you have explored in contexts ranging from patient-provider communication to digital communication between young adult patients with cancer, as in “Patterns of Social Support Communicated in Response to Expressions of Uncertainty in an Online Community of Young Adults with Cancer.” From this research, are there particular forms of social and emotional support that seem valuable to patients across these contexts? Are there unique qualities of communicative, social support between young people compared to other populations you have studied?
[Dr. Erin Donovan] I will discuss patient-provider health care encounters first. One key thing that we have studied and incorporated into our training is the idea that support should not be understood as “either/or.” We have really good typologies of support: emotional, esteem, informational, tangible, and so on. In reality, people are doing more than one thing at a time. There are ways to give information that are also full of emotional support. We can communicate caring while giving specific technical answers that patients or family members might want, like how to change the dressing on a wound after surgery. There is a way to give that information while also reminding people that you are there for them and you care about them.
I worked with a team on a training for medical students about providing support. Part of what we encouraged them to do was think of the support provision as a sequence, where a patient asks a question and you give them an answer, but then you follow that up with your own question like, “What else is on your mind? What else can I help you with?” You do not want to approach the conversation as if they are only asking for discrete pieces of information. Try not to assume people are simply dealing with a deficit of information. Sometimes the needs are much more relational and interpersonal.
We used an example where the patient would ask, “How long am I going to stay in the hospital?” The answer might be two nights, but we encouraged our trainees to follow providing that information by asking, for instance, “Is there something that you are concerned about? Is there something that you are wondering about?” They might be worried about any number of things; maybe they are concerned with who is going to take care of their pets. This is a very small discursive thing to do, but it can truly help people and help them feel cared for.
The research that we did on young adults coping with cancer looked at online support communities. As with our work on patient-provider communication, one of our findings was people are exchanging and providing multiple types of support simultaneously. When someone would post on this forum and ask things like, “How long did it take for your hair to grow back?” or “Does anybody know a good fertility specialist in Houston?,” the typical cadence of a response was a combination of informational, emotional, and esteem support. They would often say, “Here’s something I’ve tried,” or, “This is a website that was useful for me,” or “This was my experience,” and then pair that with, “You’re doing great,” “Hang in there,” and “We’re here for you.” That whole package is important. It is still conceptually useful to be able to identify different types of support, but in reality, supportive communication is much more complex than that.
I am not alone in thinking about support in this way. I was trained by Daena Goldsmith, and many other social support researchers make similar claims. The claim that emotional support and informational communication can be paired together is not controversial in any way, but it is sometimes newsworthy to people who work in healthcare.
[MastersinCommunications.com] One important contribution you have made to health communication theory is developing the “Theory of Communication Work” in pieces like “The Labor of Communicatively Coping: Toward an Integrative Theory of Communication Work” and “The Labor of Talking to Stay Healthy and Socially Connected: Communication Work During the COVID-19 Pandemic.” Would you introduce us to the concept of Communication Work? What does attending to the labor of communication help clarify about processes like coping with illness that we might otherwise overlook?
[Dr. Erin Donovan] I have always been interested in what makes conversations about health and illness challenging and what can make them easier. In some of the research that I was doing several years ago, I was listening to people talking in focus groups. They were describing their experiences coping with cancer, talking to their families, and talking to their healthcare providers. I realized what they were doing sounded like work.
Specifically, it resonated with how work is described in the Theory of Illness Trajectories, which is a health sociology theory that talks about the labor that people do when they are coping with a chronic condition. I want to give credit to the participants for inspiring that moment for me.
I went back and revisited the literature on work and illness trajectories and realized there was nothing in that theory that talked about communication as work. It was focused on the work that comes from, for example, testing blood sugar, taking medication, doing physical therapy, or coping with the loss of professional identity: all the things people have to do when they are living with a serious illness. But, partly because they were not communication scholars, this scholarship was not positioned to capture how talking is work. Seeking information online is work. It is not just a communication behavior; it is communication labor.
I started digging into that and finding more evidence to support this idea. We have conducted a number of qualitative and interpretive studies and also have collected some quantitative data. The concept of communication work is about being attuned to how the communication itself can be a stressor in conversations during illness or about health. It can be an added stressor on top of a health stressor, and so it complements my research interests in stress and coping. Stress occurs when the demands of a situation exceed our resources to manage them. Sometimes people feel like they have an overwhelming amount of information to sort through related to their illness and do not even know where to start. They may need someone to support them because the language might not be accessible to them.
One of the features of communication work that I have written about is how people perceive that the benefits of this work outweigh its costs. But there are a lot of costs. It is demanding. It takes time, it takes effort, it can be emotionally depleting on top of the depletion that you are already feeling because of your illness. You are already fatigued. You are already feeling nauseous because of your chemotherapy. You are already unable to attend family events when your chronic pain is flaring up. Then you have the extra task of notifying somebody and explaining why you have to back out of plans. That takes a toll on people.
The idea of communication as work is meant to stress that communication is effortful. It is demanding, and we do not necessarily have the resources to manage it. However, as communication instructors, we have a general approach that allows us to help people have these conversations more effectively. We can give people tools.
Part of what I think is useful about the construct of communication work is that it opens up these avenues to ask questions and to gather evidence about whether some health stressors entail more communication work than others and, if so, why. I have written about how, if people are managing a very poorly understood illness or have medically unexplained symptoms that people might not believe are real, that is going to involve more work. It is more work to talk about something like fibromyalgia than it is to talk about high blood pressure, because people know what high blood pressure is. They accept that that is a real thing.
I think it is important that we examine what predicts communication work and its consequences. For example, people who do more communication work have lower life satisfaction. That is important to know. The next step is to figure out why that is happening and what we can do to support people. This is also significant to understanding the labor of providers within the healthcare system. Perspectives in sociology remind us that what seems like a personal problem might be a system problem. It may not be that your physician is trying to be unkind or dismissive — it could be that they are rushed. They are trying to do what they can in a very limited amount of time before they have to enter a whole bunch of information into the electronic health record. I think asking why this is so much work, whom it is work for, and how that work is being distributed is a critical way of thinking about how we can do better.
How can we alleviate the stress on everyone — the patients, their families, and the healthcare providers? I think there is an important distinction in the communication work that patients or loved ones do compared to healthcare professionals. For patients, it is unpaid labor. For healthcare professionals, communication and emotional labor is part of their job. They have to break bad news, they have to explain complicated things, they have to have stressful conversations with people. At the same time, it being part of their job does not make it easy. It does not mean that providers are always good at it. I want to know how we can help everyone navigate this labor.
[MastersinCommunications.com] Your research has investigated the significance of digital technologies to health communication in a number of contexts, including online communities and blogs, as in your piece, “Cyberframing Cancer: An Exploratory Investigation of Valenced Cybercoping on Cancer Blogs,” and e-health applications as a means to encourage men to engage with prenatal health. Would you discuss some of the important ways digital technologies have shaped the landscape of health communication, and reflect on the inequities their popularization risks introducing, given the concerns you raise in “Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide”?
[Dr. Erin Donovan] Even from the earliest research on online support groups, like that conducted by David Gustafson in the 1990s, we learned so much about what those digital technologies enable people to do. If you lived in a rural area where there were no face-to-face, brick and mortar support groups for your health condition, you could suddenly find people to connect with. Digital media allows you to be anonymous. It creates a record so that if you happen to be up at 3 a.m., you can look back to see what people were talking about earlier in the evening. You can post questions, and people can provide you information.
The proliferation of technology in health communication democratized health information. Previously, if you were a patient interested in the latest science on your health, you would have to go to a university that had a medical school library, talk to the librarian, get access to the stacks, and make photocopies of the medical journals. Today, so much research is publicly available through the National Institutes of Health and PubMed. People can see what information is available about the latest treatments. That is very important. It is important for patient empowerment. It means people can arrive at their healthcare appointments with information and questions about their care.
At the same time, there are some challenges. Part of what we were asking with respect to equity was, “Does everyone have the same access to and ability to use this information?” In the traditional notion of the digital divide, it is a question of inequitable access, where some people have broadband internet and other people do not, or some people can afford devices, and other people cannot. Our question was, “Does someone’s level of health literacy also provide them with greater ability to productively use that information?”
The answer is yes, which is important, and we have seen this confirmed in other research as well. People with lower health literacy — who have less ability, not only to access, but to interpret and act on health information — sometimes do not know what they do not know, or what questions they should be asking, because they have not been as well-informed. Other research has suggested that, if someone hears something from a doctor, and they do not fully understand the information, they will often Google it later on, but then there is so much complex information that they get overwhelmed. The abundance of accessible information is not necessarily filling that gap, with respect to health literacy.
I collaborated on that health literacy project with my colleague here at UT Austin, Michael Mackert, who is the director of our Center for Health Communication. He is also the PI on the prenatal health project you mentioned, where one of our Center for Health Communication teams developed an app for expectant and new dads. That project was born out of his experience when he was expecting his kids and was looking for information online. He was looking for apps, and all the apps were for moms and pregnant people, so he decided to develop this app to tailor information to dads.
I collaborated with him and his team on some of this project. We were testing out the message and the types of information that were most useful. We were testing things like descriptions of the baby’s size and if dads preferred descriptions of sports equipment or fruit: your baby’s the size of a tennis ball, versus your baby’s the size of a lime. It turns out they liked fruit.
We have been able to do a lot of cool work, thinking about what people need, how to make it accessible in the sense that the technology fits in their pocket, how to make it accessible in the sense that it is written in everyday language. It is prompting people to think about topics that they might want to discuss with their healthcare providers that maybe they would not have known to ask about. Our goal is not to interfere with the patient-clinician relationship, but rather to enhance it. We want to supplement the information that people have, help them make sense of it, and help them use their time in the exam room efficiently to get their needs met.
[MastersinCommunications.com] You have also been invested in contributing to instructional communication scholarship, especially related to training medical professionals, and have applied your expertise in this area by working with the Dell Medical School and other institutions to train future health practitioners. Would you describe some of your applied training experiences and what they have helped you understand about some of the most pressing communication needs of healthcare providers?
[Dr. Erin Donovan] The number one thing I try to tell healthcare professionals is that it is not a personal failure if this type of conversation is hard for you, stresses you out, or makes you feel tired and not want to come to work the next day. These are just hard things to do, and that is partly because you do want to do them well. Healthcare professionals are very motivated. They care about their patients and they want to help people. They are doing hard jobs and important technical work.
It is so important that we have had this culture shift in medicine where there is an expectation of patient-centered care, patient-centered communication, and better “bedside manner.” Patients have better health outcomes when they feel like their healthcare professionals care about them, encourage them, reassure them, and value them. It is important to build those relationships. The way that I think about the communication work of healthcare is meant to extend that same empathy to healthcare professionals — to say, “This is hard. You’re a surgeon, you are not a social worker. This is not what you were trained to do. These are high-level communication skills. But they are teachable and learnable.”
This connects to our whole ethos as communication professors. We believe that people can get better at this with practice and with preparation. This reinforces the idea of communicative labor: it is work to practice a conversation ahead of time. It is work to think about your communication, rehearse it, and hone your communication skills. But it is possible.
Breaking bad news to families is one skill I get asked to talk about the most in our training sessions. There is no perfect way to do it, but there are research-based ways to make those conversations less difficult. Similarly, I have helped train medical and pre-med students to think about end-of-life conversations. We revised the communication curriculum in our College of Pharmacy here at UT Austin several years ago to broaden the communication evidence base behind some of the communication skills that they were learning. We used to have a Master’s program in Healthcare Transformation here at UT Austin, which was focused on developing communication skills training for leaders in healthcare. Sometimes, what you have to do is persuade and motivate your team.
Our Center for Health Communication has done a lot of applied work related to helping healthcare professionals with their communication skills. I helped develop a webinar about difficult conversations related to opioids with one of my colleagues, who is an internal medicine professor. We are using communication theory and research to say, “Here are the reasons why those conversations are challenging, and here are some of the things that you might do, not to make them easy, but to make them more successful and less stressful.”
For example, reinforcing the idea that you care about your patients’ pain and you do not want them to be in pain. You are not saying, “I don’t believe that you are in pain.” You are not trying to say, “I think that you are trying to take advantage of your prescription.” You are not trying to imply that you think that they are abusing their opioid. You are trying to get on the same page with your patient and meet people where they are.
We have also done work connected to helping professionals have conversations in pharmacies. There is a law in Texas that requires pharmacists to check a database before they dispense opioid prescriptions to make sure that someone is not getting multiple prescriptions. It can be a real communication challenge when you are telling a patient, “I’m sorry, I can’t fill your prescription.” We have done some trainings and developed online resources to help people initiate and negotiate those conversations. Again, they are still hard, but we are trying to make them at least a little bit easier and help people feel more confident and empowered to do that communication labor.
I have another colleague at the medical school named Greg Wallingford. He developed a supportive communication intervention that I helped him evaluate, which responds to the aftermath of a “code” at the hospital. Someone “coding” is a very stressful situation. It means a patient’s heart has stopped. The medical team tries to resuscitate them, but most of the time the patient does not survive. My colleague observed that, when this happened, the healthcare team would just trickle off, and they were expected to get on with their day. He felt like that was not ideal, so he developed a “rapid supportive debrief,” which was a conversation guide that would clip to people’s badge lanyards.
It contained prompts to encourage people to basically take five minutes and talk through what happened. To say, “Let’s take a moment, let’s honor that patient, let’s acknowledge how hard we worked to care for that patient,” and to open space for people to share about that experience. Importantly, this is not a technical debrief, nor is it about attributing responsibility for what happened. It is intended as a way for healthcare workers to process their stress and trauma.
We have done some interviews with the clinicians who have participated in the debriefs, and they said that it made them feel more connected to their team. Especially for medical students, who were maybe seeing a “code” for the first time, it reassured them that they had not done anything wrong. It helped them to feel more able to reach out to mentors and attendings later on if they had questions, or if they were struggling. Providing a scaffolding for how to have these difficult conversations can make that work a little bit less stressful and hopefully more satisfying, and that is good for patients too, because it promotes better patient care and health outcomes.
[MastersinCommunications.com] You have also worked on grant-funded projects in partnership with several notable organizations, including the Robert Wood Johnson Foundation, the LIVESTRONG Foundation, and the Texas Health and Human Services Commission. Are there applied projects you would spotlight from these or other collaborations that you have found especially meaningful or impactful?
[Dr. Erin Donovan] One major project I have been working on is funded through the Texas Health and Human Services Commission. It is called the “Turn To” campaign. This is the largest behavioral health campaign that the state of Texas has ever run. Dr. Mike Mackert and I were the Co-Principal Investigators on the project. Our team’s role was to do the formative research that informed the messaging and the approach of the campaign, and then to do the research along the way to evaluate how well the campaign assets were working, how people were responding to them, and whether people were engaging with them.
This is a very applied project. The goal of this campaign was basically to help Texans cope with mental health struggles and, in particular, turn to healthy and adaptive ways of coping, as opposed to things like substance use. We developed an online mental health screener, which is a five-minute check-in where people can answer questions about their mental health and it will connect them to resources. For example, if you are struggling with anger, it will suggest some things you could do in the immediate moment, as well as longer term strategies. If you are struggling with housing insecurity, it might connect you with some places that can help. If you are struggling with substance use, here are some immediate, intermediate, and long-term ways to help with that.
We have billboards, YouTube ads, and public service announcements that direct people to the online screener and some of these resources. We have had more than 60,000 people take the mental health check-in in Texas, and we are analyzing those data. About 60 to 70 percent of people whom we have surveyed have said that they have taken some sort of action because of the campaign. As an interpersonal communication scholar, one of the actions that interests me is whether they have reached out to talk to somebody about their mental health struggles. People have, which is exciting. At the same time, campaigns notoriously have small effect sizes. There is only so much we can do, and answering many of our questions will require years of research.
For another part of the project, my team, my graduate students, and I developed conversation guides based on communication research and theory to help people have conversations about their mental health struggles or about their substance use struggles. These guides give tips for how to be supportive if somebody is turning to you with some of their own concerns. We have tested different versions of those conversation guides to identify the best ways to deliver this information so that it is helpful to people.
This is a good example of a project that needs a lot of funding to be successful. It is a 12-million-dollar, four-year project. A lot of that money is for the media buy [e.g., purchasing advertising]. A lot of that money is to support the staff, the designers, the public health educators, the research team, and the administrators, as well as the people who are writing the reports, the people who are traveling to the photo shoots, and more. There is just so much happening on that type of project. But it is really exciting. It has implications for people’s health and their day-to-day lives, and it allows us to dig into interesting scholarly questions at the same time. It has just been a tremendous collaboration. It is affecting people’s lives. It is thrilling to be out in the wild and see a bus drive by with a campaign you helped design.
[MastersinCommunications.com] Are there insights you would share on the process of developing these collaborations or grant-writing that might be useful for students at the beginning of their research careers?
[Dr. Erin Donovan] For graduate students, the best thing to do is work with your faculty mentors on a research team. Our grad students are all active in apprenticing with their advisors and their professors. They work as research assistants or volunteer to help on projects. You learn a lot by just being in meetings with these big teams. You see how much work is happening and realize that you are only noticing a small piece of it. There are a dozen people working on some of these projects. There are full-time graphic designers, project managers, and administrative professionals, as well public health educators, faculty researchers, postdocs, and student researchers. We have tons of people who are all doing their part on the project.
For a graduate student, I think it is good to have the experience of assisting with research and being exposed to the wide range of skills that are needed. It teaches you how you would build out your key personnel, giving examples of who you would hire to make your own grant-funded project successful. Those projects tend to be led by a faculty member who is the Principal Investigator (PI), responsible for writing and submitting the grants, running the projects, hiring the teams, and getting the grad students involved.
The infrastructure for doing that at a research institution is just going to be more robust than at some smaller schools. We have full-time, pre-award and post-award staff who are helping to do all of the calculations for the budget and who know all of the reporting that has to be turned into the funding agencies. That infrastructure is crucial and we lean on those folks heavily. This is not to say it is not possible elsewhere.
The other thing that I say to students is that seed money and pilot money are real money. Often smaller pots of money are available, either through external or internal funding. You do not necessarily need a two-year, multi-million dollar grant, depending on the type of research that you do. As researchers, part of what we are trying to accomplish is advancing our scholarship. Different resources are needed to advance different types of scholarship. You do not need to get grants just for the sake of getting grants. As I tell my students, it depends on the type of work that you want to do, but it can make large-scale projects more feasible.
[MastersinCommunications.com] Based on your experience and expertise, do you have advice for students interested in health communication, interpersonal communication, or instructional communication who are considering pursuing a graduate degree?
[Dr. Erin Donovan] If you are interested in it, do it. I think there is so much important work to be done. I feel as though we are still just scratching the surface of all the ways we can learn about health communication, interpersonal communication, and instructional communication. There are so many questions to be answered, and there is a lot of interest from people who want our expertise because it informs how they can do their work. If it interests you, do it.
I often tell our prospective graduate students that, as communication scholars, we have the ability to transcend specific applied contexts. What I mean by that is, we develop our expertise in communication processes — in disclosure, breaking bad news, uncertainty management, persuasion — that have relevance to health communication, applied communication, interpersonal communication, and more. Having a hard conversation about mental health is not the exact same thing as having a hard conversation about prenatal health, or heart health, or chronic pain, but they have theoretical commonalities.
Our scholarly tools allow us to work with people who have clinical or public health expertise across so many different types of applied problems and health contexts. We get to learn about the lived experience of people who have things like colorectal cancer from a communication perspective, and then collaborate with the colorectal surgeon who treats them to enhance the interpersonal and patient-provider experience. That is part of what I think is rewarding about being the health communication person on a research team. We get to learn about new areas and see how our field can connect across those contexts, without having to narrowly specialize. While the health stressors, the medicine, and the science will change, the communication questions will endure and cut across.
Thank you, Dr. Donovan, for exploring your important work on health communication campaigns, the significance of interpersonal communication and communicative labor in health contexts, and more!
Please note: Our interview series aims to represent the diverse research being pursued by scholars in the field of communication, which is often socially and politically engaged. As a result, all readers may not agree with the views and opinions expressed in this interview, which are independent of the views of MastersinCommunications.com, its parent company, partners, and affiliates.
