Health Communication

Introduction

Health communication is a young but rapidly growing interdisciplinary area of study concerned with studying the powerful roles performed by human and mediated communication in health care delivery and health promotion. The field of health communication began to formalize in the early 1970s, but has roots that go back to early Greece and the medical philosopher Hippocrates who established the Hippocratic Oath concerning the ethics of medical practice. Health communication has developed as an exciting, applied social scientific area of inquiry that uses both qualitative and quantitative research to examine the many ways that communication influences health, health care delivery, and health promotion. Research concerning health communication is often problem-based, focusing on identifying, examining, and solving health care and health promotion problems. Health communication scholars typically examine the pragmatic influences of communication practices and policies on health care and public health, often using the data they gather to enhance the delivery of health care and direct health promotion efforts.

Health communication is recognized as a major subfield within the broader academic discipline of communication science. Communication science itself is a broad discipline, represented by a wide range of interest groups and divisions within professional communication associations, such as the International Communication Association and the National Communication Association. The breadth of the communication discipline is also reflected in the different academic programs that house the communication sciences, with school and department titles such as communication studies, mass communication, media studies, journalism, speech communication, and information studies.

The study of health communication is interdisciplinary and combines and applies important theories, concepts, and methods from diverse areas of communication science (such as the study of language and behavior, interpersonal communication, group/organizational communication, persuasion, media studies, intercultural communication, and new communication technologies), as well as from the diverse academic fields of public health, health education, health psychology, medical sociology, medical anthropology, health economics, epidemiology, and medical informatics. Health communication also draws liberally from the literature and theories of the health professional fields, including medicine, nursing, social work, and clinical psychology. Health communication is an extremely broad research area, examining many different levels and channels of communication in a wide range of social contexts. Health Communication, a five-volume reference work published in 2010, identifies five primary areas of health communication inquiry that cut across multiple levels, channels, and settings for communication: (1) health communication in the delivery of care, (2) health communication and health promotion, (3) health risk communication, (4) health communication and new information technologies, and (5) health communication and the health care system.

Early Development of the Health Communication Field

There were many starting points in the development of the field of health communication. One influential starting point was rooted in the communication discipline’s adoption of theories and methods from other social sciences, such as psychology and sociology, which were actively studying the health care system. Scholars in these social science fields were beginning to examine communication variables in health, which encouraged communication scholars to follow suit. The field of psychology generated a large body of literature that was very influential in the development of health communication inquiry. The humanistic psychology movement of the 1950s and 1960s, for example, pioneered by scholars such as Carl Rogers, Jurgen Ruesch, and Gregory Bateson, stressed the importance of therapeutic communication in promoting psychological health and was most influential in the development of the health care delivery perspective to health communication inquiry.

The powerful 1967 book, The Pragmatics of Human Communication, by Paul Watzlawick, Janet Beavin, and Don Jackson, builds upon the literature of humanistic psychology, indelibly tying together humanistic psychology and human communication. This book was very influential in the development of the fields of interpersonal communication and health communication. Written from an interactional family therapy perspective, the book examined the ways communication defines and influences interpersonal relations, clearly illustrating how the quality of relational communication can lead to therapeutic or pathological outcomes. This book, along with other humanistic psychology literature, provided a very influential springboard to the development of current interests in the field of health communication in provider-consumer relations, therapeutic communication, and the provision of social support.

The psychological literature about persuasion also provided a broad theoretic foundation for the nascent field of health communication, influencing the development of the health promotion approach to health communication inquiry. The persuasion literature, in combination with the complementary sociologically based diffusion of innovations literature, social scientific theories about mass media influence, and emerging literature about social marketing, encouraged communication scholars to study the role of communication in health promotion and develop persuasive communication campaigns to promote public health. A notable example of an early health communication campaign based upon a combination of social scientific theories is the Stanford Heart Disease Prevention Program. This landmark study illustrated the role of communication in health promotion with a longitudinal field experimental evaluation of a multicity health promotion intervention program. This study, initiated in the early 1970s as a collaboration between cardiologist Jack Farquhar and communication scholar Nathan Maccoby, clearly demonstrated the powerful influences of communication campaigns on public health promotion.

The medical sociology literature was also influential in the development of the field of health communication. Medical sociologists have long been interested in the doctor–patient relationship and the social structure of health care delivery systems. Irving Kenneth Zola, for example, in a now famous study, examined the ways that culture influences patients’ presentations of health problems to health care providers, illustrating the need for practitioners to understand the backgrounds and orientations of their clients and develop situationally specific strategies for communicating with individual patients. Arthur Kleinman’s moving book Patients and Healers in the Context of Culture further reinforced this lesson about cultural influences on doctor–patient interactions and has encouraged current work on culture and health communication.

There were also important studies from the field of medicine that increased interest in health communication. For example, Barbara Korsch and Vida Negrete’s influential article “Doctor–Patient Communication,” published in 1972 in the prestigious international journal Scientific American, made communication in health care delivery an important academic and public issue that communication scholars raced to address.

Literature, Professional Organizations, and Conferences

A field of study is largely defined by the body of literature it generates, and the field of health communication has a rich and varied literature. The first books concerning health communication written by communication scholars began appearing in the 1980s with Health Communication: Theory and Practice by Gary Kreps and Barbara Thornton, The Physician’s Guide to Better Communication by Barbara Sharf, and Health Communication: A Handbook for Health Professionals by Peter and Laurel Northouse. These first three introductory texts were followed by a rapid succession of important health communication books, edited volumes, and a burgeoning literature of journal articles, solidifying and enriching the field of health communication.

As literature concerning the role of communication in health care and health promotion began to increase, there was a growing need for academic legitimization for communication scholars studying the role of communication in health. In response to this growing need, communication scholars interested in health care and health promotion banded together in 1972 to form the Therapeutic Communication interest group of the International Communication Association (ICA). The formation of this professional group is one of the most influential moments in the genesis of the modern field of health communication because it provided an academic home for an eclectic group of scholars, communicated to the rest of the communication discipline that health was a legitimate topic for communication research, and encouraged scholars in the discipline to consider health-related applications of their work.

The annual ICA conventions were important sites for an emerging group of health communication scholars to meet, present their research, and generate new ideas and new directions for this new field of study. At the 1975 ICA convention, held at the LaSalle Hotel in Chicago, members of the Therapeutic Communication Division voted to change the name of the group to the broader title of Health Communication, recognizing the many ways that communication influences health and health care. The ICA Health Communication Division not only provided academic legitimization for a growing body of college faculty and graduate students, but the conference programs also encouraged other communication scholars to conduct health communication research.

In 1977, the ICA began publishing the influential Communication Yearbook annual series, which included very important chapters about the emerging field of health communication. In the first four volumes of the Communication Yearbook series each of the divisional interest groups (including the Health Communication Division) was allotted dedicated sections of the book to present research overviews and exemplar studies. In each of the first four volumes, Health Communication Division officers wrote important definitional overview chapters about the nature, purposes, and scope of health communication inquiry. These overview chapters, along with the accompanying research reports, provided an excellent showcase for the developing field of health communication. Later issues of Communication Yearbook published major review chapters along with accompanying responses from accomplished scholars representing the different ICA divisions. The major review chapters concerning health communication were instrumental in defining this field of inquiry, and the chapter responses helped frame the major issues in the field for a large audience of scholars.

In 1985, the Speech Communication Association (SCA, now renamed the National Communication Association, NCA), the largest of the communication discipline’s professional societies, established a Health Communication Division from the fledgling Commission for Health Communication. Many ICA Health Communication Division members also joined the NCA Health Communication Division, but a large body of communication scholars who had limited exposure to health communication because they did not participate in the ICA now learned more about this field of inquiry. The ICA and NCA Health Communication Divisions began to share publication of the Health Communication Newsletter, later renamed Health Communication Issues, and jointly offered annual outstanding health communication scholar, dissertation, and thesis awards, rewarding and encouraging outstanding health communication scholarship. In 2004 the Coalition for Health Communication (CHA) was established as an interorganizational task force representing health communication interest groups from the ICA, NCA, American Public Health Association (APHA), and the Association for Education in Journalism and Mass Communication (AEJMC). CHA now distributes the Health Communication Digest, and posts information online about graduate programs, research and publication opportunities, conferences, job announcements, and online resources in health communication.

The health communication conference programs at ICA and NCA became increasingly popular within the field, and in the mid-1980s several health communication miniconferences were founded to meet burgeoning scholarly interest in this area. One of the first of these conferences was the “Medical Communication Conference” held at James Madison University in Virginia. This miniconference was quickly followed by a “Summer Conference on Health Communication” held at Northwestern University in 1985. This very successful conference, which included a proceedings volume of contributed conference papers, began a popular trend of small research conferences focusing on health communication inquiry.

The Northwestern conference was followed by the first of several very effective annual “Communicating With Patients” conferences sponsored by the Communication Department of the University of South Florida. Two important international conferences were organized in 1986, the “Oxford University/ICA Conference on Health Education in Primary Care” held in the United Kingdom, as well as the “International Conference on Doctor– Patient Communication,” held at the University of Western Ontario (Canada). Since then, there have been many additional international health communication conferences, which have expanded global interest in health communication inquiry.

In 1989, a series of ICA Mid-Year Conferences on Health Communication, held at Monterey, California, was started. The University of Kentucky began the successful Kentucky Conference on Health Communication (KCHC), which is held in Lexington, Kentucky, every other year. In 2011, the D. C. Health Communication (DCHC) Conference was established at George Mason University to be held every other year in rotation with the KCHC. In 1994, a “Conference on Health Communication, Skills, Issues, and Insights” was held at the State University of New York at New Paltz and NCA held a Summer Conference on Health Communication in Washington, D. C. Emerson College also initiated a series of conferences on health communication. These health communication miniconferences spurred the growth of health communication inquiry both by serving as channels for disseminating health communication research information to a very large and often diverse audience of scholars and also by providing health communication scholars with attractive outlets for presenting their work.

In 1989 the first refereed scientific journal, Health Communication, dedicated exclusively to health communication inquiry, was introduced by founding editor Teresa Thompson. Introduction of this journal marked the coming of age of this young field of study and encouraged scholars from around the globe to take health communication study seriously. In 1996 a second dedicated refereed quarterly health communication journal, the Journal of Health Communication, was introduced under the founding editorship of Scott Ratzan. The two dedicated health communication journals complement each other and provide important scholarly outlets for health communication scholarship, indicative of the growth and maturation of this field of study. Still other journals such as Patient Education and Counseling, the Journal of Communication in Health Care, Cases in Public Health Communication and Marketing, Social Marketing Quarterly, and the Journal of Health and Mass Communication are now dedicated to publishing health communication research.

Education and Inquiry

The growth of health communication literature and professional organizations led to the introduction of health communication courses at colleges and universities. Some of the earliest health communication courses were housed in departments of speech communication at large research universities such as the University of Minnesota, Pennsylvania State University, and the University of Southern California. Several medical schools also began offering health communication courses focusing on interviewing skills for physicians at the University of Illinois, Southern Illinois University, University of North Carolina, and the University of Calgary. These courses were precursors to the development of many more undergraduate and graduate health communication courses in colleges both nationally and internationally.

Several undergraduate and graduate health communication programs and majors are now offered at many colleges. Focused doctoral programs in health communication are being offered at George Mason University, the University of Kentucky, Michigan State University, the University of Southern California, the University of Pennsylvania, Ohio State University, the University of Oklahoma, Indiana University-Purdue University at Indianapolis, the University of Lugano (Switzerland), the University of Amsterdam, the University of Munich, the National University of Singapore, and elsewhere. Emerson College offers a unique collaborative M.A. graduate program with Tufts University’s School of Medicine that emphasizes both health communication inquiry and the health care delivery system.

There has been growing support for health communication inquiry from many important government agencies, such as the National Cancer Institute (NCI), the U.S. Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), and the Agency for International Development (AID); large health foundations, such as the Robert Wood Johnson Foundation (RWJF), the Kaiser Family Foundation, and the Bill & Melinda Gates Foundation; and major health corporations. Many health communication scholars are attracting federal research funding. For example, the NCI, the largest institute of the National Institutes of Health (NIH), identified cancer communication as a primary scientific priority in 1999 and implemented a comprehensive program of health communication research that included the Health Information National Trends Survey (HINTS), the Centers of Excellence in Cancer Communication Research, the Health Communication Interventions Research Program, the Digital Divide Pilot Projects, and an active program of Small Business Innovation Research (SBIR) grants in multimedia technology and health communication. Responsibility for developing many of these new research and outreach initiatives rests with the Health Communication and Informatics Research Branch (HCIRB), a part of NCI’s Behavioral Research Program within the Division of Cancer Control and Populations Sciences that is dedicated to research about the influences of communication and informatics. The introduction of the HCIRB in 1999 coincides with and complements the NCI’s identification of cancer communication as an area of extraordinary opportunity for research investment.

There is also a growing emphasis on public advocacy, consumerism, and empowerment in health communication research that is helping to revolutionize the modern health care system by equalizing power between providers and consumers, and relieving a great deal of strain on the health care system by encouraging disease prevention and self-care and making consumers equal partners in the health care enterprise. Current and future health communication research will increasingly focus on effective dissemination of relevant health information to promote public health. Modern health promotion efforts will recognize the multidimensional nature of health communication, identify communication strategies that incorporate multiple levels and channels of human communication, and implement a wide range of different prevention messages and campaign strategies targeted at relevant and specific audiences.

Health communication research programs are increasingly examining the health communication needs of marginalized cultural groups and identifying strategies for enhancing health communication with members of these groups. The maturing field of health communication is building strong momentum toward conducting sophisticated translational and international research, and developing influential evidence-based outreach and educational programs. The field of health communication inquiry holds great promise for conducting work that will make important contributions to the quality of health care and health promotion in the modern world.

Bibliography:

1. Kreps, G. L. “The Maturation of Health Communication Inquiry: Directions for Future Development and Growth.” Journal of Health Communication, v.17/5 (2012).
2. Kreps, G. L. and E. W. Bonaguro. “Health Communication as Applied Communication Inquiry.” In The Handbook of Applied Communication Research, L. Frey and K. Cissna, eds. Hillsdale, NJ: Lawrence Erlbaum Associates, 2009.
3. Kreps, G. L., E. W. Bonaguro, and J. L. Query. “The History and Development of the Field of Health Communication.” In Health Communication Research: A Guide to Developments and Direction, L. D. Jackson and B. K. Duffy, eds. Westport, CT: Greenwood Press, 1998.
4. Kreps, G. L., J. L. Query, and E. W. Bonaguro. “The Interdisciplinary Study of Health Communication and Its Relationship to Communication Science.” In Beyond These Walls: Readings in Health Communication, L. Lederman, ed. Oxford: Oxford University Press, 2007.
5. Rogers, E. M. “The Field of Health Communication Today.” American Behavioral Scientist, v.38 (1994).