HEALTH COMMUNICATION

Health communication is a rich, exciting, and relevant area of study that investigates and elucidates the many ways that human and mediated communication dramatically influences the outcomes of health-care and health-promotion efforts. While health communication is a relatively young area of communication inquiry and education, research and writing on this topic has grown tremendously since the early 1980s, generating increasing numbers of important research findings and publications. A major reason for the tremendous growth and development of inquiry related to health communication is the importance of this research area for addressing complex and challenging healthcare demands in society and guiding the promotion of public health.

Communication is at the very center of healthcare and health-promotion efforts. To gather relevant diagnostic information from health-care consumers, doctors, nurses, and other health-care providers depend on their ability to communicate effectively by asking pertinent questions, interpreting responses, and probing for more detailed information. Consumers depend on their own ability to communicate with health-care providers when seeking help, identifying health problems, interpreting health-care recommendations and treatment strategies, and negotiating their way through the often complex modern health-care systems. At the broader system-wide level, communication is the primary mechanism that professionals have for engendering cooperation and coordination. In a large hospital, for example, the efforts of physicians, nurses, pharmacists, laboratory technicians, therapists, and administrative personnel must be carefully coordinated in order to accomplish treatment goals.

Similarly, communication is an important element of health-promotion efforts (i.e., campaigns designed to influence public health knowledge, attitudes, and behaviors in order to help reduce health risks and encourage the adoption of healthy behaviors and lifestyles). The campaigners must be able to communicate successfully with their intended audiences if the important messages about relevant health risks and appropriate health-preserving behaviors are going to be heeded. In health-promotion efforts, care must be taken to craft messages that are appropriate and compelling for the target audiences and to guarantee that the messages are delivered to these audiences through the most effective communication channels possible. The effectiveness of communication in virtually all health-care and health-promotion activities is directly related to the potency of the health outcomes achieved, and in many cases these outcomes can mean life or death for health-care consumers.

Health Communication as an Important Area of Study

A large and developing body of scholarly research in the area of health communication powerfully illustrates the centrality of communication processes in achieving important health-care and health-promotion goals. For example, Gary Kreps and Dan O'Hair (1995) have reported a series of studies showing the influences of communication strategies and programs (introduced at individual, dyadic, group, organizational, and societal levels) on health knowledge, behaviors, and outcomes. Similarly, a study by Sheldon Greenfield, Sherrie Kaplan, and John Ware (1985) has clearly demonstrated the positive influences of increased patient-provider communicative involvement in directing health-care treatment in achieving desired health outcomes. In addition, James Dearing and his colleagues (1996) have illustrated the positive influences of social marketing and diffusion-based communication campaign strategies in encouraging at-risk populations to adopt important health-risk-prevention behaviors. Large-scale longitudinal (multi-year) communication intervention programs, such as the Stanford Five City Heart Health Program and the Minnesota Heart Health Communication Program also demonstrate the positive influences of these campaigns on promoting adoption of lifestyle changes to prevent cardiovascular disease and reducing gaps in public health knowledge. There is great potential for the use of strategic programs in the area of health communication to provide health-care consumers and providers with needed health information and to help address important public health needs.

In response to the growing body of health communication research and intervention work, there is increasing recognition within the academic world and throughout the health-care delivery system that health communication is a most important and relevant area of inquiry for addressing salient health-care and health-promotion issues. This recognition is also occurring in many of the major centers for public health policy (such as the Centers for Disease Control and Prevention, the National Institutes of Health, other agencies of the U.S. Department of Health and Human Services, and the World Health Organization). In fact, the National Cancer Institute (1999), the largest institute in the National Institutes of Health, identified health communication as one of the institute's major areas of research support and investment for reducing the national cancer burden and fighting the war against cancer.

Health communication issues are increasingly a primary topic of large-scale funded research programs sponsored by numerous major foundations, health-care corporations, and government agencies. It is especially common for these organizations to fund the development and implementation of important campaigns for promoting public health and preventing the spread of serious health threats. Increased funding for research has spurred tremendous growth in inquiry, education, and publication in the area of health communication. Similarly, scholarly divisions and interest groups related to health communication have been established in many social scientific professional societies. For example, almost all of the communication discipline's professional associations, such as the International Communication Association, the National Communication Association, the American Public Health Association, and several regional communication societies, have interest groups or divisions devoted to health communication. In addition, there is strong interest in health communication by medical, nursing, pharmacy, and other allied health professions. Health communication is closely aligned with other areas of social inquiry such as health administration, health psychology, medical sociology, and health anthropology. Well-attended scholarly conferences presenting state-of-the-art research and intervention programs for health communication are held on a regular basis, both in the United States and internationally. Indeed, increasing numbers of theses and dissertations written by graduate students concern health communication, and courses in health communication have become standard fare in many undergraduate and graduate communication and public health educational programs across the United States and around the world.

There is no doubt that education and research in the area of health communication is achieving a higher level of disciplinary maturation than ever before—generating stronger scholarly interest, support, and productivity. However, the powerful, complex, and widespread influences of communication on health care and health promotion demand careful examination, leading to the systematic study of health communication. There is still much to be learned about health communication, and there are many areas where knowledge of health communication can be applied to enhancing the quality of public health. As scholarly inquiry in this area grows, new and exciting areas of examination have developed.

Need for Relevant Health Information

Health information is the primary commodity of health communication. Consumers of health care depend on the quality of the health information that they can access to make important health-care choices. There are many different sources of health information available today. In addition to gathering health information directly from their health-care providers, consumers can consult their public libraries (or, if available, a local university or medical library) that have access to reference books, journals, and computerized sources, such as the National Library of Medicine's Medline database. There is a large and growing list of health information services available to consumers via the Internet, which has rapidly become an extremely powerful source of health information for both consumers and health-care providers. However, the sheer number of information sources and the incredible volume of health information that is available today can sometimes overload and confuse consumers.

Consumers can obtain information about specific health-care issues from advocacy groups (e.g., the Alzheimer's Association, the American Cancer Society, and the American Heart Association), health-care delivery centers (e.g., hospitals, clinics, and health maintenance organizations), and research organizations (e.g., the World Health Organization, the Centers for Disease Control and Prevention, and the National Institutes of Health). Government health agencies typically provide excellent, up-to-date information on most serious diseases. For example the National Cancer Institute operates a toll-free telephone information system, the Cancer Information Service, which can be accessed from anywhere in the United States at 1-800-4-CANCER. The hotline operators try to answer any questions about cancer, and they provide referral and treatment information when it is needed. The operators can also have searches conducted on the Physician Data Query database in order to access the latest information about cancer treatment and clinical research that is being conducted.

Health Communication and Health Informatics

One area of tremendous growth in the study of health communication is the way in which computer-based technologies can be used to process and disseminate relevant health information. The dawn of the information-oriented society has spawned a communication revolution in modern health care that has changed the way health care is delivered. Quality health care is closely tied to the widespread availability of health information. Unprecedented levels of health information are now available to both consumers and health-care providers via a broad range of new and more traditional communication channels (e.g., the Internet, interactive CD-ROM programs, television, and different print media).

The use of new communication technologies to process and disseminate health information has spawned an exciting new area of inquiry, health informatics. Health informatics involves the study of computer-based dissemination of information. As information technologies advance, there are a variety of new computer-based tools and media for disseminating and accessing health information. There are also new mechanisms (based on advances in areas such as artificial intelligence and decision sciences) for manipulating, interpreting, and applying health information. Health informatics scholars are interested in studying the ways computer-based information systems can be used to

1. disseminate relevant information to key audiences,
2. increase public knowledge about important health-care treatment and risk prevention issues,
3. promote the adoption of healthy behaviors and lifestyles by the public,
4. facilitate adoption of the best treatment modalities and technologies by health-care providers,
5. encourage collaboration and multidisciplinary consultation in health-care treatment,
6. facilitate, when relevant, patient entry into appropriate clinical trials (controlled scientific studies of new and promising treatment modalities, usually conducted at major medical centers),
7. enhance social support and psychosocial adaptation for health-care consumers and their caregivers.

The widespread availability of relevant and accurate health information offers the great promise of demystifying many of the complexities and uncertainties of health care and the health-care system for consumers, shedding light on health-care processes and treatment strategies that were once only the domain of health-care professionals. Access to relevant and timely health information can help consumers participate fully in health-care decision-making and encourage greater cooperation and collaboration between health-care providers and consumers than ever before. This health information revolution can also help healthcare professionals access state-of-the-art prevention, diagnostic, and treatment information and, through easy contact with other providers, engage in multidisciplinary consultation with other health professionals in coordinating health-care services. New communication technologies have also helped promote increasing use of telemedicine (i.e., health-care services delivered via interactive communication channels such as computer, video, and teleconferencing technologies) to assist consumers in remote and isolated geographic locations. However, on the negative side, this information revolution has also led to a general overload of available health information that is of limited quality and that inevitably serves to confuse and misdirect-health care consumers and providers, thereby decreasing the quality of health-care choices that are made. Scholars of health communication have an opportunity to help promote public health by focusing on the role of information in the modern health-care system. Research on health communication can help to sort out the ways in which communication can most profitably inform consumers and providers about relevant health issues, identify the best ways to develop and present high-quality health information to key audiences, and encourage effective collaborative decision-making in modern health-care efforts.

Major Levels and Areas of Inquiry

There are many important areas of health communication education and inquiry that range from the intrapersonal study of health beliefs and attitudes to the mass-mediated dissemination of health information within and across societies. A good framework for describing the primary levels of the analysis of health communication differentiates between intrapersonal, interpersonal, group, organizational, and societal levels of inquiry. The ability of scholars to examine the influences of communication on health outcomes at multiple levels of interaction occurring within a broad range of social settings clearly illustrates the power and pertinence of inquiry into health communication, yet it also illustrates the complexity of this area of inquiry.

Intrapersonal health communication inquiry examines the internal mental and psychological processes that influence health care, such as the health beliefs, attitudes, and values that predispose health-care behaviors and decisions. Scholars focusing on these intrapersonal issues in health communication often benefit from adopting a psychological frame of reference to their inquiry, examining the ways in which health communicators process information, create meanings, and craft messages. There has been excellent progress in integrating health communication and health psychology scholarship, and there should be further opportunities for collaboration between these interrelated areas of inquiry. Some of the issues scholars might examine from an intrapersonal perspective include the development of unique health beliefs within different cultural groups that influence the health behaviors of individual members of these cultures, the ways in which certain health-related attitudes and values might predispose certain target audiences toward accepting or rejecting advice provided in campaigns for health promotion, and the emotional effects of specific health threats (e.g., breast cancer) and treatment strategies (e.g., radical mastectomy) on healthcare consumers. The intrapersonal perspective on health communication provides unique insights into the personal orientations, expectations, and predispositions held by the different participants in the health-care system and enables health communicators to adjust their messages to these particular psychological variables.

Interpersonal health communication inquiry examines relational influences on health outcomes, focusing on the study of provider-consumer relationships, dyadic (face-to-face) provision of health education, therapeutic interaction, and the exchange of relevant information in health-care interviews. This provocative area of inquiry focuses on the development of cooperative relationships between mutually dependent participants in the modern health-care system, such as the study of provider-patient relations, interprofessional relations among health-care providers, and multicultural relations within the health-care system. Relationship development is a complex social process that develops incrementally as relational partners exchange messages and get to know one another. The stronger the interpersonal relationships that health-care participants can develop with one another, the more likely they are to develop trust in one another, share relevant health information, and work cooperatively during challenging, complex, and sometimes even tense situations.

Relationship development is very important to health-care delivery, from the point of view of both the provider and the consumer. Health-care providers need to encourage their patients to trust them, provide them with full information about symptoms and past health behaviors, listen carefully to instructions and to provide informed consent explanations (in which health-care providers are legally required to explain the costs and benefits of alternative treatments and identify the relative implications of the treatment strategies that are recommended), and to follow carefully the treatment protocols that are prescribed for them. Health-care consumers depend on relationship development to gain the trust and concern of their providers, to gather full information from providers about treatment options, and to encourage providers to allow them to participate actively in making important treatment decisions.

The interpersonal perspective has been a dominant area of health communication inquiry over the years, focusing directly on important healthcare delivery issues. It is a complex area of study, with many different personal, psychological, cultural, linguistic, and nonverbal variables at play. Care must be taken when studying interpersonal aspects of health communication to address fairly the important cultural, political, and power issues that underlie interpersonal relations in the delivery of health care.

Group health communication inquiry examines the role communication performs in the interdependent coordination of members of collectives (e.g., health-care teams, support groups, ethics committees, and families) as the group members share relevant health information in making important health-care decisions. Healthcare teams are comprised of specialists from different professional backgrounds (e.g., medicine, pharmacy, nursing, therapy) who work together to help plan and implement complex treatment strategies for the same patient. As specialization of services and technologies continues to increase, there is a growing dependence on health-care teams in the delivery of modern health care, as well as growing interdependence among the different members of these health-care teams. However, due to differences in professional knowledge, specialization, and orientation toward the consumer's health care, it is common for differences of opinion to emerge between members of healthcare teams. These differences of opinion, while sometimes uncomfortable for team members to deal with, can be very useful, because they highlight different aspects of health care that all members of a team may not have been aware of. By sharing such information, the team can make more informed choices about treatment strategies. It is important, though, for team members to be willing to accept points of view that are different from their own and to use group communication effectively to work through conflict and make good health-care decisions.

There are many difficult ethical issues concerning quality of care, access to care, consumer dignity, and end-of-life issues that have led to the widespread use of ethics committees in healthcare systems to ensure that fair and moral choices are made in health care. (These committees also help guard health-care systems from legal problems and litigation claims.) Ethics committees are often comprised of different health-care professionals, religious leaders, bio-ethicists, health-care administrators, lawyers, and concerned lay individuals (often representing the consumer or a consumer advocacy group). These individuals meet to communicate about complex ethical choices that often have to made in health-care systems, such as who among many applicants should get access to specialized, yet limited, treatment equipment and resources (e.g., organ transplants). Group communication among the members of these ethics committees is the primary process by which ethical decisions are reached.

The growing complexities of modern healthcare delivery, with new diagnostic tools and sophisticated treatment technologies and strategies, demand greater input from groups of individuals to make difficult and challenging health-care decisions. Interdependent health-care providers, administrators, and consumers must learn how to share relevant information and coordinate efforts in group settings. Because communication performs such important functions in group coordination and information exchange, a communication perspective is particularly appropriate for the study of health-care teams, ethics committees, and other decision-making groups.

Organizational health communication inquiry examines the use of communication to coordinate interdependent groups, mobilize different specialists, and share relevant health information within complex health-care delivery systems to enable effective multidisciplinary provision of health care and prevention of relevant health risks. With the rise of managed care, the delivery of health-care services has become increasingly controlled by financial and bureaucratic concerns. There is growing frustration among many consumers about the quality of care they receive and their ability to participate actively in making important healthcare decisions. There are many important opportunities for scholars in the area of health communication to examine ways to promote greater receptivity, flexibility, and sensitivity toward consumers within the increasingly complex and highly regulated modern health-care system.

Communication between different interdependent departments in health-care systems is crucial for coordinating health-care efforts. For example, in-patients receiving treatment in hospitals are housed within specific hospital wards, yet they are often sent to different departments (e.g., radiology, surgery, therapy) for treatment. It is important for these departments to share information about the consumers they serve, to keep track of the consumers' needs and activities as they move through the hospital, and to coordinate the care of these patients. Organizational communication tracks the ways these departments share information, coordinate activities, and adapt to each other as they share the accomplishment of organizational goals.

Societal health communication inquiry examines cultural influences on health care and the generation, dissemination, and utilization of health information communicated via diverse media to the broad range of professional and lay audiences in society that influence health education, promotion, and health-care practices. Social marketing has been widely adopted by communication scholars as an important strategic framework for designing sophisticated campaigns of health promotion. In the past, research focusing on societal inquiry was conducted primarily by communication scholars who specialized in media studies and examined the ways that various media can deliver messages on health promotion and risk prevention to targeted audiences. However, as efforts at health promotion have become more and more sophisticated, using multiple message strategies and delivery systems, there are increasing opportunities for greater participation by communication scholars (and others) with expertise in analyzing the intrapersonal, interpersonal, group, and organizational levels of health communication.

Health Communication Channels

Inquiry into health communication also involves examination of many communication channels. Face-to-face communication between providers and consumers, members of health-care teams, and support group members are the focus of many studies. A broad range of both personal communication media (e.g., telephone, mail, fax, e-mail) and mass communication media (e.g., radio, television, film, billboards) are also the focus of much research. More and more, the new communication technologies that have developed have been examined as important media for health communication. These new media, especially the interactive computer technologies and the Internet, have become increasingly important sources for relevant health information and support for many consumers and health-care providers. For this reason, they will be a most promising topic for future research.

Settings for Health Communication

The settings for the study of health communication are quite diverse and include the wide range of settings where health information is generated and exchanged, such as homes, offices, schools, clinics, and hospitals. Scholars of health communication must be aware of the widespread nature of health communication so they can design and conduct studies in many diverse field settings. Research has examined such diverse issues as the role of interpersonal communication in developing cooperative provider-consumer relationships, the role of comforting communication in providing social support to those who are troubled, the effects of various media and presentation strategies on the dissemination of health information to those who need such information, the use of communication to coordinate the activities of interdependent health-care providers, and the use of communication for administering complex health-care systems. Since the study of health communication encompasses such a broad range of media, channels, levels, and settings, it is a convergent research area that benefits from the work of scholars representing multiple research traditions, disciplines, methodologies, and theoretical perspectives. Indeed, health communication is a "transdisciplinary" area of inquiry, attracting researchers who represent multiple related social scientific, humanist, and technical disciplines and conduct research that focuses on a diverse set of health issues in a broad range of health-care settings.

Conclusion

Health communication is an exciting multifaceted area of applied communication inquiry that examines the role of messages, message exchange, and information about health care and health outcomes. Evidence suggests that communication plays extremely important functions in health care and health promotion. Future study of health communication will help identify the primary communication mechanisms that are at work in modern health care and health promotion, thereby guiding effective and strategic use of communication by health-care consumers and providers. Knowledge about the role of communication in health care, coupled with the skills to access and share relevant health information effectively, will help both consumers and providers get the most out of the modern health-care system.

See also:Group Communication; Health Communication, Careers in; Interpersonal Communication; Organizational Communication; Provider-Patient Relationships; Public Health Campaigns.

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Gary L. Kreps