Cover page

Table of Contents

Cover

Title page

Copyright page

Part I: Introduction

Chapter 1 Overview of Communication and Health

Arguments for the Need to Study Health Communication

Defining Health Communication

A Brief History of Health Communication Research

Current Challenges to the Healthcare System and the Role of Health Communication Research

Overview of the Book

Summary

Part II: Interpersonal Perspectives

Chapter 2 Provider–Patient Communication

Provider and Patient Views of Health and Healthcare

Provider Perspective

Patient Perspective

Provider–Patient Interaction

Improving Provider–Patient Communication

Outcomes of Provider–Patient Communication

Communication and Medical Malpractice Lawsuits

Other Challenges of Provider–Patient Communication

Summary

Chapter 3 Caregiving and Communication

Caregiving

Hospice and Palliative Care

Older Adult Health Concerns and Communication Issues

Attitudes Toward Death and Dying

Summary

Part III: Social, Cultural, and Organizational Contexts

Chapter 4 Social Support and Health

History of Social Support and Health Research

Types and Functions of Social Support

Models of Social Support and Health

Perceptions of Support Providers

Strong Tie Versus Weak Tie Support Networks

The Role of Communication in the Social Support Process

Communication within Social Networks, Social Support Processes, and Health

Support Groups for People with Health Concerns

Communication Processes within Support Groups

Support Group Participation and Health Outcomes

Social Support Interventions

Summary

Chapter 5 Culture and Diversity Issues in Healthcare

Patient Diversity and Issues with Healthcare

Cultural Differences in Concepts of Health and Medicine

Recognizing Cultural Diversity in Health Beliefs

Alternative Medicine

Spirituality, Culture, and Health

Social Implications of Illness

Changing Social Perceptions of Stigmatized Health Issues through Communication

Culturally Centered Health Campaigns

Provider Diversity

Summary

Chapter 6 Communication and Healthcare Organizations

Healthcare Organizations as Systems

Types of Healthcare Organizations

Communication within Healthcare Organizations

Healthcare Organization Culture

Influences on Healthcare Organization Communication

Provider Stress, Conflict, and Support within Healthcare Organizations

Summary

Part IV: Influences of Technologies and Media

Chapter 7 New Technologies and Health Communication

Health Information on the Internet

New Technologies and Patient–Patient Communication

New Technologies and Provider–Provider Communication

New Technologies and Provider–Patient Communication

New Technologies and Health Campaigns

Summary

Chapter 8 Mass Communication and Health

Two Perspectives of Media Influence

Needs Fulfilled by the Mass Media Concerning Health

Media Usage, Health Portrayals, and Health Behaviors

Health News Stories in the Media

Summary

Part V: Risk, Campaigns, Communities, and Teams

Chapter 9 Risk and Crisis Communication

Defining Risk Communication

Global and Large-Scale Health Threats

At-Risk Communities within the United States

Communication Strategies for Addressing Health Risks

Community-Based Health Initiatives for At-Risk or Marginalized Populations

Risk Communication Strategies at the Provider–Patient Level

Summary

Chapter 10 Health Campaigns and Community Health Initiatives

Campaign Goals

Theoretical Approaches to Health Campaigns

The Process of Conducting a Health Campaign

Formative Campaign Evaluation

Summary

Chapter 11 Interdisciplinary Healthcare Teams

Diversity of Healthcare Professionals

Importance of Interdisciplinary Teams

Continuum of Healthcare Teams

Model of Synergistic Healthcare Teams

Summary

Part VI: Contexts, Challenges, and Choices

Chapter 12 Political Issues and Health Communication

Politics and Health Communication

Message Framing Theory and Political Communication

Current Political Issues Surrounding Health and Healthcare

Health Literacy

Health Stigma, Discrimination, and Politics

The Medical Marijuana Debate

The Politics of Life and Death

Right to Life Issues in the Media

The Politics of Nutrition

International Health Communication Issues

Summary

Chapter 13 Epilogue: Looking Toward the Future of Health Communication Research

Emerging Trends and Challenges in Health and New Communication Technologies

Emerging Trends and Challenges in Communication and Mental Health Issues

Emerging Trends and Challenges in Intercultural Health Communication

Emerging Trends and Challenges in Risk/Crisis Communication

Ongoing Theoretical, Methodological, and Dissemination Issues Surrounding Health Communication Research

Summary

Index

Title page

Part I

Introduction

Chapter 1

Overview of Communication and Health

This second edition of Health Communication in the 21st Century provides an in-depth look at one of the fastest growing and pragmatic areas of research in the communication discipline: health communication. Most people would agree that our health and our ability to communicate are two central and very important aspects of human life. Yet, at some point in your study of communication, you may be asked the same thing that family members and friends frequently ask us: What exactly is health communication? Many people do not understand how the concept of health is related in any way to the term communication. For most people, the term health conjures up images that seem to have little or nothing to do with communication, including doctors, laboratory tests, waiting rooms, dieting, and exercise regimes. Moreover, the term communication is usually associated with things like interpersonal relationships, the Internet, and radio and television.

However, as we will see throughout this book, many different aspects of health and a variety of communication processes are intertwined in complex and interesting ways. We will examine many contexts of communication and communication-oriented topics, including communication and perceptions of health, provider–patient relationships, everyday relationships and physical health, communication networks within health organizations, intercultural communication and health beliefs, health risk messages, health campaign message design and dissemination, health information and images in the mass media, and the use of new communication technologies in healthcare. We hope that as you read this book you will be excited and intrigued by the rich perspective the study of health communication can bring to our everyday understanding of health and healthcare.

Arguments for the Need to Study Health Communication

Despite vast improvements in public health and healthcare in the US and worldwide over the last century, we still have a long way to go in terms of making our society and the world a healthier place. Within the US, we currently spend over one trillion dollars a year on healthcare services, making it the leading sector of the US economy (US Census Bureau, 2005). However, a wide variety of problems still exist in terms of our nation’s ability to provide adequate care for everyone and in terms of maximizing efforts to prevent and control diseases and other health problems. It appears that the severity of many of these problems could potentially be reduced by improving communication among providers, between providers and patients, between health researchers, and between public health leaders and the public.

One-half of all deaths in the US can be attributed to preventable behavioral and social factors, such as unhealthy diets, smoking, alcohol use, and inadequate exercise (Neuhauser & Kreps, 2003). Over 60 percent of Americans are overweight and only 24 percent engage in moderate physical exercise on a regular basis (Neuhauser & Kreps, 2003). Current disease screening is inadequate. Cancer mortality rates alone could be reduced by 60 percent if people were to follow early detection recommendations (Willett, Colditz, & Mueller, 1996). Cancer is still one of the most significant health challenges facing society, and the second leading cause of death in the US (American Cancer Society, 2006). A lack of health maintenance behaviors among people who are currently living with a disease has been found to be significantly related to mortality rate. For example, one study found that only 30 percent of hypertensive men act to control their high blood pressure (US Department of Health and Human Services (USDHHS), 1999). In addition, there have been relatively few studies of how to improve the quality of life among people living with disease, such as cancer and HIV survivors, especially the ways in which communication processes and practices may help people to cope with living with disease (Kreps, 2003a).

In terms of health promotion, a large portion of health campaigns have not led to substantial health behavior change among members of the US population (Snyder & Hamilton, 2002). For example, health campaign designers spent millions of dollars on California’s 5-a-day campaign, which was designed to raise people’s awareness of the benefits of eating more fruits and vegetables. While the campaign was successful at raising people’s awareness of the issue, researchers found that relatively few people actually increased their consumption of fruits and vegetables following the campaign (Foerster & Hudes, 1994).

Worldwide, we see a number of health issues that are directly and indirectly related to communication. Global issues such as lack of access to adequate healthcare, war, poverty, hunger, environmental injustice, and lack of education about health issues continue to pose problems for people around the world. Unfortunately, many of these issues have had the greatest impact in underdeveloped countries and among the underserved populations. In Africa, for example, over nearly 25 million people are living with HIV/AIDS, and over 6 million are living in Asian countries (Joint United Nations Program on HIV/AIDS, 2004). More recent issues, such as avian flu and terrorism, present health communication researchers with numerous challenges in terms of finding ways to best communicate information about health risks and in terms of coordinating efforts to cope with these types of crises after they occur.

Health communication researchers are currently working to better understand these issues so that they can offer suggestions for improvement. While communication issues may not account for all of the problems mentioned above, it is clear that communication is an important underlying factor for most of them. A better understanding of how communication is related to these and other health problems may ultimately help to reduce incidents of disease, human suffering, and mortality rates while increasing physical and psychological well-being and satisfaction with healthcare among members of society. The chapters in this book examine multiple ways in which a better understanding of health communication in a variety of contexts, including relationships, organizations, and the mass media, can improve health outcomes.

Defining Health Communication

Despite the fact that we all have ideas about what it means to be healthy or ill, the term health is a complicated concept to define, due to multiple interpretations based on individual experience and culture. The World Health Organization (WHO) defines health as a “state of complete physical, mental and social well-being” (cited in Costello, 1977, p. 558). Moreover, the WHO definition conceptualizes health and disease as dynamic processes as opposed to stable entities. In other words, both health and disease are seen as being in a constant state of change. This definition also recognizes that health goes beyond physical and psychological health to include aspects such as a person’s quality of life. As we will see in this book, a variety of communication problems can occur in healthcare settings due to different conceptions of health and disease.

Defining communication presents similar challenges. Most definitions of communication view it as a process that involves a sender, a receiver, a message, and a channel. However, a variety of issues, such as the ability of multiple messages to be communicated simultaneously through both verbal and nonverbal channels, the transactional nature of communication (when sender and receiver mutually influence one another), physical and psychological noise in the channel, channel limitations on multiple senders and receivers, and many other facets of the communication process, make it difficult to define.

If you are a communication major, then you may have noticed that communication courses typically focus on one context of communication (e.g. interpersonal or mass communication). Health communication research encompasses many different contexts of communication. For example, researchers who study health communication from an intrapersonal communication perspective tend to focus on people’s attitudes, beliefs, values, and feelings about health-related concepts and messages. Interpersonal health communication scholars tend to focus on relationships, such as those between providers and patients, or they study how everyday relationships (i.e. family members, co-workers, and friends) impact our health.

Other health communication scholars examine health from an organizational standpoint, and they tend to focus on features of the health organizations such as hierarchies, information flow in organizations, and employee–management relationships. Intercultural health communication scholars tend to focus on the unique role that culture plays in terms of how people understand health and illness as well as how intercultural differences affect healthcare relationships. A large number of health communication scholars focus on social influence and they devote their efforts to understanding how health messages and campaigns can be improved in terms of leading to health behavior changes for large groups of people. Many health communication researchers are interested in the role of the mass media in helping to shape our understanding of specific health-related issues and our more general conceptions of health and illness. Finally, a growing number of health communication researchers are interested in the role that new technologies play in disseminating health information, facilitating relationships among people who share similar health conditions, and improving communication between providers and patients and within health organizations.

A Brief History of Health Communication Research

Although the term health communication has only been around since the mid-1970s (Atkin & Marshall, 1996; Rogers, 1996), communication scholars have taken a scientific approach to studying communication within health contexts for decades. Prior to the formation of the communication discipline in the 20th century, the US has had a rich history of communication campaigns addressing a variety of health issues, such as alcohol abuse, smallpox, improper handling and storage of food, and inadequate healthcare for underserved populations (Paisley, 2001). According to Thompson, Robinson, Anderson, and Federowicz (2005), research in the area of health communication has grown exponentially over the last 30 years. This growth has not only occurred in the US, but can also be seen in the work of scholars from around the world, including researchers from the eastern European/Scandinavian countries, Australia/New Zealand, Asia, and the UK. Organizations such as the European Association for Communication and Healthcare now publish the journal Patient Education and Counseling, and it sponsors a conference every two years that attracts interdisciplinary health communication researchers from all over the world.

Scholars in the social sciences who were interested in the study of communication began to examine the healthcare system in the late 1960s, which encouraged communication scholars to follow. Korsch and Negrete’s (1972) “Doctor–Patient Communication,” published in Scientific American, is still regarded as a foundation of the field (Thompson et al., 2005). Much other work came from medical researchers, influencing the study of provider–patient interactions in particular. In 1972 a group of scholars with backgrounds in communication formed the Therapeutic Communication interest group of the International Communication Association (ICA), which was renamed the Health Communication Division in 1975 (Thompson et al., 2005).

The formation of this area provided the earliest forum for the presentation of research on health communication. When ICA began publishing annual reviews in Communication Yearbook, there were many chapters on health communication that began defining and showcasing the field. The Commission on Health Communication of the Speech Communication Association (later renamed the National Communi­cation Association) was formed in 1985, further indicating the growth of work in this area. These developments were followed by numerous conferences and mini-conferences focusing on health communication, including those held at the University of Kentucky.

This widespread interest in health communication led to the creation of two important publication outlets for health communication researchers. The first issue of the journal Health Communication appeared in early 1989. This was followed in 1996 by the Journal of Health Communication. These publications played an instrumental role in helping to spur the growth of health communication as an area by disseminating health communication research to a wider audience within and outside of the communication discipline.

At the same time that these developments were taking place, important curricular growth was being observed in health communication courses at universities around the world. Many universities now offer programs focusing primarily on health communication and others have strengthened and expanded their health communication offerings. Funding opportunities have increased. Health communication scholars have moved into important policy and administrative positions within the Centers for Disease Control, the National Cancer Institute, and the National Institute for Drug Abuse.

The area of health communication is now widely recognized as vibrant, theoretically driven, pragmatic, and a key contributor in shaping national health policies (Kreps, 2003b). The research in health communication has always focused on real-world, significant problems, not “ivory tower” concerns that are sometimes seen in academia, and this is still the case today. According to Atkin and Marshall (1996):

This specialization has grown rapidly in response to growing pragmatic policy interests, particularly in the public health agencies of the federal government and among private sector healthcare providers. Pressing needs to address alarming problems such as smoking, substance abuse, poor nutritional habits, and AIDS have given a strong impetus (and expanded funding) to the systematic study of communication processes and effects. (p. 479)

The many opportunities for researchers to address real-world health concerns make health communication an exciting area to study. Health communication scholars have had a rich history of conducting research outside of the academic setting. In fact, many of the health communication research studies you will read about in this book were interventions designed to improve physical and mental health outcomes in a number of contexts, such as health campaigns, provider–patient relationships, organizations, and the use of new technologies in healthcare.

The area of health communication continues to grow and diversify. New areas of research have expanded health communication into health domains that many people in the communication discipline probably did not consider 30 years ago, such as hospice and palliative care, spirituality and health, on-line support groups, and telemedicine. However, a number of health communication topics have remained as prominent themes in the health communication literature over the past 30 years. According to Thompson et al. (2005), in an analysis of the topics that appeared in the journal Health Communication between 1989 and 2003, over 20 percent of the articles have dealt with provider–patient interaction, followed by health campaigns (13.4%), risk communication (11.8%), health and aging (8.4%), language and health (7%), media (5.9%), and social support and health (4.3%).

Many of the prominent theories that are still used in the area of health communication have their origins in communication, social psychology, and anthropology (Atkin & Marshall, 1996). This reflects the ways in which theory has developed in the various contexts of health communication research. For example, several theories of provider–patient interaction have their roots in interpersonal communication research, a number of the theories used to understand intercultural health issues have their origins in anthropology, and many of the theories of social influence that are associated with health campaigns have been borrowed from social psychology. As we will see, communication scholars are continuing to refine these earlier theories as well as developing new health communication theories.

Current Challenges to the Healthcare System and the Role of Health Communication Research

There are a number of other current issues that may challenge the US healthcare system in the future. This section presents a brief overview of some of the most prominent issues affecting healthcare within the US, and some of the ways in which health communication research can make a difference.

Aging Population

The next several decades will witness a substantial increase in older adults within the US. As we will see, while age by itself is not necessarily predictive of illness, health problems do tend to occur more frequently as we age. Unfortunately, our healthcare system still suffers from a number of communication-related problems when it comes to providing care to older patients. In terms of physician training, geriatrics is still a subspeciality of family medicine, and other issues, such as negative stereotypes of older patients, misunderstandings about the aging process, and health insurance needs of older people, will likely present numerous challenges to the healthcare system. There is a substantial need for health communication researchers to gain a better understanding of health issues associated with our aging population and for the development of interventions that can make a positive impact on this situation.

Cultural Diversity and Healthcare

Cultural diversity will continue to have a major influence on our healthcare system as people from cultures that have very different perceptions of illness, health, and healthcare immigrate to the US. As we will see, some cultural belief systems regarding health can be at odds with more mainstream conceptions of health, causing problems for both patients and providers. In addition, within the US, there are many different co-cultures based on ethnicity, region, and socioeconomic status. Culture is often related to health disparities, access to healthcare services, and health literacy, which puts many groups within the US at greater risk for health problems. Health communication scholars are attempting to gain a better understanding of how intercultural differences impact health and healthcare. In addition, many health communication scholars are researching ways that health communication problems based on intercultural differences can be improved as well as ways in which health disparities can be reduced.

Tension Between Traditional and New Approaches to Healthcare

Healthcare providers have followed a number of traditional approaches to healthcare that have been challenged in recent years, and the tension between advocates of these approaches and people who favor new ways of thinking about healthcare will likely continue in the future. For example, physicians and other healthcare providers have traditionally been trained to follow the biomedical model of medicine (Schreiber, 2005; Tyreman, 2006). This is an evidence-based (and largely physical health-oriented) approach to medicine that relies on scientific methods and procedures for verifying disease, such as laboratory tests (Tyreman, 2006). While the strength of this approach lies in its ability to accurately pinpoint causes of symptoms (which also aids in selecting the appropriate treatment), it is not without its limitations. By focusing primarily on physical causes of illness, the biomedical approach does not always take into account psychosocial aspects of illness, such as cultural norms, coping abilities, and life events that may interact with physical health problems. Allegiance to this approach may result in a number of problems, including failure to recognize how features of a patient’s day-to-day world (such as cultural beliefs, support networks, and financial status) may lead to their inability to comply with recommended treatments. In addition, conditions that do not necessarily have a clear biological cause (e.g. chronic fatigue syndrome) may be dismissed by providers who follow this approach.

Other traditional approaches to healthcare include a curative approach to fighting disease. While most people would agree that using available medications and procedures that can save a person from suffering or death are beneficial, the nature of illness makes this a more complicated issue. With many diseases, such as cancer, chemotherapy and other curative treatments may only temporarily fight the disease. More­over, these approaches have negative implications for a patient’s quality of life (e.g. sickness from chemotherapy, loss of hair from radiation treatment, time spent in the hospital while recovering from surgery). In many cases, a person who does not have long to live due to a terminal illness may spend his or her days in the hospital, sick, embarrassed, or in pain rather than spending quality time with family and friends. As a result, in recent years, we have seen a greater interest in homeopathic and other alternative treatments to fighting disease that have fewer side effects than traditional medications. In addition, there has been a rising interest in palliative care, or an approach to medicine that emphasizes reducing pain and suffering among terminally ill patients as opposed to prolonging life at the expense of sickness, pain, embarrassment, and time away from loved ones. As you can imagine, there are many differences of opinion on what is best for the patient when dealing with these issues, and these debates are likely to continue in the future. Health communication researchers will continue to play an important role in examining how people often view illness and treatment differently, in providing evidence for the benefits of alternative approaches to medicine, and as advocates for alternative ways of understanding illness and treatment.

Funding for Health Research

Since September 11, 2001 and the continued threat of terrorist attacks, funding for a variety of healthcare initiatives has been reallocated to the War on Terror. While curtailing terrorist threats is certainly related to our physical and psychological health, the costs of fighting terrorism are substantial. As a result, money that was once allocated to government agencies such as the Department of Health and Human Services, which provides money for research to such organizations as the National Institutes of Health and the Centers for Disease Control and Prevention, has been diverted to the Department of Homeland Security. This funding is important in order to gain a better understanding of health problems and develop healthcare interventions for important underserved populations within the US. The threat of terrorism will likely continue to impact funding for healthcare research in the future. Health communication scholars play an important role as advocates for health research funding and in providing scientific evidence for the key role of communication in improving health outcomes. Such efforts are needed to insure that government funding of research in this area continues.

Changes to Health Insurance and Managed Care

The rising cost of health insurance and health services will likely continue to have a substantial impact on consumers in the coming years. Healthcare organizations are always trying to find innovative ways to reduce the cost of healthcare services (which ultimately influences the cost of healthcare insurance). Health communication researchers have discovered that many costly problems, such as high provider turnover rates, are often related to communication problems. As a result, health communication researchers have developed interventions designed to ameliorate these problems and reduce costs that are ultimately passed along to consumers. However, much more research is needed to discover how communication interventions can be used to make healthcare organizations more efficient, helpful, and satisfying for patients.

The Impact of New Technologies on Healthcare

In recent years, the widespread adoption of computers, new software programs, the Internet, and other new technologies (e.g. cellular technology, global satellite positioning chips) has led to a variety of changes in communication within the healthcare system, the ways in which people obtain health information, and the ways in which they communicate about health in daily life. Communication technologies will likely continue to develop and significantly impact the ways in which we communicate about health. At no other time has health information been more accessible to people due to the advent of the Internet. However, not all people have access to this technology, the skills to use it, or the ability to interpret the available health information. The Internet has also become an important channel for providers to communicate with other providers, as a source of social support for patients, and as a means for health campaign designers to reach large numbers of individuals with unique health-oriented messages due to the features of this new medium (e.g. interactivity, multimedia, and the ability to use the computer to tailor health messages). Health communication researchers will continue to play a crucial role in examining the benefits and limitations of these technologies.

Overview of the Book

This second edition of the book provides expanded coverage of issues in all of the chapters based on recent developments in the growing body of health communication research. In addition to this expanded coverage, we also added an additional chapter (Chapter 12) on political issues and health communication. The following section provides a description of each chapter and it highlights new areas of research that we cover in this edition.

Chapter 2 examines key issues and theories related to provider–patient interaction, including patient information and affective needs, communication skills training for providers, patient/provider differences in perspective of health, barriers to effective provider–patient communication, communication issues related to medical malpractice and dissatisfaction, and privacy issues in provider–patient communication.

Chapter 3 explores a number of communication issues and theories related to caregiving, including communication needs of patients and caregivers, hospice and palliative care, and communication issues related to end-of-life decision-making, death, and dying.

Chapter 4 provides an in-depth look at social support theories and processes as they relate to health. It examines dilemmas of social support and the relationship between support and health outcomes, and it takes an in-depth look at research on support groups for people coping with various types of health issues.

Chapter 5 examines cultural differences in beliefs about health and healthcare and different cultural healthcare practices within the USA, integrating intercultural communication theories and intergroup theories. The chapter also examines topics such as homeopathic approaches to healthcare and spirituality and health.

Chapter 6 explores health organizations from the standpoint of organizational communication theory. The chapter focuses on issues such as the flow of information in organizations, the history and influence of managed care, the interrelationships of multiple organizations in the allied health professions, and current issues facing healthcare organizations.

Chapter 7 looks at the growth and application of new communication technologies in healthcare settings. It examines a variety of topics, such as telemedicine, provider and patient use of the Internet for health information, electronic records, computer-mediated support groups, and the use of new technologies to tailor and disseminate health campaign messages.

Chapter 8 focuses on the role of the mass media in influencing our health beliefs, attitudes, and behaviors. It discusses theories about the influence and uses of mass media. It explores topics such as the relationship between mass media messages and lifestyle choices, the mass media and health policy, and direct-to-consumer advertising.

Chapter 9 provides an introduction to theory/research in the area of risk communication. In addition, the chapter discusses current issues such as responding to terrorism and natural disasters, and various approaches to campaigns designed to target at-risk populations.

Chapter 10 examines health communication campaigns. It introduces a number of social influence theories related to the design and implementation of health campaigns. In addition, it focuses on mediated and interpersonal approaches to health campaigns, message design issues, and campaign evaluation.

Chapter 11 looks at theories of teamwork and group communication as they relate to healthcare teams. In addition, it focuses on interdisciplinary healthcare teams, leadership, and problems that can occur in healthcare group decision-making.

Chapter 12 examines the growing area of political issues and health communication. It provides an overview of recent health-related issues that have appeared in the political arena, including the healthcare reform debate, stem cell research, right to life issues, factory farming and nutrition, medical marijuana, and a host of other issues. Specifically, the chapter explores the role of media in political discussions and focuses on framing theory. In addition, it examines health disparities and access to healthcare issues, health-related stigma and discrimination, and the politics of global health problems.

Chapter 13 highlights a number of promising areas of health communication research that will likely be research trends in the future. Specifically, it focuses on a variety of topics, such as media convergence and self-care, mental health issues, emerging trends in intercultural health communication, research, and developments in risk/crisis communication research. Moreover, the chapter will briefly discuss some of the limitations to current health communication research.

Summary

Health communication is a vibrant and growing area of the communication discipline. In addition, researchers from other disciplines, such as medicine, public health, psychology, and business, are making significant contributions to our knowledge of this area. While health communication has been a defined area of academic research for only about 30 years, the US has had a rich history of addressing public health issues. However, statistics dealing with disease incident rates, patient dissatisfaction with healthcare, and the failure of many health campaigns to significantly impact health outcomes point to the need for health communication research in the future. People who are interested in a variety of contexts of communication are attracted to the area of health communication, particularly because of the ability to address significant real-world problems. Despite advances in health communication over the last three decades, there are a number of current issues that will likely pose problems for the healthcare system in the future. Health communication researchers are in a unique position to find ways to confront these issues and ultimately make improvements to the healthcare system and health outcomes.

References

American Cancer Society (2006). Cancer statistics. Retrieved January 23, 2006, from www.cancer.org.

Atkin, C., & Marshall, A. (1996). Health communication. In M. B. Salwen & D. W. Stacks (Eds), An integrated approach to communication theory and research (pp. 93–110). Mahwah, NJ: Lawrence Erlbaum.

Costello, D. E. (1977). Health communication theory and research: An overview. In B. D. Ruben (Ed.), Communication yearbook I (pp. 557–568). New Brunswick, NJ: Transaction Books.

Foerster, S. B., & Hudes, M. (1994). California dietary practices survey: Focus on fruits and vegetables, trends among adults, 1989–1993, topline report. Sacramento, CA: California Department of Health Services and California Public Health Foundation.

Joint United Nations Program on HIV/AIDS. (July, 2004). 2004 report on the global AIDS epidemic. Retrieved August 28, 2004, from www.unaids.org/.

Korsch, B., & Negrete, F. (1972). Doctor–patient communication. Scientific American, 227, 66–74.

Kreps, G. L. (2003a). The impact of communication on cancer risk, incidence, morbidity, mortality, and quality of life. Health Communication, 15, 161–169.

Kreps, G. L. (2003b). Opportunities for health communication scholarship to shape public health policy and practice: Examples from the National Cancer Institute. In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds), Handbook of health communication (pp. 609–624). Mahwah, NJ: Lawrence Erlbaum.

Neuhauser, L., & Kreps, G. L. (2003). Rethinking communication in the e-health era. Journal of Health Psychology, 8, 7–23.

Paisley, W. J. (2001). Public communication campaigns: The American experience. In R. E. Rice & C. K. Atkin (Eds), Public communication campaigns (3rd ed., pp. 3–21). Thousand Oaks, CA: Sage.

Rogers, E. M. (1996). The field of health communication today: An up-to-date report. Journal of Health Communication, 1, 15–23.

Schreiber, L. (2005). The importance of precision in language: Communication research and (so-called) alternative medicine. Health Communication, 17, 173–190.

Snyder, L. B., & Hamilton, M. A. (2002). A meta-analysis of US health campaign effects on behavior: Emphasize enforcement, exposure, and new infor­mation, and beware the secular trend. In R. C. Hornik (Ed.), Public health communication: Evidence for behavior change (pp. 357–383). Mahwah, NJ: Lawrence Erlbaum.

Thompson, T. L., Robinson, J. D., Anderson, D. J., & Federowicz, M. (2005). Where have we been and where can we go? In K. B. Wright & S. C. Moore (Eds), Applied health communication: A sourcebook. Cresskill, NJ: Hampton Press.

Tyreman, S. (2006). Causes of illness in clinical practice: A conceptual exploration. Medicine, Health Care and Philosophy, 9, 285–291.

US Census Bureau. (2005). Healthcare and social assistance industry data. Retrieved July 23, 2012, from www.census.gov/econ/www/servmenu.html.

US Department of Health and Human Services (USDHHS) (1999). Health people 2000, progress review: Heart disease and stroke. Bethesda, MD: Department of Health and Human Services.

Willett, W., Colditz, G., & Mueller, N. (1996). Strategies for minimizing cancer risk. Scientific American, 275, 325–333.

Part II

Interpersonal Perspectives

Chapter 2

Provider–Patient Communication

Chances are you have had an experience similar to the following when visiting the doctor. You arrive 30 minutes early for your appointment for a persistent cough, and fatigue, and find that you have to wait 30 minutes in the waiting area for a nurse to bring you into an examination room where you have to wait another 10 minutes for the doctor to arrive. Finally, the doctor arrives, briefly listens to your lungs, and asks you only a few questions before calling in the nurse to give you a prescription for some antibiotics. You might feel that the doctor did not spend as much time as you would have liked him or her to spend with you, or perhaps you had questions about whether or not you were contagious, questions about the prescription, or how long your symptoms might last. Maybe you did not get the opportunity to voice your concerns about how frequently you have been sick lately, or you never got an opportunity to ask the doctor for a note for your boss verifying that you are sick. You may have left the doctor’s office feeling unsatisfied with the visit because you were still uncertain about what caused you to be sick, what to expect in terms of getting better, or because he or she did not meet your other needs. Research indicates that communication interventions to improve quality of care should target both providers and patient communicative behaviors (see e.g. Epstein et al., 2007; Sparks, 2007, 2008; Sparks & Villagran, 2010). Research reveals physicians who are more patient-centered are perceived as better communicators, resulting in more satisfied and compliant patients (Street, Gordon, & Haidet, 2007).

The reality for most doctors and patients is that the fear, dread, and terror that can accompany certain diagnoses (such as cancer or HIV) require a greater emphasis on communication processes to combat the uncertainty and negativity greatly affecting an individual’s cognitive and emotional capacity in ways never before experienced (Sparks & Villagran, 2010). Open, honest, communication between providers and patients can be a valuable weapon against the assault on self-identity that often accompanies a negative diagnosis. Communication becomes more important as cognitive, affective, and behavioral responses to illness intersect with biological problems that patients must face and overcome (Villagran & Sparks, 2010). Negative experiences such as these that you may have had with your doctor or other healthcare providers are often due to a variety of communication problems that commonly occur within healthcare settings. While it might be easy to blame providers in these cases, it is important to remember that communication problems are rarely one-sided, and there may have been a variety of reasons for them. Communication between providers and patients can potentially lead to successful health outcomes and improved quality of life, or it can create major problems for both providers and patients depending upon how it is handled. Many patients feel that their doctors do not listen to them, they are controlling, or they are not sensitive to many of their concerns. However, people often do not recognize that they play an important role as patients in the provider–patient relationship, and the way they communicate with their physician and other providers is important in terms of receiving the care they need in a satisfying manner. Providers also want their patients to be satisfied with the care they receive. Health communication does not just influence whether or not we are satisfied with our healthcare providers. Scholars within the fields of medicine, nursing, and communication have extensively studied provider–patient communication over the last few decades, and they have found that how providers and patients communicate in healthcare settings can potentially impact physical and psychological health outcomes, and problems such as medical errors and malpractice suits.

This chapter explores many aspects of provider–patient relationships. Specifically, it examines how providers and patients often differ in their perceptions of healthcare and healthcare needs, characteristics of communication between provider and patient, and successful and unsuccessful outcomes of provider–patient interaction.

Provider and Patient Views of Health and Healthcare

Providers and patients often have very different views about health and healthcare. The perspectives of providers are heavily influenced by the specialized training and education they receive in their training and through their day-to-day work in healthcare settings. Most patients typically do not have specialized training in healthcare or related subjects such as biology and anatomy. Instead, everyday people learn about health and the healthcare system largely through the media, interpersonal channels, and their own subjective everyday experiences of health (Cline, 2011). The following sections explore the different perspectives providers and patients have of health and the healthcare system, and how these perceptions can influence provider–patient communication as well as health and quality of life outcomes.

Provider Perspective

Provider Training

In many ways, providers learn about many aspects of health in ways that are similar to patients (at least prior to their training). For example, providers learn about a variety of health issues and lifestyle behaviors that affect health from the media, in the same way that patients do. In addition, providers have typically been patients themselves at some point in their lives. Yet, the specialized training most providers receive socializes them in ways that can lead to a much different perspective of health and healthcare than the average patient. The amount, length, and complexity of training, of course, depend upon the type of provider we are talking about. Physicians, physician assistants, nurses, and technicians differ from each other in their education and training, but all of these providers share some commonalities in terms of their socialization into medical and health occupations.

Being a medical doctor is one of the most difficult professions an individual can prepare for in terms of education and skills training, and this is one of the reasons why physicians have such a high status among healthcare professionals. Most physicians begin their college education as pre-medicine majors, and they take an extensive amount of coursework in the physical and biological sciences. Similar to other standardized tests, potential medical students have to take the Medical College Admission Test (MCAT) exam and obtain a high enough score to get into a medical school. Medical school is an arduous process for most medical students, who in addition to hundreds of hours of study and clinical training have to cope with rites of passage such as hazing and often intense criticism from medical faculty and peers.