Feb 1, 1996 - The ®rst master's degree program in health communication between a ..... arts, information technology, medicine, public administration, ...
The Status and Scope of Health Communication SCOTT C. RATZAN J. GREGORY PAYNE Emerson College Boston, Massachusetts, USA
CAROL BISHOP Purdue University West Lafayette, Indiana, USA We examine the ® eld of health communication with a multimethodological analysis, presenting a brief historical synopsis of the academic literature as well as the results of a survey administered to academicians who identi® ed communication and health to be major ® elds of interest. After this descriptive backdrop of health communication, we offer a prescription for an ideal health communicatorÐ that is, one with an interdisciplinary backgroundÐ to use ethical, persuasive means to craft, deliver, and evaluate campaigns that promote good health and disease prevention; to plan, in¯ uence, and implement health policy; and to employ ethical decision making that will enhance the quality of life for individuals and communities throughout the globe.
The relationship between communication and health continues to be a focus of attention for academic scholars in many disciplines as well as for writers publishing in trade publications, and journalists. Within the general context of a global society increasingly concerned with health communication issues is the intense scholarly debate on the de® nitions and parameters of this emerging ® eld of study. Our purpose in this article is to address these issues by conducting a multimethodological analysis that includes (a) a brief historical synopsis of the academic interest and literature in health communication and (b) the results of a survey administered to academics who identify communication and health to be major ® elds of interest. For the purpose of brevity, we advance the study conclusion and use the term health communication to encompass the study of communication as it relates to health issues. We examine the origin, acceptance, and use of this term.
Historical Backdrop of Health Communication The methodological study of communication and health in the social sciences is principally a contemporary phenomenon. However, isolated references to the relationship between these vital aspects of the human experience date back to ancient Greece. The most notable of all physicians, Hippocrates, cited a nonmedical rationale for health in Precepts: ª Some patients, though conscious that their condition is perilous, recover their health simply
Portions of this article were presented at the Speech Communication A ssociation’ s Convention on Communication and Health in July 1995, Washington, DC. The survey research was supported in part by a graduate research grant from Emerson College.
25 Journal of Health Communication, Volume 1, pp. 25±41, 1996 Copyright 1996 Taylor & Francis 1081-0730/96 $12.00 + .00
through their contentment with the goodness of the physicianº (Hippocrates, 460 b.c./1984, p. 319). To the Greeks, being of sound mind and body was an essential ideal of the polis and a prerequisite for the citizen orator. A symbiotic relationship between effective and persuasive communication and good health was a Homeric ideal for those in pursuit of aret… (excellence). Yet, inherent in Hippocrates’ s comment are the roots of the tradition of a unidirectional communication ¯ ow from the powerful physician to the passive patient that persists today. Also evident is the omission of any sense of the physician’ s obligation to society, a questionable communication norm still in widespread practice. The intimate connection between com munication and good health permeates hum ankind’ s multicultural history. From the magical melody of the African witch doctor, the black magic prescriptions of the medicine men of the Dark Ages in Europe and Asia, the blind faith in science as the fountainhead of knowledge during the Enlightenment, to today’ s information superhighways, communication and health remain common topoi (topics) of our existence. Systematic academic study of communication and health, particularly as an interactional process, has traditionally been sporadic but has intensi® ed in the past 35 years (Costello, 1977; Pantell et al., 1982; Rogers, 1994). Contemporary interest among academics centers on the common relationship of communication and maintenance of health or the prevention of disease (Finnegan & Viswanath, 1990; Freimuth et al., 1993; Makoul, 1991; Parrott et al., 1992). During the 1970s, a number of academics interested in communication and health established the International Com m unication A ssociation ’ s Division of Health Com munication. The first avenue for scholarly research in ª health communicationº appeared in a special section of the Com munication Yearbook I, published in 1977. In 1978, ª the ® rst signi® cant study of doctor-patient communicationº (Pettegrew & Logan, 1987, p. 682) was published by Arnston et al. The 1980s witnessed further activity and interest. One of the largest and most prestigious national communication organizations, the Speech Communication Association, established the Health Com munication Com mission in 1986. The ® rst publication devoted to research in this areaÐ Health Com municationÐ was founded in 1988. Responding to the increased interest in the general public for adequate information on health issues, and mirroring the academic response to such concern, the federal government, through the Centers for Disease Control and Prevention (CDC), announced the establishment of an Of® ce of Health Communication in 1993. Most of the scholarly books in health communication have appeared during the past two decades. Subject matter re¯ ects the divergent interests of scholars. Treatises on the theory and practice of communication and health care include Health Comm unication (Kreps & Thornton, 1992), Communicating with Medical Patients (Stewart & Roter, 1989), Communication and Health: Systems and Applications (Ray & Donohew, 1992), (Case Studies in Health Com munication (R ay, 1993), Perspectives on Health Com munication (Thornton & Kreps, 1993), Effective Communication in Health Care (M unn & M etzger, 1981), Com munication for Health and Behavior Change: A Development Country Perspective (Graeff et al., 1993), Com municating Effectively in Multicultural Health Care Settings (Kreps & Kumimoto, 1994), and Com munication and Health Outcomes (Kreps & O’ Hair, 1995). The need for the health professional to be cognizant of communication theory and the tactics required for more effective communication have also been addressed, in such works as Health Communication: Strategies for the Health Professional (Northouse & Northouse,
1992), Communication for Health Professionals: A Relational Perspective (Thom pson, 1986), Promoting Cultural Diversity: Strategies for Health Care Professionals (Kavanagh & Kennedy, 1992), Communic ation Between Doctors and Patients (Bennett, 1976), and Caregiver-Patient Communication: Readings (Ruben & Guttman, 1993). Finally, there are special-interest books ranging from disease prevention to health promotion. For instance, AIDS, drug abuse, and the ethics of treating the elderly and the terminally ill have inspired insightful works including: AIDS: A C om m un ication Perspective (Edgar et al., 1992), AIDS: Effective Health Communication for the `90s (Ratzan, 1993), and Gerontology and the Construction of Old Age: A Study in Discourse Analysis (Green, 1993). In addition, several recent publications examine health communication in the larger mass media context, addressing media strategies for effective campaigns and social marketing principles as they apply to health and communication. Making Health Com munication Programs Work (U.S. Department of Health and Human Services, 1992), Images of Disability on Television (Cumberbatch & Negin, 1992), Designing Health Com munication Campaigns: What Works? (Backer et al., 1992), and Mass Media Images and Impact on Health: A Sourcebook (Signorelli, 1993) discuss such issues. The relationship between communication and health is also a provocative topic beyond the disciplines’ traditional confines. In Health Psychology , Friedman and DiMatteo (1989) include a chapter entitled ª Communication with Patients.º In 1991, American Behavioral Scientist devoted an issue to communicating to promote health (Kreps, Ed., Vol. 34, No. 6). This relationship has also been a focus of several articles throughout many disciplines; for example, psychology (Dimatteo, 1979; Heszen-Klemens, 1987), sociology (Carlisle-Frank, 1991; Seeman & Evans, 1962), and medicine (Ben-Sira, 1976; Emanuel & Emanuel, 1992; Francis et al., 1969; Harper, 1971). In 1994, a theme issue of the American Behavioral Scientist was entitled ª Health Com munication: Challenges for the 21st Centuryº (Ratzan, Ed., Vol. 38, No. 2) and, according to the publisher, is one of the top three best-selling issues of the journal. Despite the burgeoning interest in research and publications in communication and health, the parameters governing this ® eld of study continue to evolve. A working de® nition acceptable to a large number of those involved in such activity is yet to be determined (Cassata, 1980; Pettegrew & Logan, 1987; Roper, 1993). In addition, critics cite inconsistency and disunity within this body of research as a major handicap in establishing such pertinent criteria (Cassata, 1980; Costello, 1977; Kreps, 1990). Other sympathetic, yet insightful critics have leveled a more pointed charge: Although the volume of research in health communication has been high, the quality has been low (Burgoon, 1992; Phillips & Jones, 1991).
Health Communication Denitional Overview The challenge before scholars in health communication is to establish boundaries for a ® eld of study that are ¯ exible, yet not so broad as to be nonoperational for serious inquiry (Infante et al., 1993; Pettegrew & Logan, 1987; Rossiter, 1975). Boundaries that are too permeable provide little, if any, relevant guidance for those who hope to enter the ® eld and enrich its understanding. Such tenuous demarcation offers little direction as to what constitutes acceptable modes of serious study. Given this dilemma, many scholars have merely concocted their own de® nition and parameters for topics in health communication that ® t their respective research agendas.
The Communication -Levels Approach to Dening Health Communication Given the challenges of a developing ® eld, it is axiomatic to say that there is a need to identify a widely accepted de® nition as well as legitimate parameters of study that would promise more stability and guidance than currently exists. Toda y’ s communication discipline is loosely organized around analysis of levels of communication, generally accepted as intrapersonal, interpersonal, small group, organizational, mass, and public. These levels are re¯ ected in the order and organization of professional groups, scholarly journals, and communication departments and faculties. We believe that application of such levels can help categorize and de® ne the study of health communication (Cassata, 1980; Fitzpatrick, 1992; Pettegrew & Logan, 1987). Berger (1991) argued that health communication should be studied within the existing levels of communication as a matter of academic simplicity. He posited that the development of additional subsets would threaten to fragment the communication ® eld further. According to Berger, prior health communication research has been inherently within the communication ® eld, albeit labeled differently, and this trend is likely to continue. Among researchers using the communication-levels approach to the study of health communication, two levels of communication have received the most attention: interpersonal and mass communication. In addition, examination of de® nitions offered reveals these two levels to be primary topoi of researchers’ descriptions of the essence of health com munication. Of these two levels of anlaysis, interpersonal communication has by far received the most attempts at de® nition. Generally, the study of interpersonal communication focuses on face-to-face communication between two or more people. Much of the literature in health communication addresses this level, examining the patient-provider relationship (Arnston et al., 1978; Ballard-Reisch, 1990; Beisecker & Beisecker, 1993; Brenders, 1989; Evans et al., 1992; Garko, 1992; Korsch et al., 1968; President’ s Com mission, 1982; Quill, 1983; Sharf, 1984; Street & Wiemann, 1987; Wyatt, 1991). De® ning the ® eld from an interpersonal perspective, Costello (1977) asserted that relationships in health communication should be the central component of a de® nition: ª Comm unication research may usefully begin to focus on the dynamics by which the health professional and patient establish, maintain, exploit and/or alter their relationshipsº (p. 565). Echoing this perspective in addressing the various levels of analysis and subsets of health communication, Burgoon (1992) de® ned medical communication as ª the clinical study of medicine in the form of doctor-patient interactions and the myriad of interpersonal communication activities that have intruded themselves on the examination roomº (p. 102). The other popular level of analysis of health communication is mass communication. This level focuses on effective message dissemination for health promotion, disease prevention, and health-related messages transmitted through mediated channels, including health marketing and policy-making (Jackson, 1992; Payne et al., 1989). Among those whose de® nition of health communication is representative of the mass communication emphasis are Maibach et al. (1993), who have asserted that ª health communication is a crucial element in disease prevention and health prom otion campaigns because the provision of relevant and persuasive health information is the primary social process that can empower individuals to take charge of their own healthº (p. 15). A similar mass communication theme with an emphasis on social marketing is evident in the rationale for the establishment of the Of® ce of Health Communication by the CDC. The CDC described health communication as ª the crafting and delivery of messages and
strategies, based on consumer research, to promote the health of individuals and communitiesº (Roper, 1993, p. 181). There are obvious handicaps to using the communication-levels approach; for one thing, research tends to focus on one level of analysis, while ignoring others within the wide spectrum of health communication research (Costello & Pettegrew, 1979; Finnegan & Viswanath, 1990; Fitzpatrick, 1992; Roper, 1993). Despite the de® nitional positioning, Freimuth et al. (1993) asserted that ª health communication scholars have broadened their scope, even though they have clung to the unfortunate dichotomy between interpersonal (primarily health professional and client interactions) and mass communication (mediated health campaigns)º (p. 510).
The Operational Approach to Dening Health Communication Recognizing the limitation of the communication-levels perspective, some researchers have opted for operational de® nitions in their study of health communication. Within such de® nitions lie the fundamental focus of the scholar’ s research. Two popular operational de® nitions focus on distinct characteristics of the health communication act: (a) the context of communication and (b) the topic of communication (directly and indirectly affecting health). De® nitions that address the context of the communication concentrate on the situational and environmental factors that affect the communication act. In 1980, Cassata de® ned health communication as ª the study of communication parameters (levels, functions, and methodologies) applied in health situations/contextsº (p. 584). In 1992, Kreps and Thornton de® ned the relationship of communication and health as ª human interaction in the health care processº (p. 2). The focus, according to these researchers should be on the intervening factors that affect the context, rather than the overall result. Such a de® nition is inclusive of all communication levels of analysis, yet exclusive of contexts that focus on physical and mental health and interactions within a health delivery system. Another operational de® nition emphasizes the topic of communication. The implicit message is that communication at any level, in any context, is health communication if the topic addresses health issues. An early advocate of this de® nitional perspective was Pettegrew, who in 1982 identi® ed health communication as a subset of human communication; its primary requisite was that its topic be related to a health issue. A decade later, Northouse and Northouse (1992) de® ned health communication as ª health related transactions between individuals who are attempting to maintain health and avoid illness . . . a subset of human communication that is concerned with how individuals in a society seek to maintain health and deal with health related issuesº (pp. 4 and 6). A broader, neoAristotelian view of health communication as the ª process and effect of employing ethical persuasive means in human health care decisionsº has been presented by Ratzan (1993, p. 5). The ® rst master’ s degree program in health communication between a medical school and a college of communication (Tufts University School of Medicine and Emerson College) offered the most current de® nition in the design of the program: ª {H}ealth communication is . . . the art and technique of informing, in¯ uencing, and motivating individual, institutional, and public audiences about important health issues. Its scope includes disease prevention, health prom otion, health care policy, business, as well as enhancement of the quality of life and health of individuals within the community (Ratzan et al., 1994a, p. 362). The topic de® nitional perspective offers researchers very broad parameters. Most of the research currently being conducted could ® t within this framework.
The Need to Dene the Parameters of the Health Communication Field Although debate about communication levels and operational de® nitions can help further clarify the relationship between communication and health, efforts must be made to de® ne its unique characteristics so that it may be distinguished from other related forms of communication. This important step can establish it as a legitimate ® eld of study within the speech communication discipline (Costello, 1977; Pettegrew & Logan, 1987). Such an objective was identi® ed by early scholars interested in this area. In 1975, Rossiter wrote, ª It is desirable to show how these proposed efforts will add uniquely to knowledge which has already been acquired by research in related areasº (p. 129). The failure to arrive at a common de® nition and parameters for research is rooted in the diversity of the backgrounds, education, and training and in researchers’ respective understandings in the area of health communication. Pettegrew and Logan (1987) based the inability to agree on a common de® nition of health communication to be rooted in the age-old problem of de® ning the term health. A t the core of this problem is the incapacity of some researchers to differentiate ª medicalº from ª healthº in their research. The biological orientation of many medical professionals suggests that the proper de® nition of health is the absence of disease. This perspective has certain rami® cations. If health is de® ned as the absence of disease, the rubric health communication should cover situations in which physical health is the topic of interaction or situations that directly address physical health as a topic. Potential topics within this particular context would include medical interviewing, compliance in following medical prescriptions, and mass media campaigns for health promotion and disease prevention. Given the limitations imposed by the absence-from-disease health perspective, other relevant issues, such as supportiveness in self-help groups, communication based on psychological rami® cations of treatment, intra- and intergroup dynamics (i.e., leadership, decision making, and con¯ ict resolution in health care or situations that affect health care) would be addressed in communication contexts other than health communication. In contrast to this biological orientation is the biosocial (also called biopsychosocial) perspective on the de® nition of health. According to the World Health Organization (1958) health addresses the physical, mental, and social well-being of humankind. With this de® nition, virtually all communication is health communication. In contrast to the narrow biological orientation, the biosocial view of health incorporates all levels of analysis and all contexts and topics that emphasize or affect health. Thus although there continues to be widespread interest in the relationship between communication and health, signi® cant differences of opinion remain on an acceptable de® nition of health communication and on the parameters for scholarly inquiry and research. As health communication continues to evolve, pragmatic steps must be taken to help de® ne and re® ne it as a legitimate ® eld of inquiry. Such steps include (a) establishment of a substantial body of literature in the area (Sharf & Poirier, 1988); (b) identi® cation of the important areas that demand attention and research for further understanding among academic and general public audiences; and (c) eventual establishment of core competencies for students wishing to pursue scholarly research and professional careers in the health communication area.
Survey of Academics Who Identied Health and Communication as Major Fields of Interest In a step toward de® ning the parameters of the ® eld of health communication, we administered a survey to 195 members of the Division of Health Communication of the
International Comm unication Association in the 1992-93 academic year. The three main areas explored by the survey were as follows: 1. What is the current status of the subject of health communication within academia? Do institutions offer courses on this subject in their curricula? What types of aca demics claim to have expertise in the relationship between communication and health? 2. What academic courses are we offering to prepare students for careers as health communication professionals? What types of careers are available now for health communication professionals, and what type of careers will be available in the future? 3. What is the overall reaction to health communication as a ® eld? Is it considered a component of another area of communication or a stand-alone ® eld?
Findings In selecting members of the Division of Health Communication of the International Comm unication Association as our subjects, our goal was to capture the thinking of opinion leaders on the current status of communication and health. However, even within this sample of members of the Division of Health Communication, less than half (44%) of the 78 survey respondents identi® ed health communication as their primary area of interest. Quantitative and qualitative responses to some speci® c survey questions can be found in the Appendix. Approximately half of all respondents reported that although there was no speci® c program of study in health communication at their institution, the communication curriculum included speci® c courses in this area. Approxim ately 80% of the respondents reported that issues related to communication and health were discussed in at least one course, generally Interpersonal Communication or Mass Communication. Given the specialization inherent in the ® eld of communication, and health communication in particular, appropriate training and education of professors who teach such courses is a major issue. Providing insight into the pedagogical process, 95% of the respondents, undoubtedly in¯ uenced by their own training, designated communication schools and departments as the ap propriate place for training health communication professionals. Sixty-nine percent stated that such training should be in public health disciplines; 44% believed medical schools should provide such instruction. From these data, it is not clear where medical students and health communication professionals should be anchored to receive proper health communication training. However, the survey respondents believe ª they {medicine} should come to us {communication},º rather than having ª us go to them.º This disciplinary division is rife with potential con¯ ict and similar to that characteristic of overlapping areas of academia. Furthermore, divisiveness poses a detrimental threat to the further development of this academic area, especially within the context of future reserach. The data also highlight that within colleges and departments of communication there is widespread disagreement as to the ideal design of the curriculum for those interested in the health communication professions. They also suggest that at present we may not be providing adequate training for those seeking potential careers in health communication. For instance, our respondents indicated that if a person earned a degree in health communication, he or she could be prepared to work in public health campaigns (85%), research (78% ), public relations in hospitals/health (71% ), and education (65%). The ® rst and sec-
ond answers are consistent with our subjects’ responses regarding the necessary components of a health communication program: Public health was identi® ed by 76% of the respondents as a necessary component, and research methodology was selected by 81% as a requisite course. Re¯ ecting the dif® cult choices and need for careful deliberation in health communication on all levels, 74% of those surveyed identi® ed ethics as a necessary educational component, suggesting the need for professionals to have a foundation in ethics in order to understand the intense debate on research, health care, and policymaking. A surprising result was the low salience of public relations as a necessary component of the curriculum. Although 71% of the respondents believed that students who earned a degree in the ® eld of health communication could enter a career in public relations, only 33% identi® ed public relations courses as a necessary component of a curriculum. Within the external communication mix, only 37% earmarked marketing as a necessary component, whereas 19% singled out advertising in this category.
Analysis Several perceptions of the relationship between health and communication emerge from the present research. First, one major exigence remains unaddressed: the lack of a generally agreed upon de® nition. All of the de® nitions discussed throughout this article emphasize distinct aspects of health communication. In addressing the lack of a universally accepted de® nition of com munication, Infante et al. (1993) argued that the lack of such a consensus does not in itself represent a crisis, because de® nitions simply represent a current line of thinking and are expected to evolve as knowledge increases. Furthermore, the inability to arrive at a single, universally acceptable de® nition plagues other subsets of communication as well. In response to this dilemma in interpersonal communication, Cappella (1987) argued, Attempts to de® ne whole domains of inquiry are usually doomed to be inaccurate or incomplete. No sooner has the pen been lifted from paper but an uncooperative researcher will have published a new line of inquiry that seems not to ® t the newly penned de® nition. Actually, the most accurate and least explicit de® nition on interpersonal communication as ® eld of study would be what researchers do and what they allow other researchers to publish. (p. 685) Perhaps Cappella’ s insights will suf® ce until ongoing research and agreements can coalesce academic opinion on this important requisite. Another trend clear from the present review of the literature and survey results is that health communication is the title preferred for the studies and interests related to communication and health. Both the Division of Health Communication in the International Com munication Association and the Health Communication Commission of the Speech Com munication Association have adopted health communication as the appropriate title for study of this type. The title of this journal echoes this sentiment. Sharf and Poirer (1988) stated, ª The term `health communication’ was carefully selected over `medical communication’ in order to emphasize a more encompassing concept that includes positive as well as pathological, lay as well as professional, aspectsº (p. 225). Furthermore, if the biopsychosocial de® nition of healthÐ the all-encom passing
WHO de® nition discussed earlierÐ is accepted, then health communication encompasses the information and studies inherent within the other de® nitions. Health communication has evolved into a useful title to de® ne this emerging ® eld as a broadbased area of study, not limited to only physical, occupational, intellectual, social, or emotional health, but encompassing all of these facets. The trend in health communication research seems to favor the biosocial perspective, rather than the traditional biological view of health. Re¯ ecting a view of health communication as multidimensional, the majority of respondents in our survey checked many of the communication levels as encompassing health communication. Interpersonal and mass communication were the two highest rated areas, consistent with the material published on communication and health to date and with the areas in which our respondents had expertise. An indication of the pervasive importance of health communication in the future is that the number one area cited for future work by our subjects is transcendent of all levels of communication: the need to target disease prevention/health prom otion. Evidence suggests this area of research and inquiry will continue to grow rapidly in the years ahead. Association membership and the development of educational programs are some of this evidence. Membership in the Speech Communication Association’ s Health Communication Commission has grown signi® cantly to more than 500 members, thus attaining Divisional status. M em bership in the Intenational Com munication Association’ s Division of Health Communication now approaches 300. In addition, there are several masters’ programs that offer an emphasis in health communication, including programs at the University of Southern Florida, the University of Maryland, the University of Kentucky, Johns Hopkins University, and Texas A&M University. Michigan State University and Cornell University are currently researching the implementation of a health communication emphasis in their communication programs. Furthermore, the newly formed joint masters’ program between Emerson College and Tufts University School of Medicine, initiated in 1994, is the ® rst cooperative effort between a medical school and a college with a long tradition in communication. More than 60 students are enrolled in the Health Communication degree program in its second year of operation. A similar joint effort between the schools of communication and medicine began at Northwestern University in 1995; however, it is not a degree-granting program.
Conclusion In his History of Public Health, Rosen (1958) reminded that current understanding of a ® eld requires historical perspective to guide the future. The evolution in communication, now ending its ® rst-century anniversary of scholarly debate, discussion, and insight, evokes such re¯ ection. The middle of the 20th century witnessed a major innovation in higher education in the United States: Wilbur Schramm’ s initiation of the ® rst university unit called com munication. Today, there are more than 2,000 communication departments, and most of them have been established in the past three decades. As we approach the next millennium, the ® eld of communication has a central role in the solutions to many of our global problems. Furthermore, it is at the core of our concerted attempt to preserve and protect our most vital asset: the vitality and health of humankind. Embracing the biosocial perspective of health communication means following the global organizational and governmental trend to take the technological superhighway to the future. Within this context, the health communication scholar has an ethical responsi-
bility to use his or her technological toolchest to get the message out on what makes one truly ª healthyº and to help promote ethical behavior to enhance the overall public good. As we prepare our students to meet these challenges, our focus should be interdisciplinary. We must work to persuade health communicators to Use ethical, persuasive means to craft, deliver, and evaluate campaigns that promote good health and disease prevention; n Plan, in¯ uence, and implement health care policy; and n Employ ethical decision making that will enhance the quality of life for individuals and communities throughout the globe. n
This challenge requires a concerted effort from those in the ® elds of communication arts, information technology, medicine, public administration, psychology, public health, law, nutrition, public policy, and sociology, among others. What is called for is a devoted scienti® c community working closely with humanistic and ethical experts in a variety of quantitative and qualitative ® elds of study. Tom orrow’ s health communication curriculum requires a multidisciplinary approach employing traditional aspects of the communication act and social marketing principles. Furthermore, scholars of health communication must serve as an ethical compass in guiding public opinion on these vital issues. Over a century ago, Abraham Lincoln wrote, ª With public sentiment nothing can fail; without it nothing can succeed. Consequently, he who molds public opnion goes deeper than he who enacts statutes or pronounces decisions.º Lincoln’ s declaration rings true for scholars and professionals in health communication today. Our efforts to advance a healthier global public are among the most powerful weapons available to humankind in meeting the challenge of an impending tomorrow.
References Arnston, P., Droge, D., & Fassl, H. E. (1978). Pediatrician±parent communication ® nal report. In B. Ruben (Ed.), Communication yearbook 2 (pp. 505±522). New Brunswick, NJ: TransactionInternational Communication Association. Backer, T. E., Rogers, E. M., & Sopory, P. (1992). Designing health communication campaigns: What works? Newbury Park, CA: Sage. Ballard-Reisch, D. S. (1990). A model of participative decision making for physician-patient interaction. Health Communication, 2, 91±104. Bennett, A. E. (1976). Communication between doctors and patients. Oxford, England: Oxford University Press. Beisecker, A. E., & Beisecker, T. D. (1993). Using metaphors to characterize doctor-patient relationships: Paternalism versus consumerism. Health Communication, 5, 41±58. Ben-Sira, Z. (1976). The function of the professional’s affective behavior in client satisfaction: A revised approach to social interaction theory. Journal of Health and Social Behavior, 17, 3-11. Berger, C. (1991). Chautauqua: Why are there so few communication theories? Communication Monographs, 58, 101±113. Brenders, D. A. (1989). Perceived control and the interpersonal dimension of health care. Health Communication, 1, 117±128. Burgoon, M. (1992). Strangers in a strange land: The Ph.D. in the land of the medical doctor. Language and Social Psychology, 11, 101±106. Cappella, J. N. (1987). Interpersonal communication: De® nitions and fundamental questions. In C. R. Berger & S. H. Chaffee (Eds.), Handbook of communication science (pp. 675±709). Newbury Park, CA: Sage.
Carlisle-Frank, P. (1991). Examining personal control beliefs as a mediating variable in the healthdamaging behavior of substance use: An alternative approach. Journal of Psychology, 125, 381±397. Cassata, D. M. (1980). Health communication theory and research: A de® nitional overview. In D. Nimmo (Ed.), Communication yearbook 4 (pp. 583±589). Brunswick, NJ: TransactionInternational Communication Association. Costello, D. E. (1977). Health communication theory and research: An overview. In D. Nimmo (Ed.), Communication Yearbook 1 (pp. 557±567). New Brunswick, NJ: TransactionalInternational Communication Association. Costello, D. E., & Pettegrew, L. S. (1979). Health communication theory and research: An overview of health organizations. In D. Nimmo (Ed.), Communication yearbook 3 (pp. 607±623). New Brunswick, NJ: Transaction-Inernational Communication A ssociation. Cumberbatch, G., & Negin, R. (1992). Images of disability on television. London: Routledge. DiMatteo, M. R. (1979). A social-psychological analysis of physician-patient rapport: Toward a science of the art of medicine. Journal of Social Issues, 35, 12±33. Edgar, T., Fitzpatrick, M. A., & Freimuth, V. S. (1992). AIDS: A communication perspective. Hillsdale, NJ: Erlbaum. Emanuel, E. J., & Emanuel, L. L. (1992). Four models of the physician-patient relationship. Journal of the American Medical Association, 267, 2221±2226. Evans, B. J., Stanley, R. O., & Burrows, G. D. (1992). Communication skills training and patients’ satisfaction. Health Communication, 4, 155±170. Finnegan, J. L., & Viswanath, K. (1990). Health and communication: Medical and public health in¯ uences on the research agenda. In E. B. Ray & L. Donohew (Eds.), Communication and health: Systems and applications (pp. 9±24). Hillsdale, NJ: Erlbaum. Fitzpatrick, M. A. (1992). Communication, language and health: An overview. Language and Social Psychology, 11, 1±8. Francis, V., Korsch, B., & Morris, M. (1969). Gaps in doctor-patient communication: Patients’ response to medical advice. New England Journal of Medicine, 280, 535±540. Freimuth, V. S., Edgar, T., & Fitzpatrick, M. A. (1993). The role of communication in health promotion. Communication Research, 20, 509±516. Friedman, H. H., & DiMatteo, M. R. (1989). Health psychology. Englewood Cliffs, NJ: Prentice Hall. Garko, M. G. (1992). Physician-executives’ use of in¯ uence strategies: Gaining compliance from superiors who communicate in attractive and unattractive styles. Health Communication, 4, 137±154. Graeff, J. A., Elders, J. P., & Booth, E. M. (1993). Communicating for health and behavior change: A developing country perspective. San Francisco, CA: Jossey-Bass. Green, B. S. R. (1993). Gerontology and the construction of old age: A study in discourse analysis. New York: Aldine de Gruyter. Harper, D. (1971). Patient follow-up of medical advice: A literature review. Journal of Kansas Medical Society, 72, 265±271. Heszen-Klemens, I. (1987). Patients’ noncompliance and how doctors manage this. Social Science and Medicine, 24, 409±416. Hippocrates. (1984). Hippocrates I (W.H.S. Jones, Trans.). Cambridge, MA: Harvard University Press. (Original work published 460 B .C .E .) Infante, D. A., Rancer, A. S., & Womack, D. F. (1993). Building communication theory. Prospect Heights, IL: Waveland Press. Jackson, L. D. (1992). Information complexity and medical communication: The effects of technical language and amount of information in a medical message. Health Communication, 4, 197±210. Kavanaugh, K. H., & Kennedy, P. H. (1992). Promoting cultural diversity: Strategies for health care professionals. Newbury Park, CA: Sage.
Korsch, B. M., Gozzi, E. K., & Francis, V. (1968). Gaps in doctor-patient communication. Pediatrics, 42, 855±871. Kreps, G. L. (1990, November). Mapping out the future: The need for health communication education. Paper presented at the annual meeting of the Speech Communication Association, Chicago. (ERIC Document Reproduction Services No. ED 324 718). Kreps, G. L., & Atkin, C. (Eds.). (1991). Communicating to promote health. American Behavioral Scientist, 34, 648±767. Kreps, G. L., & Kuminoto, E. (1994). Effective communication in multicultural health care settings. Newbury Park, CA: Sage. Kreps, G. L., & O’ Hair, D. (Eds.). (1995). Communication and health outcomes. Cresskill, NJ: Hampton Press. Kreps, G. L., & Thornton, B. C. (1992). Health communication: Theory and practice (2nd ed.). Prospect Heights, IL: Waveland Press. Maibach, E. W., Flora, J. A., & Nass, C. (1991). Changes in self-ef® cacy and health behavior in response to a minimal contact community health campaign. Health Communication, 3, 1±15. Maibach, E. W., Kreps, G. L., & Bonaguro, E. W. (1993). Developing strategic communication campaigns for HIV/AIDS prevention. In S. C. Ratzan (Ed.), AIDS: Effective health communication for the ’ 90s ( (pp. 14±35). Washington, DC: Taylor & Francis. Makoul, G. (1991). Communication in the health care context: A review essay. Comm unication Education, 40, 407±414. Munn, H. E., Jr., & Metzger, N. (1981). Effective communication in health care: A supervisor’s handbook. Rockville, MD: Aspen Systems. Northouse, P. G., & Northouse, L. L. (1992). Health communication: Strategies for health professionals. East Norwalk, CT: Appleton & Lange. Pantell, R. H., Stewart, T. J., Dias, J. K., Wells, P., & Ross, A. W. (1982). Physician communication with children and parents. Pediatrics, 70, 396±402. Parrott, R., Burgoon, M., & Ross, C. (1992). Parents and pediatricians talk: Compliance-gaining strategies’ use during well-child exams. Health Communication, 4, 57±66. Payne, J. G., Ratzan, S. C., & Baukus, R. A. (1989). Newspaper coverage of the Harvard Medicare projects: Regional distinctions or discreet disregard. Health Communication, 1, 227±238. Pettegrew, L. S., & Logan, R. (1987). The health care context. In C. R. Berger & S. H. Chaffee (Eds.), Handbook of communication science (pp. 675-709). Newbury Park, CA: Sage. Phillips, G. M., & Jones, A. J. (1991). Medical compliance: Patient or physician responsibility? American Behavioral Scientist, 34, 756±767. President’ s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1982). Making health care decisions: The ethical and legal implications of informed consent in the patient-practitioner relationship. Washington, DC: U.S. Government Printing Of® ce. Quill, T. E. (1983). Partnerships in patient care: A contractual approach. Annals of Internal Medicine, 98, 228±234. Ratzan, S. C. (1993). Health communication and AIDS. In S. C. Ratzan (Ed.), AIDS: Effective health communication for the ’ 90s (pp. 1±11). Washington, DC: Taylor & Francis. Ratzan, S. C. (1994). CommunicationÐ The key to a healthier tomorrow. American Behavioral Scientist, 38, 202±207. Ratzan, S. C. (1994a). Education for the health professional. American Behavioral Scientist, 38, 361±380. Ray, E. B. (Ed.). (1993). Case studies in health communication. Hillside, NJ: Erlbaum. Ray, E. B., & Donohew, L. (Eds.). (1992). Communication and health: Systems and applications. Hillside, NJ: Erlbaum. Roper, W. L. (1993). Health communication takes on new dimensions at CDC. Public Health Reports, 108, 179±183. Rosen, G. (1958). A history of public health.New York: MD Publications.
Rossiter, C. M., Jr. (1975, summer). Defining therapeutic communication. Journal of Communication, pp. 127±130. Ruben, B. D., & Guttman, N. (1993). Caregiver-patient communication: Readings. Dubuque, IA: Kendall-Hunt. Seeman, M., & Evans, J. W. (1962). Alienation and learning in a hospital setting. American Sociological Review, 27, 772±783. Sharf, B. F. (1984). The physician’s guide to better communication. Glenview, IL: Scott, Foresman. Sharf, B. F., & Poirier, S. (1988). Exploring (un)common ground: Communication and literature in health care settings. Communication Education 37, 224±235. Signorelli, N. (1993). Mass media images and impact on health: A sourcebook. Westport, CT: Greenwood Press. Stewart, M., & Roter, D. (Eds.). (1989). Communicating with medical patients. Newbury Park, CA: Sage. Street, R. L., & Wiemann, J. M. (1987). Patient satisfaction with physicians’ interpersonal involvement, expressiveness and dominance. In M. McLaughlin (Ed.), Communication yearbook 10 (pp. 591±612). Newbury Park, CA: Sage. Thompson, T. L. (1986). Communication for health professionals: A relational perspective. Lanham, MD: University Press of America. Thornton, B. C., & Kreps, G. L. (Eds.). (1993). Perspectives in health communication. Prospect Heights, IL: Waveland Press. U.S. Department of Health and Human Services. (1992). Making health communication programs work (NIH Publication No. 92-1493). City, State: National Cancer Institute, Of® ce of Cancer Communications. World Health Organization. (1958). The ® rst ten years of the World Health Organization. Geneva, Switzerland: Author. Wyatt, N. (1991). Physician-patient relationships: What do doctors say? Health Communication, 3, 157±174.
Appendix The following are further highlights from our survey of 195 members of the Division of Health Communication of the International Communication Association in the 1992-93 academic year.
Health Communication as Its Own Genre ª Do you believe the study of communication and health to be its own genre?º Yes No M aybe
57 35 8
Given the importance of this question within the context of the emerging research, we provided an open-response area to allow subjects to explain their opinions. Those who thought the study of the relationship between health and communication should be viewed as a distinct genre offered several explanations in support of their position. The rationale most frequently given was that communication and health encompass more than exists within today’ s framework of communication. The following are representative responses: I believe that we express health relevant messages within a framework that de® nes the parameters of the kinds of messages that are sent and received. While they rely on work from the ® eld of communication, the health context affects message construction and interpretation. The complexity of the variables associated with health and communication warrant genre status. Several genres are included within the communication and health genre. Health maintenance needs to be conceptualized differently from other communication goals, such as information transmission, attributional persuasion, product sales, etc. The means to these ends are different in principle as well as in practice. Health is too important a topic, too serious an issue, to be studied hap-hazzardly {sic}, relegated to second-class status. It involves all aspects of communication, but they combine in a unique fashion to deal with, albeit not exclusive to, life and death issues.
Other respondents viewed communication and health as its own genre by virtue of current academic emphasis: The maturity of theorizing and methods in both health education and health communication is now advanced to the point where a new genre is naturally form ing. Research literature and current level of education practice warrant {the study of the relationship between communication and health} being conceived of as its own genre.
Nam e for the Field ª How should the study of communication and health be labeled?º Health communication Health care communication Public health communication Health and risk communication Medical communication Health prom otion and disease prevention Social and environmental communication Other
55 8 8 7 5 4 1 6
Appropriate Training for Health Communicatio n Professionals ª The appropriate training for professionals in communication and health would be in schools of:º Com m unication Public health M edicine Related health sciences Social work Sociology/anthropology Public administration Law Other
71 54 34 31 22 22 7 6 13
Graduate Degree Programs ª If a graduate degree program in the study of communication and health were to be offered, which of the following would be necessary components?º Com munication theory Research methods Public health Ethics M arketing Sociology Public relations Negotiation Rhetoric Advertising Biological science M edical technology Earth sciences Other
72 68 59 58 29 29 26 19 17 15 15 14 2 38
Employment Prospects ª If one earned a degree in the ® eld of communication and health, s/he could be prepared to work in:º Public health campaigns Research PR in hospitals/health Education Mass communication Marketing comm. Ethics Delivery of services M arketing Television Other
66 61 55 51 35 33 29 28 27 18 8
Future Direction for Academic Interest ª Research/education should be targeted toward:º Disease prevention/health prom otion Patient/provider communication Mass communication Organizational communication Political communication and policy Epidem iology/basis for disease Other Insurance/third-party intervention
66 63 43 40 33 25 20 18
