Communicating About Health Current Issues and Perspectives

Communicating About Health: Current Issues and Perspectives continues to live up to its long-standing reputation as the most dynamic and current exploration of health communication on the market. This book offers rich, current research and in-depth analysis of the cultural, social, and organizational issues that influence health communication and health advocacy.

Communicating About Health is an indispensable resource for readers seeking to improve their communication abilities in fields related to health. This text explores health communication through the eyes of patients, care providers, healthcare leaders, campaign designers, and more. Readers will learn how culture, media, personal identity, technology, social networks, and other factors contribute to health and healing.

Athena du Prè, Ph.D., is a Professor of Communication and Director of the Strategic Communication & Leadership master's degree program and the Health Communication Leadership graduate-level certificate program at the University of West Florida. Her research interests include patient-caregiver communication, coping with health crises, humor and healing, and workplace dynamics. Dr. du Pré is a former journalist and hospital public relations director. She received a Ph.D. in communication from the University of Oklahoma in 1995. Since joining the UWF faculty, she has twice been honored with Distinguished Teaching Awards by the student body. She is also coauthor, with Ron Adler and George Rodman, of Oxford's Understanding Human Communication and Essential Communication.

Barbara Cook Overton earned a Ph.D. in Health Communication from Louisiana State University and is the author of Unintended Consequences of Electronic Medical Records: An Emergency Room Ethnography (2019).

I. What Is Health?
II. What Is Health Communication?
A. Defining Communication
1. Collaborative Sense-Making
2. Multiple Levels of Meaning
3. Context and Culture
B. Defining Health Communication
C. The History of Health Communication
III. Health Care Models
A. Biomedical
B. Biopsychosocial
C. Sociocultural
IV. A Systems-Level Approach
V. The Importance of Health Communication
A. Communication Is Essential to Health Care Encounters
B. Communication Can Be a Source of Comfort and Support
C. Communication Can Reduce Health Disparities
D. Communication Can Educate People About Health
E. Communication Helps Health Organizations Operate Effectively
F. Health Communication Presents Career Opportunities
VI. The Importance of Health Communication
A. Communication Is Essential to Health Care Encounters
B. Communication Can Be a Source of Comfort and Support
C. Communication Can Reduce Health Disparities
D. Communication Can Educate People About Health
E. Communication Helps Health Organizations Operate Effectively
F. Health Communication Presents Career Opportunities
VII. Summary
VIII. Glossary
IX. Discussion Questions

Box 1.1 Career Opportunities: Profiles of More Than 100 Health-Related Jobs
Box 1.2 Ethical Considerations: An Essential Component of Heath Communication
Box 1.3 Health Communication Organizations and Resources
Box 1.4 Perspectives: A Memorable Hospital Experience
Box 1.5 Learn While You Make a Difference

Chapter 2: The Landscape for Health Communication
I. Current Issues in Health Care
A. Early and Preventive Care
B. Health Disparities and Access
C. Navigating a Complex System
D. Communication Skill Builders: Navigating the Health Care System
II. Health Communication in a Changing World
A. Global Health
B. Changing Populations
1. Ageing
2. Racial and Cultural Diversity
C. Communication Technology
III. Communication in Managed Care
A. Conventional Insurance
B. Health Maintenance Organizations
C. Preferred Provider Organizations
D. High-Deductible Health Plans
E. Pros and Cons of Managed Care
1. Advantages
2. Disadvantages
IV. Health Care Reform
A. Universal Coverage
B. Single- and Multi-Payer Systems
1. Single-Payer
2. Multi-Payer
C. The Affordable Care Act
V. Summary
VI. Glossary
VII. Discussion Questions

Box 2.1-Selecting a Managed Care Plan
Box 2.2-Ethical Considerations: Classroom Debate on Health Care Reform

Table 2.1 World Health Systems Performance Ranking

Chapter 3: The Roles of Patients and Health Care Providers
I. Health Care Encounters and Power Differentials
A. Knowledge and Power
B. Unequal Talking Time
C. Sensitive Subjects
D. Dismissive Behavior
E. Transgressions
F. Why Do We Do It?
G. Communication Skill Builders: Building Trusting Relationships
1. Break the ice.
2. Don't avoid important but sensitive issues.
3. Encourage and ask questions.
4. Avoid assumptions.
5. If you feel uncomfortable, say so.
6. Make an explicit commitment to diversity.
Box 3.1 Ethical Considerations: The Truth, the Whole Truth …. or Not?
II. Collaborative Communication
A. Reasons for a Shift
B. Model of Collaborative Interpretation
C. Integrative Health Theory
III. Partnership-Building Strategies
A. Shared Decision Making
1. Care Providers' Expertise
2. Patient Perspectives
3. Puzzle Approach
B. Communication Skill Builders: Motivational Interviewing
1. Set a respectful tone.
2. Let the interviewee (decision maker) set the agenda.
3. Gauge the decision maker's interest.
4. Explore ambivalence.
5. Listen.
6. Elicit-provide-elicit.
7. Weigh the merits of multiple options (including doing nothing).
8. Partner; don't persuade.
9. Roll with resistance.
10. Gauge the decision maker's self-efficacy.
11. Focus on small, incremental changes.
12. Collaborate and empower.
Box 3.2 Perspectives: A Mother's Experience at the Dentist
C. Narrative Medicine
1. Qualities of Narrative Medicine
2. Functions of Health Narratives
D. Communication Skill Builders: Strategies for Care Providers
1. Act interested.
2. Set aside distractions.
3. Allow silence.
4. Ask “What else?”
5. Avoid abrupt topic shifts.
6. Pay attention to distress markers.
7. Reassure.
E. Communication Skill Builders: Strategies for Patients
1. Reflect on what's important to you.
2. Create a brief health history.
3. Write down and rank order your concerns.
4. Don't overlook valuable resources.
5. Help set the agenda.
6. Take an active role.
V. Summary
IV. Glossary
V. Discussion Questions

Chapter 4: Patient Perspectives
I. Voice of Lifeworld
A. Feelings Versus Evidence
B. Specific Versus Diffuse
C. Bridging the Gap
D. Communication Skill Builders: Talking to a Care Provider
1. Try the PACE method.
2. Ask questions.
3. Don't abuse the clock.
Box 4.1 Perspectives: The Agony of Uncertainty
II. Health Literacy
A. Reasons for Health Literacy Challenges
B. Health Literacy and COVID-19
C. Communication Skill Builders: Assisting People with Health Literacy Challenges
1. Create shame-free environments.
2. Let patients know what's expected.
3. Use metaphors to explain complex information.
4. Evaluate messages for readability.
5. Use the teach-back method.
D. Communication Skill Builders: Increasing Comprehension as a Patient
1. Be explicit about your concerns.
2. Ask three key questions.
3. Admit it if you don't understand.
III. Health and Identity
A. Health, Identity, and Facework
B. Face-Threatening Health Concerns
C. Face-Consistent Health Concerns
IV. Invisible Illnesses
A. “You Don't Look Sick”
B. Communication Skill Builders: Calling Attention to Overlooked Concerns
1. Document your symptoms.
2. Resist the urge to minimize.
3. Ask outright for serious consideration.
4. Be patient with medical uncertainty.
5. Try a second visit.
6. If necessary, find a new provider.
V. Patient Satisfaction
A. Selecting Care Providers
B. Communication Skill Builders: Enhancing Patient Satisfaction
1. Provide prompt attention.
2. Build relationships.
3. Take your time and educate.
4. Welcome loved ones.
5. Learn from patients' feedback.
Box 4.2 Ethical Considerations: Does Satisfaction Reflect Quality?
VI. Cooperation and Informed Consent
A. Reasons for Noncooperation
B. Communication Skill Builders: Creating Mutually Acceptable Treatment Plans
1. Engage in shared decision making.
2. Listen for hesitancy.
3. Ask about reservations.
4. Encourage regular communication.
C. Informed Consent
1. Infamous Violations of Patient Rights
2. Informed Consent Laws
3. Challenges Associated With Informed Consent
Box 4.3 Career Opportunities: Patient Advocacy
VII. Summary
VIII. Glossary
IX. Discussion Questions

Chapter 5: Care Provider Perspectives
I. Care Provider Preparation
A. Historical Perspective
B. The Role of Communication
C. Communication Training and Integrated Approaches
D. Socialization
II. Systems-Level Influences on Care Providers
A. Organizational Culture
B. Time Constraints
III. Psychological Influences on Caregivers
A. Emotions
B. Mindfulness
C. Confidence
D. Satisfaction
E. Communication Skill Builder: Dealing with Difficult Patients
IV. Stress and Burnout
a. Causes
b. Healthy Strategies
V. Medical Mistakes
a. Why Mistakes Happen
b. What Happens After a Mistake?
c. Managing Medical Mistakes
d. Disclosing an Error
e. Communication Skill Builders: Responding to Medical Mistakes
VII. Summary
VIII. Glossary
IX. Discussion Questions

Box 5.1: Career Opportunities: Care Providers
Box 5.2: Perspectives: Understanding Physician Hierarchy
Box 5.3: Perspectives: Levels of Nursing
Box 5.4: Perspectives: Blowing the Whistle on an Impaired Physician

Chapter 6: Diversity in Health Care
I. Intersectionality Theory
II. Socioeconomic Status
A. Implicit Bias
B. Communication Gaps
C. Structural Inequities
D. Limited Access to Care
E. Logistical Challenges
F. Communication Skill Builders: Building Trust with Underserved Patients
1. Diversify your team.
2. Engage in shared decision making.
3. Be careful not to shame.
4. Show concern explicitly.
5. Explain your thinking.
6. Invite open communication.
III. Gender and Sexual Orientation
A. Words Matter
1. Gender Identities
2. Sexual Orientations
B. Sex, Gender, and Health
1. Marginalization
2. Fear of Judgment
3. Overlooked Concerns
4. Missed Opportunities for Social Support
C. Communication Skill Builders: Talking Respectfully About Gender and Sex
1. Use preferred pronouns
2. Avoid deadnaming.
3. Don't ignore the topic.
4. Don't be nosy.
5. Don't judge. (just mentioned in other CSB.)
6. If you mess up, apologize and correct yourself.
IV. Race and Ethnicity
A. Distrust
B. High Risk and Low Knowledge
C. Limited Access to Services
D. Underrepresentation
Box 6.1. Ethical Considerations: Who Gets What Care?
V. Language Differences
Box 6.2 Career Opportunities: Diversity Awareness
Box 6.3 Perspectives: Language Barriers in a Health Care Emergency
VI. Disabilities
A. Health Passports
B. Communication Challenges and Approaches
1. Word Choices
2. Intrusive Questions
3. Overhelping
4. Reluctance to Address Sensitive Issues
5. LOUD and Sloooow
C. Ableist Language
D. Communication Skill Builders: Avoiding Ableist Language
1. Take stock of your implicit biases.
2. Befriend a wide range of people.
3. Think about the words you use.
4. Practice alternatives.
5. Point out underlying assumptions.
6. Be an ally.
7. If you mess up, apologize and do better.
VII. Age
A. Children
1. Adult Involvement
2. Caring for the Rest of the Family
B. Adolescents
1. What is normal?
2. Sensitive Topics
3. Social Isolation
C. Communication Skill Builders: Talking With Young People About Illness
1. Let the young person set the tone.
2. Cover the information bases.
3. Ask questions and listen.
4. Go easy on medical terminology.
5. Be honest.
D. Older Adults
1. Aging Population
2. Ageism
3. Impact on Health Communication
4. Communication Patterns
VIII. Summary
IX. Glossary
X. Discussion Questions

Chapter 7: Cultural Conceptions of Health and Illness
I. Culture and Health Communication
A. Culture-Centered Approach
B. Reflective Negotiation Model
II. Cultural Conceptions of Health
A. Health as Organic
B. Health as Harmonic Balance
1. Physical, Emotional, and Spiritual
2. Harmony With Nature
3. Hot and Cold
4. Energy
III. Making Sense of Health Experiences
A. Health Condition as Social Asset
B. Health Condition as Social Liability
1. Disease as Curse
2. Stigma
3. The Morality of Prevention
4. Victim Role
Box 7.1 Theoretical Foundations: Theory of Health as Expanded Consciousness
IV. Sex, Gender, and Health
A. Male Identity and Health
1. Expected to Be Stoic
2. Pressure to Provide
3. Homicides
B. Female Identity and Health
1. Presumed Emotionality
2. Assumed Powerlessness
3. Domestic and Sexual Violence
V. Family Roles and Health Communication
Box 7.2. Perspectives: Thai Customs and a Son's Duty
VI. Illness and Coping Metaphors
A. “Fight for Your Life”
B. “Strive for Peace and Flexibility”
VII. Sick Roles and Healer Roles
C. Mechanics and Machines
D. Parents and Children
E. Spiritualists and Believers
F. Providers and Consumers
G. Partners
Box 7.3. Ethical Considerations: Physician as Parent or Partner?
Box 7.4. Perspectives: Partners in Care
VIII. Holistic Care
H. Terminology
I. Popularity
J. Advantages
K. Drawbacks
Box 7.5. Holistic Medicine at a Glance
Box 7.6. Career Opportunities: Holistic Medicine
IX. Summary
X. Glossary
XI. Discussion Questions

Chapter 8: Social Support, Family Caregiving, and End of Life
I. Coping
A. Problematic Integration
B. Locus of Control
C. Crisis
D. Normalcy
Box 8.1 Career Opportunities: Social Services and Mental Health
II. Social Support
A. Types of Social Support
1. Instrumental Support
2. Informational Support
3. Esteem Support
4. Emotional Support
B. Sources of Social Support
1. Strong- and Weak-Tie Relationships
2. Support Groups and Virtual Communities
C. Communication Skill Builders: Do's and Don'ts of Comforting
1. Comfort in, dump out.
2. Don't ask a lot of questions.
3. Do offer to help in specific ways.
4. Don't engage in toxic positivity.
5. Do acknowledge and respect emotions.
6. Don't say “I know how you feel.”
7. Do provide support with no strings attached.
8. Don't overdo it.
9. Do realize you don't have to be perfect.
III. Family Caregivers
A. Stress and Burnout
B. Communication Skill Builders: Reducing Your Stress as a Family Caregiver
1. Develop a support network.
2. Feel what you feel.
3. Take care of yourself.
4. Enjoy special moments.
5. It's okay if you can't do it forever.
C. Communication Skill Builders: Caring for Caregivers
1. Hold family meetings.
2. Listen.
3. Show appreciation.
5. Make it a team effort.
Box 8.2 Perspectives: A Long Goodbye to Grandmother
IV. End-of-Life Experiences
A. Death as an Enemy
B. A “Good Death”
C. Palliative Care
D. Communication Skill Builders: Delivering Bad News
1. Foreshadow the disclosure.
2. Choose the right setting.
3. Acknowledge and legitimize emotions.
4. Take your cues from the recipient.
5. Be ready with options and a plan of action.
6. Schedule an informational follow-up visit.
E. Advance Directives
Box 8.3 Sources of Support for Family Caregivers
V. Summary
VI. Glossary
VII. Discussion Questions

Chapter 9: Technology and Health
I. Health Information Haves and Have Notes
A. ePatients
B. Digital Divide
1. Sociodemographics
2. Disabilities
3. Confidence
II. Why and When Do People Seek eHealth Information?
A. Information Sufficiency Threshold
B. Health Information Acquisition Model
C. Theory of Motivated Information Management
D. Integrative Model of Online Health Information Seeking
E. Unified Theory of Acceptance and Use of Technology
III. Is eHealth Information Useful to Everyday People?
A. Advantages
1. Rich Array of Information
2. Source of Practical Advice
3. Social Support
B. Disadvantage
1. Unreliable Information
2. Conflicting Information
3. Overwhelming Amounts of Information
4. Privacy Concerns
C. Communication Skill Builders: Using the Internet Effectively
IV. mHealth
A. Health-Monitoring Apps
B. Mental Health Apps
C. Apps for Health Professionals
D. Texting for Health
E. Potential Disadvantages of mHealth
F. Potential Advantages of mHealth
VI. Telehealth
A. Telemedicine
B. Communication Skill Builders: Preparing for a Telemedicine Appointment
C. Patient Portals
D. Pros and Cons of Telehealth for Consumers
1. Patient-Provider Communication
2. Online Access to Personal Health Records
3. Opportunity to See Many Providers
E. Pros and Cons of Telemedicine for Health Professionals
1. Opportunity to See Many Patients
2. Cost
3. Workload
4. Accessible Information about Patients

VII. Summary
VIII. Glossary
X. Discussion Questions

Box 9.1 Career Opportunities: Health Information Technology

Chapter 10: Communication in Health Organizations
I. Conflicting Goals
II. Enhancing Health Care Experiences
III. Health Care Administration
A. Communication Patterns
B. Organizational Identity
C. Communication Skill Builder: Servant Leadership and Empowerment
1. Invert the Pyramid
2. Build Relationships by Listening
3. Push Decision Making to the Lowest Level Possible
4. Hold People Accountable
5. Give Constructive Feedback
6. Celebrate Successes
IV. Human Resources
A. Theoretical Foundations
B. Communication Skill Builder: Building a Great Workforce
1. Hire Carefully
2. Teach the Culture and Values
3. Continually Recruit Internal Talent
V. Marketing and Public Relations
A. Foundations for Theory and Practice
1. Focus on Relationships
2. Integrate
3. Develop Reputation, Not Only Image
B. Crisis Management
C. Communication Skill Builder: Using Social Media Effectively
1. Cultivate a Following
2. Engage in Two-Way Communication
3. Focus on Message Quality
4. Use Visuals
5. Post Educational Content
6. Develop a Social Media Policy
VI. Service Excellence
VII. Summary
VIII. Glossary
IX. Discussion Questions
Box 10.1 Career Opportunities
Box 10.2 Monetizing Health Care
Box 10.3 Resources: Journals in the Field
Figure 10.1 Inverted Pyramid

Chapter 11: Media and Health
I. Media Effects
II. How Media Influences Behavior
A. Social Mimicry
B. Cultivation Theory
C. Social Cognitive Theory
D. Social Comparison Theory
III. Media Literacy
IV. Advertising
A. Nutrition and Obesity
1. Effects on Children
2. Effects on Adults
B. Alcohol
C. Tobacco and Nicotine
D. Pharmaceutical Advertisements
1. Advantages of DCT Advertising
2. Disadvantages of DCT Advertising
3. Communication Skill Builders: Evaluating Medical Claims
V. News Coverage
A. Accuracy and Fairness
B. Sensationalism
C. Communication Skill Builders: Evaluating Health News
D. Advantages of Health News
E. Communication Skill Builders: Presenting Health News
VI. Media Portrayals of Health
A. Body Image
B. Mental Illness
C. Disabilities
D. Sex
E. Violence
VIII. Social Media
A. Influencers
B. Health Effects
IX. Summary
X. Glossary
XI. Discussion Questions

Chapter 12: Public Health and Crisis Communication
I. What Is Public Health?
II. Risk and Crisis Communication
A. Risk Communication
B. Managing Risk Perceptions
C. Crisis Communication
D. How Scared Is Scared Enough?
E. In the Heat of the Moment
III. Crisis Communication Models and Guidelines
A. The World Health Organizations' Guidelines on Communicating Risk
B. Message Mapping
C. The IDEA model
D. The Crisis and Emergency Risk Communication (CERC) model
IV. Social Media and Crisis Communication
V. Case Studies: A Global Perspective
A. COVID-19
B. Avian Flu
C. Zika
D. The Opioid Epidemic
E. AIDS
VI. Summary
VII. Key Terms and Theories
VIII. Discussion Questions

Box 12.1 Career Opportunities: Public Health
Box 12.2 Parents Grapple with Vaccine Information
Box 12.3 Helping During a Disaster
Box 12.4 Typhoid Mary and TB Andy
Box 12.5 ETHICAL CONSIDERATIONS: Who Should Be Protected?
Box 12.6 Lessons for Public Health and Crisis Communication

Chapter 13: Planning Health Promotion Campaigns
I. Background on Health Campaigns
A. Types of Campaigns
B. Motivating Factors
II. Step 1: Defining the Situation and Potential Benefits
A. Current Situation
B. Benefits
C. Diverse Motivations
III. Step 2: Analyzing and Segmenting the Audience
A. Community Expectations
B. Get to Know the Audience
C. Data Collection
1. Ethical Commitments
2. Data-Gathering Options
D. Choosing a Target Audience
1. Theoretical Foundations
2. Reaching Under-Informed Audiences
E. Audience as a Person
F. Segmenting the Audience
G. Young Audiences
H. Sensation-Seekers
IV. Step 3: Establishing Campaign Goals and Objectives
A. Accountability
V. Step 4: Selecting Channels of Communication
A. Channel Characteristics
B. Message Impact
1. Arousal
2. Involvement
C. Multichannel Campaigns
VI. Summary
VII. Key Terms and Theories
VIII. Discussion Questions

Box 13.1 Career Opportunities: Health Promotion and Education
Box 13.2 Ethical Considerations: The Politics of Prevention

Chapter 14: Designing and Implementing Health Campaigns
I. Theories of Behaviors Change
A. Self-Determination Theory
B. Prospect Theory
C. Health Belief Model
D. Social Cognitive Theory
E. Theory of Reasoned Action
F. Transtheoretical Model
G. Wrapping It Up
II. Culture Centered Approach
III. Step 5: Designing Campaign Messages
A. Tailoring
B. Designing the Message
1. Message Framing
2. Narrative Messages
3. Logical Appeals
4. Emotional Appeals
5. Novel and Shocking Messages
C. Choosing a Voice and/or Spokesperson
IV. Step 6: Piloting and Implementing the Campaign
V. Step 7: Evaluating and Maintaining the Campaign
A. Evaluation
B. Maintenance
VI. Summary
VII. Glossary
VIII. Discussion Questions

Box 14.1. Ethical Considerations: Three Issues for Health Promoters to Keep in Mind
Box 14.2. Career Opportunities: Health Campaign Design and Management