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Communication Health Communication
by
Glenn Leshner, Elizabeth Gardner
  • LAST REVIEWED: 09 November 2017
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756841-0074

Introduction

The area of health communication research and theory focuses primarily on the application of communication theory, concepts, and strategies in the service of enhancing public health, and understanding how such processes work. The approaches are numerous and represent significant scholarship across bio-psycho-social levels of analysis. Research can range from how individuals cognitively and emotionally process individual health-related messages to social and cultural contexts that influence how health campaigns are implemented. It can include targeted messaging through mass media or interpersonal communication between patient and health-care provider. Recently, research on issues involving new media and technology has emerged. Overall, research represents efforts from two perspectives: from the field of public health and from the field of communication. Although both areas are interested in improving public health as a general goal, communication scholars emphasize theory and processes, while public health emphasizes outcomes. Recent advances in health communication are integrating these two approaches.

General Overviews

Health communication books primarily revolve around the interactions between health concerns and the health industry with interpersonal, organizational, and mass communication. Authors generally come from either the communication or public health disciplines. The interdisciplinary nature of health communication research is blurring those distinctions, however. Health communication research draws on a large variety of theoretical approaches, especially those from allied fields such as psychology, sociology, and public policy. Research also crosses bio-psycho-social levels of analyses and includes both quantitative and qualitative methodological approaches. Berry 2007 explores the general applications of communication, both verbal and nonverbal, for those whose work involves communicating with patients and relatives, and other careers. Institute of Medicine 2002 focuses on message tailoring. Guttman 2000 discusses values, ethics, and responsibilities of public health campaigns. Schiavo 2007, Thomas 2006, and Wright, et al. 2008 comprehensively cover a wide range of health communication topics. Witte, et al. 2001 is an often cited book on theoretically based health message design.

  • Berry, Dianne. 2007. Health communication: Theory and practice. Maidenhead, UK: Open Univ. Press.

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    This book includes chapters on hard-to-reach populations and communication in difficult situations (e.g., genetic counseling). Two chapters are devoted to health information campaigns and skills training. The book would be a useful supplementary text for health psychology or public health students.

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  • Guttman, Nurit. 2000. Public health communication interventions: Values and ethical dilemmas. Thousand Oaks, CA: SAGE.

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    In discussing values, ethics, and responsibilities of public health campaigns, Guttman draws on a variety of theoretical frameworks to address the central question of how far interventions should go to change people’s attitudes, beliefs, and behavior. She includes “work sheets” for analyzing and comparing health communication interventions.

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  • Institute of Medicine. 2002. Committee on Communication for Behavior Change in the 21st Century: Improving the health of diverse populations. In Speaking of health: Assessing health communication strategies for diverse populations. Washington, DC: National Academy Press.

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    This book focuses on message tailoring for reaching target audiences in meaningful ways. It also suggests creative strategies for communicating with diverse audiences. The book is useful for students in health communication and public health, scholars, and practitioners, who are interested in communicating with diverse communities about health issues.

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  • Schiavo, Renata. 2007. Health communication: From theory to practice. San Francisco: Jossey-Bass.

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    A comprehensive introduction to current issues, theories, and special topics in health communication, combined with a guide to health communication campaigns and program development. The book is designed as an introductory text for students and professionals with no significant field experience, but it also includes advanced topics for health communication practitioners and researchers. It is well indexed, making the book ideal for students who wish to delve deeper into a particular topic.

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  • Thomas, Richard K. 2006. Health communication. New York: Springer.

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    This book provides a broad background in health communication, with examples of successful applications. It covers basic theory, design strategies for health campaigns, and program evaluation. Includes a discussion on interactive health media in addition to traditional mass media, and covers ways to reach at-risk populations. It can be a useful introductory/supplemental text for novice undergraduate students in communication, public health, and related courses.

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  • Witte, Kim, Gary Meyer, and Dennis Martell. 2001. Effective health risk messages: A step-by-step guide. Thousand Oaks, CA: SAGE.

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    This book provides instructions for developing theoretically based campaign messages. Introduces theories that inform message development and campaign evaluation. Worksheets are provided at the end of each chapter to provide readers with hands-on, practical experiences in developing effective health risk messages. This book is suitable for practitioners, researchers, and students, and can serve as a supplementary text for public health and health communication classes.

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  • Wright, Kevin B., Lisa Sparks, and H. Dan O’Hair. 2008. Health communication in the 21st century. Malden, MA: Wiley-Blackwell.

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    This book was written by communication scholars and, as such, has a distinct communication point of view. It is suitable for undergraduate students in an introductory course in health communication, and includes sections on social and cultural contexts, new media, interpersonal communication issues, and emerging challenges. It also can work for students in communication and health-care professions.

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Anthologies and Edited Volumes

Anthologies presented here represent a wide range of research, theory, case studies, and topical essays. Students may notice that some research approaches health communication with an emphasis on health (e.g., Ray 2005), while other research emphasizes communication (e.g., Crano and Burgoon 2002). Additionally, some research may stress interpersonal and organizational communication (e.g., health-care providers talking with patients, public health policy; Jackson and Duffy 1998), while other research emphasizes mass communication (e.g. health information campaigns; Atkin and Wallack 1990, Hornik 2002, Kreps 2010, Maibach and Parrott 1995, Salmon1989, Thompson, et al. 2003). The volumes presented here touch on all of the perspectives, indicating the interdisciplinary nature of the field. Students will find chapters written by communication scholars, public health researchers, and health and medical professionals.

  • Atkin, Charles, and Lawrence Wallack, eds. 1990. Mass communication and public health: Complexities and conflicts. Newbury Park, CA: SAGE.

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    This book examines the challenges practitioners face as they attempt to change health behaviors. It examines why public information campaigns have achieved limited success and what can be done to improve their effectiveness. Although a bit dated, it remains one of the first comprehensive books on mass communication health campaigns.

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  • Crano, William D., and Michael Burgoon, eds. 2002. Mass media and drug prevention: Classic and contemporary theories and research. Mahwah, NJ: Erlbaum.

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    This book reports the findings of the 17th Claremont Symposium on Applied Social Psychology. It represents work by the National Youth Anti-Drug Media Campaign (funded by the National Institute on Drug Abuse) and focuses largely on a media advocacy approach. Communication scholars dominate, focusing on mass media’s role in reducing drug abuse. The book will appeal to social scientists interested in persuasion and the media, and can be a rich source of literature for health communication and psychology students.

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  • Hornik, Robert C., ed. 2002. Public health communication: Evidence for behavior change. Mahwah, NJ: Erlbaum.

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    This volume presents case studies that show how public health communication has affected health behavior. It includes sixteen studies of large-scale communication efforts in a variety of health areas, as well as several analytic chapters. It is suitable for scholars, students, practitioners, and policy makers in public health, health communication, and health psychology.

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  • Jackson, Lorraine D., and Bernard K. Duffy, eds. 1998. Health communication research: A guide to developments and directions. Westport, CT: Greenwood.

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    Chapters in this book examine the role of communication in a variety of interpersonal contexts (e.g., cultural factors and treatment adherence between health professional/client relationships) and issues of organizational communication and policy. It also contains a chapter on health information campaigns and another on health images in the media. The book is suitable as an introductory resource for health communication and sociology students and for professionals.

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  • Kreps, Gary L., ed. 2010. Health communication. 5 vols. Thousand Oaks, CA: SAGE.

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    This five-volume set is perhaps the most comprehensive treatment of the research in health communication to date. The volumes focus on health communication in delivering health care, health promotion, risk communication, and new information technologies.

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  • Maibach, Edward, and Roxanne Louiselle Parrott, eds. 1995. Designing health messages: Approaches from communication theory and public health practice. Thousand Oaks, CA: SAGE.

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    An edited volume with often cited chapters, this book explores the question of message design from both theoretical and practical perspectives. The authors base message design decisions on appropriate theories of human behavior and communication. The book covers theory-driven and audience-centered approaches used in real health information campaigns. This can be a resource for mass communication and public health scholars, students, and professionals.

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  • Ray, Eileen B., ed. 2005. Health communication in practice: A case study approach. Mahwah, NJ: Erlbaum.

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    This book focuses on the complexities of health communication with in-depth attention to personal, familial, organizational, and cultural contexts through the use of in-depth case studies. The case studies permit students to delve deeply into a given topic and encourage conceptual and analytical reading. This is appropriate for advanced undergraduates and graduate students in a variety of communication and health-allied classes.

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  • Salmon, Charles T., ed. 1989. Information campaigns: Balancing social values and change. Thousand Oaks, CA: SAGE.

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    Although this edited volume centers on a broader notion of information campaigns than might interest health communication researchers, many of the chapters contextualize their discussions around health communication issues and campaigns. The book’s contributors represent many of the most prolific scholars in communication, including its editor. Excellent background for graduate students in any field interested in social marketing.

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  • Thompson, Teresa L., Alicia Dorsey, Katherine Miller, and Roxanne Parrott, eds. 2003. Handbook of health communication. Mahwah, NJ: Erlbaum.

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    This handbook was much needed due to the explosion of quality health communication, and represents the expansive, current body of scholarly work in health communication. As with most handbooks, it summarizes work for those both familiar and unfamiliar with the area, and suggests avenues for future research. It is suitable for students, researchers, and practitioners with interests in the various aspects of health communication.

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Datasets and Archives

Information about health and health communication research abounds on the Internet. All the organizations listed here are part of, or funded by, a government or non-profit entity. Many non-profit organizations, for example, the American Cancer Society, American Lung Association, and so on, also have websites that contain information which may be useful to a health communication scholar. The National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) websites provide archives of primary research, data, and news. Several datasets are available (Annenberg National Health Communication Survey (ANHCS); CDC WONDER DATA2010; Health Information National Trends Survey (HINTS)) that provide data dealing directly with health communication. PubMed, a service of the National Library of Medicine, is a search engine that accesses an enormous collection of health and health-related research. The Centers for Excellence and Cancer Communication Research (CECCR) sites focus on the cancer communication research conducted at four National Cancer Institute–funded sites.

Journals

The explosion of health communication research is reflected in the substantial number of specialty journals devoted to many aspects of the intersection of health concerns and communication processes. Health communication research also appears in general journals as well, such as Communication Research, Human Communication Research, and Media Psychology. The Journal of Communication devoted a special issue to health communication research in 2006. There are a number of specialty journals that publish health communication research. The most prominent are Health Communication, Journal of Health Communication, and Health Education & Behavior. Each publishes a variety of research topics and approaches, although the emphasis tends to be on data-based studies, as does the newer Journal of Health & Mass Communication. Health Promotion Practice and Journal of Communication in Healthcare tend toward professional applications. Several journals are affiliated with health or academic organizations (Health Psychology and Health Promotion International). All are refereed.

Health Campaigns Research

Research into the effectiveness of health communication campaigns can take several forms, and depends in large part on the strategies and tactics of the campaigns themselves. Three common approaches include diffusion of innovation (DOI), social marketing, and media advocacy. DOI focuses on factors that impact how “innovations” (e.g., health information and behaviors) spread through a community or society. Rogers 2003 is the key resource on DOI theory. David, et al. 2006 provides an example of DOI research, while Hornik 2004 describes Everett Rogers’s central role in DOI development. Social marketing is modeled on principals from marketing, essentially the selling of behaviors and attitudes. Media advocacy focuses on enacting change at the policy or social level by garnering media coverage of health issues that demonstrates an environmental rather than individual orientation to public health. Rice and Atkin 2001 contains chapters on social marketing and media advocacy research. Kreps 2009 is an example of theoretical integration that can inform both research and practice. Also provided are works representing the media channel framework (Stanford Communication Model), research integral to several fields, including communication and epidemiology, represented by Flora and her colleagues (Flora, et al. 1997, Schooler, et al. 1998, Stephens, et al. 2004).

  • David, Clarissa, Joseph N. Cappella, and Martin Fishbein. 2006. The social diffusion of influence among adolescents: Group interaction in a chat room environment about antidrug advertisements. Communication Theory 16:118–140.

    DOI: 10.1111/j.1468-2885.2006.00008.xSave Citation »Export Citation » Share Citation »

    The goal of this study was to test the effects of online group interaction among adolescents about antimarijuana advertisements on relevant attitudes and behaviors. The authors conducted an experiment that manipulated chatting and argument strength in antidrug ads. They found a boomerang effect, where those who chatted reported more pro-marijuana attitudes and beliefs than those who just viewed the ads.

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  • Flora, June A., Melissa N. Saphir, Caroline Schooler, and Rajiv N. Rimal. 1997. Toward a framework for intervention channels: Reach, involvement, and impact. Annals of Epidemiology 7:S104–S112.

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    Flora and her colleagues propose the media channel framework, a guide for planners of mass media interventions to predict which media channels will have the greatest impact with their intended audience. Demonstrated with survey data from the Stanford Five-City Project, this framework orders media channels along two dimensions: reach/specificity and arousing/involving.

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  • Hornik, Robert. 2004. Some reflections on diffusion theory and the role of Everett Rogers. Journal of Health Communication 9:143–148.

    DOI: 10.1080/1081070490271610Save Citation »Export Citation » Share Citation »

    Hornik’s thoughtful essay focuses on the adoption process. In particular, he examines this particular portion of the DOI theoretical framework, which is important for scholars who are interested in the role of public health information campaigns and how such campaigns can influence behavior.

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  • Kreps, Gary L. 2009. Applying Weick’s model of organizing to health care and health promotion: Highlighting the central role of health communication. Patient Education & Counseling 74:347–355.

    DOI: 10.1016/j.pec.2008.12.002Save Citation »Export Citation » Share Citation »

    This article describes Weick’s model of organizing as a useful theory that can help increase understanding of the communication demands of health care and health promotion. It identifies relevant applications from the model for health communication research and practice.

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  • Rice, Ronald E., and Charles K. Atkin. 2001. Public communication campaigns. 3d ed. Thousand Oaks, CA: SAGE.

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    This is the third edition of the classic book by Rice and Atkin. In addition to including current theory and research, it contains chapters on more recent and controversial campaigns, including examples from both AIDS and antidrug campaigns. The final section introduces a variety of recent campaign dimensions, including community-oriented campaigns, entertainment-education campaigns, and Internet/Web-based campaigns. A valuable resource for students, both undergraduate and graduate, and researchers in the fields of communication, mass media, and public health programs.

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  • Rogers, Everett. 2003. Diffusion of innovations. 5th ed. New York: Free Press.

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    This is the fifth edition of the classic book on diffusion of innovations. Although not specifically about health communication, this theory has guided many public health campaigns and subsequent research. This book would be helpful for any student of health communication.

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  • Schooler, Caroline, Steven H. Chaffee, June A. Flora, and Connie Roser. 1998. Health campaign channels: Tradeoffs among reach, specificity, and impact. Human Communication Research 24:410–432.

    DOI: 10.1111/j.1468-2958.1998.tb00423.xSave Citation »Export Citation » Share Citation »

    In an effort to chart the effectiveness of different health campaign media channels, Schooler and colleagues apply the media channel framework to impact data from the Stanford Five-City Multifactor Risk Reduction Project (FCP). The authors frame the channel framework as a way for planners to maximize resources such as time and money for the greatest potential impact.

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  • Stephens, Keri K., Rajiv N. Rimal, and June A. Flora. 2004. Expanding the reach of health campaigns: Community organizations as meta-channels for the dissemination of health information. Journal of Health Communication 9:97–111.

    DOI: 10.1080/10810730490271557Save Citation »Export Citation » Share Citation »

    Analyzing data from the Stanford Five-City Project, these scholars examine the relationships between membership in community organizations and health outcomes, above and beyond general media use, demographics, and health-specific media use.

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Fear Appeal Research

Research on the processing and effects of fear appeal messages has been ongoing for more than fifty years. Fear appeals are generally defined as messages that include a threat to one’s health if an unhealthy behavior is engaged in (or if a healthy behavior is not). The following works include the article most often cited as the first experimental study on fear appeals. The classic Janis and Feshback 1953 is one of the earliest examinations of fear appeal effects. It was followed by a progression of fear appeal theories, which developed over time, as each theory built on its predecessors. The parallel processing model in Levanthal 1971 introduces the idea that fear messages can deflect a person’s response into fear or danger control. The protection motivation theory (PMT) in Rogers 1975 and Rogers 1983 improves on the parallel processing model by introducing antecedent variables, such as perceived severity and susceptibility. Witte 1992 and Witte 1994 build on PMT, and their extended parallel process model (EPPM) has received wide acceptance as a useful way of modeling how fear appeals are processed. Dillard and Anderson 2004, and Witte and Allen 2000 are important pieces that reflect on the knowledge developed through fear appeal research.

  • Dillard, James P., and Jason W. Anderson. 2004. The role of fear in persuasion. Psychology & Marketing 21:909–926.

    DOI: 10.1002/mar.20041Save Citation »Export Citation » Share Citation »

    Previous research on fear/threat appeals has correlated fear intensity with persuasion. The authors propose that fear might influence persuasion in at least four conceptually distinct ways: (1) the proclivity to experience fear, (2) the rise from baseline to peak, (3) peak intensity, and (4) the decline from peak to postmessage fear. The authors find positive relationships between traitlike activation of the behavioral-inhibition system (BIS) and various indices of fear arousal.

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  • Janis, Irving L., and Seymour Feshback. 1953. Effects of fear-arousing communications. The Journal of Abnormal and Social Psychology 48:78–92.

    DOI: 10.1037/h0060732Save Citation »Export Citation » Share Citation »

    This is the classic study on the effects of fear appeal messages, which showed that tooth-decay messages moderate or strong in fear were less effective than messages minimal in fear. Students should be familiar with this study because it serves as the foundation for later conceptual and theoretical work in the area.

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  • Leventhal, Howard. 1971. Fear appeals and persuasion: The differentiation of a motivational construct. American Journal of Public Health 61:1208–1224.

    DOI: 10.2105/AJPH.61.6.1208Save Citation »Export Citation » Share Citation »

    This theoretical article contrasts two models of how individuals react to threatening messages: the drive model and the parallel processing model. Leventhal details the parallel processing model, which provides the theoretical foundation for much subsequent fear appeal research, and how it relates to preventive health behavior. He defines the two key elements, fear control and danger control, and relates how an individual’s appraisal of the message impacts each.

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  • Rogers, Ronald W. 1975. A protection motivation theory of fear appeals and attitude change. Journal of Psychology 91:93–114.

    DOI: 10.1080/00223980.1975.9915803Save Citation »Export Citation » Share Citation »

    Rogers introduces protection motivation theory. In the model, components of fear appeal messages (severity, susceptibility, and efficacy of recommended response) initiate cognitive mediating processes (appraised severity, expectancy of exposure, and belief in efficacy of response, respectively), which arouse protection motivation. This motivational state is proposed as a predictor of response acceptance.

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  • Rogers, Ronald W. 1983. Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In Social psychophysiology. Edited by John Cacioppo and Richard Petty, 153–176. New York: Guilford.

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    Rogers reviews empirical tests of protection motivation theory (PMT) and presents an updated version of the model. The main revisions to PMT include (1) expanding antecedent conditions to include both environmental and intrapersonal sources of information, (2) distinguishing threat appraisals from coping appraisals, and (3) adding self-efficacy to the model as a separate construct from response efficacy.

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  • Witte, Kim. 1992. Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs 59:329–349.

    DOI: 10.1080/03637759209376276Save Citation »Export Citation » Share Citation »

    This conceptual article synthesizes decades of fear appeal research and presents Witte’s dual-process model, which distinguishes thoughtful, adaptive responses to threatening messages from fear-driven, maladaptive responses. The extended parallel process model (EPPM) details how fear appeal processing during exposure to a threatening persuasive message leads to either acceptance of the message’s recommendation (adaptive, danger control) or rejection (maladaptive, fear control).

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  • Witte, Kim. 1994. Fear control and danger control: A test of the extended parallel process model (EPPM). Communication Monographs 61:113–134.

    DOI: 10.1080/03637759409376328Save Citation »Export Citation » Share Citation »

    This article details a comprehensive empirical test of the EPPM. The investigation provides general support for the model and confirms the parallel cognitive (adaptive danger control) and emotional (maladaptive fear control) processes. Specifically, fear directly predicts fear control but not danger control processes, efficacy appraisals predict danger control but have no association with fear control, and threat perception partially mediates the path from fear to behavior under conditions of high perceived efficacy.

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  • Witte, Kim, and Mike Allen. 2000. A meta-analysis of fear appeals: Implications for effective public health campaigns. Health Education & Behavior 27:591–615.

    DOI: 10.1177/109019810002700506Save Citation »Export Citation » Share Citation »

    This meta-analysis of decades of fear appeal research suggests that strong fear appeals produced high levels of perceived severity and susceptibility, and were more persuasive than low or weak fear appeals. The authors found that high-efficacy fear messages produced the greatest behavior change. This study can provide students with a broad view of fear appeal research.

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Message Information and Processing Theories

How individuals process media messages has always been of interest to health communication scholars. The theories and concepts presented here focus on message processing perspectives that are either specific to health communication or were developed in other disciplines and often employed in health communication research. Admittedly, there are many other message processing theories that are also used in health communication, including those are also heavily utilized in other information processing and persuasion research (e.g., ELM, TRA/TPB, LC4MP). The health belief model has influenced much succeeding research. Prospect theory serves as the basis for much of the framing research in health communication, particularly how individuals process gain- and loss-framed messages. Psychological reactance theory spurned research that explores why individuals resist messages designed to enhance their health. How risk is perceived has been shown to impact many attitudes and behaviors, including information seeking. The risk perception attitude framework is offered as a potentially useful way of examining this phenomenon. Social cognitive theory explains how people can acquire attitudes and behaviors through social modeling. The concept of self-efficacy is central to much health communication research, including research on fear appeals. The stages of change theory and message tailoring paradigm emphasize creating messages designed to target particular characteristics of individuals, including the stage where an individual is in the addiction recovery process.

Health Belief Model

The health belief model (HBM), first proposed by Rosenstock 1974, sought to link perceptions to health behavioral change. It emphasizes several important perceptual concepts, such as perceived severity, susceptibility, and barriers. Janz and Becker 1984 reviews much of the HBM literature a decade after Rosenstock’s piece.

  • Janz, Nancy K., and Marshall H. Becker. 1984. The health belief model: A decade later. Health Education Quarterly 11:1–47.

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    The authors review forty-six empirical tests of health belief model (HBM) constructs’ influence on various preventive (e.g., vaccination) and sick-role (e.g., medication compliance) health behaviors. Across studies, perceived barriers were the most influential dimension on health behavior change. Perceived severity was least influential for preventive actions, but second-most influential for sick-role behaviors.

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  • Rosenstock, Irwin M. 1974. The health belief model and preventive health behavior. Health Education Monographs 2:354–386.

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    This monograph outlines the health belief model, which holds that perceptions of susceptibility to and severity of disease interact with cues about benefits and barriers to action, to guide motivated health behavior change. The article discusses evidence in support of (and in contrast to) the model and explores the influence of demographic variables.

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Message Tailoring

The idea of tailoring message content to particular audience segments was made possible on a large scale by new communication technologies. Message tailoring has been a focal point of one of the Centers for Excellent in Cancer Communication Research (CECCR), and is represented by Hawkins, et al. 2008. Tailoring can be based on a number of individual difference variables, such as demographic and cultural factors. Kreuter has been one of the foremost researchers on tailoring messages for enhanced health outcomes (see Kreuter and Haughton 2006, and Hawkins, et al. 2008).

  • Hawkins, Robert P., Matthew Kreuter, Kenneth Resnicow, Martin Fishbein, and Arie Dijkstra. 2008. Understanding tailoring in communicating about health. Health Education Research 23:454–466.

    DOI: 10.1093/her/cyn004Save Citation »Export Citation » Share Citation »

    A panel of scholars from National Cancer Institute–funded CECCR programs explicates the concept of tailoring as linked processes of audience segmentation and message customization. The article outlines two primary goals/mechanisms of tailoring (enhance processing, acceptance) and three classes of message strategies (personalization, feedback, content matching), and compares the relative efficacy of strategies across different goals.

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  • Kreuter, Matthew W., and Lorna T. Haughton. 2006. Integrating culture into health information for African American women. American Behavioral Scientist 49:794–811.

    DOI: 10.1177/0002764205283801Save Citation »Export Citation » Share Citation »

    This article examines culturally appropriate tailoring strategies for health communication. A cancer prevention campaign exposed 1,227 African American women to magazines tailored with behavioral (e.g., knowledge, self-efficacy), cultural (e.g., collectivism, religiosity), or combined content. All conditions elicited similar short-term effects, yet only the combined treatment produced long-term change, suggesting that group- and individual-based tailoring strategies are most effective when intertwined.

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Prospect Theory and Message Framing

Framing theory, first proposed by Kahneman and Tversky 1984 as a subjective choice model, has been applied to a variety of social science fields, including health communication. The idea of framing health behaviors as something to gain or to lose has generated a substantial amount of research. Salovey and his colleagues have been at the forefront of this effort. Rothman, et al. 2006 provides a summary about how this theory can help promote healthy behaviors.

  • Kahneman, Daniel, and Amos Tversky. 1984. Choices, values, and frames. American Psychologist 39:341–350.

    DOI: 10.1037/0003-066X.39.4.341Save Citation »Export Citation » Share Citation »

    This article details prospect theory, which contends that the framing of decisions interacts with the subjectivity of human choice. In contrast to rational decision-making models, prospect theory holds that framing outcomes as gains prompts risk aversion (i.e., people prefer a “sure gain”), whereas losses prompt risk seeking (i.e., rejection of a “sure loss”). Additional theoretical tenets, such as subjective weighting of probabilities, are also discussed.

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  • Rothman, Alexander J., Roger D. Bartels, Jhon Wlaschin, and Peter Salovey. 2006. The strategic use of gain- and loss-framed messages to promote healthy behavior: How theory can inform practice. Journal of Communication 56:S202–S220.

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    This article reviews research on two primary frames in health communication: appeals that emphasize the benefits of adopting a recommendation (gain frames) or those that emphasize the costs of nonadoption (loss frames). Based on findings from cancer communication literature, the authors conclude that gain-framed messages are most effective for prevention behaviors, while loss-framed messages are most effective for detection behaviors.

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Psychological Reactance Theory

Brehm and Brehm 1981 introduces psychological reactance theory, which attempts to explain why individuals sometimes do not adopt information that is beneficial for them. Its application to health communication is especially valuable because it helps to identify key barriers to health message acceptance. Dillard and Shen 2005 attempts to focus reactance as a combination of cognitions and affects.

  • Brehm, Sharon S., and Jack W. Brehm. 1981. Psychological reactance: A theory of freedom and control. San Diego, CA: Academic Press.

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    This book compiles fifteen years of research on psychological reactance, providing an empirical grounding for the conceptual tenets of reactance theory. Early chapters integrate research on components, determinants, and effects of reactance, followed by a longer series of psychology-focused topical chapters, such as reactance and individual differences, and clinical applications.

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  • Dillard, James P., and Lijiang Shen. 2005. On the nature of reactance and its role in persuasive health communication. Communication Monographs 72:144–168.

    DOI: 10.1080/03637750500111815Save Citation »Export Citation » Share Citation »

    This article demonstrates that state reactance can be operationalized as an amalgam of self-reported anger and negative thoughts, by comparing four conceptual models across twin experiments (flossing, alcohol). The study also illustrates the negative influence of controlling language in persuasive health communication on message outcomes, as mediated by state reactance.

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Risk Perception

How risk is perceived has been shown to impact many attitudes and behaviors, including information seeking. Slövic 1987 proposes a risk perception model that has been applied to health risks. Turner, et al. 2006 tests Rimal’s risk perception attitude framework across two health risks. This model has the potential to yield fruitful research.

  • Slövic, Paul. 1987. Perception of risk. Science 236:280–285.

    DOI: 10.1126/science.3563507Save Citation »Export Citation » Share Citation »

    Slövic proposes a psychometric model to predict acceptance or rejection of hazards such as nuclear power or nanotechnology. The typology is anchored by axes classifying how new and catastrophic the risk is perceived to be. According to the model, risk communicators should emphasize the familiar aspects and potential benefits of hazards to allay concerns.

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  • Turner, Monique M., Rajiv N. Rimal, Daniel Morrison, and Hyojin Kim. 2006. The role of anxiety in seeking and retaining risk information: Testing the risk perception attitude framework in two studies. Human Communication Research 32:130–156.

    DOI: 10.1111/j.1468-2958.2006.00006.xSave Citation »Export Citation » Share Citation »

    A pair of between-subjects experiments (skin cancer, diabetes) tested the risk perception attitude framework, which argues that efficacy beliefs moderate the influence of risk perception on information-seeking behaviors. High risk, particularly when coupled with low efficacy, induced anxiety, which bolstered information-seeking intentions and, indirectly, behaviors, but also hindered retention.

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Social Cognitive Theory

Social cognitive theory (SCT) developed out of social learning theory, and attempts to explain how people learn through observing the reward and punishment of others’ behaviors. SCT has been a central theory to health message effectiveness, especially in regard to the important factors of social modeling. Self-efficacy, as Bandura 1977 argues, is a central appraisal process in SCT. Bandura 2001 is a comprehensive review of SCT, and a good primer for students unfamiliar with the key tenets of the theory.

  • Bandura, Albert. 1977. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84:191–215.

    DOI: 10.1037/0033-295X.84.2.191Save Citation »Export Citation » Share Citation »

    This article outlines a cognitive processing model of behavior change centered on self-efficacy, an appraisal mechanism proposed to mediate the influence of treatment interventions on behavior change. The author presents an experiment that demonstrates the effectiveness of an efficacy-building approach to elicit positive behavior change among adult snake phobics.

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  • Bandura, Albert. 2001. Social cognitive theory of mass communication. Media Psychology 3:265–298.

    DOI: 10.1207/S1532785XMEP0303_03Save Citation »Export Citation » Share Citation »

    In this article, Bandura expands his concept of self-efficacy to a model where personal experiences, behavioral patterns, and environmental factors converge to determine behavior change. Reviewed studies indicate that media interventions can effectively convey coping strategies/tactics to audiences and link together people for higher-order learning and persuasion effects.

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Trans-Theoretical Model of Behavior Change

The trans-theoretical model of behavior change, also called stages of change theory, emphasizes messages that target the stage when an individual is in the addiction recovery process. Prochaska and Velicer 1997 details the model and how it can inform message design. Jones, et al. 2003 applies the stages of change model to diabetes.

  • Jones, Helen, Lynn Edwards, T. Michael Vallis, Laurie Ruggiero, Susan R. Rossi, Joseph S. Rossi, Geoffrey Greene, James O. Prochaska, and Bernard Zinman. 2003. Changes in diabetes self-care behaviors make a difference in glycemic control: The Diabetes Stages of Change (DiSC) study. Diabetes Care 26:732–737.

    DOI: 10.2337/diacare.26.3.732Save Citation »Export Citation » Share Citation »

    This article reviews a stage-matched intervention promoting diabetes self-care. Diabetics in the stage-matched condition, compared to a control group receiving traditional diabetes treatment, reported better blood glucose self-monitoring, healthier eating, and greater likelihood to stop smoking. Increased self-monitoring of blood glucose interacted with the treatment to predict weight loss and lower blood glucose levels.

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  • Prochaska, James O., and Wayne F. Velicer. 1997. Behavior change: The transtheoretical model of health behavior change. American Journal of Health Promotion 12:38–48.

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    This article details an integrative model of behavior change that matches outreach strategies to six “stages” on a temporal continuum from addiction to recovery (precontemplation, contemplation, preparation, action, maintenance, termination). Messages targeted at different stages should use different strategies, such as fear appeals for preaction stages and counterconditioning exercises for post-action stages.

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Health Literacy

Health literacy is an important concept because research has linked it to health knowledge, health behaviors, and health outcomes. Currently, there is not one commonly accepted definition of health literacy. Conceptually, health literacy has been defined from a clinical perspective, where it is considered a property of an individual to be assessed in order to mitigate the negative health impact of an individual’s poor literacy. The most commonly used measures in the early 21st century reflect that approach. American Medical Association 1999 defines health literacy in this way. This definition captures key elements of health care, but ignores important factors external to the health-care sector (Institute of Medicine 2004). Health literacy is also being studied from a public health perspective, where it is viewed more as an attribute of an individual that can be improved. This approach tends to view health literacy as an outcome variable, rather than a diagnostic. The Institute of Medicine definition aligns with such a perspective. Both perspectives recognize the importance of individuals’ motivations and abilities to obtain, understand, and use information to make informed health decisions and interact successfully with the health-care system, rather than simply possessing a set of literacy skills. According to Nutbeam 2008, the definition adopted by the World Health Organization sees health literacy more as a process that can empower individuals to take control of their health (see Schapira, et al. 2008; Quick Guide to Health Literacy).

  • American Medical Association. 1999. Health literacy: Report of the Council on Scientific Affairs. Ad hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Journal of the American Medical Association 281:552–557.

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    A dozen AMA experts in health literacy compiled this report, which synthesizes academic literature (1966–1996) on definitions of health literacy, outcomes of low health literacy, and communication strategies for physicians. The report discusses areas for future research, such as screening techniques, and the adoption of health literacy as a policy issue.

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  • Institute of Medicine. 2004. Health literacy: A prescription to end confusion. Washington, DC: National Academies Press.

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    This report contends that nearly half of the American population faces difficulty utilizing health information. Emphasizing systemic as well as individual responsibility for health literacy, recommends action steps to improve low health literacy based on comprehensive assessments of health information delivery across a variety of contexts.

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  • Nutbeam, Don. 2008. The evolving concept of health literacy. Social Science & Medicine 67:2072–2078.

    DOI: 10.1016/j.socscimed.2008.09.050Save Citation »Export Citation » Share Citation »

    This article contrasts conceptualizations of health literacy as a risk factor for poor health status (clinical approach) and as an asset for improved health control (public health approach). Nutbeam concludes that both perspectives inform a nuanced understanding of health information use and calls for integration of the camps to address inadequacies in current measurement tools.

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  • Schapira, Marilyn M., Kathlyn E. Fletcher, Mary Ann Gilligan, Toni K. King, Purushottam W. Laud, B. Alexandra Matthews, Joan M. Neuner, and Elisabeth Hayes. 2008. A framework for health numeracy: How patients use quantitative skills in health care. Journal of Health Communication 13:501–517.

    DOI: 10.1080/10810730802202169Save Citation »Export Citation » Share Citation »

    Based on focus groups with primary-care patients, this article proposes a conceptual framework for health numeracy, the quantitative complement to health literacy, comprising three skills domains: primary (e.g., counting, arithmetic), applied (e.g., following a prescription regimen, paying medical bills), and interpretive (e.g., understanding the ability of statistics to represent future possibilities).

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  • US Department of Health and Human Services. Quick Guide to Health Literacy Washington, DC: Office of Disease Prevention and Health Promotion.

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    This user-friendly guide for health professionals and educators includes fact-filled overviews of health literacy concepts and practical strategies to improve the usability of health information and services, and build patient knowledge. Information is in plain language and richly supplemented with best practices and examples, such as talking points for a patient/provider exchange.

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Multicultural Approaches

Cultural factors, including race and ethnicity, are important factors in health communication research. Much of the research efforts that take cultural factors into account are driven by data that show persistent health disparities among cultural subgroups. Such factors can impact how individuals are best reached in health promotion campaigns (Flora, et al. 1977, Hecht, et al. 2006, Hornik and Ramirez 2006), how individuals differentially interpret messages (Kar and Alcalay 2001, Kreuter and McClure 2004, Viswanath and Emmons 2006), how individuals interact (or don’t) with the health-care systems, etc. Understanding how cultural factors, across individual and societal levels, impact health outcomes is crucial to understanding how to reduce health disparities (Ball-Rokeach and Wilkin 2009). The works cited here provide an indication of how researchers think about the value of incorporating cultural factors into their research.

  • Ball-Rokeach, Sandra, and Holley A. Wilkin. 2009. Ethnic differences in health information-seeking behavior: Methodological and applied issues. Communication Research Reports 26:22–29.

    DOI: 10.1080/08824090802636983Save Citation »Export Citation » Share Citation »

    This article presents the results of a field experiment on how survey methodologies (Internet vs. telephone) affect researchers’ recommendations about the best communication channels that practitioners should employ to reach ethnic populations. Findings for Hispanics and Anglos from two different surveys were compared. The authors found that responses varied as a function of the methodology employed.

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  • Flora, June A., Caroline Schooler, and Rosalind M. Pierson. 1997. Effective health promotion among communities of color: The potential of social marketing. In Social marketing: Theoretical and practical perspectives. Edited by Marvin E. Goldberg, Martin Fishbein, and Susan E. Middlestadt, 353–374. Mahwah, NJ: Erlbaum.

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    This book chapter, written by scholars affiliated with the Stanford Five-City Project, shows how social marketing can provide a useful theoretical framework for effect health promotion among communities of color. Specifically, it illustrates how to incorporate culturally appropriate and culturally relevant material to three social marketing principles: audience orientation, message tailoring, and exchange theory.

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  • Hecht, Michael L., John W. Graham, and Elvira Elek. 2006. The drug resistance strategies intervention: Program effects on substance use. Health Communication 20:267–276.

    DOI: 10.1207/s15327027hc2003_6Save Citation »Export Citation » Share Citation »

    This study evaluates the Drug Resistance Strategies (DRS) Project, a culturally grounded, communication-based substance use prevention program implemented in middle schools in Phoenix, Arizona. When compared to a control group, the DRS intervention appeared to significantly limit the increase in the number of students reporting recent substance use, especially alcohol and marijuana use.

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  • Hornik, Robert C., and A. Susana Ramirez. 2006. Racial/ethnic disparities and segmentation in communication campaigns. American Behavioral Scientist 49:868–884.

    DOI: 10.1177/0002764205283806Save Citation »Export Citation » Share Citation »

    This article describes what communication campaigns do to address racial health disparities and looks for evidence that segmented campaigns reduce disparities. The authors note several arguments that segmentation can risk negative effects yet find no evidence about whether racial/ethnic segmentation reduces disparities, although they argue that some approaches to segmentation are justified.

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  • Kar, Snehendu B., and Rina Alcalay, eds. 2001. Health communication: A multicultural perspective. Thousand Oaks, CA: SAGE.

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    This book is based on a review of available literature and intervention experiences selected from modern and traditional societies. It focuses on a particular project designed to develop health promotion interventions from a multicultural perspective, and is suitable for students and practitioners interested in a multicultural perspective.

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  • Kreuter, Matthew W., and Stephanie M. McClure. 2004. The role of culture in health communication. Annual Review of Public Health 25:439–455.

    DOI: 10.1146/annurev.publhealth.25.101802.123000Save Citation »Export Citation » Share Citation »

    This is a theoretical paper that examines the role of culture as a factor in enhancing the effectiveness of health communication. The authors describe how culture may be applied in audience segmentation and introduce a model of health communication planning, based on McGuire’s communication/persuasion model.

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  • Viswanath, K., and Karen M. Emmons. 2006. Message effects and social determinants of health: Its application to cancer disparities. Journal of Communication 56:S238–S264.

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    In an attempt to inform health disparities among various cultural subgroups in the United States, this article reviews message effects research, particularly framing and narrative, and links those phenomena to sociostructural factors, such as socioeconomic status, social organizations, social networks, community environment, and public policies. The authors show how individual-level mechanisms can be linked to social variables to help explain message effects on health behavior.

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Patient/Parent/Provider Communication

A substantial amount of research is conducted that examines patient/provider communication. The ultimate goal of this research is to improve that communication in order to enhance patients’ health knowledge, attitudes, and behaviors. Cameron 2009 and Rimal 2001 examine theoretical and methodological issues, respectively. Epstein and Street 2007 reports on critical processes that influence the effectiveness of clinicians’ communication with patients. Northouse and Northouse 1998 is perhaps the most comprehensive look at patient/provider communication. Williams, et al. 2002 links health literacy and its impact on patient/provider communication. Albrecht, et al. 2009 provides a useful model for clinical communication.

  • Albrecht, Terrance L., Louis A. Penner, and Rebecca J. W. Cline. 2009. Studying the process of clinical communication: Issues of context, concepts, and research directions. Journal of Health Communication 14:47–56.

    DOI: 10.1080/10810730902806794Save Citation »Export Citation » Share Citation »

    Albrecht and her colleagues present a model pertinent for clinical communication. Of particular interest is the description of their ongoing oncology research program where the authors videorecord interactions between physicians, patients, and family/companions during the discussion of a clinical trial. They also describe their coding procedures.

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  • Cameron, Kenzie A. 2009. A practitioner’s guide to persuasion: An overview of 15 selected persuasion theories, models and frameworks. Patient Education and Counseling 74:309–317.

    DOI: 10.1016/j.pec.2008.12.003Save Citation »Export Citation » Share Citation »

    This article summarizes fifteen theories that apply to health communication. Several (e.g. consistency theories, cognitive processing models) are not specific to health communication, while others are (e.g., fear appeal theories). Cameron presents a nice range of theories and summaries, which can inform both researchers and practitioners.

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  • Epstein, Ronald M., and Richard L. Street Jr. 2007. Patient-centered communication in cancer care: Promoting healing and reducing suffering NIH Publication No. 07-6225. Bethesda, MD: National Cancer Institute.

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    This National Cancer Institute (NCI) monograph identifies the main patient/provider communication issues that research has shown impact health outcomes. It examines the emotional and cognitive processes that a cancer patient may be undergoing and provides information for clinicians on how to best communicate with their patients.

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  • Northouse, Laurel L., and Peter G. Northouse. 1998. Health communication: Strategies for health professions. 3d ed. Stamford, CT: Appleton & Lange.

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    This text helps nurses and other health care professionals improve their personal communication style for more effective provider/patient communication. New models of communication have been added in this edition, as well as a new chapter on multicultural issues and one on communicating across the lifespan. Good for nursing and allied health profession students.

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  • Rimal, Rajiv N. 2001. Analyzing the physician-patient interaction: An overview of six methods and future research directions. Health Communication 13:89–99.

    DOI: 10.1207/S15327027HC1301_08Save Citation »Export Citation » Share Citation »

    Rimal presents a study on coding schemes across six varied studies that documented physician-patient interaction in Texas. He categorizes the way the different studies defined communication, distinguishing between the transmission and ritualistic views. The author also distinguishes the studies based on who exerts the control in their communication, patients or physicians. He offers benefits of improved communication on the part of physicians.

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  • Williams, Mark V., Terry Davis, Ruth M. Parker, and Barry D. Weiss. 2002. The role of health literacy in patient–physician communication. Family Medicine Journal 34:383–389.

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    This article reports on a literature review conducted on health literacy. The authors found that overall, health literacy is poor in the general population, and that those with poor health literacy tend to have worse health status. They call for the education of medical students and physicians in improved patient-doctor communication skills.

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Media Content

There are numerous approaches to examining mediated content in health communication. The studies listed here examine health content in news and advertising, strategies for persuasive message content, and how individuals look for health information in media. Slater, et al. 2008 and Slater, et al. 2009 examine how cancer is covered in US newspapers. Basil, et al. 2000 and Kelly, et al. 2000 track cigarette advertising in magazines. Hinyard and Kreuter 2007 shows how narratives can be used in persuasive communication. Dillard, et al. 2007 links the perceived effectiveness of persuasive messages to formative campaign research. Rideout 2008 measures the impact of an episode of Grey’s Anatomy on the public’s learning about a health issue.

  • Basil, Michael D., Debra Z. Basil, and Caroline Schooler. 2000. Cigarette advertising to counter New Year’s resolutions. Journal of Health Communication 5:161–174.

    DOI: 10.1080/108107300406875Save Citation »Export Citation » Share Citation »

    Content analyses of popular magazines (1964–1995) show that tobacco advertising, both inside magazines and on their back covers, is more frequent in the months following New Year’s Eve than during other months of the year. The authors conclude that cigarette marketers capitalize on periods when recent quitters are most vulnerable.

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  • Dillard, James P., Kirsten M. Weber, and Renata G. Vail. 2007. The relationship between the perceived and actual effectiveness of persuasive messages: A meta-analysis with implications for formative campaign research. Journal of Communication 57:613–631.

    DOI: 10.1111/j.1460-2466.2007.00360.xSave Citation »Export Citation » Share Citation »

    This meta-analysis introduces empirical support for the conceptual link between perceived and actual message effectiveness variables. The authors found a moderate correlation between the two, indicating the usefulness of perceived efficacy variables in formative campaign research. The moderating roles of novelty, focus (promotion/prevention), and type of measure (impact, attribute) are also discussed.

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  • Hinyard, Leslie J., and Matthew W. Kreuter. 2007. Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview. Health Education & Behavior 34:777–792.

    DOI: 10.1177/1090198106291963Save Citation »Export Citation » Share Citation »

    This article is a good primer for the use of narrative in health messages. It defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical and empirical explanations of narrative effects in persuasion, and outlines future research needs in narrative health communication.

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  • Kelly, Kathleen J., Michael D. Slater, David Karan, and Liza Hunn. 2000. The use of human models and cartoon characters in magazine advertisements for cigarettes, beer, and nonalcoholic beverages. Journal of Public Policy & Marketing 19:189–200.

    DOI: 10.1509/jppm.19.2.189.17135Save Citation »Export Citation » Share Citation »

    This article tracks the use of human and cartoon models in advertisements for cigarettes, beer, and nonalcoholic beverages over one year (1996–1997) from twelve popular magazines. Cigarette ads featured more lifestyle content and cartoon characters than either beverage category. Moreover, cartoon-based cigarette ads were disproportionately more common in younger-audience magazines.

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  • Rideout, Victoria. 2008. Television as a health educator: A case study of Grey’s Anatomy Menlo Park, CA: Henry J. Kaiser Family Foundation.

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    This study measures the impact of a medical story line in an episode of the television program Grey’s Anatomy. This is a unique case study in that the researchers worked with program writers and producers to include a medical issue in the plot. Three cross-section surveys measured the episode impact on viewers. Learning about the likelihood of HIV transmission from mother to child increased upon viewing the program.

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  • Slater, Michael D., Marilee Long, Erwin P. Bettinghaus, and Jason B. Reineke. 2008. News coverage of cancer in the United States: A national sample of newspapers, television, and magazines. Journal of Health Communication 13:523–537.

    DOI: 10.1080/10810730802279571Save Citation »Export Citation » Share Citation »

    This piece focuses on the content rather than outcomes of cancer news, aggregating articles from 2002–2003. For all cancer types examined, proportion of coverage did not match proportion of incidence, most notably for breast (overrepresented) and lung (underrepresented) cancers. Coverage also concentrated on treatment, rather than prevention or detection practices.

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  • Slater, Michael D., Andrew F. Hayes, Jason B. Reineke, Marilee Long, and Erwin P. Bettinghaus. 2009. Newspaper coverage of cancer prevention: Multilevel evidence for knowledge-gap effects. Journal of Communication 59:514–533.

    DOI: 10.1111/j.1460-2466.2009.01433.xSave Citation »Export Citation » Share Citation »

    This article finds that regional/market-size differences in news coverage and education are linked to knowledge disparities about cancer prevention at the regional level. The influence of news consumption on knowledge was contingent on nonlinear moderation by education level. Macro-level factors such as regional news availability also predicted knowledge gaps.

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Interactivity/Technology

Advances in new communication technologies have empowered health consumers with unique opportunities to obtain information about health issues in new ways. These technologies also afford health providers with interesting ways to communicate with health consumers and scholars with new research opportunities to explore the processes involved in how people obtain health information. These technologies can also provide systems of information, social, and emotional support to patients and other health information seekers. The range of research is nearly as broad as the range of new communication technologies; thus, the work listed here reflects that variability. Parker and Thorson 2009, Rice and Katz 2001, and Whitten and Cook 2004 provide broad and encompassing approaches to health communication technologies. Kreuter, et al. 1999 focuses on using computer technology for message tailoring.

  • Kreuter, Matthew, David Farrell, Laura Olevitch, and Laura Brennan. 1999. Tailoring health messages: Customizing communication with computer technology. Mahwah, NJ: Erlbaum.

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    Through the use of new technologies, researchers and practitioners in health education and health communication can provide health information and behavior change strategies that are customized to the unique needs, interests, and concerns of different individuals. These tailored health messages can be effective in assisting individuals in understanding and responding to health concerns.

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  • Parker, Jerry C., and Esther Thorson, eds. 2009. Health communication in the new media landscape. New York: Springer.

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    This book aggregates contributions from scholars in communication, journalism, health informatics, public health, and from medical and health professionals. It is a wide-ranging text that will be of interest to students in a variety of health communication fields as well as health professionals who wish to engage patients in new and effective ways.

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  • Rice, Ronald E., and James E. Katz, eds. 2001. The Internet and health communication: Experiences and expectations. Thousand Oaks, CA: SAGE.

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    This book provides an in-depth analysis of the changes in human communication and health care resulting from the Internet revolution. The contributors, representing a wide range of expertise, provide an extensive variety of examples from the micro to the macro, including information about HMO websites, Internet pharmacies, and Web-enabled hospitals.

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  • Whitten, Pamela, and David Cook, eds. 2004. Understanding health communication technologies. San Francisco: Jossey-Bass.

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    This text provides a hands-on guide for students and professionals for effective deployment of management of communication technologies in health settings. It provides an overview of the distribution and use of communication technologies within the health field and includes information about current and emerging health care communications technologies.

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Audience Segmentation

Audience segmentation research has received significant attention. The idea is to determine how and which consumers seek health information and how they use that information. Segmentation is particularly useful in helping health program planners reach and effectively support consumers with the most appropriate health information. Traditionally, segmentation has been conducted using demographic variables, but this has resulted in limited effects (e.g., Kazbare, et al. 2010, Slater 1996). More recently, psycho-behavioral segmentation (Dutta-Bergman 2005, Wolf, et al. et al. 2010) using a combination of cognitive, behavioral, and other individual difference variables has been used to segment audiences with regard to a variety of important health issues. Donohew, et al. 1994 and Stephenson 2002 represent the Kentucky school, which applies the individual difference variable of sensation seeking to various health communication problems. The works presented here represent a mix of segmentation research in order to show a range of ways by which audiences have been segmented and the relationships segmentation has with a variety of outcome variables.

  • Donohew, Lewis, Philip Palmgreen, and Elizabeth P. Lorch. 1994. Attention, need for sensation, and health communication campaigns. American Behavioral Scientist 38:310–322.

    DOI: 10.1177/0002764294038002011Save Citation »Export Citation » Share Citation »

    This article represents the Kentucky school of health communication, dominant in the field of sensation-seeking research. The study details the formation and implementation of a televised antidrug public service announcement campaign targeting high sensation seekers (SS). Messages high in attention value (AV) resonated most strongly with high-SS, and low-AV messages with low-SS. message characteristics to appeal to high-SS individuals (e.g., emotionality, ambiguity) and lab and field tests of campaign content are also discussed.

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  • Dutta-Bergman, Mohan J. 2005. The relation between health-orientation, provider-patient communication, and satisfaction: An individual-difference approach. Health Communication 18:291–303.

    DOI: 10.1207/s15327027hc1803_6Save Citation »Export Citation » Share Citation »

    Health orientation is an individual-difference concept defined as an individual’s motivation to engage in healthy attitudes, beliefs, and behaviors. Dutta-Bergman finds that patients who were actively oriented toward their health sought out health information, held strong health beliefs, and were also more likely to actively participate in the doctor-patient relationship.

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  • Kazbare, Laura, Hanx C. M. van Trijp, and Jacob Kjær Eskildsen. 2010. A-priori and post-hoc segmentation in the design of healthy eating campaigns. Journal of Marketing Communications 16:21–45.

    DOI: 10.1080/13527260903342712Save Citation »Export Citation » Share Citation »

    A nutrition-oriented public health program for 13- to 15-year-olds was administered to compare the impact of four segmentation models: single-segment; a priori grouping based on demographics or, alternatively, behavioral variables; and post-hoc segmentation. Results favor the post-hoc model for a healthy diet campaign, and imply that audience segmentation should extend past demographic variables.

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  • Slater, Michael D. 1996. Theory and method in health audience segmentation. Journal of Health Communication 1:267–284.

    DOI: 10.1080/108107396128059Save Citation »Export Citation » Share Citation »

    This article aims to reinforce the theoretical foundation of health audience segmentation practices by reviewing the segmentation literature and critically examining common methods. It argues that health communication research and practice should move toward hierarchical multivariate segmentation techniques and outlines how these clustering strategies can be implemented.

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  • Stephenson, Michael T. 2002. Sensation seeking as a moderator of the processing of anti-heroin PSAs. Communication Studies 53:358–380.

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    An experiment examined young adults’ (N = 200) processing of antidrug video public service announcements, concentrating on the roles of sensation seeking (SS) and perceived message sensation value (PMSV). PMSV facilitated cognitive and affective processing, especially for high-SS individuals. It also predicted stronger antiheroin attitudes for this group indirectly through enhanced narrative and sensory processing.

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  • Wolff, Lisa S., Holly A. Massett, Edward W. Maibach, Deanne Weber, Susan Hassmiller, and Robin E. Mockenhaupt. 2010. Validating a health consumer segmentation model: Behavioral and attitudinal differences in disease prevention-related practices. Journal of Health Communication 15:167–188.

    DOI: 10.1080/10810730903528041Save Citation »Export Citation » Share Citation »

    A national mail panel survey (N = 1,650) confirmed the validity of a psycho-behavioral model of health audience segmentation based on health information-seeking behaviors and its corresponding ten-item screening instrument. The segments (formed by a 2 × 2 matrix of doctor-dependence/independence and active/passive health orientation) are linked to patterns of prevention-related attitudes and behaviors.

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Contemporary Issues

A number of scholars think and write about issues in health communication that are not easily categorized in the usual manner. The following articles include some pieces written about health communication in a reflective manner that cut across traditional domains and concerns, each of which could develop into its own subfield. Fishbein and Cappella 2006 provides a theoretical framework for developing effective health communication. Witte and Meyer 1996 proposes an ecological theory in order to help organize years of studies. Kreps and Maibach 2008 explores important issues at the intersection of communication and public health. Kreps, et al. 2002 discusses what the authors call “big science” as an opportunity to enhance federally funded research.

  • Fishbein, Martin, and Joseph N. Cappella. 2006. The role of theory in developing effective health communications. Journal of Communication 56:S1–S17.

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    The authors argue for the centrality of communication theory and how theory can be applied to developing messages designed to promote healthy behavior. They propose an integrative model of behavioral prediction, which integrates a number of behavioral theories. They use data from a study on smokers’ intentions to continue smoking and to quit, and show how the model helps identify the critical beliefs underlying these intentions.

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  • Kreps, Gary L., and Edward W. Maibach. 2008. Transdisciplinary science: The nexus between communication and public health. Journal of Communication 58:732–748.

    DOI: 10.1111/j.1460-2466.2008.00411.xSave Citation »Export Citation » Share Citation »

    This article examines the major theoretical and practical intersections between health communication and public health disciplines. It identifies theoretical, methodological, and societal contributions from health communication and suggests directions for future collaborations. It also examines ways that collaboration between health communication and public health has begun to generate important scientific outcomes.

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  • Kreps, Gary L., K. Viswanath, and Linda M. Harris. 2002. Advancing communication as a science: Research opportunities from the federal sector. Journal of Applied Communication Research 30:369–381.

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    The authors argue that communication science can be advanced by pursuing what they call a “big science” strategy, where the goal is to apply research findings to significant social issues and problems. By “big science,” the authors mean research programs that employ large samples and longitudinal designs. These types of research programs are expensive, and the authors review major funding programs in various government agencies.

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  • Witte, Kim, and Gary Meyer. 1996. Bringing order to chaos: Communication and health. Communication Studies 47:229–242.

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    Witte and Meyer discuss an ecological theory of health communication that addresses how it influences health and health-related behaviors. They use chaos theory concepts to support a synergistic model of health communication, showing how many health communication variables can work together to help influence health behaviors. The authors propose this model in contrast to reductionist health communication research.

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