Chapter 11 Health Communication
Fear Appeals
Defined: Messages which emphasize the harmful physical or social consequences of failing to comply with message recommendations Components include: 1. Severity 2. Susceptibility 3. Perceived efficacy - Response - Self
emotions
a patient-provider communication principle expression, recognition, and subsequent transacted meaning of emotion impact patient provider relationships just as they do other relationships. Patients and providers should recognize profound influence of emotion and their mutual emotional investments.
patient expertise
a patient-provider communication principle patients should be considered experts about their unique situation, regardless of how common illness or medical concern. Their expertise, and contributions should be valued as providers expertise.
roles and expectations
a patient-provider communication principle patients/providers should recognize influence of traditional roles and expectations while attempting to establish more constructive and effective comm styles. They must express their expectations of relationship, interaction and each other.
physical and psychosocial connections
a patient-provider communication principle there exists a powerful connection b/w hlth and everyday life. Both patients and providers dont always recognize importance of everyday life experiences and focus attention on biological causes. A holistic understanding of patient experiences can improve diagnoses and treatment options.
patient stories
a patient-provider communication principle these reveal what ppl perceive as most important details or elements of situation. They hold crucial info pertaining not only to physical symptoms but also to psychological and relational issues connected w/ specific patients illness.
satisfaction w/ the encounter
benefit of effective patient-provider relationships -this can enhance feelings of this which is increasingly recognized as important goal in addition to traditional goal of patient recovery or survival. Studies indicate that patient satisfaction is connected w/ communication among patients and providers. This is consequence of comm taking place at various pts thruout care and may involve face to face, digital, and other types of interaction.
improved physical and psychological hlth
benefit of effective patient-provider relationships Its fairly easy to understand how effective patient provider comm can enhance this since it increases adherence to treatments. If physician is right, then this will increase likelihood that patients will overcome ailment. Effective comm increases chances that providers will ask right questions during evaluations and patients will be willing to be forthcoming, freely supplying providers with info that they dont otherwise know and could speed their arrival at proper diagnosis. Effective patient-provider comm will decrease patient anxiety and stress related to interaction and overall medical concerns bc patient feels accepted, understood, and safe.
Greater likelihood of adherence to treatments
benefit of effective patient-provider relationships This may result from improved understanding on part of patients and from improved confidence in both providers and their own abilities to remember and follow treatment guidelines.
decrease in malpractice lawsuits
benefit of effective patient-provider relationships medical providers dont often get sued when patients hlth improves. Overal comm patterns of providers influence on likelihood that this will or will not be filed. Patient provider comm is important when problems are encountered during treatment.
microagressions
everyday things that are said to ppl that theyre an "other." ex) what are you? Do you speak peruvian?
weathering
existence of prejudice and racism takes a toll on health
Challenges in Healthcare System
include: 1) Aging population - Geriatrics field, Care-giving, Medicare 2) Cultural diversity - Cultural belief systems, health disparities 3) Approaches to health care - Biomedical model of medicine, curative, psychosocial aspects, palliative care 4) Public distrust - Public distrust of officials, public agencies, corporations 5) Episodic issues - Issues rise and fall on the national agenda - Issue coverage of health issues fluctuates
Direct-to-Consumer Advertising
(DTCA) is any promotional effort by a pharmaceutical company to present prescription drug information to the general public through the lay media DTCA fueling debate in health care
factors that contribute to health disparities?
1) othering 2) weathering 3) microagressions
Problem w/ health campaigns
Great...but a lot of campaigns that you come in contact with do not work Why? - Marketing products versus health - Not understanding all of the components needed - Not performing audience analysis
Health Campaigns
One of the most common impacts media has on health is in the form of this Essentially, these are an attempt to: - Create some form of health awareness - Cause some type of behavior change - Advocate for a specific public policy
ventilation
Supportive function of everyday communication everyday com allows for this of stress and worries allowing ppl to feel better and preventing stress and worry from being problem. Talking about problems w/ others can be productive way of managing concerns and anxieties.
detection
Supportive function of everyday communication everyday comm provides baseline from which ppl may perceive comm of others. There exist certain patterns of interaction that ppl come to expect from those in their social networks (such as being talkative or subdued). Changes in patterns could be signal that someone is in need of support.
regulation
Supportive function of everyday communication everyday comm serves as this mechanism in two ways. 1) since everyday comm is viewed as trivial or mundane, social support can be sought and provided w/ seemingly less consequence when compared w/ social support sought and provided during moments of deep discussion. 2) everyday comm can serve as precursor to deeper discussions. Broaching topic during course of everyday comm allows ppl to evaluate another persons response and determine whether or not a more in depth discussion or increased disclosure of issue would be warranted and worthwhile.
information
Supportive function of everyday communication everyday comm w/ members of social network enables ppl to determine who might be reliable source of support when needed. It provides insight into nature of social support. Observing how much support actions as advice giving, resource granting, and others are constructed and evaluated allows ppl to develop proper frames to better understand and enact social support.
distraction
Supportive function of everyday communication sometimes best way to deal w/ problem is by not dealing w/ it. Since everyday comm is viewed as mundane, routine, trivial, and light, it is often a welcome alternative to discussions of major health issues and problems.
perpetuation
Supportive function of everyday communication this is concerned not w/ determining potential sources of support but rather w/ maintaining sources of support. Everyday com serves to sustain relationships and enable their continuance. It helps ensure that sources of support are available when necessary.
Health Literacy and Numeracy
The degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.
What is Health Communication?
The study and use of communication strategies to inform and influence individual and community decisions that enhance health. (Healthy People, 2010) It links the domains of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health (NCI, 1991; Piotrow et al, 1997; Jackson et al., 1998) includes: 1) health professional-patient relations (2) individuals' exposure to, search for, and use of health information (3) individuals' adherence to clinical regimens and recommendations (4) the construction of public health messages and campaigns (5) the dissemination of individual and population health risk information (6) images of health in the mass media and the culture at large (7) the education of consumers about how to gain access to the public health and health care systems (8) the development of tele-health applications (9) health information technology
Benefits of Effective patient-provider relationships
These include: 1. satisfaction w/ the encounter 2. Greater likelihood of adherence to treatments 3. improved physical and psychological hlth 4. decrease in malpractice lawsuits
Provider-Patient Interactions
Two sides to every coin - Interaction between physicians and patients - Problems occur at either end of the conversation Different perspectives of health, treatment and access to care - Diagnosis vs. comforting; evidence-based and patient-centered care - Treatments and costs - Uncertainty, psychosocial needs - Time constraints - Available information
provider expertise
a patient-provider communication principle beyond utilizing specialized medical knowledge to confirm illness and to set forth treatment options, providers should use their knowledge to educate patients. Sharing their expertise w/ patients in manner thats clear and understandable can enhance patient and provider relationships and improve hlth and healing process.
Reciprocity
a patient-provider communication principle as w/ any relationship, patients will act in accordance w/ provider interaction styles (positive or negative) and vice versa. Both patients and providers must recognize influence of this on their relationship, treating each other w/ respect and recognizing concerns and needs of each other.
health communication
it comprises lifestyle choices ppl make, how they talk to friends and family about illness and hlth, the kinds of social support that they give and recieve, decisions to reveal or conceal private info about pain or fear, media images and appeals splashed over billboards or buses or on TV and internet. This is built into everyday comm and relationships. Hlth and illness are physical but how we think about them and respond to them is symbolic and relational. there are 3 main topics of this: 1) patient -provider relationships 2) social networks - explore impact of this on hlth by examining influence of friends, families, and others on lifestyle choices or willingness to accept hlth advice and influence on everyday comm on social support. 3) media and technology - how this influences hlth comm and what ppl make of govt hlth campaigns. how entertainment/news impact ppls lifestyle choices.
Patient-Provider Relationships
main topic of health communication comm b/w patient and provider is problematic w/ patients feeling treated dismissively by doctors who think theyre gods. Or doctors feel frustrated that patients cant remember simple instructions. we examine typical interactions and discuss suggestions for developing more effective relationships. 1. patient-provider identities 2. how patients and providers communicate 3. improving patient-provider communication 4. Benefits of effective patient provider relationships
Social Networks and health
main topic of health communication no examine how relationships w/ friends, family, acquaintances, and other members of this have an impact on hlth. These influence many lifestyle choices, from eating and exercising to smoking, drinking, and taking drugs. These provide various forms of support. We will examine... 1. influence of social networks on health and lifestyle 2. Social networks and support 3. secondary goals of social support 4. everyday comm and foundation of social support 5. comm privacy management
Media, Technology, and health
main topic of health communication these are fundamental components of everyday life and influence hlth comm. hlth issues make up great deal of these two things including in tv programs, newspaper and mags, ads, and internet sites. This content influences ppls lifestyles, awareness of hlth issues, and understanding of hlth issues as well as how ppl talk about hlth both w/ social network and w/ their hlth provider. We will examine: 1) impact of entertainment media on health comm 2) news media and health 3) advertising medications 4) health comm and internet
food desserts
ppl dont have access to grocery store
Nurturing support
primary way of social support involves helping ppl feel better about themselves and issues theyre experiencing. Includes emotional support and esteem support. Emotional support enables ppl to express their feelings and to have those feelings validated by others. Providing ppl w/ expression of emotions can be beneficial in coping and healing process. Emotional support involves making ppl feel valued by letting them know you care and theyre needed. Hlth problems may lead ppl to view themselves as burdens. This form of support entails reinforcing relational connections by letting those experiencing hlth problems know that others will tick around even when things get rough. - esteem support involves making ppl feel competent and valued. hlth problems are acommpanied by perceived lack of control which is increased by well meaning assistance and advice from others. Pppl may feel as though theyre incapable of normal acts or making their own decisions. This form of support promotes feelings of competence and ability by allowing and encouraging ppl to act on their own to take pt in decision making related to their care.
action facilitating support
primary way of social support involves providing info or performing tasks for others. includes informational support and instrumental support. Informational support involves providing someones w/ info in order to increase his/her knowledge of hlth issues. ex) someone dealing w/ hypertension may be provided w/ info found online by friend. Providing info to someones increases their understanding and ability to make informed decisions and increases their feelings of competence, value, which are issues related to nurturing support. When you provide info, your reinforcing his/her importance and validating their ability to make their own decisions. Additional symbolic meaning is inherent in provision of info as relational support. These same meaning are evident w/ instrumental support which involves performing tasks for someone. ex) you might perform tasks around home when friend is too sick or give someone ride to doctor. Doing these things reinforces personal and relational relationship.
Relational goals of social support
secondary goals of social support closely associated w/ identity goals, these goals guide social support. Of primary concern are expectations surrounding relationships. Although the comm transacting relationships is more important indicator of potential social support than actual type of relationship, certain relationships are expected to fulfill social support functions. A friend would be expected to provide support in times of need whereas acquaintance might not be for ex. When relationship provides support expected, this reinforces the relationship and make both relational partners feel better about themselves and relationship. On other hand, when relationship doenst provide support expected, a person might experience disappointment and rejection along w/ feeling worse about situation.
identity goals of social support
secondary goals of social support these goals inherent in social support are connected w/ face wants. Ppl desire to be seen as worthwhile and decent overall (positive face wants) and dont wish to be imposed upon or treated in negative manner (negative face wants). the possibility of negative face arises w/ request for or offer of social support. Asking for ride to hospital for ex may place person in inferior position and may be seen as imposition of a burden on person being asked. ppl must manage interactions in way that ensures prevention of negative face or in manner that minimizes this. Providing or receiving social support can be consistent or inconsistent while transacted identities. consequently, ppl may struggle w/ desire to create identities that may be hindered thru support actions. Lack of autonomy or independence is key to concern for those seeking or receiving social support.
Improving patient-provider communication
the importance of patient and provider relationship based on partnership or mutuality in which interactants share control of interaction and equally negotiate an understanding of patient needs and treatments is established thru extensive transformations of existing comm patterns. Roter an Hall have outlined 7 communication principles that would improve existing interactions among patients and providers. 1. patient stories 2. patient expertise 3. provider expertise 4. physical and psychosocial connections 5. emotions 6. reciprocity 7. roles and expectations
how patients and providers communicate
these interactions most often transact relationships that place the patient in passive role and place provider in dominant role, as outlined in machine-mechanic relationships and child-parent relationship, both of which require a large degree of trust of physician by patient. Driven by traditional and cultural norms, such interaction styles can interfere w/ comm and wellness processes in certain circumstances. - providers tend to dominate interactions w/ patients thru questions and directives. providers also focus mostly on establishing patients physical problems and not psychosocial ones. This approach likens patients to machines and gives no acct to relevant and emotional and relational needs. When patients try to incorporate such issues into interaction, providers tend to interrupt them and refocus physical symptoms. providers may miss opportunities to find actual cause of patients problem or miss relevant treatment opportunities. - patients unwillingness to disclose their medial cooncers to providers complicates things more. When dealing w/ personal/embarrassing issues, patients avoid disclosing info that would be pertinent to providers. In fact, patients undergoing medial examination sometimes delay disclosing real reason for their visit until provider is getting to leave room. These "doorknob" disclosures result in another medical evaluation or interview being conducted, resulting in further delay to next patient.
children and parents
type of patient-provider identity patients and providers display more emotional and personal involvement compared w/ mechanistic view. however, provider portrays dominant role of expert while patient assumes a submissive and dependent role. This approach is most common.
partners
type of patient-provider identity patients and providers work together to solve problem and viewed as equals, each bringing knowledge. The provider possesses unique medical knowledge, and patient has unique knowledge about his/her physical and emotional state. Although this view is increasingly supported by medical professionals and patient groups, its sometimes difficult to achieve due to preconceived notions of patient and provider relationships along w/ unwillingness or inability on the part of both patients and providers.
Consumers
type of patient-provider identity patients are increasingly viewing themselves as paying providers for specific info and expecting them to carry out their wishes. This view transacts patient role as an increasingly dominant one.
machines and mechanics
type of patient-provider identity providers viewed as competent experts analytically diagnosing a physical problem and then fixing it. Patients are passive and allow expert mechanic to give them proper tune up w/ little or no input or objection.
Searching for information
under hlth comm and internet 72% of internet users have searched for hlth info online w/in past yr. Underscoring the relational components of hlth of those ppl seeking online hlth info, half searched for info on behalf of someone else. Types of hlth info internet users search for online in order of frequency include: 1. specific disease or medical condition 2. specific medical treatment or procedure 3. weight control 4. hlth insurance, medicare, or medicaid 5. food safety or recalls 6. drug safety or recalls 7. advertised drug 8. medical test results 9. caring for an aging relative or friend 10. pregnancy or birth control 11. reducing health care costs
Support
under hlth comm and internet internet being used for this and many groups are now available online and beneficial for their convenience and easy to access and provides outlet for ppl who choose not ot attend face to face meetings for personal reasons. online support groups have found to benefit users thru mult forms of social support. Support comes in form of info from others. Thirty percent have consulted online medical reviews of hlth care services and treatments. 26% of internet users indicate reading about someones elses hlth or medical issues on new groups, websites or blogs. 16% have searched for ppl online who might share same hlth concerns. number of internet users seek online support will likely increase familiarity w/ and access to internet.
connecting patients and providers
under hlth comm and internet internet is used as means of connecting patients and providers. Some providers are connecting w/ patients thru social networking sites. providers able ot supply patients w/ gwneral med info and encourage hlthy lifestyle choices b/w visits. patients provided w/ another means of contacting providers when needed. social networking site connections may encourage partner identity, enabling both patient and providers to play active roles in hlthcare and treatment. Theres also concerns about privacy and relational boundaries w/ this. internet is being used for patient evaluation and treatment by providers. rather than interacting in office, patients interact thru webcams. Virtual and online interactions provide benefits like decreased costs, increased accessibility, and increased convenience. Online treatment is new but likely to become more common w/ time.
News media and health
under media, technology, and health TV news programs, newspapers, mags, and general hlth programming are sources of info and misinformation about hlth. Like entertainment programming, news and hlth programming can lead to increased awareness and understanding of hlth related issues, which can be very beneficial but info can be wrong. Certain illness are more frequently addressed in news media than others. ex) some cancers have been found to be under reported like lymphatic by news media, while others have been over reported like breast cancer. News media provides audiences w/ social and moral meanings of hlth related issues. Those encouraged by news media are biased toward certain perspectives. ex) obesity is associated w/ poor choices while thinness is associated w/ moral vriture and these reinforce stereotypes by overlooking biological causes and socioeconomic associations.
Advertising medications
under media, technology, and health The FDA (food drug administration) requires drug mftrs to list side effects of medication. When benefits and virtues of drug are included in an ad, side effects must be included too. When only name of drug is mentioned then you just have to ask doctor about it but side effects dont have to be included. Direct to consumer advertising impacts hlth comm in positive and negative ways. First, it increases patient awareness of illnesses treated by medications. This increased awareness could beneficial if patient recognizes legitimate symptoms from commercial or ad and seeks treatment. But it could lead to unnecessary treatment and over medication. Many of these ads includes symptoms that everyone has. - second it increases patient awareness of available treatment option. This awareness could be beneficial but has negative outcomes. Drug treatments focus on physical elements of illness and tend to overlook psychosocial factors contributing to illness and non medical treatments. Such ads increases prescription of certain meds even though other meds may be just as if not more effective. - third, direct to consumer ads increases likelihood that patients will take more active role in discussions w/ providers. An increased awareness may encourage patients to feel equivalent to providers. But providers need to spend time reeducating patients, limiting time available to discuss other issues and concerns about patients illness and treatment options.
entertainment media and health
under media, technology, and health hlthcare has been staple of this type of programming. Vast tv programs focus on medical professions. Hlth related issues on these and other programs along w/ depictions of hlth related issues thru other media sources influence audience awareness and understanding of issues. Much of info ppl possess comes from this. Media depictions of hlth related issues are frequently inaccurate which may lead to inaccurate perceptions of health care. ex) representations including demographic of both patients and medial providers portrayed in media are inaccurate w/ actual patients and medial providers. - this portrayal may lead to inaccurate understandings. May provide audience w/ unrealistic expectations. - media portrayals of hlth care sometimes been criticized for potentially giving audiences false hope thru depictions of medical miracles. The mortality rate of fictional hospital patients has been shown to be nine times higher than mortality rate of real hospital patients.
Health communication and internet
under media, technology, and health internet has tremendous impact on hlth comm. Will examine: 1) internet for hlth info 2) internet for coping/support 3) internet for patient-provider connections
Patient- Provider identities
under patient provider relationships relationship and identity are created during patient and provider interactions and are co-constructed. Both parties responsible for relationships and identities created during interaction. Interactants may not always agee w/ relationships and relational identities being created. Altercasting involves ways in which persons comm influences identity of another person. This can work in 2 ways. 1) persons comm can force identity on another person. ex) patient saying to provider "Well your are the expert so what do you suggest?" positions provider to live up to the label. 2) person attempts to create identity, the comm of another may affirm or negate that identity. If patient suggests particular treatment option to provider, who in turn replies, "I'm an expert so you had better let me decide whats best for you" then provider is combating identity being created by patient. - The identities created in patient and provider interactions include: 1. machines and mechanics 2. children and parents 3. consumers 4. partners
Drinking w/ others
under social networking and hlth and lifestyles alcohol consumption is another lifestyle behavior associated w/ relationships. Alcohol plays prominent role in holidays and occasions. Family and friends impact use of alcohol. Talk about drinking alcohol in families is indicator of persons attitudes toward drinking. A persons use of this is influenced by parents consumption of alcohol and talk about alcohol w/in families. Friends influence use too. Drinking among college friends continues to be problem on campuses. Pressures to drink in general often based on relational obligation, and those who try to avoid consumption of alcohol experience relational distress as result. Drinking at parties is viewed as way to establish social capital in new environment. Thru talk about alcohol and updates on social networking sites, there is tendency to believe that drinking is more common than it actually may be among ones social network. These beliefs may result in perceiving that alcohol consumption is necessary to fit in when it may not be necessary.
Smoking w/ others
under social networking and hlth and lifestyles attitudes towards smoking and smoking related behaviors are connected to social networks. Smoking is shared relational activity. ex) smoking might be way to forge and maintain relational connections w/ colleagues and classmates thru sharing cigarettes. Relationships w/ others thru social bonding provided commonly shared smoking habits have been listed as one of benefits. - in addition to smoking as shared relational activity, ppls talk about smoking serves to minimize perceived risks. This talk influences likelihood that person will continue. Smokers reinforce each others vision of smoking. social networks also influence attempts to cease smoking. This influence can be negative. ex) smokers often report negative relational consequences when attempting to stop smoking such as decrease in number of smoking friends. This influence can be positive bc friends/family may provide support when person is trying to quit. There are sites like Quiznet which suports smokers trying to quit.
Eating and exercising w/ others
under social networking and hlth and lifestyles family members have influence on food consumption and exercise habits thru both their actions and ways in which talk about these things. ex) food is ritually connected w/ holidays and celebrations in families and its possible that you associate food w/ joy and happiness. some families may incorporate hlthy diets and exercise in everyday lives and talk which reinforces behaviors. - friends influence on diet and exercise decisions too. ppl w/ overweight friends tend to be overweight themselves although direction of causality is hard to establish. Obesity can be influenced by friends. Behaviors and talk about food and exercise influence ppls attitudes and decisions that are made about diet, exercise, and ordering supersized meal. Friends eating habits and exercise routines may influence set of stds for your own. Part of reason ppl are influenced is thru comparing themselves to others.
Social Networks and Support
under social networks and health This can be important element when managing illness and any number of hlth and wellness issues. Two primary types of social support are: 1) action-facilitating support 2) nurturing support
Everyday Communication and Foundation of social support
under social networks and health its here in everyday comm where ppl establish their beliefs about likelihood of receiving support from members of their networks along w/ expectations surrounding how support will be potentially acquired and fulfilled when needed. Everyday comm serves to underscore existence and continuance of relationship, thereby establishing the possibility that someone could serve as resource for support if occasion arises. Its not existence of relationship that guarantees probability of support but its communication that transacts relationship. What this means is that beyond instrumental and relational objectives fulfilled thru everyday comm theres supportive functions of everyday comm. Every time you speak w/ someone your establishing basis for support. There are 6 supportive functions of comm: 1)information, 2) perpetuation, 3) detection, 4) ventilation, 5) distraction, 6) regulation
Secondary goals of social support
under social networks and health these are just as significant as the primary goals and it could be argued that fully understanding primary goal would be impossible w/o them. These goals involve identities and relationships. 1. identity goals of social support 2. relational goals of social support
Social networks and health and lifestyles
under social networks and health these influence decisions ppl make regarding hlth related issues and overall lifestyles. the nature of hlth, the evaluation of hlth advice, and meanings of hlth and lifestyle choices are all transacted in interactions w/ others. Examples include: 1. eating and exercising w/ others 2. smoking w/ others 3. drinking w/ others
communication privacy management
under social networks and health w/in social network, there are some w/ whom you will disclose info and some ppl whom you wont. - this theory explains how ppl create and mange privacy boundaries in relationships. Self disclosure deals w/ revelation of private, sensitive, and confidential info. - private info comes w/ perceived ownership. Seen as controllable. This control entails determining who is given access and right to keep some info private. ownership can be personal or collective. - what one person considers private info may not be considered private info by another person. There are diff privacy boundaries or borders b/w whats considered private and whats not. - these privacy boundaries vary in their degree of permeability. Relationships determine actual permeability of these boundaries. Depending on degree of closeness and relational type, some ppl will be allowed access to info. - access to private info demands coordination by those involved. ppl must cooperate to keep boundaries intact and to ensure that info revealed isnt misused by recipient. Certain topics may be avoided in relationship. This also entails ensuing that when private info is shared, its not used against person. - boundary turbulence occurs when ppl struggle to coordinate privacy rules and boundaries. ex) ppl dealing w/ infertility must determine what to reveal or coneal when issue arises in convo. Such decisions may lead to strengthening boundaries, loosening boundaries, and developing ways to manage topic depending on relational connections and situations.
othering
when doctors dont learn new practices to support other subsegments of people from diff ethnic backgrounds or cultures that carry diff medical problems/needs