The Routledge Handbook of Language and Health Communication

Heidi Hamilton, Wen-ying Sylvia Chou, Heidi Hamilton, Wen-ying Sylvia Chou

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415670432
• eBook ISBN: 9781317932321
• Topic: Languages & Linguistics
• Subtopic: Linguistics
• Index: Languages & Linguistics

The Routledge Handbook of Language and Health Communication consists of forty chapters that provide a broad, comprehensive, and systematic overview of the role that linguistics plays within health communication research and its applications.

The Handbook is divided into three sections:

• Individuals' everyday health communication
• Health professionals' communicative practices
• Patient-provider communication in interaction

Special attention is given to cross-cutting themes, including the role of technology in health communication, narrative, and observations of authentic, naturally-occurring contexts. The chapters are written by international authorities representing a wide range of perspectives and approaches.

Building on established work with cutting-edge studies on the changing health communication landscape, this volume will be an essential reference for all those involved in health communication and applied linguistics research and practice.

Part I

Individuals’ everyday health communication

Perceptions and understandings about health

1

Health communication ‘noise’

Insights from medical anthropology

Nancy J. Burke and Judith C. Barker

Introduction

Health promotion and communication studies often focus on the message and the medium, with the intent of affecting some sort of individual-based behavior change. Relying on a variety of health behavior change theories, the assumption is that effective communication of information can change a person’s intention, which will then lead to a change in behavior (Pasick et al. 2009; Pasick and Burke 2008). While behavioral science seeks to understand, explain, and often change human behavior through the adoption of healthier lifestyles, behaviors, and attitudes, the theories employed have an individual, cognitive focus, largely abstracted from social context (Frohlich et al. 2001; Singer and Weeks 1996; Williams 1995). Based on these theories, much health communication research places emphasis on cognitive and motivational variables including how individuals interpret information, how they value that information, and how capable they feel to use the information (Bandura 1984; Krumeich et al. 2001; Singer and Weeks 1996). Social, organizational, historical, political, and cultural influences upon individual behavior are often relegated to the position of background variables, acknowledged only insofar as they affect beliefs that are theorized to be a dominant influence, or comprise factors thought to facilitate or block behavior change. However, critics have highlighted the limitations of this approach. For example, Glass and McAtee state,

The study of health behavior in isolation from the broader social and environmental context is incomplete, and has contributed to disappointing results from experiments in behavior change. The solution requires a shift in emphasis, a reorientation of theories and new methods.

(Glass and McAtee 2006)

These broader social, cultural, and environmental contexts have been qualified elsewhere as the ‘noise’ that complicates health communication and behavior change research, and which requires attention for effective translation and implementation (Getrich et al. 2007; Hohmann and Shear 2002). Similar to factors often described as barriers to communication by psychologists and behavioral scientists, what we refer to as ‘noise’ is not peripheral in the sense of the background static you might hear between radio stations, but rather constitute key components of health communication. In contrast to this understanding, Dixon-Woods and colleagues outline how ‘noise’ is traditionally conceptualized in patient education research framed within what they call the ‘stimulus-response sequence’ (Dixon-Woods et al. 2007). According to this model, ‘failure of the recipient to interpret the message as intended is attributed to “noise” or “interference” in the system, such as poor readability of the printed materials or (reading) incompetence on the part of patients’ (Dixon-Woods et al. 2007). In other words, the onus is on the recipient — patient — to correctly apprehend the intended message. Patients, in this model, are characterized as passive; ‘written information will “do” something’ to them (Dixon-Woods et al. 2007). Misunderstanding is, in this model, constructed as a technical problem which can be resolved through the application of principles of clear writing, leaflet design, and full disclosure. ‘Noise’ in this case is constructed as something to be overcome, to be fixed through application of specific communication techniques. In the research presented herein, the aspects of ‘noise’ emergent from personal, community, and institutional contexts and converging in problematic health communications may also be viewed as opportunities; sites for reconstitution of the whole patient as they interact with and within their social contexts; and spaces for rethinking effective communication. This chapter, then, illustrates the importance of tending to the ‘noise’ generated in various contexts, and posits that this ‘noise’ is an essential component of health communication. The chapter draws upon research conducted by the two authors in oncology and dental settings to illustrate the value of ethnography for questioning and broadening assumed understandings of ‘effective communication’ and ‘culture’ in health promotion activities, widely construed.

Critical issues and topics

Ethnography and health communication research

The value of qualitative methods for the study of health communication and promotion is well established (Pasick and Burke 2008; Popay et al. 1998; Kiefer 2006). Depending on the scope of the research question, a range of qualitative research approaches can be employed, from broadly encompassing ethnography through successively constricted approaches such as interviews, focus groups, observations, or archival examinations. The funding, time, and staff available for research can often limit the scope of the study, sometimes with unfortunate results. The narrow focus of much qualitative health research (often restricted to focus groups exploring the beliefs and practices of lay persons, for example) limits findings to variations on, and explorations of, preconceived biomedical and social-psychological concepts. Such an approach seldom generates new insights because it fails to understand communication as a result of interaction between health provider and patient, or to question the assumptions underlying the research or the categories and concepts employed; in other words, it does not ‘reconfigure the boundaries of the problem’(Lambert and McKevitt 2002). Much qualitative health research also fails to examine the diversity of beliefs and practices encountered in the study populations or settings, which frequently are insufficiently identified, and to understand the degree to which provider-side behaviors help create and sustain barriers to patient participation in various healthcare decisions, as discussed below (Burke 2010; Butani et al. 2008).

Ethnography, however, takes as its starting point the questioning of categories and the critical analysis of the social and historical contexts in which a particular issue has emerged or in which a particular research topic has become acceptable. Ethnographic research questions the assumed normative and universal nature of biomedical categories, and takes a holistic approach to studying phenomena. For example, in a study of clinical communciaton, all actors and stakeholders are included (patients, providers, clinic staff, family members, etc.). Both lay and expert knowledge are explored, juxtaposed, and examined, each within its own context (Fetterman 1997; Lambert and McKevitt 2002; Mitteness and Barker 1995; Popay et al. 1998; Spradley 1979). Another key element that differentiates ethnographic study of health communication from many other qualitative health research and social behavioral approaches is that ethnographers do not limit their understanding to informant statements. As such, medical anthropology distinguishes between what people say should be the case (their opinions and beliefs), multiple perspectives on what is thought to be happening or has happened in the past (i.e., normative behaviors), and actual documented practices (Fetterman 1997; Lambert and McKevitt 2002; Spradley 1979). Ethnographic understanding is achieved through the combination of in-depth open-ended conversational and semi-structured interviews and participant observation. Participant observation involves observation of naturally occuring activities in the research setting and casual comments or informal conversations as well as more formally structured inquiry, through which the researcher identifies cultural norms, influences of socio-economic status and class on relationships and interactions in practice, and other cultural patterns that are not easily articulated or about which discussions are forbidden or difficult (Bernard 2006). The following two examples of ethnographic study of clinic-based communication highlight the different forms of data and consequent interpretations and understandings afforded by anthropologic approaches.

Current contributions and research

Clinical trials participation

Since the passage of the National Institutes of Health (NIH) Revitalization Act in 1993 in the United States, an inordinate amount of resources have been devoted to increasing the participation of minority participants in clinical trials. Approximately 20 percent of all adult cancer patients are medically eligible to participate in a cancer clinical trial, but only 2.5–9 percent of all adult patients do so. Accrual is even less for minority and medically underserved populations (Wendler et al. 2006).¹ Research conducted on the topic has documented barriers that individuals, ethnic groups, and communities face to clinical trial participation (Christian and Trimble 2003; Corbie-Smith et al. 2004; Cox and McGarry 2003; Ford et al. 2005; Noah 2003; Yancey et al. 2006). Research with African Americans, for example, has shown barriers to opportunity, acceptance (including perceived harms of clinical trials and mistrust of research, researchers, and the medical system), and awareness (Corbie-Smith et al. 1999; Ford et al. 2005; Freimuth et al. 2001; Gorelick et al. 1996; Stallings et al. 2000). Documented barriers to participation for Latinos include transportation, toxicity of treatment, and mistrust of research and the medical system (Borrayo et al. 2005; Ford et al. 2005). While cultural barriers such as ‘fatalism’ for Latinos and the legacy of Tuskegee experiments for African Americans have also been discussed in the literature, how these interact with system barriers associated with low health literacy is not understood (Davis et al. 2002). Despite insights gained from this research and resources dedicated to addressing the 1993 mandate, there has been little success in improving understanding of the issues facing participants or in increasing their enrollment in all phases of clinical trials.

Between 2008 and 2010, Burke, the first author, spent 18 months conducting participant observation in oncology wards in a public hospital. This included observation of clinic visits, treatment discussions, and clinical trials recruitment; participation in clinic rounds and staff meetings; attendance at tumor boards; and participation in patient education and support groups. In the course of the study, over 150 patient visits were observed and 37 patients of diverse ethnicities participated in in-depth interviews in which they recounted their understandings and evaluations of diagnosis and treatment experiences, decision-making pro...

Table of contents

• Cover Page
• Half Title Page
• Series Page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of illustrations
• List of Contributors
• Acknowledgments
• Introduction: health communication as applied linguistics
• Part I Individuals' everyday health communication
• Part II Health professionals' communicative practices
• Part III Patient–provider communication in interaction
• Index