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 p ro d u ce.
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 e p r o d uce.
Features in the New Editiono not r
e o n l y,d
e r s o n al us 0 - 0 9-03
P 0 2
2 that maintains the readability and real-life examples that have made previous
This edition features a more streamlined format
editions so popular. Each chapter now ends with a glossary of terms, an easy-reference summary in outline form, and updated
discussion questions. Here is an overview of new coverage:

• Chapter 1 (Introduction) includes updated examples and research along with new coverage of the World Health
Organization’s perspective on health in the context of everyday life.
e p r o d uce.
hasobeen
d tr
nosignificantly
• Chapter 2 (The Landscape for Health Communication)
e o n l y, updated with insights and tips about
navigating the health care maze.n
so The us also includes-0new9-information
alchapter 03 about health disparities and health care
reform, including anP e r 0
20as2managed care, multi-payer systems, Medicare for All, and the
explanation of concepts such
Affordable Care Act.

• Chapter 3 (Patient–Caregiver Communication) includes updated information about the impact of patient–provider
communication on health, diagnoses, satisfaction, and pain. New sections offer strategies for discussing sensitive

uce.
subjects and engaging in shared decision making.
e p ro d
l y , d not r
• Chapter 4 (Patient Perspectives) has been reorganized to focus more on patient satisfaction and identity work. New
o
a l u s e on
segments provide patients tips for talking to care providers and responding to face-threatening health concerns.
03
n
Perso features new information
0 2 0 -0 9-interprofessional
• Chapter 5 (Care Provider Perspectives)
2 about
also includes updated information about diverse career opportunities in patient care.
education and teamwork. It

• Chapter 6 (Diversity in Health Care) includes new and expanded coverage of gender identity and sexual orientation,
ethnicity and race, and the link between health and socioeconomic status. Additional skill builder tips and examples
have been added to provide diverse perspectives.

e p ro d uce.
not r
• Chapter 7 (Cultural Conceptions of Health and Illness) presents new coverage of a culture-centered approach to

on l y, d o
health communication as well as the effects of social stigma and cultural adaptability.
a l u s e 03of Life) features expanded coverage of the dialectical push
•
P e
Chapter 8 (Social o n
rsSupport, 2 0
Family Caregiving,
0 - 0 9-End
and
and pull people feel when managing 2
health concerns as well as new research about adapting to a “new normal” after a
serious health event.
• Chapter 9 (eHealth, mHealth, and Telehealth) has been updated to reflect current issues and cutting-edge research in
eHealth. Special attention has been given to emerging mobile technologies, wearable devices, and health apps.

e p r o uce.
Providers’ experiences and perspectives relevant to eHealth and telehealth are included.
d
• Chapter 10 (Health Care Administration, Human Resources,
l y, d o not r and PR) presents new and updated
Marketing,
in s
examples of communication specialists u e n and the work they do. Coverage of staffing shortages is updated
ocare
a l health
-03resources, and public relations.
Persskillon
along with communication 2 0 -0
builders related to0leadership,
2
9human
• Chapter 11 (Health Images in the Media) presents new research on the ways media can inform our reading of certain
health issues and behaviors, such as binge drinking, vaping, and sexual assault. Social media’s effect on health is
addressed, and an expanded discussion of direct-to-consumer pharmaceutical advertisements explores media’s impact
on provider–patient relationships.

p r o d u ce.
• Chapter 12 (Public Health and Crisis Communication) has been revised with a renewed focus on crisis and risk

not re
 n o t r e pro
s e o ly, 0d9o-03
communication models from the CDC and the World Health Organization. Social media’s role in crisis communication
n
nal u 2020-
is explored and recommendations are offered. Case studies have been updated to reflect current research on HIV/AIDS,
Zika, and the opioid epidemic.Perso

• Chapter 13 (Planning Health Promotion Campaigns) has been updated to reflect new research and trends in health
promotion campaigns. Special attention has been given to campaigns addressing vaping and methamphetamine abuse,
as well as those using social media. An expanded discussion on message tailoring explores multiple ways messages can
be designed for diverse audiences.

• Chapter 14 (Designing and Implementing Health Campaigns) presents research on health promotion campaigns that
extend the utility of the health belief model and transtheoretical model. Updated examples highlight the latest research
on source credibility, narrative messages, gain- and loss-frames, and affect appeals.
Overview of the Book
e p ro d uce.
l y, d o not r
n a l u s e on -03
PART I: P e r so
Establishing 0 2 0
a2Context- 0 9 for Health Communication
The first two chapters provide an introduction to health communication. Chapter 1 establishes the nature and definition of
health communication, current issues, and important reasons to study health communication. Chapter 1 also provides tips for
making the most of features such as Ethical Considerations, Theoretical Foundations, and Career Opportunities boxes that
appear throughout the book.

p ro d u ce.
ot re
Chapter 2 explores how health communication is evolving within the context of social and public issues. Understanding these
, d o n
l u s only
issues allows for deeper appreciation of topics described in the rest of the book. The chapter culminates with a look at health
e
Person
a 9 -03
care reform measures, helping students better understand how policy debates and topics in the news affect them personally.
2 0 - 0
20
PART II: The Roles of Patients and Professional Caregivers

Part II focuses on interpersonal communication between patients and health care providers. Chapter 3 describes patient–
provider communication in terms of who talks, who listens, and how medical decisions are made. It features a broader array of

p ro d ce.
providers than in the past, thanks to emerging research about nurses, pharmacists, paramedics, physical therapists, technicians,
u
, d o ot re
and others. The chapter features a discussion of narrative medicine and real-life examples of patient–provider communication.
n
s e nl y
oconsidering
o n a l u
Chapter 4 examines health communication through patients’ eyes,
s express themselves - 0 9 -03 This edition looks closely at how
what motivates patients, what they typically like
and do not like about health care, and erpeople
Phow 2 0 2 0
in health encounters.
communication is influenced by the nature of illness, patient disposition, and threats to personal identity. It includes
information about communication skills training for patients and updated information about patient narratives and self-
advocacy.

In Chapter 5, readers view health from the perspective of professional care providers. This edition explores the philosophy
behind caregiver training programs and how that has changed through the years. As in Chapter 3, coverage includes a broader

p ro d uce.
array of professionals than in the past. This chapter features coverage of mindfulness and other strategies to help care providers
e
l y, d o not r
remain emotionally resilient. It also presents tips for communicating with difficult patients, communicating when time is

a l u s e on 03
limited, and disclosing medical mistakes. It concludes with a unit on multidisciplinary teamwork. Information is provided on
n -
P e r so 2 0 - 0 9
20
more than 30 careers in medicine, dentistry, nursing, and allied health.

PART III: Sociocultural Issues

Chapter 6 focuses on diversity among patients and health professionals. It begins with a feature on intersectionality theory and
includes expanded coverage of nuanced gender identities. The chapter presents information and strategies for communicating
p ro d u ce.
ot re
effectively with people who differ in terms of social status, gender, race, language, ability, and age. The section on health
, d o n
only
literacy is substantially updated. Case studies describe the experiences of a Spanish-speaking woman in an English-speaking
a l u s e
Person
hospital and a college student coping with a physical disability.

9 03
 Pe -03
- 0 9
Chapter 7 describes social and cultural conceptions of health and healing. It presents a model of cultural competence and
2 0
20
exposes readers to ideas about health around the world, including conceptualizations of health as a balance between the
physical and spiritual, between elements of “hot” and “cold,” between different types of life energy, and more. Coverage of
holistic medicine appears in this chapter, as do diverse expectations about the roles of patients and caregivers. The chapter
includes a feature about the theory of health as expanded consciousness and many examples illustrating diverse perspectives.

r o d u c e.
PART IV: Coping and Health Resources
, d o n ot rep
l u s e only
Pewe rsmay a to maintain and regain
onuse 2 0 -0 9 -03and when that is not possible, to cope at
Part IV focuses on the array of resources
the end of life.
20 health,

Chapter 8 illustrates the importance of social support and provides tips for supportive communication. This edition features
updated coverage about the role of communication in family caregiving and end-of-life experiences. The chapter also examines
instances of social support “gone wrong”—episodes in which people’s efforts to help actually hurt, and how we can avoid
making the same mistakes. Another section within the chapter explores the notion of animals as supportive companions. The

d u ce.
chapter includes sections on transformative health care experiences and organ donation decisions.
p r o
o n oand e
t rtelehealth.
o nl y
Chapter 9 presents updated information about eHealth,, dmHealth, It presents evidence that, around the world,
l u s e
r s
more people now have mobile
P e onatechnology - 0 9-0in3their homes. We explore how health communication
than have electricity
0 2 0
2 new information resource to benefit diverse patent populations around the world.
specialists are trying to make the most of this
The chapter addresses such questions as Why and under what circumstances do people seek electronic health information? Is
eHealth information mostly helpful or counterproductive? and How does eHealth communication compare with face-to-face
interactions? Readers will learn more about the emergence of virtual hospitals, mobile devices, and health apps, and will
debate the pros and cons of telehealth in terms of health communication. Information about medical information and
technology careers is presented.

e p ro d uce.
PART V: Communication in Health l y, d o not r
Organizations
n a l u s e on - 03
P e r s o 2 0 - 0 9
20 specialists play in health. The chapter is loaded with theories
Chapter 10 presents new examples of roles that communication
and expert tips related to health care administration, public relations, being a servant leader, promoting a shared vision,
working in teams, and rewriting the rules by which health care organizations operate. The chapter culminates with tips for
service excellence from some of the best medical centers in the world. Coverage includes theories and related stories from
professionals in the field.

ro d u c e.
PART VI: Media, Public Policy, and Health Promotion
d o n o t rep
l u s e only,
Chapter 11 provides the latest informationrabout
P
a images in advertising,
e sonhealth 2 0 -0 9 -03and entertainment. It features new
news,
20
coverage about body image and social media, as well as media influence on obesity, alcohol and nicotine use, sex, and
violence. The chapter also includes a section on the international impact of entertainment-education and information about
careers in health journalism. It includes tips for reporting health news, using interactive media to present health information,
and developing media literacy.
In Chapter 12, readers explore the real-life lessons of health communication professionals involved with Ebola, AIDS, SARS,
avian flu, Zika, the opioid epidemic, and other health threats. The chapter presents advice for preventing and minimizing
crises, responding in the heat of the moment, and managing public fears and information needs. The emphasis is on
collaborative communication that is timely, data based, and culturally sensitive.

Chapters 13 and 14 guide readers through the creation and evaluation of public health campaigns. Both chapters include real-
life campaign exemplars and sample PSAs, as well as expanded coverage of campaign design resources and message framing.
An updated section discusses the lessons of the critical-cultural approach as we contemplate the ethics of persuading people in
diverse cultures to reexamine health-related behaviors. These chapters showcase careers in health promotion and health
campaign design.
 p ro d u ce.
, d o n ot re
se onl y
PA RTPeIrson a l u -0 9-03
2 0 2 0

ESTA B L I SHING A CO NTEXT

FOR H E A LTH ly, do not reproduce.
s e on
COMMPUerNso I CATION
n a l u
20 2 0 - 0 9 -03

Athena du Pré Barbara Cook Overton

p ro d u ce.
, d o n ot re
l u s e only
P erson a
2 0 -0 9 -03
20
It’s an exciting time to study health communication. To contribute in meaningful ways, we must be up to date, well informed,
and aware of the big picture. This section lays the groundwork for that. You can read the rest of the book in any order you like,
but begin with this section. In Chapters 1 and 2, you will learn about philosophical perspectives and recent events that have led

uce.
us to the current moment. Understanding that journey makes it easier to envision the future—and ways that you can make a
e p ro d
ot r
difference in it.
y, d o n
l u se onl
Person
a
0 2 0 -0 9-03
2

o duce .
ot r e p r
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P e 20 2 0
CHAPTER 1
ce.
Introduction , d o n ot re p ro d u
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Person
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2
Athena du Pré Barbara Cook Overton

In 2020, a new virus spread around the world, sickening or killing at least 2 million people. As the crisis escalated, communication
was a powerful tool for persuading people to engage in protective behavior. But the message was mixed. On the same day the World

p r o d u ce.
Health Organization declared a global health emergency, the United States president announced that the virus was “under control”

, d o ot re
and a week later said the “risk was low.” Within weeks, hospitals in hardest hit areas were overwhelmed. As officials prepared tents
n
l u s only
and auditoriums to serve as makeshift hospitals, some government leaders issued stay-at-home orders to reduce the risk of contagion,
e
P erson a
2 0 -0 9 -03
while others encouraged people to continue shopping and going to work and school.
20
Pandemics present a powerful reminder how important (and challenging) health-related communication can be. But health
communication doesn’t occur only during a crisis. It’s part of our everyday lives. We communicate about health with friends,
family members, coworkers, and health professionals. Our ideas about health are influenced by the internet, movies, public
service and announcements, and more.

In this chapter, we consider what health and health communication are all about. We examine philosophical perspectives of
health and healing. Then we focus on how and why people communicate as they do about health. The chapter concludes with

p ro d ce.
key reasons to study health communication, including particularly promising career growth. (See Box 1.1 for a list of health-
u
related careers featured throughout the book.)
, d o n ot re
l u s e only
Person
a
0 2 0 -0 9-03
BOX 1.1 2
Career Opportunities

Profiles of More Than 125 Health-Related Jobs

Career boxes throughout the book showcase careers related to health and health care. Here are some of the
jobs profiled in each chapter.

p ro d u ce.
ot re
Chapter 3 Research/Education Consultant
, d o n
l u s e only Professor

Person
a
0 2 0 - 0 9-03
Researcher
2
Chapter 4 Case manager
Patient Advocacy
Patient advocate
Patient care coordinator
Patient navigator
 Social worker

ro d u c e.
Chapter 5 Care Providers
d o n o t rep
Clinical laboratory assistant

l u se on ,
Dentallyassistant

e r s o n a 0 - 0 9 -
Dental hygienist 03
P 0 2
2Dentist
Doctor of osteopathic medicine
Emergency medical technician
Hospitalist
Licensed practical nurse
Medical doctor
Medical records technician
e p ro d uce.
Nurse practitioner
l y, d o not r
n a l u s e onhealth/safety
Occupational
- 0 3
technician
P e rs o 2 0 -0 9
20 therapist
Occupational
Pharmacist
Pharmacy technician
Physical therapist
Physician assistant
Psychiatric technician or aide
Psychiatrist
r o d u c e.
d o n t rep
Psychologist
o
l u s e only,Radiology3technologist
a 09-0 therapist
Person 2020-Registered
Recreational
nurse
Respiratory therapist
Speech-language therapist
Surgeon
Surgical technologist

duce.
Chapter 6 Diversity Diversity officer
r e p ro
l y, d not
Equal Employment Opportunity (EEO) officer
o
l u s on care interpreter
e Health
e r s o n a 0 -0 9 - 03
Chapter 7 P 0 2
2Acupuncturist
Holistic Medicine
Chiropractor
Holistic nurse
Massage therapist
Midwife
 Naturopathic physician
Nutritionist/dietician
p ro d u ce.
Reiki practitioner
, d o n ot re
s e onl y
a l u 9-03
Person
Yoga instructor
2 0 2 0 - 0
Chapter 8 Mental Heath Home health aide
Hospice/palliative care provider
Mental health counselor
Psychologist
Senior citizen services providers
Social service manager
Social worker
p ro d u ce.
, d o n ot re
s e y
onl Computer3and information systems manager
l u
Chapter 9 Medical Technology
a 9-0
Person 2 0 2 0 - 0
Health information administrator or technician
Software developer

Chapter 10 Chief financial officer

Health Care
Administration Chief operating officer
Departmental director
Director of human resources
Health information manager
p ro d u ce.
Medical director ot re
l y, d o n
u n
o office manager
se Medical
o n a l 0 9-03
Pers 2 0 2 0
Nursing -
director
President or CEO
Strategic planning director

Health Care Human Compensation and

Resources benefits manager
Customer service

ce.
representative
p ro d u
, d o n ot re manager
Human resource

s e onl y
a l u 9-03
Person 2 0 2 0 -0 Recruiter
Training and
development specialist

Advertising designer
Health Care Marketing and
Community services
Public Relations
director
In-house communication
 p ro d u ce. director

, d o n ot re
l u s e only Marketing professional

Person
a
2 0 - 0 9 -03 Pharmaceutical sales
20 representative
Physician marketing
coordinator
Public relations
professional
Strategic planning
manager

p ro d u ce.
Healthly, d o not re
Chapter 11 Health Journalism
l u se on publication 3
news editor/reporter
a -0editor
Person -0 9
Health
2 0
0 or magazine editor
2Journal
Media relations specialist
Nonprofit organization publicity manager

Chapter 12 Public Health Business or billing manager

Communication specialist
Emergency management director
ro d u c e.
Environmentalist
, d o n ot rep
s e only
Epidemiologist
l u
a
Person Fundraiser 2 0 -0 9 -03
20
Health campaign designer
Health department administrator
Health educator
Health inspector
Health researcher
Media relations professional

ro d u c e.
Nonprofit organization director

d o n o t rep
only,Nutritionist/dietician
Nurse

n a l u s e -03
P e r s o 2 0 - 0 9
20 Patient advocate or navigator
Physician
Public policy advisor
Risk/crisis communication specialist
Social worker

Chapter 13 Community health educator

Health Promotion and
e.
produc
 e p ro d uce
not r
Education Corporate wellness director
l y , d o
n a l u se on
Fitness instructor
- 3
0designer/manager
P e r s o Health0
02 - 0 9
campaign
2Health information publication designer
Hospital-based health educator
Patient advocate or patient navigator
School-based health educator

Chapter 14 Health Campaigns Communication director

Director of nonprofit organization
Media relations specialist
Professor/educator
Public relations specialist
Publication designer
The Importance of Health Communication p r o d u ce.
, d o n ot re
s e onl y
a l u
soanhospital patient,2she0felt 03
09-comforted
Perwas
While Lisa Suennen 20“at-times and at other moments abandoned.” Some care providers were
thoughtful, attentive, and helpful. However, others failed to listen to her, explain procedures, or communicate well with one another
(Suennen, 2015). Some nurses told her they were too busy to respond when she rang the bell for help, diagnostic tests weren’t ordered
on time, and her insurance claim was denied after paperwork was mishandled.

During a health care experience, communication is more than a nicety. It can enhance healing via a two-way exchange of

p ro d ce.
information, comfort, stress reduction, trust, and mutually satisfying solutions (Street, Makoul, Arora, & Epstein, 2009). By
u
, d o ot re
contrast, ineffective health communication often leads to increased anxiety, errors, mistrust, and poor decisions. For these
n
l u s only
reasons, dissatisfying interactions are linked to adverse health outcomes and to burnout among health care professionals (e.g.,
e
Person
a 0 - 0 9 -03
Clayton, Iacob, Reblin, & Ellington, 2019; Kodjebacheva, Estrada, & Parker, 2017). And the effects go both ways. Burnout
2
20
tends to lead to worse communication, causing an even steeper downward spiral (Clayton et al., 2019).

Interpersonal interactions are only part of the picture. They occur in the context of culture, economics, environmental
conditions, and public policy. As you will see throughout the book, communication is often the vehicle through which these
factors are realized and negotiated. A great deal is at stake. As health communication scholar Gary Kreps (2005) observes,

uce.
“many of the people who are most at risk for poor health outcomes from cancer and other serious health problems are members

ep ro d
ot r
of underserved populations” (p. S68). In the United States, people of low socioeconomic status are five times more likely to be

y, d o n
onl
in poor health than affluent individuals are (Khullar & Chokski, 2018, para. 5).
a l u s e 03 States has a chronic health condition
There is no “us” and “them” when itP n About 1 in 4 people
erstoohealth. 0 2 0 - 0 9-United
comes
2 in the
such as heart disease, mental illness, depression, or diabetes (“National Health Council,” 2014). Medical costs escalate when
these conditions are not well managed. There is also a price to pay in terms of pain, stress, and lost productivity. People with
chronic illnesses are six times more likely than others to miss work regularly (Fouad et al., 2017). Experts say we could save
trillions of dollars (and untold suffering) worldwide by helping people prevent and manage long-term health concerns (“Heart
Disease,” 2015; National Alliance on Mental Illness, 2019; “National Diabetes,” 2017; Rapaport, 2018).

p ro d u ce.
n
The good news is that along with challenges come new possibilities.
o re future may belong to those who not only improve
ot The
health care but fundamentally reimagine the o , d
nlityis provided. “Health in 2040 will be a world apart from what we have
a l u s e way
4).-03
Pe sonBetts, & Davis,
now,” predict analystsr(Batra,
20 2 0 - 0
2019, para. 9
For one thing, technology is changing the health information available to everyday citizens. To return to our opening example,
Suennen might realize in the future that her heart is malfunctioning even before she feels symptoms or visits a doctor.
Wearable devices such as smartphones can now monitor people’s health and alert them to seek care when needed. This has
already saved a number of lives (Smith, 2018). And the trend is growing. Before long, it may be possible to equip your

uce.
bathroom mirror and other features of daily life to monitor key health indicators (Batra et al., 2019). At another level, the days
e p ro d
not r
of one-way communication from health experts to health care consumers are giving way to more collaborative models in
l y, d o
e on
which patients can more easily ask questions and share health data with care providers, even when they cannot be with them in

o n a l u s 9 -03
Pe s 20 2 0 - 0
person. We talk more about the impact of health information technology in Chapter 9.
r
Another change involves the way that health care services are provided. Clinics and hospitals aren’t going away, but additional
services are emerging that embed health care more into everyday life. For example, many neighborhood pharmacies now
function as “health hubs” that offer vaccinations and nutrition counseling and monitor people’s blood pressure, diabetes,
cholesterol, and more. Considering that the United States spends 90% of its health care money on chronic conditions,

p ro d ce.
affordable and convenient care is crucial to moderating costs (“Health and Economic,” 2019).
u
, d o n ot re
l u s e only
Person
a
2 0 - 0 9 -03
20

p ro d u ce.
, d o n ot re
se onl y
a l u 9-03
Person 2 0 2 0 -0
Some neighborhood pharmacies now serve as “health hubs” where people can have their blood pressure and other health
indicators monitored without a trip to the doctor’s office.
Have you ever asked a pharmacist for advice or assistance? If so, were you satisfied with the interaction? Why or
why not?

Of course, these new resources are only helpful if you can readily use them. In Chapter 2 we talk about the cost of receiving
care, and in Chapter 6 about literacy challenges that make it difficult for many people to understand and use health
communication.
 .
A Systems-Level Approach ot reproduce
l y, d o n
u se o n
r s o n a l -0 9-03
P e 0 2 0
2 that, we explore health communication from a systems perspective in this
No facet of health occurs in isolation. Recognizing
book. Health care is a system in that it consists of interrelated elements that influence and rely on one another to function as a
cohesive whole (von Bertalanffy, 1968). Your family is a system, as are your university, your workplace, and the larger
industries and cultures that influence you.

Health care is an overarching system composed of many subsystems, such as clinics, pharmaceutical firms, nonprofit

p ro d u ce.
organizations, hospitals, community groups, and more. The implications of a systems approach, as we will apply it, are

, d o n ot re
only
captured well by management theorist Peter Senge (2006). Here are four tenets of systems theory as he explains them that will
l u s e -03
ersona
help you develop a sophisticated understanding of health communication.
P 2 0 - 0 9
20
The structure of a system influences the people within it. As Senge (2006) observes, “when placed in the same system, people,
however different, tend to produce similar results” (p. 42). That’s not to say that people have no choice about their behavior.
But it reminds us of the larger reality—that our choices are strongly influenced by the relationships, structures, and norms in
which we find ourselves. To return to the example that opens this chapter, the care providers who communicated poorly with
Suennen may have been careless or indifferent. On the other hand, they may have been stressed, burned out, or struggling to
keep up in understaffed units.
ep ro d uce.
, d o n ot r
s e onl y
a l u 9-03
Person 2 0 2 0 - 0

p ro d u ce.
, d o n ot re
l u se only
Person
a
2 0 -0 9 -03
20
Much like a living organism, components of the health care system are interdependent and resistant to radical change.
However, small changes can be pivotal.
If you could make one change to the health care system, what would it be and why?

uce.
Superficial “fixes” seldom lead to long-term success. Senge (2006) points out that “the easy way out usually leads back in” (p.
e p ro d
not r
60) and very often “today’s problems come from yesterday’s solutions” (p. 58). For example, it seems reasonable on the
l y, d o
e on
surface to reward care providers when patients experience extraordinary gains in good health. However, that practice presents a

o n a l u s 9 -03
Pe s 20 2 0 - 0
disincentive to take on patients with complex and high-risk conditions. As a result, people in the greatest need may have
r
difficulty finding someone to care for them—not because care providers are unconcerned but because the system discourages
it. In systems theory, the law of unintended consequences points out that even well-intentioned solutions may have undesirable
effects. To avoid simplistic assumptions that may cause more problems than they solve, look below the surface. Former health
care executive Robert Hugin (2018) makes the case, saying that “to produce the right solutions, we must ask the tough
questions, and not grasp at quick fixes just because they seem popular or convenient” (para. 6).
p r o d u ce.
o n re tendency to favor balance
ota system’s
, d
Systems resist radical change. A central tenet of systems theory involves homeostasis,
ly especially if they challenge well-established ways
onchanges,
l u s e
a on the very nature
and stability. This quality makes systems resistant to radical or fast
03 “the harder you push, the harder the
-system,
Pwarns onbased
ersthat, 2 0 - 0 9
of thinking or behaving. Senge (2006)
20 of a
system pushes back” (p. 58). You have probably noticed this if you have tried to drastically change your diet or lifestyle, or if
you have witnessed grand initiatives at work that tend to be abandoned and forgotten in favor of the next big initiative (which
is likely to meet the same fate). However much we may wish for sudden, sweeping changes in health care, truly long-term
solutions are likely to be achieved gradually.

d u ce.
Seemingly small changes can produce powerful results. The good news is that the interdependent nature of systems makes
p ro
o n ot re
them highly sensitive to slow, small changes. A key leverage point can have powerful results. For example, the health care
, d
y
l but in Chapter 2 we discuss how health care navigators in some areas are
onsoon,
system isn’t likely to become simpler anyetime
s
a l u -03 Another example involves efforts to promote community
P erson
helping patients understand
2 0
and navigate the system
2 0 - 0
more9effectively.
wellness. Health campaigns designed by outsiders are often ineffective at changing a target audience’s attitudes and behaviors.
However, when professionals work with members of a particular culture to identify their health-related goals and culturally
acceptable options, the outcomes may be more successful (Dutta & de Souza, 2008; D. B. Friedman, Hooker, Wilcox,
Burroughs, & Rheaume, 2012).

All in all, Senge (2006) points out, “systems thinking is both more challenging and more promising than our normal ways of
dealing with problems” (p. 63). Improving health communication is not as simple as saying “Do better!” By the same token,
blaming individuals seldom gets us far. But a sophisticated understanding of the underlying factors at play can help reveal
leverage points with lasting impact.
Philosophy of This Book d u ce.
p r o
, d o n ot re
s e onl y
a l u
n convictions. One2is0that 03health communication strategies are effective, sustainable,
9-best
e rsomain
This book is based on two
P 0 - 0 the
and respectful to the people involved. The 2
other is that we are best equipped to understand (and to improve) the system when
we understand health communication from a wide range of perspectives—cultural, physical, interpersonal, social,
organizational, and political.

Here are some examples of what can go wrong when people focus on one area of communication but neglect others:

• Patients are well treated, but their families feel distraught and uninformed.

o d u c e.
• A campaign director unfamiliar with cultural ideas about health creates messages that are unappealing or offensive to
r
the target audience.
d o n o t rep
s e ly, the dynamics of patient–caregiver communication is
onunderstand
a l u 3
-0needs.
rsonservices 9
• A marketing/public relations director who does not
unable to help shapeP epromote
and that2 0
meet2 0 - 0
stakeholders’
• A team member uninformed about health care administration and current issues misses out on leadership opportunities.

• Care providers who do not communicate effectively with each other confuse patients and their loved ones with
contradictory information.
• Health communication researchers focus only on individual actions rather than recognizing the social and
organizational constraints that may limit people’s options.

p ro d u ce.
• A high-tech means of sharing health information benefits people who are already well informed but increases the gap

, d o n ot re
between information haves and have-nots.
s e onl y
a l u 9-I,0the3book is organized roughly from micro-
P
After establishing the context for current rsoinnhealth communication
eissues 2 0 2 0 in0Part
-
to macrolevel perspectives. We focus on interpersonal connections between patients and professional caregivers in Part II, and
then broaden the scope in Part III to consider the influence of diversity and culture. Part IV explores health care resources,
including social support and technology. In Part V, we consider the ways that people in health care organizations use
communication to lead, inspire, and support team members, and to partner with the community. The book concludes in Part VI
with coverage of health communication in the media, public health, and health care campaigns. In real life, of course, we
encounter these factors simultaneously rather than one by one. Keep the interplay between them in mind.

r o d u c e.
t rep
Here are some ways to get the most from this book:

d o n o
l u s e only,
• Don’t Key terms andatheories
overlook Perso
n 9 -03as in the main text.
appear in boxes as well
2 0 -0
boxes
20
and
sidebars.

• Engage Questions throughout the book prompt you to reflect on your viewpoints and experiences. Critical thinking,
in the ability to link abstract ideas to actual practices, is one of the most useful ways to put what you learn to
critical
thinking. good use.
e.
produc
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