Chapter 11: Information, Communication and Health Literacy
- Health Communication: all interpersonal, organizational or mass communication that concerns health.
- It can occur in various contexts (public health campaigns, doctor-patient communication)
- Can be applied in a variety of settings (clinics, schools, workplaces, online communities)
- Used in a variety of channels (face-to-face communication, posters, social media)
- Deliver a variety of messages (healthy eating, smoking cessation, safe sex)
- Serve variety of purposes (risk assessment, communication of diagnosis, service awareness,
- Communication: the exchange of information between one person, or “entity” and one or more others.
- Shannon and Weaver (1949) model of communication:
- Source: where the message is coming from
- Transmitter: something that encodes the message into signals
- Channel: where encoded signals are transmitted
- Receiver: something that decodes the signal back into the message
- Destination: where the message goes
- Example: reading this textbook. Authors = source, reader = destination, printed text = transmitter, book =
channel, readers brain = receiver
- Noise: Can interfere with the communication process
- Physical noise: loud music, talking
- Cognitive noise: being distracted by other concerns
- Affective noise: anxiety about an upcoming meeting
- Socio-cultural noise: different meanings of different words to different cultures (abbreviations/slang)
Health Care Professional-Patient Communication
- There are direct and indirect pathways that link effective communication with health outcomes.
- Direct path: highlights benefits related to improved survival and remission rates, enhanced emotional well-
being, pain control, functional ability, vitality and reduced suffering.
- Patient-centered communication style: makes use of the patient’s knowledge and experience through
techniques, such as silence, listening, and reflection.
- Doctor-centered communication style: makes use of the doctor’s knowledge and skills with minimal input
from the patient.
- Huynh and Sweeny (2013) updated these styles and outlined three patterned approaches to patient care
- Laissez-faire: negligent and unsympathetic towards patients
- Transactional: set health goals and provides patients with instructions, feedback, and reinforcement
to pursue these behaviour goals
- Transformational: provides health goals, inspires and motivates patients to be personally engaged in
- There has been a shift from a doctor-centered approach to a patient-centered approach. This has led to
patient empowerment, which encourages patients to be proactive about their health.
- Patient-centered communication refers to communication among health care professionals (HCP), service
users and their families intended to promote patient-centered care.
- This communication style aims to elicit and understand perspectives of patients and their families about the
patient’s particular health condition, its management and treatment.
- Reach a shared understanding of the patient’s health condition that takes into account the psychosocial
contexts that underpin their experiences.
- Shared decision making enables HCP and patients to share power and responsibility.
- Therapeutic alliance: relationship between mental health practitioners and their clients.
- Patient-centered communication can strengthen therapeutic alliance.
- Patient-centered communication promotes trust, loyalty and positive regard between HCP and patients. This
relationship can be strengthened through longitudinal care, but the patient must have a positive experience. If
they go through a negative experience they will not be likely to have a strong bond with this specific HCP. E-Health and Telemedicine
- E-Health: a general term referring to the application of digital information and communication technology
(ICT) to health care. This can include sites such as WebMD or sites to provide information about illnesses, self-
help, or reviews of health care facilities.
- This type of communication is growing rapidly because of how the web is growing.
- The internet is bringing a shift in the patient role from passive recipient to active consumer of information.
- Younger, more educated people tend to use the internet for self-diagnosis.
- The majority of health-related internet searches by patients are usually carried out before a clinical encounter.
The purpose of these searches is to gather information before deciding whether to implement self-care and/or
get professional help.
- Internet is also used to help in formulating better informed questions to ask your doctor, or to help reassure
you the doctor has made the right diagnosis.
- There are online support groups that help people with specific diagnosis’s connect with similar people globally
to discuss their problems and lives. This gives individuals support and help with others who are undergoing
what they are.
- Online groups can act as peer-led self-management programmes that can help improve the health literacy
and experience of members concerning arthritis.
- There are also webpages that support unhealthy behaviour (pro-anorexia sites encouraging anorexic
- The web allows people to speak freely and openly within a safe and supportive space, connecting with people
who are similar to them.
- Activities that can be carried out online offer numerous benefits such as it can increase interactions, facilitate,
share and obtain health information with other users. But despite these benefits online users must be weary of
the lack of reliability, confidentiality, and privacy of online health communication platforms.
- Patient informatics: is becoming an increasingly useful addition to the training of HCPs by:
- Increasing their own awareness, knowledge and skills through access to the Internet
- In learning how best to engage with the growing use of online health information by a sophistication
of, many service users.
Gender and Social Differences in HCP-Patient Communication
- Significant gender difference was found with female doctors providing more preventive services and
psychosocial counselling while male doctors spend more time on technical practice behaviour (physical
- The patients of female doctors were overall ore satisfied.
- Same-sex dyads (male doctor and male patient, or female doctor and female patient) were characterized by
friendlier and calmer tones that opposite-sex dyads (male doctor and female patient, or female doctor and
- Same-sex dyads:
- Male doctor/male patient: characterized by relative ease ad equality between doctors and patients
with talk focused on the patients’ social agenda
- Female doctor/female patient: more patient centered and had longer consultations containing the
most psychosocial aspects and bio-medical talk (medical and therapeutic issues)
- Opposite-sex dyads:
- Male doctor/female patient: the least patient centered. Doctors spent more time discussing
screening services and conducting physical examinations. Doctors were also made more presumptions about
- Female doctor/male patient: characterized by less ease between doctors and patients. Doctors gas
the least friendly voice tone and patients were the most bored.
- Patient-centered communication was used more with patients whom they perceived as more satisfied, more
likely to adhere and those with better communication skills. This was also seen if the patients expressed
positive affect, were more involved, and who were perceived to be less contentious.
- Patients with a lower SES received less socio-emotional talk and more doctor-centered style (less
involvement in shared-decision making and more biomedical talk).
- Patients from a higher SES were given more information, more explanations, and more emotional support.
Doctors were also more patient centered Message Framing
- Prospect theory: proposed that people consider their ‘prospects’ (potential gains and losses) when making
decisions, and therefore, people’s preferences are sensitive to the framing of information.
- People tend to avoid risks when considering