Health Communication: From Theory to Practice

With a myriad of relatively recent books on health communication and related topics available, there would need to be a pressing need to publish yet another one. In her introduction, Schiavo states that such a need became evident during her search for a textbook to use in the course that she was teaching. In short, she wanted a book that “combined a theoretical and practice-based overview of current issues and topics … with a step-by-step practical section that would help readers acquire technical skills.” At well over 400 pages, including a glossary, a lengthy list of references, subject and name indexes, abundant tables and figures, and two appendixes, this book seems a likely candidate to fill any void in previous offerings. Although this book appears to be the author's first major foray into print publishing, she has written several unpublished reports and has been an active contributor to The Health Communications Initiative [1], where she first presented some of the concepts later included in the book. She continues to teach numerous workshops in the field and is actively involved in the American College of Public Health. The book itself is divided into three parts. Part one, “Introduction to Health Communication,” defines the concepts and clearly establishes the importance of various sociocultural/socioeconomic influences on health beliefs and models. A major strength of the book is the liberal use of practical examples to illustrate and reinforce the theoretical issues being presented, as these may be minimal in less exhaustive texts, such as Berry's Health Communication: Theory and Practice [2]. Health sciences librarians involved in outreach activities or those who work with patients or the public will find chapter 3, “Cultural, Gender, Ethnic, Religious, and Geographical Influences on Conceptions of Health and Illness,” of particular interest. Part two, “Health Communication Approaches and Action Areas,” provides a more in-depth look at the various types of communication presented in part one, including interpersonal communication, public relations/public advocacy, community mobilization, professional medical communications, and constituency relations, where the constituents range from patients to health care providers, drug companies, policymakers, and other key stakeholders. Again, the numerous case studies, lists (do versus don't, definitions of communication formats, etc.), and even testimonials from other experts are particularly helpful in the selection and integration of the most appropriate tools for engaging constituents and for implementing action programs. Part three, “Planning, Implementing, and Evaluating a Health Communication Program,” outlines practical methods for converting communication initiatives into actions. While most readers would not need a rationale for the need to plan, the differentiation between traditional (vertical or centralized) and participatory (horizontal or decentralized) planning may be of interest because of the cultural implications. As in the previous two parts, this section of the book offers practical examples and applications, complete with a review of preferred channels and barriers and strengths and weaknesses of actual projects. A review of qualitative versus quantitative research methods is somewhat cursory but may be helpful to those not familiar with the concepts. Unfortunately, libraries are mentioned only in passing as “good places to start a search” as they “provide access to databases and online journals” (p. 269). The author then advises, however, that “most health organizations now have the internal capability to conduct these searches from their offices.” MEDLINE receives but a token nod here, along with Lexis-Nexis and “several commercial databases to which users can subscribe or access using a public library system” in an equally abbreviated section on database and Internet searching. The author instead focuses on the Internet and the evaluation of websites, including Table 10.2, reprinted from a 1999 BMJ article (p. 271). Literature reviews of peer-reviewed and trade publications, newsletters, and so on are once again suggested as a means of monitoring results in Table 13.1, along with “internet searches” (p. 344), but there is neither any mention of electronic alerting services by journal or topic nor any direction given in the text on how or in what resources such searches should be performed. The book is clearly designed to be a used as a teaching tool, and, in this regard, it is successful. Each chapter ends with a “Key Concepts” review that reiterates the main points. Suggested activities in the “For Discussion and Practice” sections could be used in a classroom or workshop setting to help learners apply the principles to real-life situations. Most disappointing, but probably not surprising to most health sciences librarians, is the conspicuous absence of the roles that they or libraries, including the National Library of Medicine (NLM), play in any of the types of presented communication; the planning, design, and implementation of action plans; or the subsequent evaluation process. In chapter 7, “Professional Medical Communications,” for example, neither librarians nor informationists appear in the pathways described, although the author emphasizes that professional communication is an important component of health communications programs and that it requires specialized skills and tools that may not always be used with other audiences (p. 178). Moreover, clinical librarian and reference services are not mentioned in the discussion of effective ways through which health care provider behavior can be influenced, particularly in encouraging evidence-based practice (pp. 182–5). This oversight may touch a nerve with librarians who routinely teach, use, and promote evidence-based health care. Academic health sciences librarians may find this book quite useful, as the author has provided a thorough overview of factors that must be considered to achieve success in implementing instructional, patient/consumer health, or outreach programs. A sampling of similar current texts reveals a similar disregard for the profession, so librarians clearly need to apply the principles outlined here in marketing themselves and their abilities. Readers seeking more in-depth coverage of professional and patient or consumer communication or health literacy may want to consider Consumer Health Informatics: Informing Consumers and Improving Health Care [3]—which includes chapters on NLM outreach efforts, patient-to-patient or patient-to-computer communication, and design of consumer health websites— or the American Medical Association's Understanding Health Literacy: Implications for Medicine and Public Health [4]. Health Communication in the 21st Century [5] explores the impact that new technologies have had on health communication. Chapters on interdisciplinary and synergistic health care teams and on interpersonal communication issues related to hospice or palliative care, caregivers, and support providers may make it of more practical value in these settings.