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HEALTH COMMUNICATION, 16(4), 475^92Copyright © 2004, Lawrence Eribaum Associates, Inc.

Enacting "Health Communication":The Field of Health Communicationas Constructed Through Publication

in Scholarly Journals

Christina S. Beck, Jose Luis Benitez, Autumn Edwards,Amanda Olson, Aarthi Pai, and Maria Beatriz Torres

School of Interpersonal CommunicationOhio University

Based on an analysis of articles in health communication journals and in regional, na-tional, and international communication journals, this study identifies publicationtrends and research priorities for health communication articles in the 1990s and theyear 2000. Based on a content analysis of article abstracts, researchers determined theextent to which health communication articles appeared in various journals as well asthe emphasis on specific topics in health communication research, methodological ap-proaches, and theoretical frameworks. The article concludes with reflections on theimplications of this study for future work in the area of health communication.

In 1989, Jon Nussbaum wrote that "with the publication of this initial issue of thescholarly journal. Health Communication, the decade of the 1980s is concludingwith a strong piece of evidence that health communication as a legitimate field ofinquiry has finally arrived" (p. 35). Indeed, as Kreps, Bonaguro, and Query (1998,p. 10) argued, "The publication of this journal marked the coming of age of thisyoung field of study and encouraged scholars from around the globe to take thisfield of study seriously." The addition of a second scholarly journal focusing onhealth communication issues. Journal of Health Communication: InternationalPerspectives, in 1996 further attests to the credibility and growth of this emergingarea of study (see Kreps, Query, and Bonaguro, in press; Kreps, Bonaguro, andQuery, 1998).

Requests for reprints should be sent to Christina S. Beck, School of Interpersonal Communication,Ohio University, Athens, OH 45701-2979. E-mail: [email protected]

476 BECK ET AL.

Although the publication of these journals suggests maturation of this field ofstudy (see Kreps, Query, and Bonaguro, in press; Kreps, Bonaguro, and Query,1998), important questions linger: To what extent are health communication schol-ars publishing in other international, national, and regional communication journalsthat do not emphasize health communication? How do scholarly journal articles fittogether to represent priorities, trends, theoretical and philosophical orientations,and methodological approaches of the field of health communication?

As we reach yet another milestone—the publication of the Handbook of HealthCommunication, 13 years after the origination of the journal Health Communica-tion—this study offers an analysis of how health communication scholars enactedthe field by publication in scholarly journals during the decade of the 1990s and theyear 2000. After offering a theoretical and empirical rationale for this investiga-tion, we detail the methods that we employed to conduct this study and the resultsfrom this content analysis of health communication journal articles. We concludethis article with implications and conclusions that may be drawn from this researchreport.

CONSTRUCTING HEALTH COiVIMUNICATION

In the inaugural issue oi Health Communication, Gary Kreps recalled a conferencein which the following question was raised: "If all the research generated by thediscipline in the previous 10 years were somehow erased, of what possible differ-ence would it make to the public at large?" (1989, p. 12). We would like to pose adifferent, yet related, question: In the past decade, what types of contributions didhealth communication scholars make to our body of knowledge about health com-munication through scholarly journal articles?

We believe that trends in health communication journal publications refiexivelyindicate definitions of health communication, prioritized topics, privileged theo-retical and philosophical positions, primary methodological approaches, and in-deed, the commitment of health communication scholars to making a differenceand in what ways. Certainly, health communication scholars also present researchand theoretical arguments in books and non-academic forums (as Blair, Brown,and Baxter, 1994, assert in a related article), and we do not dispute nor minimizethe contributions of published works beyond scholarly journals. However, espe-cially because journal publications result from a refereed, competitive review andselection process (through which reviewers and editors refiexively indicate whatcounts as "valuable" or "sound" scholarship), an examination of published articlescan provide insight into the prioritizing and legitimizing of certain aspects ofhealth communication research within the academic discipline.

ENACTING "HEALTH COMMUNICATION" 4 7 7

The Discourse of Scholarship in Journals

In his disctission of social constructionism, Kenneth Gergen (1999, p. 42) invitesus to explore the "social pragmatics of textuality, that is, the ways in which textsare constructed by communities for certain purposes." In particular, Gergen (1999,p. 42) suggests that "we move from a concern with text in itself to text as rhetoric,that is, a language designed to do something within a community."

Certainly, authors of scholarly articles desire to share information with others inthe academic community. However, the construction and selection of each article,especially when considered as part of the larger collection of journal articles abouta topic such as health communication, reflexively communicates more than its im-mediate content. Choices made by authors about research agendas and by editorsabout the appropriateness of theoretical, methodological, and empirical argumentswork rhetorically to reflect disciplinary priorities and boundaries. In short, journalarticles serve multiple, concurrent, communicative functions within our scholarlycommunities and conversations.

In their feminist critique of the academic publishing process, Blair, Brown, andBaxter (1994, p. 402) argue that "the writing practices that mark what counts asscholarly discourses in this field must not be maintained without scrutiny. It surelyis incumbent upon the adherents of any academic field to scrutinize and evaluatetheir own rules of engagement and practice." By emphasizing the potential for si-lencing ideological perspectives through the review process, Blair, Brown, andBaxter also highlight a clear rationale for examining and discussing journal con-tent beyond individual articles. As Blair, Brown, and Baxter (1994, p. 403) con-tend, "The examination of ourselves as a community requires that we look at pat-terns in our writing and speaking and at the ideological positions such patternsdepend on, reproduce, or refuse."

Reflections on the State of HealthCommunication Research

Health communication scholars seem particularly committed to taking stock ofthe state of health communication research. Scholars discuss the history and fu-ture of health communication in overview books (see, e.g.. Beck, 2001; Du Pre,2000; Geist-Martin, Ray, & Sharf, 2003; Jackson & Duffy, 1998; Kreps &Thornton, 1992; Thornton & Kreps, 1993), special issues of journals (see, e.g.,Ratzan, 1994), journal articles (see, e.g., Kreps, 1989; Lupton, 1994; Nussbaum,1989; Rogers, 1994; Rootman & Hershfield, 1994; Sharf, 1993, 1999; Smith,1989), and book chapters (see, e.g., Kreps, 2002; Kreps, Query, & Bonaguro, inpress). Through such works, authors herald rapidly increasing attention to healthcommunication issues and the potential for contributing to conversations beyond

478 BECK ET AL.

the academy (see, e.g., Kreps, 2002; Rogers, 1994; Sharf, 1999). Kreps (2002, p.232) asserts:

There is no doubt that health commutiication research has achieved a level of disci-plinary maturatioti, generating strong scholarly interest, support, and productivity ...A major reason for the tremendous growth and development of health communica-tion inquiry is the importance of this research area for addressing the complex andchallenging health care demands of society and guiding the promotion of publichealth.

Particularly because of the complexities of contemporary health communica-tion and the potential wide-ranging benefits of our research, we should engage in aclose examination of the focus of our research and the prioritizing of theoreticaland methodological orientations. Yet, to date, the reflections on the state of healthcommunication research rely on generalizations, not specific empirical data, abouttrends, themes, directions, and so on, of our collective body of knowledge aboutcommunication in this consequential context. Thus, as a means of producing suchdata for future dialogues within the community of health communication scholars,we pose the following research questions:

RQl. To what extent is health communication literature published inhealth, regional, national, and international communication journals?

RQ2. To what extent are specific topics within health communication prior-itized in health, regional, national, and international communicationjournals?

RQ3. To what extent are methodological orientations prioritized in health,regional, national, and international communication journals?

RQ4. To what extent are theoretical orientations identified and prioritizedin health, regional, national, and international communication jour-nals?

METHODS

We sought to answer these research questions by collecting data about health com-munication articles from health, regional, national, and international communica-tion journals and then conducting a content analysis of that data, resembling proce-dures employed in a similar study of organizational communication articles in the1980s by Meyers, Brashers, Center, Beck, and Wert-Gray (1992). This section de-scribes our specific methods of data collection and data analysis.


Data Collection

As a research team, we examined the tables of contents from specified journalsfrom 1989 through the most current issue available during our study. (We con-cluded data collection in February, 2001.) We targeted communication journalsthat are edited by regional, national, and international communication associations(such as the National Communication Association, the International Communica-tion Association, Western States Communication Association, Eastern StatesCommunication Association, Central States Communication Association, andSouthern States Communication Association). We also included communicationjournals that are identified in the Matlon Communication Index, but not sponsoredby one of the forenoted associations, as well as three journals that overtly featurehealth communication articles.

Table 1 lists the journals that we tapped for this study. It also indicates issuesthat we were unable to obtain through local resources at our university. Althoughwe intended to review Howard Journal of Communication and Text and Perfor-mance Quarterly for the purposes of this investigation, too many issues of thosejournals were missing from our library for us to include them in this study.

TABLE 1List of Journals

Journal

Communication EducationCommunication MonographsCommunication QuarterlyCommunication ResearchCommunication StudiesCritical Studies in Mass CommunicationElectronic Journal of CommunicationHealth CommunicationHuman Communication ResearchJournal of Applied Communication

ResearchJournal of Broadcasting and Electronic

MediaJournal of CommunicationJournal of Health CommunicationJournalism QuarterlyQualitative Health ResearchQuarterly Journal of SpeechSouthern Journal of CommunicationWestern Journal of CommunicationWomen's Studies in Communication

VolumesIncluded

V. 39-51 (1)V. 57-68V 38-49(1)V. 17-29(1)V. 41-52 (1-3)V. 7-18V. 1-11 (1)V. 1-14(1)V. 16-27(1-3)V. 18-28 (1&2)

V. 34-45

V. 40-51 (1&2)V 1-6V. 67-78(1-3)V 1-12(1)V. 76-87V. 54-67V. 54-65V. 13-24

Volumes Missing (If Any)

V. 48 and V. 49V. 62 (4); V. 67 (2-4)NoneNoneNoneY7(l -3) ; V. 8(3&4); V. 9(4)V.7(l&3)NoneNoneV. 18(3&4)

V. 41(1); V. 43

NoneNoneNoneNoneNoneV.56 and V. 58NoneV 23

480 BECK ET AL.

Our research team divided into three sets of coders. Each set of coders locatedand collected the title pages for its assigned journals. Coding Team One sought is-sues of Southern Communication Journal, Health Communication, and Qualita-tive Health Research. Coding Team Two pursued Communication Monographs,Journal of Communication, Human Communication Research, Quarterly Journalof Speech, Journal of Applied Communication Research, Communication Educa-tion, and Critical Studies in Mass Communication. Coding Team Three searchedfor issues of Women's Studies in Communication, Communication Studies, Com-munication Quarterly, Journalism Quarterly, Western Journal of Communication,Journal of Broadcasting and Electronic Media, Communication Research, Elec-tronic Journal of Communication, and Journal of Health Communication.

Data Analysis

After copying title pages from all available issues during the specified time frame,each coder marked each title from his or her data set (i.e., group of assigned jour-nals) as either a health communication article or not a health communication arti-cle. For the purposes of this study, the coders did not treat book reviews or intro-ductory remarks by journal editors as articles. According to our predefined codingrules, an article counted as a health communication article if it (a) contained thewords "health communication" in the title or (b) referred to health, disease, dis-ability, or social support and communication. If a determination could not be madefrom the title, coders were instructed to review abstracts to assess the article's fo-cus. After examining the titles of articles within their data sets. Coding Team Oneemerged with a .92 reliability rate. Coding Team Two with a .98 reliability rate,and Coding Team Three with a .97 reliability rate. Overall, the reliability rate fordetermining an article's status as a health communication article or not a healthcommunication article was .97. Each team discussed and resolved its disagree-ments, and the first author reviewed all decisions to ensure that coding reflecteddecision rules and the focus of the article. In only a few instances (n = 11), the firstauthor determined that coding decisions did not capture the focus of the article,and she reversed those initial decisions.

Table 2 indicates the extent to which health communication articles appeared ineach of the journals within the specified time frame. Of the 5,506 total articles, thecoders identified 15% (n = 850) as health communication articles. Journals such asHealth Communication (n = 261, tOO%) and Journal of Health Communication (n= 113, 100%) featured health communication articles exclusively whereas Com-munication Education included no health communication articles in the issues un-der investigation.

After agreeing upon the titles that reflected health communication articles,each team of coders obtained and copied the first page of each article. Followingcoding instructions (available from the first author), each coder made five deci-


TABLE 2Percentage of Health Communication Articles

275241351362276205175261262194322375113799411216265282121

5506

0712361346

261214682

1132226467616850

03310523

10082421

1003643321315

Total HC HCJournal Articles articles (No.) articles (%)

Communication EducationCommunication MonographsCommunication QuarterlyCommunication ResearchCommunication StudiesCritical Studies in Mass CommunicationElectronic Journal of CommunicationHealth CommunicationHuman Communication ResearchJournal of Applied Communication ResearchJournal of Broadcasting and Electronic MediaJournal of CommunicationJournal of Health CommunicationJournalism and Mass Communication QuarterlyQualitative Health ResearchQuarterly Journal of SpeechSouthern Communication JournalWestern Journal of CommunicationWomen's Studies in CommunicationTotal Articles:

sions about each abstract. The coders evaluated each abstract with regard to itstopic, ideological orientation, type of data, type of data analysis, and theoreticalorientation. All members of the research team discussed the coding categoriesprior to commencing the study. Unfortunately, as coding ensued, the coders de-termined that the ideological orientation of the article was too difficult to deter-mine from the abstract, and the research team decided to eliminate that codingdecision from the study.

After an initial examination of the abstracts, the team reconvened and revealedthe need to add the categories of health behavior, health and identity, mass media,health experiences, methods, and ethics. Overall, the coders achieved .72 agree-ment on Decision One—the most prevalent topic in an article—and .78 agreementon Decision Two—type of data utilized in an article. The coders attained .76 agree-ment on Decision Three—type of data analysis employed in an article—and .95agreement on Decision Four—the theoretical orientation of an article. Followingtheir comparison of coding, each coding team discussed and resolved its differ-ences, and we include those decisions in our data set.

Thus, based on an examination of 19 journals over an eleven year period, ourdata set consists of 850 health communication article abstracts, 15% of the total

482 BECK ET AL.

5,506 articles published in those journals during that time span. As we detail in theresults section, this content analysis of journal articles enables us to answer our re-search questions about the enactment of health communication through journalpublications in this important time period.

RESULTS

In their recent book, Geist-Martin, Ray, and Sharf (2003, p. 3) define health com-munication "as the symbolic processes by which people, individually and collec-tively, understand, shape, and accommodate to health and illness." With the adventof managed care, consumerism, and the Internet, Beck (2001) argues that health is-sues pervade the attention of politicians, practitioners, and people from all walks oflife. Given the symbolic nature of accomplishing health, illness, wellness, andhealth care, communication scholars hold much potential for contributing to ongo-ing conversations about these important issues. The findings from this study offerone vista for understanding the nature of those contributions thus far.

Overall Publication in Communication Journals

Coders identified 15% of journal articles within the time span of this study ashealth communication articles (see Table 2). Journals such as Health Communica-tion and Journal of Health Communication featured health communication articlesexclusively. Communication Education published no health communication arti-cles during this time period.

Table 3 indicates the extent to which health communication articles appeared ininternational, national, regional, and inter/other disciplinary journals. The Interna-tional Communication Association journals. Human Communication Researchand Journal of Communication, published 637 articles, with only 23 (3%) in thearea of health communication. The five journals of the National CommunicationAssociation that were coded for the purposes of this study featured 1,131 total arti-cles, with only 63 (5%) health communication articles. Notably, the Journal of Ap-plied Communication Research published the greatest proportion of health com-munication articles—24% of its articles during the time period focused on healthcommunication.

Similar to the publications of the International Communication Association andthe National Communication Association, the regional communication associa-tion journals did not emphasize health communication articles during this time pe-riod. Of the 1,657 total articles, 90 articles were in the area of health communica-tion, again only five percent of the total.

As we will elaborate in our discussion, health communication scholars cer-tainly seek and secure outlets for their work beyond regional, national, and interna-


TABLE 3Proportion of Health Communication Articles in Communication Journals

Articles HC HCJournal (No.) Articles (No.) Articles (%)

Journals Published by the InternationalCommunication AssociationHuman Communication ResearchJournal of CommunicationTotal

Journals Published by the NationalCommunication AssociationCommunication EducationCommunication MonographsCritical Studies in Mass CommunicationJournal of Applied Communication ResearchQuarterly Journal of SpeechTotal

Journals Published by Regional CommunicationAssociationsCommunication QuarterlyCommunication ResearchCommunication StudiesSouthern Journal of CommunicationWestern Journal of CommunicationWomen's Studies in CommunicationTotal

tional communication journals. Health Communication and Journal of HealthCommunication., in addition to interdisciplinary journals such as QualitativeHealth Research, provide homes for numerous articles in this area. In addition,health communication scholars publish in medical, sociology, anthropology, andother health-related publications. Yet, the low percentage of health communicationarticles in mainstream communication journals indicates a lack of prioritizing ofsuch articles by editors and reviewers and/or of mainstream communication jour-nals as possible outlets for this type of research.

Prioritizing of Specific Topics in HealthCommunication Articles

As Kreps (2001, p. 233) contends, "health communication inquiry is an ex-tremely broad research area, examining the important roles performed by humanand mediated communication in health care and health promotion in a widerange of social contexts." Despite the breadth of health communication research.

262375637

2752412051942161131

3513622762652821211657

21223

07446663

12361376690

813

0322435

310532135

484 BECK ET AL.

individual scholars may approach the field quite narrowly. For example, Rogers(1994) argued that health communication scholars typically either design andevaluate health interventions or more widely disseminate those interventions thathave been found to be effective. Yet, as Kreps, Query, and Bonaguro (in press)detail, health communication researchers focus on differing levels of health ex-perience—interpersonal interactions between health care providers and h althcare seekers, group interactions (such as support groups or health care teams),and organizational communication, in addition to work on health education andpromotion.

In this study, we examined the specific topics of health communication articlesin this sample to identify trends in these target journals. We coded abstracts ofhealth communication articles with regard to the dominant specific topic in eachwork. Although articles could (and did) refer to multiple specific topics (such asphysician-health care seeker interaction and technology), coders determined themain focus of each article and coded accordingly.

Of the 850 health communication articles in this sample, 13% (n = 110) high-lighted health information. Articles about health information detailed the extentto which individuals possessed or sought to acquire health information. Notably,the emphasis on health information in these articles coincides with Witte et al.'s(1996, p. 230) definition of health communication as "the exchange, transmis-sion, perception, and/or intemalization of health-related information, withinvarying social and physical environments, regarding factors that influence healthand/or health-related behaviors."

Coders differentiated between health campaigns and health information bydiscerning whether the article emphasized a description of what individualsknow (or want or should know) as opposed to an analysis of a campaign's effec-tiveness, failure, etc. The two issues may be linked, especially in terms of forma-tive evaluative research (see related work by Atkin & Freimuth, 2001); however,we separated them to offer a finer specification of the specific topics within thisstudy.

Interestingly, public health campaigns constituted the second most prevalenttopic in this set of health communication articles (n = 105,12%). Given our codingrules, we remain reluctant to combine these top two categories, however, clearly,one-fourth of the health communication scholars prioritized the analysis of pos-sessing, seeking, and sharing health information (n = 215, 25%).

Consistent with Kreps, Bonaguro, and Query (1998), an important aspect ofhealth care delivery emerged as the third ranked topic in the health communicationarticles—physician-health care seeker interaction (n = 95, 11%). In addition todoctor-patient communication and health information dissemination, Sharf(1993) stressed social support as a key area of health communication research, andin this sample, 71 articles (8%) focused on some aspect of social support andhealth communication.


Other specific health communication topics received less attention. Despite theprevalence of the Internet and other technological advances in medicine, healthcommunication scholars published few research reports on technological issueswith regard to health care (« = 13,2%). Further, in spite of the increasing emphasison interdisciplinary teams in health care settings, researchers produced only 13(2%) articles on interactions between health care professionals.

Methodological Orientations of HealthCommunication Articles

A relatively large number of health communication article abstracts failed to pro-vide information about the methods of data collection (n - 268,25%) and methodsof data analysis (n = 225, 26%). Thus, we tread carefully with regard to conclu-sions about methodological orientations of the health communication articleswithin our sample, an issue that we will pursue more completely in the discussionsection. Of the 582 abstracts that specify methods of data collection, 154 research-ers utilized qualitative interviews as the primary means to gather data about healthcare issues, 26% of the adjusted sample. Authors utilized self-report data from ac-tual health care participants in 23% of the articles specifying methods of data col-lection (n = 131). Interestingly, only 8% of articles that specified type of data de-pended on data from responses to artificial scenarios (n = 48).

Coding categories that indicate data from actual health care participants includequalitative interviews, self reports, ethnographic/participant observation, taped in-teractions, focus groups, and diaries. After totaling those categories (n = 394), wefind that 68% of the articles reporting methods of data collection prioritized actualexperiences and reactions, as opposed to artificial scenarios. Of course, given thelimitations of the coding categories, we do not know exactly who those partici-pants were nor what their level of experience might be. However, we do know thata majority of health care researchers sought the voice of individuals who have con-fronted or were in the process of experiencing some health communication issue.

In the 625 abstracts that reported methods of data analysis, researchers tendedto analyze the data through thematic analysis (n = 342, 55%) as opposed tomultivariate analysis (n = 168, 27%). Rhetorical analysis (n - 60, 10%), contentanalysis (n = 49,7%), conversation analysis (n = 3, >1 %), and meta analysis (n - 3,>1%) occur much less.

Theoretical Orientation of Health Communication Articles

Witte et al. (1996) observe that health communication has been critiqued for a lack oftheory. Although some health communication scholars did prioritize theory in theirarticle abstracts (n = 198,23%), the vast majority did not. Of the 850 health commu-nication studies in this sample, 652 authors did not refer to any theory or theoretical

486 BECK ET AL.

orientation in their article abstract, 77% of the sample. Notably, we did not examinethe entire article for our study so, certainly, some articles could have highlighted atheoretical framework within the text but omitted that component of the study in theabstract. However, given that scholars (from communication and other disciplines)utilize article abstracts as summaries of the main arguments of articles, we believethat our sample offers a strong sense of the extent to which health communicationscholars emphasize theory to internal and external audiences.

As Table 4 suggests, the health communication articles in this study employedan array of theoretical frameworks to guide investigations. In fact, we treated the

TABLE 4List of Theoretical Frameworks Employed in Health

Communication Articles*

Theoretical framework

Grounded theoryReinforcement expectancy theoryBurkeian rhetoricHealth belief modelFear appealDiffusion of innovationNarrative theoryRelational communication theoryProblematic integration theorySelf efficacySense-making modelInnoculationSocial marketingEntertainment-educationHealth persuasion theoryUncertainty reduction theorySocial psychological theory of planned behaviorKnowledge gap hypothesisSystems theoryCommunication boundary theoryInconsistent nurturing theoryCompliance gainingCommunication accommodationKnowledge gapTheory of reasoned actionPerspective by incongruityInconsistent nurturing as controlPhenomenologyMedia system dependency theoryFeminismSocial learning

No.

21987776554333333322222222222222

%

11544443332222222211111111111111

*Percentage based on 198 abstracts that mention some sort of theoretical framework.


construct of "theoretical framework" or "theoretical orientation" quite liberally. Ifan abstract referred to a theorist (e.g., Kenneth Burke or Erving Coffman), a model(e.g.. Heuristic Systematic Model of Persuasion or Health Belief Model) or whatwe knew to be a theoretically-driven construct (e.g., facework), we counted it as anarticle with a theoretical framework. In so doing, we acknowledge that othersmight dispute Goffman's status as a theorist or facework as a theory. However, aswe will detail in the discussion section, we are struck that, even with our generoustreatment of "theory," so many article abstracts exclude any countable reference totheory. We also marvel at the breadth of theoretical frameworks that were high-lighted in the abstracts. In the 198 abstracts that mention some sort of guidingframework, 86 different ones were noted. Largely due to its use in QualitativeHealth Research, Grounded Theory surfaced as the most prevalent theoreticalframework (n = 21,11%). Other theories that garnered multiple mentions includedReinforcement Expectancy Theory (n = 9, 5%) and references to some aspect ofBurke's rhetoric (n - 8,4%). Authors also specified the Health Belief Model, FearAppeal, and Diffusion of Innovation seven times each (4%), Narrative Theory (n =6,3%), Relational Communication (n - 5,3%), Problematic Integration Theory (n= 5, 3%), and Self Efficacy (n = 4, 2%) (see Table 4).

Interestingly, authors labeled their theoretical frameworks differently from oth-ers who hold similar orientations to their work. For example. Diffusion of Innova-tion can fit with Social Marketing (n = 3,2%) and Entertainment-Education (n = 3,2%). However, because we could not make such an inferential leap from informa-tion in the abstracts, we chose to preserve the authors' labels instead of combiningthem into potentially erroneous larger categories.

DISCUSSION

We began this project with the goal of identifying how the field of health commu-nication has been enacted through publication in communication and health com-munication journals. Although other scholars have reflected on the state of the dis-cipline, we believe that this analysis of journal article abstracts offers empiricaldata for future discussions about trends in our area of research. In this discussionsection, we ponder key findings from this study, consider potential limitations ofthis project, and highlight the need for additional deliberation about directions inhealth communication research.

Pondering Key Findings

As Tables 2 and 3 indicate, health communication articles constitute 15% of the to-tal articles that were published in communication and health communication arti-cles during the scope of our study. With the wide array of areas in communication.

488 BECK ET AL.

that percentage, on the surface, reflects a rather strong commitment to the produc-tion and publication of research in the area of health communication. However,upon closer reflection of Table 2, that percentage may be misleading. All of the261 articles in Health Communication and all of the 113 articles in Journal ofHealth Communication were coded as health communication articles. Combinedwith the 264 articles from Qualitative Health Research, 638 of the 850 health com-munication articles came from health communication journals, not mainstreamcommunication journals, a whopping 75% of the articles identified as health com-munication for this study. Only 25% of the sample emerged from regional, na-tional, and international communication journals without a health communicationemphasis.

Taken in light of the other articles featured in those journals, only 212 health com-munication articles appeared amid a total of 4,721 in regional, national, and interna-tional communication journals, a mere 4%. Without access to information about thequality and quantity of submissions by health communication scholars to thesenon-health communication specific journals, we cannot construct an argumentabout the appropriateness of this percentage (nor should we argue for a quota systemwherein health communication should expect some proportion of journal space). Byhighlighting this percentage, we hope to raise awareness about our relative visibilitywithin more mainstream journals. In so doing, we also acknowledge that visibility ofhealth communication research also occurs in other important ways to colleagueswithin and beyond the communication discipline (e.g., obtaining and publicizing ex-ternal grants, sharing scholarly findings outside academic journals, building profes-sional connections in communication and health related communities, etc.). How-ever, as we noted earlier in this essay, journals serve as the forum for major scholarlydiscussions, and the ability of health communication scholars to gain a seat at the ta-ble for those conversations impacts the extent to which we can impact the communi-cation discipline, theoretically, empirically, and methodologically.

In addition to providing data about the quantity of health communication re-search that has been published in various journals, this study offers insights intotopical, methodological, and theoretical priorities of health communication arti-cles during the scope of this study. Overall, this analysis of health communicationarticle abstracts indicates a range of topics, methodological approaches, and theo-retical orientations.

These findings highlight the diversity of health communication topics. We con-sciously decided to create categories that remained close to the topic specified ineach abstract. In so doing, we believe that we have captured the range of unique in-terests and research agendas in health communication research. We contend thatthis breadth in topics mirrors the complexity and scope of this area of research.

However, as we cluster categories, we find clear confirmations of earlier claimsthat health communication research tends to emphasize public health and interper-sonal interactions about health (see, e.g., Kreps, 2002). By combining categories


such as health information, public health campaigns, health behaviors, and massmedia, an emphasis on public health communication becomes clear (n = 294,35%). Additionally, by merging categories such as physician-health care seekerinteractions, support system interactions, other health care provider interactions,interactions between health care professionals, and provider-support system inter-actions, we note an emphasis on interpersonal interactions between health careparticipants (n = 221, 26%).

This study also provides insights into the methodological approaches of healthcommunication scholars. A lack of information in a significant number of ab-stracts hinders our ability to draw sweeping conclusions (a limitation to be dis-cussed in the next section). Yet, our analysis of abstracts with descriptions of meth-ods of data collection and data analysis reveals a commitment to the voices ofhealth care participants. Tbis study shows that health communication researchersprioritize methods of data collection that permit actual health care participants toshare their stories, reactions, or opinions.

In addition, the data from this study suggest an acceptance of methodologicalplurality. Of the 625 abstracts that detailed methods of data analysis, 55% of theabstracts indicate thematic analysis of data, and 27% specify multivariate analysisof data. Certainly, the inclusion of Qualitative Health Research impacted the largenumber and percentage of abstracts noting thematic analysis. Yet, with 10% of theabstracts claiming some form of rhetorical analysis, and 8% indicating contentanalysis, we believe this data set suggests strong appreciation for a variety of ap-proaches to data analysis. Especially given the breadth and complexity of healthcommunication, we applaud the apparent commitment to diverse methods of an-swering research questions as well as the apparent emphasis on the voice of actualhealth care participants.

We tread carefully with regard to conclusions about theoretical frameworks. Ofcourse, some abstracts may have failed to note guiding frameworks that were de-tailed within the text of articles, contributing to the small number of abstracts thatdid offer some description of framework. While we do not conclude that this studysuggests a lack of theory in health communication, we do contend that health com-munication scholars miss opportunities to participate in larger theoretical conver-sations due to the presentation of their work.

Even if a far greater proportion of health communication scholars ground theirwork theoretically than this analysis of article abstracts reveals, computer searchesthat depend on key words from abstracts will not connect searchers with articlesthat do not include references to theory in abstracts. If health communicationscholars want to position themselves for making contributions to theories abouthealth communication as well as to broader discussions about theory within thecommunication discipline, they must make the theoretical underpinnings of theirarticles clearer and more readily available to others. Especially when health com-munication has been critiqued for lacking theory, researchers must detail the theo-

490 BECK ET AL.

retical frameworks that drive their research and then discuss the implications fortheory within the area of health communication and, if possible, for theory withinthe discipline of communication. Especially in this era of computerized literaturesearches, scholars must make those arguments readily accessible by highlightingtheory in abstracts and key word lists.

Detailing Limitations of Study

As we just alluded in the prior section, a primary limitation of this study resultsfrom our decision to code article abstracts instead of entire articles. Due to limitedtime and budget, we chose abstracts for our sample, following the precedent of an-other study of disciplinary articles (see Meyers, et al., 1992). We acknowledge thatwe could have gained more information about each article if we had had the re-sources to obtain copies of the 850 health communication articles.

However, despite this limitation, we believe that this study offers rich insightsinto the pervasiveness of health communication research and into the research pri-orities of health communication scholars. We do encourage other researchers topursue the actual articles to gain a deeper understanding of trends in theoreticalframeworks for health communication research. Yet, our findings about the lack ofdetail about theory in health communication article abstracts raise important con-cerns about the ability of health communication scholars to participate in discus-sions about theory, given increasing dependence on computer search engines.

Additionally, this sample of journal article abstracts limits our ability to com-ment on overall visibility and prioritizing in the field of health communication.Building on the arguments of Blair, Brown, and Baxter (1994), health communica-tion scholars participate in dialogues about research findings and implications ofresearch for health care participants in a wide array of forums. Health communica-tion researchers write books, publish in journals beyond the communication disci-pline, and present findings in a broad range of contexts, within and beyond acade-mia. Through our decision to limit this study to articles within communication andhealth communication journals, we do not dismiss or demean that other importantwork. We focused on those publications because we lacked the resources of timeand money to expand our investigation. However, although inherently limited inscope, we do argue that this examination offers an important reflexive glance at re-search priorities by health communication scholars as co-determined by research-ers, editors, and reviewers through the review process in our discipline.

Discussing Future Directions

As we discussed in the first section of this essay, health communicationscholars routinely take stock of their research. We believe that this study contrib-utes to future conversations about directions for continued research in healthcommunication.


For example, although work in the area of health communication is, by nature,"specialized," the low proportion of health communication articles in mainstreamcommunication journals may indicate a need to build bridges between health com-munication and other contexts of health communication. In what ways can our em-pirical discoveries inform, influence, and inspire researchers in other areas (suchas organizational communication, interpersonal communication, public sphere re-search, etc.)? In what ways can our theoretical insights contribute to ongoing con-versations about feminism, postmodernism, post-structuralism, the work of Ken-neth Burke or Erving Goffman, and so on? In what ways can research in healthcommunication become "relevant" to others beyond health communication re-searchers and health practitioners and consumers? If health communication schol-ars find ways to make such links, perhaps the contributions of health communica-tion research can expand far beyond the boundaries of this "specialized" context.

Additionally, this investigation highlights current research priorities as well asareas that lack relative attention. In particular, in this era of increasing utilization ofteam-based care, we are struck by the lack of research on interactions betweenhealth care professionals. Further, especially given the complexities of health carein contemporary society, we believe that our understanding of health communica-tion would be enriched by more attention to ethics and health care provider interac-tions with support system members.

CONCLUSION

Overall, we argue that this study offers important information about research prior-ities and publication trends in the area of health communication. In particular, wehope that this data can be enlightening to scholars as health communication contin-ues to develop as an academic area and a resource for practitioners.

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