Health communication is now considered as critical to understanding and explaining how health behaviors are initiated, changed, and maintained. While communication has always been considered an important mechanism to reinforce or promote health behaviors, transformative developments in information and communication technologies, and their broad and deep penetration make understanding the role of communication central to them. Yet the role of communication is often misunderstood with the assumption that communication has a direct influence on health behaviors. While there are conditions under which that is empirically true, more often communication has a powerful influence on critical antecedents to health behaviors. Understanding the influence of communication on the antecedents and the pathways and mechanisms through which the influence flows is central to studies of health behavior and it is here that health communication theories work in conjunction with health behavior theories.
This chapter will contextualize health communication in social and behavioral change and its potential direct and indirect roles in explaining health behaviors. We will discuss the role of communication as a multilevel phenomenon drawing on the social ecological model1 as a broad framework and introduce key themes in recent health communication research. These themes include key constructs and hypotheses in health communication and major genres and formats through which health communication has contributed to public health.
HEALTH COMMUNICATION THEORIES
The field of health communication has embraced many theories and models whose roots can be traced to the broader disciplines of communication, social, and behavioral sciences. The decades-old emphasis on evidence-based practice in public health (see Chapter 41 by Mercer) has recently been complemented by the idea that empirical evidence alone is inadequate to direct practice, and that the explanatory and predictive capabilities of theory should be exploited in designing programs and evaluations.2 Theories, both explanatory and change theories, are helpful to delineate the range of factors that influence and inform the development and implementation of interventions.3 Specifically, using theory, practitioners and researchers can identify the range of intermediary factors that characterize the link between communication interventions and behaviors.3
Below, we will briefly discuss selected communication theories that have been widely used in health particularly in understanding and influencing health behavior at individual and social contextual levels. This is neither meant to be an exhaustive list of theories or models of health communication nor a complete explanation of influence of communication on health behaviors but is meant to be indicative of how communication may influence critical antecedents to health behaviors.
One challenge facing health communication practitioners and researchers lies in the difficulty of distinguishing between effects that stem from message variability and effects that stem from audience variability.4 Different theories have been put forward to provide conceptual and analytical frameworks that account for message variability, audience variability, and the resulting communication effects. In strategic communication, the format of a message (“construction”) ...