the nature of interpretive/critical approaches to health communication research, it is not always possible, practical, or desirable to consider theory as distinct from methodology and representation. Theories exist in this context as explanatory concepts that are related but not unified and generated rather than extended, challenged, or confirmed. To that end, contemporary interpretive/critical scholarship often intertwines theory with method and combines findings with discussion in carefully crafted expressions (i.e. written, oral, and/or visual) that emphasize local knowledge, in‐depth understandings, and intersubjectivity. Despite these differences from theory‐driven (often post‐positivist) work, however, rigor, validity, and ethical considerations throughout the research process remain paramount.
In this chapter, I offer a brief introduction to four common theoretical frameworks that incorporate these tenets and help guide interpretive/critical health communication research. First, I present shared philosophical foundations underlying interpretive scholarship, followed by explanations of grounded theory, narrative theorizing, autoethnography, and rhetoric of health and medicine. None of these theoretical approaches or methods originated in health communication; however, they have been employed extensively in health contexts and by health communication scholars, many of whom have expanded, shaped, and/or strengthened them through health communication research.
Philosophical Foundations
Interpretive/critical scholars approach knowledge and the world in very different ways from post‐positivist theorists. Rather than engaging in a scientific search for universal explanations and causal relationships, interpretive/critical theorists instead seek in‐depth understandings of social life and lived experiences. For them, reality is subjective, multiple, and socially constructed, with participants creating, interpreting, and challenging shared meanings through communicative behavior. People build their own understandings from cultural norms, values, and beliefs, and these understandings then evolve and develop through interaction. Because we come to agreement about what is real intersubjectively, interpretive/critical scholarship does not measure the (in)accuracies of messages against an objective reality; instead, researchers embrace their own subjectivity and acknowledge that they are “interpreting others’ interpretations” (Zoller and Kline 2008, p. 93). In this double hermeneutic (Giddens 1984), interpretive/critical scholars seek to understand socially constructed realities and, in doing so, contribute to them, as well. While interpretive scholars strive for thick description of a particular context, critical scholars examine how communication in health contexts creates, reproduces, or challenges dominant power relations and ideologies (Zoller and Kline 2008).
Miller (2005) distinguished between theories that (i) examine general processes of meaning construction for consideration across situational boundaries and (ii) seek to understand local and emergent communication phenomena in specific situations and contexts (see also Dutta and Zoller 2008). Some of these theories are discussed elsewhere in this book (see, for example, Chapters 4, 5, 13, and 14). Regardless, interpretive/critical research is often viewed as “an ongoing process in which there is a continual intertwining – even a blurring – of data collection, analysis, and theorizing” (Miller 2005, p. 63). Just as meaning arises in interaction, concepts and issues of study emerge through the research process itself. Thus, like the social reality being theorized about, interpretive/critical theory is created inductively through observation and interaction. Rejecting the desirability or possibility of separating the knower from the known, researchers immerse themselves in local contexts, combine qualitative methods with their own perspectives and experiences, and seek inside understandings in research conducted jointly with participants. Accordingly, a single study often represents several theoretical commitments (e.g. grounded theory, ethnography, and narrative analysis) in what is usually a back‐and‐forth, rather than linear, process (Zoller and Kline 2008).
The following theoretical frameworks serve as popular, robust examples of the continual intertwining of data collection, analysis, and theorizing in interpretive/critical health communication research. As Zoller and Kline (2008) note, they overlap and may be employed alone as combined theory and method or used as theory, method, or both with other approaches. I offer exemplary scholarship throughout the chapter – with a focus on theory rather than method – to illustrate their growing and influential contributions to heath communication research.
Grounded Theory
Grounded theory – in various guises – is an especially popular and fruitful approach to research in health contexts and by health communication scholars. Originally developed in the 1960s by medical sociologists Barnie Glaser and Anselm Strauss studying the experiences of hospitalized dying patients, the first conceptualization of grounded theory has been recast by other scholars from different paradigms over the years. The basic steps have remained similar across these formulations; however, significant variability continues to exist in the understanding and application of grounded theory principles and practices within and beyond health communication.
Theory as Process
Research methods and theory development are intimately connected in the grounded theory approach with researchers placing particular emphasis on the comparative process. Indeed, Glaser and Strauss (1967) originally claimed that the “strategy of comparative analysis for generating theory puts a high emphasis on theory as process; that is, theory as an ever‐developing entity, not as a perfected product” (p. 32). As researchers gather data, they compare new data to existing data, sort those data into meaningful and related categories, and then expand or alter existing categories as needed for theoretical sampling. This process of constant comparison occurs at every step of the research process as scholars compare and refine data and emerging findings. Researchers also consult extant research throughout data gathering and analysis, using it to make sense of emic (participant) categories and drawing relationships to etic (researcher and theoretical) ideas that may be used as sensitizing concepts for further analysis. These comparisons occur within an evolving study design in which research questions are shifted, added, or deleted as initial findings prompt new forms of data or additional data from new participants. Ideally, the goal is to abstract categories into a single statement of theory; however, most health communication research stops short of new theory generation, offering useful typologies, extensions to current theory, or pragmatic implications for improving communication instead (Ellingson and Borofka 2014).
Glaser and Strauss (1967) introduced grounded theory as a way to develop theories from research rather than deduce testable hypotheses from existing theories. This traditional systematic formulation was steeped in the tenants of positivism pervading social sciences at the time and focused on discovering themes that emerged naturally and dispassionately from the data. They originally believed that (i) theory is embedded in and emerges from the data; (ii) researchers should remain objective during data collection and analysis (and even save the literature review until after analysis to ensure a blank slate); and (iii) even without one truth, research can capture a semblance of reality in the data and present that reality as a set of theoretical findings (Corbin 2009). Later, Strauss broke from Glaser and, with his colleague Juliet Corbin, recast grounded theory in a post‐positivist vein. Their evolved conceptualization (Strauss and Corbin, 1990) acknowledged the researcher’s more active role in generating themes while still emphasizing validity checks and systematic procedures for doing so.
More recently, medical sociologist Kathy Charmaz (2006) situated grounded theory within social constructionism, contending that researchers create both data and analysis from shared experiences and relationships with participants and other sources of data, including the researcher’s own perspectives, positions, and privileges. Unlike earlier conceptualizations of grounded theory, she claimed that theories do not emerge from the data but are instead constructed through the researcher’s past and present participation in the social world. Constructivist grounded theorists take a reflexive