The first author of the present chapter, who is also the editor of the journal Health Communication, began soliciting submissions in 1987, and the first issue of the journal came out in January of 1989. The journal originally published four issues a year, but at the time of the writing of this chapter is publishing 14 lengthy issues a year. During 2019, the journal processed 776 submissions. Two hundred and nine issues of the journal have now been published. Health Communication was shortly followed by The Journal of Health Communication: International Perspectives, Patient Education and Counseling, Journal of Communication in Healthcare, Communication and Medicine, and several other outlets. The Journal of Health Communication began publishing in 1996. The first edition of the Handbook of Health Communication (chapters of which were translated into Korean) was published in 2003, and the second edition, The Routledge Handbook of Health Communication was published in 2011. The third edition of the handbook is in press at the time of the writing and will be published in 2021. The Sage Encyclopedia of Health Communication came out in 2014. All of these publications are evidence of the rapid growth of this area of study.
International interest in health communication has also increased notably over the last three decades. This is reflected in the subtitle of the Journal of Health Communication: International Perspectives, but is really reflected in the work published in all the health communication outlets. The journals all receive and publish submissions from a variety of countries. As continents, Europe, Oceania (Australia and New Zealand), and Asia are particularly active in health communication scholarship, as is North America. Within Europe, scholars in the Netherlands, Switzerland, and the UK are highly involved in health communication research. The Asian countries of Korea, China, Taiwan, and Singapore are also replete with active health communication researchers. In North America, health communication research is conducted in both the US and Canada.
The initial issue of Health Communication included many invited pieces by such important scholars as Barbara Korsch, Gary Kreps, David Smith, and Jon Nussbaum. These pieces attempted to set the agenda for the field – and they did, continuing to be cited during subsequent decades. Several articles in the 100th issue of the journal referred back to these articles and identified the progress that had been made over the last 100 issues. Much advancement was, indeed, apparent. Many of the directions suggested by these scholars have now been actualized.
Early submissions to and publications in Health Communication tended to be atheoretical and offered relatively simplistic views on communicative processes, although not as simplistic as those that are still apparent in the research conducted today by submitters without a background in the social sciences. The quality and focus of most of the work that is now submitted to the journal has changed substantially in the 30‐some years in which the journal has been publishing, and work is rarely accepted for publication without a guiding theoretical foundation.
As is the case with any area of study or phenomenon, varying definitions of health communication have been offered. The process of communication focuses on simultaneous, transactional message co‐creation of meaning through interaction. Health communication focuses on such processes as they relate to and impact health and health care delivery. The primary areas of study that are the foci of health communication work include provider–patient communication, health campaigns and other types of health promotion, health information in the media, eHealth and mHealth, health risk communication, communicative processes within health organizations, and everyday health communication (see Kreps 2020, for more detailed discussion of many of these areas). Everyday health communication focuses on communication about health and as it impacts health among family members and friends, as opposed to that communication which takes place with formal health care providers and through mediated channels of communication (Cline 2011; Head and Bute 2018).
What are Health and Health Care Delivery?
Although most of us probably have an ordinary conception of health as a state of being disease‐free, more precise conceptualizations of it have been offered. The World Health Organization defines health as “a state of complete physical, mental and social well‐being and not merely the absence of disease or infirmity” (The World Health Organization 2020, n.p.). Please note the focus on mental and social issues as well as physical health.
Building on this, the US National Institutes of Health (NIH) defines health care delivery as “The concept concerned with all aspects of providing and distributing health services to a patient population” (NIH 2020, n.p.). Although this definition appears to focus on formal health care delivery, health communication scholarship goes well beyond this traditional emphasis. The best health communication work is that which is grounded in theory.
What is Theory? What is Health Communication Theory?
The term “theory” is used rather loosely in ordinary conversation (“I have a theory about why my brother is so messed up”) but has a more precise meaning in scholarship. Once again, many different definitions are offered of theory. Put fairly simply, a theory is an attempt to explain a phenomenon or set of phenomena in a testable manner. It provides guidance for research and can serve as a lens or a map. It is a supposition that is based on past research. This makes it an educated guess. It should not be tautological or based on circular reasoning. The theory should be independent of the phenomenon to be explained. Theories make predictions which are then testable.
Theory plays a different role in qualitative/interpretive research than it does in positivist/quantitative research. Whereas good quantitative research is typically grounded in and tests theory, qualitative research is more likely to generate theory. The goal of interpretive work is to reform society and generate understanding more than to test predictions and hypotheses. Jill Yamasaki (Chapter 3 in this volume) articulates this difference in more detail and makes clearer the role of theory in interpretive work.
Babrow and Mattson (2011) offered a useful definition of health communication theory in the 2nd edition of the Routledge Handbook of Health Communication. They define health communication theory “as consciously elaborated, justified, and uncertain understanding developed for the purpose of influencing practice related to health and illness” (p. 19). This will be our working definition of health communication theory in this volume.
Why Do We Need Health Communication Theory?
As is the case with any area of scholarly study, health communication work that is guided by a theoretical framework is stronger than work that is atheoretical. Some work that falls within the general category of health communication is problem‐focused but not theoretically framed. Work that is based in theory is more systematic than is work that is problem‐oriented but atheoretical. Work that is grounded in theory is generalizable beyond the particular context or health condition that was the focus of the original study. Good theories are not content‐ or health‐problem‐specific. They apply to broader communicative processes, not just to a particular health problem or in a particular setting. Good theory is, most importantly, practical and applicable to social concerns.
If a study on diabetes management is grounded in a perspective such as the theory of reasoned action, findings from that study will provide insights that scholars may apply to other health problems and contexts. Although generalizability is partially based on sampling, design issues, and ecological validity concerns, it is also based on theoretical framing. Through the theoretical grounding of a study the broader base of knowledge is extended. This is the goal of scholarship. This is how a body of knowledge is built.
One of the more interesting examples of theory being extended into new areas of study is cybersecurity. If imitation is the sincerest form of flattery, theories of health and health communication should at least blush occasionally. Several theories discussed within this volume have gained theoretical traction in research on computer security.
Scholars studying how to motivate end users to engage in safe computer practices use the health belief model (Rosenstock 1974), the protection motivation theory