Elsevier

Social Science & Medicine

Volume 56, Issue 3, February 2003, Pages 449-464
Social Science & Medicine

Moving from information transfer to information exchange in health and health care

https://doi.org/10.1016/S0277-9536(02)00045-XGet rights and content

Abstract

Communication in most health and health care settings assumes that information provision is both necessary and sufficient to improve individual behavior and, subsequently, health. This paper examines and challenges commonly accepted practices of information transmission in health settings, demonstrating how such practices are insufficient because they are rooted in a one-way model of information transfer. Three case studies show how this model is pervasive in different health and health care milieus: patient/provider encounters, health promotion programs, and national health policymaking. Drawing on critical theoretical perspectives, the work shows the limits of current information transfer approaches by critiquing the dominant assumptions that underpin current practice. At the same time, it provides empirical examples of the usefulness of critical approaches to identify relations of power in health communication. The paper concludes by suggesting that researchers and practitioners move beyond traditional practices of information transfer (based on a one-way monologue) and toward a more useful and appropriate notion of information exchange (based on two-way dialogue).

Introduction

The past several decades have been marked by debate over the success of health education and promotion practices aimed at changing the health behaviors of individuals and groups. Health communication practices and frameworks are largely based on the assumption that changes in individual knowledge, attitudes, and beliefs will translate into changes in behavior. These efforts imply a unidirectional, uncomplicated, and linear flow from information creator to information user, and from the scientific/technical setting to the social contexts of individual lives. They likewise assume that merely providing information is sufficient to produce improved health outcomes in individuals and populations, and that individuals, regardless of social context, have the power and agency to implement change and to act on information as it is made available. While there has been increased questioning of the effectiveness of such an approach in health and health care, few workable alternatives have been proposed.

Using data from three field studies, this paper shows how such commonly accepted views of health communication are inadequate because they imply a one-way transfer of information based on a one-sided relationship between communicator and receiver. We outline the limits of such approaches by critiquing three key problems inherent in health information transfer: (1) a focus on the individual, (2) the privileging of expert over lay perspectives, and (3) the assumption that a one-way flow of information, from provider to recipient, is appropriate. By examining how information moves about in settings as diverse as patient/provider encounters, health promotion programs, and national health policymaking, our paper illustrates the pervasiveness of such existing health information practices across very different health contexts. We conclude by suggesting that researchers and practitioners must move beyond traditional practices of information transfer (based on a ‘monologue’) toward a more useful and appropriate concept of information exchange (based on a ‘dialogue’) as a first step in reorienting health communication practices currently in place.

Section snippets

Background

In recent years, critical theoretical approaches have increasingly been applied in health contexts (Lupton, 1998; Robertson, 1998; Bunton, Nettleton, & Burrows, 1995; Fox, 1994). While many researchers have moved forward on theoretical issues related to health, there has been a concurrent call for the application of critical concepts in empirical settings (Moss, 1997). In response, researchers have employed critical approaches to uncover meanings behind taken-for-granted health actions and

Information transfer in multiple contexts: three studies

The following three case studies were originally designed to understand decision-making processes of individuals and groups in various health contexts. None of the studies were meant to examine information flows per se; however, the key theme of one-way information transfer resonated throughout each study, calling for our collective re-examination of each project in light of this new understanding. Taken individually, the studies represent doctor–patient encounters, public health programming,

Discussion

The three case studies presented here represent diversity in health contexts, geographical areas, and how the various providers and users of information were positioned in the hierarchy of health communication. However, the cases show a remarkable similarity in their underlying problems. Each showed how health communication practices remain firmly rooted in the individualist ethic—information providers focused on individual determinants of health and assumed that individual behavior change is

Moving from information transfer to information exchange

Our analysis has shown the limitations of the dominant approach to information transfer, and how practices based on this approach are pervasive—firmly rooted in multiple levels of health practice, promotion, and policy. We propose that traditional health communication, based on the monologue of information transfer, can and should be replaced by a more appropriate concept of information exchange, based on two-way dialogue. Using the concept of ‘exchange’ as opposed to ‘transfer’ is a powerful

Acknowledgements

The cases discussed here were supported by the Social Sciences and Humanities Research Council (SSHRC Doctoral Fellowship #752-97-1065), the Eco-Research Program in Environmental Health at McMaster University, the McMaster Research Centre for the Promotion of Women's Health, the Virginia Tech Graduate Research Development Program, and the Quinnipiac University Faculty Research Grant-in-Aid Program. The authors extend a special thanks to the women of Fairmount County and the researchers and

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