Fünf Fragen an... Dale Brashers
I began by studying argumentation in graduate school. During that time, I became interested in an activist group known as the AIDS Coalition to Unleash Power (ACT UP). I started a research project to study ACT UP's social movement strategies aimed at changing health care practices and ending discrimination against people living with the human immunodeficiency virus (HIV) in the US and many other countries (including Germany). I was conducting an ethnographic study of the organization, and I became very interested in the relationship between social movement activism and individual self-advocacy. That study lead to an interest in how activist patients interact with their health care providers. Health communication, as an area of research, was developing very quickly at the time (the journal Health Communication began publishing during my first year of doctoral studies). Since that time, the membership of the Health Communication Division of the National Communication Association has grown 500%, there are now two journals devoted entirely to health communication, and there is a Handbook of Health Communication that summarizes a large body of research.
My main research interests have been patient decision making and uncertainty management. Patients primarily manage uncertainty by communicating with others (e.g., seeking information and/or social support). We have been testing interventions with people living with HIV or with cancer to determine if improvements in communication skills can lead to improvements in health. For example, in one study, we use a "peer support" model in which a person living with HIV was trained to provide information to people who are newly diagnosed with the illness. These lessons include (a) how to talk to your doctor, (b) how to disclose to your family, (c) how to effectively use the Internet for health information, (d) how to access local resources, and so on. The peer support provider acts as lay educator for the newly diagnosed person. We subsequently follow the participants for 9 months after the intervention and compare them to a group that received standard care at the clinic (which includes meetings with a psychologist, social worker, and support groups). We are trying to determine if people who receive our intervention learn better communication skills, and if that affects their psychological and physical health outcomes. I'm also conducting a large meta-analysis of the literature on HIV and social support with two of my colleagues here at the University of Illinois.
The ways in which people communicate to manage health and illness.
These two areas very clearly are connected -- people receive health information (and misinformation) from both interpersonal and mass media sources. When they make decisions about health behaviors or try to understand their illness, people integrate knowledge and experiences from both types of communication. There are advantages and tradeoffs between the two. Interpersonal health communication can be tailored to individual needs and wants; mass-mediated communication, however, can more efficiently disseminate information to much larger audiences. Individuals can provide social support, including emotional support, through interpersonal channels; yet mass-mediated sources can provide information in a private or confidential setting. I think it's vital that we understand that both are an important part of people's health experiences, and that we must study (and understand) both forms of communication and the relationship between the two.
There is clearly some level of integration of interpersonal and mass-mediated sources occurring that we need to begin to study -- for example, people can "attend" support groups on the Internet. This phenomenon makes social support available for people who have relatively rare diseases or for people who live in remote areas, because they can join the group from any location in which they have computer and Internet access. People can also join the group somewhat anonymously (i.e., without the use of their real names), which may be important if they are embarrassed or fear being stigmatized about their illness; but it's not clear whether people receive the same level of emotional support from people they never see in a face-to-face setting.
It's become clear that communication is a vital component of overall health care. People facing illness or trying to maintain good health confront many challenges: making decisions about treatments and other courses of action, managing uncertainty about their future or the trajectory of their illness, coping with large volumes of information containing potentially conflicting advice, and responding to changes in their identities and relationships as a consequence of illness. I'm most interested in understanding in what ways communicating with others influences these important components of the "life-or-death" decisions that people must make about their health. That is, I believe that communication really does matter to people's health, and that we can improve their lives by examining that relationship.
Associate Professor
Director of Graduate Studies
http://www.spcomm.uiuc.edu
http://www.uiuc.edu/~dbrasher