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

Introduction

This article is an examination and sustained critique of current approaches to communication and information provision within health settings. The authors argue that current practices are based in a one-way model of information transfer that is characterised by a focus on individual behaviour and responsibility, and which is rooted in power relations that are derived from an expert-oriented, unidirectional pattern of speech. They support their criticisms with evidence from a series of qualitative interviews with different populations being addressed, focusing on different subject areas.

According to the authors, there are three major problems with the current approach, including: a focus on the individual, the privileging of expert information over lay knowledge, and the assumption that a one-way flow of information is appropriate. They provide evidence of these problems by using three different case studies, each of which looks at a different level of health care: patient/provider encounters, health promotion programmes, and national health policymaking. They conclude by suggesting that there is need to re-arrange health communications at all levels into a two-way exchange, a dialogue that takes into account the social forces that shape knowledge and perceptions regarding health issues.

Key Points

The authors contend that health communication frameworks are rooted in assumptions that behaviour change will result from the successful introduction of changes in individual knowledge, attitudes, and beliefs. They argue that this approach is linear, and fails to grasp the complexities of behaviour change. The simple transfer of information is a feature of these one-sided relationships between communicator and receiver. Most damaging is that these assumptions are rigid and that many practitioners involved in the health field continue to believe that this is the appropriate strategy for health communication.

The authors' first critique focuses on the individualistic approach to public health, in which personal risks factors are at the forefront of messages and the belief is that a better-informed individual should be at the heart of health solutions. This approach tends to encourage 'blaming the victim', wherein poor health is attributed to the failure of the patient to pursue healthy lifestyle choices. The authors note that this approach fails to take into account the structural barriers that may obstruct an individual's ability to exercise choice. This approach also centres on the body as an object or machine that has a predetermined state of perfection from which stems a desire to constantly fix the body to fit into the norm. Case examples providing evidence of this illustrate doctors' assumption that poor women's health problems are related to poor choices; these physicians do not consider social and economic factors that may interfere with their ability to pursue a healthier lifestyle. For example, public health messages on sun safety disregard social norms that value bronzed skin tones and encourage tanning, suggesting that those who choose to tan are acting immorally and irresponsibly.

The second problem is related to the privileging of expert over lay perspectives with regard to health. The authors point to the social construction of facts and the use of expert/technical language that makes a large amount of health information inaccessible to the average person. The provider of information is the expert, while the receiver is the layperson who is expected to absorb the information in full. Examples include the dismissal of self-diagnosis by doctors and marginalisation of perspectives related to women's bodies and their health. Furthermore, receivers of public health messages often modify the information received to fit into their existing lifestyles and reduce the conflict between what they want to do and what they think they 'should' do. Sunbathers, for example, stress how they sought a balance between getting a tan and avoiding cancer. Expert language also invades the development of national health policymaking, as scientists present facts to policymakers who may question the usability and practicality of certain amounts of information.

The third problem relates to the transfer of information, a "monologue that implies that the provider can exercise power over the receiver." Receivers of information are assumed to be without relevant knowledge - merely empty vessels waiting to be filled. Doctors interviewed in the study admitted that they had mainly been trained to only collect immediately relevant information from patients before making diagnoses and giving prescriptions. This one-way transfer is also present in science-policy relationships wherein scientists see a policy-maker's hesitation (caused by political necessity) as foolish and misguided. Scientists do not respond to suggestions that the information they are providing is of limited use.

The authors conclude by pointing out that this approach, based in information transfer, ignores the social context of receivers and denies them agency and adaptive powers. Furthermore, these power relationships result in an active resistance to messages. They suggest that this approach is pervasive, and will require substantial changes and reforms throughout the entire health realm. They present several alternative approaches that recognise that inequality, social relations, and structural constraints may be the most influential factors in determining the health of groups of people and argue that a continued critical evaluation of health programmes is needed to reveal the deeply embedded power differentials located in the medical and public health field.