Research Narrative
I am fundamentally interested in applied communication. This is a critical time to be studying aspects of applied communication, including health communication, as there are so many new governing agencies, changing institutional restrictions and cultural clashes that occur during this privileged exchange. Ultimately, I study the degree to which outside influences (organizational structure, government mandates, managed care rules, and cultural variability) affect the privileged interaction between power differentated relationships. In this statement, I will first provide a summary of how my research agenda has evolved, then forecast its future direction.
I first became interested about theorizing power-differentiated relationships and their interaction upon publishing a theoretical article in the Journal of Health Psychology. This article, co-authored with Dan O'Hair and Joyce Allman, provides a foundation for studying the cognitive and affective elements of health interaction. It also offered a radical change to Expectancy Theory, a relatively murky theory in our discipline, hypothesized to predict communicative behaviors. Using social and cognitive psychology, which is my educational background, we develop a model to describe how individual expectations govern the interaction between physician and patient. This provided a coherent theory for predicting differences between groups, based on varying expectations. An early version of the manuscript was presented at the Eastern Communication Association (ECA) convention, where it received the “Top paper in Health Communication” award.
Shortly thereafter, using tenants of the model, I integrated expectancy theory into an article published with a faculty colleague here at Fresno State. This primary research (quantitative data) article “Using gender differences and patient satisfaction as predictors to patient attitudes” investigated the varying degree of satisfaction a patient has with a physician, based on certain psychological attitudes. An earlier version of this paper was presented to the Western States Communication Association (WSCA) convention in Vancouver.
At the same time, I used a similar satisfaction variable in an article published in Communication Research Reports, on the effects of health delivery systems on patient satisfaction and compliance. I was quite encouraged that a draft of this paper, presented to the WSCA conference in Denver, received the “Top Paper in Organizational Communication” award. This paper was a significant for me. As it not only continued with the psychological grounding of provider-patient interaction (the paper included other psychological pursuits, such as health-self-efficacy), but it also began to account for agency influence on dyadic interaction. Specifically, this paper used several data analysis techniques to quantify the degree to which health systems (HMO’s, PPO’s, Medicare, etc.) change the way patients interact with caregivers. Several of these ideas were subsequently addressed with a quantitative analysis paper on agency influence presented to the National Communication Association (NCA) in New York.
Using the concept of outside agencies affecting interaction, I teamed with two colleagues, Dan O'Hair and Jerry Ledlow, to publish “Predictors of communication quality: The patient, provider, and nurse call center triad.” I am very proud of this publication for a number of reasons. First, it utilizes a rather sophisticated technique to both model and quantify agency encroachment (the nurse call center) on provider-patient interaction. Second it is included in the highly competitive (acceptance rate roughly 10%) flagship journal for my area of research, Health Communication. Third, it provided a watershed of direction for future research including the delivery of care as a variable.
One such area of increasing interest is cancer care delivery and communication. Few articles in my discipline have approached the subject. However, things are changing. A health communication researcher, and colleague, was placed in the information branch of the National Cancer Institute. Soon afterwards, we found opportunities for our discipline to contribute to the critical national dialogue of this topic. A graduate student in our department wished to investigate the impact of childhood cancer on the nuclear family. A quick survey of our discipline revealed very little research in the area but many disjointed articles in numerous other disciplines, mostly medicine, nursing and public policy. I thought this would be an excellent addition to the Handbook in Cancer Care and Communication, being published by Hampton Press. Our book chapter conceptualizes the relational changes that occur during the varying stages of childhood cancer, from diagnosis through treatment and into palliative care.
I have a second co-authored chapter in the Handbook of Cancer Care and Communication which addresses environmental influences in cancer care treatment. This article spotlights several areas of investigation for communication scholars into the delivery of care. While the chapter addresses many ways cancer care treatment is affected by organizational agency, of particular interest for me is the conceptualization of organizational cultural competence of the system itself.
I was so interested in this idea of a systems perspective of organizational cultural competence that I contacted a colleague, Jerry Thurston, and co-authored an article specifically addressing this idea. The chapter, “Cultural competence and organizational barriers to the delivery of healthcare” explores five dimensions of care, each of which is prone to cultural discrimination. This article moves the idea of agency from the tangible (nurse call center) into the abstract (an organization’s understanding of a patient’s culture) to assess the same outcome, delivery of care. The book in which this chapter appears is my newest book, co-edited with a colleague from the University of Oklahoma, entitled Applications in Health Communication, which published by Hampton Press.
In conclusion, I would like to emphasize a couple of things. It should be clear that I quite enjoy collaborative research. Much, but certainly not all, of the research described above is coauthored, with CSUF colleagues, students or faculty colleagues at other institutions; I recognize, appreciate and value collaborative research, especially with students. Also, I have only touched on those publications which are part of the fabric of my thread of research in health communication.