A PARADIGM OF INTRAPERSONAL HEALTH COMMUNICATION MODELS AND THEORIES AND THEORIES

Various health communication models and theories relating to persuasive communication, behaviour change communication and cognition are explained in section 3.3 below. For the purposes of this study, different health communication models/theories (part 1 and part 2 of the literature review chapters) are explained in order to contextualise the conceptual contribution for diabetic care in South Africa (which will be discussed in chapter 5). In chapter 2, the context of the South African public health-care system was detailed explaining how public health-care in South Africa is more embedded in the biomedical framework. The political structure of South Africa has greatly impacted on public health-care service delivery (as

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explained in chapter 2). In the next section, a literature review is conducted of different health communication models and theories as they relate to communication dynamics for the purposes of this study.

Communication dynamics in relation to this study refers to the different dynamics that occur in the medical system which may affect health-care. For example, communication dynamics between the HCP and patient as well as among HCPs, affect patient dynamics in health-care service delivery. The health system is made up of different dynamics, which include health-care dynamics, patient dynamics, health-care provider dynamics, systematic dynamics (different systems that control the medical arena) and group dynamics. The fields of sociology and health-care posit different health-care dynamics to understand social phenomena (Clarke 2001:7).

3.2.1 Differences between a model and a theory

Different health communication models and theories are reviewed in section 3.3 and chapter 4, however, clarification is provided with regard to the differences between a theory and a model in table 3.1 below.

The differences between a theory and a model, as expounded by Sharma and Romas (2012:41), are explained below.

Table 3.1: Summary of the differences between a model and a theory

Theory Model

Explains or predicts phenomena Simplified, miniaturized applications of concepts for addressing problems

Micro-level guidance Macro-level guidance

Empirically tested Not enough empirical evidence Based on previous literature Creative

Usually parsimonious Usually tries to cover a lot

Does not contain any model May embody one or more theories (Source: Sharma & Romas 2012:41)

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For the purposes of this study, health communication models and theories relating to persuasive, cognitive and behaviour change communication are reviewed to contextualise communication dynamics for this study.

3.2.2 Approaches to health communication

According to Edwards (2014:56–57), the following approaches to health communication/health promotion exist:

• The medical approach. This refers to the biomedical approach which is discussed in chapter 2. HCPs tend to focus on diagnosis and treatment only. As explained in chapter 2, the medical approach is scientific in nature and lacks psychosocial elements which are important for health-care and treatment purposes.

• The behavioural approach. This approach tends to focus on persuading people (people refer to patients in the context of this study) towards altering their behaviour in order to maintain their health. Behaviour in this context refers to lifestyle changes. For the purposes of this study Type 2 diabetes is considered to be more of a lifestyle illness (compared to Type 1 diabetes, since Type 1 diabetes cannot be prevented and is more harmful in its symptoms and occurs in people who are usually underweight or normal weight) –hence the behavioural approach is key in selection of appropriate health communication models.

• The educational approach. This approach assumes that providing information (in the form of education) on aspects of health-care to people is enough to assist them to maintain their health effectively. According to this approach, people are educated on lifestyle health promotion maintenance.

• The social change approach. The social approach deals with factors/issues relating to the broader socioeconomic and environmental perspectives. The social aspects of health-care will be expanded on in chapter 4.

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3.2.3 A brief summary of planning models for health education and health promotion models

Health communication in relation to communication dynamics between HCP-patient relationships and HCP-HCP relationships was the focus of this study. A subsection of health communication also exists which relates to health promotion that includes the planning of communication campaigns, health education strategies and interventions which are conducted in order to educate the masses on various health issues. In table 3.2 provides a brief summary of these models as they emerged in chronological order.

Table 3.2: Summary of planning models for health promotion and health education programmes

Health education/health promotion model Summary of the model Model for Health Education Planning (Ross &

Mico 1960)

This model includes six phases, namely:

programme initiation, needs assessment, goal setting, planning/programming, implementation and evaluation. This model consists of three dimensions (subject matter steps, techniques and interactions) towards planning,

implementing and evaluating a health programme. It is not used much in current practice.

Precede-Proceed Model (1980) This model comprises of eight phases that assist with planning any health programme. These phases include Social assessment,

epidemiology assessment, educational and ecological assessment, administrative and policy assessment and intervention alignment,

implementation, process evaluation, impact evaluation and outcome evaluation.

Planned Approach to Community Health (PATCH) (Centres for Disease Control and Prevention 1980)

This model deals with the planning for community health programmes.

The multilevel approach to community health model (Simons-Morton, Greene & Gottlieb 1980)

Focus is on community health where the communicator is placed at the centre of

planning. No extensive local needs assessment is required.

Assessment Protocol for Excellence in Public Health Model (National Association of Country and City Health Officials 1980)

This model helps in building organisational capacity and was intended to be used by local health departments. It promotes leadership roles

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Health education/health promotion model Summary of the model for health departments.

CDCynergy (Centres for Disease Control and Prevention 1990/1997)

This refers to a multimedia CD program (comprising six phases: phase 1: describe problem, phase 2: analyse problem, phase 3:

plan intervention, phase 4: develop intervention, phase 5: plan evaluation, and phase 6:

implement plan) developed for planning health communication programmes.

Intervention mapping (Bartholomew &

Colleagues 1990, adapted from Bartholomew and colleagues 2006)

Deals with individual behaviours in an

environmental context (context includes: living context, family context, social networks, organisations, communities and societies) PEN-3 Model (Airhibenbuwa 1993, 1995) This model comprises three dimensions (cultural

identity, relationships and expectations and cultural empowerment) which are interrelated and interdependent. The word “PEN” is abbreviated per dimension discussed above.

This model emerged later and caters for culture and relationships in promoting health-care from a health promotion and purely health campaign context for individuals, extended families or communities.

This model was initially created for health campaigns in African countries and the abbreviation “PEN” was later expanded within the dimension of relationships and expectations borrowing from the HBM, TRA and the Precede-Proceed Model. Many health communication models and theories emerged from existing models and theories (or by borrowing tenets or constructs from existing models and theories) – one such example is the PEN 3 Model.

Generalised Model (GM) Comprises of five steps (assessing needs, setting goals and objectives, developing interventions, implementing interventions and evaluating results) towards planning a health promotion programme for specific health-related issues.

(Source: adapted from Sharma & Romas 2012:43-60; Cottrell, Girvan, Mckenzie & Seabert 2015:121 -125)

Table 3.2 shows the different health promotion models that exist in the literature from historically and at present. A critique of most of the models explained above is that they are more suited towards the planning, implementation and assessing of health promotion campaigns as opposed to emphasising communication dynamics in

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relation to HCP-patient relationships or HCP-HCP teamwork dynamics, which occur in a health communication setting for diagnostic and treatment adherence purposes.

In the section below provides a review of seminal intrapersonal health communication and persuasive behaviour change communication models.