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Communication: concepts, practice and challenges †.

Disclaimer: Views expressed here are only those of the author and not those of World Health Organization (WHO).

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Davison Munodawafa, Communication: concepts, practice and challenges, Health Education Research , Volume 23, Issue 3, June 2008, Pages 369–370, https://doi.org/10.1093/her/cyn024

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Communication involves transmission of verbal and non-verbal messages. It consists of a sender, a receiver and channel of communication. In the process of transmitting messages, the clarity of the message may be interfered or distorted by what is often referred to as barriers.

Health communication seeks to increase knowledge gain. This is the minimum expectation and acceptable requirement to demonstrate that learning has taken place following an intervention using communication. Once knowledge gain is established, it is assumed that the individual will use the knowledge when the need arises or at an opportune time. There is evidence in several school-based health interventions demonstrating that young people who got exposed to specific information, e.g. against smoking or engaging in harmful practice, tended to posses decision or refusal skills.

Communication requires full understanding of behaviors associated with the sender and receiver and the possible barriers that are likely to exist. There are also challenges with establishing the source of what is to be communicated since this is a pre-requisite for program success. Often, communication (i.e. messages) originated from professionals or the government and ignore involving the intended beneficiaries. As a result, those communication activities seeking to impart knowledge and skills and/or behavior change often fail to realize the ultimate goal of behavior change because the beneficiaries find no relevancy in the activities.

Communication processes can be classified into two categories namely (i) mass media and (ii) Group media. Mass media focuses on reaching a wide audience while the group media reaches a specific group with clearly defined characteristics. Radio, television and Internet are examples of mass media channels while drama, storytelling, music and dance fall under group media.

Selecting a communication channel requires a complete understanding of the strengths, limitations and possible solutions related to each potential channel. Those entrusted with developing health education interventions that require communication need to be aware of the limitations in order to identify other complimentary activities to be able to achieve desired results. The context in which communication takes place is a major determinant to achieving the desired results. First, there should be a situational analysis conducted which includes also an audience analysis and this could be a rapid or comprehensive assessment. The findings of a situational analysis are then fed into decisions regarding the appropriate messages and channels to be applied. The situational analysis presents opportunities for implementing multiple communications where necessary.

In order to succeed in establishing effective health interventions using communication, the participation of intended beneficiaries throughout the programme phases is a pre-requisite. In other words, the intended beneficiaries should participate in setting objectives, selecting activities as well as monitoring of the effectiveness of the activities and participate in the planning and implementation. The beneficiaries should also be a part of establishing an environment that is conducive to delivering effective communication activities. In order to realize this goal in programme terms, policies and legislations that promote communication are required at national level. In many countries, mass media outlets such as television, radio, internet and newspapers are either a State monopoly or are under the ownership of private companies thereby making it hard for public service organizations to easily access them. The high fees levied for using these information outlets is quite prohibitive to most public health services organizations particularly those operating at community level.

Communication is not a panacea for all public health concerns and therefore expectations should be realistic. To guarantee that communication is being applied appropriately, the situational analysis findings should inform the next steps as discussed earlier. In this regard, it is essential to distinguish whether the problem or concern is not linked to lack of policy or legislation and not necessarily communication. Communication has been considered a failure in certain situations when, in fact, the problem required a policy or legislative remedies and not communication. The identification of predisposing, enabling and reinforcing factors to knowledge acquisition and behavior change should guide communication processes.

In some cases, public health problems encountered by the community are policy, economic or political related, and no amount of communication would influence change because there is need for a policy or political decision.

Communication approaches that provide opportunities for interpersonal interaction are likely to yield desired behavior change. These interpersonal group communications include drama, song, story telling and debate among others. The interpersonal communication can take into consideration social, cultural and behavioral factors that influence health outcomes unlike with mass media.

Communication conveys complex, sensitive and controversial information. It is critical that those responsible for facilitating information dissemination receive training in handling sensitive or controversial issues in order not to diminish the possible gains from communication.

Ultimately, credibility of the source of information is highly correlated with achievement of desired behavior outcomes. Those involved in communicating vital health information should ascertain that they are credible sources of information among the public. All content to be communicated should be thoroughly verified in order to avoid misinformation or sending conflict misinformation or sending conflict messages because once something is communicated, it can not be recalled ‘ uncommunicated’. In other words, a retraction of a statement or any apology does not mean that communication did not take place or what was communicated has been erased. It remains as a record despite the retraction. Guarantee freedom to communicate by not allowing any form of put-down or unconstructive criticism before, during and after communication.

Last but not least, listening is part of communication. Unfortunately, it is rarely taught formally and also neither is it acknowledged during development of communication interventions. In order for one to listen effectively, it is a must that one does not appear to be impatient or in a hurry. Both persons should allow each other to freely communicate without interference.

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In This Article Expand or collapse the "in this article" section Definitions and Concepts of Communication

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Definitions and Concepts of Communication by Robert T. Craig LAST REVIEWED: 15 April 2024 LAST MODIFIED: 21 June 2024 DOI: 10.1093/obo/9780199756841-0172

What is communication? The question is deceptively simple, not because there is no straightforward answer but because there are so many answers, many of which may seem perfectly straightforward in themselves. Communication is human interaction . . . the transfer of information . . . effect or influence . . . mutual understanding . . . community . . . culture . . . and so on. Any effort to reconcile these straightforward definitions quickly runs into contradictions and puzzles. Human interaction involves the transfer of information, but machines also exchange information, and so do animals and chemical molecules. Is human communication essentially different in some way? Effect or influence is not the same as mutual understanding and is sometimes quite the opposite. Is mutual understanding ever really possible? Is communication an intentional act or a process that goes on regardless of our intentions? If communication is culture, is it necessarily also community? Doesn’t the concept of communication vary, depending on how it is understood and practiced in each culture? Is it all relative, then, or are there good reasons to be critical of some cultural concepts? Obviously, communication can be defined in many different ways, and at least some of those differences seem potentially consequential. Whether we think of communication as essentially information transfer, or mutual understanding, or culture can make a difference, not only for how we understand the process intellectually but also for how we communicate in practice. Of course, we need not all agree on a single definition or choose a single definition for ourselves, but we can learn a lot by contemplating and debating the theoretical and practical implications of different concepts and theories of communication. This is what communication theorists do, and the academic subject of communication theory is a rich and varied resource for learning how to think about communication. The field of communication theory encompasses several distinct intellectual traditions, some thousands of years old, others very new. Some theories lend themselves to scientific empirical studies of communication, others to philosophical reflection or cultural criticism. This article is intended to represent the diversity of communication theory, hopefully in ways that are useful and inviting of further study rather than merely confusing. Included are introductory overview essays, textbooks, and other general sources such as encyclopedias, anthologies, and journals. Other sections cover historical studies on the idea of communication, ethnographic studies on culturally based concepts of communication, and theoretical models of the communication process. The section titled Conceptual Issues is divided into eleven subsections, each focusing on a key conceptual issue or controversy in communication theory.

For readers wanting to dip a toe in communication theory before diving in, the articles in this section provide overviews of the concept of communication while introducing important issues and conceptual approaches. Eadie and Goret 2013 surveys key concepts of communication that have influenced the academic field of communication studies. Cobley 2008 sketches the origins and historical development of the concept of communication. Steinfatt 2009 discusses the problem of defining communication and some characteristics of communication that affect the usefulness of definitions. Craig 1999 presents a conceptual model of communication theory as a field that integrates seven distinct intellectual traditions.

Cobley, Paul. 2008. Communication: Definitions and concepts. In International encyclopedia of communication . Edited by Wolfgang Donsbach. Oxford and Malden, MA: Blackwell.

Sketches the ancient origins of the concept of communication, the distinction between communication as process and product, the social uses of communication, and 20th-century concepts that contributed to communication theory. Also notes the importance of understanding miscommunication.

Craig, Robert T. 1999. Communication theory as a field. Communication Theory 9.2:119–161.

DOI: 10.1111/j.1468-2885.1999.tb00355.x

Conceptualizes communication theory as a field of “metadiscursive practice” in which diverse theoretical concepts of communication are engaged with each other and with ordinary (nontheoretical) concepts in ongoing debates about practical communication problems. Identifies seven interdisciplinary “traditions” of communication theory, each grounded in a distinct, practically oriented definition of communication.

Eadie, William F., and Robin Goret. 2013. Theories and models of communication: Foundations and heritage. In Theories and models of communication . Edited by Paul Cobley and Peter J. Schulz, 17–36. Handbooks of Communication Science, HOCS 1. Berlin and Boston: De Gruyter Mouton.

With a focus on concepts of communication within the academic field of communication studies, this chapter organizes conceptions of communication under five broad categories: shaper of public opinion; language use; information transmission; developer of relationships; and definer, interpreter, and critic of culture.

Steinfatt, Thomas M. 2009. Definitions of communication. In Encyclopedia of communication theory . Edited by Stephen W. Littlejohn and Karen A. Foss. Thousand Oaks, CA: SAGE.

Argues that the problem of defining communication is not to discover the correct meaning of the term but is rather to construct a definition that is useful for studying communication. Distinguishes several characteristics of communication that affect the usefulness of definitions. A critique of this piece is that it presupposes a transmission (speaker to listener) model of communication and fails to address alternative models that highlight constitutive, systemic, and other characteristics of communication (see under Conceptual Issues ).

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Communication Skills

Estefania Oliveros

a Division of Cardiology, Icahn School of Medicine Mount Sinai Hospital, New York, New York

Yevgeniy Brailovsky

b Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York

Kevin S. Shah

c Department of Internal Medicine, Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah

Graphical abstract

Communication is part of human behavior that allows societal survival. The hospital is a small structured society that relies on an organized system of communication to function. The patient remains at the center of this micro-society. In this paper, we divided communication skills into 3 parts: between the physician and the patient; between the physician and the family; and between health care providers ( Figure 1 ). The ultimate goal of all these connections is to guide the patient toward health, wellness, and comfort.

Communication skills in the hospital: tips and barriers.

Communication With the Patient

The goal of any communication with the patient is for the physician to learn the patient’s experience and facilitate improving their well-being. Communication is the foundation for obtaining medical history, as well as conveying a diagnosis and treatment plan. Good communication skills by physicians have been shown to improve patient satisfaction, adherence to therapies, and to reduce the likelihood of malpractice claims 1 , 2 , 3 , 4 . Establishing a trusting relationship with common goals is critical for mutually beneficial physician−patient interactions.

Patients are in a vulnerable state because of their illness and expectations to share intimate details with their physician. Their comfort stems from the perception that the physician is empathetic, competent, and genuinely interested in their well-being. Components of effective communication with the patient include meeting at eye level, maintaining eye contact, and demonstrating affirmative gestures. Speaking slowly and avoiding distractions goes a long way to capture the patient’s attention and build rapport with the patient in an otherwise busy and often chaotic clinical setting.

When meeting with a patient for the first time, it is important to assess what the patient already knows and determine what they would like to learn. Although some patients prefer general descriptions of their disease processes, others may want to delve into primary literature upon which recommendations are based. Beyond this, empathy is a critical component of communication. Patient’s symptoms and feelings should never be minimized. A physician should be honest in relaying information, but also remain hopeful for the patient and act in their best interest at all times. Furthermore, admitting when an error has occurred or when there is uncertainty about medical evidence is critical for building a trusting physician−patient relationship.

People communicate with gestures, body position, facial expression, and words. With experience, we look beyond oral communication and learn to recognize nonverbal cues to best understand how disease is affecting the patient’s life and goals. Train yourself to pick up cues about the patient from the objects that they keep around them and their interactions with their family members. Communication has 2 components, speaking as well as listening. Understand patient’s fears and hopes. Be mindful not to introduce your own bias in the conversation and not follow particular stereotypes.

Communication With Families and Social Support

Culture is learned and shared, and sometimes there is no conscious awareness of the matter. The first step when communicating with families is to understand the surroundings of the patient. Define the cultural values and their expectations. Our language, clothing, and mannerisms are the way we express and interact with one another. We work on a daily basis with the terms “illness,” “death,” “love,” and “suffering.” The conscious acceptance of critical illness as part of our daily experience makes our minds adjust to a different reality than that of the individual who is seeing their loved one have a major stroke, heart attack, or die from cardiogenic shock. The normalcy with which we deal with disease may play a role in how we cope as individuals, but this should not disconnect us from the family that we are trying to support. A social support group may be there when the patient becomes sick and can witness symptoms, they may be patient’s caretakers and may ultimately outlive the patient.

The social meaning of disease is interpreted by the personal collected experiences of the individual. Society understands that people are born, may have a disease, and ultimately die. But in many instances, people manage to survive certain maladies. In the current climate we have high expectations for how much should be done for those who are sick. We are at a point where technology has made leaps in terms of care to prolong life expectancy and survival of otherwise fatal disease processes.

We often need to communicate “heavy” news. Under stress, people develop a narrow perception of circumstances. There is often an expected degree of fear and anxiety. The goal is to provide comfort and information. Knowledge can relieve anxieties or instill more fear in individuals. The physician has to be a thermometer of the room and expectations. By simply asking: “what are the expectations?”, the physician may be able to fulfill the need of the patient. Families often undergo the disease process, and they may outlive the patient. Once we start the patient−physician relationship, we may also include their support system, which may be the cornerstone in the disease process of the individual and their recovery.

Communication Between Health Care Providers

In the era of ever-growing reliance on technology, electronic medical records (EMRs), and social media, face-to-face interactions are quickly disappearing. Physicians are having “conversations” via EMR notes that are auto-populated with rubbish and get copied forward with inaccurate information. EMRs were meant to take us away from unreadable handwritten notes in paper charts but have actually turned out to be a step backwards. Clinicians are frustrated by lack of communication among the hierarchical ladder, from interns, residents, fellows, and faculty from service to service. Patient care has a lack of team approach, and physician burnout is on the rise. As medicine becomes ever more complex and treatment requires varying expertise, the days of “cowboy medicine,” when a single physician could effectively care for a patient, are fleeting (5) . Medicine is an inherently human profession and experiences the human shortcomings of arrogance, insecurity, and misunderstanding (6) . Like everything else we do as clinicians, effective communication requires training, mentorship, and practice.

We divided this section into 3 components: communication between superior and subordinate; communication between subordinate and superior; and communication among team members. Each component requires different sets of skills, and, as we progress in our careers, we must master each one to improve ourselves and provide the best care we can for our patients. We all want to work with competent, motivated, and engaged clinicians. It is important to recognize that achieving that goal is the responsibility of everyone on the team.

Superior and subordinate

Supervising physicians are entrusted with creating an environment that ensures patient safety, fosters scientific inquiry, and contributes to trainee education. There is a fine line between effectively supervising a trainee and micromanaging. By providing trainees with autonomy, we can instill a sense of responsibility, and with that comes motivation to improve. Alternatively, when you take autonomy away, people can feel discouraged from participating in decision-making and not motivated to improve (7) . If you do not listen to people around you, you often surround yourself with people who do not have anything to say.

It is important to create an environment of psychological safety (8) . Trainees must be comfortable asking questions and proposing incomplete ideas that can be discussed as a group, without fear of being ridiculed or embarrassed. However, psychological safety does not mean a place of no retribution. People should be expected to be held accountable for successes and failures (8) . Supervisors must provide an environment that encourages inquiry that is free of judgement, in which trainees are encouraged to ask questions and feel comfortable reporting when something does not seem right, or going frankly wrong. The leader must set the expectations and goals upfront, reassess the progress, and give prompt feedback and redirection. This approach relieves anxiety, promotes a good line of communication, and improves the care we can provide for our patients.

Subordinate and superior

We all perform poorly from time to time. Whether it is not doing well on a test, taking an incomplete history from a patient, forgetting to include something on a differential, or getting a paper rejected from a journal. It is critical to know how to respond to criticism and constantly look for ways to improve yourself.

Being on the receiving side of criticism can feel overwhelming, paralyzing, and frankly embarrassing. When we hear criticism, our bodies automatically go into a self-defense mode (9) . It helps to remember that when someone is giving you feedback, they have already evaluated you and the only thing they are judging now is whether you are open or defensive (9) . You have to learn how to love criticism and be prepared to receive feedback. If criticism is sprung on you unexpectedly, your body may retreat to a self-defense mode and not only will it not benefit you, you are more likely to become resentful and avoid the person giving you feedback in the future. Our goal as clinicians is to constantly improve, so we have to change our frame of mind and expect and welcome feedback.

How to work effectively as a group

The complexity of medicine has increased over time. We recognize that whether we are treating a patient with valvular heart disease, myocardial infarction, pulmonary embolism, or cardiogenic shock, we often require expertise from several specialists. We have moved away from individual-based model to team-based models: heart team, valve team, pulmonary embolism response team, and shock team, just to name a few. However, simply bringing multiple people into a group does not automatically translate into improved outcomes. There are several drawbacks of the team approach that must be explicitly recognized. With larger groups, comes the possibility that individuals may silence themselves for the fear of sounding incorrect, some people silence others by dominating the conversation, and finally, everyone supports the boss’s favorite idea (9) . We can combat these shortcomings by encouraging participation from all members of the group, especially the quiet ones. We must also foster an environment where incomplete ideas are welcomed for discussion. Communication with other health care providers, including nursing staff, social workers, physical and occupational therapists, as well as pharmacists, will work toward effective patient care and minimize mistakes.

Humility is an essential component of any effective team. We must recognize our own shortcomings, appreciate other people’s strength, and give credit where it is due, and put success of the team above personal gain.

Overall, the physician’s role is to become an effective communicator among colleagues, patients, and family members to guide the patient toward the path of health, wellness, and comfort.

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.