Cegala and Brashers lead Ohio State toward health communication with two NIH-funded projects

Many NCA members will remember that the Communication and Journalism programs at The Ohio State University underwent a forced and not entirely happy marriage recently. Both programs were located in a College of Social and Behavioral Science, and the dean of that college had questioned their fit within the emphasis of the college.

Any number of faculty would have taken such an attack as a death knell, and a forced merger such as the one at Ohio State would have sent many programs into a tailspin. Faculty members Donald Cegala, professor, and Dale Brashers, assistant professor, however, decided to use the merger as an opportunity to advance their research interests in health communication. And, both Cegala and Brashers recently received National Institutes of Health grants that helped to further their cause.

Cegala’s project is smaller but promises the more immediate payoff. He received a $73,000 grant from the Agency for Health Care Policy and Research for a one-year study of how training in communication skills can help patients and doctors to meet their information needs and goals when they interact and can thus lead to a higher level of patient compliance with treatment. Cegala’s training package includes materials on information seeking, information giving, and information verifying.

Cegala and his research associates anticipate dividing his subject pool into three groups: a trained group that receives the entire program; an "attention" control group, which receives a document summarizing the main points of the training program; and an untrained control group. To insure that physicians do not change their behavior when interacting with patients who are in the study, the physicians will not be told which patients are study participants. They will also agree to be videotaped randomly interviewing patients, but they will not be aware which interviews are being videotaped.

Cegala intends to collect his data over time to see how the effects of the training persist. He’ll measure the types of questions asked and how they were answered, the patients’ and doctors’ assessments of their communication competence in the interview, patient recall of the information provided, the degree to which doctors and patients felt that patient needs were met in the interview, the degree to which the patient adhered to the doctor’s prescriptions, and the length of various types of consultations. Assuming that Cegala finds differences in how his subject groups react, he will begin to look at how his training package can best be delivered to the patients and to the physicians.

Brashers’ project is a FIRST grant, designed to allow recent Ph.D.s to begin a five-year program of research on health topics. Brashers’ FIRST grant was given through the National Institute for Nursing Research and comes to a total of $510,000 over the five-year period of the grant. Because the research must be projected to last over the term of the grant, Brashers’ research will be conducted in two phases.

In the first phase, Brashers and associates Judy Neidig and Stephen Haas will conduct focus groups with persons who have been diagnosed as being either HIV-positive, or as having contracted full-blown AIDS. The focus groups will discuss how uncertainty affects how they manage their illness. Specifically, the discussion will focus on the sources of uncertainty these patients feel in conjunction with their illness, their sources of information, how they appraise their uncertainty, the barriers they encounter to information seeking, and strategies they use to manage their uncertainty. The study will also assess whether the stage of the disease affects how uncertainty is perceived or how information is sought.

From this information Brashers and his associates will design a program to help HIV and AIDS patients to manage their uncertainty and to become better information seekers. The second phase of the research will study whether implementation of such a program will have the desired effects.

In this phase of the research, Brashers and associates will collect data over time. They’ll randomly divide subjects into treatment and control groups, administer an eight-session training program that focuses on HIV as an illness, treatments for HIV, the health care system, how HIV affects daily living, communication skills for dealing with health providers (using Cegala and colleagues’ work for this portion of the intervention), communication skills for dealing with friends and family, and finding additional information through library and Internet research. They’ll then take a series of measures focusing on uncertainty management, information seeking, and adaptation. These measures will be repeated several times. After six months, the control group will be given the same treatment and their responses will be compared to the performance of the treatment group.

Brashers got started on this line of research while a doctoral student at the University of Arizona, and he was able to develop a theory to underlie the work he is now doing while there, as well as to gain experience while working on his mentors’ health communication projects. Cegala holds a joint appointment in the Department of Family Medicine and has been working on developing the communication skills of doctors and patients for some time.

Asked how this work would benefit the newly-merged Ohio State department, Cegala commented that it brings in an area of study that is a natural for collaboration between communication and journalism scholars in the department. Brashers commented that the ability to fund graduate research assistants and to purchase equipment will be of significant assistance to the department. Brashers also commented that Stephen Haas, his graduate research assistant had just been approved for separate funding to complete his dissertation research, and department faculty are showing interest in beginning an applied master’s program focusing on health communication.

It has been said that time heals all wounds, but that may not be entirely true in academia. What can be said is that increased funding that flows to a department from an active grant programs can generate renewed enthusiasm for cooperation in the academic enterprise.