Health Communication Research Measures

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Introduction

Social science theorists have long envisioned how social scientists could organize so that the knowledge borne from our work might contribute to the improvement of both science and society (Campbell, 1971; Cronbach, 1982). Such aspiration requires that researchers understand what their forefathers did before them and with what results so that we may incrementally improve (Merton, 1965). In the health promotion field, progress in this direction has occurred, for example, through the production of consensus statements about standards of evidence (Flay et al., 2005).

Alas, the challenge of learning incrementally and cumulatively from others’ work is daunting. Not only are we limited in terms of how much each of us can know (Simon, 1955), but the expansion of scientific knowledge continues unabated. We publish our results in more journals than ever before and increasingly cite others’ work that appears in new and far flung journals (Acharya et al., 2014). If modern society can be thought of as an information processor, then it is at present an increasingly decentralized one.

Researchers and policy makers who attend to issues of research measurement have attempted to coalesce what we know. For certain measures, compendiums exist of their validity, reliability, long and short forms, and adaptations to suit particular applications or topics, along with examples for how to use them and interpret results (Kiresuk, Smith, & Cardillo, 1994). Online resources such as the Measurement Instrument Database for the Social Sciences do not as of yet cover much of relevance to the scholar of health communication. Other online resources such as the Grid-Enabled Measures portal sponsored by the U.S. National Cancer Institute list many measures (834 as of April 2015) but very few concern communication. ← 1 | 2 →

The present book is a modest effort to better share what is known about health communication research measures in a format that is accessible and will be used. Ours is not a comprehensive collection. Other measures could well be included. Nor is this an especially broad perspective since we focus on quantitative measures that are suited to survey research. Yet we submit that the measures included here are centrally important to the study of health communication whether one’s academic home is public health, health services research, or communication science. These measures do well by the standards of scale development (DeVellis, 2003) though for most of these topics what you have in your hands is a living literature that will continue to evolve. What the chapters herein represent are up-to-date reports about key social science constructs and ways of measuring them, whether your interest is in patient-provider dyadic communication, uncertainty management, self-efficacy, disclosure, social norms, social support, risk perception, health care team performance, message design and effects, health and numerical literacy, communication satisfaction, social influence and persuasion, stigma, health campaigns, reactance, or other topics. We thank the chapter authors for summarizing their own work and that of others in brief, informative, and illustrative accounts. They have done a terrific job.

Acharya, A., Verstak, A., Suzuki, H., Henderson, S., Iakhiaev, M., Lin, C., & Shetty, N. (2014). Rise of the rest: The growing impact of non-elite journals. Nonpublished paper. October 9. Google Inc.

Campbell, D. T. (1971). Methods for the experimenting society. Paper presented at the meeting of the American Psychological Association. Washington DC.

Cronbach, L.J. (1982). Designing evaluations of educational and social programs. San Francisco: Jossey-Bass.

DeVellis, R. F. (2003). Scale development: Theory and applications. Second edition. Thousand Oaks, CA: Sage.

Flay, B. R., Biglan, A., Boruch, R. F., Gonzalez Castro, F., Gottfredson, D., Kellam, S., Moscicki, E. K., Schinke, S., Valentine, J. C., & Ji, P. (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6, 151–175.

Kiresuk, T. J., Smith, A., & Cardillo, J. E. (1994). Goal attainment scaling: Applications, theory, and measurement. Hillsdale, NJ: Lawrence Erlbaum.

Merton, R. K. (1965). On the shoulders of giants. New York: Free Press.

Simon, H. A. (1955). A behavioral model of rational choice. Journal of Economics, 69, 99–118.

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1. Communication Competence

JOHN BANAS,
University of Oklahoma
& DANIEL R. BERNARD,
California State University, Fresno

In his book Blink, Gladwell (2005) informs readers that the best predictor of malpractice lawsuits is not, in fact, the degree to which a doctor erred in performing her or his duties but rather the quality of the doctor-patient interaction as perceived by the patient. This example is typical of Gladwell’s writing in several ways: it distills a great deal of research into a pithy and memorable factoid, it presents an empirical reality that is counterintuitive to readers, and it elevates a research area to new importance.

As counterintuitive as the above example might be for many, scholars of health communication have long recognized the importance of knowledge and skill regarding effective and appropriate communication, which taken together form the construct of communication competence. Indeed, health and interpersonal communication researchers have long championed the importance of communication competence for mental, physical, and emotional health outcomes. In their Handbook of Interpersonal Competence Research, Spitzberg and Cupach (1989) reviewed research that found people who lack communicative competence to be at increased risk for a variety of negative health outcomes, including: anxiety, depression, hypertension, loneliness, premature mortality, therapeutic outcomes, low self-esteem, and suicide.

Researchers have examined health and communication competence in a variety of ways. Scholars have looked at the predictors of competence, the outcomes of communication competence, as well as how competence is interdependent with other variables in health processes. Examples of research include how communication competence influences health outcomes (such as stress and burnout among health care workers), or how perceptions of ← 3 | 4 → competence affect health care encounters (such as how patient and physician competence shape primary care medical interviews).

Kreps’ (1988) Relational Health Communication Competence Model (RHCCM) demonstrates how communication competence can be a central construct in health communication research. The RHCCM is a theoretical framework that explicitly recognizes the centrality of communication competence for understanding interdependent communication roles in health care. It is through communication competence that people can accomplish instrumental tasks, such as convincing people to perform actions or providing corrective feedback after a poor performance, while also maintaining interpersonal relationships. The RHCCM predicts that high levels of communication competence lead to “therapeutic communication, social support, satisfaction, information exchange, and cooperation,” whereas poor communication competence leads to “pathological communication, lack of social support, dissatisfaction, information barriers, and lack of cooperation” (Kreps, 1988, p. 354).

The field of communication has a longstanding interest in competence, leading to several separate definitions and measures of the construct. Although the current page limit makes discussing all of the definitions impossible, the present chapter presents three scales, Wiemann’s (1977) communicative competence scale, Spitzberg’s (2007) Conversational Skill Rating Scale (CSRS), and Guerrero’s (1994) Communication Competence Scale. These three scales have been used in contemporary health communication studies, and they offer different approaches to the measurement of perceived communication competence.

Measuring Communication Competence

Attempting to consolidate the cognitive and behavioral perspectives (which produced overlapping and occasionally contradictory definitions) regarding communication competence into one multi-dimensional scale, Wiemann (1977) explained communicative competence as other-oriented communication that is also successful in accomplishing the goals of the speaker. Specifically he described it as “the ability of an interactant to choose among available communication behaviors in order that he (she) may accomplish his (her) own interpersonal goals during an encounter while maintaining the face and line of his (her) fellow interactants within the constraints of the situation” (p. 198). This description underscores the self-presentation theoretical underpinnings of Wiemann’s scale.

Communicative competence is conceptualized as a plurality of communication behaviors that include empathy, affiliation, behavioral flexibility, relaxation, and interaction management (Wiemann, 1977; Wiemann & ← 4 | 5 → Backlund, 1980). Interaction management was originally labeled “general competence” and describes the smooth synchronization of turn-taking among interactants. Empathy describes concern for others’ feelings and the ability to understand others. Affiliation describes general likeability and listening skill. Behavioral flexibility is a measure of rigidness and a person’s ability to adapt to changing situations. Relaxation is how comfortable a person is with communication and interacting with new people.

Wiemann (1977) tested 57 Likert-type items and eventually retained 36 (see Table 1). The scale can be used for both self-report or for evaluating others. As a whole, the reliabilities of the scale are quite good, with recent studies reporting Cronbach’s alphas ranging from .87 (Wright, Rosenberg, Egbert, Ploeger, Bernard, & King, 2013) to .97 (McKinley & Perino, 2013). Wright, Banas, Bessarabova, and Bernard (2010) reported reliabilities for each of the subscales, revealing adequate reliabilities: interaction management (Cronbach’s α = .70), affiliation (Cronbach’s α = .68), empathy (Cronbach’s α = .74), social relaxation (Cronbach’s α = .72), and behavioral flexibility (Cronbach’s α = .69).

Although Wiemann (1977) and Wiemann and Backlund (1980) explicated five clear dimensions about communication competence, the factor structure of the scale was problematic from the start. Indeed, Wiemann’s initial investigation only revealed four dimensions, and many of the items loaded on factors that were inconsistent with theoretical predictions. Despite these problems with fitting the theorized factor structure with the original data, a more recent study by Wright, Banas et al. (2010) found support for the theorized five-factor measurement model. It should be noted that Wright, Banas et al. only used 27 of the 36 items as 9 items were dropped to improve the reliability and fit of the structural equation model that was tested in their study (the 27 items are marked with an asterisk below). The factor loadings were quite good, ranging from .59 to .85.

Table 1. Communicative Competence Scale (CCS; Wiemann, 1977).

Interaction Management (Originally General Competence)

1. I find it easy to get along with others.*
2. I am “rewarding” to talk to.*
3. I can deal with others effectively.*
4. I do not mind meeting strangers.*
5. I generally say the right thing at the right time.*
6. I interrupt others too much. (R)
7. I am easy to talk to. ← 5 | 6 →
8. My conversation behavior is not “smooth.” (R)
9. I am an effective conversationalist.
10. I don’t follow the conversation very well. (R)
11. I pay attention to the conversation.

Affiliation

1. I am a good listener.*
2. My personal relations are cold and distant.* (R)
3. I like to be close and personal with people.*
4. I am supportive of others.*
5. I am a likeable person.*
6. People can go to me with their problems.*
7. I am interested in what others have to say.

Empathy

1. I ignore other people’s feelings.* (R)
2. I generally know how others feel.*
3. I let others know I understand them.*
4. I understand other people.*
5. I listen to what people say to me.*
6. I can easily put myself in another person’s shoes.*
7. I won’t argue with someone just to prove I am right.
8. I usually do not make unusual demands on my friends.

Social Relaxation

1. I am relaxed and comfortable when speaking.*
2. I am generally relaxed when conversing with a new acquaintance.*
3. I enjoy social gatherings where I can meet new people.*
4. I am not afraid to speak with people in authority.*
5. I like to use my voice and body expressively.*

Behavioral Flexibility

1. I can adapt to changing situations.*
2. I treat people as individuals.* ← 6 | 7 →
3. I generally know what type of behavior is appropriate in any given situation.*
4. I am flexible.*
5. I am sensitive to others’ needs of the moment.*

(Items with (R) are reverse coded.)

In a recent study of communication competence, social support, and depression of college students comparing Facebook and face-to-face support networks, Wright et al. (2013) used Wiemann’s (1977) CSS but treated it as a unidimensional scale instead of a multi-dimensional one labeled interpersonal competence. The reliability was good (α = .85).

In addition to Wiemann’s scale, Spitzberg (2007) developed the Conversational Skills Rating Scale (CSRS). Spitzberg and colleagues have been researching communication competence for a great deal of time. Although the CSRS has primarily been associated with pedagogical purposes, Spitzberg notes that it was designed for a wide range of research applications. One of the features that distinguish the scale is the focus on conversational skills: “CSRS was developed to provide a subjectively based, yet relatively specific, assessment of the skills component of conversational interaction” (2007, p. 4).

The CSRS has been widely studied, including research related to health communication. An early application of the scale was used to examine the connection between interpersonal competence and loneliness over time (Spitzberg & Hurt, 1987b). More recently, Spitzberg and Cupach (2002) outlined several psychological and physiological health contexts related to interpersonal competence. Specifically, Spitzberg and Cupach suggested that lacking interpersonal competence may exacerbate existing health conditions because these individuals are likely unable to marshal social resources for support.

The CSRS (Table 2) is comprised of 25 molecular items and 5 molar items. The molecular items measure specific conversational behaviors that comprise conversational competence and molar items measure general perceptions of competence. The CSRS is subdivided into four clusters: attentiveness (i.e., other-orientation), composure (i.e., calmness, confidence), expressiveness (e.g., facial and vocal), and coordination (i.e., controlling the flow of the conversation, or interaction management). The 25 molecular items are measured on a 5-point, Likert-type scale (1 = Inadequate, 2 = Fair 3 = Adequate, 4 = Good, 5 = Excellent). The 5 molar items are measured on a seven-point, ­semantic-differential scale. The order of the items have been re-sequenced since the scale was first ← 7 | 8 → posited (Spitzberg and Hurt, 1987a) so that behaviors considered immediately apparent are listed first and more subtle items are listed later (Spitzberg, 2007). The CSRS can be used to measure self, other, and third person assessment of competence. Although the factor structure has varied some across different contexts, Spitzberg (2007) argues that, “in terms of validity, it has generally produced validity coefficients in the expected direction and of reasonable magnitude” (p. 18). Internal consistency has consistently been over .80, and is usually in the high .80s to low .90s.

Table 2. Conversational Skills Rating Scale (CSRS; Spitzberg, 2007).

(CSRS Molecular items)