http://hints.cancer.gov

briefs

NUMBER 14

Social Context Influences

Interpersonal Health

Communication 

Studies have shown that a person’s social context can affect

health communication access and usage, which, in turn, can

affect health behaviors and outcomes, such as smoking,

cancer screening, and disease.

A person’s social context is made up of macro-level

environmental factors such as racial and ethnic disparities,

socioeconomic inequalities, access to social networks and

social capital, social support, and mass media. Communication

inequalities are defined as differences among social groups in

the generation, manipulation, and distribution of information

at the population level, and access to and ability to take

advantage of information at the individual level.

Health communication does not take place in a vacuum,

devoid of external influence. In fact, interpersonal health

communication exchanges, including those between friends,

family members, patients, health care providers, and others,

are part of a complex social system that influences

information exchange and subsequent health knowledge,

behaviors, and outcomes. Forms of interpersonal

communication that may impact health include information

seeking, uncertainty management, and stress buffering.

Structural Influence Model (SIM)

of Communication Inequality

Source:Viswanath, Ramanadhan & Kontos, 2007

Social

Determinants

Socioeconomic

Position

• Education

• Income

• Employment

• Occupation

Place

• Neighborhood

• Urban versus Rural

Mediating/

Moderating

Conditions

Sociodemographics

• Age

• Gender

• Race/Ethnicity

Social Networks

• Social Capital

• Resources

Health

Communication

Outcomes

• Health Media Use

and Exposure

• Information Seeking

• Attention

• Information

Processing

Health

Outcomes

• Knowledge

• Health Beliefs

• Comprehension

• Capacity for Action

• Incidence

• Health Behaviors

• Prevention

• Screening

• Treatment

• Survivorship

• End-of-life Care

HINTS Data Highlight Role

of Social Context in Health

In a publication using HINTS 2003 and 2005 data, researchers

explored the role of social context in interpersonal

communication endeavors related to health, such as knowledge

of cancer prevention behaviors and satisfaction with

doctor–patient communication.

Knowledge of Cancer Prevention Behaviors

HINTS 2005 data show that belonging to two or more

community organizations is associated with increased

knowledge of a colon cancer screening test, as well as

increased knowledge of recommended levels of exercise and

fruit and vegetable intake to reduce cancer risk.These findings

support other research, which has shown that social ties are a

source of information exchange and that higher community

involvement is associated with a more accurate recall of health

promotion messages.

Satisfaction with Doctor–Patient

Communication

HINTS 2003 data indicate that Spanish-speaking Hispanics,

individuals with low education, and those living in the poorest

households are the least likely to report that their physician

explains information in an understandable manner, respects

their comments and questions, or involves them in decisions

about their medical care.These findings add support for other

research showing that those with the lowest levels of education

are the least likely to seek health-related information and the

most likely to have difficulty finding, understanding, and trusting

the quality of the information they receive.

Cont>

Quick Facts

• Aspects of social class influence patterns of health behavior

and health outcomes.

• Interpersonal relationships and social ties can act as a

buffer to reduce the impact of stress on personal health,

and can promote information sharing and preventive action.

• Both doctors and patients bring to their medical

discussions all of their personal characteristics and socialcontextual influences, including age, race/ethnicity, gender,

education, personality, social attitudes, values, and physical

and mental health.

• Patient-provider communication influences health outcomes

such as patients’ compliance with treatment, response to

treatment, length of time in the hospital, and quality of life.

In this HINTS Brief, we illustrate the crucial role of social context in health-related interpersonal communication.
HINTS Data Highlight Role of Social Context in Health (cont)

65

55

45

35

25

White

English-Speaking

Hispanic

Spanish-Speaking

Hispanic

Black

Less than

High SchoolHigh School

Some College

College

Graduate

< $25,000

$25,000 to

< $34,999

$35,000 to

< $49,999

$50,000 to

< $74,999

≥ $75,000

Race/Ethnicity Education Income

Percentage

Age-adjusted prevalence of respondents to the 2003 HINTS

survey who say that their physician always explains things so

they can understand.

Source:Ackerson,Viswanath 2009.

65

55

45

35

25

White

English-Speaking 

Hispanic

Spanish-Speaking 

Hispanic

Black

Less than 

High SchoolHigh School

Some College

College 

Graduate

< $25,000

$25,000 to 

< $34,999

$35,000 to 

< $49,999

$50,000 to 

< $74,999

≥ $75,000

Race/Ethnicity Education Income

Percentage

Age-adjusted prevalence of respondents to the 2003 HINTS

survey who say that their physician always respects what

they have to say.

Source:Ackerson,Viswanath 2009.

Satisfaction with Doctor–

Patient Communication

Differences by Race/Ethnicity, Education, and Income

A majority of Americans who have seen a healthcare provider in the

last year report that the doctor–patient communication experience is

always or usually satisfactory in terms of having issues explained in an

understandable manner, and feeling that their questions and comments

are respected by their provider. Satisfaction with doctor–patient

interactions can differ, however, by the social characteristics of patients.

For example, there is a fine gradation in patient satisfaction by levels of

education and income. Further, ethnicity and language play a role.

Race/Ethnicity

Spanish-speaking Hispanics are the least likely to report that their

physician always explains things in an understandable manner, and that

their physician respects what they have to say. In contrast, Blacks,

followed by Whites and English-speaking Hispanics, are the most likely

to be satisfied with the doctor–patient communication experience.

Education

HINTS respondents with higher levels of education are more likely to

say that their physician always explains things in an understandable

manner, and that their physician respects what they have to say. There

is a fine gradation by education level, whereby those patients with the

highest levels of education are more satisfied with their doctor–patient

communication experience than those with lower levels of education.

Income

Similar to differences in satisfaction with the doctor–patient

communication experience by education, there is an income gradient in

levels of patient satisfaction.Those HINTS respondents with the highest

levels of income are more satisfied with their doctor–patient

communication experience than those with lower incomes.

How Can This Inform Your Work?

A large body of evidence has documented profound social disparities in

health. Recent research has delineated how some macro-level factors

such as social class and social networks, and secular trends such as the

penetration of new communication technologies, contextualize

interpersonal interactions. As such, interpersonal interactions, either

between patients and providers or family members and friends, offer a

potential opening to bridge current disparities in health—if social

context is taken into account when developing interpersonal

communication strategies to reach underserved populations with 

health messages.

About HINTS

http://hints.cancer.gov

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS) in 2002 and 2003, surveying 6,369

Americans. Subsequent surveys followed in 2005 and 2008. HINTS was created to monitor changes in the rapidly evolving field of health

communication.The survey data can be used to understand how adults use different communication channels to obtain health information for

themselves and their loved ones, and to create more effective health communication strategies across populations.

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings.They introduce population-level estimates for specific questions

in the survey and summarize significant research findings that are a result of analyzing how certain demographic characteristics influence specific

outcomes. Many Briefs summarize research findings from recent peer-reviewed journal articles using HINTS data.

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER

• Visit http://cancer.gov

• Order NCI publications at https://cissecure.nci.nih.gov/ncipubs/

References Used in This HINTS Brief

Ackerson LK,Viswanath K.The social context of interpersonal communication and health. J Health Comm 2009; 14:1,5–17.

Ackerson LK,Viswanath K. Communication inequalities, social determinants, and intermittent smoking in the 2003 Health

Information National Trends Survey. Prev Chronic Dis 2009 Apr;6(2):A40.

Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci and Med 2003;

57(5):791–806.

Baile WF,Aaron J. Patient-physician communication in oncology: past, present, and future. Curr Opinion in Oncol 2005; 17(4):331–5.

Chang A. It’s no LOL: Few US doctors answer e-mails from patients. Boston Globe. [Internet]. 2008 Apr 22.Available from:

http://www.boston.com/news/education/higher/articles/2008/04/22/its_no_lol_few_us_doctors_answer_e_mails_from_patients.

Christakis NA, Fowler JH.The spread of obesity in a large social network over 32 years. N Engl J Med 2007; 357(4):370–9.

Fox S. Online health search 2006 [Internet].Washington: Pew Internet & American Life Project. 2006 Oct 29. 22 p.

Available from: http://www.pewinternet.org/~/media/Files/Reports/2006/PIP_Online_Health_2006.pdf.pdf.

Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health care.Washington, D.C.: Nat

Acad Press; 2003.

Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient/physician communication during

medical visits.Am J Pub Health 2004; 94(12):2084–90.

Street RL, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk,

November 2009 or is it just the doctor? Soc Sci and Med 2007; 65(3):586–98.