Patient Education and Counseling 82 (2011) 281–284

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Patient Education and Counseling

journal homepage: www.elsevier.com/locate/pateducou

Editorial

Methodological pluralism in health communication research

1. Introduction These diverse qualitative, quantitative and integrative

approaches are applied and reflected upon in each article in this
In the last 30 years, the amount and quality of research in the special issue as well as in the research design, hypotheses, data
field of health communication has increased extensively [1]. One collection tools, data analysis strategies, and interpretation of the
reason for this significant growth is the accumulating evidence research findings of the studies presented.
that communication is a crucial and outcome-relevant element Based on the content of this special issue and PEC’s tradition
within clinical encounters, health promotion programs, and public of receptivity to new and innovative methods, we suggest that
health policies [2]. Patient Education and Counseling (PEC) has been the best health communication research demonstrates a
one of the leading journals contributing to the emerging field of productive balance of diverse methodological paradigms—that
health communication research and its evolution. A key factor in is, a balance of qualitative and quantitative research, a balanced
this development has been the support provided by PEC through its integration of both qualitative and quantitative paradigms and a
publication of studies employing a wide range of research balance of different scientific disciplines conducting and
methodologies from a multidisciplinary assortment of investiga- publishing health communication research together. This
tors. We believe that this methodological pluralism at PEC has balanced ‘‘methodological pluralism’’ is necessary (see Fig. 1,
contributed to a greater understanding about the complex box 2) to effectively capture the complexities of health care
influences of communication on health care and health promotion. processes (see Fig. 1, box 1) and to gather advanced insights into
Our primary goals for this special issue were to illustrate this health communication phenomena (see Fig. 1, box 3), which in
methodological diversity and to examine important methodologi- turn facilitate the dissemination and implementation of
cal developments, innovations, and applications necessary for research results and foster improvement of health care (see
expanding the evidence in health communication research. Fig. 1, box 4). In other words, having a bigger toolbox means
Moreover, we hope that this special issue on methodology greater opportunities to find suitable instruments for effectively
complements and builds upon a previous special issue of PEC investigating health communication issues. This is imperative
regarding theories in health communication research [3]. because in every study the research problem being investigated
should define the methods used; the methods should not define
the problem [5]. The following citation from Bowling [6, p. 3]
2. The need for methodological pluralism in health underlines the advantages of a ‘‘methodological pluralism’’ for
communication health communication research:

Studies in health communication have always been empirically ‘‘All methods have their problems and limitations, and the
driven (Greek: empeiria; from experience) because the individual overreliance on any one method, at the expense of using
experiences of patients and their providers are indispensable to multiple research methods, to investigate the phenomenon of
understanding communication in health care. To appropriately interest can lead to ‘a very limited toolbox,’ sometimes with
study these experiences, scientific methods (Greek: méthodos), ‘‘a questionable validity, and consequently to a limited under-
type of planned investigation or scientific procedure based on a system standing of the phenomena of interest.’’
of rules for gathering scientific knowledge or practical results’’ (Greek
translation, [4, p. 497–498]), have been adopted as crucial research In that light, the randomized controlled trial (RCT) is one example
tools for health communication inquiry. Accordingly, methodology for the overreliance on one method, because it can lead to a limited
is the ‘‘science and/or theory of applied methods’’. This special issue understanding of phenomena, particularly in health communication
on methodology in health communication research is character- research. The RCT has initially been developed as a method to reduce
ized by a context effects (e.g., of the provider) to investigate the specific effect
of a treatment (e.g., a pill). But today we know a lot about the positive
(1) broad diversity of advanced qualitative and quantitative influences of the ‘‘specific effect’’ of the provider on patients’ health
methods and developments, [7]. As a result, we need to adapt the design of the classical RCT to this
(2) integration of both qualitative and quantitative research knowledge. Furthermore, it is also reasonable to use multiple
methods and research methods in a RCT by integrating e.g., qualitative methods to
(3) multidisciplinary and interdisciplinary approaches to research gain an in-depth understanding of the ‘‘specific effect’’ of the
methodology. provider [7].

0738-3991/$ – see front matter ß 2011 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.pec.2011.01.018
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282 Editorial / Patient Education and Counseling 82 (2011) 281–284

11 2
Health care reality is becoming Transformation of complexity into
more complex, e.g.: a pluralistic methodological
approach in health
Multifaceted nature of health care communication research:
and health promotion
Diversity of qualitative and
Patient and provider experiences
quantitative methods
Clinical practice
Integration of qualitative and
Multidisciplinary and
quantitative
tit ti research h methods
th d
interdisciplinary provision of
Multidisciplinary and
healthcare
interdisciplinary approaches to
Societal environment
research methodology
Health care system and policy

44 3
Facilitates dissemination and Adequate application of a
implementation
p of research results p
pluralistic gy leads to
methodology
and fosters improvements in advanced research results in
health care: health communication:

Patient care Deeper, broader

Patient-provider communication Multidimensional
Health promotion Patient- and provider-centered
Patient provider centered
Provider education Realistic
Collaborative provision of health Practical
care Context-related
Health policy Comprehensive
Unexpected results

Fig. 1. Methodological pluralism as a central ‘‘setscrew’’ for quality, evidence and practical relevance in health communication research.

Our illustration implies that the kind of methodology received from several contributors illustrates the need for
(see Fig. 1, box 2) has a direct influence on the kind of research scholarly outlets for examining relevant methodological issues.
results, i.e., a ‘‘methodological pluralism’’ will probably lead to
deeper, broader, etc. research results (Fig. 1, box 3). The quality of 4. Special issue content
these results and the evidence they provide depend, of course, on
how methods are applied. A careful and rigorous application of The content of this special issue focuses on a balanced
methods, data analysis, interpretation of findings, and consider- ‘‘methodological pluralism’’ in health communication research
ation of ethical issues is required [6,8] to put research results in as described in Section 2. The 30 articles included in this issue
the ‘‘right light’’. Finally, our illustration also shows that discuss different methodological topics which can best be
advanced research results (Fig. 1, box 3) produced by a characterized by diversity, innovation, reflection, integration and
reasonable ‘‘methodological pluralism’’ (Fig. 1, box 2) are able practice.
to facilitate the dissemination and implementation of research
results as well as improvements in health care (Fig. 1, box 4), 4.1. Diversity in health communication research methods
because these results (Fig. 1, box 3) are closer to health care
reality (Fig. 1, box 1). The issue starts with an in-depth reflection on methodological
Summarizing these methodological reflections, we assume that diversity in health communication research [10] and on innovative
the judicious use of methodological pluralism can maximize applications of these methods [11].
research credibility [9] and increase the validity of health
communication inquiry [6]. 4.2. Advanced statistical and intervention methods

3. Selection of papers In this section, topics range from the use of advanced statistical
methods, such as Rasch analysis [12] and logfile analysis [13], to
Invitations to submit papers were sent to all EACH and AACH intervention methods including immersive virtual environments
members in March 2010. Abstracts were submitted by 61 potential [14] and unannounced standardized patient encounters [15].
authors, 28 from the US and 33 from Europe and Israel. Of these, 37
were invited to submit a manuscript, two of which did not. Thirty 4.3. Reflections on the strengths and weaknesses of existing methods
manuscripts were ultimately accepted for publication; five were
rejected. Several articles discuss and reflect on the strengths and
The huge response to the call for papers for this special issue weaknesses of study designs using mind–body interventions
indicates not only a high interest in research methods, but also the [16] and information seeking [17], a novel feedback method for
relevance of research methodology within the health communica- communication interventions [18], and the quality of different
tion community. Furthermore, the very positive feedback we measures [17,19].
 Editorial / Patient Education and Counseling 82 (2011) 281–284 283

4.4. Development of innovative methods (3) education [8] for health communication researchers, students,
and health care providers on the use, applications and
The contributions on the development of innovative research integration of both qualitative and quantitative methods.
methods address the challenges posed by psychophysiological
methods such as electrodermal activity [20], the development of
new instruments to assess the patient–provider relationship Ideally, we hope to foster the development of new methods
[21,22], and one new assessment tool for detecting differences combining the advantages of both qualitative and quantitative
between two intervention groups in cancer care [23]. research methods in order to better assess the complexities of
health communication in health care (Fig. 1, box 1). Patton [40, p.
4.5. Qualitative research methods: uses and innovative development 252] described this ambitious desideratum with the following
luminous analogy:
Four articles discuss and investigate issues concerning the uses
‘‘Mixing parts of different approaches is a matter of philosophi-
and innovative development of qualitative research methods.
cal and methodological controversy. . . In practice, it is
Whereas the article by Britten [24] offers a general reflection on the
altogether possible, as we have seen, to combine approaches,
use of qualitative research in health communication, the articles by
and to do so creatively. Just as machines that were originally
Goldblatt et al. [25], Yosha et al. [26] and Graffigna et al. [27]
created for separate functions such as printing, faxing, scanning,
demonstrate qualitative research innovations as regards sharing
and copying have been combined into a single integrated
research findings with participants [25], examine the process of
technological unit, so too methods that were originally created
patient navigation in cancer care [26] and explore the heuristic
as distinct, stand-alone approaches can now be combined into
value of ethnoscience [27].
more sophisticated and multifunctional designs.’’
4.6. Applying different interaction analysis systems
We hope that the selection of studies in this special issue will
Several authors also investigate important issues concerning give researchers a reasonable picture of the different shades of
the application of interaction analysis systems. Their articles focus ‘‘methodological pluralism’’ in health communication research, how
on topics ranging from slicing RIAS codes thin [28] to the content this kind of research can function and the many benefits it entails.
analysis method of focus group video recordings [29], the synthesis
of qualitative linguistic research [30] and the challenging Acknowledgements
assessment of eye contact during consultations [31].
We would like to thank all of the external reviewers who
4.7. Integrating multiple research methods provided us with timely and detailed reviews for all of the articles
submitted to the journal for consideration for publication in this
Several articles contribute to the integration of multiple special issue. We are also grateful to Ann Marie Ryan (Journal
research methods [32–36]. These articles clearly show that Manager Elsevier) for her excellent support during the whole
methodological integration [10] is possible and is being applied process of collecting manuscripts and editing the issue.
very well in different settings. Melanie Neumann would like to thank her research group for
their great patience, understanding and support during the editing
4.8. Translating data into practice process of this special issue.
Gary Kreps would like to thank Melanie Neumann and Adriaan
Finally, three papers in this issue discuss different aspects of Visser for their collegiality, patience, and understanding during the
translating data into practice, including physicians’ reflections on development and review of this special issue.
their clinical practice and their methodological implications [37],
the challenges of implementing communication training in a big References
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