Health Communication Theory. Группа авторов

and situated practices. From this perspective:

      Theorizing means stopping, pondering, and thinking afresh. We stop the flow of studied experience and take it apart. To gain theoretical sensitivity, we look at studied life from multiple vantage points, make comparisons, follow leads, and build on ideas… The acts involved in theorizing foster seeing possibilities, establishing connections, and asking questions.

      (Charmaz 2006, p. 244; emphasis in original)

      This approach explicitly assumes that any theoretical rendering offers an interpretive portrayal – rather than an exact picture – of the studied world (Charmaz 2006, p. 17). While all approaches to grounded theory can be found in health communication literature, the post‐positivist and social constructionist types are far more common than the original conceptualization, paralleling larger trends in qualitative methodology (Ellingson and Borofka 2014).

      Theory as Product

      With roots in medical sociology and nursing, grounded theory has had meaningful impacts on health‐related research. Within health communication, Ellingson and Borofka (2014) cited three specific strengths of this approach. First, they claimed that grounded theory highlights participant voices and experiences through categories grounded in participant perspectives. For example, Donovan‐Kicken et al. (2012) grounded their analysis in 40 cancer survivors’ descriptions of the demands, obligations, and preparatory activities involved in discussing their illness. From these results, they then theorized the construct of communication work, which focuses on the labor and resources devoted to managing talk while living with illness. In another study, Peterson (2010) grounded her analysis in descriptions of the challenges that 45 women living with HIV or AIDS face while seeking and receiving social support. The research served as an initial step toward the development of a normative model of social support for women living with HIV.

Second, Ellingson and Borofka (2014) noted that grounded theory “often generates pragmatic, heuristic implications for improving communication within a variety of health contexts that, while not generalizable, are widely applicable and useful” (p. 538). For example, Martin’s (2016) study of the experience and communicative management of identity threats among 47 people with Parkinson’s disease offered insights that could be utilized in healthcare and interventions for combating identity loss and responding to identity challenges in adaptive ways. In another study, Ellingson (2007)’s ethnography of a dialysis unit yielded implications for several areas of health communication research, including improved staff training and delivery of care, further articulation of the relationship between communication and technology in contemporary healthcare, and the development of models of nursing leadership.

      Finally, Ellingson and Borofka (2014) claimed grounded theory in health communication research “produces findings rich in contextual and interactional details that complement and contextualize other qualitative, critical, and quantitative analyses” (p. 538). To illustrate, critical health communication scholars have paired grounded theory with (i) the culture‐centered approach (see Chapter 14) to reveal enrollment disparities among African Americans and hospice care (Dillon and Basu 2016); (ii) media framing to elaborate tensions that emerge within the discursive space of HIV/AIDS in Indian newspapers (de Souza 2007); and (iii) functional theories of stigma to acknowledge the role of medical power, discrimination, and authority in healthcare encounters with transgender patients (Poteat, German, and Kerrigan 2013). Further, as a well‐known health communication scholar specializing in feminist and grounded theory methodologies, Laura Ellingson has advocated for studies that embrace a continuum approach across social science methodologies. From this approach – which Ellingson (2009) deemed crystallization – grounded theory, which is typically represented in traditional research report genres, can be creatively paired with more artistic representation, including photovoice techniques (e.g. Evans‐Agnew, Boutain, and Rosemberg 2017) and poetic transcription (e.g. Ellingson 2011).

Narrative Theorizing

The communication discipline boasts a rich history of narrative theory (see Bochner 2014; Fisher, 1987), and communication scholars have contributed meaningfully to the narrative turn in health contexts (see Harter et al. 2020; Harter, Japp, and Beck 2005; Sharf et al. 2011; Sharf and Vanderford 2003). At the heart of his narrative paradigm, rhetorician Walter Fisher (1984) claimed that people are homo narrans – or natural storytellers who think in stories: “Narratives enable us to understand the actions of others ‘because we all live out narratives in our lives and because we understand our own lives in terms of narratives’” (p. 8). These ideas both incorporated and extended literary theorist Kenneth Burke’s (1935/1984) arguments that narratives represent “equipment for living” – or the symbolic resources that allow individuals to size up circumstances and chart future action. According to Sharf et al. (2011), the robustness of narrative theorizing in current health communication scholarship rests in part in its focus on webs of interwoven social (and material) forces. “No story is solely personal, organizational, or public,” they explained. “Personal stories cannot escape the constraints of institutional interests, nor are they separate from cultural values, beliefs, and expectations. Meanwhile, institutional structures and scripts intertwine to form the social milieu in which performances unfold” (p. 38).

      Although narrative is a broad term that encompasses a multidisciplinary collection of theories and methods, the maturation of health narrative theorizing speaks to enduring and emerging issues of concern for health communication scholars (Harter et al. 2020). To illustrate, Lynn Harter, one of the premiere narrative theorists in health communication, launched Defining Moments, a forum in Health Communication and a complementary podcast dedicated to showcasing the social and material power of storytelling. In the first 10 years, authors of the collective essays narrated “myriad maladies, infirmities, and oddities of the human condition” and storied a vast number of topics with particular import for fostering well‐being, humanizing healthcare, and advocating for change (Harter et al. 2020, p. 262).

      Illness as a Call for Stories

In foundational work based on his own and others’ experiences, sociologist Arthur Frank (1995) positioned illness as a call for stories. His popular typology presents three common plotlines that “wounded storytellers” use to first understand and then to explain their illnesses. The most familiar and socially condoned is the restitution plot, which posits that health problems can be remedied and the body restored to its pre‐illness state. In contrast, the chaos plotline stories illness as incoherent and disordered, with no hope for control and no promise of getting better. Frank (1995) argued wounded storytellers learn to tell the quest narrative – the third plotline, in which illness is deemed a source of insight to be shared with others – when they “meet suffering head on. They accept illness and seek to use it” (p. 115). Scholars have employed this typology as a theoretical framework in research especially focused on life with chronic illness, impairment, or loss (e.g. Titus and de Souza 2011); however, it may not be applicable for all illness situations, including ailments that are chronic but managed, and successful recoveries/remissions that provoke new emotional, cognitive, and physical challenges, like long‐term cancer survivors’ late effects from treatment (e.g. Ellingson 2017).

      Illness narratives are generated in response to a rupture or turning point in a person’s life (Bruner 1990) and are told in and through the body (Frank 1995), meaning “the body is simultaneously cause, topic, and instrument of whatever story is told” (Sparkes and Smith 2008, p. 302). Inherently, narratives of health and illness are embodied and dialogic, calling upon listeners (or readers, viewers, touchers) to join with tellers (or writers, filmmakers, artists) in the creation and re‐creation of meaning (Harter et al. 2020). Narrative theorists (Frank, 1995; Kleinman, 1988) underscore the importance of reciprocity for bearing witness to individual or community suffering and trauma. Storytellers have the moral responsibility to guide others who may follow, just as storylisteners have the moral – and often uncomfortable – obligation to listen and respond to that suffering.

      Core dimensions of