Part I: 20th-century career developments and influences
By Robert A. Logan PhD, School of Journalism and Mass Communication, University of Iowa, 1977
Introduction to part I
Instead of focusing on contributions, I will snatch a career portrait invitation to introduce a few origins of my professional life. I will note a couple of experiences that became career touchstones and mention a few mentors and ideas that influenced my research.
While I have been distracted by life events such as personal relationships, family responsibilities, volunteer professional chores, tennis, military service, travel, and daily details, my career direction is semi-linear. It was launched in a Chicago bookstore during my first urban, solo foray around age 16.
The profile is divided into two parts, which focus on 20th—and 21st-century career influences and developments. Part I explores zen and life shock in a bookstore, science journalism, Joye Patterson, and William Stephenson’s ideas. References are provided at the end of each part.
Zen and life shock in a bookstore
On a fall Friday afternoon (circa 1964), I walked a familiar stretch of Michigan Avenue alone for the first time to meet my mother and grandmother @ Orchestra Hall (the home of the Chicago Symphony). While I am unsure why I was unleashed that day, the experience was my first taste of big-city freedom. As a kid and a teen, yes, I walked solo in the suburban town where I was raised and in similar areas. But until that afternoon, unchaperoned downtown Chicago visits were verboten. I remember the thrill of being trusted and the initial chance to experience what I long relished–self-determined hours in a sophisticated urban environment.
Strolling south, I dropped by Stuart Brent Books. For years, I heard local and visiting professionals (e.g. physicians, attorneys, professors, engineers, researchers, journalists, writers, and a range of readers) uniformly praise it (stuart-brent-books-a-memory, n.d.) Full disclosure: I had met Stuart Brent (a writer, public intellectual, television host, professor, store owner, and neighbor) a couple of times (about-stuart-and-the-brent-family, n.d.). Despite requests, I could not convince an elder to accompany me to the renowned bookstore. And I certainly lacked the self-confidence to ask Prof. Brent to invite me there.
Inside, I quickly noticed that an uncharacteristically modest display space was devoted to best-selling books and periodicals. A contrastingly large magazine rack carried the Journal of the American Medical Association (JAMA–published in the neighborhood), Science, the University of Chicago Law Review, Harvard Business Review, and other disciplinary-focused publications that I had never seen (or heard of). Similarly, a centerpiece space was devoted to new books about medical research, legal issues, architectural design, and research in an array of disciplines. Many adjacent shelves contained books about the arts, philosophy, history, new plays, novels, poetry, and literary criticism. I noticed many of the centerpiece books were published by universities worldwide in addition to the usual commercial publishers.
The bookstore also carried some rarely available British newspapers and magazines (e.g. The Economist, The Guardian, The Times) and sometimes received The New York Times on the day it was published (a then-Midwestern rarity). In another first, some available newspapers, periodicals, and books were in non-English languages.
Already overwhelmed, I began thumbing through JAMA. While I grasped a sentence or two within an abstract or editorial, I understood little else. My frustration persisted as I browsed a few other journals and a couple of academic books.
I asked myself, "What is this? Why can’t I understand anything?” While I was told I attended an academically rigorous public high school, why was I so ill-prepared for books and periodicals written in British and American English?
Educationally disoriented and embarrassed by my ignorance, I was somewhat overcome. While I lacked the vocabulary to explain it at the time, I underwent a bipolar exhilaration and humiliation crowned by cognitive dissonance.
Still, I was drawn to understand and appreciate a personally stunning experience. Why am I so emotionally ajar, I thought? Is this feeling an outsized embarrassment or what the Japanese call zen? Hoping it might be the latter, I avoided anger at myself or the messengers (the authors and publishers) and did not conclude that intellectual work was alien. Instead, I knew I had to make personal sense of what I experienced and how it made me feel.
I decided to give myself some time to let the upheaval sink in… After a few weeks, I began to realize that the bookstore life shock was a reaction to my first exposure to unfiltered knowledge. I recognized (probably for the first time) that all the textbooks I read in high school and most of the materials I had read in familiar (and most popular) books and periodicals targeted those sans professional knowledge or expertise.
I pondered the Grand Canyon gap between public knowledge and professional proficiency. Looking back, I guess I could have been angry that school textbooks and popular mass media were dumbed down. I also could have been upset about a conspiracy of scholars and professionals to sustain what Thayer (1974) called an ‘epistemic community,’ or a self-contained group defined by an enduring, exclusive, and shared vocabulary that was inaccessible to outsiders.
However, I began to appreciate those who tried to help people understand knowledge and remove some barriers. It struck me that the mass communication of knowledge was an honorable pursuit, and respect emerged for dedicated journalists and writers.
Over time, the latter morphed into an admiration for persons who create knowledge. I began to imagine that scholarship (regardless of discipline) was also a highly honorable and productive use of one’s time and career (albeit quite different than journalism).
I’m not sure when I started daydreaming about the professional combination that awaited me–careers in journalism and as a mass communication scholar. But as related dreams resurfaced, I sensed I would never be self-satisfied if I did not pursue them.
Science journalism and Joye Patterson
After years consumed by distractions, I decided to step up and learn how to be a journalist. I saw journalism as a practical route to start at least one of the two careers I envisioned. Comparatively speaking, learning how to mass communicate knowledge seemed quicker and less expensive than being a knowledge creator. So, I started modestly…
From the start of my MA at the Missouri School of Journalism, I knew I was interested in writing or editing about professionals who excelled at their respective professions, jobs, and crafts. The latter scope was wide enough to include attorneys, architects, economists, clergy, artists, mass media creators, and policymakers, to name a few. After several months, I realized the most interesting and personally meaningful challenge was explaining science and medical research.
Compared to other professions and endeavors, science and biomedicine impressed me as the most evidence-based and the most committed to fully disclosing methods and communicating the limitations of evidentiary findings. Comparatively, the methodological steps to obtain evidence, its rigor, and intra-professional communication seemed more foundational. In science and biomedical research, investigator independence, judgment, detail, disclosure, and self-criticism were normative.
I also realized that I would never be bored covering science and medical research. I would be perpetually overwhelmed by the expanding spectrum of new and diverse knowledge from different disciplines, similar to the exhilarating rush and challenge that I first experienced at Brent Books.
Initially, Mizzou journalism professor Joye Patterson helped me understand how to write about science for lay audiences. From the outset, Patterson emphasized the professional rifts between scientists and journalists, which impacted my science writing efforts and, later, my transition to mass communication research (Joye Patterson remembered, n.d.).
Patterson explained the best approach to covering science and medicine was to focus on research. She added the best way to impress a physician or scientist was to note the discrepancies between the conclusions describing a study in press releases and the actual data. The latter encouraged me to learn how to understand a study’s comparative rigor and whether the rhetoric that explained contributions in news releases exaggerated its findings.
Patterson’s guidance improved my work, differentiated my approach, and helped me become more self-critical (which cultivated my future skills as an editor). As I looked for discrepancies between data, headlines, and summaries, I slowly noticed other research details, such as whether the hypotheses were carefully derived from a literature review, the extent to which a study’s data were accessible, and whether the research had an underlying theoretical framework. While I rarely wrote about the latter issues (and had negligible newsroom time to pursue them), the effort triggered an unexpected long-term impact. I began to become familiar enough with the research process to consider the next step: learning how to generate knowledge.
Yet, when Joye Patterson advanced the idea that I seek a PhD in mass communication, she explained that I needed to appreciate the difference between research and scholarship. She explained a researcher focused on the types of methodological and reporting details to which I was becoming accustomed. But Patterson added a scholar exhibited a broader capacity to embed research data within the extant literature and contextualize the greater importance of individual or collective studies within a field’s underlying conceptual frameworks. Patterson also emphasized the need for a scholar to think conceptually, both conventionally and unconventionally, and relish making sense of seemingly conflicting ideas.
While I was grateful for Patterson’s counsel, I had little confidence that I could advance from a researcher into a scholar until she introduced me to her mentor and colleague, Missouri journalism professor William Stephenson.
William Stephenson’s ideas
I met Stephenson during his final year at Missouri in 1973. He then became a visiting professor at the University of Iowa School of Journalism and Mass Communication, where he co-directed my doctoral studies from 1974-77.
Soon after our introduction, I discovered that as a young scientist in the 1920s, Stephenson participated in the development of two foundational 20th-century fields: physics and psychology and one subfield, psychometrics (Good, 2010). Stephenson (who was British) received a doctorate in physics and psychology during the first third of the 20th century. Stephenson’s mass communication scholarship began about 30 years after his contributions to the other two.
As a young physicist, Stephenson witnessed an era when his peers lined up into schools of thought based on significant yet conflicting evidence regarding whether light was a particle or a wave. Bohr’s transformative idea that each was complementary (and not mutually exclusive) became a foundation in physics and influenced at least three of Stephenson’s conceptual cornerstones (Stephenson, 1988a; Good, 2010).
First, Stephenson gleaned that conventional scientific wisdom (even if evidence-based) could accidentally become one-dimensional and self-reinforcing if alternative concepts, approaches, and data were not considered. So, to Stephenson, unconventional ideas needed to be generated and explored as part of science’s self-correcting process. Second, Stephenson became more impressed by those who perceived that scientific progress sometimes reflected inferential leaps instead of widely accepted constructs scientific judgment was a byproduct of induction, deduction, and falsification (Stephenson, 1961; Stephenson, 1988b). While Stephenson appreciated evidence-based logical positivism, he noted the persistence of inconsistent ideas, incomplete data, indeterminism, and empirical uncertainty in scientific inquiry. From this, he gleaned that a degree of subjectivity was omnipresent in scientific approaches–and investigator inference occasionally required abduction infused by individual creativity (Stephenson, 1961). Third, since the latter ideas were not embraced by his peers during the first third of the 20th century, Stephenson perceived their oversight as a rich opportunity to establish a research career.
Stephenson pioneered Q technique and methodology to systematically assess the latent subjectivity in human notions, feelings, abstractions, suggestions, inferences, and ideas in science and elsewhere (qmethod.org, n.d.). He proposed that human subjectivity could be systematically assessed and introduced Q method’s philosophical underpinnings and pragmatic tools to sustain its use (qmethod.org, n.d.). Throughout a six-decade career, Stephenson remained mindful that Q was less an end than intended to address a niche in the philosophy of science and scientific approaches.
Apple Computer’s late 20th-century advertising pitch, ‘Think different,’ also described Stephenson’s apperception, approach, and scholarship. For example, Stephenson’s initial application of his ideas to psychometrics and statistical inference in social science inverted population study datasets. Instead of inserting the participants in a dataset’s vertical column (from 1-n) and providing their responses (to items/tests) in horizontal rows (or people by items/tests), Stephenson recommended this should be inverted (or assess items/tests by people) (Stephenson, 1935).
While straightforward to execute, the transposition reframes research approaches in psychometrics within the humanities and social sciences. As people-by-test datasets are designed to assess pre-selected constructs and concepts drawn from the extant literature, test-by-people datasets are best suited to generate new conceptual frameworks or ideas.
One of the most consistent elements of Stephenson’s research was the generation of alternative conceptual frameworks that were the byproduct of his distinctive methods. The latter reflected his interest in using quantitative and mixed methods for construct/hypotheses exploration rather than verification. His alternative research methods sought to unlock the potential for factors (clusters of like-minded judgments generated by a study’s participants instead of the investigators) to emerge that potentially provided new conceptual frameworks, hypotheses, and ideas (Stephenson, 1977).
Stephenson’s approach was first applied to mass communication research in the 1960s (about a decade before I met him). At the start of Stephenson’s mass communication research career, a prevailing evidence-based construct suggested adults converged on print media for information gain (e.g. to become better informed). Fittingly, he immediately explored whether the process of reader engagement was conceptually more expansive.
In his initial Q studies of news readers, Stephenson found some participants fit the prevailing construct that linked interest in news reading with being a better-informed citizen, employee, parent, fan, investor, etc. Yet, at the same time, Stephenson’s initial studies suggested others were drawn in by a mass media-generated experience that prompted self-reflection during a habitual daily interlude (Stephenson, 1967). Some persons habitually read a newspaper (or attended to print media) at the same time, in the same place, and in the same order daily. The daily ritual was something people looked forward to–and they were frustrated by any interruptions. In the process, these readers often lost track of time and mentioned how the experience fostered musings such as daydreaming, random thoughts, and occasional insights, and a welcome opportunity to think for oneself (Stephenson, 1967, 1973; Logan, 1991, 2022).
Using Huizinga’s (1950) description of play to explain the phenomenon, Stephenson noted its consistency in subsequent Q studies. These studies suggested that play was omnipresent (for some) in the dynamics of media engagement and experiences, such as reading a newspaper, watching broadcasts, or routine shopping behaviors (Stephenson, 1967, 1974; Logan, 2022).
Importantly, Stephenson did not challenge the prevailing construct of information gain and assessing evidence-based constructs. Instead, he suggested that ideas derived from consumers and Gestalt psychology provided alternative explanations, insights, hypotheses, and expectations about mass media engagement.
I will eschew additional details since others have elaborated on Stephenson’s ideas and scholarly impact in science, psychology, and communication (Brown & Brenner, 1972; Brown, 1972, 1980; Good, 2010; Rhodes, Thomas, & Ramlo, 2022). Smith (1999) notes the specific contributions of Stephenson’s innovative ideas and approaches to the history of 20th-century psychology. I have also written about Stephenson’s ideas (Logan, 1991, 2003, 2022).
However, in terms of his mentorship, Stephenson fits all the elements of Patterson’s depiction of a scholar (as opposed to a researcher). Working with and reading Stephenson was a persistent challenge in critical thinking and finding commonalities among an array of conflicting ideas and experiences. While helping me understand the value of appreciating scholarship, his ideas imparted a groundwork that helped me think conventionally and unconventionally.
About a decade after the Brent Books experience, Stephenson provided a second intellectual deluge. In contrast, he provided a foundation equipped with strategies that helped me learn how to create knowledge. As he once told me, “Robert, to get the big picture, you need to step outside of the frame.”
References
Brown, S.R. (1980). Political subjectivity: Applications of Q methodology in political science. Yale University Press. https://qmethod.org/portfolio/brown-1980-political-subjectivity/
Brown, S.R., & Brenner, D.J. (1972). Science, psychology, and communication: Essays honoring William Stephenson. Teachers College Press.
Brown, S.R. (1972). A fundamental incommensurability between objectivity and subjectivity. In: Brown, S.R., & Brenner, D.J. Science, psychology, and communication: essays honoring William Stephenson. Teachers College Press, p. 57-94.
Good, J.M. (2010). Introduction to William Stephenson's quest for a science of subjectivity. Psychoanal Hist. 12(2), 211-41. doi: 10.3366/pah.2010.0006. PMID: 20845572.
Huizinga, J. (1950). Homo ludens. Beacon Press.
https://stuartbrent.com/pages/about-stuart-and-the-brent-family. Retrieved June 19, 2024.
https://americanwritersmuseum.org/stuart-brent-books-a-memory/. Retrieved July 9, 2024.
https://journalism.missouri.edu/2012/04/joye-patterson-remembered-as-innovator-in-the-field-of-science-journalism-at-mu/
https://qmethod.org. Retrieved June 19, 2024.
Logan, R.A. (2022). The arts, health literacy, health disparities, and play theory. In: Rhodes, J.C., Thomas, D.B., & Ramlo, S.E. (Eds). Cultivating Q methodology: Essays honoring Steven R. Brown. International Society for the Scientific Study of Subjectivity, Bookbaby, p. 181-200.
Logan, R.A. (2003). Stephenson, MacLean & qualitative mass communication research. Journal of Human Subjectivity. 1(2), 4-30.
Logan, R.A. (1991). Complementarity, self, and mass communication: The contributions of William Stephenson, 1902-1989. Mass Comm Review. 18, 27-39.
Rhodes, J.C., Thomas, D.B., & Ramlo, S.E. (Eds). (2022). Cultivating Q methodology: Essays honoring Steven R. Brown. International Society for the Scientific Study of Subjectivity. Bookbaby.
Smith, N.W. (1999). Current systems in psychology. Belmont, CA: Wadsworth.
Stephenson, W. (1953). The study of behavior: Q technique and its methodology. Chicago: University of Chicago Press.
Stephenson, W. (1935). Correlating persons instead of tests. Character and Personality. 4, 17-24. http://doi.org.10.1111/j.1467-6494.1935.tb02022.x
Stephenson, W. (1961). Scientific creed: the centrality of self. The Psychological Record. 11, 18-25. https://doi.org/10.1007/BF03393382
Stephenson, W. (1973). Play theory and value. In: Thayer, L. (Ed). Communication: Ethical and moral issues. Gordon and Breach.
Stephenson, W. (1967). The play theory of mass communication. Chicago: University of Chicago Press.
Stephenson, W. (1977). Factors as operant subjectivity. Operant Subjectivity. 1, 3-16. https//doi.org/10/15133/j.os.1977.001
Stephenson, W. (1961). Scientific creed -1961. Abductory principles. Psychological Record. 11, 9-17.
Stephenson W. (1988a). William James, Neils Bohr, and complementarity. V - phenomenology of subjectivity. The Psychological Record. 38, 203-219.
Stephenson, W. (1988b). Falsification and credulity for psychoanalytic doctrine. Operant Subjectivity. 11, 73-97.
Thayer, L. (1974). Communication and social change. In: Budd, R.W., & Ruben, B.D. (Eds). Communication and social change, New Brunswick: Rutgers University Press.
Part II: 21st-century career developments and influences
Introduction to part II
Part II focuses on the author’s career developments in the 21st century, with occasional flashbacks. It explores the U.S. National Library of Medicine and Don Lindberg, the potential of health literacy, and closing thoughts. References are provided at the end.
The U.S. National Library of Medicine (NLM) and Don Lindberg
Will Stephenson and Joye Patterson introduced me to the National Library of Medicine and Donald A.B. Lindberg, MD, in 1972 and 1977, respectively. From 1977 to 2002, during my career in journalism/mass communication higher education, NLM and Lindberg provided the institutional and individual leadership models that I most admired. In 2003, I took early retirement from the faculty of the University of Missouri School of Journalism to join NLM and work with Dr. Lindberg. I was a member of NLM’s senior staff from 2005 until my retirement in 2019.
For five decades, the two NLM leadership contributions I most admired were the library’s adoption of mass media technology for medical professionals, bioscientists, and the public and its assertion of educational values during the conversion from analog to digital inter-professional and mass communication.
My high regard for NLM began when Joye Patterson first suggested I use Index Medicus to generate news stories. Index Medicus (a periodical formerly published by NLM) organized the biomedical literature by indexing the research of leading refereed biomedical journals into disciplines and biomedical specialties (https://en.wikipedia.org/wiki/Index_Medicus, n.d.). In the late 20th century, it was replaced by MEDLINE and PubMed – NLM’s online, free, Internet-accessible gateway to biomedical literature (https://pubmed.ncbi.nlm.nih.gov/, n.d.). MEDLINE and Pub Med removed much of the lag time from original publication to user availability (and eventually provided access to published articles and so much more).
While PubMed is one of many examples of NLM’s leadership in extending digital technology to medical professionals and the public, the tradition established by Index Medicus paved its legacy.
Earlier, Index Medicus accelerated the professional and public diffusion of medical knowledge (what physicians call bench-to-bedside). Prior to the digital age, it used mass media (a printed periodical) to inform medical professionals and the public about basic and applied research in biosciences, biomedical research, and most areas of public health and medicine.
MEDLINE and Pub Med (which embraced digital technology) enabled free public access to evidence-based medical knowledge for anyone with a computer (and later a smartphone or tablet) and the Internet. Smith (2021) describes MEDLINE and Pub Med’s evolution as examples of innovative medical informatics, focused organizational administration, and the value of professional and U.S. Congressional leadership. Smith (2021) explains that NLM avoided the temptation to monetize the public and professional diffusion of medical information and pursued MEDLINE and PubMed’s development based on educational values.
During our initial conversations in 1977, Don Lindberg noted NLM was the ideal place to develop digitally based services for medical professionals, which, if successfully implemented, could be expanded and made available to patients. Lindberg’s 1977 vision preceded the introduction of the PC and Mosaic, the first accessible free Internet gateway, by several years. At the time, Lindberg was an NLM grantee, a pathologist, a faculty member at the University of Missouri School of Medicine, and a recognized pioneer in the then-new fields of medical informatics and AI. I was one of his post-doctoral students.
Imagine my excitement in the spring of 1984 when Lindberg told me he would become the director of NLM. I knew what was coming (Logan, 2021).
From 1984 until his retirement in 2015, Lindberg and his biomedical informatics peers, and NLM’s staff with external assistance, adopted some of the Internet-based vision and digital tools used by innovative physicists, astronomers, and molecular biologists to bridge the communication gaps among biomedical scientists and researchers, clinical and public health practitioners, and the public. For the next 31 years, NLM accomplished every aspect of Lindberg's plan and much more (Humphreys, et.al., 2021). In a combination of vision, pragmatism, multidisciplinary thinking, and leadership, the pioneering innovations developed during Lindberg’s NLM tenure included MEDLINE, Pub Med, PubMed Central, Clinicaltrials.gov, MedlinePlus.gov, UMLS, PubChem, Entrez, GenBank, NCBI Blast, Hazardous Substances Data Bank, Toxicology Data Network, genetic surveillance platforms, support for electronic health records, expert systems, machine learning, medical libraries, High-Performance Computing and Communications, the Visible Human, and Turning the Pages (Humphreys, et al., 2021).
Mo and Denny (2021) describe NLM’s aggregate accomplishments, including how its services undergirded the global collaborative biomedical research that accelerated and enabled the development of a COVID-19 vaccine between 2020 and 2022.
To offset the digital divide, NLM also created initiatives designed to improve medical communication with and the health of medically underserved audiences (Siegel, 2021).
A book I recently co-edited details NLM’s and Lindberg’s leadership (Humphreys et al., 2021; Logan, 2021). I was proud to work at an institution that pioneered the use of digital technologies for educational purposes and asserted that its initiatives should empower healthcare professionals and advance the greater public interest. NLM’s diverse and multidimensional projects consistently reflected a larger educational, public, and professional service vision.
I should add that there were leaders in journalism and mass communication higher education who realized that digital technology represented a new mass medium and the dawn of a cultural era. Some mass communication peers were commendably mindful of Innis, McLuhan, Carey, and Stephenson’s ideas that the evolution of mass media medium resulted in transformative cultural, economic, social, and professional changes (Innis, 1964, 1972; McLuhan, 1962, 1964; Carey, 1967, 1989; Stephenson, 1967). However, during the last half of my career, I suggest NLM best evinced the idea that the ultimate value of a new mass medium is to bridge the gaps (and contribute to) the professional, student, and public understanding of health and boost individual empowerment.
Health literacy’s potential
After arriving at NLM in 2003, I switched my research emphases from science and health communication to health literacy (HL). Health literacy represented a career extension and an evolution. This section identifies a few of HL’s similarities and differences with science, health communication, and related research areas and discusses the potential for future collaboration and constructive insights.
First, health literacy is operationally defined as: “…allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information. Health literacy is the use of a wide range of skills that improve the ability of people to act on information to live healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills” (Centreforliteracy, n.d.). HL is divided into four areas of research and professional practice: personal, organizational, digital, and numeracy (healthypeople, n.d.). While HL is a branch of general literacy, its narrower focus facilitates research specificity and precision (Sorensen et al., 2012).
Health literacy is like but also reflects a different direction than health, environment, and science communication and related fields, such as strategic communication, health promotion, and health education (Kreps et al., 2020). Science communication includes strategic communication. Health promotion and health education are separate but similar fields.
To back up, I admire the collective work of science/environment and health communication research colleagues who advance specific constructs, such as self-efficacy, uncertainty, news gatekeeping, news framing, and news agenda setting (Bucci & Trench, 2014; Harrington & Record, 2023). I suggest the research evidence about these and other constructs has improved the professional communication between scientists and journalists and provided fresh insights regarding the audience for health and science news (Bucci & Trench, 2014; Logan, 2008, 2014; Harrington & Record, 2023). Among its contributions, the latter research suggests how the selection and framing/contextualization of science/health news by reporters, editors, and producers are associated with audience perceptions of the importance and policy urgency of diverse scientific and medical topics (Logan, 2001, 2008, 2014). This has important implications for science policy and the broader public appreciation of integrating scientific processes in making public policy decisions. While Joye Patterson and Will Stephenson abstained from promoting the idea that news coverage was linked to elevating popular support for science, they understood that science and health news could help the public better understand evidence-based thinking and the knowledge it generates, which they believed was socially constructive.
As the constructs represent potentially shared areas among science mass communication and health communication with health literacy research, other commonalities include numeracy (or the public’s understanding of scientific information, biostatistics, and scientific processes) and the impact of health misinformation and disinformation in the news and social media on popular misunderstandings about science and medicine. Certainly, some negative public attitudes about vaccinations during the COVID-19 pandemic (in several nations) illustrate the need for more research (and professional and policy concern) about consumer numeracy and public exposure to misinformation and disinformation in the news, mass, and social media (McCaffery, et.al., 2020, 2023; Pickles, et.al., 2022; Wolf, et.al, 2020; Logan, 2023).
The attention to ‘plain language’ within HL also helps media practitioners refine their use of health terms and concepts for the public (Parker & Ratzen, 2020; Oransky, 2020). Additional areas in HL practice encourage better access to medical information for journalists and the public (which attracted NLM’s attention during HL’s nascent stage) (Oransky, 2020).
Conversely, there are important differences among HL, science communication, and health communication researchers, which partially stem from their professional locus and focus (Kreps et al., 2020). For instance, health literacy practitioners (and most health education and health promotion specialists) tend to work in medical education, schools of education, schools of public health, or health-related fields rather than higher education schools of mass communication and communication. Health communication faculty frequently work in higher education schools of communication or schools of journalism/mass communication, as do many science communication researchers. HL research tends to focus less on assessing news and social media content and, instead, frequently evaluates how health literacy levels (or prior knowledge) impact clinical and public health outcomes. So, HL research tends to concentrate on the issues that challenge clinical and public health practitioners instead of evaluating and potentially enhancing the impact of news, mass and social media, or health educational efforts in primary and secondary schools.
Perhaps the differences in disciplinary locus and focus are best illustrated by HL’s primary research findings, which suggest:
- Low health literacy levels are normative in many countries (Pelikin, Strabmayr, & Ganahl, 2020)
- Health literacy levels are statistically associated with survival and recovery rates (and patient preventive behaviors) for cancer, stroke, heart disease, and a variety of chronic illnesses and overall life expectancy (Baker, 2006; Flaherty, 2008; Parker & Ratzen, 2012; Rudd, 2017; O’Conor et al., 2020)
HL associations extend to other health concerns, such as oral health, depression, medication knowledge, accident/injury prevention, health screening, and immunizations (O’Conor et al., 2020; Guo et al., 2023) HL is also associated with how patients and caregivers optimally use the healthcare delivery system (it impacts outcomes, such as whether a person has a physician or provider, sees a provider/MD annually, receives recommended vaccinations, gets screenings, unnecessarily uses emergency clinical services, follows health provider instructions, is re-hospitalized after surgery or a medical procedure) (Parker & Ratzen, 2012; Rudd, 2017; O’Conor et al., 2020; McCaffery et al., 2023)
Improving HL represents a constructive approach to addressing many aspects of the ‘Quadruple Aim’ (enhance quality of care, advance community health, reduce medical costs, and improve the care and experience of patients, caregivers, and providers within the healthcare delivery system) (Andresen, Rosof, & Arteagan, 2020; Rickard & Hudson, 2020; Berwick, Nolan, & Wittington, 2008; Bodenheimer & Sinsky, 2014).
Compared to science and health communication, HL provides a different path by focusing on individual, public health, and health care delivery system outcomes instead of validating evidence-based constructs.
However, HL findings also suggest that it is one of the social determinants of health. In turn, assessing HL’s role as a social determinant furnishes stimulating opportunities for collaboration among social determinants, health literacy, science’s mass communication, health communication, and researchers in related fields (Schillinger, 2020). While the evidence is preliminary, some practitioners also suggest that HL may be the most modifiable social determinant of health (Nutbeam & Lloyd, 2011; Schillinger, 2020; McCaffery et al., 2023).
The social determinants of health (identified by scholars in yet another discipline) assess how public health, clinical health, illness, recovery, and empowerment are impacted by an array of socially derived intermediate variables that include and eclipse conventional demographics (Nutbeam & Lloyd, 2011; Smith & Carbone, 2023). While HL is one of several demographic influences (such as education and income), non-demographic social determinants include conditions such as employment, access to green space, access to health care, food security, and neighborhood cohesion (Schillinger, 2020).
Consequently, assessing HL within a social determinant framework raises two foundational research questions: Is health literacy empirically more (or less) robust than other social determinants of health? To what comparative degree is HL a modifiable social determinant of health?
Since evidence-based answers are QED (yet to be determined), the resulting knowledge gap creates significant opportunities for collaborations among HL, science communication, and health communication researchers (and related fields) to assess and conceptually frame the comparative role and importance of HL, the news media, social media, and educational and community interventions as intermediate variables that impact diverse health outcomes.
Certainly, an interdisciplinary approach to addressing these research questions would generate a new era of collaboration that could lift all boats. In suggesting this, I return to NLM’s legacy that the ultimate contributions of a new mass medium and evidence-based community interventions are to bridge the gaps in public, student, and professional understanding of health and science (and other issues) and boost empowerment.
Otherwise, the public benefits of assessing whether health literacy is the most modifiable social determinant of health, coupled with the simultaneous evaluation of the comparative impact of journalism and mass media content and the potential for multidisciplinary interaction, generated my interest in HL research and practice. Like Lindberg’s and Stephenson’s influence and my first encounter at Brent Books, I was overwhelmed by my first exposure to HL findings and its conceptual horizons. I was also intrigued by the sheer diversity of stakeholders who were engaged in HL research and practice which included physicians, other clinicians, public health professionals, researchers from several disciplines, caregivers, hospitals, insurers, schools, government regulatory and research branches, medical societies, Pharma, patient and community organizations (to name a few). I also began to understand the importance of assessing similar research questions about health’s social determinants in diverse healthcare delivery payer settings (for-profit, publicly funded, and mixed).
Unsurprisingly, I dove into NLM’s HL activities, co-edited two books and a journal issue on HL research and practice, and participated in the Roundtable on Health Literacy, National Academies of Sciences, Engineering, and Medicine (Logan & Siegel, 2017, 2020; Logan, 2015, 2023; Kurtz-Rossi & Logan, 2015; Auld et al., 2020; Hernandez & Parker, 2020).
The multidimensional elements of the HL field and its synergy with related disciplines provided a capstone to my career's diverse elements.
Closing thoughts
I gratefully thanked Stuart Brent (1912-2010) about 15 years after first visiting his store, which closed in 1994 (about-stuart-and-the-brent-family, n.d.). Whenever I produce a book in recent years, I imagine finding it on a shelf in Brent Books.
Besides key experiences, mentors, and ideas, I appreciated the assistance of my former students and colleagues at the University of Missouri-Columbia School of Journalism and the School of Medicine, the University of Iowa, the University of South Florida, California Polytechnic State University-San Luis Obispo, and in a few newsrooms. My friends and family also had an implicit influence. My grandmother Ollie (who was English) befriended psychiatrists and psychologists and admired Scottish philosophers (such as David Hume and Adam Smith). Her enthusiasm created a groundwork for me to work with William Stephenson in the 1970s. Her influence may be why I had solo time to explore downtown Chicago in 1964.
Finally, I am surprised that my career has been semi-linear and spanned six decades. While my initial exposure to reducing gaps in understanding and creating knowledge was accidental, it suggests the value of self-determination and finding a sense of purpose after being overwhelmed and a bit humiliated. I hope my experience suggests that producing original research, helping people understand knowledge, and removing barriers between public knowledge and professional proficiency is a virtue.
My deep appreciation to those who create knowledge, mass communicate knowledge, provide evidence-based solutions to improve the public’s understanding of health and science, expand multidisciplinary-conceptual research foundations, and persevere.
References
Andresen, M.L., Rossof, B.M., & Arteagan, H. (2020). Achieving the quadruple aim through bidirectional care. In: Logan, R.A., & Siegel, E.R. (Eds). (2020). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 52-64.
Auld, M.E., Allen, M.P., Hampton, C., Montes, J.H., Sherry, C., Mickalide, A.D., Logan, R.A., Alvarado-Little, W., & Parson, K. (2020). Health literacy and health education in schools: collaboration for action. NAM Perspect. Jul 20;2020:10.31478/202007b. doi: 10.31478/202007b. PMID: 35291735; PMCID: PMC8916818.
Baker, D.W. (2006). The meaning and the measure of health literacy. J Gen Intern Med. 8,878-83
Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Aff. 27,759-769.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. An Fam Med. 12,573-576.
Bucci, M. & Trench, B. (Eds). (2014). Routledge Handbook of Public Communication of Science and Technology. New York: Routledge. Second edition.
Carey, J.W. Harold Adams Innis and Marshall McLuhan. (1967). The Antioch Review. 27(1),5-39. doi:10.2307/4610816.
Carey, J.W. (1989). Technology and ideology: the case of the telegraph. In: Carey, J.W. Communication as culture: Essays on media and society. New York: Routledge, p. 201-230.
Flaherty, J.H. (2008). Cancer screening in older patients: life expectancy, prioritization, and health literacy. Am Fam Physician. Dec 15;78(12):1336, 1338. PMID: 19119549.
Guo, C., Cui, Y., Xia, Z., Hu, J., Xue, Y., Huang, X., Wan, Y., Fang J., & Zhang, S. (2023). Association between health literacy, depressive symptoms, and suicide-related outcomes in adolescents: A longitudinal study. Journal of Affective Disorders. 327, 15-24. https://doi.org/10.1016/j.jad.2023.01.054.
Harrington, N.G., & Record, R.A. (2023). Health communication. New York: Routledge, Second edition.
Hernandez, L., & Parker, R.M. (2020). Roundtable on health literacy: issues and impact. In: Logan, R.A., Siegel, E.R. (Eds). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 169-187.
Humphreys, B.L., Logan, R.A., Miller, R.A., & Siegel, E.R. (Eds). (2021). Transforming biomedical information and health information access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press.
https://stuartbrent.com/pages/about-stuart-and-the-brent-family. Retrieved June 19, 2024.
https://americanwritersmuseum.org/stuart-brent-books-a-memory/. Retrieved July 9, 2024.
http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdf. Retrieved July 3, 2024.
https://pubmed.ncbi.nlm.nih.gov. Retrieved June 17, 2024.
https://en.wikipedia.org/wiki/Index_Medicus. Retrieved June 10, 2024.
https://health.gov.healthypeople. Retrieved June 14, 2024.
Innis, H.A. (1964). The bias of communication. Toronto: University of Toronto Press.
Innis, H.A. (1972). Empire and communications. Toronto: University of Toronto Press.
Kreps, G.L., Neuhauser, L., Sparks, L., & Labelle, S. (2020). Promoting convergence between health literacy and health communication. In: Logan, R.A., & Siegel, E.R. (Eds). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 526-543.
Kurtz-Rossi, S, & Logan R.A. (2015). Why we need a health literacy association. Discussion Paper, Institute of Medicine, Washington, DC. http://nam.edu/wpcontent/uploads/2015/06/HealthLiteracyAssociation1.pdf
Logan, R.A. (2021). Don Lindberg’s home library and leadership traits. In: Humphreys, B.L., Logan, R.A., Miller R.A., & Siegel, E.R. (Eds). (2021). Transforming biomedical informatics and health information access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press, p. 437-453.
Logan, R.A. (2023). Preface: lessons learned during the COVID-19 pandemic about public receptivity, health literacy, and health communication. A tribute to Andrew Pleasant. Inf Serv Use. 43:2, 79-88. doi: 10.3233/ISU-230194.
Logan, R.A. (2014). Health campaigns research. In: Bucci, M., & B. Trench, B. (Eds). Routledge Handbook of Public Communication of Science and Technology. New York: Routledge, p. 198-213. Second edition.
Logan, R.A. (2008). Health campaigns research. In. Bucci, M., & B. Trench, B. (Eds). Handbook of Public Communication of Science and Technology. New York: Routledge, p. 77-92.
Logan, R.A. (2001). Science mass communication: Its conceptual history. Science Communication. 23(2), 135-163.
Logan, R.A., Wong, W.F., Villaire, M., Daus, G., Parnell, T.A., Willis, E., & Paasche-Orlow, M.K. (2015). Health literacy: A necessary element for achieving health equity. Discussion Paper, NAM Perspectives. Washington, DC. http://www.nam.edu/perspectives/2015/Health-literacy-a- necessary-element-for-achieving-health-equity.
Logan, R.A., & Siegel, E.R. (Eds). (2020). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press.
Logan, R.A., & Siegel, E.R. (Eds). (2017). Health literacy: New directions in research, theory, and practice. Amsterdam: IOS Press.
McCaffery, K.J., Dodd, R.H., Cvejic, E., Ayrek, C., Batcup, J.M., Isautier, T., Copp, C., Bonner, K., Pickles, B., Nickel, T., Dakin, S., Cornell, S., & Wolf, M.S. (2020). Health literacy and disparities in COVID-19-related knowledge, attitudes, beliefs and behaviours in Australia. Public Health Res Pract. 30(4). doi:10.17061/phrp30342012.
McCaffery, K.J., Ayre, J., Dodd, R., Pickles, K., Copp, T., Muscat, D.M., Nickel, B., Cvejic, E., Zhang, M. Mac, O., Isautier, J., Cornell, S., Wolf, M.S., & Bonner, C. (2023). Disparities in public understanding, attitudes, and intentions during the Covid-19 pandemic: the role of health literacy. Inf Serv Use. 43:2, 101-113.
McLuhan, M. (1962). The Gutenberg galaxy; The making of typographic man. Toronto: University of Toronto Press.
McLuhan, M. (1964). Understanding media: The extensions of man. New York: McGraw Hill.
Mo H., & Denny, J.C.. (2021). The U.S. National Library of Medicine’s impact on precision and genomic medicine. In: Humphreys, B.L., Logan, R.A., Miller, R.A. & Siegel, E.R. (Eds). Transforming biomedical information and health information access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press, p. 74-84.
Nutbeam, D., & Lloyd, J.E. (2011). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health. Apr 1; 42, 159-173. doi: 10.1146/annurev-publhealth-090419-102529. Epub 2021 Oct 9. PMID: 33035427.
O’Conor, R.A., Moore, A., & Wolf, M.S. (2020). Health literacy and its impact on health and healthcare outcomes. In: Logan, R.A. & Siegel, E.R. (Eds.) Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, 2020, p. 3-21.
Oransky, I. (2020). Will improvements in health journalism improve health literacy? In: Logan, R.A., & Siegel, E.R. (Eds.) Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 511-525.
Pickles, K., Copp, T., Meyerowitz-Katz, G., Dodd, R.H., Bonner, C., Nickel, B., Steffens, M.S., Seale, H., Cvejic, E., Taba, M., Chau, B.K., & McCaffery, K.J. (2022). COVID-19 vaccine misperceptions in a community sample of adults aged 18-49 years in Australia. Int J Environ Res Public Health. 19(11, 6883. doi:10.3390/ijerph19116883
Pelikan, J.M., Strabmayr, C., & Ganahl, K. (2020). Health literacy measurement in general and other populations: Further initiatives and lessons learned in Europe (and beyond). In: Logan, R.A., & Siegel, E.R. (Eds). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 170-191.
Parker, R.M., & Ratzan, S.C. (2012). Health literacy: a second generation of direction for Americans. J Health Comm. 2010, 15 Suppl 2 (November), 20-33. doi: 10:1080/10810730.2010.501094
Rickard, R.V., & Hudson, S. (2020). How health literacy develops the ‘Four Aims’ of better health. In: Logan, R.A., & Siegel, E.R. (Eds.) Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 42-51.
Rudd, R. (2017). Health literacy: insights and issues. In: Logan, R.A., & Siegel, E.R. (Eds). Health literacy: New directions in research, theory, and practice. Amsterdam: IOS Press, p. 60-80.
Schillinger, D. (2020). The intersections between social determinants of health, health literacy, and health disparities. In: Logan, R.A., & Siegel, E.R. (Eds.). Health literacy in clinical practice and public health: New initiatives and lessons learned at the intersection with other disciplines. Amsterdam: IOS Press, p. 22-41.
Siegel, E.R. (2021). Don Lindberg’s outreach legacy at the National Library of Medicine. In: Humphreys, B.L., Logan, R.A., Miller, R.A., & Siegel, E.R. (Eds). Transforming biomedical information and health information access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press, p. 235-244.
Smith, K.A. (2021). Free MEDLINE access worldwide. In: Humphreys, B.L., Logan, R.A., Miller, R.A., & Siegel, E.R.(Eds). Transforming biomedical information and health information access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press, p. 167-177.
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle G., Pelikan, J., Slonska, Z., & Brand H. (HLS-EU) Consortium Health Literacy Project European. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. Jan 25; 12, 80. doi: 10.1186/1471-2458-12-80. PMID: 22276600; PMCID: PMC3292515.
Smith, S., & Carbone, E.T. (2023). Health literacy and empowerment in the COVID-19 era. Inf Serv Use. 43:2, 89-10.
Stephenson, W. (1967). The play theory of mass communication. Chicago: University of Chicago Press.
Wolf, M.S., Serper, M., Opsasnick, L., O'Conor, R.M., Curtis, L., Benavente, J.Y., Wismer, G., Batio, S., Eifler, M., Zheng, P., Russell, A., Arvanitis, M., Ladner, D., Kwasny, M., Persell, S.D., Rowe, J. A., Linder, S., & Bailey, C. (2020). Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak: A cross-sectional survey. Ann Intern Med. 173(2), 100-109. doi:10.7326/M20-1239.
Biosketch
Robert A. Logan, PhD, retired from the Senior Staff of the U.S. National Library of Medicine (NLM) in 2020 and is a professor emeritus at the University of Missouri-Columbia School of Journalism.
Logan was a professor, associate dean, and chair of the University Faculty Council at Missouri. He is the primary editor of: Betsy L. Humphreys, Robert A. Logan, Randolph A. Miller, Elliot R. Siegel. (Eds). Transforming Biomedical Information and Health Information Access: Don Lindberg and the U.S. National Library of Medicine. Amsterdam: IOS Press, 2022.
Logan was the project officer for several NLM research contracts, directed the Association of Health Care Journalists-NLM Journalism Fellows program, and participated in the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy from 2015-19. He wrote, narrated, and produced ‘To Your Health,” NLM’s weekly podcast from 2006-2019.
At NLM, Logan co-developed https://www.tuftsmedicine.org/research-clinical-trials/research-institutes-research-department/center-health-literacy-research-and-practice/health-literacy-tool-shed, a website to assist health literacy researchers, and chirr.nlm.nih.gov, a discontinued website that helped scholars understand significant constructs and theoretical frameworks in health communication. Earlier in his career, Logan was a science/medical newspaper reporter and editor.
Prior to joining NLM, Logan received more than $600,000 in grants and contracts as a principal investigator and more than $8 million as a co-investigator.
Dr. Logan has published more than 70 articles in refereed journals and a similar number of book reviews, mostly in Choice. Currently, he serves on the editorial board of four internationally prominent refereed journals in science communication and mass communication.
Logan is the first editor of two books about health literacy: Robert A. Logan, Elliot R Siegel. Health Literacy in Clinical Practice and Public Health: New Initiatives and Lessons Learned at the Intersection with Other Disciplines. Amsterdam: IOS Press, 2020; and Robert A. Logan. Elliot R. Siegel. Health Literacy: New Directions in Research, Theory, and Practice. Amsterdam: IOS Press; 2017.
Logan is the first author of four additional books: Social Responsibility in Science News: Four Case Studies (Washington: The Media Institute, 1997); and Environmental Issues for the 1990s: A Handbook for Journalists (Washington: The Media Institute, editions in 1993, 1994, 1995).
Logan twice served as President of the International Society for the Scientific Study of Subjectivity (ISSSS) and twice as Head of the Council of Divisions and the Mass Communication and Society Division within the Association for Education in Journalism and Mass Communication. He co-founded ISSSS and the International Health Literacy Association and currently serves on its Executive Board.
Dr. Logan's research areas include: health literacy; public understanding of science and biomedicine; theory and applications of Q methodology; and mass communication ethics. Logan is a member of the Journalism Advisory Board at California Polytechnic State University-San Luis Obispo and the Dean’s Leadership Advisory Council @ the Missouri School of Journalism.
Logan is a member of the Cosmos Club of Washington, D.C. He grew up in Highland Park, Illinois, received a BA from Tulane University in 1969, an MA from the Missouri School of Journalism in 1973, and a PhD from the University of Iowa School of Journalism and Mass Communication in 1977.