**4. Theoretical framework**

To propose a theoretical framework of HMD, Parse's ground theory of human becoming was borrowed, which encompasses three major themes: meaning, rhythmicity, and co-transcendence [20]. The theory of human becoming was developed to move nursing's view of a person from a medical model to a human science [50]. In the theory, the person is seen as "a participant in experiencing situations." The theory explains "how the meaning in any situation is related to the particular constituents of that situation" [51]. Parse emphasized that a human being can become human becoming by exchanging energies through interaction between other human beings and their environment [52–54].

Parse identified nine themes from the three philosophical assumptions (**Table 1**). In the theory, "meaning" refers to an ever-changing interpretation one gives to what is valued and the ways in which these interpretations reflect the person's reality. "Rhythmicity" refers to the cadent, mutual patterning of the human-universe mutual process. "Transcendence" refers to reaching beyond the possible, to the hopes and dreams envisioned in multidimensional experiences [20, 50, 52].

Human becoming is (1) freely choosing personal meaning in situations in the inter-subjective process of living value priorities, (2) co-creating rhythmical patterns of relating in mutual process with the universe, and (3) co-transcending multidimensionally with the emerging possible [20, 51, 54, 55]. **Figure 2** presents the concept of HMD based on these philosophical principles as a medium of communication within the health information context.

In this context (**Figure 2**), "meaning" is the effort to create an other-centered environment with the view that human care and the healthcare environment are not fixed; therefore, the other is an individual entity as a whole (illuminating meaning of others' experience). "Rhythmicity" is the development of partnership through openness of environment, that is, the development of empathy through continuous relationship with others (concurrently synchronizing rhythms for patients and their family members or caregivers). "Co-transcendence" is infinite potentiality to expand empathy, strengthening one's own specific method and mobilizing transcendence, reaching beyond and transforming toward possibility.

The ultimate product of HMD is better health outcomes, which facilitate the healing process and human dignity by way of "caring presence" [56]. This is in the same vein with the "ethics of care" based on emotion that is advocated by Carol Gilligan [57], which originates from the premises that (1) as humans, we are inherently relational and responsive beings and (2) the human condition is one of connectedness and interdependences (**Figure 3**). Ethics of care

directs our attention to the need for responsiveness in relationships (paying attention, listening, responding) and to the costs of losing connection with oneself or with others. Its logic is

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Current practice establishes providers as advocates for their consumers. For example, pain perceived by patients should be understood not just as a complaint but as a part of agony. This is why medical humanism must embrace the patients' pain [10, 27, 58]. The essence of suffering, as depicted by Eric Cassell, is "experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity" [27]. Parse's theory of human becoming also assists individuals in taking an active decision-making role in self-care, so that patients feel empowered [20, 54].

inductive, contextual, and psychological, rather than deductive or mathematical.

**Figure 2.** Health information context.

**Figure 3.** Ethics of care.


**Table 1.** Three principles of Parse's human-becoming theory.

**Figure 2.** Health information context.

**4. Theoretical framework**

32 Selected Issues in Global Health Communications

experiences [20, 50, 52].

**Nine themes from philosophical assumptions**

Meaning Imaging, valuing, languaging

Co-transcendence Powering, originating, transforming

**Table 1.** Three principles of Parse's human-becoming theory.

other human beings and their environment [52–54].

To propose a theoretical framework of HMD, Parse's ground theory of human becoming was borrowed, which encompasses three major themes: meaning, rhythmicity, and co-transcendence [20]. The theory of human becoming was developed to move nursing's view of a person from a medical model to a human science [50]. In the theory, the person is seen as "a participant in experiencing situations." The theory explains "how the meaning in any situation is related to the particular constituents of that situation" [51]. Parse emphasized that a human being can become human becoming by exchanging energies through interaction between

Parse identified nine themes from the three philosophical assumptions (**Table 1**). In the theory, "meaning" refers to an ever-changing interpretation one gives to what is valued and the ways in which these interpretations reflect the person's reality. "Rhythmicity" refers to the cadent, mutual patterning of the human-universe mutual process. "Transcendence" refers to reaching beyond the possible, to the hopes and dreams envisioned in multidimensional

Human becoming is (1) freely choosing personal meaning in situations in the inter-subjective process of living value priorities, (2) co-creating rhythmical patterns of relating in mutual process with the universe, and (3) co-transcending multidimensionally with the emerging possible [20, 51, 54, 55]. **Figure 2** presents the concept of HMD based on these philosophical

In this context (**Figure 2**), "meaning" is the effort to create an other-centered environment with the view that human care and the healthcare environment are not fixed; therefore, the other is an individual entity as a whole (illuminating meaning of others' experience). "Rhythmicity" is the development of partnership through openness of environment, that is, the development of empathy through continuous relationship with others (concurrently synchronizing rhythms for patients and their family members or caregivers). "Co-transcendence" is infinite potentiality to expand empathy, strengthening one's own specific method and mobilizing

The ultimate product of HMD is better health outcomes, which facilitate the healing process and human dignity by way of "caring presence" [56]. This is in the same vein with the "ethics of care" based on emotion that is advocated by Carol Gilligan [57], which originates from the premises that (1) as humans, we are inherently relational and responsive beings and (2) the human condition is one of connectedness and interdependences (**Figure 3**). Ethics of care

principles as a medium of communication within the health information context.

transcendence, reaching beyond and transforming toward possibility.

Rhythmicity Revealing-concealing, enabling-limiting, connecting-separating


**Figure 3.** Ethics of care.

directs our attention to the need for responsiveness in relationships (paying attention, listening, responding) and to the costs of losing connection with oneself or with others. Its logic is inductive, contextual, and psychological, rather than deductive or mathematical.

Current practice establishes providers as advocates for their consumers. For example, pain perceived by patients should be understood not just as a complaint but as a part of agony. This is why medical humanism must embrace the patients' pain [10, 27, 58]. The essence of suffering, as depicted by Eric Cassell, is "experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity" [27]. Parse's theory of human becoming also assists individuals in taking an active decision-making role in self-care, so that patients feel empowered [20, 54]. Accordingly, other-centered or audience-centered HMD highly regards the various channels for communication that makes access to healthcare service consistent [44, 58].

should be conducted to propose theoretically adequate constructs, to empirically test and validate the constructs, and examine the relationships between the constructs to generate empirical evidence [64]. The individual effects model, which focuses on individuals as they improve their knowledge and attitudes, and the social diffusion model, which leads to behavior change among social groups, may be considered to pose theoretical constructs within the

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Previous research has consistently reported that a directional gap exists when conceived of communication. A majority of the studies show communications *from* providers *to* consumers, and the remainder show communications *between* providers and consumers [60]. Therefore, communications *from* consumers (i.e., self-reporting), *between* consumers (i.e., self-help groups), or *to* providers from another source (i.e., communication training) should be carefully designed at both the policy and programmatic levels [60, 63]. No matter how knowledgeable healthcare providers might be, if they are not able to successfully communi-

The initial work of this study was presented at the International Association of Societies of Design Research 2015, Brisbane, Australia. The travel was fully supported by the National Research Foundation (NRF) of Korea Grant (NRF-2014S1A5B8044097) funded by the Korean Government, Korea. To further define and utilize social communication in healthcare, this study has been continuously developed by the support of Provost's Grant for Multidisciplinary Research (2018–2019) funded by Rutgers, The State University of New Jersey—Camden, USA,

The authors certify that there is no conflict of interest with any financial or non-financial inter-

1 School of Nursing, Rutgers, The State University of New Jersey, Camden, NJ, USA

2 Integrated u-Healthcare Design, Design Institute, College of Design, Inje University,

context [63].

**Acknowledgements**

**Conflict of interest**

**Author details**

Ji-Young An1

South Korea

cate with their consumers, they may not be of help.

as well as the NRF of Korea Grant (NRF-2017S1A5B8066096).

est in the subject matter or materials discussed in this manuscript.

\*

and Jinkyung Paik2

\*Address all correspondence to: dejpaik@inje.ac.kr
