|
Introduction
Questions to Ask and Answer
The Role of Health Communication in Disease Prevention and Control
What Health Communication Can and Cannot Do
Planning Frameworks, Theories, and Models of Change
How Market Research and Evaluation Fit Into Communication Programs
Selected Readings
-
Can communication help us achieve all or some of our aims?
-
How can health communication fit into our program?
-
What theories, models, and practices should we use to plan our communication program?
-
What types of evaluation should we include?
 There
are numerous definitions of health communication. The National Cancer Institute
and the Centers for Disease Control and Prevention use the following:
The study and use of communication strategies to inform and influence
individual and community decisions that enhance health.
Use the principles of effective health communication to plan and create
initiatives at all levels, from one brochure or Web site to a complete
communication campaign. Successful health communication programs involve more
than the production of messages and materials. They use research-based
strategies to shape the products and determine the channels that deliver them
to the right intended audiences.
Since this book first appeared in 1989, the discipline of health communication
has grown and matured. As research has continued to validate and define the
effectiveness of health communication, this book has become a widely accepted
tool for promoting public health. Healthy People 2010, the U.S.
Department of Health and Human Services’ stated health objectives for the
nation, contains separate objectives for health communication for the first
time. Meanwhile, the availability of new technologies is expanding access to
health information and raising questions about equality of access, accuracy of
information, and how to use the new tools most effectively.
Understanding what health communication can and cannot do is critical to
communicating successfully. Health communication is one tool for promoting or
improving health. Changes in health care services, technology, regulations, and
policy are often also necessary to completely address a health problem.
Communication alone can:
-
Increase the intended audience’s knowledge and awareness of a health issue, problem, or solution
-
Influence perceptions, beliefs, and attitudes that may change social norms
-
Prompt action
-
Demonstrate or illustrate healthy skills
-
Reinforce knowledge, attitudes, or behavior
-
Show the benefit of behavior change
-
Advocate a position on a health issue or policy
-
Increase demand or support for health services
-
Refute myths and misconceptions
-
Strengthen organizational relationships
Communication combined with other strategies can:
-
Cause sustained change in which an
individual adopts and maintains a new
health behavior or an organization adopts
and maintains a new policy direction
-
Overcome barriers/systemic problems,
such as insufficient access to care
Communication cannot:
-
Compensate for inadequate health care or access to health care services
-
Produce sustained change in complex health behaviors without the support of a larger program for change, including components addressing health care services, technology, and changes in regulations and policy
-
Be equally effective in addressing all issues or relaying all messages because the topic or suggested behavior change may be complex, because the intended audience may have preconceptions about the topic or message sender, or because the topic may be controversial
Communication Can Affect Multiple Types of Change
Health communication programs can affect change among individuals and also in
organizations, communities, and society as a whole:
-
Individuals—The interpersonal level is the most fundamental level of health-related communication because individual behavior affects health status. Communication can affect individuals’ awareness, knowledge, attitudes, self-efficacy, skills, and commitment to behavior change. Activities directed at other intended audiences for change may also affect individual change, such as involving patients in their own care.
-
Groups—The informal groups to which people belong and the community settings they frequent can have a significant impact on their health. Examples include relationships between customers and employees at a salon or restaurant, exercisers who go to the same gym, students and parents in a school setting, employees at a worksite, and patients and health professionals at a clinic. Activities aimed at this level can take advantage of these informal settings.
-
Organizations—Organizations are groups with defined structures, such as associations, clubs, or civic groups. This category can also include businesses, government agencies, and health insurers. Organizations can carry health messages to their constituents, provide support for health communication programs, and make policy changes that encourage individual change.
-
Communities—Community opinion leaders and policymakers can be effective allies in influencing change in policies, products, and services that can hinder or support people’s actions. By influencing communities, health communication programs can promote increased awareness of an issue, changes in attitudes and beliefs, and group or institutional support for desirable behaviors. In addition, communication can advocate policy or structural changes in the community (e.g., sidewalks) that encourage healthy behavior.
-
Society—Society as a whole influences individual behavior by affecting norms and values, attitudes and opinions, laws and policies, and by creating physical, economic, cultural, and information environments. Health communication programs aimed at the societal level can change individual attitudes or behavior and thus change social norms. Efforts to reduce drunk driving, for example, have changed individual and societal attitudes, behaviors, and policies through multiple forms of intervention, including communication.
Multistrategy health communication programs can address one or all of the above.
Communication Programs Can Include Multiple Methods of Influence
Health communicators can use a wide range of methods to design programs to fit
specific circumstances. These methods include:
-
Media literacy—teaches intended audiences (often youth) to deconstruct media messages so they can identify the sponsor’s motives; also teaches communicators how to compose messages attuned to the intended audience’s point of view
-
Media advocacy—seeks to change the social and political environment in which decisions that affect health and health resources are made by influencing the mass media's selection of topics and by shaping the debate about those topics
-
Public relations—promotes the inclusion of messages about a health issue or behavior in the mass media
-
Advertising—places paid or public service messages in the media or in public spaces to increase awareness of and support for a product, service, or behavior
-
Education entertainment—seeks to embed health-promoting messages and storylines into entertainment and news programs or to eliminate messages that counter health messages; can also include seeking entertainment industry support for a health issue
-
Individual and group instruction—influences, counsels, and provides skills to support desirable behaviors
-
Partnership development—increases support for a program or issue by harnessing the influence, credibility, and resources of profit, nonprofit, or governmental organizations
| Characteristics of Effective Health
Communication Campaigns |
| Certain attributes can make health
communication campaigns more effective. Use the guidelines in this section to
plan your campaign. |
Define the communication campaign
goal effectively:
-
Identify the larger goal
-
Determine which part of the larger goal could be met by a communication campaign
-
Describe the specific objectives of the campaign; integrate these into a campaign plan
|
Define the intended audience
effectively:
-
Identify the group to whom you want to communicate your message
-
Consider identifying subgroups to whom you could tailor your message
-
Learn as much as possible about the intended audience; add information about beliefs, current actions, and social and physical environment to demographic information
|
Create messages effectively:
-
Brainstorm messages that fit with the communication campaign goal and the
intended audience(s)
-
Identify channels and sources that are considered credible and influential by the
intended audience(s)
-
Consider the best times to reach the audience(s) and prepare messages accordingly
-
Select a few messages and plan to pretest them
|
Pretest and revise messages and
materials effectively:
-
Select pretesting methods that fit the campaign’s budget and timeline
-
Pretest messages and materials with people who share the attributes of the
intended audience(s)
-
Take the time to revise messages and materials based upon pretesting findings
|
Implement the campaign
effectively:
-
Follow the plans you developed at the beginning of the campaign
-
Communicate with partners and the media as necessary to ensure the campaign
runs smoothly
-
Begin evaluating the campaign plan and processes as soon as the campaign
is implemented
|
|
| Note.
Adapted from the University of Kansas Community Toolbox, Community Workstation,
available at
http://ctb.lsi.ukans.edu/tools/CWS/socialmarketing/outline.htm.
Accessed March 7,⁕2002. |
| Theories Guide Action to Increase
Mammography Use |
| Fox Chase Cancer Center, in
cooperation with area managed care organizations, designed a program that was
based on key elements of the health belief model to encourage women to have
regular mammograms. Selected women received educational materials explaining
that virtually all women are at risk for breast cancer, regardless of the
absence of symptoms, and that risk increases with age (susceptibility). The
materials stressed that early detection brings not only the best chance of cure
but also the widest range of treatment choices (benefit). Women received a
letter stating their physician#8217;s support (cue to action) and a coupon for
a free mammogram (to overcome the cost barrier). Those who did not have a
mammogram within 90 days received different forms of reminders (cues to
action). In the most intensive reminder, a telephone counselor called selected
women to review their perceptions about susceptibility, benefits, and barriers.
Program evaluation showed that mammography use increased substantially. |
| The Fox Chase program also applied
social learning theory in developing interventions to encourage physician
support of mammography and to improve clinical breast examinations (CBEs). The
planners examined the environmental and situational factors that might affect
physician behavior and tried to change the low expectations of physicians about
the benefits of breast screening. The interventions included observational
learning by watching an expert perform a CBE, an opportunity to increase
self-efficacy by practicing CBE with the instructor, and the use of a feedback
report and CME credits to reinforce physician skills. |
| In taking a community approach to
change, a UCLA mammography program used a diffusion of innovations model.
Community analysis showed that women who were early adopters (leaders) already
had a heightened awareness of the value of mammography. To reach middle
adopters, the program mobilized the social influence of the early adopters by
using volunteers who had breast cancer to provide mammography information. The
program also provided highly individualized educational strategies linked to
social interaction approaches to reach late adopters. A social marketing
framework influenced the program’s planning approach, and media materials
incorporated the health belief model to promote individual behavior change. |
|
| Note.
From "Audiences and Messages for Breast and Cervical Cancer
Screenings," by B. K. Rimer, 1995, Wellness Perspectives: Research, Theory,
and Practice, 11(2), pp. 13−39. Copyright by University of
Alabama. Adapted with permission. |
Communication programs can take advantage of the strengths of each of the above
by using multiple methods. A program to decrease tobacco use among youth, for
example, could include:
-
Paid advertising to ensure that youth are exposed to on-target, unfiltered
motivational messages
-
Media advocacy to support regulatory or policy changes to limit access to tobacco
-
Public relations to support anti-tobacco attitudes
-
Media literacy instruction in schools to reduce the influence of the tobacco industry
-
Entertainment education and advocacy to decrease the depiction of tobacco use in movies
-
Partnerships with commercial enterprises (such as retail chains popular among youth) to spread the anti-smoking message
Using multiple methods increases the need for careful planning and program
management to ensure that all efforts are integrated and consistently support
program goals and objectives.
Sound health communication development should draw upon theories and models that
offer different perspectives on the intended audiences and on the steps that
can influence their change. No single theory dominates health communication
because health problems, populations, cultures, and contexts vary. Many
programs achieve the greatest impact by combining theories to address a
problem. The approach to health communication we use in this book is based on
the social marketing framework. (See Appendix B for
an overview of some other relevant theoretical models.) Social marketing
concentrates on tailoring programs to serve a defined group and is most
successful when it is implemented as a systematic, continuous process that is
driven at every step by decision-based research, which is used as feedback to
adjust the program.*
| National Objectives for
Research and Evaluation |
| The Health Communication chapter of Healthy
People 2010, the nationwide health promotion and disease prevention
agenda, identifies increasing the proportion of health communication activities
that include research and evaluation as one of six objectives for the field for
the next decade (objective 11-3). This objective focuses attention on the need
to make research and evaluation integral parts of initial program design.
Research and evaluation are used to systematically obtain the information
needed to refine the design, development, implementation, adoption, redesign,
and overall quality of a communication intervention. |
 |
Why Use Theories and Models?
Although theories cannot substitute for effective planning and research, they
offer many benefits for the design of health communication programs. At each
stage of the process outlined in this book, theories and models can help answer
key questions, such as:
-
Why a problem exists
-
Whom to select
-
What you need to know about the population/intended audience before taking action
-
How to reach people and make an impact
-
Which strategies are most likely to cause change
Reviewing theories and models can suggest factors to consider as you formulate
your objectives and approach, and can help you determine whether specific ideas
are likely to work. Theories and models can guide message and materials
development, and are also useful when you decide what to evaluate and how to
design evaluation tools.
Conducting market research is vital to identifying and understanding intended
audiences and developing messages and strategies that will motivate action.
Evaluations conducted before, throughout, and after implementation provide data
on which to base conclusions about success or failure and help to improve
current and future communication programs.
Evaluation should be built in from the start, not tacked on to the end of a
program. Integrating evaluation throughout planning and implementation ensures
that you:
-
Tailor messages, materials, and activities to your intended audience
-
Include evaluation mechanisms (e.g., include feedback forms with a community guide)
-
Define appropriate, meaningful, achievable, and time-specific program objectives
Evaluating your program’s communication efforts enables you to:
-
Understand what is and is not working, and why
-
Improve the effort while it is under way and improve future efforts
-
Demonstrate the value of the program to interested parties such as partners, funding agencies, and the public
-
Help program staff see how its work affects the intended audiences
In this book, we address appropriate evaluation activities for each stage; see
the Communication Research Methods section for a
description of the different types of research and evaluation that support each
stage of the health communication process. See Appendix A
for sample forms and instruments.
* From Theory at a Glance: A Guide for Health Promotion
Practice (NIH Publication No. 97-3896), by the National Cancer
Institute, 1995. Bethesda, MD. In the public domain.
| Andreasen, A. (1995). Marketing social change: Changing behavior
to promote health, social development, and the environment. San
Francisco: Jossey-Bass. |
| Backer, T. E., Rogers, E. M., & Sopory, P. (1992). Designing
health communication campaigns: What works. Thousand Oaks, CA: Sage. |
| Bandura, A. (1986). Social foundations of thought and action: A
social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall. |
| Centers for Disease Control and Prevention. (2001). CDCynergy
2001 [CD-ROM]. Atlanta. |
| Glanz, K., Lewis, F. M., & Rimer, B. K. (Eds.). (1997). Health
behavior and health education: Theory, research, and practice (2nd
ed.). San Francisco: Jossey-Bass. |
| Glanz, K., & Rimer, B. K. (1995). Theory at a glance: A guide
for health promotion practice (NIH Publication No. 97-3896). Bethesda,
MD: National Cancer Institute. |
| Goldberg, M. E., Fishbein, M. F., & Middlestadt, S. E. (Eds.).
(1997). Social marketing: Theoretical and practical perspectives. Mahwah,
NJ: Erlbaum. |
| Green, L.W., & Kreuter, M.W. (1999). Health promotion
planning: An educational and ecological approach (3rd ed.). Mountain
View, CA: Mayfield. |
| Maibach, E., & Parrott, R. L. (Eds.). (1995). Designing health
messages: Approaches from communication theory and public health practice.
Thousand Oaks, CA: Sage. |
| National Cancer Institute. (1993). A picture of health (NIH
Publication No. 94-3604). Rockville, MD: U.S. Department of Health and Human
Services. |
| Rimer, B. K. (1995). Audiences and messages for breast and
cervical cancer screenings. Wellness Perspectives: Research, Theory, and
Practice, 11(2), 13−39. |
| Siegel, M., & Doner, L. (1998). Marketing public health:
Strategies to promote social change. Gaithersburg, MD: Aspen. |
| U.S. Department of Health and Human Services. (2000). Healthy
people 2010 (2nd Ed.; in two volumes: Understanding and improving
health and Objectives for improving health.). Washington, DC: U.S.
Government Printing Office. |
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