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Promoting Immediacy in Health Communication Gary L. Kreps, Ph.D., University Distinguished Professor Director, Center for Health and Risk Communication George Mason University Fairfax, VA 22030, USA [email protected] How can we communicate to build meaningful and collaborative health promoting relationships? Effective health communication depends more on the quality of the messages we exchange than on the media we use to convey health messages! Too many health messages are: & unimaginative (just the facts m’aam) Overly technical (medicalese) Overly complex & formal (bureaucratic) Insulting/disempowering (clean up your act) Directive/prescriptive (we know what’s best for you) Static (our way or the highway) Not much fun (limited entertainment value) One-way (limited interaction) Boring Health communication is often too artificial to achieve health goals: ♦ ♦ ♦ ♦ ♦ ♦ ♦ How engaging are most HC messages? Do we capture audience attention (exposure)? Do we communicate clearly (literacy)? Do we communicate humanely (sensitivity)? Do we communicate persuasively? Do we adapt well to unique individuals? Do we promote immediacy? Immediacy refers to communication that promotes: ♦ ♦ ♦ ♦ ♦ ♦ ♦ Physical and emotional closeness Comfort Engagement and caring Personal involvement Intensity and enthusiasm Authenticity Enjoyment Where is the Passion in Health Communication Programs (HCPs)? ♦ ♦ ♦ ♦ ♦ ♦ ♦ Do HCPs move you? Do HCPs provide both the sizzle and the steak? Are HCPs robotic? Are HCPs soulful or soul-less? Are HCPs alienating or encouraging? Are HCPs emotionally provocative & engaging? Are HCPs interesting/relevant to users? Immediate communication can enhance health promotion: ♦ ♦ ♦ ♦ ♦ ♦ ♦ Increase access (exposure) to health information Improve quality of communication & care Increase consumer participation/involvement Promote coordination of care/services Relieve demands on health care staff Reduce costs/increasing efficiency Influence health behaviors/outcomes Demonstrated outcomes derived from immediate communication: Brings communicators closer together Enhances expression of affect Increases cognitive and affective learning Increases perceptions of credibility & identification Enhances motivation & participation Encourages communication and feedback Reduces resistance & verbal aggression Nonverbal aspects of immediacy can demonstrate: Friendliness (smiling, congruence, proximity) Animation (movement, gestures, vocal variety) Involvement (eye contact, touch, direct orientation) Excitement (vocal intensity, expressions, design) Comfort (relaxed body posture, proximity, touch) Caring (congruent expressions, appropriate touch) Verbal aspects of immediacy can demontrate: Familiarity (refer to person by name, experience) Involvement (use collective terms like “we” and “us”) Clarity (familiar terms, explain complex concepts) Interest (personal interaction, relevant small talk) Reinforcement (specific and appropriate feedback) Shared Control (input, feedback, and preferences) Caring (congruence, concern, and empathy) Immediacy can help meet reciprocal interpersonal needs: Inclusion (need to include others and to be included) Control (need to exert control and let others control) Affection (need to express and receive affection) (Schutz, W. (1958) FIRO: A Three Dimensional Theory of Interpersonal Behavior. NY: Holt, Rinehart and Winston.) The best health interventions use immediacy to engage audiences ♦ Use relevant communication messages ♦ address personal concerns ♦ are dramatic and interactive ♦ Develop involving messages ♦ ♦ tie in to values and concerns adjust to unique needs/issues Immediate health interventions are responsive to users’ Beliefs, values, norms, & expectations Experiences and concerns Language skills and orientations Health literacy levels (language & numbers) Levels of motivation to seek health information Media use patterns Social network memberships Immediacy helps to capture audience attention: Connects users on a personal level (empathy) Engages users dramatically (dynamism) Provides vivid, relatable, models (identification) Adapts messages to specific users (personal) Uses multiple complimentary messages (reinforce) Illustrates key concepts (visual/narrative) Provides subconscious encouragement (motivate) Tailors messages to individual needs (adapt) The immediacy of information sources is influenced by: Credibility (believable) Familiarity (comfortable) Expertise (knowledgeable) Engagement (friendly/convivial/interesting) Trust (consistent & fair) Reliability (available when needed) Sensitivity (caring & appropriate) The most immediate health messages are: Close and familiar (comfortable for users) Easy to understand (makes sense to me) Dramatic and memorable (emphatic) Embedded in compelling stories (narrative) Easy to apply (builds self-efficacy) Reviewable (take-away media & messages) Interactive (provides feedback loops) Reinforcing (motivating) Communication research/planning is key for promoting immediacy! ♦ Audience analysis/needs analysis (foundation for intervention design) ♦ Participative design (work with audience members) ♦ Message and media testing (develop/refine communication strategies) ♦ Usability testing (key user response data) ♦ Formative, Process, and Summative evaluation (adapting strategies, what works & why) References to immediacy and instructional outcomes research: Andersen, J.F. (1979). Teacher immediacy as a predictor of teaching effectiveness. In D. Nimmo (Ed.), Communication Yearbook, 3 (pp.543-559). New Brunswick, NJ: Transaction. Arbaugh, J. B. (2001). How instructor immediacy behaviors affect student satisfaction and learning in web-based courses. Business Communication Quarterly, 64: 42-54. Chesebro, J.L. and McCroskey, J.C. (2001). The relationship of teacher clarity and immediacy with student state receiver apprehension, affect, and cognitive learning. Communication Education, 50, 59-68. Gorham, J. (1988). The relationship between verbal teaching immediacy behaviors and student learning. Communication Education, 17, 40-53. Kelley, D.H. and Gorham, J. (1988). Effects of immediacy on recall of information. Communication Education, 37, 198-207. Pogue, L. and AhYun, K. (2006). The effect of teacher nonverbal immediacy and credibility on student motivation and affective learning. Communication Education, 55, 331-344. References to immediacy and health communication: Kreps, G.L. (2014). Achieving the promise of digital health information systems. Journal of Public Health Research 3:471, pp. 128-129. Kreps, G.L., & Neuhauser, L. (2013). Artificial intelligence and immediacy: Designing health communication to personally engage consumers and providers. Pt. Ed. & Counseling, 92, 205-210. Neuhauser, L., Kreps, G.L., Morrison, K., Athanasoulis, M., Kirienko, N., & Van Brunt, D. (2013). Using design science and artificial intelligence to improve health communication: ChronologyMD case example. Patient Education and Counseling, 92, 211-217. Kreps. (2012). Consumer control over and access to health information. Annals of Family Medicine, 10(5). http://www.annfammed.org/content/10/5/428.full/reply#annalsfm_el_25148 Kreps. (2012). Engaging health communication. In T.J Socha and M.J. Pitts. (Eds.). The positive side of interpersonal communication (pp. 249-258). New York: Routledge. Neuhauser & Kreps. (2011). Participatory design and artificial intelligence. In Green, Rubinelli, & Scott. (Eds.). Al and Health Communication (pp. 49-52). AAAI Press. Kreps & Neuhauser (2010). New directions in ehealth communication: Opportunities and challenges. Pt Ed & Counseling, 78, 329-336. Kreps & Neuhauser (2010). E-Health and health promotion. Journal of Computer-Mediated Communication, 15(4), 527-529.