Download Health Communication Defined and Applied

Health Communication Defined and Applied
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Allison Erickson
April 2013
Table of Contents
Chapter
Page
1. Introduction ................................................................................................................................. 2
Health Communication ............................................................................................................... 2
The Scenario................................................................................................................................ 4
2.Communication Theory ............................................................................................................... 7
Theories Explored ....................................................................................................................... 7
3.Communicating with the Students ............................................................................................. 11
Effective Communication ......................................................................................................... 11
4. Communicating with Staff and Administration ........................................................................ 14
Sending an Informational Message ........................................................................................... 14
5. Communicating with Parents and Guardians ............................................................................ 16
Seeing the Whole Picture .......................................................................................................... 16
6. Summary ................................................................................................................................... 18
7. Recommendations ..................................................................................................................... 19
References ..................................................................................................................................... 21
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Chapter 1
Introduction
Health Communication
The Basics
Public health professionals are often tasked with the responsibility of communicating
aspects of health to a target audience. Often the target audience is policy making individuals or
groups and audiences in the general public. Health communication can specifically address a
small or large population given the topic needing communication. According to the Centers for
Disease Control and Prevention (CDC) (2011), health communication is, “The study and use of
communication strategies to inform and influence individual decisions that enhance health.”
Successful health communication programs, according to the National Cancer Institute (2008),
“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” (p. 2). For the first time, health communication objectives were included in Healthy
People 2010. The validation of the effectiveness of health communication continues to occur
throughout the United States in order to increase a change in health behaviors and policy making
(NCI, 2008).
Continuing, health communication is important for a number of reasons. First, health
communication can: Increase an individual or group’s knowledge and awareness of a health
problems or issues and solutions; provoke action; reinforce knowledge, attitudes, and
understanding; advocate for a particular position in regards to health policy; contest myths and
misconceptions; and increase demand for health services or changes (NCI, 2008). Secondly,
according NCI (20008) health communication cannot: Take the place of inadequate health care
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services or access to health 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” (p. 3); and cannot be equally
effective in addressing every issue of a complex health behavior or concern.
Health Communication Process
The health communication process is structured into four different parts, as indicated by
the NCI (2008). These four aspects include planning and strategy development; developing and
pretesting concepts, messages and materials; implementing the program; and assessing
effectiveness and making refinements. There is an immense amount of strategic planning that
goes into the development of successful health communication, no matter the target audience.
The National Prevention Information Network (NPIN) (2013) indicates that health
communication takes many forms, whether written or verbal, as well as traditional and new
media outlets. In addition, NPIN (2013) says that all strategic communication planning involves
a serious of steps. These steps include identifying the health problem and determining how the
communication will be a part of the intervention; determine the target audience for the
communication program and develop the best ways to reach them; test the communication
concepts, messages, and materials with different representatives from the target audience; with
results from the testing, then implement the health communication program; and, finally, assess
the effectiveness of the messages that reached the target audience and modify as needed (NPIN,
2013).
In order for a health message to be received as intended, health professionals spend large
amounts of time developing the message being communicated. Effective listening skills, clear
visions, and time sensitive behaviors are all vital in developing the messages. Furthermore, Unite
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for Sight (2013) suggests that in order for health communication to have an impact, there are
certain criteria that need to be met. These criteria are: Accuracy, availability, balance,
consistency, cultural competence, evidence-based solutions, reach, reliability, and repetition. To
focus on a few criteria, availability means that the content being communicated is accessible.
“Placement varies according to the audience, message complexity, and purpose, ranging from
interpersonal and social networks to billboards and mass transit signs to prime-time TV or radio,
to public kiosks, to the Internet” (United for Sight, 2013). Also, evidence-based information
allows the message to be credible instead of hypothesized and vague. Lastly, repetition means
that the delivery and/or access to the content are repeated over time to reinforce the impact and
to reach a larger number of individuals who may have missed the message in the beginning.
The Scenario
Disease Outbreak
A small community in Northern Minnesota with a population of 4,000 people, where
residents primarily working on local farms or in the downtown community in local businesses
and schools. Few residents work outside the community in other towns. The town has three four
schools; two elementary, one junior high, and one high school, all of which are public schools.
The local high school students travel numerous miles for extracurricular activities for sports and
music competitions due to the distance between each small town. In recent months, the local
health clinic has seen an influx in a sexually transmitted disease known as gonorrhea. Gonorrhea
is a bacterium that grows easily in the warm, most arias of the reproductive tract, including the
cervix, uterus, and fallopian tubes (CDC, 2012). Males, too, are subject to contracting gonorrhea
with infection in the urethra. Although gonorrhea is a common infectious disease, the community
is becoming concerned with the sexual practices of the local young population, especially the
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high school students. The CDC (2012) indicates that people can get gonorrhea by having sex
with someone who has the disease. “’Having sex’ means anal, vaginal, or oral sex. Gonorrhea
can still be transmitted via fluids even if a man does not ejaculate. Gonorrhea can also be spread
from an untreated mother to her baby during childbirth” (CDC, 2012).
The local health clinic began to see an influx of patients who reported a burning sensation
when urinating, as well as reporting whitish and yellow-colored discharge from the penis. These
symptoms can primarily from male clients. Nevertheless, there was an increase in female clients,
too. Symptoms that a female faces are often mild and can be confused with a bladder or vaginal
infection because the symptoms are similar to a male’s. Importantly, however, the CDC (2012)
notes that, “Women with gonorrhea are at risk of developing serious complications from the
infection, even if symptoms are not present or are mild.” These serious complications include
gonorrhea spreading to the fallopian tubes or the uterus, causing painful pelvic inflammatory
disease (PID). If PID becomes advanced, a woman may lose her ability to have children or
experience an ectopic pregnancy. If gonorrhea progresses more seriously in a male, it can cause
epididymitis in which the coiled tubes in the back of the testicle become inflamed. The
epididymitis can prevent a male from being able to produce sperm. In order to identify the cases
of gonorrhea, the local health clinic performed urine tests on all patients who presented
symptoms and reported having sexual relations in the past three weeks.
Health Communication Applied
Due to the increased number of students being diagnosed with gonorrhea, the local health
clinic called in public health officials from the Minnesota Department of Health. The health
officials were tasked with effectively communicating strategies for reducing the prevalence of
the disease to the high school students, provide action steps for the staff and administration of the
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school and school district, and educate parents or legal guardians in communicating effectively
with their children about safe sex practices. All communication is focused on reducing or
avoiding panic, clearly communicating the message for clear understanding, and measuring the
compliance to the message.
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Chapter 2
Communication Theory
Theories Explored
Communication for Persuasion Theory
The use of persuasive communication involves using verbal and non-verbal messages to
influence the attitudes and behaviors of a target audience (Ajzen, 1992). Designing a message to
sway the minds and hearts of the target audience is the main premise of persuasive
communication. Historically, the scientific work of persuasive communication began during
World War II to study to the effects of war-time propaganda. Then in the 1950s, Carl Hovland, a
professor at Yale University, performed extensive research on persuasive communication (Ajzen,
1992). “The empirical work of the Hovland group was guided by a loose theoretical analysis
based on learning principles, and by a conceptual framework that incorporated context variables,
target variables, and mediating processes” (Ajzen, 1992, p. 5). Hovland suggested that having
exposure to a persuasive message will suggest a new response, and then the new response
provides an opportunity to practice the response.
Continuing, the Hovland group also focused the scientific study of persuasive
communication on the effects of the communicator’s credibility.
Of all the contextual factors studied in the Hovland tradition, variations in the
source credibility have produced the most consistent findings. By and large,
communicators high in expertise and trustworthiness tent to be more persuasive
than communicators with low standing on these factors. (Ajzen, 1992, p. 5)
However, one may note that not all evidence suggests that a communicator’s credibility increase
an amount of change. Ajzen (1992) suggests that the high credibility may have a negative effect
on change. Even though a communicator may not have a high credibility, attractiveness and
social expertise may aid in persuasion.
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Persuasive communication is an important factor when communicating a message to
ignite behavior and policy change. The goal of persuasive communication is to change the
attitudes and actions of the target audience. In health communication, persuasive communication
is a key factor in advocating for the change in behavior or policy. Persuasion is gives the why in
a health communicators message. Without communicating the why, health communicators will
be less likely to promote change.
Cultivation Theory of Mass Media
The cultivation theory was developed by George Gerbner in 1977. Gerbner stated that,
“television has the power to influence our reality, and it is ‘primarily responsible for our
perceptions of day-to-day norms and reality’” (University of Oklahoma (OU), 2002, p. 4). The
television, according to Gerbner, was the main source of information for the American public;
therefore it is a central part of American culture. Part of Gerbner’s research compared light to
heavy television viewers and the perception of reality for each viewer after watching for a given
amount of time. “[Gerber] and his associates found heavy-television viewers are more likely to
perceive the world as it was portrayed on television. In fact, heavy viewers had a tendency to
view the world as a scarier place” (OU, 2002, p. 5). Essentially, television content and the
messages received contribute to the viewer’s biases or perceptions. For example,
A study of American college students found that heavy soap opera viewers were
more likely than light viewers to over-estimate the number of real-life married
people who had affairs or who had been divorced and the number of women who
had abortions (Chandler, 1995, p. 3).
Criticizers of the cultivation theory believe that Gerbner has over-simplified the theory.
Denis McQuail criticizes that a person’s behavior and attitude is influence by other social media
avenues, other than just the television (Chandler, 1995). In addition, “A correlation between
television exposure and the beliefs of viewers, do not, of course, prove that there is a causal
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relationship, although it may suggest the possibility of one” (Chandler, 1995, p. 4). There are
also criticisms that cultivation theorists have not used careful controls of various variables to
effect cultivation effects. Therefore, criticizers believe other factors that developmental stages,
education level, socio-economic background, and family attitudes should be variables and factors
studied to influence the impact of heavy and light television viewers.
Using the cultivation theory in health communication can either greatly help or hurt the
communicator’s message. Having a platform of communication on a television increases the
likelihood that the message will be seen and heard across a number of populations. However, for
individuals who have high television viewing behaviors, the message can turn into a false reality.
For example, say there is a public service announcement (PSA) that airs every 30 minutes on the
local channels in a community. This PSA focuses on the importance of childhood vaccination for
chickenpox. If an individual watches television often, especially on the local channels, this
message would be heard very often. So, according to the cultivation theory, this heavy television
viewer would, in some way, possibly begin to think that every child must get a chickenpox
vaccination to prevent further health risk. There would be little logical thinking about one’s own
personal choice because of assuming that every child must get one. Thus, the use of health
communication over the television really lies on the eyes and ears of the viewer and how often
the television is being viewed.
Mass Communication Theory
Media in the United States has continued to grow and change over the 20th and 21st
centuries. At the beginning of the 1900s, newspaper circulations were growing, radio was
beginning its development, and magazines were quickly growing (Self, Gaylord, & Gaylord,
2009). Later, television began to develop.
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The driving force for this development was an understanding about the role of
media in the United States. It was grounded in free market principles of the
Enlightenment and emerging ideas about mass, heterogeneous societies from
sociology. Communication media were thought to be good for making money,
good for informing citizens about issues important to them, good for finding truth
in democracy, and good for uniting the country. (Self et al., 2009, p. 32).
The developments of new media outlets gained the trust and faith of politicians, advertisers,
major companies, and ordinary citizens. This trust opened the doors for new schools of
journalism throughout the United States, as well as an increase in researchers focusing efforts on
data collection on how the media influences larger audiences. By the end of the 20th century,
newspaper circulation began declining and cable television and the internet began ruling much of
media world. Researchers began wondering how well media was informing citizens, instead of
offering added pleasure.
Mass communication continues to drive the way individuals receive messages.
Particularly for health communication, the mass media greatly impacts the receiver’s belief. As
stated prior, there can be a misunderstanding with mass communication where it becomes more
pleasurable and less informational. Health communicators learn to alter the message to be both
pleasurable and informational. This balance can be difficult to achieve. Using the appropriate
media resources for a specific message is a vital part of communicating the message correctly.
Today, social networking has become a large part of the mass communication family. With this
development, health communicators are learning to alter messages to particular populations
allowing for greater understanding and implementation of the new behavior or policy.
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Chapter 3
Communicating with the Students
Effective Communication
Tailoring the Message
Due to the outbreak of disease occurring among the students of the high school, the
public health officials find that this is the primary audience to communicate with. The students
are communicating with one another about the recent outbreaks, so the goal for public health
officials is to create an environment for safe and informative conversation. First, however, the
public health officials speak with the staff of the health clinic to determine what information has
been given to the students already. Once that has been figured out, the health officials are able to
clearly define the areas that must be discussed with the students. The items to be discussed with
the students include safe sex practices, how to find more information about gonorrhea, and what
is the next step if one would were to expect infection. All information that is communicated with
the students will be done during the school day. The health officials find that communication
during the school day is the best solution to making sure every student hears the messages being
communicated.
Safe Sex Communication
Even though many of the students have had education about safe sex practices, the health
communicators find that this is an essential aspect in reducing the number of gonorrhea cases.
Many times, sex education is one or two weeks long during the school year, giving no real
attempt for the information to be absorbed and implemented into the student’s lifestyle.
Therefore, by focusing a large part of the message on improving safe sexual behaviors, there is a
greater opportunity for the information to be absorbed. One tool that the health communicators
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will use is pictures and real stories of victims of a sexually transmitted disease. Yes, the pictures
can be disturbing and may create discomfort. However, as the saying goes, pictures speak a
thousand words. Students can hear a message over and over again without having any visual
connection. Therefore, the health communicators find it necessary to show the students what
gonorrhea can look like. By showing this message, students will then be able to assess
symptoms. In addition, the use of stories increases the likelihood the students will experience a
connection. Even though a student may not have gonorrhea, listening to a personal story helps
initiate a response to healthier lifestyle choices.
How to Obtain More Information
The health communicators are aware that many of the students run on social networking.
Therefore, there has been a number that students can text to receive information in a confidential
manner. In addition to the texting, the health officials have set up a 24 hour help line for the
student to call. This help line utilizes the resources at the Department of Health due to staffing
needs. The health clinic has also provided the office phone number to students to call to ask
questions and to schedule an appointment. Additionally, at least one health official has been
assigned to the high school every day for the next two weeks. This health official is available to
speak with the students in a private office to answer questions and have face to face
conversation. The health department saw this as an opportunity to increase the trust the students
can have with the health department and also a way to increase the knowledge about the
outbreak.
Communicating Next Steps
Due to the fact that the health communicators cannot stay in the town for months on end,
the messages must continue to be communicated. The health officials have developed posters,
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flyers, and brochures to have both at the high school and at the local health clinic. The texting
number has also been approved to be available as needed for the students on an ongoing basis.
Health officials decided keeping the line open for students, not only for the gonorrhea outbreak,
but for other health outbreaks will increase understanding and availability in getting questions
answered in a timely manner. Sexual transmitted disease outbreak is something that should not
be taken lightly; therefore, the health communicators see a great need for also educating the
clinic staff on effective health communication. The tools and resources utilized by the public
health officials are going to be available for the clinic to use. These tools and resources are a way
to continue the connection between public health, clinic staff, and the students of the local high
school.
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Chapter 4
Communicating with Staff and Administration
Sending an Informational Message
Decreasing Chaos, Increasing Understanding
When a small high school sees an increase in a sexually transmitted disease, the staff and
administration is likely to become fearful and chaotic. It is the role of the health communicator to
decrease this chaos and increase the understanding of the problem. The health communicators
will have a separate meeting with the primary administration before speaking with the entire
staff. Going to the leaders of the school, first, will give the health communicators and
understanding of the staff dynamics and how the message should be communicated for
understanding. The health communicators begin by informing the administration of the raw
facts; how many students are known to be infected, when it is estimated the outbreak began, and
what the public health department is currently doing. Giving the raw facts to the leaders creates a
baseline understanding of what is already known. Also, these facts will allow the administration
to help develop solutions to reduce the number of cases and reduce the likelihood this would
happen again.
After meeting with the administration, both the health communicators and administration
would communicate how the staff can assist with controlling the outbreak. Basic information
will be communicated to the staff as to what resources the students have available to them and
how to answer questions about the outbreak with students. Open communication between staff
and students creates and environment of trust and understanding. Also, because the staff will
have the information about the public health resources being provided, then the staff becomes a
tool for effective communication and understanding. Additionally, the staff will play a key role
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in offering understanding, rather than judgment about the disease. Sexually transmitted diseases
have a stigma that follows. Therefore, communicating what gonorrhea is and how it can be
contracted with the staff members creates a baseline foundation of education and understanding
throughout the school.
Continuing, the health officials have equipped the school’s administration and staff with
talking points when communicating with the parents and guardians of the students. Many of the
details regarding these resources will be addressed in the next chapter. Nevertheless, the
communicators recognize that there must be fluid and consistent messaging from the school, the
health clinic, and the health officials.
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Chapter 5
Communicating with Parents and Guardians
Seeing the Whole Picture
Reducing Fear, Expanding Knowledge
In the small town where the outbreak has occurred, many parents are fearful of the
diseasing spreading further. The health officials are aware that a child’s sexual practices are
rarely, if ever, known by the parents. Therefore, the lines between confidentiality and
understanding can be quite blurred. To reduce the fear in the parents, the health officials have
mailed general letters to parents of a high school student in the community. The following is an
example of the letter mailed:
To the Parent/Guardian of (student’s name),
In recent weeks, the local health clinic has informed the Minnesota Department of Health
of an increased number of gonorrhea cases in the community. Many of these cases have been
seen in students who are attending the Senior High. We understand that this is a sensitive subject
and may come as a surprise to many. However, the health and well-being of your student takes
priority. Therefore, we encourage you to have an open conversation with your student about the
situation at hand. If you are interested in how to have this conversation and would like tips,
please call us at 1-800-GET-INFO or visit our website at www.openthedoor.org. In addition, the
high school will be hosting informational sessions on Tuesday and Thursday over the next two
weeks. These sessions are an opportunity for you to gain understanding about the outbreak, ask
questions, and be equipped with resources and tools for communicating with your student.
Again, we understand that this is a sensitive and uncomfortable conversation to have, but we are
more than willing to support you and your student in becoming informed and taking action.
Sincerely,
The Minnesota Department of Health
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The intent of this letter is to provide a baseline for what is already known and how the parents
are able to effectively communicate with the student. It is vital for the health officials to be a part
of the conversation as much as the parents would need.
Sex Education for Parents
Although sex education was an important aspect when communicating with students,
many parents do not feel equipped in having an open conversation about safe sex behaviors.
Therefore, the health officials are also offering informational sessions at the high school two
nights a week for the next two weeks. These informational sessions are a chance for parents to
understand the outbreak more fully and also be equipped with tools and resources for effective
health communication. Additionally, the sessions provided by the health officials will offer the
whole picture when discussing sexual health. Sexual health involves being able to openly discuss
sexual behavior with individuals that one trusts. Therefore, the health communicators will spend
time communicating effective ways to opening the door to honest conversation with one’s child.
Essentially, even if the child is diagnosed with gonorrhea, there must be an open conversation.
Also, because this is a sensitive topic, the health officials have offered to sit in on the
conversations if asked to provide support for both the parent and the student. This was decided
because of the need for having a resource during a difficult conversation.
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Chapter 6
Summary
Health communication is a vital part in advocating for a change in behavior or policy. No
matter what the scenario, health communication must be clear and concise, as well as be tailored
to suit a target audience. In the given scenario, health officials were tasked with communicating
about a gonorrhea outbreak in a small town in Northern Minnesota. Given the sensitivity of the
disease outbreak, the officials needed to communicate the same message to three different target
audiences: the students at the high school, the administration and staff, and the parents or
guardians of the students. Each target audience played a critical role in reducing the spread of the
disease. The health communicators understood the needs of each audience and tailored
accordingly. Also, much of the communication was through education. In order to reduce chaos
and fear, the communicators understood that there had to be baseline knowledge of the disease
and how to prevent its spread before focusing on other aspects. All information was absorbed
and understood because the messages were tailored to the specific audiences. The health
communicators knew that the messages were clearly communicated and absorbed because the
health clinic saw a decrease in the amount of cases, but an increase in individuals being tested.
Also, the seminars held for the parents and guardians at the school had high attendance every
night, some parents coming more than once. Therefore, the health communicators knew the
messages communicated and the methods used were effective in reducing the prevalence of
gonorrhea in the community.
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Chapter 7
Recommendations
This author fully understands how important a health message is in preventing disease,
increasing understanding, and offering solutions. The theories of different communication styles
greatly influence how society views different messages. This author believes that the mass
communication and persuasion theory impact health messages the most. These theories are
impactful because the general public is surrounded by mass communication on a daily basis.
From internet, to television, to alerts on a mobile device, this author sees how a health message
must tailor to the world of mass communication. However, this author understands the
cultivation theory in how messages seen continually can either help or hurt a message’s impact.
Therefore, a health communicator must listen and be aware of how the target audience will best
absorb and implement the message into one’s daily lifestyle.
Continuing, this author recommends a health communicator use other resources to
increase the impact of the message. Bringing in other individuals who have a personal story
related to the content being communicated or using pictures and other images allows the target
audience to feel a sense of connection to the message. For example, this author appreciates the
television commercials for quitting tobacco use. There is no researcher behind a desk saying one
should quit tobacco because of the health risks. Rather, the commercial uses personal stories of
people who have lost limbs, throats, and family from tobacco use. The use of personal stories in
a health message makes the message real-life, not just research based. That is important when
communicating to the general public.
Overall, this author appreciates the amount of time and energy that is placed into a health
communicator’s message. Knowing one’s target audience and listening to the needs of the
audience is vital for the message to be received, absorbed, and implemented. As the world of
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mass communication continues to ebb and flow, health communicators must continue to
fluctuate how the health messages are being communicated. If not, the message will be lost in
translation with little change in the health behaviors and policies of our nation today.
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References
Ajzen, I., (1992). Persuasive communication theory in social psychology: A historical
perspective. University of Massachusettes – Amherst, 1-16.
Centers for Disease Control and Prevention. (2012). Gonorrhea – CDC fact sheet. Retreived
from: http://www.cdc.gov/std/Gonorrhea/gon-fact-sheet-press-june-2012.pdf
Centers for Disease Control and Prevention. (2011). Health communication basics. Retrieved
from: http://www.cdc.gov/healthcommunication/healthbasics/whatishc.html
National Cancer Institute. (2008). Making health communication programs work. Retrieved
from: http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/Pink_Book.pdf
National Prevention Information Network. (2013). Health communication strategies. Retrieved
from: http://www.cdcnpin.org/scripts/campaign/strategy.asp
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