media coverage of health issues and how to work more effectively with journalists: a qualitative...

RESEARCH ARTICLE Open Access

Media coverage of health issues and how towork more effectively with journalists:a qualitative studyJulie Leask1*, Claire Hooker2, Catherine King3

Abstract

Background: The mass media has enormous potential to influence health-related behaviours and perceptions.Much research has focused on how the media frames health issues. This study sought to explore how journalists inAustralia select and shape news on health issues.

Methods: The study involved semi-structured interviews with 16 journalists from major Australian print, radio andtelevision media organisations reporting on avian influenza and pandemic planning. Journalists, including reporters,editors and producers, were interviewed between October 2006 and August 2007. Thematic analysis was used todraw out major lessons for health communicators.

Results: Journalists routinely attempted to balance different, sometimes competing, aims amidst significantoperational constraints. They perceived the most trusted sources on health issues to be respected andindependent doctors. Specialist health and medical reporters had a more sound technical knowledge, channels toappropriate sources, power within their organisations, and ability to advocate for better quality coverage.

Conclusions: An awareness of how to work with the media is essential for health communicators. This includesunderstanding journalists’ daily routines, being available, providing resources, and building relationships withspecialist health reporters.

BackgroundIt is well recognised that the media plays an enormouslyinfluential role in public responses to health issues. Themass media - print, television, radio and internet - hasan unparalleled reach as a communication mechanism[1]. It has substantial power in setting agendas, that is,what we should be concerned about and take action on,and framing issues, that is, how we should think aboutthem [2].Public health professionals have always been sensitive

to the persuasive power of the mass media [3,4]. In factpublic health has often had the challenging task of bothusing the media to influence health practices whilecountering this same influence where it encourages

unhealthy choices. These issues are especially acute in acrisis, such as the current A(H1N1) ‘swine’ influenzapandemic. On such occasions hitting the right pitch iscrucial, and difficult. Health communicators may needto advocate rapidly and effectively for the public adop-tion of basic preventive measures, like handwashing,while such messages may be displaced in a mass mediadominated by discussion of technical interventions, suchas thermal scanners.For public health communicators to attempt to

achieve their goals, it is essential to understand how themass media works. Over the past three decades, a num-ber of works have investigated how news is sought andshaped by journalists within media organisations [5-8].Others have proposed strategies for increasing newscoverage of significant health and medical issues [9]. Butthese strategies need to be pursued carefully. It is wellrecognised that the mass media, especially its traditionalcomponents, print, television and radio, is in many waysa poor vehicle for the communication of scientifically

* Correspondence: [email protected] Research Fellow and Conjoint Senior Lecturer, National Centre forImmunisation Research and Surveillance, The Children’s Hospital atWestmead, Discipline of Paediatrics and Child Health, University of Sydney,AustraliaFull list of author information is available at the end of the article

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accurate information about health and medicine, proneto sensationalism, sins of omission, and sheer inaccu-racy. Many health and medical scholars and profes-sionals would agree with those doctors and newscommentators who recently stated that the media failshealth services, and that the structural limitations onnews production made “evidence based journalism” a“forlorn hope” [10-12].Significantly though, none of these dispirited commen-

tators had researched the views of on-the-ground news-room journalists, producers or editors, the people whoselect, shape and present news [13]. While many studiesof news production processes exist, few address implica-tions for public health directly, nor explore ways inwhich it can extend its reach and impact through themass media. Some do identify that health communica-tion will always be limited within the mass media[14,15]. The fact that health professionals and journalistshave different values and goals - not to mention differ-ent concepts of validity, objectivity and significance - isas well known as the frustrations that arise from thesedifferences [14,16]. Journalists tend to use anecdotal orrhetorical rather than statistical evidence; rely on experttestimony rather than on publications; emphasise con-troversy rather than consensus; and represent issues interms of polarities rather than complexities [14]. Thereare significant barriers to increasing quality of healthand medical reporting. These include: lack of technicaltraining for journalists [6], the time constraints of newsproduction [7,15], and the commercial imperatives thatdrive story selection and headlines [6,15].However, it is not all bad news. Research on reporters’

attitudes and practices shows that their concerns andaspirations are often much closer to those of the healthand medical professionals they report on, and some-times place them in some conflict with editors and pro-ducers [8,15,17]. Editors and producers in turn confronttensions between economic and structural imperativesand their own sets of values and commitments. Thiscomplexity makes researching journalists very impor-tant, and suggests the possibility for improved engage-ment with the mass media [7,18].Furthermore, public health can have a more productive

engagement with the mass media if there is greater under-standing of how health news is constructed within mediaorganisations. Armed with this knowledge, public healthprofessionals engaged in advocacy can have the greatestpossibility of working with, rather than against, the media.Accordingly, this study aimed to identify how journal-

ists from all sectors of the news production processworked within their organisations to select, shape andpresent health news stories. It was conducted as part ofa wider study examining the production of news onavian influenza. The study offers recommendations for

public health professionals in working more effectivelywith the media. It adds to the relatively small pool ofempirical literature on journalistic practices in healthand medical contexts [7,8,19].

MethodsStudy designThis paper reports on some of the findings from a studythat was designed to seek journalists’ perceptions andreporting practices on avian/pandemic influenza. Weconducted interviews with journalists between October2006 and August 2007, many months after a peaking ofmedia reporting of the avian influenza threat thatoccurred in Australian between October and December2005. The interviews were semi-structured and dividedinto two parts. Participants were told they would beasked general questions about journalistic practice fol-lowed by specific questions about pandemic influenzareporting. This paper focuses on the general questions,including how stories were selected, how the focus or‘angle’ was formed, and how journalists perceived ethi-cal, social and other issues in their work.

Recruitment and samplingEthical approval was gained from The University of Syd-ney Human Research Ethics Committee (Ref 9345). Parti-cipants were Australian reporters, editors and producersin newsprint and broadcast (radio and television) mediaknown to have been involved with reporting on avian/pandemic influenza. We recruited to ensure a mix ofmajor cities and type of media organisation includingcommercial and non-commercial, broadsheet andtabloid. Both specialist medical journalists and non-medi-cal journalists were included. Criterion sampling wasused for print journalists. We approached those withnine or more bylines selected from 1200 Australian printmedia articles on pandemic influenza sourced from theFactiva news media database at the peak of reporting onthe avian influenza threat in late 2005. For television andradio participants, advice was sought from two intervie-wees to name journalists who were likely to report fre-quently on this topic. We sought more print journalistsbecause television and radio news is often selected fromthe major daily newspapers and hence they have a moreimportant role in selecting and framing news. Our studywas focused on journalists working in the traditionalmass media, since this media still tends to be identifiedas setting the agenda for public discussion, and becausethose working in traditional mediums were often report-ing, or reported, online as well.

Data collectionThe majority of interviews were conducted via telephoneby one researcher (JL) and lasted approximately


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30 minutes. Interview confidentiality was explained toeach participant along with a description of how theirquotes would be attributed in reports in terms of theirgeneral work designation. Consent forms were signedand all interviews were digitally recorded, transcribedverbatim and imported into NVivo v.7 qualitativesoftware.

AnalysisThis study focuses on the general aspects of the journal-ists’ work. Analysis was informed by a priori interests inhow media messages are framed along with the questionof how health professionals using the media can bestwork with journalists [9,20]. Coding was primarilyundertaken by one researcher (JL) and proceeded itera-tively according to the principles of thematic coding[21]. Preliminary codes were identified and then cate-gorised and developed into more abstracted themes thatcaptured participants’ contextual responses to the con-straints of media production processes. A subset ofeight transcripts were also reviewed independently by asecond researcher (CK) and themes discussed andrevised. The coded text was reviewed by all researchersand re-categorised to demonstrate connections and rela-tionships between themes in a process loosely influ-enced by recent evolutions in grounded theorytraditions [22]. Each theme was then reviewed by allauthors to discuss general findings, exceptions anddifferences between participant groups.

ResultsTwenty-three journalists were approached. Threedeclined; three did not respond; and one interviewrecording failed. Sixteen interviews were analysed. Thejournalists were senior with a median of 14.5 years injournalism (range: 5-37 years). Most had worked formultiple organisations and in differing roles althoughthey usually stuck to the one medium, for example,print. Of the entire sample, seven were specialist health/medical reporters. Table 1 shows the type of media androle for the participants.Our primary finding was that journalists routinely

attempted to balance different, sometimes competing,aims (e.g. between depth and newsworthy quality) amidsignificant operational constraints. In this paper, we

identify these constraints through an examination ofjournalists’ daily newsgathering routines. We show howjournalists were committed to various ethical principleswithin these constraints. Finally, we argue that specialistmedical reporters have much greater capacity to pro-duce and advocate for quality health stories. While thisanalysis focuses on the general aspects of news report-ing, the journalists made their responses in the contextof a discussion on reporting on avian influenza, then asignificant (if fading) health risk issue.

Daily newsgathering routinesTime: opportunities, limits, deadlinesThe daily schedule and strict deadlines dominated thedays of all the journalists in this study. Most journalistshad only a concentrated time window between about 10am and 2 pm to assemble their story: to gather back-ground information, become familiar with technicalaspects of the issue, find and conduct interviews, updateeditors or producers, and check the accuracy of draftsor scripts. The stories themselves were usually brief,particularly in broadcast news, where they rangedbetween 1.5 and 3.5 minutes. As one journalist com-mented,

On one axis you have maximum accuracy, integrity,detail - all of those wonderful things. And then onthe other one you’ve got time. Your job is to do thebest you can within that parameter. (Newspapermedical reporter)

In both television and print media, the stories for theday would be identified, reviewed and allocated during amid morning news conference of producers/editors whodetermined what stories would run and often theirangle. A second mid afternoon news conference finalis-ing prominence effectively formed the deadline for newstories, after which all but the most newsworthy storieswould be excluded.Selecting news and forming the angleA very high volume of information inflow meant editors,producers and reporters had to exercise much judge-ment on selection of news. Some participants had diffi-culty in clearly articulating what drove them to chooseone story over another. One producer described a gen-eral ability fostered by many years in journalism.

Our key job is news judgement, which all journoslearn about and spend their whole lives developingand changing etc. (Producer, television news)

Other participants reflected on what made a storynewsworthy and, while a general question, it is likelytheir responses suggest they had avian and pandemic

Table 1 Interviewed Australian journalists in study ofnews reportage of health issues

Reporter Producer/Editor Total

Newspaper 6 2 8

Radio 2 1 3

Television 2 3 5

TOTAL 10 6 16


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influenza in mind. A story’s ability to gain entry to theday’s news was influenced by it emerging during peaknews gathering times; by momentum; sensationalism(fear, death, destruction, such as a threatened pan-demic); novelty (new, fresh, exciting, different, quirkysuch as a new medical technology); whether it involveddisagreement or controversy; was something thataffected audiences directly; had local relevance; or had amoral element. Sometimes the criteria were mediumspecific, for example, good visuals for television. Theseelements of newsworthiness tended to be those commonto all news sectors, not just health.

What’s new, fresh, exciting, different, what people aregoing to say, ‘Gee, is that right’? (Newspaper medicalreporter)

The interviews highlighted the derivative nature ofparticularly broadcast news, which largely confineditself to expanding on stories emerging from the wiresand morning newspapers. All daily news and currentaffairs journalists reported watching the wire feedsand their competitors in both print and broadcastmedia. This meant that news selection and angle for-mation were oriented around distinguishing oneselffrom one’s competitors. For journalists with the abilityto source their own stories (usually medical reporters),going local - using local experts, local audiences andhand picked real-life cases - was regarded as the pre-mier means of providing a novel angle and compellingstory.

It’s quite competitive - you’re trying to get some sortof fresh angle that nobody else has, which means youwork the contacts quite a bit, depending on whicharea, you’ll be ringing around people who you knowmight be in the know or have a pretty good idea ofwhat’s going on. (Newspaper medical reporter)

Finding and quoting sourcesJournalists’ sources of information for stories were bothpassively acquired (e.g. media contacts, media releases),particularly in the morning, and actively sought (e.g.calling local medical experts, medical journal contents).The best people to interview for health stories wereseen to be accessible, independent, highly respected intheir fields, and preferably doctors. All journalistsneeded access to expert sources who could rapidlyrespond to requests for background information, inter-views or verification and who could condense informa-tion into ready-made soundbites. Non-medical reporterswith little science background found it important toaccess brief, readily digestible information, and keypoint fact sheets were particularly helpful with moretechnical issues. Cases of interest and angles conveying

the direct relevance of the story to audiences were alsosought.

Often I do get pointy headed stories and twist themaround to a more consumer oriented angle....But if Ican’t find a line that means something for a subur-ban family then it’s usually going to be difficult toget it into a newspaper. (Newspaper medicalreporter)

In broadcast media, the critical resource was the visualimage. The availability and vividness of images was astrong determinant of whether a story ran at all, andhow prominent it was.

Managing constraints: the ethics of reportingJournalists were keenly aware of shortcomings inmedia stories as a result of constraints on time, spaceand resources. Many compensated for these con-straints by adhering as best they could to their tenetsof quality journalism: being informative, responsibleand critical.Being informativeAs in other studies, journalists articulated an over-whelming commitment to keeping the public informed.This was foundational to their resolution of ethicalissues in their professional lives. While they were awareof and concerned about public impacts of some report-ing, they felt the act of reporting to be of primaryimportance:

Most journalists would always err on the side ofreporting first and that is your first duty and thensocial impact that follows from that. You don’t reallygain anything by lying to people and giving them afalse sense of security. (Television current affairsproducer)

The exceptions to the primacy of informing were inreporting suicides and bomb scares, where not reportingbetter served the public interest.Not fear mongeringJournalists frequently commented that the commercialgoals of the media often sensationalised stories, particu-larly through the use of dramatic headlines.

Just as a joke, the chief of staff will go ‘now I’d likeyou to create a bit of fear and panic out there, thereare some storms coming in’. It’s just a joke, but thereis an element of truth in it, in that the most sensa-tional part will be your lead. (Radio news reporter)

They countered this tendency through maintainingaccuracy and thoroughness in the stories that


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accompanied these headlines. One radio producer men-tioned vocal tone and choice of experts.

It’s about just the way you report, I guess it’s aboutspeaking in measured tones and going to experts whoare not likely to be as emotional and emotive. (Radioproducer)

Being critical; avoiding others’ agendasJournalists frequently commented that one of their mostimportant roles was to question and critique those onwhom they were reporting. As well as being importantin itself, this allowed journalists to avoid being seen tobe used to further any particular agenda.

The media is not the public relations wing of thehealth department. We are not there simply to reportwhat they want to tell the public - though we willusually do that also. But our role is to ask challen-ging, independent questions. (Newspaper medicalreporter)

In line with other studies, “objectivity” was muchprized by this study’s journalists. It was attained, not byevaluating evidence, but rather by quoting respectedhealth experts and by finding and reporting on dissent-ing opinions.

It’s a matter of balance, and again you’re castingaround in the time you’ve got - which may not bevery much - to ensure that if it is some quite specta-cular claim being made, that it’s well-based and ifthere are people who disagree you quote and reportwhat they’ve got to say about it. (Newspaper medicalreporter)

A key role: the specialist reporterSpecialist health and medical reporters had muchgreater capacity to produce better quality health stor-ies. This occurred despite the similar seniority of non-specialist reporters and related to key factors specificto their role. Their familiarity with technical aspectsof medicine and health enhanced their ability to com-prehend and accurately report complex issues. Theywere able to build networks of contacts among expertswith whom they could develop trusting relationships,and so gain greater depth and insight into stories, andpass on tips about ‘the talent’ - expert sources - tochiefs of staff and junior journalists. Specialist medicalreporters enjoyed considerable autonomy within newsorganisations, and were able to select, pursue andform angles for stories. They were more likely to pro-duce a health story sourced from their own contacts,rather than derive news and expert comments fromother news.

Their seniority within their organisation enabled themto negotiate with producers and editors, including advo-cating for ‘worthy’ (but not necessarily high rating) stor-ies. Said one newspaper medical reporter, “A big part ofthe battle is trying to ensure that it gets a run that youthink it’s worth.” As arbiters of reporting quality, specia-list reporters had a significant gatekeeper role for lettingstories in, and keeping them out, of the paper.

If all I’ve done all day long is keep three really crapstories out of the paper then I consider I’ve done agood day’s work. And sometimes that can be quite alot of work if somebody higher up than me has gotthemselves all ignited about something. Then there’sa lot of work to do to hose people down and to bringthese things round. (Newspaper medical reporter)

They also corrected technical inaccuracies of otherjournalists in their organisation.

A mistake gets repeated again and again and again...so any specialist reporter will put out a nationalnote, saying ‘attention all, please ensure this is cor-rect’. (Radio news general reporter)

Discussion and recommendationsOur study highlighted that time constraints and accessto resources and technical expertise remain the majorissues for journalists in producing high quality healthand medical stories. We also found that the derivativenature of most stories fosters homogeneity in storyselection and angle and prevents a degree of criticaljournalism. The increased use of syndicated material(e.g. Reuters) also erodes localism which, according toChadwick, “weakens the civic conversation at state,regional, municipal and even neighbourhood level” [23].The ability of medical reporters in our study to sourceand localise stories counterbalanced this. It is then sig-nificant that the decline of resources for mainstreammedia is threatening the existence of the specialistreporter.Our study also found that reporters shared the same

concerns as health professionals about the depth, accu-racy and social impact of their reporting. For example,they considered this in how they sought to present andportray stories of the pandemic threat. Many wouldassuage the dissonance felt between the commercialimperatives of media and the need for ethical reportingby articulating their commitment to informing, checkingthe accuracy of stories, balancing sensational headlineswith sober, factual reporting, locating respected expertsources and by remaining ‘objective’ - aware of, but notactively supporting, any particular agenda, and covering


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a range of opinions. It appeared that notions of objectiv-ity and facts helped them to rationalise this potentialconflict but also prevented them from acknowledgingthat all news is constructed and hence never solely ‘fac-tual’ [24].We have described the importance of specialist

health and medical reporters: having baseline levels oftechnical knowledge to help them maximise technicalaccuracy; negotiate with editors and producers aboutthe selection and angle of medical stories; and buildand sustain networks of expert sources. Their gate-keeping role allowed them to include important stor-ies and exclude poor ones, based on their own notionsof quality. Thus a journalists’ ways of seeing the worldand their frameworks would have an important bear-ing on story selection. The resulting gatekeeping couldfunction to maintain quality insofar as radical, ‘inaccu-rate’ messages were often excluded as a result. Thisserved the media’s function of getting accurate infor-mation ‘out there’ such as during an emerging pan-demic. However, it could also reduce diversity instory, angle and source selection. As Hodgetts andcolleagues have argued, it could succeed in privilegingdominant biomedical notions of health while failing torepresent minority views or those more marginaliseddiscourses such as the social determinants of health[8,19,25]. Indeed, in discussing the pandemic problemand its solutions, we found that medical reportersconceptualised it as a biomedical problem, subject tosolutions such as antiviral medication and vaccinesrather than public health, social or policy solutionssuch as social distancing, quarantine, agricultural ortrade regulation. This finding was reflected in themedia coverage to which these reporters contributed(personal communication, Samantha Siripol, Univer-sity of Sydney, 2009).We relied on what journalists told us they did and

their perceived roles. In such studies there is always thechance that participants present an idealised account ofhow things should be rather than what they are. How-ever, the grounding in a real life reporting issue (avian/pandemic influenza) may have helped them locate theiraccounts in actual practice. The study is limited by arelatively small number of editors and producers notallowing the full exploration of how a particular role ormedium influenced news production. Further, thestudy’s core aim was to understand avian influenzareporting. Participants’ anticipation of this topic contex-tualised the responses to the general questions that wereport in this paper. In particular, selection of sourcetended to focus on sources most able to comment onthe topic of influenza and less on health stories in gen-eral. While not a limitation, it is an important contextto these findings.

Our study suggests that improved public health advo-cacy will result from the following recommendations forpublic health professionals and others involved with themedia, particularly:

1. Timing. For soliciting a journalist’s interest in anissue, a morning phone call during peak story sour-cing time is best. Avoid the late afternoon withnewspaper and evening news reporters. Large newsorganisations may be a more efficient way to broadlydistribute stories (e.g. Reuters, AAP).2. Be available. Being readily accessible is necessaryfor journalists to gain background, interview or filmyou and to check stories. This means ready tele-phone contact, timely return of calls, and a willing-ness to drop other things.3. Provide pre-prepared resources. Depending onthe topic, this may include fact sheets, visual aids,and soundbite quotes. Anticipate lack of technicalfamiliarity and provide definitions and distinctions(e.g. an antiviral is not the same as a vaccine).4. Find a personal touch. To make a story compel-ling to the ordinary citizen, journalists will seek indi-viduals who can provide a personal account of theimpact of the health issue on them. Providing anaverage ‘Joe Blow’ angle will help the issue get mediaattention.5. Stay networked. Find and cultivate specialistmedical reporters, be willing to provide them withbackground, and help supply them with stories ifavailable.6. Appeal to ethical values. Journalists prioritise thereporting of information over almost all other con-siderations. However, they are also sensitive aboutthe potential negative impacts of media coverage ofpublic health issues. It is therefore worth making anexplicit appeal to a journalist’s values and making acase for covering, or not covering, a particular issueor taking a particular angle (always understandingthat the journalist needs to exercise his or her ownautonomy and judgment in the end). Senior and spe-cialist reporters have power to advocate for how astory is reported and may be willing to makechanges if a suitable rationale is given.

More extensive general guidelines for how doctors [26]and scientists can most effectively communicate with orrespond to the mass media have been drawn up by var-ious organisations and are available on the internet (see,for example, http://www.sciencemediacentre.org).These suggestions focus on media advocacy in a main-

stream media context which remains the most influen-tial avenue for public health communicators to target.However, the rise of social media and the decline of the


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http://www.sciencemediacentre.org

traditional consumption patterns of mainstream newsmedia presents challenges and opportunities in howpublic health professionals now work with the media.The opportunities include the capacity for public healthprofessionals to have direct and unfiltered input intoissues via blogging and Twitter; to take advantage ofsocial networking sites to promote and advocate forhealth; and the ability for leading health organisationswhose integrity and achievements have made themhighly trusted to become the authoritative sources ofaccurate health information, communicated on theirown terms. However, in a far more fragmented mediacontext there is the increasing diminution of the role ofspecialist reporters with resulting loss of baseline techni-cal knowledge, gatekeeping and thoughtful, investigativehealth journalism.Regardless of the future media landscape, we argue

that public health communicators should be strategic inhow they work with journalists, keeping in mind theabove and other guidelines for communicating with themainstream media. In this way we can minimise thefaults and maximise the benefits of our current mediaenvironment.

AcknowledgementsThe authors thank the reviewers, Sarah E Gollust and Darrin Hodgetts, fortheir helpful comments on the manuscript.

Author details1Senior Research Fellow and Conjoint Senior Lecturer, National Centre forImmunisation Research and Surveillance, The Children’s Hospital atWestmead, Discipline of Paediatrics and Child Health, University of Sydney,Australia. 2Senior Lecturer, Medical Humanities, Centre for Values, Ethics andLaw in Medicine, University of Sydney, Australia. 3Information Manager,National Centre for Immunisation Research and Surveillance, The Children’sHospital at Westmead, Australia.

Authors’ contributionsContributors: JL and CH designed the study. JL conducted most of theinterviews. JL and CK developed initial codes. All authors reviewed thecodes, developed the themes and wrote the paper. All authors read andapproved the final manuscript.Funding: JL and CK are funded by the National Centre for ImmunisationResearch and Surveillance (NCIRS) which provided funding for the study.NCIRS is supported by the Australian Government Department of Health andAgeing, the NSW Department of Health and The Children’s Hospital atWestmead. CH is funded by the University of Sydney.This research was undertaken independent of any of its funding sources.

Competing interestsThe authors declare that they have no competing interests.

Received: 10 May 2010 Accepted: 8 September 2010Published: 8 September 2010

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doi:10.1186/1471-2458-10-535Cite this article as: Leask et al.: Media coverage of health issues andhow to work more effectively with journalists: a qualitative study. BMCPublic Health 2010 10:535.


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