the importance of health communication
TRANSCRIPT
The Importance of Health Communication
The Importance of Health CommunicationLeslie Snyder, Ph.D.University of Connecticut
Communication Campaigns & ProgramsCommunication campaign:Organized communication activities, Directed at a particular audiences, For a particular period of time, To achieve specified goals.Communication program:Organized communication activitiesDirected at particular audiencesTo achieve specified goals.
What Can Health Communication Accomplish?Population behavior changePolicy changeChange language to alter perceptions of problems & solutionsIdentify & support people in needProfessional training & improved patient-provider encountersOrganize stakeholders (boards, coalitions)Diffuse /translate successful programs
Wellstarts Comprehensive Intl Breastfeeding Campaign1. Change international policies.2.Organize conferences to gain support of national leaders, medical elites, & key orgs. 3. Change national policies."Right to breastfeed" at work.4. Change hospital policies.5. Train professionals6. Organize national chapters of the intl org. for trained prof., & support with media materials, newsletter,reference materials.7. Change curriculum in medical & nursing schools.8. Media campaigns to reach pregnant & lactating women, fathers, influential older women.9. Organize support groups for lactating women.10. Language changes"Baby formula" becomes "breastmilk substitute."Issue is dubbed, "Lactation management".11. Organize means of collecting feedback on progress made to date.4
When is Health Communication More Effective?
How to Create a Health Communication Campaign More Likely to SucceedFollow the steps for strategic communication Use appropriate theories of behavior change & communicationPay attention to contextual factors, including differences among the target populations and their environments
Strategic Communication Steps7Research behavior, resources, targets, contexts (social, political, economic, legal)Communication Plan goals, targets, persuasive strategy, channels, behaviorManagement Plan: personnel, resources, timetable, integration with otherorganizations & events.Prepare Messages Develop & pretest messages, media, & train interpersonal channels.Implement & Monitor Evaluate & Adjust communication plans, messages, etc.
Goals & BehaviorsState specific, realistic goals that include behavior change for each target group
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Average Effects of Media Campaigns by Topic Meta-analytic findings
9.7331504791298984E-32.8999999999999998E-22.6938031797380801E-27.5829555739970189E-45.4276314402375986E-32.8919672785634037E-33.4999999999999996E-23.2878024804109507E-28.9378509812799989E-31.7056896812185002E-28.2084528266329893E-31.1172046847017003E-23.1403739237903176E-26.0907004555620994E-33.0896256715177903E-22.8377519062166005E-29.7331504791298984E-32.8999999999999998E-22.6938031797380801E-27.5829555739970189E-45.4276314402375986E-32.8919672785634037E-33.4999999999999996E-23.2878024804109507E-28.9378509812799989E-31.7056896812185002E-28.2084528266329893E-31.1172046847017003E-23.1403739237903176E-26.0907004555620994E-33.0896256715177903E-22.8377519062166005E-2Smoking cessationMammographyHeart disease preventionOrgan donationFamily planningSeat belt useAlcohol useOral healthFruit & vegetablesCondom useSeat belt useFat consumption0.033.7999999999999999E-20.050.056.4000000000000001E-27.0000000000000007E-20.090.130.130.135732143148200010.150.2Average Effect Sizes (r)Campaigns promoting a new behavior are more effective10
12%4%5%Snyder et al., 2004
Breast Cancer Prevention & Support Potential BehaviorsNutritionExerciseSmoking CessationMinimize 2nd hand smoke exposureModerate alcohol (1 drink/day?)Screening behaviorsGenetic testingObtain family historySeek support if indicated
Targeting
Who are you trying to reach?Divide the potential target into segmentsDemographic groups Target theoretically meaningful segments of the audience.12
Thoughtful Segmentation:by outcomes Goal behaviorsCurrent & past behaviorsNeeds Decision-makers Attitudes, perceptions, values Knowledge
Who should do what?Who has been doing what?Who has the most need & who knows it?Who has the power to make it happen?Who needs to believe what?Who needs to know what?13
Breast Cancer in Young Women Some potential SegmentsBy risk: African-American womenAshkenazi women American Indian/Alaska Native women???Other women???family historygenetic predisposition smokersliving with smokersOverweight & obeseBy needs: Young survivor support & cancer preventionDecision makers: health care providers families
Break groups down further based on target behaviors who needs to start doing what
Ease of change /motivation Timing of information-seeking & decision-makingCommunication channel use & accessibilitySocial, cultural, linguistic communication differences Political & organizational concerns
Who is closer to change?When are which people more open to change?Who is reachable through what means?Who treats communication about the topic differently?Who should be targeted and who cannot be targeted, given the political and organizational reality?16Thoughtful Segmentation:by communication issues
Break down groups again by who needs different messages & channels.
Narrow or Broad Targets?Trade-off Narrow target groups, can message more effectivelyBroad target groups, (often) more reachCompromise start off broadly with common message points, then design special messages/ channels for populations who need further communication.OR use tailored (individualized) messaging when applicable.
Exposure, exposure, exposureGreater exposure is associated with greater behavior change (Snyder et al., 2002)Average exposure 40% US health campaigns Pay attention to intensity of messages frequency of exposureUse multiple channels & formats, especially novel ones
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Sources of information for Hispanic families with kids 5 & under in LA, 2002
20Cheong, P.H., Wilkin, H.A., & Ball-Rokeach, S. (2004). Diagnosing the communication infrastructure in order to reach target audiences: A study of Hispanic communities in Los Angeles. In Whitten, P. & Cook, D. (Eds.). Understanding health communication technologies. San Francisco, CA: Jossey-Bass, 101-110.
Channel considerationsEffectiveness at reaching & affecting peopleCost within budgetCost-effectivenessTiming When are they ready to hear youHow to sustain behavior change
Channel comparisons:Meta-analysis of meta-analyses Searched for all meta-analysis of interventions using media, through 2010.Compared to a synthesis of interpersonal-only meta-analyses (Johnson et al., 2010).
Snyder & La Croix (in press) In Rice & Atkin, Ed. 4, Public Information Campaigns.
Mammography Screening Interventions
1.2999999999999998E-21.4999999999999999E-21.999999999999999E-21.999999999999999E-22.8999999999999998E-21.3999999999999999E-21.5000000000000006E-22.0000000000000018E-20.032.8999999999999998E-2Interpersonal interventionsTailored interventionsPhone interventionsLetters (invite & remind)Media campaigns9.7000000000000003E-25.5E-20.210.190.03Average Effect Sizes
Smoking cessation & prevention interventions
2.5000000000000012E-21.2999999999999998E-21.0999999999999996E-25.3000000000000012E-21.0000000000000005E-27.1999999999999995E-21.4999999999999998E-26.0000000000000019E-32.5000000000000012E-21.2999999999999998E-21.0999999999999996E-25.3000000000000012E-21.0000000000000005E-27.1999999999999995E-21.4999999999999998E-26.0000000000000019E-3Interpersonal interventionsComputer-based interventionsPhone interventions (not mobile)Mobile phone interventionsMedia campaignsCessation (adult)Web-based interventionsCessation (youth)Interpersonal interventionsMedia campaignsPrevention (youth)0.117000000000000027.3000000000000009E-28.1000000000000003E-20.244000000000000113.0000000000000002E-29.0000000000000024E-29.0000000000000024E-24.8000000000000001E-2Average Effect SizesInternet & health
Internet use: 93% teens; 95% 18-29, 87%30-49 (2011) Wireless internet use: 79% of 18-29 year olds; 60% 30-49 year olds (2009, 2011)Search the net for health information 28% teens; 75% adultsPatients (2008)Internet searches affect treatment decisions.Use info to ask docs new questions.Medical professionals still dominant source of info for people with urgent health questionsRecognition of misinformation on the web BUT do not check the source of the info they find25Susan Fox, Aug 26, 2008, The Engaged E-patient Population. http://www.pewinternet.org/pdfs/PIP_Health_Aug08.pdf
50% of Adults Use Social Networking Sites
Pew Internet & American Life data, 2011
Social MediaTo get news out:YouTube & Red Cross videos about the Haiti earthquake within 30 min. valuable bcs already recognized as a resource for reporters.Messages:Teen dating violence PSAs & peer messages Thats not cool.com 250,000 hits on 3 videos. Target 8th & 9th graders. Sex info for teens via text or web. Text4Baby
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Match formats for goals & target groupsTailored / individualized (more effective than non-tailored)News/ PR (less expensive; need news hook)Advertising (free often aired at poor times)Entertainment (may reduce counterarguing)
ExampleTailored Calendars to Promote Childhood Immunization (Kreuter, Caburnay, Chen, & Donlin, 2004)
Parents of babies aged birth to 1 year received calendars tailored by:childs agepicture & name of child,immunization dateslocal health center info, child developmental info, other health & safety info.
Results: More intervention than control babies were up to date on their vaccines at age 24 months (66% vs 47%, d=.43).
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Use promotions to help normalize the messageObjectsContestsEventsTie-ins30
Interpersonal ChannelsMake sure patient-provider encounters are high qualityBrief interventions can be effective (Babor, 2005)Train outreach staff in both content & communication skillsOutreach workers from the target audience is associated with better campaign messages in Uganda for AIDS (Kiwanuka-Tondo & Snyder, 2002)May increase sustainability by institutionalizing interventions31
Outreach workers vs. peer-driven snowball communication for AIDS with IV drug users (Broadhead & Heckathorn)
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MessagesPretest & improve all messages & media before useMake sure all channels share consistent messages including physiciansSelect simple, memorable concepts to promote
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Brand Thoughtfully
Emphasize information NEW to the target group
To capture attention, use high quality executions & fresh messagesTo increase memory, use execution elements like logos, slogans, & jinglesTo increase attention, use multiple executions refresh media messages oftenCelebrities, characters, babies, animals36
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Use explicit, intense, or entertaining messages
Other potential message issues from theoryStage of behavior change (e.g. unaware, contemplating, decision, maintenance)Beliefs, including risk-taking, psychological reactanceEssential knowledge (e.g. how to, when to, clear up misconceptions)Peer norms, perceptions of commonness of the behavior, & identification with people doing/not doing the behavior
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Analyze current messages
Evaluate if need 2-sided messages that attacks incorrect messages.Evaluate need to undermine credibility of misleading message sources.39Too Smart to Smoke, Colorado
Coke girl band ad, linking Coke with a macrobiotic diet. http://mfile.akamai.com/332/rm/cocacola.download.akamai.com/332/corporate/_media/tv/us_girlsbandfirst_300k.ram
Consider advocacy for environmental changesReduce access to unhealthy products & increase access to healthy options (e.g. dining out)Use price strategies to encourage healthy choicesEasy/free distribution of products that support healthy choicesCondoms, calcium supplements40
Evaluation Monitor to make sure the plan is being followedcheck distribution of materialsobserve interpersonal outreachperiodically solicit feedback from all staffDesign evaluation with pretest & control group, if possibleneed to rule out secular trend causing changebetter designs have better chance of detecting change (Snyder et al., 2009)Measure intermediate steps to behavior change to track progress41
Gaps in health communication researchBehavior maintenance, sustainability, & cultural (belief) changeCoordinate common behavior changee.g. Diet & exercise promotion
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Thank you!Leslie Snyder
Chart40.120.060.05
Chart1 (2)0.170.05
EnforcementEnforcement messages
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EnforcementEnforcement messages
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New InformationNew information messages
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Role modelsRole models
Sheet1PresentAbsentEnforcement0.170.05PresentAbsentNew Information0.140.08PresentAbsent, persuasion onlyAbsent, persuasion & coersionRole models0.050.050.09CommencementPreventionCessation0.120.060.05
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010203040OrganizationsFrom workUse internetListen to radioRead leaflets & foldersRead book or magazineRead newspaperContact health care providersTalk with family & friends/phoneWatch TVPercentage of users, N=327Cost to educate per person$0$100$200$300$400$500$600$700Peer-driven siteOutreach workers