The Importance of Health Communication

1. The Importance of Health Communication Leslie Snyder, Ph.D. University of Connecticut

2. CommunicationCampaigns & Programs Communication campaign: • Organized communication activities, • Directed at a particular audiences, • For a particular period of time, • To achieve specified goals. Communication program: • Organized communication activities • Directed at particular audiences • To achieve specified goals.

3. What Can Health Communication Accomplish? • Population behavior change • Policy change • Change language to alter perceptions of problems & solutions • Identify & support people in need • Professional training & improved patient-provider encounters • Organize stakeholders (boards, coalitions) • Diffuse /translate successful programs

4. Wellstart’s Comprehensive Int’l Breastfeeding Campaign 1. 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 professionals 6. Organize national chapters of the int’l 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.

5. When is Health Communication More Effective?

6. How to Create a Health Communication Campaign More Likely to Succeed • Follow the steps for strategic communication • Use appropriate theories of behavior change & communication • Pay attention to contextual factors, including differences among the target populations and their environments

7. Strategic Communication Steps Communication Plangoals, targets, persuasive strategy, channels, behavior Researchbehavior, resources, targets, contexts (social, political, economic, legal) Management Plan: personnel, resources, timetable, integration with other organizations & events. Evaluate & Adjustcommunication plans, messages, etc. Prepare MessagesDevelop & pretest messages, media, & train interpersonal channels. Implement & Monitor

8. Goals & Behaviors • State specific, realistic goals that include behavior change for each target group

9. Average Effects of Media Campaigns by Topic – Meta-analytic findings

10. Campaigns promoting a new behavior are more effective 5% 4% 12% Snyder et al., 2004

11. Breast Cancer Prevention & Support Potential Behaviors • Nutrition • Exercise • Smoking Cessation • Minimize 2nd hand smoke exposure • Moderate alcohol (1 drink/day?) • Screening behaviors • Genetic testing • Obtain family history • Seek support if indicated

12. Targeting • Who are you trying to reach? • Divide the potential target into “segments” • Demographic groups • Target theoretically meaningful segments of the audience.

13. Thoughtful Segmentation:by outcomes • Goal behaviors • Current & past behaviors • Needs • 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?

14. Breast Cancer in Young Women – Some potential Segments • By risk: • African-American women • Ashkenazi women • American Indian/Alaska Native women??? • Other women??? • family history • genetic predisposition • smokers • living with smokers • Overweight & obese • By needs: Young survivor support & cancer prevention • Decision makers: • health care providers • families

15. Break groups down further based on target behaviors – who needs to start doing what

16. Thoughtful Segmentation:by communication issues • 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? • Ease of change /motivation • Timing of information-seeking & decision-making • Communication channel use & accessibility • Social, cultural, linguistic communication differences • Political & organizational concerns

17. Break down groups again by who needs different messages & channels.

18. Narrow or Broad Targets? • Trade-off – • Narrow target groups, can message more effectively • Broad target groups, (often) more reach • Compromise – 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.

19. Exposure, exposure, exposure • Greater 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 exposure • Use multiple channels & formats, especially novel ones

20. Sources of information for Hispanic families with kids 5 & under in LA, 2002 Cheong, 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.

21. Channel considerations • Effectiveness at reaching & affecting people • Cost – within budget • Cost-effectiveness • Timing • When are they ready to hear you • How to sustain behavior change

22. 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.

23. Mammography Screening Interventions

24. Smoking cessation & prevention interventions

25. Internet & 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% adults • Patients (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 questions • Recognition of misinformation on the web BUT ¾ do not check the source of the info they find Susan Fox, Aug 26, 2008, The Engaged E-patient Population. http://www.pewinternet.org/pdfs/PIP_Health_Aug08.pdf

26. 50% of Adults Use Social Networking Sites Pew Internet & American Life data, 2011

27. Social Media • To 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 – That’s not cool.com 250,000 hits on 3 videos. Target 8th & 9th graders. • Sex info for teens via text or web. • Text4Baby

28. Match formats for goals & target groups • Tailored / individualized (more effective than non-tailored) • News/ PR (less expensive; need news hook) • Advertising (free often aired at poor times) • Entertainment (may reduce counterarguing)

29. Example Tailored Calendars to Promote Childhood Immunization (Kreuter, Caburnay, Chen, & Donlin, 2004) • Parents of babies aged birth to 1 year received calendars tailored by: • child’s age • picture & name of child, • immunization dates • local 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).

30. Use promotions to help “normalize” the message • Objects • Contests • Events • Tie-ins

31. Interpersonal Channels • Make sure patient-provider encounters are high quality • “Brief interventions” can be effective (Babor, 2005) • Train outreach staff in both content & communication skills • Outreach workers from the target audience is associated with better campaign messages in Uganda for AIDS (Kiwanuka-Tondo & Snyder, 2002) • May increase sustainability by institutionalizing interventions

32. Outreach workers vs. peer-driven snowball communication for AIDS with IV drug users (Broadhead & Heckathorn)

33. Messages • Pretest & improve all messages & media before use • Make sure all channels share consistent messages – including physicians • Select simple, memorable concepts to promote

34. Brand Thoughtfully

35. Emphasize information NEW to the target group

36. To capture attention, use high quality executions & fresh messages • To increase memory, use execution elements like logos, slogans, & jingles • To increase attention, use • multiple executions • refresh media messages often • Celebrities, characters, babies, animals

37. Use explicit, intense, or entertaining messages

38. Other potential message issues from theory • Stage of behavior change (e.g. unaware, contemplating, decision, maintenance) • Beliefs, including risk-taking, psychological reactance • Essential 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

39. Analyze current messages 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 • Evaluate if need 2-sided messages that attacks incorrect messages. • Evaluate need to undermine credibility of misleading message sources. Too Smart to Smoke, Colorado

40. Consider advocacy for environmental changes • Reduce access to unhealthy products & increase access to healthy options (e.g. dining out) • Use price strategies to encourage healthy choices • Easy/free distribution of products that support healthy choices • Condoms, calcium supplements

41. Evaluation • Monitor to make sure the plan is being followed • check distribution of materials • observe interpersonal outreach • periodically solicit feedback from all staff • Design evaluation with pretest & control group, if possible • need to rule out secular trend causing change • better designs have better chance of detecting change (Snyder et al., 2009) • Measure intermediate steps to behavior change to track progress

42. Gaps in health communication research • Behavior maintenance, sustainability, & cultural (belief) change • Coordinate common behavior change • e.g. Diet & exercise promotion

43. Thank you! Leslie Snyder leslie.snyder@uconn.edu