Health Communications in the Community

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Health Communications in the Community

• Peter D. Rumm MD, MPH
• Associate Professor, CHMP, DSPH 215.7621652
  pdr26_at_drexel.edu

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An example of the growing emphasis on
communication

• The Centers for Disease Control and Prevention
  (CDC) announced the award of a seven-year, 73
  million contract to provide a single point of
  contact for consumers and health professionals to
  access comprehensive, timely, and credible health
  information. Communicating directly with the
  American public has become a vital part of CDCs
  role in protecting the nations health and
  safety, said CDC Director Dr. Julie Gerberding.
  
• With this unified approach, we will attempt to
  get the right health information to the right
  people at the right time.
  
• We are very excited about this new opportunity to
  improve CDCs service to the public and health
  professionals, said Jim Seligman, CDC Chief
  Information Officer. Accurate health information
  is vitally important for people to make good
  health choices

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Case Study - Promoting an Asthma Program

• Why? The growing incidence of asthma is a medical
  mystery.
  
• Excellent guidelines and treatments available but
  often not followed by patients or practitioners.
  
• Problem is especially prevalent in inner city
  African American children 3 to 4 x mortality rate
  as suburban white children.

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Define a goal then act

• For example more publicity about the problem,
  i.e. awareness.
  
• First step planning
• Second step implementation
• Third step evaluation

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Develop in this case a Media Plan

• Identify goals. What are the best strategies for
  reaching people? What do you want them to know?
  What actions do you want them to take? Identify
  audiences you want to reach. What media do they
  use?
• Develop appropriate messages for each target
  audience. What are the actions you want people to
  take? What are the benefits of taking these
  actions?
• Compile a media list, using a media directory
  available at most public libraries.
  
• Produce materials for a press kit. Include how
  asthma affects the local community, how many have
  asthma, who the local experts are.
  
• Write a media advisory (one page describing the
  event and inviting the media) and a press release
  (a mini news story).
  
• Construct a timetable of outreach events and
  activities. How far in advance do you need to
  prepare? What are local media deadlines?
  
• Add an evaluation component. How will you
  determine whether you have been successful?
  

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Recommendations on implementation

• Become familiar with local news media. Pay
  specific attention to reporters who have covered
  stories related to asthma or other health
  issues..
• Call local media outlets and ask who covers
  health. Find out who does local cable programming
  and contact their news and public affairs
  programs. Invite reporters to cover events. List
  events in community calendars in local media.
  Special events, such as World Asthma Day or town
  meetings, are opportunities to make news and can
  provide a visual context for a TV interview.
• Partner with other organizations, such as a local
  sports team or local chapters of the American
  Lung Association, Asthma and Allergy Foundation
  of America.
• Identify a local respiratory specialist willing
  to talk to the media. Place the spokesperson on
  talk shows.

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Recommendations on an evaluation

• Establish baseline measurements.
• Ask whether the objectives and/or audiences were
  reached.
  
• Track phone calls and other responses, the number
  of mentions in the news, the number of
  impressions (people reached).
  
• http//nhlbi.nih.gov/health/prof/lung/asthma/am_sp
  01/tips.htm

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What is health communication anyway?

• The study and use of communication strategies to
  inform and influence individual and community
  decisions that enhance health.
  
• Definition of CDC and the NCI/NIH.

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Some things it can do

• Increase knowledge of intended audience
• Influence perceptions and beliefs that could
  shape norms/policy
  
• Reinforce healthy behavior
• Increase demand for services
• Refute myths
• Advocate a position
• Increase surveillance and disease awareness
• Distribute emergency messages in a real time
  manner increasingly through the HAN and other
  techniques

• Strengthen organizational relationships
• Show the benefit of behavior change
• Prompt action
• Done properly clarify the true risk (and/or
  benefit) of a disease or behavior change
  
• With other strategies can begin to tackle
  difficult problems such as access
  
• With varying success, cause sustained individual
  behavior change

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What it cannot do

• Compensate for inadequate care or access
• Produce sustained change in behaviors at the
  individual/population level unless part of a
  sustained/comprehensive program
  
• Always be effective many barriers to effective
  communication.
  
• Please suggest some of these!

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Characteristics of effective health communication
campaigns

• Some examples VERB, Red Dress, and Pink Ribbon
• Campaign goal is defined and part of larger
  goal.
  
• Messages created effectively.
• Ability to pre-test, retest, and update.
• Implement effectively
• Most importantly evaluate and improve

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The planning process

• Usually best campaigns have planning done in
  teams with necessary expertise from broad
  disciplines.
  
• Set defined objectives
• By 2005 increases the number of women 40 or
  above, in Washington DC who are getting annual
  mammogram from 60 to 70 through a media
  campaign highlighting currently available
  programs.
• 80 of the women in the campaign catchment area
  will on a community survey state they had
  awareness of the campaign.
  
• At least 25 of the women surveyed will state
  they got the mammogram due to the campaign.
  

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Chose the media

• What is meant by the term channel of
  communication?
  
• In targeting low income/low educational level
  females - what might be effective channels of
  communication to get a message promoting breast
  cancer screening across?
• Would these channels be the same in all cultures?

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Choosing the appeal

• Consider emotional, humorous, serious, scientific
  the list is endless.
  
• Threat appeals are not usually effective for most
  audiences (especially youth why do think this
  is so?).
  

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Testing a concept message

• Want to find out through testing on small groups
  of the intended audience such things as
  
• Is the appeal strategy effective?
• Are terms confusing or culturally biased (polyp
  man line up example)?
  
• Any language barriers?
• Could the message actually change behavior or
  attitudes
  

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Deciding materials/honing the message

• Print format, distribution, media
• Audio
• TV, video, film
• Web based (how appropriate is it for general
  audiences currently?)
  
• Alternative or targeted campaigns might require
  special material selection churches, fairs,
  work, schools.

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Rules to go by

• Dont stray too far known scientific knowledge.
• Be consistent in message.
• Be clear. Kiss Principle
• Be credible
• Understand there is a risk benefit of using
  celebrities
  
• Hone materials to be culturally sensitive and
  specific
  

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Launching the program

• See publicity if possible through news outlets,
  free sources, professional and community
  contacts.
  
• Consider a press release and formal media kit if
  it is an innovative or controversial campaign or
  you are trying to change policy or build
  awareness.
• Build evaluation of initial launch into the
  campaign be ready to modify if not the right
  message.
  
• Science and an art on how much of media and
  expense are used in the initial blast of media
  vs. what can be sustained.
  
• Consider the ethical dilemma of not having enough
  funds to sustain an effective campaign.
  

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Evaluation

• Qualitative is truly important in media helps
  understand why, helps tailor the message, and
  some messaging and evaluation is hard to capture
  through statistical analysis. Classic technique
  is the focus group.
• Quantative increasingly CDC and other agencies
  want demonstratable results very quickly.
  Important to measure earl shifts in attitudes,
  penetrance of message, and any potential steps
  toward behavior change.
• Should also measure reliability and validity of
  the message if it is being altered in differing
  formats.
  
• Build the cost of evaluation into the
  program/campaign biggest common mistake.
  
• Most often argue the point to get resources to do
  evaluation.
  
• Fortunately skills learned in epid, stat, and CHP
  are very transferable.
  
• One can quickly pick up terms like media share,
  markets etc. what MPH trained professionals (my
  view) strongly bring to the table is credibility
  often missing in media campaigns.

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Design a campaign

• Background
• Men are much less likely to access medical care
  than females.
  
• PSA test for prostate now a grade C
  recommendation by the USTFPS. Many agencies
  including NCI, ACS believe in informed consent
  and that most men should be tested by age 50
  (still somewhat controversial).
• Concerns about treatment are abating somewhat as
  new less invasive procedures being developed.
  
• African American men though have dramatically
  higher rates (about 30) of prostate cancer than
  white men even among educated men with good
  health care.

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Design a campaign for Pittsburg

• That
• Promotes all men discussing with their health
  care provider the pros and cons of PSA.
  
• Promotes that AA men may be of higher risk.
• Through a tie in with other current mens health
  issue (guess what this is) men are coming in more
  regularly for checkups.
  
• Several drug companies agree to underwrite
  screening costs and initial consultation for men
  without insurance coverage.
  
• Stresses that PDOH working with the CDC can test
  out a program similar to that of breast and
  cervical cancer, whereby a man diagnosed goes on
  Medicaid for up to 5 years for treatment if
  unable to pay.

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Three classroom groups

• I. Design an overall campaign for the city.
• II. Design a campaign specifically geared just to
  AA men.
  
• IIII. Design a campaign to reach all health
  providers in the city area.
  
• Each group has 200,000 budget x 3 yrs.
• Groups one and two can get some free radio time
  on stations that might be appropriate to their
  targeted audiences.
  
• The CMOs of the health plans offer to a media
  spokesman from group III present at grand rounds
  in four of six hospitals that see about 75 of
  the pop ululation but few outpatients is this a
  good idea?

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Focus group results

• Campaign materials for group I and II are too
  complicated and not culturally sensitive.
  
• Were written at a 12th grade level.
• Conversely, the health professionals thought
  materials too simplistic and therefore, might not
  change the screening counseling and/or behavior.
  
• Also, health professionals skeptical about a new
  payment program being sustainable past a one year
  pilot and are concerned about the ethics. As a
  group you negotiate with the PDOH and the CDC and
  get 5 years promised.
• Several doctors want their information in a web
  based format and suggest this should be also done
  for their patients discuss the pros and cons.

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Define by next class

• Social marketing
• Market share
• Market penetration
• Efficacy vs. efficiency of communication
• What is the hardest skill for any communicator to
  know?