Health communication

Health Communication is a transdisciplinary field that is integral to a variety of other fields, including public health, healthcare, global health, and community development. Health communication is most commonly understood as a field of theory, research, and practice which studies and uses communication strategies, methods, programs, and interventions as a means to inform and influence individual and community decisions "that enhance health". It is a common area of study within the larger Communication discipline explained by the National Communication Association. Effective and successful uses of health communication will utilize multifaceted approaches in order to best reach intended audiences with comprehensive interventions and messages that will ultimately protect public health outcomes. Intended outcomes of health communication can include: increasing audience knowledge and awareness of a health issue; influencing behaviors and attitudes towards a health issue; demonstrating healthy practices; showing benefits of behavior changes to public health outcomes; advocating a position on a health issue or policy; increasing demand or support of health services; and arguing myths and misconceptions related to health.

Overview

A goal of effective health communication is to create higher levels of health literacy within a society, by using tools and methods of communication to promote healthy changes and lifestyle practices. Health communication is a recently blooming field of study, with official recognition as a subset of communication first coming from the International Communication Association in 1975, and formal recognition from the American Public Health Association in 1997 within the Public Health Education and Health Promotion division. Careers in the field of health communication range widely between the public, private, and volunteer sectors and professionals of health communication are distinctively trained to conduct communication research, develop successful and repeatable campaigns for health promotion and advocacy, and to evaluate how effective these strategies have been for future campaigns. Clear communication is essential to successful public health practice at every level of the ecological model; intrapersonal, interpersonal, group, organizational, and societal. In each instance of health communication, there must be careful deliberation concerning the appropriate channel for messages to best reach the target audience, ranging from face-to-face interactions to television, Internet, and other forms of mass media. The recent explosion of new Internet communication technologies (particularly through the development of health websites (such as MedlinePlus, Healthfinder, and WebMD), online support groups (such as the Association for Cancer Online Resources), web portals, tailored information systems, telehealth programs, electronic health records, social networking) and mobile devices (cell phones, PDAs, etc.) means that the potential media are ever changing. The social and cultural contexts in which health communication occurs are also widely diverse and can include (but are not limited to) homes, schools, doctor’s offices, and workplaces, and messages must consider the variant levels of health literacy and education of their audience, as well as demographics, values, socioeconomic issues, and many other factors that may influence effective communication.

Strategies and Methods

Tailoring a health message is one strategy for persuasive health communication. For messages of health communication to reach selected audiences accurately and quickly, health communication professionals must assemble a collection of superior and audience appropriate information that target population segments, as well as continually synthesize knowledge from a myriad of other scholarly disciplines including marketing, psychology, and behavioral sciences. Once this information has been collected, professionals can choose from a variety of methods and strategies of communication that they believe would best convey their message. These methods include campaigns, entertainment advocacy, media advocacy, new technologies, and interpersonal communication.

Campaigns

Health Communication campaigns are arguably the most utilized and effective method for spreading public health messages, especially in endorsing disease prevention (e.g. cancer, HIV/AIDS) and in general health promotion and wellness (e.g. family planning, reproductive health). The Institute of Medicine argues that health communication campaigns tend to organize their message in relation to addressing a diverse audience in one of three ways:

• By catering to the common denominator within the audience
• By creating one central message and then later making systematic alterations in order to better reach a certain audience segment, while retaining the same central message
• By creating distinctly different messages for different audience segments

Both the Centers for Disease Control and Prevention as well as scholars of health communication emphasize the importance of strategic planning throughout a campaign, which includes a variety of steps to ensure a well-developed message is being advocated. These steps consist of:

• Reviewing background information to define what the problem is and who is affected by the problem
• Setting communication objectives and proposing a plan to meet the wanted outcome
• Analyze the target audience by determining interests, attitudes, behaviors, benefits, and barriers
• Select channels and materials for communication in relation to what will most effectively reach audiences
• Develop and pretest message concepts to determine understanding, acceptance, and reaction to the message
• Implement communication with selected audience and monitor exposures and reactions to the message
• Assess the outcome and evaluate the effectiveness and impact of the campaign, noting if changes need to be made

Entertainment Advocacy

Using the entertainment industry as a platform for advocating health information and education is a communication strategy that has become increasingly popular. The most utilized strategy is for health communication professionals to create partnerships with storyline creators so that public health information can be incorporated into within the plot of a television show. The Centers for Disease Control and Prevention has formed a strong partnership with Hollywood, Health, and Society, at the University of Southern California Norman Lear Center to continue to produce new storylines on television and in film studios that will help to promote public health information. Some of the resources provided with this partnership include comprehensive "tip sheets" to provide writers with easy to access and trustworthy information on health issues as well as meetings and panels to discuss new information and resources. Some of the most notable examples of this method of communication in recent years have been with the films Contagion and I Am Legend in understanding the spread of disease, NBC's series Parenthood in Asperger's Syndrome, and with the CW's series 90210 and spreading cancer awareness. Writers and storyline developers have an increased motivation to continue to incorporate public health information into their scripts with the creation of the Sentinal for Health Awards in 2000, which honors storylines that effectively promote health topics and audience awareness of public health issues. Surveys conducted by Porter Novelli in 2001 reported many interesting statistics on the effectiveness of this strategy, such as that over half of regular prime time and daytime drama viewers have reported that they have learned something about health promotion or disease prevention from a TV show. Amongst this data, minority groups are significantly represented with well over half of African American and Hispanic viewers stating that they had either taken some form of preventative action after hearing about a health issue on TV, or that a TV storyline helped them to provide vital health information to a friend or family member.

Media Advocacy

Media Advocacy encompasses the utilization of strategic mass media tools combined with widespread organization in order to advocate for healthy public policies or lifestyles. This can include the use of Text Messaging and Email to spread messages from person to person, as well as using Social Networking sites such as Facebook, Twitter, and Instagram to promote health information to a wide ranging audience. As technologies expand, the platforms for health communication through media advocacy will undoubtedly expand as well.

New Technologies

Health communication has grown significantly along with new computer-based interactive technologies that allow consumers to search for and access detailed and specific information, control how the information is presented to them, and ask and respond to questions at their own discretion. These technologies include online health and medical website (e.g. WedMD) and online support groups and chatrooms (e.g. Association for Cancer Online Resources). One important aspect of this method of health communication is that it is extremely important in overcoming the barriers of low literacy, in that it creates a platform for personalized information easily accessed by people of all literacy and education levels and not overwhelmed with unexplained medical jargon.

Interpersonal Communication

Health communication relies on strong interpersonal communications in order to influence health decisions and behaviors. The most important of these relationships are the connection and interaction between an individual and their medical provider (e.g. Physician, Therapist, Pharmacist) and an individual's social support system, which can include family, friends, or a general community that positively influence the individual's decision to make healthy choices.

Applications/Applied Health Communication

Health communication has become essential in promoting the general public health in a myriad of situations. One of health communication's most important applications has been throughout major Environmental events (e.g. hurricanes, flooding, tornados) and addressing the affected audience's questions and needs quickly and efficiently, keeping the protection of public health and the forefront of their message. Health communication professionals are constantly working to improve this type of risk communication in order to be prepared in the case of an emergency.

Another increasingly important application of health communication has been in reaching students in the college community. The National College Health Assessment has measured that 92.5% of college students reported being in "good, very good, or excellent health", however college students seem to battle serious problems with stress, depression, substance abuse, and a general lack of nutrition in comparison to other age groups and audiences. Professionals in health communication are actively striving for new ways to reach this at-risk audience in order to raise standards of public health in the college setting and to promote a healthier life style amongst students.

Challenges and Criticisms

Health communication faces many challenges. While problems can be attributed to many factors, some of the most essential issues have to do with the gap between health literacy and health communication, flaws in communicating through the mass media, and a lack of trained professionals.

Literacy-Communication Gap

One of the most pertinent challenges health communication faces is the general gap that has formed between the population's health literacy and the use of health communication. While the goal is that health communication will effectively lead to health literacy, issues such as the use of unexplained medical jargon, ill-formed messages, and often a general educational gap have created a gap. Specifically, studies have been done amongst elderly populations in America to illustrate a common audience who is left at a disadvantage due to this issue. The older adults comprise an age group that generally suffers from the most chronic health conditions in comparison to other age groups, however studies have shown that even this group have difficulty understanding written health materials, understanding health care and policies, and generally do not comprehend medical jargon. Such shortfallings of health communcation may lead to increased hospitalizations, the inability to respond to and manage a disease or medical condition, and a generally declining health status.

Mass Media

Mass Communication is used to promote beneficial changes in behavior among members of populations. A major criticism of the use of mass media as a method of health communication is the unfortunate ability for false and misinformed messages to spread quickly through the mass media, before they have the chance to be disputed by professionals. This issue may generate unwarranted panic amongst those who receive the messages and be an issue as technology continues to advance. An example of this may be observed in the ongoing distrust of vaccinations due to the publication of numerous messages that wrongly link the childhood measles-mumps-rubella (MMR) vaccination with the development and onset of Autism. The speed with which this message spread due to new social networking technologies caused many parents to distrust vaccinations and therefore forgo having their children receive the vaccine. Although this panic has been ferociously labeled as fictitious, many still harbor a lingering suspicion towards vaccinations and refuse them, which has caused an immediate public health concern.

Lack of Trained Professionals

As jobs and opportunities in health communication continue to increase, the field is met with an immediate challenge for a lack of trained professionals. As an academic study, there are only a handful of graduate programs that offer a focused study of health communication and therefore not enough professionals are produced in order to sufficiently fill the jobs that are being created. Health communication professionals are specifically trained in methods and strategies for effective communication of public health messages, with qualifications in research, strategic development, and evaluating effectiveness. However, in many instances trained professionals are not consulted before a message is produced and distributed to audiences. This is partially because of a lack of professionals to fill jobs, but also may be credited to the fact that other professionals tend to discredit the necessity of health communication professionals, and therefore bypass their help and release messages based on their own knowledge of communication.

Development

Health communication as an area for study and practice has momentum for continued growth as well as increasing visibility across disciplines and among public health officials, practitioners, and funding agencies. Academic programs across the country have added undergraduate specializations, minors, and majors in health communication, while graduate programs have defined tracks to train future health communication scholars, carved out research areas, and received funding for specific grants and to develop Centers for Communication. As of 2013, the Coalition for Health Communication lists twenty-four graduate programs with an intense focus in health communication and a goal to develop students as professionals in the field of health communication. Even with this dramatic increase in the number of degree programs, there is still an always growing demand for more academic opportunities that will expand the field of health communication professionals. Health communication is also now starting to be called "public health", especially in scholarly areas such as academic programs in universities. The future of health communication is growing and continues to in ways not only in areas of medical practice, but on as varied sites as social networks such as Facebook and Twitter. Health communication in future development will focus on social marketing and networking approaches to influence individuals to adopt healthy behaviors, linking profiles and information through social network sites. By having health communication online many people all around the world, who may not be involved in medical scholarly practices, will have a chance to become informed on the most recent and important advances and news in health and medical practices. Health communication scholars are participating in the creation of the Healthy People 2020 goals, of which an entire section is devoted to the role of health communication. The attention will continue to grow due to the need for translational research that moves research from the bench and into practice, the impacts of technology on health, the changing needs of United States and Global populations, and the prominence placed on multi-disciplinary teams for conducting funded research. The future of health communication is promising and as an area of study, it is poised for multiple pursuits over the next few decades. Effective media communication is therefore a key responsibility of public health professionals and information officers, especially during emergencies. This field guide summarizes the practical steps that can be taken to strengthen and enhance efforts made in this area. The guide can act as a rapid primer document as it highlights aspects of media communication activities that are crucial during a public health emergency. The target audiences for this field guide are WHO office and field personnel who are unfamiliar with media interactions or who wish to sharpen their skills in this area. It is also intended to help public health officials in other organizations and networks to deal with the media communication

History

Although health communication is not new, the field has developed as its own entity over the past 30 years or so. Key events include (from Kreps et al. 1998):

• 1975 – International Communication Association establishes the Therapeutic Communication Interest Group (which later became the “Health Communication” Division)
• 1979 – The American Academy on Physician and Patient (later renamed the American Academy on Communication in Healthcare) was established to promote research, education, and professional standards in patient-clinician communication.
• 1985 – National Communication Association forms the Commission for Health Communication, which later became the Health Communication Division
• 1984 – Health communication textbooks begin appearing: Kreps & Thornton (1984), Sharf (1984), and Northhouse & Northhouse (1985)
• 1989 – First peer reviewed journal devoted to health communication, Health Communication. Followed in 1996 by the Journal of Health Communication
• 1995 – Undergraduate and graduate health communication majors begin to be offered. Tufts University School of Medicine offers the first Master of Science in health communication together with Emerson College
• 1998 – The Health Communication Working Group of the American Public Health Association was established to examine the role of health communication in public health promotion.
• 1999 – The National Cancer Institute (National Institutes of Health) establishes the Health Communication and Informatics Research Branch (HCIRB) in their Behavioral Research Program, Division of Cancer Prevention and Control. The National Cancer Institute identifies health communication as an extraordinay research opportunity for promoting cancer prevention and control.
• 1999 – The National Cancer Institute establishes the Health Communication Intervention research program, funding seven multi-year research projects to study innovative strategies for communicating cancer information to diverse populations.
• 1999 – The Journal of Medical Internet Research is established to study health and health care in the Internet age.
• 2002 – The National Cancer Institute establishes the Health Information National Trends Survey (HINTS) biennial representative national survey of consumer health information seeking, acquisition, and use to evaluate progress in cancer communication and to guide health communication intervention.
• 2003 – The National Cancer Institute announced establishment of four national Centers of Excellent in Cancer Communication Research (CECCRs) providing five year funding for research centers at the University of Pennsylvania, University of Wisconsin, University of Michigan, and Saint Louis University. The CECCR program was designed to make major advances in health communication research and application, as well as to train the next generation of health communication scholars.
• 2004 – The Centers for Disease Control and Prevention (CDC) establishes the National Center for Health Marketing (NCHM)for promoting and conducting health marketing and communication research to support national health promotion efforts.
• 2004 – The Coalition for Health Communication (CHC) is established as an inter-organizational task force whose mission is to strengthen the identity and advance the field of health communication. CHC represents the ICA and NCA Health Communication Divisions and the APHA Health Communication Working Group.
• 2007 – The first dedicated Ph.D. program in Health and Strategic Communication is offered by the George Mason University Department of Communication.
• 2008 – The National Cancer Institute announced re-issuing of the national Centers of Excellent in Cancer Communication Research (CECCRs) program. They provided five years of funding for five research centers (at the University of Pennsylvania, University of Wisconsin, University of Michigan, Washington University, St. Louis, and Kaiser Permanente, Colorado. The new CECCR program was designed to continue progress in advancing in health communication research and application, as well as to train the next generation of health communication scholars.
• 2009 – First serious efforts put forth by Home Controls' HealthComm Systems to educate consumers regarding affordable, unobtrusive home technology allowing the aging to remain at home for months or years longer than ever before
• 2009 – The Society for Participatory Medicine (SPM) is established to promote participatory medicine by and among patients, caregivers and their medical teams and to promote clinical transparency among patients and their physicians through the exchange of information, via conferences, as well through the distribution of correspondence and other written materials. The SPM publishes the Journal of Participatory Medicine.
• 2009 – The Murrow Center for Media and Health Promotion is established at Washington State University.

Disciplines

Scholars and practitioners in health communication are often trained in disciplines such as communication studies, sociology, psychology, public health, or medicine and then focus within their field on either health or communication. Practitioners are pragmatic and draw from social-scientific scholarship, theories from the humanities, and professional fields such as education, management, law and marketing (Maibach 2008). Professionals trained in health communication encounter a wide range of employment opportunities spanning between the public, private, and volunteer sectors and have the opportunity for a large amount of career mobility. Examples of jobs in each of these categories include federal, state, and local health departments in the public sector, Pharmaceutical companies and large corporations in the private sector, and various non-profit organizations such as the American Cancer Society and the American Heart Association in the volunteer sector.

See also

• Community health, health promotion, health literacy, social marketing, communication, advocacy, Problematic Integration Theory

References

Notes

Bibliography

• U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2010. Volumes 1 and 2, Chapt. 11, p 11-20. http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm.
• Cline R., American Public Health Association (APHA) Health Communication Working Group Brochure, 2003. http://www.healthcommunication.net/APHA/APHA.html. Retrieved on January 2010.
• Schiavo, R. Health Communication: From Theory to Practice. San Francisco: Jossey-Bass, 2007.
• Thompson, Teresa; Roxanne Parrott, Jon Nussbaum (2011). The Routledge Handbook of Health Communication (2 ed.). ISBN 978-0-203-84606-3. 
• Kreps, G. L.; et al. (1998). "The History and Developments of the Field of Health Communication". Health communication research : a guide to developments and directions. Westport, Conn.: Greenwood Press. 
• [R. N.]; Lapinski (2009). "Why Health Communication is Important in Public Health". 
• Maibach, E. W. (2008). "Communication for Health". 
• Ringo Ma. (Ed.) (2009). Jiankang chuanbo yu gonggong weisheng [Health communication and public health]. Hong Kong: Hong Kong Educational. (in Chinese and English)
• Ringo Ma. (Ed.) (2009). Yi bing goutong zhi duoshao [How much do you know about doctor-patient communication?]. Hong Kong: KAI Education. (in Chinese and English)
• Teresa L. Thompson; Alicia Dorsey; Roxanne Parrott; Katherine Miller (1 April 2003). The Routledge Handbook of Health Communication. Taylor & Francis. ISBN 978-1-4106-0768-3. Retrieved 30 May 2013. 

External links

• International Communication Association, Health Communication Section
• Coalition for Health Communication
• American Public Health Association Health Communication Working Group
• Health Communication Partnership
• Office of Disease Prevention and Health Promotion Health Communication Activities
• Graduate Program in Health Communication, Tufts University School of Medicine
• Health Communication
• Journal of Health Communication