Module 1: Health Communication Strategies

• 1.1 Characteristics of Effective Health Communication
• 1.2 Barriers to Effective Health Communication
• 1.3 Strategies to Improve Health Communication

1.1 Characteristics of Effective Health Communication

Effective health communication is essential because it equips the public with the tools and knowledge to respond appropriately to health crises such as flu outbreaks, HIV/AIDS, malaria etc. Some features of effective health communication include:

• High impact health communication catalyzes behavioral changes on a societal level; it galvanizes entire communities into action, prompting them to live a healthy lifestyle by taking the necessary measures to prevent disease and to protect, maintain and improve their own health, such as good nutrition, regular exercise, responsible sexual behavior, eschewing destructive behaviors such as cigarette smoking, drug abuse etc.(1) 
• In order for a health communication program to have an impact, it should disseminate appropriate health content that satisfies the following criteria, as prescribed by the Office of Disease Prevention and Health Promotion:(2)
  • Accuracy: The content is valid and without errors of fact, interpretation, or judgment.
  • Availability: The content (whether targeted message or other information) is delivered or placed where the audience can access it. Placement varies according to the audience, message complexity, and purpose, ranging from interpersonal and social networks to billboards and mass transit signs to prime-time TV or radio, to public kiosks (print or electronic), to the Internet.
  • Balance: Where appropriate, the content presents the benefits and risks of potential actions or recognizes different and valid perspectives on the issue.
  • Consistency: The content remains internally consistent over time and also is consistent with information from other sources (the latter is a problem when other widely available content is not accurate or reliable).
  • Cultural Competence: The design, implementation, and evaluation process that accounts for special issues for select population groups (for example, ethnic, racial, and linguistic) and also educational levels and disability.
  • Evidence-based: Relevant scientific evidence that has undergone comprehensive review and rigorous analysis to formulate practice guidelines, performance measures, review criteria, and technology assessments for tele-health applications.
  • Reach: The content gets to or is available to the largest possible number of people in the target population.
  • Reliability: The source of the content is credible, and the content itself is kept up to date.
  • Repetition: The delivery of/access to the content is continued or repeated over time, both to reinforce the impact with a given audience and to reach new generations.
• Moreover, any effective health communication strategy must take a multi-pronged approach,(3) coupling with other interventions, such as policy changes, improvements in health delivery systems, etc. If a health communication initiative does not have support at the policy level, its efficacy and impact are much less predictable than if it has institutional backing.
• In developing health communication initiatives, it is crucial to consider socio-cultural milieu of the target audiences with respect to their cultural characteristics, language preferences and media habits.(4) For instance, the health communication program developer does not want to design a health education website, only to find out later that his target audience is mainly comprised of individuals who are either technologically illiterate, or simply do not have access to the Internet.  

1.2 Barriers to Effective Health Communication

Effective health communication can be impeded by:

• Low health literacy: Because health information is normally relayed in the form of written communication, the illiterate/semi-illiterate often cannot access the information. Thus, health literature should be custom-made for each target audience and written in a style appropriate to their level of comprehension. At the same time, health literacy programs should train low-literacy individuals to avail themselves of these health resources.(5)  
• Limited Internet access: The Internet has become the channel of choice for information delivery worldwide. However, in certain communities, even in the developed world, internet access is still too costly, or maybe even outright unavailable. Moreover, though there is abundant health information on the Internet, it is still out of reach of those in resource-poor settings. Given the importance of the Internet in disseminating vital health information, there should be increased effort to bring access to rural communities and the developing world.  In particular, this effort should involve both the public and private sectors, namely the government agencies and technology corporations.(6)
• Lack of research activity in developing countries: Research and evaluation are required in order to design, develop and implement effective health communication interventions. Unfortunately, most research is done with an eye to solving health problems in the developed world, while pressing health problems in the developing world are often neglected.(7) Even if research is done in developing countries, it seldom comes to the attention of health professionals.

  "Few reports of health research from developing countries are published in journals indexed by Western services such as Medline. Western indexing services cover some 3000 journals, of which 98% are from the developed world. The whole of Latin America accounted for 0.39% of the total number of articles referenced by Medline in 1996, down from a "high" of 2.03% in 1966. Because only a small number of journals from developing countries are indexed by Medline, research from these countries is almost invisible.”(8)

• Proliferation of low quality healthcare information on the Internet: As the volume of Internet content increases on a daily basis, consumers need help evaluating the reliability of the information that they are bombarded with. According to the Office of Disease Prevention and Health Promotion,“People are using the Internet to look up information, purchase medications, consult remotely with providers, and maintain their personal health records. Approximately 70 million persons in the United States use the Internet for health-related reasons, and the potential for harm from inaccurate information, inferior quality goods, and inappropriate services is significant.”(9)In order to protect consumers, Internet health resources and health-related Web sites should be required to adhere to a strict code of conduct. Site owners should disclose their identity and essential contact information clearly and honestly. They should explicitly state the purpose of their site and provide proper citation for the content they display. They should inform their users how personal information is used, and whether the content is periodically updated to prevent misinformation.
• Inability of health workers to communicate with patients:(10) Due to various communication hurdles such as language barriers, socio-cultural differences etc., health workers sometimes have difficulty transmitting vital health information to their patients. Moreover, given the shortage of human resources, which is a common problem in developing countries, health workers often deal with multiple patients at a time, making communication even more difficult.    

1.3 Strategies to Improve Health Communication(11)

Listed below are some general strategies that governmental bodies can take to enhance the quality of health communication at a macro level:

• Government agencies and technology corporations should collaborate together to bring Internet access into more households.
• For the benefit of people with marginal literacy skills, pertinent health information should be written at their level of comfort. Health literacy programs targeting their skill improvement should be organized.
• Set up training centers that equip health communication professionals and health professionals with good communication skills. Serving an educational purpose, these centers will be equipped with health communication and media technologies like media labs, conference rooms etc. They should offer continuing education and distance learning courses. Amongst other purposes, they would serve the mission of “(1) promoting the adoption of health communication theories and practices in health care, disease prevention, and health promotion initiatives, (2) developing and disseminating quality standards, (3) coordinating initiatives to develop a consensus research agenda, (4) developing systems to identify and assess health communication research, (5) evaluating communication strategies, messages, materials, and resources, (6) fostering networking and collaboration among health communicators, health educators, and other health professionals, (7) promoting health communication skills training for health professionals, and (8) promoting research and dissemination activities among specific population groups.”(12)

At a micro level (i.e. within organizations and communities), these are some recommendations:

• Workplace guides: During a disease outbreak, employers have a responsibility for employee productivity and health. The distribution of workplace guides to contain the spread of communicable disease is an important health communication strategy. These guides contain information on how to develop workplace preparedness plans, as well as prevention and support programs in a systematic manner. In addition, workplace-wide lectures, as well as providing peer educators could further enhance health communication. (13) 
• Community skits: In a community setting, it is useful to organize short dramas or skits that portray the attitudes of the local people towards their health. By understanding local attitudes, health workers can plan interventions targeting specific behavioral changes. Theatre is also a strategic way to draw children’s attention to health problems.(14)

In addition to the above, a wide range of tools and publications have been developed by various agencies such as the Center for Global Health Communication and Marketing to provide health communication training to healthcare workers.

It is important to think outside the box when developing health communication tools. Health communication developers often come up with creative strategies to appeal to the wider public. A simple, but creative strategy such as issuing a vaccination diploma to every child who receives a vaccination, could lead to large positive health outcomes for the community. 

“…this incentive (who doesn’t like to receive a diploma?) dramatically simplifies the messages surrounding immunization. Instead of the whys and wherefores of immunization, the central message becomes, “Make sure your child receives his vaccination diploma before his first birthday.” If a family has received the diploma, they are encouraged to brag about it and to be sure that each child has one. Health workers like this tool as well because of the appreciation mothers express when they receive the diploma.”(15)

Identifying the Target Audiences:(16) Health communication strategies must be geared towards a clearly defined target audience in order to achieve optimal effect. There are two kinds of target audiences, namely the primary target whose behavior is to be influenced directly, and the secondary target who can influence the primary target such as a family member who makes decisions about the household or health worker with whom the primary audience comes into contact. As much information as possible should be collected about the target audiences, especially with regards to their views and understanding of disease.

“Each specific segment would know, believe, and/or do different things about behaviors related to malaria prevention and treatment. You would need to promote different solutions or strategies to address each segment's situation because each segment is likely to have different barriers to (reasons not to) and benefits for adopting those solutions.”(17)

Go To Module 2: Culture and its Influence on Health Communication >>

Footnotes