Health Communications in the Community

1. Health Communications in the Community Peter D. Rumm MD, MPH Associate Professor, CHMP, DSPH 215.7621652 pdr26@drexel.edu

2. 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 CDC’s role in protecting the nation’s 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 CDC’s 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

3. 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.

4. Define a goal then act For example – more publicity about the problem, i.e. awareness. First step = planning Second step = implementation Third step = evaluation

5. 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?

6. 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.

7. 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_sp01/tips.htm

8. 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.

9. 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 Some things it can do

10. 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!

11. 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

12. 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 orabove, 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.

13. 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?

14. 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?).

15. 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

16. 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.

17. Rules to go by • Don’t 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

18. 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.

19. 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.

20. 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.

21. 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 men’s 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.

22. 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?

23. 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.

24. 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?