Use communication strategically to improve health.
Health communication encompasses the study and use of
communication strategies to inform and influence individual and community
decisions that enhance health. It links the domains of communication and health
and is increasingly recognized as a necessary element of efforts to improve personal and public
health.[1], [2], [3] Health communication can contribute
to all aspects of disease prevention and health promotion and is relevant in a number of contexts, including
(1) health professional-patient relations, (2) individuals’ exposure to, search
for, and use of health information, (3) individuals’ adherence to clinical recommendations
and regimens, (4) the construction of public health messages and campaigns, (5)
the dissemination of individual and population health risk information, that
is, risk communication, (6) images of health in the mass media and the culture
at large, (7) the education of consumers about how to gain access to the public
health and health care systems, and (8) the development of telehealth applications.3, [4], [5],
[6], [7],
[8], [9], [10], [11]
For individuals, effective health communication can help
raise awareness of health risks and solutions, provide the motivation and
skills needed to reduce these risks, help them find support from other people
in similar situations, and affect or reinforce attitudes.1
Health communication also can increase demand for appropriate health services
and decrease demand for inappropriate health services. It can make available
information to assist in making complex choices, such as selecting health
plans, care providers, and treatments.1
For the community, health communication can be used to influence the public
agenda, advocate for policies and programs, promote positive changes in the
socioeconomic and physical environments, improve the delivery of public health
and health care services, and encourage social norms that benefit health and
quality of life.2
The practice of health communication has contributed to
health promotion and disease prevention in several areas. One is the
improvement of interpersonal and group interactions in clinical situations (for
example, provider-patient, provider-provider, and among members of a health
care team) through the training of health professionals and patients in
effective communication skills.3, 4
Collaborative relationships are enhanced when all parties are capable of good communication.
Another area is the dissemination of health messages through
public education campaigns that seek to change the social climate to encourage
healthy behaviors, create awareness, change attitudes, and motivate individuals
to adopt recommended behaviors.6, 9, 10
Campaigns traditionally have relied on mass communication (such as public
service announcements on billboards, radio, and television) and educational
messages in printed materials (such as pamphlets) to deliver health messages.
Other campaigns have integrated mass media with community-based programs. Many
campaigns have used social marketing techniques.
Increasingly, health improvement activities are taking advantage of digital technologies,
such as CD-ROM and the World Wide Web (Web), that can target audiences, tailor
messages, and engage people in interactive, ongoing exchanges about health.4, 11, [12] An
emerging area is health communication to support community-centered prevention.[13]
Community-centered prevention shifts attention from the individual to
group-level change and emphasizes the empowerment of individuals and
communities to effect change on multiple levels.
A set of Leading Health Indicators, which focus on key
health improvement activities and are described in Healthy People 2010:
Understanding and Improving Health, all depend to some extent on effective
health communication. The promotion of regular physical activity, healthy
weight, good nutrition, and responsible sexual behavior will require a range of
information, education, and advocacy efforts, as will the reduction of tobacco
use, substance abuse, injuries, and violence. For example, advocacy efforts to
change prices and availability of tobacco and alcohol products have resulted in
lower consumption levels. (See Focus Area 26. Substance Abuse and Focus Area
27. Tobacco Use.) Effective counseling and patient education for behavior
change require health care providers and patients to have good communication
skills. Public information campaigns are used to promote increased fruit and
vegetable consumption (5-A-Day for Better Health!), higher rates of preventive
screening (mammogram and colonoscopy), higher rates of clinical preventive services
(immunization), and greater rates of adoption of risk-reducing behaviors (Back
to Sleep and Buckle Up for Safety).
Health communication alone, however, cannot change systemic
problems related to health, such as poverty, environmental degradation, or lack
of access to health care, but comprehensive health communication programs
should include a systematic exploration of all the factors that contribute to
health and the strategies that could be used to influence these factors.
Well-designed health communication activities help individuals better
understand their own and their communities’ needs so that they can take
appropriate actions to maximize health.
The environment for communicating about health has changed
significantly. These changes include dramatic increases in the number of
communication channels and the number of health issues vying for public
attention as well as consumer demands for more and better quality health information,
and the increased sophistication of marketing and sales techniques, such as
direct-to-consumer advertising of prescription drugs and sales of medical
devices and medications over the Internet. The expansion of communication
channels and health issues on the public agenda increases competition for
people’s time and attention; at the same time, people have more opportunities
to select information based on their personal interests and preferences. The
trend toward commercialization of the Internet suggests that the marketing
model of other mass media will be applied to emerging media, which has
important consequences for the ability of noncommercial and public
health-oriented health communications to stand out in a cluttered health
information environment.
Communication occurs in a variety of contexts (for example,
school, home, and work); through a variety of channels (for example,
interpersonal, small group, organizational, community, and mass media) with a
variety of messages; and for a variety of reasons. In such an environment,
people do not pay attention to all communications they receive but selectively
attend to and purposefully seek out information.8 One of the main challenges in the design of effective
health communication programs is to identify the optimal contexts, channels,
content, and reasons that will motivate people to pay attention to and use
health information.
A one-dimensional approach to health promotion, such as
reliance on mass media campaigns or other single-component communication
activities, has been shown to be insufficient to achieve program goals.
Successful health promotion efforts increasingly rely on multidimensional interventions
to reach diverse audiences about complex health concerns, and communication is
integrated from the beginning with other components, such as community-based
programs, policy changes, and improvements in services and the health delivery
system.10, [14] Research shows that health communication best supports
health promotion when multiple communication channels are used to reach
specific audience segments with information that is appropriate and relevant to
them.6 An important factor in the design of multidimensional programs is to allot
sufficient time for planning, implementation, and evaluation and sufficient
money to support the many elements of the program. Public-private partnerships
and collaborations can leverage resources to strengthen the impact of multidimensional
efforts. Collaboration can have the added benefit of reducing message clutter
and targeting health concerns that cannot be fully addressed by public
resources or market incentives alone.
Research
indicates that effective health promotion and communication initiatives adopt
an audience-centered perspective, which means that promotion and communication
activities reflect audiences’ preferred formats, channels, and contexts.6
These considerations are particularly relevant for racial and ethnic
populations, who may have different languages and sources of information. In
these cases, public education campaigns must be conceptualized and developed by
individuals with specific knowledge of the cultural characteristics, media
habits, and language preferences of intended audiences. Direct translation of
health information or health promotion materials should be avoided. Credible
channels of communication need to be identified for each major group.
Television and radio serving specific racial and ethnic populations can be
effective means to deliver health messages when care is taken to account for
the language, culture, and socioeconomic situations of intended audiences.
An
audience-centered perspective also reflects the realities of people’s everyday
lives and their current practices, attitudes and beliefs, and lifestyles. Some
specific audience characteristics that are relevant include gender, age,
education and income levels, ethnicity, sexual orientation, cultural beliefs
and values, primary language(s), and physical and mental functioning.
Additional considerations include their experience with the health care system,
attitudes toward different types of health problems, and willingness to use
certain types of health services. Particular attention should be paid to the
needs of underserved audience members.
Targeting
specific segments of a population and tailoring messages for individual use are
two methods to make health promotion activities relevant to audiences.[15] Examples include the targeted use of
mass media messages for adolescent girls at increased risk of smoking;[16] the tailoring of computer-generated nutritional information to help individuals
reduce their fat intake and increase fruit and vegetable consumption;[17] and a national telephone service for Spanish
speakers to obtain AIDS information as well as counseling and referrals.[18]
Interventions
that account for the cultural practices and needs of specific populations have
shown some success. For example, a breastfeeding promotion program among Navajo
women that was based on investigations of their cultural beliefs about infant
feeding practices showed increased rates of breastfeeding.[19]
Similarly, an intervention that used the novela, a popular form of Latino mass
media, to reach young people and their parents sought to improve
parent-youth communication in Hispanic families and to influence the
adolescents’ attitudes about
alcohol.[20]
Advances
in medical and consumer health informatics are changing the delivery of health
information and services and are likely to have a growing impact on individual
and community health.3, 4, 11, [21]
The convergence
of media (computers, telephones, television, radio, video, print, and audio)
and the emergence of the Internet create a nearly ubiquitous networked
communication infrastructure. This infrastructure facilitates access to an
increasing array of health information and health-related support services and
extends the reach of health communication efforts. Delivery channels such as
the Internet expand the choices available for health professionals to reach
patients and consumers and for patients and consumers to interact with health
professionals and with each other (for example, in online support groups).
Compared
to traditional mass media, interactive media may have several advantages for
health communication efforts. These advantages include (1) improved access to
personalized health information, (2) access to health information, support, and
services on demand, (3) enhanced ability to distribute materials widely and
update content or functions rapidly, (4) just-in-time expert decision support,
and (5) more choices for consumers.4, 21
The health impact of interactivity, customization, and enhanced multimedia is
just beginning to be explored, and already interactive health communication
technologies are being used to exchange information, facilitate informed
decisionmaking, promote healthy behaviors, enhance peer and emotional support,
promote self-care, manage demand for health services, and support clinical
care.
Widespread
availability and use of interactive health communication and telehealth
applications create at least two serious challenges. One is related to the
risks associated with consumers’ use of poor quality health information to make
decisions. Concerns are growing about the Web making available large amounts of
information that may be misleading, inaccurate, or inappropriate, which may put
consumers at unnecessary risk. Although many health professionals agree that
the Internet is a boon for consumers because they have easier access to much
more information than before, professionals also are concerned that the poor
quality of a lot of information on the Web will undermine informed
decisionmaking. These concerns are driving the development of a quality
standards agenda to help health professionals and consumers find reliable Web
sites and health information on the Internet. An expert panel convened by the
U.S. Department of Health and Human Services describes high quality health
information as accurate, current, valid, appropriate, intelligible, and free of
bias.4
The
other challenge is related to the protection of privacy and confidentiality of
personal health information. The personal privacy and the confidentiality of
health information are major issues for consumers, and these concerns are magnified
when information is collected, stored, and made available online.4
As the availability and variety of interactive health applications grow,
consumer confidence about developers’ ability or intent to ensure privacy will
be challenged. In the near future, personal health information will be
collected during both clinical and nonclinical encounters in disparate
settings, such as schools, mobile clinics, public places, and homes, and will
be made available for administrative, financial, clinical, and research
purposes. Although public health and health services research may require
de-identified personal health information, policies and procedures to protect
privacy will need to ensure a balance between confidentiality and appropriate
access to personal health information.
The
trend of rapidly expanding opportunities in health communication intersects
with recent demands for more rigorous evaluation of all aspects of the health
care and public health delivery systems and for evidence-based practices.[22] Numerous
studies of provider-patient communication support the connection among the
quality of the provider-patient interaction, patient behavior, and health outcomes.[23] As the knowledge base about
provider-patient interactions increases, a need becomes apparent for the
development of practice guidelines to promote better provider-patient
communication. Additional evidence about the process of health
information-seeking and the role of health information in decisionmaking also
is needed. Health communication campaigns could benefit as well from more rigorous
formative research and evaluation of outcomes. Expected outcomes should be an
important consideration and central element of campaign design. As health
communication increasingly involves electronic media, new evaluation approaches
are emerging.4, [24], [25], [26] Given the critical role that
communication plays in all aspects of public health and health care, health
communication and outcomes research should become more tightly linked across
all health communication domains.
Because
national data systems will not be available in the first half of the decade for
tracking progress, one subject of interest concerning health communication is
not addressed in this focus area’s objectives. Representing a research and data
collection agenda for the coming decade, the topic covers persons who report being
satisfied with the health information they received during their most recent
search for such information. Health-conscious consumers increasingly are proactive
in seeking out health information. Individuals want information about prevention
and wellness as much as about medical problems. Public health and the medical
community share an interest in promoting—and sustaining—informed decisions for
better health. Surveys suggest that people want to get health information
from a professional and that counseling by health professionals can be
effective both in reducing lifestyle risks and supporting self-management of
chronic diseases like diabetes. (See Focus Area 1. Access to Quality Health Services
and Focus Area 7. Educational and Community-Based Programs.) However,
diminished time in clinical visits and some clinicians’ discomfort with open communication
work against optimum information exchange. In addition, many people want information
to be available when and where they need it most. Health information should be
not only easily accessible but also of good quality and relevant for the needs
of the person. The increasing use of the Internet as a source for health
information will require greater awareness of the importance of the quality of
information.
Often
people with the greatest health burdens have the least access to information,
communication technologies, health care, and supporting social services. Even
the most carefully designed health communication programs will have limited
impact if underserved communities lack access to crucial health professionals,
services, and communication channels that are part of a health improvement
project.
Research indicates that even after targeted health
communication interventions, low-education and low-income groups remain less
knowledgeable and less likely to change behavior than higher education and
income groups, which creates a knowledge gap and leaves some people chronically
uninformed.[27] With communication
technologies, the disparity in access to electronic information resources is
commonly referred to as the “digital divide.”[28] The digital divide becomes more critical as the
amount and variety of health resources available over the Internet increase and
as people need more sophisticated skills to use electronic resources.[29]
Equitably distributed health communication resources and skills, and a robust
communication infrastructure can contribute to the closing of the digital
divide and the overarching goal of Healthy People 2010 to eliminate health
disparities.
Even
with access to information and services, however, disparities may still exist
because many people lack health literacy.[30] Health literacy is increasingly
vital to help people navigate a complex health system and better manage their
own health. Differences in the ability to read and understand materials related
to personal health as well as navigate the health system appear to contribute
to health disparities. People with low health literacy are more likely to
report poor health, have an incomplete understanding of their health problems
and treatment, and be at greater risk of hospitalization.[31] The
average annual health care costs of persons with very low literacy (reading at
the grade two level or below) may be four times greater than for the general
population.[32] An
estimated 75 percent of persons in the United States with chronic physical or
mental health problems are in the limited literacy category.[33]
People withchronic conditions, such as asthma, hypertension, and diabetes,
and low reading skills have been found to have less knowledge of their
conditions than people with higher reading skills.[34], [35]
Although
the majority of people with marginal or low literacy are white native-born
Americans,[36] changing demographics suggest that
low literacy is an increasing problem among certain racial and ethnic groups,
non-English-speaking populations, and persons over age 65 years. One study of
Medicare enrollees found that 34 percent of English speakers and 54 percent of
Spanish speakers had inadequate or marginal health literacy.[37]
As the U.S. population ages, low health literacy among elderly people is
potentially a large problem. Nearly half of the people in the elderly
population have low reading skills, and reading ability appears to decline with
age. A study of patients 60 years and older at a public hospital found that 81
percent could not read and understand basic materials such as prescription
labels and appointments.[38]
For
health communication to contribute to the improvement of personal and community
health during the first decade of the 21st century, stakeholders, including
health professionals, researchers, public officials, and the lay public, must
collaborate on a range of activities. These activities include (1) initiatives
to build a robust health information system that provides equitable access, (2)
development of high-quality, audience-appropriate information and support
services for specific health problems and health-related decisions for all
segments of the population, especially underserved persons, (3) training of
health professionals in the science of communication and the use of communication
technologies, (4) evaluation of interventions, and (5) promotion of a critical understanding
and practice of effective health communication.
A
national health information infrastructure (NHII) provides a framework that
stakeholders can use to communicate with each other and to transform data into
useful information on multiple levels. Efforts are under way throughout the
world to develop integrated national and global health information
infrastructures to support health improvements. In the United States, the
National Committee on Vital and Health Statistics (NCVHS) is advising the
Secretary of Health and Human Services and Congress on the health information
needs of the country. The NCVHS defines NHII as all of the technologies,
standards, applications, systems, values, and laws that support individual
health, health care, and public health. Issues related to technical standards,
privacy and confidentiality, and regulatory guidelines are being addressed by
the public and private sectors.[39], [40]
The
infrastructure makes it possible for people not only to use health information
designed by others but also to create resources to manage their own health and
to influence the health of their communities. For example, community groups
could use computers to gain access to survey information about the quality of
life in their neighborhoods and apply this information to create an action plan
to present to local elected and public health officials. Information is a
critical element of informed participation and decisionmaking, and appropriate,
quality information and support services for all are empowering and democratic.
As
patients and consumers become more knowledgeable about health information,
services, and technologies, health professionals will need to meet the challenge
of becoming better communicators and users of information technologies. Health
professionals need a high level of interpersonal skills to interact with diverse
populations and patients who may have different cultural, linguistic, educational,
and socioeconomic backgrounds. Health professionals also need more direct training
in and experience with all forms of computer and telecommunication technologies.
In addition to searching for information, patients and consumers want to use
technology to discuss health concerns, and health professionals need to be
ready to respond. To support an increase in health communication activities, research
and evaluation of all forms of health communication will be necessary to build
the scientific base of the field and the practice of evidence-based health
communication. Collectively, these opportunities represent important areas to
make significant improvements in personal and community health.
Health
Communication is a new focus area for Healthy People 2010.
Health Communication
Goal: Use
communication strategically to improve health.
|
Number
|
Objective Short Title
|
|
11-1
|
Households with Internet access
|
|
11-2
|
Health literacy
|
|
11-3
|
Research
and evaluation of communication programs
|
|
11-4
|
Quality
of Internet health information sources
|
|
11-5
|
Centers
for excellence
|
|
11-6
|
Satisfaction
with health care providers’ communication skills
|
Target: 80
percent.
Baseline: 26
percent of households had access to the Internet at home in 1998.
Target setting
method: Better than the best.
Data source:
Computer and Internet Use Supplement to the Current Population Survey, U.S.
Department of Commerce, Bureau of the Census.
|
Households, 1998
|
Internet Access
at Home
|
|
Percent
|
|
TOTAL
|
26
|
|
Race and ethnicity (head of household)
|
|
American Indian or Alaska Native
|
DNA
|
|
Asian or Pacific Islander
|
DNA
|
|
Asian
|
DNC
|
|
Native Hawaiian and other
Pacific
Islander
|
DNC
|
|
Black or African American
|
DNA
|
|
White
|
DNA
|
|
|
|
Hispanic or Latino
|
13
|
|
Not Hispanic or Latino
|
DNA
|
|
American Indian or Alaska Native
|
19
|
|
Asian or Pacific Islander
|
36
|
|
Black or African American
|
11
|
|
White
|
30
|
|
Gender (head of household)
|
|
Female
|
DNA
|
|
Male
|
DNA
|
|
Family income level
|
|
Poor
|
DNA
|
|
Near poor
|
DNA
|
|
Middle/high income
|
DNA
|
|
Education
level (head of
household)
|
|
Less than high school
|
DNA
|
|
High school graduate
|
14
|
|
At least some college
|
DNA
|
|
Geographic location
|
|
Urban
|
28
|
|
Rural
|
22
|
DNA = Data have not been analyzed. DNC = Data are not
collected. DSU = Data are statistically unreliable.
Many health care
organizations and public service agencies use the Internet as one of their main
channels for information delivery. Access to the Internet and subsequent
technologies is likely to become essential to gain access to health information,
contact health care organizations and health professionals, receive services at
a distance, and participate in efforts to improve local and national health.4, 11
The integration of communication media means electronic access to health information
not only via computers but also with Web-enabled televisions and telephones,
handheld devices, and other emerging technologies. Technical literacy, or the
ability to use electronic technologies and applications, will be essential to
gain access to this information.
Internet availability in the
home is an important indicator of equitable access among population groups. An
increasing number of people have access to the Internet at work and public facilities,
such as libraries and community centers, but several limitations affect the use
of online health information and support in these settings. Some employers
monitor electronic mail and the types of sites visited by employees. Access in
public settings may be problematic because of privacy and confidentiality
concerns, and access may be needed during times when these facilities are
unavailable. Because of the potentially sensitive nature of health-related uses
of the Internet, access at home is essential.
Although the proportion of
people with access to the Internet has risen dramatically since 1995, many
segments of the population lack access, such as low-income and rural
households; persons with less education; and certain racial and ethnic groups, such
as African Americans and Hispanics.28
Internet access rates vary considerably according to income. Only 11 percent of
households earning $24,999 or less have access, whereas 19 percent are
connected among those earning $25,000 to $34,999; 30 percent have access among
those earning $35,000 to $49,999; and 52 percent of households with $50,000 or
greater in income have an Internet connection.28
Barriers to Internet access include cost, lack of services in certain
communities, limited literacy, lack of familiarity with different technologies,
and, especially for people with disabilities, inaccessible formats that limit
appropriate and effective technology use. Initiatives to promote universal access
to the Internet will involve public and private sector stakeholders,
particularly government agencies and technology corporations.
Potential data
source: National Adult Literacy Survey, 2002, U.S. Department of Education.
Responses
from the National Adult Literacy Survey indicate that approximately 90 million
adults in the United States have inadequate or marginal literacy skills.36
Written information is not the only way to communicate about health, but a
great deal of health education and promotion are organized around the use of
print materials, usually written at the 10th grade level and above. These
materials are of little use to people who have limited literacy skills.[41] The result is that a very large
segment of the population is denied the full benefits of health information and
services.
Closing the gap in health literacy is
an issue of fundamental fairness and equity and is essential to reduce health
disparities. Public and private efforts need to occur in two areas: the
development of appropriate written materials and improvement in skills of those
persons with limited literacy. The knowledge exists to create effective,
culturally and linguistically appropriate, plain language health
communications. Professional publications and Federal documents provide the
criteria to integrate and apply the principles of organization, writing style,
layout, and design for effective communication.41, [42] These criteria should be widely distributed
and used. Many organizations such as public and medical libraries, voluntary,
professional, and community groups, and schools could offer health literacy programs
that target skill improvement for low-literacy and limited English proficient
individuals. If appropriate materials exist and people receive the training to
use them, then measurable improvements in health literacy for the least
literate can occur.
Potential data
sources: Sponsored survey of Federal Register notices; Grantmakers in Health; National Health Council.
Effective
health communication programs are built on sound research and evaluation.
Meaningful research and evaluation are not afterthoughts but integral parts of
initial program design. Research provides the ideas and tools to design and
carry out formative, process, and outcome evaluations to improve health
communication efforts, certify the degree of change that has occurred, and
identify programs or elements of programs that are not working.1, 10
Research and evaluation systematically obtain information that can be used to
refine the design, development, implementation, adoption, redesign, and overall
quality of a communication intervention.[43], [44]
Programs
funded by Federal, philanthropic, and not-for-profit organizations could be
strengthened with requirements for a minimum set of evaluation activities and
specific measurements. The level of research and evaluation required should reflect
the costs, scope, and potential impact (in terms of benefit or harm) of the
communication activity proposed. At a minimum, programs should be expected to
conduct appropriate audience testing for need, cultural and linguistic
competence, comprehension, and receptivity. Requirements and specifications for
evaluation could be set for grant-funded communication programs and included in
requests for funding proposals and grant program guidelines as well as for
programs directly funded and implemented by public or private sector
organizations by including research and evaluation activities in their work
plans.
Potential data
sources: Health on the Net Foundation; Health Internet Ethics (Hi-Ethics);
Internet Healthcare Coalition.
With
the rapidly growing volume of health information, advertising, products, and
services available on World Wide Web sites, serious concerns arise regarding
the accuracy, appropriateness, and potential health impact of these sites.4, 21
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,[45]
and the potential for harm from inaccurate information, inferior quality goods,
and inappropriate services is significant. Many initiatives are under way to identify
appropriate and feasible approaches to evaluate online health sites.26
Professional associations are issuing guidelines and recommendations,[46], [47],
[48]
Federal agencies such as the Federal Trade Commission are actively monitoring
and sanctioning owners of Web sites that are false or misleading,[49]
and developers and purchasers of online health resources are being urged to
adopt standards for quality assurance.4
To
allow users to evaluate the quality and appropriateness of Internet health resources,
health-related Web sites should publicly disclose the following essential
information about their site:4
(1) the identity of the developers and sponsors of the site (and how to contact
them) and information about any potential conflicts of interest or biases, (2)
the explicit purpose of the site, including any commercial purposes and
advertising, (3) the original sources of the content on the site, (4) how the
privacy and confidentiality of any personal information collected from users is
protected, (5) how the site is evaluated, (6) and how the content is updated.
An additional mark of quality which should be present in a Web site relates to
the site’s accessibility by all users. Contents of the site should be presented
in a way that it can be used by people with disabilities and with low-end
technology.
Potential data
sources: Health Communication Interest Group, American Public Health
Association; Society for Social Marketing; Association of Schools of Public
Health; Health Communication Divisions, International Communication Association
and National Communication Association; NCI.
To
enlarge the knowledge base of health communication and incorporate it into
health promotion practice, a research and training infrastructure is needed to
develop, model, and coordinate activities. For this purpose, centers for
excellence located in academic institutions, national organizations, or
research centers would be instrumental to meet scientific and practical needs.
The centers would be responsible for an array of activities, such as (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.
These
centers should provide expert staff, model curricula with core competencies in
health communication and media technologies, appropriately equipped media labs,
research seminars, continuing education and distance learning courses, and training
and placement programs to expand the pool of health communication professionals
and health professionals with communication skills. The centers also could
create databases that would catalog items such as formative and outcomes
research studies and reports and could partner with existing governmental dissemination
networks to make data publicly available. Centers for excellence in health communication
could be funded through Federal grants, foundations, or private sector health
care organizations.
Potential data
sources: National Committee for Quality Assurance; Behavioral Risk Factor
Surveillance System (BRFSS), CDC, NCCDPHP; National Health Interview Survey
(NHIS), CDC, NCHS; industry surveys (FIND/SVP, Nielsen, Jupiter
Communications).
Good
provider-patient communication contributes to quality care and improved health
status. Patients’ assessment of their providers’ communication skills is important
for individuals with a usual source of care as well as for those without, who
may have less frequent contact with the medical care system. Studies indicate
that patients find communicating with their health care providers difficult23, [50] and report that
providers do not give them enough information, even though they highly value
the information and want to know more.[51]
Clear, candid, accurate, culturally and linguistically competent
provider-patient communication is essential for the prevention, diagnosis,
treatment, and management of health concerns.23, [52]
Effective
communication underpins prevention and screening efforts at the clinical level,
when providers have the opportunity to engage in one-on-one counseling and
supply information that is culturally and linguistically appropriate and delivered
at the person’s health literacy level. Diagnoses and treatments require doctors
to negotiate a common understanding with patients about what is to be done. The
quality of provider-patient communication can affect numerous outcomes, including
patient adherence to recommendations and health status.[53]
Appropriate information and communication with a provider not only can relieve
patients’ anxieties but also can help patients understand their choices, allow
them to participate in informed decisionmaking, and better manage their own
health concerns.
 |
|
1. |
Access |
|
|
2. |
Arthritis, Osteoporosis,
and Chronic Back Conditions |
|
|
3. |
Cancer |
|
|
4. |
Chronic
Kidney Disease |
|
|
5. |
Diabetes |
|
|
7. |
Educational
and Community-Based Programs |
|
|
|
|
|
7-2. |
|
School health education |
|
7-3. |
|
Health-risk
behavior information for college and university students |
|
7-5. |
|
Worksite health
promotion programs |
|
7-7. |
|
Patient and
family education |
|
7-8. |
|
Satisfaction
with patient education |
|
7-9. |
|
Health care organization sponsorship of community health promotion activities |
|
7-10. |
|
Community health
promotion programs |
|
7-11. |
|
Culturally appropriate and linguistically competent community health promotion programs |
|
|
9. |
Family
Planning |
|
|
10. |
Food Safety |
|
|
12. |
Heart Disease
and Stroke |
|
|
13. |
HIV |
|
|
16. |
Maternal,
Infant, and Child Health |
|
|
17. |
Medical
Product Safety |
|
|
19. |
Nutrition and
Overweight |
|
|
23. |
Public Health
Infrastructure |
|
|
24. |
Respiratory
Diseases |
|
|
25. |
Sexually
Transmitted Diseases |
|
|
26. |
Substance
Abuse |
|
|
27. |
Tobacco Use |
(A listing of abbreviations and acronyms used in this
publication appears in Appendix H.)
Accuracy: Content that is valid and without errors of
fact, interpretation, or judgment.
Advocacy: Communication directed at policymakers and
decisionmakers to promote policies, regulations, and programs to bring about
change.
Availability: Content (whether a targeted message or
other information) that is delivered or placed where the audience can access
it. Placement varies according to audience, message complexity, and purpose—from interpersonal and social
networks to billboards, mass transit signs, prime-time TV, and radio and from
public kiosks (print or electronic) to the Internet.
Balance: Where appropriate, content that fairly and
accurately presents the benefits and risks of potential actions or recognizes
different and valid perspectives on an issue.
Consistency: Content that remains internally consistent
over time and also is consistent with information from other sources.
Consumer health informatics: Interactive health
communication (see below) focusing on consumers.
Consumer health information: Information designed to
help individuals understand their health and make health-related decisions for
themselves and their families.
Cultural competence: The design, implementation, and
evaluation process that accounts for special issues of select population groups
(ethnic and racial, linguistic) as well as differing educational levels and
physical abilities.
Decision support systems: Computer software programs
designed to assist diagnostic and treatment decisions. Examples include drug
alert notification systems, prompts to implement practice guidelines, and
health risk appraisals.
Evidence base: Relevant scientific evidence that has
undergone comprehensive review and rigorous analysis to formulate practice
guidelines, performance measures, review criteria, and technology assessments22 for telehealth applications.4, 24
Formative research: Assesses the nature of the
problem, the needs of the target audience, and the implementation process to
inform and improve program design. Formative research is conducted both prior
to and during program development to adapt the program to audience needs.
Common methods include literature reviews, reviews of existing programs, and
surveys, interviews, and focus group discussions with members of the target
audience.
Health communication: The art and technique of informing,
influencing, and motivating individual, institutional, and public audiences
about important health issues. The scope of health communication includes
disease prevention, health promotion, health care policy, and the business of
health care as well as enhancement of the quality of life and health of individuals
within the community.[54]
Health education: Any planned combination of learning
experiences designed to predispose, enable, and reinforce voluntary behavior
conducive to health in individuals, groups, or communities.[55]
Health literacy: The degree to which individuals have
the capacity to obtain, process, and understand basic health information and
services needed to make appropriate health decisions.30 (See also Literacy.)
Health promotion: Any planned combination of
educational, political, regulatory, and organizational supports for actions and
conditions of living conducive to the health of individuals, groups, or
communities.
Interactive health communication:The
interaction of an individual with an electronic device or communication technology
to access or transmit health information or to receive guidance on a
health-related issue.21
Internet: A worldwide interconnection of computer
networks operated by government, commercial, and academic organizations and
private citizens.
Literacy: The ability to read, write, and speak in
English and to compute and solve problems at levels of proficiency necessary to
function on the job and in society, to achieve one’s goals, and develop one’s
knowledge and potential.[56]
Medical informatics: A field of study concerned with
the broad range of issues in the management and use of biomedical information,
including medical computing and the study of the nature of medical information
itself.[57]
Outcome evaluation (sometimes called impact evaluation):
Examines the results of a communication intervention, including changes in
awareness, attitudes, beliefs, actions, professional practices, policies,
costs, and institutional or social systems.
Patient communication: Information for individuals
with health conditions to help them maximize recovery, maintain therapeutic
regimens, and understand alternative approaches. Patient communication includes
educational resources, provider-patient communication, and, increasingly,
peer-to-peer communication.
Process evaluation: Monitors the administrative, organizational,
or other operational characteristics of an intervention. Process evaluation
includes monitoring the dissemination of communication products to intended
users (whether gatekeepers or audiences) and audience members’ exposure to a
message. For an interactive health communication application, process
evaluation may include testing how the application functions.
Reach: Information that gets to or is available to
the largest possible number of people in the target population.
Reliability: Content that is credible in terms of its
source and is kept up to date.
Repetition: Delivery of and access to content
continued or repeated over time, both to reinforce the impact with a given
audience and to reach new generations.
Risk communication: Engaging communities in
discussions about environmental and other health risks and about approaches to
deal with them. Risk communication also includes individual counseling about
genetic risks and consequent choices.
Social marketing: The application of marketing principles
and techniques to program development, implementation, and evaluation to
promote healthy behaviors or reduce risky ones.[58], [59]
Tailoring: Creating messages and materials to reach
one specific person based on characteristics unique to that person, related to
the outcome of interest, and derived from an assessment of that individual.15
Targeting: Creating messages and materials intended
to reach a specific segment of a population, usually based on one or more
demographic or other characteristics shared by its members.15
Telehealth: The application of
telecommunication and computer technologies to the broad spectrum of public health,
medicine, and health.
Telemedicine: The use of electronic
information and communication technologies to provide clinical care across
distance.24
Timeliness: Content that is provided or available
when the audience is most receptive to, or in need of, the specific information.
Underserved: Individuals or groups who lack access to
health services or information relative to the national average. The
underserved population may include residents of rural, remote, or inner-city
areas; members of certain racial and ethnic groups; socioeconomically disadvantaged
persons; or people with disabilities.
Understandability: Reading or language level and
format (including multimedia) appropriate for a specific audience.
World Wide Web (Web): An international virtual
network composed of Internet host computers that can be accessed by graphical
browsers.
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