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Communicating Health: Priorities
and Strategies for Progress

Office of Disease Prevention and Health Promotion logo

Objective 11-5. Centers for Excellence in Health Communication

Drafters
Gary Kreps, Ph.D., National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

Thomas Gordon, Ph.D., Department of Public Health, Temple University

Small Group Participants
Michael Barnes, Brigham Young University

Don Cegala, The Ohio State University

Dianne Needham, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (at the time of the meeting)

Barry Portnoy, Office of Disease Prevention, National Institutes of Health, U.S. Department of Health and Human Services

Michael Slater, Colorado State University

K. Viswanath, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

Note taker: Heather Burns, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

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Text of Objective
Increase the number of centers for excellence that seek to advance the research and practice of health communication.

Scope
The objective is intended to represent an important aspect of the research and practice needs of the health communication field but cannot encompass all issues raised by and related to the subject. The objective means to serve the specific purpose of providing data on progress to establish centers for excellence and the general purpose of stimulating discussion about a wide range of research and practice needs in the health communication field.

Measurement
The objective is developmental. The health communication chapter in Healthy People 2010 (U.S. Department of Health and Human Services [HHS], 2000) notes that

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.

Several elements needed to make this a measurable objective are currently being defined. These elements include consensus about the center concept and necessary criteria to identify centers for excellence. At present, several self-identified programs around the Nation are conducting research involving health or public health and communication. Most of these are engaged in "applied" research, using existing health communication knowledge and techniques to solve particular health problems, versus focusing on "basic" research involving the processes or mechanisms of health communication research per se.

The National Cancer Institute (NCI) has taken the lead to create and fund a network of centers to accelerate the research and development of interventions for cancer communications. The grant program will fund multiple Centers of Excellence in Cancer Communications (CECCRs). The centers will encourage focused interdisciplinary studies to accelerate scientific developments in cancer communications, increase the number of investigators from a range of disciplines who focus on the study of cancer communications, and train investigators to conduct cutting-edge communications research. Because of NCI's central role in the development of formally designated centers, the Institute has been identified as the entity to undertake regular assessment of the objective.

  1. Because excellent health communication research may take place in a variety of contexts (e.g., research centers, university departments, corporate units), criteria are needed to characterize "centers for excellence." These criteria could be used to identify existing centers or to promote the development of future centers. Criteria might include
  • A primary focus on health communication research
  • A critical mass of researchers doing health communication research on a continuing basis
  • An operational emphasis on interdisciplinary research teams to provide both breadth and depth in theory and methodology
  • A clear, efficient, and effective administrative structure to manage the financial, operational, and personnel needs of the research unit
  • Solid institutional support to provide a stable research environment
  • Ongoing activities such as
  • A well-defined health communication research program
  • Frequent publication of the unit's research in book or journal form
  • The acquisition of significant levels of research funding
  • Mentoring programs to involve students (graduate or undergraduate) in research projects as a means to train future health communication researchers
  • Postdoctoral training opportunities
  • Clearly defined marketing, recruiting, and networking mechanisms
  • Publications detailing the center's characteristics, structure, and activities.
  1. Information is needed to profile and track ongoing health communication research taking place around the Nation. This would best be accomplished through a longitudinal survey mechanism to
  • Identify existing centers and research programs as a benchmark to document who is doing what kinds of research in which locations.
  • Provide a context for conceptualizing activity in the field. Having a comprehensive picture of the research activities taking place would be an important aid to conceptualizing and defining the field.
  • Identify areas of needed research. Through knowledge of the ongoing activities of the field, it would be possible to document the gaps in knowledge and research methods.
  • Monitor and track research activities and accomplishments across time. After the initial benchmark profiles of research activity are established, periodic surveys should be done to update the database, track long-term projects, and document the evolution of the field.
  • Provide empirical justification for future centers for excellence initiatives. Having an ongoing profile of health communication research activities would provide a wealth of information to justify recommendations for future centers.
  1. This action plan provides an initial assessment of relevant stakeholders. A more thorough assessment is still needed to determine who the stakeholders are, their levels of activity and involvement, their needs, and the resources they could bring to the creation of centers for excellence. Having this information would make it possible to better organize and coordinate the diverse activities of the stakeholders toward the common goal of establishing and maintaining centers for excellence. For example, it may also be important to consider building capacity for the application of communication strategies, tools, and theories in programs that prepare professionals or develop programs to reach the most underserved communities. Thus, investing in community-based participatory research partnerships between centers for excellence in health communication, Minority Serving Institutions (e.g., Historically Black Colleges and Universities), and national minority-focused leadership organizations (e.g., National Association for the Advancement of Colored People and National Council of La Raza) may be critical to ensure that the populations that bear the greatest burden of disease benefit most from new health communication approaches identified through research.

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Issues Pertaining to Measurement
Assessment issues are linked to the functions of the centers for excellence. The health communication chapter of Healthy People 2010 (HHS, 2000) describes these functions as follows:

  • 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.

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State of Knowledge About Issues Represented by the Objective
As the communications revolution blossoms, the amount and diversity of health information increases exponentially and, with it, the need for more effective ways to gather, store, and use the information. At no time in our history has the need to understand and effectively use health communication been greater. Communication is central to all forms of health care, from primary prevention to end-of-life issues. Healthy People 2010 defines health communication as "the research-based crafting and delivery of messages and strategies to promote the health of individuals and communities." Health communication, when effectively used, can inform, educate, motivate, and empower individuals, communities, and nations.

For more than 50 years, social scientists from a variety of disciplines have been studying how humans interact in an attempt to develop predictive theories. In the health arena, these theories have increasingly focused on how people process health information and how they perceive and respond to health risks. In recent years, health communication theories have aided in the development of effective health campaigns addressing a range of topics, from smoking and drug abuse to nutritional awareness and personal fitness. In general, however, knowledge of communication processes and principles has not kept pace with the increasing complexity of health information environments (e.g., new media and Internet sources) and personal health challenges (e.g., new epidemics and threats of bioterrorism). As such, there is an exceptional need to develop programs and mechanisms to stimulate more health communication research, coordinate available research resources, train more qualified researchers, organize the growing body of knowledge, and disseminate this knowledge to scientists, health practitioners, patients, and the public. The 2010 objective to increase the number of centers for excellence in health communication research is an attempt to address this critical need for quality health communication information.

Overall, the science must be developed to the point where people can be taught to evaluate health risks, deal critically with conflicting health information, and make informed choices, including judgments about complementary and alternative therapies. We must learn how to effectively inform healthcare professionals of best practices on the one hand and how to better communicate with their patients on the other. We must also learn how to use our communication knowledge to reduce health disparities, while more effectively interacting with children, older persons, minorities, culturally disparate groups, and high-risk populations. Communication is an integral component in all healthcare contexts. By increasing the number of centers for excellence in health communication research, we will be better able to empirically apply our knowledge in ways that will increase both the quality of health care in America and the overall quality of life.

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Stakeholders
The primary stakeholders for this objective are those organizations that are (or could be) directly involved in the development of centers for excellence initiatives and programs, such as

  • Academic institutions with health communication research programs or interests
  • Special interest groups involving patients, practitioners, or the public
  • Industries with health foci that would benefit from improved health communications
  • Governments at all levels and their research funding agencies
  • International groups with health foci and missions
  • Nongovernmental agencies with health-related missions
  • Professional associations involving healthcare providers
  • Patient advocacy groups
  • Healthcare practitioners from a wide range of professions

Specific professional associations that focus on health communication research, education, and applications include

  • International Communication Association
  • National Communication Association
  • American Public Health Association
  • Western States Communication Association
  • Eastern Communication Association
  • Central States Communication Association
  • American Telemedicine Association
  • American Society for Preventive Oncology
  • Society for Behavioral Medicine
  • Society for Public Health Education

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Status of Selected Stakeholder Activities
The research program most closely related to the centers for excellence objective is the NCI research initiative to develop CECCRs. This interdisciplinary research initiative, the centerpiece of NCI's Extraordinary Opportunity in Cancer Communications, is a multiyear commitment by NCI to provide support for new research and outreach efforts in cancer communications. The novelty and scope of this initiative reflect the belief that effective communications can and should be used to narrow the enormous gap between research discoveries and applications and to help reduce health disparities. Communication is central to quality health care, from primary prevention to survivorship (Institute of Medicine, 1999). In June 2003, NCI awarded $10 million each to four research centers in support of the CECCR initiative.

The Request for Applications (RFA) mandated that CECCR applicants develop an interdisciplinary research team to conduct an innovative 5-year program of health communication research. These research programs should include three or more major individual hypothesis-driven, yet interrelated cancer communication research projects; plans for several emergent pilot or developmental research projects; strategies for shared resources; and plans for training and career development programs to prepare the next generation of cancer communications scientists. The RFA suggested that to be effective, the centers' research programs should integrate cancer communications appropriately into one or more contexts of the cancer continuum—from prevention through treatment to survivorship and end-of-life research. It encouraged the development of communications research studies about challenging topics such as cancer information-seeking, decisionmaking under uncertainty, and genetic testing. The RFA also encouraged development of research projects that would provide insights into mechanisms underlying how people process information. The centers' interdisciplinary efforts are expected to result in new or improved syntheses, theories, methods, and interventions, including those for diverse populations. The centers are expected to provide an essential infrastructure to facilitate rapid advances in knowledge about cancer communications, translate theory and programs into practice, and train health communication scientists.

CECCRs are expected to conduct research that will lead to major scientific advances in knowledge about cancer communications and their translation into practice. Several overarching goals include

  • Increase the number of investigators from relevant disciplines who focus on the study of cancer communications as part of interdisciplinary teams.
  • Increase the number of peer-reviewed publications in the area of communication processes.
  • Generate basic research evidence to improve understanding of the processes underlying effective cancer communication.
  • Produce evidence-based communication interventions that can be used to modify cancer risk behaviors and improve informed decisionmaking and quality of life.
  • Support novel interdisciplinary research to inform medical, dental, pharmacy, and public health practitioners about how best to communicate to the public, patients, and cancer survivors.
  • Increase the number of evidence-based interventions in understudied areas (e.g., diagnosis, treatment, survivorship, end-of-life) and on understudied populations.
  • Train interdisciplinary investigators capable of conducting cutting-edge communications research directly relevant to the context of cancer prevention, detection, treatment, control, or survivorship.

The focus of CECCR research programs can include, but is not limited to, cancer risk communication, evidence-based interventions to enhance cancer communication, communication methods for diverse and underserved populations, innovative communication strategies to increase informed decisionmaking and participation in clinical trials, communication about genetic testing, survivorship and end-of-life issues, as well as communication interventions to improve cancer prevention and early detection behaviors. The CECCR RFA also invited research to elucidate the psychological mechanisms underlying the cancer communication process, to understand how people use cancer information, to test innovative strategies to overcome the digital divide in access to cancer-related information, and to develop and evaluate methods to enhance the dissemination of evidence-based cancer communication interventions. Researchers were encouraged to examine the ethical issues associated with cancer communications as well as the cost-effectiveness of evidence-based interventions. Messages and the way messages and information are developed, designed, displayed, and communicated should be based on scientific evidence. Yet, little research has been conducted on the usability of available cancer communications. Centers were encouraged to conduct basic, intervention, and diffusion research in a variety of settings, including laboratories and clinical and community settings. Programs should focus on translatability—from basic to intervention research to dissemination and sometimes back again.

The announcement of the CECCR initiative has focused considerable attention on health communication research. Top researchers from a number of different scientific disciplines—such as medicine, public health, communication, information science, psychology, sociology, anthropology, engineering, and gerontology—have begun new collaborations on health communication research projects. As a result of this initiative, health communication researchers are working with major cancer research centers, NCI's Cancer Information Service, healthcare delivery systems, managed care programs, social service agencies, and other Government-sponsored and nonprofit health organizations. Once the four new centers begin their work, an inevitable surge of innovative new programmatic and interdisciplinary health communication research activities will lead to new health communication research models, theories, methods, and applications. These activities will directly support the goals of this Healthy People 2010 objective.

Important new health communication research centers also have been developed, or are currently under development, at a number of U.S. universities, such as the University of Kentucky, Northwestern University, University of Michigan, Johns Hopkins University, University of Southern California, Harvard University, University of Pennsylvania, St. Louis University, Texas A&M; University, Duke University, University of North Carolina, Pennsylvania State University, Temple University, Case Western Reserve University, University of Missouri, and West Virginia University. Several major cancer centers, such as the M.D. Anderson Cancer Research Center, the Fox Chase Cancer Center, and the Fred Hutchinson Cancer Research Center, also are developing health communication research programs. These developmental activities also support the Healthy People 2010 Health Communication Centers for Excellence objective. Furthermore, interest in research and educational activities concerning health communication is increasing among professional societies, private foundations, and other funding agencies.

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Factors That Can Influence Change
Many major factors, listed below, could influence the development of centers for excellence.

  • More funding targeted for the establishment of centers
  • Agencies and institutions committing to the development of centers by including a center-like focus in mission statements and establishing research programs promoting health communication research
  • Professional associations developing task forces to study and promote centers, priority statements, and action plans emphasizing centers, programs leading to the establishment of centers, and structures to evolve internal or collaborative centers
  • Promotion of an information environment that would encourage center formation through information technologies and health information sources
  • Encouragement for healthcare payors to develop centers related to prevention and focusing on health policy
  • Support for health policies that encourage center development
  • Refinement of diffusion mechanisms for promoting centers.

Successes associated with the NCI-funded CECCR program could encourage other researchers to engage in programmatic health communication research and outreach activities and could encourage new health communication funding initiatives by other Federal agencies, private foundations, and professional societies. However, any problems experienced by the CECCR program could discourage similar investments in health communication research and outreach activities. In addition, further downturns in the economy could discourage other large-scale initiatives in health communication centers for excellence.

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Strategies and Solutions
Listed below are possible strategies for promoting the development of centers for excellence. The strategies are categorized, and each item is designated as either a long-term or short-term strategy.

Collaboration and Promotion of Centers

  • Convene stakeholders to develop strategies for developing more centers. (short-term strategy)
  • Promote centers within and across professional associations, at conferences, and at various types of professional meetings. (short-term strategy)
  • Promote collaboration among professional associations for joint efforts to create and support health communication research centers. (short-term strategy)
  • Encourage interagency collaboration to fund centers. (long-term strategy)
  • Encourage increased funding to establish centers wherever possible. (long-term strategy)
  • Encourage funding agencies, foundations, etc., to fund centers of expertise in health communication research, in addition to centers for excellence. (long-term strategy)

Assessment

  • Confirm consensus on core criteria to identify centers. (short-term strategy)
  • Confirm the reporting mechanism to provide data for the objective. (short-term strategy)
  • Establish a mechanism to track and evaluate contributions made by centers for excellence, such as the development of new health communication knowledge (e.g., models, theories); new health communication research methods (e.g., instruments, strategies); health communication practices and policies; and collaborations. (short-term strategy)
  • Develop credential or accreditation mechanisms for centers. (long-term strategy)

Infrastructure Development

  • Establish a panel of experts to oversee the development of research centers for excellence. (short-term strategy)
  • Establish a resource-sharing or consultation mechanism (e.g., a health communication research consortium) to provide added resources for developing centers. (short-term strategy)
  • Take advantage of the interest and momentum generated by the NCI RFA on CECCRs and develop ways to help worthy applicants who were not funded to establish centers. (short-term strategy)
  • Have a debriefing miniconference among NCI center grant applicants to explore strategies for collaborating and maintaining the momentum. (short-term strategy)
  • Create a think tank of key scholars, administrators, and politicians to develop strategies for establishing centers. (short-term strategy)
  • Develop networks, formal and informal, to lobby or work for center funding or programs. (long-term strategy)
  • Create a virtual center incubator to facilitate the establishment of centers. (long-term strategy)
  • Develop best practice guidelines for conducting quality health communication research. (long-term strategy)
  • Encourage the National Institutes of Health (NIH) to develop a new mechanism to fund establishment of infrastructure units to promote health communication research. (long-term strategy)
  • Establish collaborative infrastructures to fund centers and set research priorities. (long-term strategy)

Publication

  • Create special issues of journals to promote centers. (long-term strategy)

Training and Professional Development

  • Establish a health communication fellows program collaboratively among key professional groups (International Communication Association, National Communication Association, American Public Health Association). (short-term strategy)
  • Establish training of researchers as a major priority among existing centers, and fund training mechanisms (e.g., postdoctorate). (long-term strategy)
  • Use cooperative research agreements to facilitate training and research in health communication. (long-term strategy)

Recognition

  • Involve the major professional associations in the development of recognition awards for outstanding projects, distinguished individuals, and model programs or curricula. (short-term strategy)
  • Establish a prestigious center award for recognized excellence in health communication research, accompanied by a substantial grant funded by industry or foundation sources. (short-term strategy)

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Action Steps
Establish a working group or identify an existing advisory body to promote the centers objective. NCI would coordinate this group, which would comprise representatives from

  • Professional associations
  • Government agencies
  • Healthcare industries
  • Foundations
  • Patient advocacy groups

Work with existing funding sources to encourage center funding.

Develop a Web site designed to promote and facilitate the establishment of centers. The site and related support mechanisms would

  • Organize existing resources to provide technical assistance to those willing to pursue the establishment of centers.
  • Provide grant-writing assistance and grant application models.
  • Facilitate interdisciplinary collaboration among individuals and institutions.
  • Provide consultation mechanisms for easier access to needed research and administrative expertise.
  • Foster involvement of knowledgeable individuals in the peer review processes related to funding mechanisms.

Establish a formal mentoring system for health communication researchers to feed developing centers with quality research personnel.

Establish formal networks of opinion leaders via print, electronic, and interpersonal means to diffuse information to health communication researchers.

Partner with other agencies and initiatives to ensure that health communication research is incorporated and research centers are involved.

Establish formal linkages with State and local public health agencies to facilitate the involvement of established or developing health communication research centers at these levels.

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Resources Needed
NCI already has dedicated substantial resources to the creation, support, and ongoing assessment of CECCRs. Additional resources may be needed to track non-NCI-funded centers and certainly to establish additional centers.

The primary resource needs are associated with the functions to be carried out by centers, as described in the health communication chapter in Healthy People 2010:

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 healthcare organizations.

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Lead Organizations and Responsibilities
The organizations that should take the lead in moving this objective forward are as follows:

  • NCI will work with the Office of Disease Prevention and Health Promotion to develop a collaborative process to promote the centers concept, engage stakeholders, encourage funding, and provide ongoing assessment and recognition of progress.
  • The stakeholders mentioned earlier also should be involved, to the extent possible, to provide critical guidance and to engender widespread support for the overall effort.

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Timeframe for Action Steps
The timeframe recommended for the development of action plans for this objective is outlined below.

First 1 to 2 years

  • Identify the mechanism within NCI to coordinate the effort to promote the establishment of centers for excellence (see Action Steps above).
  • Create mechanisms to educate the field, funding agencies, and the public about the importance of centers.
  • Encourage special issues of journals to promote centers.
  • Convene stakeholders to develop strategies for promoting and developing more centers.
  • Collaborate with other agencies to get center grant funding set at a high priority.
  • Have a debriefing miniconference among the NCI center grant applicants to explore strategies for collaborating and keeping the momentum going.
  • Work with NCI center grant applicants to encourage submission for research program projects (PO1), postdoctorate funding, training grants, etc., to move toward center status.
  • Promote the need for centers within and across professional associations, at conferences, and at professional meetings.
  • Promote collaboration among professional associations for joint efforts to create and support health communication research centers.
  • Establish a resource-sharing or consultation mechanism (e.g., a health communication research consortium and Web site) to provide added resources for developing centers.
  • Create a think tank of scholars, administrators, and politicians to develop strategies for establishing centers.
  • Establish a health communication fellows program collaboratively among professional groups (e.g., International Communication Association, National Communication Association, American Public Health Association).

Longer term activities

  • Encourage increased funding to establish centers wherever possible.
  • Establish collaborative infrastructures to fund centers and set priorities.
  • Develop networks, formal and informal, to lobby for center support.
  • Encourage interagency collaboration to fund centers.
  • Use cooperative research agreements to facilitate training and research in health communication.
  • Encourage NIH to develop a new mechanism to fund the establishment of infrastructure units to promote health communication research centers.
  • Encourage the funding of "centers of expertise" in health communication research, as well as centers for excellence.
  • Develop best practice guidelines for conducting quality health communication research.
  • Create a virtual center incubator to facilitate the establishment of centers.
  • Establish training of researchers as a major priority among existing centers and fund training mechanisms (e.g., postdoctorate, personnel agreements).

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For More Information
NCI Centers of Excellence in Cancer Communications Research
http://dccps.nci.nih.gov/hcirb

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References
Anderson JG, Aydin CE, Jay SJ, eds. Evaluating health care information systems. Thousand Oaks, CA: Sage Publications, 1994.

Backer TE, Rogers EM, Sopory P. Designing health communication campaigns: what works? Newbury Park, CA: Sage Publications, 1992.

Finnegan JR Jr, Viswanath K. Health and communication: medical and public health influences on the research agenda. In: Communication and health: systems and applications, Ray EB, Donohew L, eds. Hillsdale, NJ: Lawrence Erlbaum Associates, 1990.

Harris LM, ed. Health and the new media: technologies transforming personal and public health. Mahwah, NJ: Lawrence Erlbaum Associates, 1995.

HHS. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.

Institute of Medicine and National Research Council. Ensuring quality cancer care. Washington, DC: National Academy Press, 1999.

Jackson LD, Duffy BK, eds. Health communication research. Westport, CT: Greenwood, 1998.

Kim P, Eng TR, Deering MJ, et al. Published criteria for evaluating health-related Web sites: review. Br Med J 1999;318:647-9.

Kreps GL, Bonaguro EW, Query JL Jr. The history and development of the field of health communication. In: Health communication research, Jackson LD, Duffy BK, eds. Westport, CT: Greenwood Press, 1998.

National Cancer Institute. Making health communications work. Pub. No. NIH 89-1493. Washington, DC: U.S. Department of Health and Human Services, 1989.

Ratzan SC, ed. Health communication: challenges for the 21st century. Special issue. Amer Behav Sci 1994;38(2).

Robinson TN, Patrick K, Eng, TR, et al., for the Science Panel on Interactive Communication and Health. An evidence-based approach to interactive health communication: a challenge to medicine in the information age. J Amer Med Assoc 1998;280:1264-9.

Science Panel on Interactive Communication and Health. Wired for health and well-being: the emergence of interactive health communication, Eng TR, Gustafson DH, eds. Washington, DC: U.S. Department of Health and Human Services, 1999.

Viswanath K, Finnegan JR. Community health campaigns and secular trends: insights from the Minnesota Heart Health Program and Community Trials in Heart Disease Prevention. In: Public health communication: evidence for behavior change, Hornick R, ed. New York: Erlbaum, 2002.

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Contents
Background on the Health Communication Focus Area in Healthy People 2010
Introduction to the Health Communication Action Plans
Objective 11-1. Internet Access in the Home
Objective 11-2. Improvement of Health Literacy
Objective 11-3. Research and Evaluation of Health Communication Programs
Objective 11-4. Disclosure of Information To Assess the Quality of Health Web Sites
Objective 11-5. Centers for Excellence in Health Communication
Objective 11-6. Healthcare Providers' Communication Skills
Acknowledgments/
Credits
Appendix. Examples of Stakeholders Involved in Technology Diffusion and Internet Access Initiatives