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.
- 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.
- 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.
- 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
- 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
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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