Health Promotion: beyond the medium and the message

Bee Healthy

When it comes right down to it, we in health promotion and communication set out to change people’s behavior by focusing on the medium and the messages we create. Accurate, timely, trustworthy and understandable information will win the day. Sort of like “inject with information and voila!”

The blame for the public’s persistent unhealthy behaviors and the baffling increase in rates of preventable illness are the result of things like: the patient’s low health literacy; the complicated language of health content that we must fix; or choosing the wrong mode of message delivery – technical problems that we can tinker with to get things right. (Zarcadoolas, 2011)

Health communicators, promoters, health literacy experts generally focus on people needing to comprehend the language of health. Along with behavioral scientists, we may along the way, delve into the cognitive and motivational roles – is the information relevant and valuable to the patient? Does the public have the capacity to use this information?

But theory and practice in health promotion falls short when we’re faced with the sobering reality that “fixing” as much of the message as we know how to doesn’t yield the informed, right-minded, decision making patient we had in mind.

noise

 

In the background of our failures lurks a closet-full of  clanking objects- cultural perspectives, lived experience of the patient, unnamed things that hobble our efforts – what Burke& Barker call the perceived “noise” in the system.

For many health communication folks, the “noise” is conceived of as a barrier that should be overcome.

Examples:

  • The patient doesn’t return for followup treatment once they see what their advanced treatment will cost.
  • The region receives severe hurricane warnings 2 seasons in a row and grows skeptical of forecasts, and doesn’t prepare.
  • The public recalls many instances where experts find out that a recommended medication is now deemed unsafe – and therefore doesn’t trust taking any medication on a daily basis.
  • The parent who believes that breakfast must include a hot meal – and doesn’t allow their child to participate in the school breakfast program.
  • The patient, the public, who’s experienced racism, sexism, ageism….and has no expectations for care and little trust in the messenger.
  • The internet savvy consumer who would rather “Google” to make a diagnosis, and then crowd source best treatments online.

I was talking to a woman in East Harlem last week about the Zika virus, the risk of microcephaly and the concern that so many black and Hispanic women in the neighborhood travel back and forth from New York to the Caribbean and Central America. She said:

“It’s a new way for the government to track us – find the illegals- just wait. You’ll see.”

How can we recognize, better understand and embrace these powerful realities in the private, public and institution spheres? It seems without doing so we really are part of the “noise.”

 

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Zarcadoolas, C. (2011) The simplicity complex: exploring simplified health messages in a complex world. Health Promot Int. 26(3): 338-50

Nancy J. Burke & Judith C Barker (2014) “Health Communication Noise:Insights from Medical Anthropology“. In H. Hamilton and Chou, W- Y. (eds.), Routledge Handbook of Applied Linguistics and Health Communication, New York, NY, Routledge.

 

 

4 replies
  1. Juan Lopez
    Juan Lopez says:

    Minority communities are particularly prone to the ‘noise’ that might drown out a powerful message of health promotion, and I feel as though it goes far beyond an increased lack of health literacy. As Chris mentioned in class, certain cultures are particularly hesitant to accept advice or tips from someone outside of their circle, ESPECIALLY if that advice will ask them to change their behavior. In thinking about my own poor habits (not too many!), I find myself justifying my behavior constantly: I’m too young to get sick, I don’t eat junk food ‘that’ often, I’m not ‘too’ overweight, etc. If we can justify poor behaviors as we engage in them, our perception can certainly be selective in terms of what it accepts or denies as a valid health message.
    I think healthy eating has an especially difficult hurdle to climb in this respect. There isn’t just ‘noise’ in the air, but a concerted, well-funded effort on the part of companies to sell their unhealthy products, particularly concentrated on the sensitive ears of children. If it were a fair fight, health care practitioners might have more of a chance at curbing poor eating behaviors, but it clearly isn’t.

    • ChrisZ
      ChrisZ says:

      I agree with you Juan that culture, beliefs, norms drive a lot of what we’ll pay attention to and what can influence and persuade us. It is an uphill road when promoting healthier behaviors, for sure.
      But then you see that skilled marketers can get most of us to notice, like, ….do almost anything. From spending money we don’t have on enormous TVs or very high end baby strollers when we really can’t afford them; to convincing us we should be drinking bottled water even though NYC has excellent drinking water; to recycling even though it can be inconvenient.
      As much as we resist adopting new behaviors, we are often, like lemmings. Following…fitting in…adopting the values and behaviors of the larger community.

  2. Jordan Cuby
    Jordan Cuby says:

    As someone with a growing interest in medical anthropology, I have began to take notice of the many nuances that frame “our” responses to public health messages. Much of it is cultural conditioning, and a lack of trust of the medical system, at least for a good number of minorities. I feel that when we try to persuade and encourage behavior change within the population, we desire that lay people would receive and conceptualize the information as we go, with a modest level of “reflexivity”. As health care providers, and practicioners and soon to be better health communicators, it is apart of our duty and training to lay aside our personal beliefs about a topic and seek out the information that is based in theory and truth, not our emotions. It is difficult to accept the fact that as people, either patient or provider, that those we seek to help receive health messages through the lens of their own experience. This is a very difficult hurdle to overcome in health communication.

  3. Sarah
    Sarah says:

    How do we “recognize, better understand and embrace the powerful realities,” which explain the barriers to the behavior change? Research. And research from multiple avenues – through data analysis and tracking and through observation and ethnographical study. And this research will never be concluded.
    We cannot stop observing and analyzing at any point in a project since ideologies change, populations (and individuals) react in unexpected ways. Moreover, if we follow the stages of change model that describes the cyclical nature of every action – we see that even if the desired result is achieved – we must continue to monitor behavior to prevent relapse.

    The insight gained into understanding the (ever-changing) realities will dictate how the language of the message and the tactics for dissemination must change to better reach the goal. Learn from past successes or past mistakes. For example, overhaul the basic message strategy when the tracking shows an undesired or even detrimental response. (Andreason, p. 17) As much as possible, integrate promotion and marketing methods to better utilize the local community/government as a partner and a resource. (Andreason, p. 24).

    To address your “noise examples..” can I posit some possible solutions? For every barrier, there’s some response?
    •The patient doesn’t return for follow-up treatment once they see what their advanced treatment will cost.
    After the patient finishes the initial treatment visit – provide information on financial support – include this information as part of the routine paperwork at the end of each visit. Include as well the “danger” should the patient be lost to follow-up to help the patient make an accurate cost-benefit analysis. If there is no policy in place for financial assistance, track this instance and observe behaviors of other patients to determine if this is an isolated event or an ongoing issue. Use the findings to lobby for change.

    •The region receives severe hurricane warnings 2 seasons in a row and grows skeptical of forecasts, and doesn’t prepare.
    Craft a narrative of a “worst case scenario.”

    •The public recalls many instances where experts find out that a recommended medication is now deemed unsafe – and therefore doesn’t trust taking any medication on a daily basis.
    Craft a narrative and show data of the many daily medications that have been found effective.

    •The parent who believes that breakfast must include a hot meal – and doesn’t allow their child to participate in the school breakfast program.
    Research this situation more. Is the child being fed before school? If so – is it a problem that the child isn’t participating? If not – what are the parent’s reasons?

    •The patient, the public, who’s experienced racism, sexism, ageism….and has no expectations for care and little trust in the messenger.
    Continue to work our hardest.

    •The internet savvy consumer who would rather “Google” to make a diagnosis, and then crowd source best treatments online
    Research what the consumer trusts. Build a start-up of recognized board certified doctors to provide diagnosis help online.

    How did you respond to the woman’s theory on the Zika virus? Was she willing to listen or did she just want or need to express herself?

    _
    Andreasen, Alan R. (1995) Marketing Social Change: Changing Behavior to Promote Health, Social
    Development, and the Environment: 1-33.

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