BBH 316 Exam 3
Develop and Test Message Concepts
-Message concepts are messages in rough form and represent ways of presenting the information to the intended audiences -may include statements only or statements and visuals -Do not develop the actual messages at this point. -In this step, you will learn about the components that go into developing and testing message concepts
step 3- Decide What Materials to Develop
-Most important: Make sure that your program's decisions about materials fit with the activities and channels you selected and will contribute to reaching the communication objectives developed in Stage 1.
selected intervention
-an intervention within the community -if only needed for certain people within the community -targets those at high risk for a specific health issue
assessments vs evaluations
-assessments collect data at the beginning/before an intervention goes into effect -evaluations (or outcomes assessments) look at data during and after
step two: development and pretesting
-begin to develop the specific message that you will use in the intervention, -create plans for the activities involved in the program, and -test out your message on the target population. -Pre-testing your materials is a critical phase of the development of health communications materials.
hygiene hypothesis
-our immune responses are trained to become effective after years of gradual exposure to microorganisms -recently humans have become increasingly hygienic, so our immune systems don't get enough exposure
intervention in a community
-target a specific sub-group or sub-population of at-risk individuals within the community -These interventions may make more sense when the at-risk population is fairly small, or where these individuals have specific needs. -example, if you are interested in the management of diabetes in pregnant women, it might not make sense to have the whole community as the target: a billboard or mass media campaign would be "overkill." It would be more beneficial to have a program that is geared specifically to the individuals at highest risk. -These programs tend to have more personal interaction, spend more time finding the participants, and can be more involved -example, they might identify at-risk women through referrals in an obstetrics clinic and call each participant individually
Information Processing and Attitude Change
-these two routes may or may not result in changes in attitude or behavior. -If you process a message using the central route ("high level"), you process the message carefully and logically. If you change your attitude or behavior it is because the message has stood up to your careful evaluation -if you process the message using the peripheral route ("low level"), you might change your attitude simply because there are strong cues that are meaningful to you - it might be that the message has an image of a celebrity or vintage car that you really like.
health beliefs model cons
-Assumptions made by the Health Beliefs Model may not apply for all cultures or populations (e.g., the assumption that individuals want good health, want to avoid bad health, and that their own actions will influence their own outcomes).
what health communication CAN do
-Increase the intended audience's knowledge and awareness of a health issue, problem or solution. -Influence perceptions, beliefs, and attitudes that may change social norms (and/or individual behavior). -Demonstrate or illustrate healthy skills. -Refute myths and misconceptions -Advocate a position on a health issue or policy.
evaluation vs research
r- usually conducted with the intent to generalize the findings from a sample to a larger population e- focused on an internal situation with no intent to generalize the results; particularizes to specific target group r- main purpose is testing a theory e- main purpose is improvement and accountability r- prove e- improve
objective (dictionary.com)
something that one's efforts or actions are intended to attain or accomplish; purpose; goal; target.
goal (Webster dictionary)
something that you are trying to do or achieve
objective (webster dictionary)
something you are trying to do or achieve : a goal or purpose this definition is the same as goal
Example of Goals
to improve and maintain the health of senior citizens through nutritional balance.
goal in health promotion
the big-picture, end-point, ultimate outcome that results from your intervention tend to be overarching principles that help guide decision making for the program
Choosing the Type of Appeal
you can scare people, tug at their hearts, make them laugh, make them feel good, or give them straight facts
target of intervention depends on
your selection of a theory resources expertise and a number of other factors
years of living free from a chronic health condition
- white populations can expect to live 67 years without a chronic condition, -African Americans can expect to live just 61 years without such a condition
case study breast cancer in rural appalachia
- women who live in rural Appalachian areas of the United States are much more likely to have cases of breast cancer first discovered when their cancer is in late stages. -cancer not detected early is a significant predictor of early mortality -special population
access to health foods
-83 million people who live in areas where there is not a single healthier food supplier within a reasonable distance -disparities in who has easy access to these healthy foods -areas whose populations are comprised of more than 13% senior citizens are less likely to have healthy food retailers than areas with fewer seniors. -Areas that have less than about two-thirds Hispanic population are more likely to have access to healthy food retailers than areas with higher percentages of Hispanics.
Motivation:
-A desire to process or interest in processing the message. -Some degree of involvement in the topic or issue. -Lower motivation or interest in the topic will lead to peripheral processing. -Conversely, high involvement increases the likelihood of central processing, e.g. message scrutiny
evaluation definition
-A process of reflection to assess value of actions in relation to projects, programs, or policies -A set of procedures to appraise program's merit and to provide information about goals, expectations, activities, outcomes, impacts, and costs
preterm births
-Approximately one third of all infant deaths in the U.S -disparities across a wide range of diseases, behavioral risk factors, environmental exposures, social determinants, and health-care access -Decreases in preterm births occurred for each of the race/ethnicity groups; white, black, Hispanic, AI/AN, and A/PI -preterm birth rate for black infants decreased by 8% to 17.1%, -preterm rate for black infants (17.1%) was approximately 60% higher than that for white infants (10.8%) -AI/AN (13.6%) and Hispanic (11.8%) infants were also at a higher risk for preterm birth in 2010 than white and A/PI infants.
5. Pretest Messages and Materials
-Assess comprehensibility—Does the intended audience understand the message? -Identify strong and weak points—What parts of the materials are doing their job best—for example, attract attention, inform, or motivate to act? What parts are not doing their jobs? -Determine personal relevance—Does the intended audience identify with the materials? -Gauge confusing, sensitive, or controversial elements—Does the treatment of particular topics make the intended audience uncomfortable?
Developing and pretesting messages and materials
-they allow you to learn early in the program which messages will be most effective with the intended audiences. Knowing this will save your program time and money by ensuring that you do not go through the entire development process with an ineffective message -Positive results from pretesting can also give you early buy-in from your organization
All of the above are forms of communication
A text message A billboard An Elmo sticker A TV commercial
SMART Objectives
Specific Measurable Achievable Relevant Time-bound
Making Health Communications Programs Work (Pink Book)- by national cancer institute
Step one: Planning and Strategy development. Step two: development and pretesting Step three: implementation Step four: evaluation
socioecological model pros
The model specifically identifies and calls for the inclusion of cultural routines and everyday practices. This can help inform how the interventions are developed.
what health communication cannot do
-Compensate for inadequate health care or access to health care services -Produce sustained change in complex health behaviors without the support of a larger program of change (e.g., changes in health care services, technologies and policies). -Be equally effective in addressing all issues or relaying all messages
operant theory (Skinner) pros
-Culture dictates what stimuli are valued as reinforcements. -Helps understand how behavior in a general population may be transmitted culturally.
health communication definitions
-Definition #1: "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" (Ratzan, S.C., ed. Health communication, challenges for the 21st century. Special issue. American Behavioral Scientist 38(2), 1994) -Definition #2: "The mechanism by which health messages are communicated from experts in the medical and public health fields to the people who can be helped by these messages." (Health Behavior Theory for Public Health Principles, Foundations, and Applications (2013). Diclemente, Salazar and Crosby.) -Definition #3: "The study and use of communication strategies to inform and influence individual decisions that enhance health." (http://www.cdc.gov/healthcommunication/healthbasics/whatishc.html)
Methods of Health Communications
-Developing partnerships with agencies, businesses, non-profits, government agencies and others to help promote health related issues and gain support for programs -Helping people use, critically evaluate, and interpret media messages Public relations which can help bring key health-related messages to mass-media -Using media to advocate for policy changes, alter attitudes and to bring health issues into the "conversation" among the population -Educating target populations about issues, behaviors and resources
communication
-Getting the message of improving health to the target population involves communicating information in some way. -Health communications can be anything from national television advertisements to one-on-one conversations between physicians and patients. -communications can inform, motivate or persuade people into changing health behaviors. -communications are rarely left to chance: health promotion professionals carefully consider what they say, how they say it, and to whom the communications are directed
areas assessed by tool from CDC reaching special populations
-Primary language spoken -Major Cultural/Religious -Taboos (dietary, medical practices, human interaction) -Unique lifestyle characteristics (tourist, homeless, isolationist, migrant, undocumented) Mobility (physical, transportation) -Access to an electronic mass communication channel (TV, radio, Internet) -Availability of physical address or phone at which to receive information by mail or phone -Availability of specialized media (media in primary language) -Presence of cognitive impairments (ability to comprehend/remember message) -Presence or degree of cultural/religious taboos -Potential of fear of coming forward for help (outstanding warrants, child support defaults, runaways, undocumented workers/families) -Presences of Physical impairments without compensating technology/ human resource support
Categories of Objectives
-Process objectives: These describe what the program is doing and how the program will be doing it. -Impact objectives: These describe how the program will change short-term, measurable behaviors, knowledge or attitudes. -Outcome objectives: These describe what the long-term outcomes and implications of the program will be.
Route
-The amount of motivation put into the persuasive message in turn determines the route by which the message is processed. -two basic routes to persuasion: the central route and the peripheral route -whether a communication is processed centrally or peripherally is determined by how much elaboration we use.
health beliefs model pros
-The concepts of barriers and susceptibility reflect cultural issues and situations occurring for each individual in their social context. -Perceptions and beliefs are reflections of an individual rather than more "global" or generic measures.
heuristic cues
-The credibility of the source of the communication. For example, the idea that "experts can be trusted." -The attractiveness of the source. For example, celebrity endorsements ("Brad Pitt is in the movie, so it has to be good.") -Perceived similarity with the source. For example, "I'll vote for him, he's the same religion as me."
Characteristics of Health Communication Programs
-They are purposive: often intended to cause specific behavior change or address attitudes about a specific risk factor. -They are aimed at a large number of individuals (e.g., a community). Although, as we mentioned, health communication can be one-on-one conversations or other smaller scale ways of imparting information, when used within a health promotion program, health communications are typically aimed at reaching as much of the target population as possible. -They are conducted within a specified period of time. Health communications, like any form of entertainment or any news story, gets "old" after a period of time. Typically, programs will have limited-time interventions or change up their approach after some period. -They involve an organized set of communication activities. These communications are typically integrated into a broad approach - you won't typically see a random flyer here and there and that is all; instead you might see some fliers, then a sign on a bus, then a billboard, then find yourself using a pen with the same health message! -They often involve theoretical frameworks to identify and communicate key concepts that can influence behavior change - involving community and the individual.
diversity
-Understanding the way your population differs (that is, their diversity) is a key element to designing and implementing health promotion programs.
examples of health disparities
-access to health foods -Years of living free of a chronic health condition -preventable hospitalizations -preterm births
Elaboration Likelihood Model (ELM)
-developed to explain how messages designed to change attitudes are received and processed.
step 4: evaluation
-evaluate how effective your program was in changing attitudes or behaviors. -You will also try to determine if there are changes you could make to improve the program for future implementations.
step 3: implementation
-implement the program including all the activities and engage all your partners in the intervention. -You will assess if the population is actually being exposed to the communications as you expect, -you will also see if the communications are having the intended effect.
universal intervention
-initial assessment shows that your community has high overall rates of heart disease and obesity -target the community as a whole -targets a general population or community
step one: planning and strategy development
-lay out how you can use communication to meet the aims of your intervention, -identify who the target of the communications will be, -use research data to help guide what messages will work best in your identified population, -think about the methods you will use to get the communications to the population, -forge partnerships with agencies, companies or others who can help the program, -consider how you will evaluate the efficacy of the communications.
community intervention
-program will likely be a big, broadly focused intervention that seeks to reach a large number of people. -your program may have smaller overall changes, but it may touch the lives of more people. -example of a mass media program focusing on smoking cessation in a community -may lead to larger changes within the community -ex: a program that seeks to change specific systems, policies or regulations within the community
global health
-recently we have seen how public health is global issue -swine flu, ebola, and other diseases
elm elaboration
-refers to the amount of effortful processing people put into receiving messages -model is looking at how likely people are to put specific effort into taking in and processing the message they receive; at a high level or at a low level -we begin by considering the amount of elaboration that is used in the persuasive message. -The amount of elaboration is determined by motivation and ability.
good health communication
-result of input from art, science, entertainment and education. -powerful tools that help "inform, influence and motivate" people regarding a range of health issues -not one size fits all -are limits to what health communication can and cannot do.
case study results
-rural isolation and economic deprivation combined to put these women at a significant disadvantage. -might never see the health communications associated with a promotion program, they might not see themselves as "included" or similar to the overall "targeted" population, or they simply may not be in a position to take advantage of the services offered by a program.
not every person has an equal opportunity to achieve the goal of improved health due to
-socioeconomic disadvantage, -geographic location or -even social discrimination or -racism.
preventable hospitalizations
-some populations are far more likely to be hospitalized because they have not sought timely medical care -differences in preventable hospitalizations, including differences by income and differences by race
tailoring
Ensuring that your intervention is suitable and appropriate for your target audience, and adapting key measures, materials or communications to fit your target audience -Differences could be related to language, culture, religion, or any number of other factors -To ensure that interventions are relevant and sensitive to the needs of the target population, health promotion professionals will look at the assessments -tailoring an intervention is a critical component of ensuring fair, meaningful and ethical interventions.
Developing Effective Print Materials for Low-Literacy Intended Audiences
Present the message in a more easily understood way to these intended audiences by making specific choices about writing style, vocabulary, typography, layout, graphics, and color -pg.74
deciding to use health communications as part of a health promotion program, include:
What information to you want to communicate? How you will reach the target population? What do you need to do with your communications (educate, motivate)? How can you be sure your messages are understood and used by the people who need those messages the most? -theories help answer these questions
CDC definition of health equity
achieved when every person has the opportunity to 'attain his or her full health potential' and no one is 'disadvantaged from achieving this potential because of social position or other socially determined circumstances.' Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment."
Cultural Disparities
can impact a whole range of health-related behaviors such as diet, hygiene, the care and prevention of illness, sexual practices, and activity levels.
step 1- communities
communities have to understand the disease, how it spreads and how to stop it
Developing and Pretesting Messages and Materials stage 1
created a communication strategy statement
goal of health promotion
health equity
Evaluations
help us to understand programs: how they work, if they work at all, what parts of the programs work and what parts don't work - and a range of other questions. -CDC have developed specific divisions that focus on evaluation
multiple layers of influence on health behaviors
individual factors, inter-personal factors, community factors, and so forth.
community theories and ELM model cons
interventions that don't address barriers in these populations may actually increase health disparities.
step 2- cases and contacts
it is necessary to have systems that can find every single case, every contact of that case, and track the transmission chains to stop the transmission.
Working With Creative Professionals
managing the relationship effectively is critical to getting the creative materials you want
step 3- treatment
need specialized ebola treatment centers, where the workers can be protected as they provide support to the people who are infected
central route
reflective; it requires some degree of mental effort messages and relies on cognitive elaboration—thinking in detail—about messages.
peripheral route
reflexive; people make decisions about the messages based on mental shortcuts in instead of detailed, deliberate thinking. These shortcuts are called heuristic cues
Concept Testing
testing the concepts with intended audiences can help you decide on message appeals, spokespersons, and language -Testing is especially important if the program deals with a new issue, because it will help you understand where the issue fits within the larger context of the intended audience's life and perceptions. -help save time and money
objective in health promotion
the "how" of the program - how an intervention will meet the stated goals.
Setting goals and objectives is a critical step in developing health promotion programs because
they help you "know where you are going" and "when you get there."
healthy people 2020 definition of health equity
"Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."
healthy people 202 definition of health disparity
"Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion."
Ethnic/Racial Disparities
- disparities facing many racial and ethnic groups is so serious that one study found a 33 year difference in life expectancy among the longest living subgroup and the shortest living subgroup -economic cost of health disparities and premature mortality cost the United States in excess of 1 trillion dollars.
reviewing existing materials
- key developmental step for a health communication program -determine whether creating them is necessary by reviewing existing materials
ability
-Being capable of critical evaluation; -having knowledge about the subject matter; -having the time and context to evaluate the message; not being distracted. -If people don't have the ability to process the information the more likely they are to process the message peripherally.
Economic Disparities
-people facing more economic disparities are less healthy and die earlier -less money, less health care -less money, more smoking (buying cigarettes can be pretty expensive)
4 steps for ebola
1) communities, 2) cases and contacts, 3) treatment, and 4) safe burial)
community theories and ELM model pros
All of these theories give opportunities in the planning stages to identify and include specific subgroups within the population. In some ways, the ability to address disparities is "built into" these models if the developers are sensitive to these issues and take the time of assess the needs of these sub-populations.
example of impact objective
At the end of the intervention [time frame], senior citizens in the program will increase their knowledge of general nutrition as compared to baseline measures [measurable] and will report consuming more days per week where they consumed three regular meals [measurable].
example of outcome objective
By the end of the program, there will be a 25% decrease in physician visits and hospitalizations related to poor nutrition among the senior citizens in Centre County, PA.
common causes of health disparities
Cultural Ethnic / racial Linguistic Economic Educational Geographical Gender
Developing Culturally Appropriate Communications
Culture encompasses the values, norms, symbols, ways of living, traditions, history, and institutions shared by a group of people. Culture affects how people perceive and respond to health messages and materials, and it is intertwined in health behaviors and attitudes
health disparity definition
Differences in health outcomes that are closely linked with social, economic, and environmental disadvantage and are often driven by the social conditions in which individuals live, learn, work, and play."
socioecological model cons
Does not consider the fact that there may several cultures that interact and influence one another.
operant theory (Skinner) cons
Does not give value to long-term outcomes (e.g., all behaviors are thought to be determined by the immediate reinforcement). Some cultures may behave in ways that forgo immediate consequences/rewards in favor of long-term gain.
4. Develop Messages and Materials
Ensure the message is accurate: Be consistent: Be clear: Be relevant to the intended audience Be credible Be appealing:
socioeconomic status (SES)
Just about any negative health outcome you can think of is probably associated with low SES status: heart disease, accidental injury, arthritis, diabetes, hypertension, infant and material mortality, various cancers, and even early mortality.
goals from the Palm Beach County School District's Wellness Promotion Goals and Objectives
Nutrition education program: Goal: To promote nutrition education with the objective of improving students' health and reducing childhood obesity. Physical activity program: Goal: To promote physical activity with the objective of improving students' health and reducing childhood obesity.
features of health communication common to all of these definitions:
Someone's exposure to, search for, and use of health information Public health messages and campaigns Health professional-patient relations The dissemination of individual and population health risk information (risk communication) Images of health in the mass media and the culture at large The education of consumers about how to gain access to the public health and health care systems The development of tele-health applications (it can also be an "art.")
example of process objective
Within 12-months of implementation [time frame] the program will provide weekly home-delivered, nutritionally-balanced meals and nutritional counseling [describes the "how" of the program] to 15% [provides a measurable activity and a realistic number] of the eligible home-bound senior citizens identified by physicians and care-takers [describes the target population].
Communication Webster dictionary definition
an act or instance of transmitting information information transmitted or conveyed: a verbal or written message a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior; personal rapport
special populations
certain people, populations, or subgroups that are more at risk -minorities, veterans, elderly, pregnant women, incarcerated individuals, homeless, migrant farm workers, people living in rural isolated areas, children -face a number of unique barriers and challenges to accessing healthcare or getting services -not reached by traditional health promotion programs
health disparities as occur when
people are not receiving the same care, information, or benefiting from health interventions in the same way as other people, based on things other than the health condition, health behaviors, clinical needs or preferences of that person
step 4- safe burial
safe and dignified burial process so that there is no spread at that time
Positive emotional appeals
show the benefits intended audience members will gain when they take the action portrayed in the message -pg. 61
Developing and Pretesting Messages and Materials stage 2
use the strategy you developed as a guide to: 1. Review existing materials 2. Develop and test message concepts 3. Decide what materials to develop 4. Develop messages and materials 5. Pretest messages and materials
