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Communication for Health

COMMUNICATION FOR HEALTH

Communication has long been an important tool in health promotion, and during the closing decades of the twentieth century it became an essential part of public health programs. Although its roots date back hundreds of years (to Cotton Mather's smallpox vaccination campaign during Colonial American times), if not thousands of years (to Aristotle's theories of persuasion), the field of public health communication is very much an outgrowth of contemporary social conditions.

Demographic, social, and technological trends that developed over the second half of the twentieth century fostered conditions in which the value of good health information, and thus the value of effective health communication, became increasingly clear. Throughout the twenty-first century, public health communication is likely to become increasingly integrated with the core public health disciplines, especially health education and health promotion. Other public health disciplines, including epidemiology, health policy, occupational health, environmental health, international health, and health services research, are coming to appreciate both the fundamental importance of communication processes and the potential of effective communication to improve the public's health.

COMMUNICATION RESEARCH, THEORIES, AND INTERVENTIONS

Public health communication includes a continuum of activities that span from research to interventions. Communication theory can and should be used to inform the research and intervention activities along this spectrum.

The purpose of health-communication research is to understand the processes of communication, how communication can help to improve health, and the effects of communication itself on health outcomes. Research questions that have attracted considerable interest include: Does violence in the media cause violent behavior? Is the increasing rate of childhood obesity the result of an increase in electronic media use? Does bias in news media coverage lead the public to worry excessively about rare health risks while ignoring more prevalent health risks? Do people process health information in systematically biased ways that contribute to "irrational" decision making? Does the news media tend to "frame" public health issues in a manner that obscures the true nature of the problem (and thereby obscuring the most promising solutions)?

Answers to these and other research questions are used to develop communication interventions that effectively improve health outcomes. For example, the National Institutes of Health (in partnership with health professional associations, voluntary health agencies, and pharmaceutical companies) has conducted a communication campaign that has contributed to more than a 60 percent reduction in the death rate from stroke. Sudden infant death syndrome (SIDS) campaigns conducted around the globe during the 1990s led to rapid and dramatic (5080%) reductions in death rates from SIDS. In 1998 and 1999, the state of Florida conducted a mass media and grassroots youth antismoking campaign (the "Truth" campaign) which reduced rates of smoking among middle school students by 40 percent and among high school students by 18 percent. The "Truth" campaign was funded through Florida's financial settlement with the tobacco industry. Florida's settlement, and the settlement signed by most other states was in large measure the result of successful public health communication efforts to reframe the tobacco issue. Previously, the media tended to frame smoking as an issue of individual choice. Communication efforts of the Campaign for Tobacco-Free Kids and other organizations during the mid-1990s succeeded in reframing the issue in terms of the tobacco industry's persistent unethical business practices and attempts to entice children to become addicted smokers.

Communication theory (which draws from a broad range of other social science and behavioral science disciplines) is the interface between health communication research and health communication interventions. Communication research is used to develop and test theories of communication, information processing, and human behavior. These theories attempt to explain how and why people process health information, the impact of communication and information on behavior, and how factors in the social and physical environment mediate the relationship between communication and behavior. Theories that have been shown to have useful predictive and prescriptive power (such as social cognitive theory, the theory of reasoned action, stages of change theory, theories of risk perception, and framing theory) are a powerful asset in planning successful public health communication interventions.

OBJECTIVES FOR COMMUNICATION INTERVENTION

Although many distinctions can be made between the various types of public health communication activities, the most important distinctions pertain to differences in objectives. Two fundamental distinctions can be made with regard to communication interventions based on their objectives. The first distinction pertains to whether the intervention seeks to influence the actions of individuals and small groups or the actions of larger groups such as workplaces, communities, states, or nations. The objectives of communication interventions at these larger levels (which are often referred to as "advocacy" interventions) are focused on bringing about changes in policies. Examples include improved safety policies in the workplace, and more rigorous DUI (driving under the influence) laws at the state or federal level. These interventions seek to improve health by improving the health capacity of the environment in which people live.

The second important distinction is among interventions at the individual (or small group) level. Informed decision-making interventions seek to inform people for the purpose of enabling them to make better health decisions, while persuasion-oriented interventions seek to persuade people to change their behaviors or beliefs. Situational factors determine which of these two approaches is most appropriate.

Persuasion-oriented interventions are appropriate when there is clear evidence that the behavior change is likely to benefit the individual, and when society is able to reach consensus about the worthiness of the behavior as a societal goal. Examples include promotion of mammograms for women over the age of forty, teen substance-abuse prevention, and promotion of bicycle helmet use by children.

Informed decision-making interventions are indicated in situations when persuasion would be inappropriate, such as when the evidence is not sufficiently clear to support one behavior over another (e.g., surgical removal versus watchful waiting for men with a diagnosis of prostate cancer), when an individual's values must be taken into consideration to determine the optimal behavior (e.g., prevention of sexual assault), and when society has been unable to reach consensus about the optimal recommended behavior (e.g., prevention of teen pregnancy).

PRINCIPLES FOR EFFECTIVE PUBLIC HEALTH COMMUNICATION

Public health communication is inherently pragmatic. It embraces theories, organizing frameworks, and implementation tactics from many different professional and academic disciplines. Four of the more important aspects of public health communication are: media campaigns, social marketing, risk communication, and media advocacy. While these differ considerably, particularly with regard to their organizing frameworks, they do share some underlying principles of effective communication.

Know Your Audience. The first and most important step in communication planning is to gain as much insight as possible into the target audience. This is done primarily by conducting original audience research (e.g., focus groups, surveys), assessing the results of previous communication efforts, and drawing from theories of communication and behavior change.

Focus on the Right Objective. The strategies and tactics of a communication intervention will differ depending on the stated objective (e.g., informed decision-making, persuasion, policy change advocacy). A clear statement of objectives focuses and enhances all other elements of the communication planning process.

Determine What Information Is of Greatest Value. For a variety of reasons, public health communication campaigns will always be limited in the amount of information they can successfully convey. Therefore, a critical step in communication planning is to determine what information has the greatest value in helping to achieve the stated objective of the campaign. The ideal (albeit rare) scenario is when a single powerful idea is sufficient to motivate and enable members of the target audience to embrace the campaign's objective.

Convey Simple, Clear Messages, Many Times, through Many Sources. After the information with the greatest value has been identified, communication planners must determine how to convey that information simply and clearly, often, and by many trusted sources. Message repetition is an important element of program success. Audiences tend to process information incrementally over time. When the message is stated simply and clearly, when it is repeated often enough, and when it is stated by many trusted sources, audience members are more likely to learn and embrace the message.

Edward W. Maibach

(see also: Communications as a Career; Communication Theory; Counter-Marketing of Tobacco; Health Promotion and Education; Mass Media; Social Marketing )

Bibliography

Andreasen, A. (1995). Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco: Jossey-Bass Publishers.

Flora, J.; Maibach, E.; and Maccoby, N. (1989). "The Role of Media across Four Levels of Health Promotion Intervention." In Annual Review of Public Health. Palo Alto, CA: Annual Reviews, Inc.

Graeff, J. A.; Elder, J. P.; and Booth, E. M. (1993). Communication for Health and Behavior Change. San Francisco: Jossey-Bass Publishers.

Guttman, N. (2000). Public Health Communication Interventions: Values and Ethical Dilemmas. Thousand Oaks, CA: Sage.

Hornik, R., ed. (2001). Public Health Communication: Evidence for Behavior Change. Mahwah, NJ: Lawrence Erlbaum Associates.

Maibach, E., and Holtgrave, D. (1995) "Advances in Public Health Communication." Annual Review of Public Health 16:219238.

Maibach, E., and Parrott, R. L., eds. (1995). Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Thousand Oaks, CA: Sage.

National Research Council (1989). Improving Risk Communication. Washington, DC: National Academy Press.

Tinker, T. L.; Pavlova, M. T.; Gotsch, A. R.; and Arkin, E. B., eds. (1998). Communicating Risk in a Changing World. Solomons Island, MD: OEM Press.

Wallack, L.; Dorfman, L.; Jernigan, D.; and Themba, M. (1993). Media Advocacy and Public Health: Power for Prevention. Thousand Oaks, CA: Sage.

Weinreich, N. K. (2000). Hands-On Social Marketing: A Step-by-Step Guide. Thousand Oaks, CA: Sage.

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