Working on Health Communication
Publication Year: 2011
Good communication is at the heart of strategies for effective health promotion and public health. At a time when lifestyle and preventable diseases are still on the rise, practitioners are in need of the skills to deliver effective health messages to the right audience, at the right time. Responding to this demand, Working on Health Communication provides a practical guide to the process of designing, implementing and evaluating campaigns. The book follows the campaign design process step-by-step. It covers every stage from selecting theoretical models and identifying the message and target audience, right through to running the campaign and evaluating its success. "Real-life examples" of actual campaigns are used throughout to show how theoretical ideas work in practice. Working on Health Communication is ideal for ...
- Front Matter
- Back Matter
- Subject Index
© Nova Corcoran 2011
First published 2011
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
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List of Figures[Page vii]
- 0.1 A new model of communication 2
- 1.1 Nine-step planning model 11
- 1.2 Total Process Planning model 12
- 1.3 PRECEDE-PROCEED planning model 15
- 1.4 Intervention Mapping planning model 19
- 2.1 The Health Belief Model 31
- 2.2 The Theory of Planned Behaviour 33
- 2.3 The Transtheoretical Model 35
- 2.4 Key variables in theoretical models 39
- 3.1 Rationale triangle 43
- 4.1 Checklist of possible questions to ask target groups 73
- 5.1 Drug driving: your eyes will give you away glasses 92
- 6.1 Poster from the ‘Live with it’ road safety campaign 104
- 6.2 Change4Life poster 106
- 6.3 Guidelines for using SMOG 111
- 6.4 Identifying and counting syllables 112
- 6.5 QUIT (2007) ‘Don't’ overdo it’ poster 116
- 7.1 Five-stage evaluation cycle 126
List of Tables[Page ix]
- 2.1 Example words that can be used when formulating objectives 25
- 2.2 Five objectives and their application to methods 27
- 4.1 Categories for planning culturally specific campagins using Kreuter et al.’s (2003) five categories 65
- 5.1 Examples of the three channels of comunication 79
- 5.2 Information technology uses in health information 90
- 6.1 Summary of recommendations in the design of print-based resources 117
- 7.1 Examples of questions to ask in each stage of the evaluation process 129
- 7.2 Common subheadings used for media analysis 137
Author's Acknowledgements[Page xi]
Thank you to all the students at the University of East London, especially those in the Communication and Health class for their enthusiasm and ideas.
I would like to acknowledge my contacts at Sage for orientating me in the right directions. I would like to thank friends and family who supplied me with ideas, sanity, time out, child-minding, food and proof reading. A special mention goes to Ben Scott, Calvin Moorley, Joanne Middleton, Emma Halliday and my parents. A big thank you to Ostyn and Huxley for keeping me grounded in the real world and being such good sleepers. A final thank you goes to the Dockland Light Railway service as all the time spent on their trains gave me my best ideas![Page xii]
Publisher's Acknowledgements[Page xiii]
Every effort has been made to trace all the copyright holders, but if any have been accidentally overlooked the publishers will be happy to make the necessary changes at the first opportunity.
Department for Transport for Figure 5.1: Drug driving: your eyes will give you away glasses (DfT 2009).
Department for Transport for Figure 6.1: ‘Live with it’ (DfT 2009) road safety campaign poster.
Department of Health for Figure 6.2: Change4Life (DH 2009) poster.
QUIT for Figure 6.5: QUIT (2007) ‘Don't over do it’ poster.[Page xiv]
Activity Discussions[Page 147]
This section contains discussions for the activities that are found in each chapter of this book. These are not designed to be definitive answers to each activity but as suggested examples to the activities.Activity 1.1: Unplanned Outcomes
Activity 1.2: Stages in the Planning Process
- Positive effects could include weight loss, reduction in fat, eating healthier foods, being more aware of dietary intake, increased self-esteem or more positive body image. Negative effects could include stress or anxiety due to negative body image, low self-esteem, dramatic dietary changes or behaviours leading to eating disorders.
Activity 1.3: Planning using the Nine-Step Model
- Planning stages for a campaign could include a range of factors. Essentially these should have included most of the steps in the nine-point planning model: rationale, needs and priorities, aims and objectives, selection of theoretical model, method, resources, budget, evaluation, action plan, implementation and feedback.
There are a number of ways this campaign could have been designed. Some examples are below.
Activity 1.4: Designing Campaigns using the 4 Ps
- The aim is to increase the number of parents who brush their children's teeth correctly for three minutes at least once a day. A theoretical model could be: the Theory of Planned Behaviour (for the role of subjective norm i.e. parental influence). The method: an oral heath pack i.e. with a parent's leaflet. Design: This describes the design of the method. i.e. the Sticker will say ‘My teeth are as clean as croc's’ with a picture of a crocodile, or the leaflet identifies three reasons why parents should brush their children's teeth. Resources: This will be a list of resources and how you have spent the £1000 budget, i.e. £500 for 500 toothbrushes. Action plan: This will be a plan of who undertakes what and when from the start to the end of the campaign. Implementation: This would be when the campaign is undertaken. Feedback: This would say when you feed back, to whom, and how.
Product is physical activity
Price is the cost of physical activity and the time spent on other things such as groups, homework and socializing.
Place is the location you want to use to promote physical activity, i.e. in the school playground or in a local park.
Promotion is the ways you will promote your small fold-out booklet.Activity 1.5: What Factors are Important in Stage 3?
Activity 1.6: Methods, Strategies and Materials
- Examples include poor sitting or standing position, inappropriate footwear, working above recommended hours before having a break, poor seating or current health levels of cashiers.
- Examples include messages that centre on correct posture and positioning at checkouts or knowing your working rights (taking a break).
One method would be to promote physical activity at a low intensity such as walking (to address uncomfortable), that is free such as a local park (to address cost and access).
Method: Walking in a local park on planned routes.
Strategy: Identify circular walking routes in the local park that take an easily followed route i.e. flat ground. There will be five walks between 15 to 30 minutes long to encourage progression to 30 minutes with seated places for rest. Maps will be distributed by district nurses on their visits to leg ulcer patients who are able to walk for more than 15 minutes unaided and can easily access a park via foot, private or public transport.
Materials: These include a short leaflet on benefits of walking in the local park specifically for leg ulcer patients, park plan, paper, cardboard, computer, coloured inks and laminating equipment.Activity 2.1: Formulating Different Objectives
Activity 2.2: Matching Objectives to your Aim
Possible objectives could be:
To increase parental knowledge of three possible triggers of a child's asthma attack.
To encourage parents to smoke cigarettes outside of the house to retain a smoke-free household.
To ensure parents are able to make the link between their smoking behaviour and their children's asthma.
Activity 2.3: Which Methods best Suit which Objectives?
- Examples include ‘To ensure every ward has fully stocked supplies of hand gel over a six month period’ or ‘To increase the number of people who are able to suggest one reason why keeping hands clean is important by 50 per cent.’
Activity 2.4: Choosing Stakeholders
Mass media such as posters, or interactive classroom activities.
Methods could include asking children to draw pictures of things you do before you wash your hands and using these for posters.
Stories, radio or drama, workshops, mass media, one-to-one or small group.
Methods could include designing an audio story around older people and diabetes diagnosis.
Activity 2.5: Using the HBM in Practice
- Supermarket owners, supermarket managers, supermarket in-store staff, food manufacturers, shoppers, local residents, local and national diet related charities i.e. BHF, local GP surgery staff, health promotion\public health department, healthy eating programmes in local area.
- Factory owners, young 16–20 factory workers, other factory workers, factory floor managers, local sexual health (GU) clinics, local GP surgery staff, local and national sexual health charities or organizations, parents, influential others, i.e. church leaders, condom manufacturers.
Activity 2.6: Targeting Variables
Example messages include: The earlier you identify breast cancer the easier it is to treat, so you can still be around for your family when they need you.
You are important to your family, this means you need to take care of yourself. Early screening for breast cancer is vital.
- In church-based locations i.e. community rooms, or family-based activities locations, i.e. local parks.
Activity 2.7: Matching what your Target Group Say to Theory
- Attitudes (for example, acceptability of assault in public), general social influences (for example, most people important to you think a boy can assault a girl), outcomes expectancy (for example, partner would become more angry if I prevent him/her from assaulting you).
- Messages could centre on violence being socially unacceptable, they could highlight the consequences of assault for both the assaulter and the assaulted, and promote mutual respect in relationships, i.e. hitting or punching is not acceptable in a relationship.
Activity 3.1: Prioritizing Health Issues
- Perceived Behavioural Control, the Theory of Planned Behaviour.
- Perceived susceptibility/severity, the Health Belief Model.
- Attitude, the Theory of Planned Behaviour or Precontemplation, the Transtheoretical Model.
- Subjective norm, the Theory of Planned Behaviour.
Activity 3.2: Designing Questions to Assist Campaign Focus
- This answer will be different depending on your own country.
- Your rated importance of this, morbidity, mortality, your location, and the current issues in your country will influence which came first.[Page 150]
- It is likely these will be different by developed or developing countries, as health issues differ in importance. For example, in the UK, HIV mortality and morbidity are low, but deaths from cancers are high, and generally safe drinking water and road infrastructures are in place.
- Aside from current and feasible solutions to the problem, data might be collected on areas such as morbidity and mortality figures such as hospital admissions, disability registers, years of life lost (DALYs) or impact of the solution.
An example based on the Health Belief Model.
Activity 3.3: Choosing a Setting for Road Safety Messages
- Possible questions include: How susceptible do you see yourself to suffering from ill health as a direct result of your diabetes? If you got sick as a direct impact of your diabetes, how severe do you think this would be? What are the benefits to losing weight? What barriers do you experience to taking physical activity?
- A different theoretical model would collect data on different questions and would choose different variables to focus on.
Activity 3.4: HPV (Human papillomavirus) Vaccine Promotion in a Community Setting
- A pub or bar.
- Example answers include: Those who drink alcohol access this location. Drinking alcohol takes place here. Additional unhealthy behaviours may include smoking. Alcohol may have an impact on judgements. Bar memorabilia i.e. bar mats, t-shirts, flags, glasses, soft drinks promotions and posters, leaflets, radio or video clips in washrooms or main bar could be used. Influences of peers and alcohol may skew judgement.
- This example may still use this location, but you could integrate other locations outside of the pub/bar too.
Activity 3.5: Source Validity and Reliability
- Need to meet with community leaders and gatekeepers especially men and highlight the importance of HPV in female health.
- Key decision-makers in the community including males and females.
- Community locations that both men and women access, for example, universities, community centres or places of worship.
- Messages should be culturally sensitive and seek to correct public confusion as well as promoting benefits. They should also be addressed to men as well as women and include the benefits of HPV vaccination and why it is important to women in a family context.
Activity 3.6: Including the Excluded
- Possible appropriate sources include journal articles, published documents from government, organizations, charities, institutes or health services.
- An example is NICE (2008) mental well-being of older people available at: http://guidance.nice.org.uk/PH16 answers will differ for this question depending on the source used.
Activity 4.1: Health Information Sources Based on Age
- Access non-traditional settings such as barbers, coffee houses or beauty salons.
- Non-traditional methods, for example, stories, drama, pictures, photographs, songs or competitions.
Activity 4.2: Campaigns for Men and Women
- Friends, younger family members, radio, television, health professionals, groups or clubs.
- Family, friends, magazines, internet, schools or television.
- Friends, magazines, groups or clubs, television, radio, internet, location specific i.e. pubs, clubs, bars.
Activity 4.3: Variables that Influence Diet
- Messages aimed at women will emphasize group support and friendship. For example, ‘Make new friends and join a new walking group for people like you.’ Messages aimed at men will emphasize new skills and knowledge. For example, ‘Join the local gym and learn how to control your diabetes through new exercises.’
- Possibly. If you are emphasizing different messages and different activities and men and women are unlikely to participate together then you may have two campaigns, or a ‘brother and sister’ campaign under one umbrella.
Activity 4.4: Five Cultural Strategies
- In the UK there are a diverse range of ethnic groups. For example, African groups may eat vegetables such as yams or plantain which many white groups do not.
- Examples include culture and acculturation, location to shops or markets that sell foods, cooking skills.
- One example is promoting fruit and vegetables that are culturally specific in images and leaflets aimed at different groups.
Activity 4.5: Targeting Physical Activity to Religion
- Peripheral, evidential and linguistic strategies are generally cheaper to use as they require adaptation of existing materials although they may be less effective than strategies that involve target groups more. Constituent involving and sociocultural strategies engage the target group more and may be more effective, but may require more time and financial costs.
- Depending on finance and time, it is likely that the last two strategies (constituent involving and sociocultural) will have a bigger impact on the target group due to their involvement in the campaign design.
- Yes. The higher strategies involve less time and contact with the target group than the lower strategies.
Activity 4.6: Tailoring to Philosophies
- Messages could be linked to messages in faith, sermons or scripture. For example: ‘Be healthy in faith and body’.
Activity 4.7: Attitudes, Beliefs and Values
- Messages could be centred on caring for the environment or encouraging physical activity in open environments such as in parks: ‘actively commuting to work helps reduce pollution’.
Activity 4.8: Beliefs and Methods
- Positive attitude to consuming high fat foods, belief that these foods taste nice.
- May have mixed attitudes towards foods depending on the links he makes between weight, heart condition and high fat foods. Belief that high fat foods may be linked to weight, places high value on the nice taste of foods like chicken and chips.
- May have a positive attitude to looking after his health due to his diabetes, believes that high fat foods are to be eaten in moderation and places low value on these.
Activity 4.9: Identifying and Defining a Target Group
- Messages are likely to be linked to fertility and infertility and may include notions of perceived susceptibility. An example message might be ‘Infertility is not as common as you think, don't take the risk and use condoms every time.’
Activity 4.10: Tailoring Information in Practice
- This could be any target group of your choice, for example 18-year-old black Caribbean men, or 60-year-old white women with grandchildren. Make sure you have converted all of the questions on the checklist.
- The response to this would depend on your answer but psychological factors and behaviours are more likely to be harder to answer than social factors.
- You would need to research your target group thoroughly using a variety of methods, for example internet or media research, alongside meeting or observing your target group.
Examples could all be centred on one theme ‘play ball’ (i.e. check your testicles) using slang (balls).
Activity 5.1: Different Channels of Communication
- ‘Play ball: Testicular cancer is not something that happens to older people.’
- ‘Play ball: ‘Early diagnosis of testicular cancer is associated with a positive outcome’.
- Q: ‘Which is the odd one out? Chlamydia, HIV or testicular cancer? A: Testicular cancer – it's not sexually transmitted.’ Play ball.
- ‘Everyone play ball: Testicular cancer affects everyone.’
Activity 5.2: Identifying Sub-Groups
- Channels include interpersonal, intrapersonal, organizational and community.
Activity 5.3: Including Interpersonal Elements
- Enjoyment, like, convenience, friends and family eat these foods, easy to cook, cheap.
- No. See Activity 4.1.
Activity 5.4: Working with Myths
- Text messaging services, a telephone helpline, email, social networking sites, use peer supporters in local settings.
- Electronic elements may be set up at a reasonably low cost, essentially the more interaction the more time and resources may be required.
Activity 5.5: Effective uses of MediaActivity 5.6: Using Magazines to Promote Health
- Incorporate the target group into all campaign messages. Focus on addressing on the main myths in messages and correcting these, such as promoting the ways TB can be transmitted.
- Messages could be linked to myths. For example, TB is not transmitted through sexual contact.
- In collaboration with the target group, find media sources that are able to explain things in more detail. Using edutainment or stories for use on the radio is a possibility to encourage interpersonal discussion that promotes correct transmission and facts around TB.
Activity 5.7: Advantages and Disadvantages of using Different Media
- One example: In the UK magazines for black women include Pride, Snoop, Black Hair, Woman to Woman.
- Using media advocacy to challenge negative roles models, promoting positive healthy role models using real life stories, images and articles.
Activity 5.8: Adapting Information Technology for Campaigns
- Newspapers are read for longer periods of time, may have higher literacy levels and can have both longer messages and content.
- Billboards have high visibility and are good for short messages. They can only be accessed by those passing the location and detailed content is not possible.
- Leaflets are easily distributed but may be easily overlooked or ignored depending on distribution methods. They are usually low cost.
- Radio reaches specific audiences and not mass groups and is able to use advertisements or content linked into shows i.e. stories or dramas.
Activity 5.9: Experimental Marketing
Customizability could include using email, text-messaging or MSN messenger.
Interconnectivity could be the use of a discussion board.
Confidentiality could be mechanisms that allow users to create a pseudonym.
Activity 6.1: Matching Aims to Messages
- An example could be: secondary school children from one school and oral hygiene. One experimental setting could be fast food restaurants.
- Strategies could include 5-minute cooking classes in the car park, free tasters, give-aways such as children's plastic plates with the campaign logo, badges or stickers and re-usable carrier bags.
Activity 6.2: Gain Frame and Loss Frame Messages
- To reduce speed and drive at 20 mph.
- Why reduce speed, why a school zone and to drive at 20 mph.
- Instruction message.
Activity 6.3 Cultural Relevance of Materials
Gain: You can prevent diabetes by changing your lifestyle and eating foods that have lower levels of sugar.
Loss: You need to reduce sugar and increase your physical activity levels to lower your risk of diabetes.
Activity 6.4: Concept, Category and Value Judgement Words
- One example in the UK might be asylum seekers from Central Africa.
- Possible considerations could be colours, images, tailoring messages to cultural beliefs, religious beliefs or resources that people can access.
Activity 6.5: Writing in the Active Voice and Framing Messages
- Words like ‘plenty’, ‘liberal’ and ‘a while’ are problem words.
‘Drink at least two litres of water each day to keep your body hydrated.’
‘Apply sunscreen at least every two hours when you are in the sun.’
‘Wait at least one hour before swimming after you have eaten.’
Activity: 6.6 SMOG Grading of a Health Resource
- ‘You should try and drink a small cup of water at least every hour in the days following your operation.’
- ‘If you spend more than an hour at your computer, try and take a break to reduce risks of postural problems.’
Activity 6.7: Turning Content into Interactive Content
- This will depend on the resource that you have chosen.
Activity 6.8: Designing a Leaflet using Best Practice
- Examples include: What are the hazards in your job? Have you had your manual handling training within the last year? When are accidents more likely to happen?
- Accidents are more likely to happen if you are taking medication. True or False? You should have your manual handling training every year. True or False?
- Examples include a space to write a note of the date when you were last trained. Write down when your training is next due. Write down three reasons why training is important.
Activity 7.1: Identifying Challenges to Evaluation
- Target group (South Asian 1st generation young families) would be involved in all pre-planning.
- The main aim is: To increase awareness of the hazards in the home associated with childhood accidents under five. This leaflet will concentrate specifically on the kitchen. The main message is to keep children safe in the kitchen by moving household substances i.e. bleach, and sharp objects out of reach, as well as ensuring safe cooking practices.
- Low grade reading levels will be used. Messages will be framed, e.g. ‘It is a good idea if you move cleaning products out of children's reach’, and thus use positive framing and active voice.
- Font size 14, with dark blue on white will be used.
- Design will use simple question and answer structure and incorporate colours selected by the target group.
- A space will be left for ‘What I will do in my home to keep my children safe …’ as well as a short five question quiz based on the leaflet content.
- Simple drawing will be used with a cross or tick to indicate good and bad practices.
- Pre-testing with target group will be undertaken.
- Locating students, local council advertising and the impacts of cycle lanes.
- Locate students in classes or common locations, i.e. student union, library and use campus mail shots, advertising or email with incentives.
Specifically link evaluation questions to the university campus campaign, i.e. recall of university messages. Ask in addition if students have seen other messages, i.e. local council ones. Ask why people have started to commute to distinguish between local council and university campaigns.Activity 7.2: Establishing a Baseline or Control Group
Activity 7.3: Using Formative Evaluation
- The same age group booking with a different travel company in the same location, or the same travel company and same age group in a different country or resort.
- Pre-testing when holidays are booked or before embarking on holiday, i.e. at the airport.
Activity 7.4: Using Process Evaluation
- Questions include: What they want stickers to look like, when helmets are least likely to be used, barriers and benefits to helmet use as noted by target group.
- Examples include: In class activities or brief focus groups at lunchtimes or after school. Encourage drawings and paintings to suggest when children should wear helmets.
Activity 7.5: Using Impact Evaluation
- Questions include: What posters/flyers have you seen and where did you see these? What were the main messages from these? Have you heard of any of the walks? Have you been on any walks? Do you know anyone else that has been on a walk? What might stop you going on a walk? Can you remember the campaign messages?
- Examples include: Questionnaires or short interviews in local locations, i.e. in the leisure centre, in popular places, i.e. local shopping centre.
Activity 7.6: Using Outcome Evaluation
- Questions include: Did you receive the email? Can you recall the main message? Did you visit the website? Have you looked for more information on prostate cancer? Do you know the signs of prostate cancer? Did you find the information you needed on the website? Have you been to a medical professional as a result of this information?
- Examples include: Email brief questionnaire, office door knocking, interviews in staff room, and short postcard style questionnaires with competition incentive.
Activity 7.7: Dissemination of Findings
- Questions include: Do you feel confident at bathing a new baby? Did the training assist you in bathing a new baby? Did you breastfeed your baby? Have you put any measures into your house for safety? Were these the result of your training? Do you feel the training helped you to cope with being a new parent?
- Examples include: Postal or telephone questionnaires, interviews face to face, follow-up visits with interviews.
Activity 7.8: Evaluation Techniques
- Health professionals, construction workers, manufacturers, sexual health charities/organizations, government, other factory operators, local government/councils, local residents, condom manufacturers, healthcare practitioners inside and outside South Africa, etc.[Page 157]
- Paper and internet document. Local findings could be condensed into local media such as newspapers or newsletters.
- Local newspapers, local reports, internet sites.
Activity 7.9: Monitoring a Health Issue in the News
Process: Did you attend the exercise session? Do you have the exercises to do at home? Are you doing the exercises at home? Are there any exercises you do not understand? Are you increasing your daily physical activity levels? What are you doing to increase these levels?
Impact: How many times a week have you been doing the exercises? How much more daily physical activity are you doing? Have you fallen during this time? Can you recall the main campaign messages?
Outcome: Are you sustaining the daily exercises? Are you still doing daily physical activity? Have you fallen within the last 6 months? Can you recall the campaign messages?
- Interviews, face-to-face visits, questionnaires, demonstration of the daily activities, field observations of physical activity.
- In homes, in local areas where people are physically active, in the clinic.
Activity 7.10: Evaluating a Website
Alcohol in the media.
Example search terms: Alcohol, drinking, booze, media, newspaper, television.
- Article about media industry and alcohol ban available at http://www.guardian.co.uk/media/2009/sep/08/ad-ban-devastate-media-industries
- Newspaper article. The Guardian newspaper.
- How much money is spent on alcohol advertising and how if alcohol advertising was banned as recommended by BMA, that media companies would lose considerable money.
- No photographs. Usual presentation in Guardian format.
- Not front page, but has attracted a number of comments from readers.
- Examples include: Is there any bias? Or whose views are represented? Whose views might be missed?
Activity 7.11: Unconventional Evaluation
- Interactive quiz, make your own porn star movie that promotes condoms and share this with a friend, telephone helpline, email contacts, competitions and social networking site tags.
- How many people complete the quiz and what age/sex are they? How many people make a film and share it with their friends? Number of emails or telephone calls. Type of emails and telephone calls. Number of people visiting the site. Number of people entering competitions.
- Process: Count the number of people who have heard about the website from a friend or different sources. Encourage target group involvement in the development of the site: ask what [Page 158]they would do through a competition to make the site better and incorporate the ideas. Have an amnesty of knives/guns and count those handed in.
- Impact/outcomes: Make a video, write a song or create art work that has the main messages of the campaign.
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