Transcript Rise of Health Communication

Meet the Authors
Nancy J. Hicks
Principal, NJH Healthcare Communications
Christina M. Nicols, MPH, MS, MS
Senior Vice President and Director of Strategic Planning and
Research, Hager Sharp
Adjunct Professorial Lecturer, The George Washington
University Milken Institute School of Public Health
Today’s Agenda
• Rise of Health Communication
• Emerging Hot Topics and Growth Areas
• Using paid media to boost health communication efforts
• Ethics in health communication
• Health literacy and risk communication
• New options for evaluation
Rise of Health Communication
• Tremendous growth in health communications over past 40
years:
• Major health systems have staffs, often more than 100, who manage
every aspect of marketing communication
• Health care companies, once focused only on investor relations (IR),
now have full product and corporate communication programs
• Health care is one of biggest growth sectors for consulting firms
• From 2000-2010 there was explosion in health care communication
firms
Rise of Health Communication
• Trends that have spurred growth:
• Rise of consumerism with unparalleled access to health information
• More than 200 million health sites on Internet
• Increased importance of wellness and consumer interest in maintaining
optimal health
• Increase in media outlets covering all aspects of health
• Role of communications in health advocacy – HIV, breast cancer as
well as policy issues, including those related to the Affordable Care Act
(ACA)
Rise of Health Communication
• Growth trajectory for the future:
• Changing health delivery system (ACA, new payment systems)
demand sophisticated communications
• Advances in medical science (e.g. personalized medicine) require
“translation” to consumers
• Aging population will demand more healthcare products and services
increasing need for marketing
• Issues such as cost of drugs will be policy priorities and a source of
public debate
Emerging Hot Topics & Growth Areas
• Topics we’ll explore:
• Using paid media to boost health communication efforts
• Ethics in health communication
• Health literacy and risk communication
• New options for evaluation
Premise: Health communicators can effectively adopt
approaches from the public health community
Using Paid Media to Boost Health
Communication
• Public relations/communications program typically don’t cover
paid media approaches to the same extent that they focus on
earned, shared and owned media
• But paid media approaches are becoming more frequently used
in communication programs, especially to complement other
media channels
Using Paid Media to Boost Health
Communication
• Benefits
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Targeted outreach
Awareness driving
Direct link to action/goal completion
Measurability
• Paid media can incur the highest costs but can also ensure the
greatest control of content and the highest degree of
guaranteed reach
How to Use Paid Media
• Consider 5 Ws and 1 H
• Who – Who is the audience and what is the best way to define them?
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•
•
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Demographics
Behaviors
Attitudes
Lifestyle
• What – What is the campaign objective?
• Awareness
• Direct response/action
• When – When and how long with the campaign run?
How to Use Paid Media
• Consider 5 Ws and 1 H
• Where – Are there key markets to target? Where can you most
effectively reach audiences?
• Why – Why will the audience care about the ad?
• How – How much?
Negotiating costs
• Two potential options
• Decreased costs against standard rates
• Added value features, such as added reach, added frequency and/or research
Using Paid Media with Other Channels
• Earned – Paid can maximize frequency and reach of earned
coverage
• Adjacency placement
• Using paid to promote earned coverage
• Owned – Use search engine marketing to boost page visits to
owned media channels
• Shared/Social – Paid can boost engagement, particularly in
Facebook
Ethics in Health Communication
• PR industry has PRSA Code and other relevant codes of ethics
• Health communicators can benefit from adopting additional
codes from public health community because our audiences
often face sensitive, stigmatized and dangerous conditions
Key Principles in Health Ethics
• Beneficence
• Fairness
• Transparency
• Disclosure
• Autonomy (informed consent)
• Evidence
Key Principles
• Beneficence
•
•
•
•
Do no harm
Prevent harm
Remove harm
Actively promote good
• Example:
• In marketing communication, promoting tobacco is acceptable as long as
there is transparency and disclosure
• But in health communication, principle of beneficence prohibits promoting
tobacco
Key Principles
• Fairness (equality)
• Many issues of fairness are beyond scope of communication, but they
can be barriers for ethical communication
• Example: Patient testimonials can challenge the fairness principle if patient had
special advantages (e.g., was in a clinical trial available to only a few or
beneficiary of an experimental drug)
• Example: Conflict in promoting effective drugs that have excessively high prices,
ensuring many cannot afford them
Key Principles
• Transparency (honesty)
• Consumers need informed choice
• Many alternative treatments available for many conditions
• Consumers have finite time to make decisions
• Communicators need to be transparent and honest about product and treatment
claims – both the benefits and risks
• Example: Manufacturers of e-cigarettes are not transparent about the
risks of nicotine
Key Principles
• Disclosure of potential conflicts
• Enables audiences to assess whether or not there is a potential bias or
hidden agenda in the communication
• Autonomy (informed consent)
• Consumers providing testimonials or personal stories, as well as those
participating in research, need to understand the risks of their
participation, particularly in health conditions that are stigmatized (e.g.,
mental health) or potentially dangerous for those participating (e.g.,
domestic violence)
Key Principles
• Evidence
• Formulate clinical questions in a way they can be answered with strong
clinical evidence
• Use best external evidence available
• Appraise evidence for:
• Validity
• Application in clinical practice
• Performance and effectiveness data
Ethical Codes to Consider
• AMA’s Code of Ethics Concerning Health Communication
• Society for Healthcare Strategy and Market Development
• PRSA Code Provisions of Conduct
Health Literacy & Risk Communication
• Most Americans have difficulty understanding and processing
health information in a way that enables them to make informed
choices about their health
• The information is complex
• Scientific concepts can be difficult to understand
• Risk estimates are challenging because many people have low
numeracy skills
What Is Health Literacy?
• Three components:
• Print literacy
• Numeracy
• Oral literacy
• Those with print literacy are not necessarily more numerate
• Only 12% of Americans have proficient health literacy
Risk Communication
• Tension between actual vs. perceived risk
• Perceived risk is an individual’s perception of the probability of a negative
outcome along with the perception of the magnitude of the negative
outcome, i.e.,
• Perceived susceptibility
• Perceived severity
• Perceived risk impacts behavior
• Example: If an individual thinks he is not likely to contract flu, he is less likely to get
the flu shot
• Assess perceived risk among audiences to tailor messages
• Address misperceptions of risk and motivate healthy behaviors
Numeracy in Risk Communication
• Informed decision making requires the ability to weigh potential
benefits against potential risks, costs or drawbacks
• Basic numeracy is a challenge for many
• People often need verbal descriptions of risk – e.g., “small chance” or
“large risk”
• People have difficulty understanding statistical concepts that
are essential in conveying risk information numerically (e.g.,
probability and error)
• Most effective strategy is to combine numbers, visuals and verbal
descriptions
Literacy Tools for Communicators
• CDC Online Health Literacy Training Module
• http://www.cdc.gov/HealthLiteracy/training/
• NIH Plain Language Training
• https://www.nih.gov/institutes-nih/nih-office-director/officecommunications-public-liaison/clear-communication/plainlanguage/training
New Approaches in Evaluation
• Communication industry has made strides to develop a
consistent approach to measurement over the past decade
• AMEC’s Valid Metrics Framework
• Process and outcomes measures more consistently used
• Additional approaches beyond process and outcomes
measures:
• Efficacy testing
• Effectiveness evaluation
Efficacy Testing
• Designed to evaluate effects of campaign or intervention under
optimum conditions
• Mimics randomized clinical trial (RCT) methodology
• Randomized control and intervention groups
• Sufficient sample size for statistical analysis
• Often involves pre- and post-intervention testing and comparison
between control and intervention groups
Efficacy Testing
• Benefits
• Determines if messages and program components produce measurable
effects under controlled conditions
• Reduces risk of campaign or program investment
• Example: Testing Diabetes HealthSense for the National Diabetes
Education Program
• Worked with American Association of Diabetes Educators to identify 10
control sites and 5 intervention sites throughout U.S.
• Pre- and post-testing of knowledge levels, self-confidence in managing
diabetes and self-reported behaviors
• Found significant positive changes among intervention participants
Effectiveness Evaluation
• Designed to evaluate effects of campaign or intervention under
real-world conditions
• Measures process and outcome dimensions of effectiveness:
• Exposure and recall
• Reactions and receptivity to messages
• Behavioral determinants (knowledge, attitudes and belief)
• (Self-reported) behavioral outcomes
Effectiveness Evaluation
• Measure exposure
• Self-reported recall and recognition measures through surveys
• Reach and frequency
• Gross impressions
• Gross rating points
• These measures enable dose-response analysis
• Use surveys to measure reactions to messages, changes in
knowledge, attitudes, beliefs and self-reported behaviors
Efficacy vs. Effectiveness Studies
Feature
Efficacy Study
Effectiveness Study
Randomize participants
Yes
No
Manipulate intervention
Yes
No
Measure campaign exposure
No
Yes
Longitudinal tracking
No
Yes, with limitations
Internal validity
Higher
Lower
Measure dose-response
Yes
Yes, with limitations
External validity
Lower
Higher
Cost
Lower
Higher
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Health Industry
Communication
New Media, New Methods, New Message
SECOND EDITION
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