The Cleaner, Happier, Healthier hygiene intervention was developed and tested in 2013, featuring the Sesame Workshop characters. Through broadcast television, four public service announcements (PSAs) addressed washing hands with soap, using a latrine, wearing sandals, and drinking clean water. The main audiences were young preschool children and their parents or guardians.
Research occurred in Bangladesh, India, and Nigeria, exploring the reach and impact of these PSAs. Although low percentages, from well-drawn samples of extremely vulnerable populations in these countries, reported awareness and recall of these messages, such percentages can reflect large numbers of viewers. Considering data from the participating children, measures of knowledge and attitudes were associated with engaging in several of the behavioral outcomes. As well, awareness and recall of the PSA messages predicted “all the time” for several of the hygiene behaviors. In contrast, parents’ reports of PSA awareness and recall were not associated with reports of children’s hygiene behaviors.
Conducting reach studies is extremely difficult, especially in developing countries and communities. Despite the challenges, this study is encouraging. Participants reported seeing the messages, and in several models, this “reach” predicted reports of hygiene and health behaviors. Lessons learned from this case study and research can offer valuable insight into the production of future health PSAs, especially with harder-to-reach populations.
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Article
A Case Study of Sesame Workshop’s Cleaner, Happier, Healthier Intervention in Bangladesh, India, and Nigeria: Reporting on Exposure and Impact
Dina L. G. Borzekowski
Article
Anxiety, Uncertainty, and Intercultural Communication
Jim Neuliep
The effects of uncertainty and anxiety are profiled in association with intercultural communication and the initiation and development of intercultural relationships. Uncertainty is cognitive and refers to what one knows about another and one’s level of predictability about another. Anxiety is the affective equivalent of uncertainty and refers to the level of discomfort associated with interacting with a stranger. Two major theories are associated with this process, including uncertainty reduction theory and anxiety/uncertainty management theory. Other communicative factors also affect uncertainty and anxiety reduction and management during intercultural communication.
Article
Appeal to Bystander Interventions: A Normative Approach to Health and Risk Messaging
Shawn Meghan Burn
Bystander intervention is a form of helping that occurs when onlookers intercede to provide direct or indirect aid to a victim. When bystanders step in to prevent or reduce harm to others, they act as agents of primary and secondary health prevention. But theory and research suggest the bystander intervention process is complex and multiple social-psychological and situational barriers imperil bystander action. Bystanders are often ill-prepared to intervene when others are at risk for emotional or physical harm. They may not notice that someone needs help due to distraction from self-focus, engagement in social interaction, intoxication, or aspects of the situation like crowding or noise. Due to inadequate knowledge, bystanders may misdiagnose the situation and believe intervention is unnecessary. The negative consequences of nonintervention may be unknown to them such that the situation fails to increase their empathic arousal and motivate their action. Lacking knowledge, they may not recognize the seriousness of the situation and or the potential costs of inaction, and so are insufficiently alarmed. Pluralistic ignorance can arise when multiple uncertain bystanders conceal their concern and hesitate to act, assuming others’ inaction means intervention is inappropriate or unnecessary. When there are multiple witnesses, bystanders may assume their help is unneeded, place intervention responsibility on others, or feel less responsible for helping due to diffusion of responsibility. When the victim is not a member of their in-group, or is assumed at fault for their predicament, they may feel less empathy and a reduced responsibility to help. Or, bystanders may assign responsibility for intervention to the victim’s friends or fellow in-group members, or to those “in charge” of the setting. Even when bystanders realize help is needed and take responsibility for helping, they may not act if they do not know how or lack confidence in their ability to successfully carry out the actions required to help. When they have the skills, they may not help if they perceive the costs of action to outweigh the benefits of action. Audience inhibition arising from group norms supporting inaction and from bystander worry about what others will think about them if they act unnecessarily or ineptly can prevent bystander action by increasing bystanders’ perceived helping costs.
Recognition of bystanders as a potentially valuable public health asset has increased interest in promoting bystander intervention. Bystander intervention promotion and communications empower bystander action by combating intervention- and audience-specific barriers to bystander intervention using targeted information, communications, and skills training. Theory and research suggest that effective promotions and communications foster context-specific attitudes, beliefs, norms, and skills such that bystanders: (1) are able to quickly and accurately identify a situation as intervention-appropriate; (2) experience action-motivating arousal (including empathy) in the face of the event; (3) have positive attitudes towards intervention and perceive the benefits of action as outweighing the perceived costs; (4) are empowered to act and feel confident in their ability to effectively intervene (bystander efficacy); and (5) are resistant to evaluation apprehension and norms contraindicating action. Effective bystander intervention promotion draws on social psychology and communications studies, and best practices for health promotion and prevention programs. The application of social marketing and formative and summative program evaluation methods enhance the potential of bystander intervention promotions and communications to empower bystander action.
Article
Communicating about Genes, Health, and Risk
Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick
The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.
Article
Communicating Religious Identities
Renate Ysseldyk
Religion encompasses many forms of communication: between groups, within groups, and with God (or other deities). Such communication can be especially powerful when group members highly identify with their religious group and the beliefs therein. Equally, it can be divisive, as evidenced by religion-based intergroup conflict and intolerance (which often overlaps along ethnic or political lines). However, not all religious communication is verbal or explicit. Religious individuals also commonly transmit their beliefs, values, and identities through symbols, physical spaces, and music. Likewise, communication with God is often pursued with silent prayer, meditation, or ritual, which also serve to reinforce one’s spirituality alongside religious group boundaries. Taken together, these varying forms of communication have implications not only for religious intergroup relations (e.g., intergroup contact or conflict), but also for intragroup relations (e.g., the strengthening of social ties) and individual health outcomes (e.g., effective communication with health care providers and coping practices). Given the importance of religious identity for many individuals, the benefits for individual well-being and intragroup relations, and yet the intergroup strife that religious group divisions can incite, the ways in which we communicate our religious group identities deserve closer attention.
Article
Communication, Aging, and Culture
Robert M. McCann
Research into age and culture strongly suggests that people of different adult generations, regardless of culture, typically regard others and act in ways that display bias in favor of one’s own age group. While people across cultures share some basic patterns of aging perceptions, there is considerable variance in views on older people from one country to the next. Over the past two decades, the tenor of communication and aging research has shifted dramatically. Traditional research into aging across cultures painted a picture of Asia as a sort of communicative oasis for elders, who were revered and communicated to by the younger generations in a respectful and mutually pleasing manner. Compelling evidence now suggests the opposite, which is that (interregion variability in results notwithstanding) elder denigration may be more pronounced in Eastern than Western cultures. Accelerated population aging, rural-to-urban shifts in migration, new technologies, rapid industrialization, and the erosion of cultural traditions such as filial piety, may partially account for these results. Additionally, there are well-established links between communication and the mental health of older people. Specifically, communication accommodation in all of its forms (e.g., over accommodation, nonaccommodation, accommodation) holds great promise as a core predictor of a range of mental health outcomes for older people across cultures.
Article
Communication and Recruitment to Clinical Research Studies
Janice L. Krieger and Jordan M. Neil
Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.
Article
Communities of Practice in Health and Risk Messaging
Nicola Andrew
A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being.
CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice.
In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.
Article
Counterfactuals in Health and Risk Messaging
Irina A. Iles and Xiaoli Nan
Counterfactual thinking is the process of mentally undoing the outcome of an event by imagining alternate antecedent states. For example, one might think that if they had given up smoking earlier, their health would be better. Counterfactuals are more frequent following negative events than positive events. Counterfactuals have both aversive and beneficial consequences for the individual. On the one hand, individuals who engage in counterfactual thinking experience negative affect and are prone to biased judgment and decision making. On the other hand, counterfactuals serve a preparative function, and they help people reach their goals in the future by suggesting effective behavioral alternatives.
Counterfactual thoughts have been found to influence an array of cognitive processes. Engaging in counterfactual thinking motivates careful, in-depth information processing, increases perceptions of self-efficacy and control, influences attitudes toward social matters, with consequences for behavioral intentions and subsequent behaviors. Although it is a heavily studied matter in some domains of the social sciences (e.g., psychology, political sciences, decision making), counterfactual thinking has received less attention in the communication discipline. Findings from the few studies conducted in communication suggest that counterfactual thinking is a promising message design strategy in risk and health contexts. Still, research in this area is critically needed, and it represents an opportunity to expand our knowledge.
Article
Creating Authentic and Lasting Community Relationships to Enhance Awareness and Understanding of Cancer Research
Linda Fleisher, Evelyn González, and Armenta Washington
Building and sustaining relationships fundamentally requires mutual trust based on authentic and reciprocal communication. Successful academic and community partnerships require a deep understanding of the needs of all stakeholders facilitated through dialogue and ongoing communication strategies. This dialogue is especially crucial to address health disparities and bridge the divide between academics and other professionals and the communities they serve. Innovative and sound health communications and community engagement approaches can help to address this divide. For those working with communities to improve health, Community Based Participatory Research (CBPR) principles can serve as a compass to guide those efforts of building on the strengths and resources within the community and ensuring co-learning to address social inequities. Moreover, using innovative and interactive health communication strategies, such as community forums, photovoice projects, and the development of culturally sensitive and relevant messaging, can empower and engage the community, facilitating long-lasting relationships between the academic institutions and communities that ultimately address the unique concerns and values of those most in need.
Article
A Culture-Centered Approach to Health and Risk Communication
Mohan Jyoti Dutta
The culture-centered approach (CCA) to health and risk communication conceptualizes the communicative processes of marginalization that constitute the everyday meanings of health and risks at the margins. Attending to the interplays of communicative and material disenfranchisement, the CCA situates health inequalities amidst structures. Structures, as the rules, roles, processes, and frameworks that shape the distribution of resources, constitute and constrain the access of individuals, households, and communities to the resources of health and well-being. Through voice infrastructures cocreated with communities at the classed, raced, gendered, colonial margins of capitalist extraction, the CCA foregrounds community agency, the capacity of communities to make sense of their everyday struggles with health and well-being. Community voices articulate the interplays of colonial and capitalist processes that produce and circulate the risks to human health and well-being, serving as the basis for community organizing to secure health and well-being. Culture, as an interpretive resource passed down intergenerationally, offers the basis for organizing, and is simultaneously transformed through individual and community participation. Culture-centered health communication, rooted in community agency, drawing upon cultural stories, resources, and practices in subaltern contexts, takes the form of organizing for health, mobilizing agentic expressions toward structural transformations.
Article
Diffusion of Innovations from the West and Their Influences on Medical Education in Japan
Mariko Morishita and Miho Iwakuma
In the 19th century, Western medicine spread widely worldwide and ultimately diffused into Japan. It had a significant impact on previous Japanese medical practice and education; it is, effectively, the foundation of contemporary Japanese medicine. Although Western medicine seems universal, its elements and origins as it has spread to other countries show localized differences, depending on the context and time period. Cultural fusion theory proposes that the culture of a host and influence of a newcomer conflict, merge, or transform each other. It could shed light on how Japanese medicine and medical education have been influenced by and coevolved with Western medicine and culture. Cultural fusion is not assimilation or adaptation; it has numerous churning points where the traditional and the modern, the insider (indigenous) and the outsider (immigrant), mix and compete. In Japan, medicine has a long history, encountering medical practices from neighboring countries, such as China and Korea in ancient times, and Western countries in the Modern period. The most drastic changes happened in the 19th century with strong influence from Germany before World War II and in the 20th century from the impact of the United States after World War II. Recently, the pressure of globalization could be added as one influence. Since cultural fusion is ubiquitous in Japanese medical fields, examples showing how the host and newcomers interact and merge can be found among many aspects of Japanese medicine and medical education, such as curricula, languages, systems, learning styles, assessment methods, and educational materials. In addition, cultural fusion is not limited to influence from the West but extends to and from neighboring Asian countries. Examining cases and previous studies on cultural fusion in Japanese medicine and medical education could reveal how the typical notion that Japan pursued Westernization of its medicine and medical education concealed the traditions and the growth of the local education system. The people involved in medicine in the past and the present have struggled to integrate the new system with their previous ideals to improve their methods, which could be further researched.
Article
Ethical Issues and Considerations in Health and Risk Message Design
Nurit Guttman
The design and dissemination of health and risk messages invariably involves moral and ethical issues. The choice of the topics, the focus on particular recommended practices, the choice of particular groups to be the intended recipients of the messages and their inclusion in or exclusion from the message development process, all raise ethical issues. Further, the persuasive tactics used to influence people to change their attitudes and beliefs and to adopt recommended changes in their lives also raise ethical concerns. For example, persuasive tactics may infringe on people’s privacy when people view images they may find intrusive, offensive, or cause them distress. Tactics that “tug” at people’s emotions may infringe on their unhindered ability to make a conscientious decision. Employing digital media and sophisticated advertising and marketing tactics also elicits ethical challenges both related to their manipulative potential and their differential reach: all of which may contribute to social and health disparities. In addition, the practices recommended in health and risk messages may conflict with values people cherish. For example, people could be urged to change the way they communicate with their spouses on intimate issues, relinquish the consumption of favorite traditional foods—or messages may raise issues that recipients find taboo according to their culture or religious beliefs. Health and risk messages may have unforeseen and unintended adverse effects that could affect people’s emotional and physical aspects by inadvertently contributing to people’s sense of guilt through shaming or stigmatization. Also, on the cultural and social level, such messages may contribute to an idealization of a certain lifestyle or commercialization of products and celebrities associated with the messages.
Philosophical and ethical frameworks typically used in communication ethics, bioethics, communication campaigns, and social marketing literature emphasize the central guiding principles of personal autonomy and privacy with the aim to ensure equity and fairness. The obligation to avoid “doing harm” includes concerns regarding labeling, stigmatizing, and depriving; the obligation to help; the obligation to respect people’s autonomy to make free choices, particularly concerns regarding persuasion tactics and manipulations and the use of threat tactics, provocative appeals, distressing images, framing tactics, cultural sensitivity, and moral relativism; the obligation to obtain consent; the obligation to truthfulness; the obligation to sincerity; the obligation to correctness, certitude, and reliability; the issue of personal responsibility; equity obligations including concerns regarding segmentation and “targeting”; the obligation to comprehensibility; the obligation of inclusion; utility and efficiency considerations; the “harm reduction” approach; and concerns regarding social value priorities and “distortions,” which includes prosocial values as moral appeals.
Article
Ethical Issues in Health Promotion and Communication Interventions
Nurit Guttman
Health promotion communication interventions invariably raise ethical issues because they aim to influence people’s views and lifestyles, and they are often initiated, funded, and influenced by government agencies or powerful public or private organizations. With the increasing use of commercial advertising tactics in health promotion communication interventions, ethical issues regarding advertising can be raised in health promotion communication when it applies techniques such as highly emotional appeals, exaggerations, omissions, provocative tactics, or the use of children. Key ethical concerns relate to infringing on people’s privacy, interfering with their right to freedom of choice and autonomy, and issues of equity (such as by widening social gaps, where mainly those who are better off benefit from the interventions). Interventions using digital media raise ethical issues regarding the digital divide and privacy. The interventions may have unintended adverse effects on the psychological well-being of individuals or groups (e.g., by inadvertently stigmatizing or labeling people portrayed as negative models). They can also have an effect on cultural aspects of society (e.g., by idealizing particular lifestyles or turning health into a value) and raise concerns regarding democratic processes and citizens’ consent to the interventions.
Interventions can have repercussions in multicultural settings since members of diverse populations may hold beliefs or engage in practices considered by health promoters as “unhealthy,” but which have important cultural significance. There are also ethical concerns regarding collaborations between health promoters and for-profit organizations. Identifying and considering ethical issues in the intervention is important for both moral and practical reasons. Several ethical conceptual frameworks are briefly presented that elucidate central ethical principles or concerns, followed by ethical issues associated with specific contexts or aspects of communication interventions.
Article
Gender as a Consideration When Designing Health and Risk Messages
E. Michele Ramsey
Given the impact of gender on health, healthcare decisions, and treatments for illness, as well as the increased inequities encountered by non-white men and women, messages about health and health risks are affected by purposeful assumptions about gender identity. While the term sex denotes the biological sex of an individual, gender identity is about the psychological, cultural, and social assumptions about a person associated with that person because of his or her sex. Gender and health are intimately connected in a number of ways, and such connections can differ based on race, ethnicity, age, class, religion, region, country, and even continent. Thus, understanding the myriad ways that notions of gender affect the health of females and males is fundamental to understanding how communicating about risks and prevention may be tailored to each group.
Gender role expectations and assumptions have serious impacts on men’s health and life expectancy rates, including self-destructive behaviors associated with mental health and tobacco use, self-neglecting behaviors linked to the reluctance of men to seek treatment for ailments, reluctance to follow a physician’s instructions after finally seeking help, and risk-taking behaviors linked to drug and alcohol use, fast driving, guns, physical aggression, and other dangerous endeavors. Because gender role expectations tend to disfavor females, it is not surprising that gender generally has an even greater impact on women’s health than on men’s. Even though biological factors allow women, on average, to live longer than men worldwide, various gendered practices (social, legal, criminal, and unethical) have serious impacts on the lives and health of women. From sex discrimination in research and treatment regarding issues linked to reproductive health, depression, sexual abuse, alcohol and drug abuse, the sex trade, and normalized violence against women (such as rape, female genital mutilation, forced prostitution/trafficking, and domestic violence), women’s lives across the globe are severely affected by gender role expectations that privilege males over females.
While some general consistencies in the relationships between gender, women, and health are experienced worldwide, intersections of race, ethnicity, class, age, country, region, and religion can make for very different experiences of women globally, and even within the same country.
The recent years have seen an increasing call to reconsider the binary means by which we have defined sex and gender. Advances in our understandings of lesbian, gay, bisexual, intersex, and transgendered individuals have challenged traditional notions and definitions of sex and gender in important and complex ways. Such an important shift warrants a stand-alone discussion, as well as the recognition that sexual orientation should not be automatically linked to discussions of sex and gender, given that such categorization reifies the problematic sex/gender binaries that ground sexist and homophobic attitudes in the first place.
Article
Global Health and Critical Studies
Mohan Jyoti Dutta
Amid the large scale inequalities in health outcomes witnessed globally, communication plays a key role in reifying and in offering transformative spaces for challenging these inequities. Communicative processes are integral to the globalization of capital, constituting the economic conditions globally that fundamentally threaten human health and wellbeing. The dominant approach to global health communication, situated within the global capitalist logics of privatization and profiteering, deploys a culturally targeted and culturally sensitive framework for addressing individual behavior. The privatization of health as a commodity creates new market opportunities for global capital. The extraction of raw materials, exploitation of labor, and the reproduction of commoditization emerge on the global arena as the sites for reproducing and circulating health vulnerabilities. By contrast, the culture-centered approach to global health foregrounds the co-creative work of building communicative infrastructures that emerge as sites for resisting the neoliberal transformation of health care. Through processes of grassroots democratic participation and ownership over communicative resources, culture-centered interventions create anchors for community-level interventions that seek to transform unhealthy structures. A wide array of social movements, activist interventions, and advocacy projects emerging from the global margins re-interpret the fundamental meanings of health to create alternative structures for imagining health.
Article
Health Care Teams as Agents for Change in Health and Risk Messaging
Kevin Real and Andy Pilny
Effective communication in health care teams is central to the delivery of high-quality, safe, dependable, and efficient patient care. Understanding how health care team communication operates within healthcare systems is important. Viewing health care teams in hospital settings as creators and channels for diffusions of health and risk messages is an important contribution to health communication scholarship. Health care teams are essential elements of healthcare systems. In many instances, they are components of multiteam systems embedded within larger network ecosystems. These teams are not identical, thus, considering how team type (e.g., unidisciplinary, multidisciplinary, interdisciplinary) shapes distinct communication processes offers a better understanding of how these teams facilitate health and risk message diffusion. TeamSTEPPS is an important framework for essential teamwork behaviors that facilitate team processes in healthcare systems. Significantly, we develop specific communication competencies drawn from observation work that facilitate health care team effectiveness. Ideas developed by Kurt Lewin are utilized to consider how different types of multiteam systems can be effective as channels and facilitators of health and risk messages. We end the chapter with examples from field research. A set of hospital nursing unidisciplinary teams comprise a network of teams that form a heterarchical structure with important messages flowing between teams. An innovative form of hospital interdisciplinary rounds relies on specific communication practices to create and exchange health and risk messages to patients, families, health care team members, and other healthcare stakeholders.
Article
Health Literacy and Health/Risk Communication
Michael Mackert, Sara Champlin, and Jisoo Ahn
Health literacy—defined as the ability of an individual to obtain, process, understand, and communicate about health information—contributes significantly to health outcomes and costs to the U.S. health-care system. Approximately one-quarter to one-half of U.S. adults struggle with health information, which includes understanding patient education materials, reading medication labels, and communicating with health-care providers. Low health literacy is more common among the elderly, those who speak English as a second language, and those of lower socioeconomic status. In addition to conceptualizing health literacy as an individual-level skill, it can also be considered an organizational or community-level ability.
Increased attention to the field of health literacy has resulted in debates about the definition and the best ways to assess health literacy; there is also a strong and growing movement within the field of health literacy research and practice to frame health literacy less as a deficit to overcome and more as an approach to empowering patients and improving outcomes. As health-care providers have recognized the importance of health literacy, workshops, and training programs have been developed and evaluated to improve the care of low-health-literate patients. Similarly, health promotion professionals have developed best practices for reaching low-health-literate audiences with traditional and new digital media, which can also increase access for patients with hearing or visual impairments. Additionally, recent policy changes in the United States, including those related to the Affordable Care Act, contribute to a greater focus and regulation of factors that impact health literacy. Researchers and practitioners together are advancing understanding of health literacy, its relationship to health outcomes and health-care costs, and improved strategies for improving the health of lower health literate patients. Development and review of health literacy pieces can aid in shared decision making and provide insights for patients on various health-care services.
Article
Health Promotion and Risk Reduction in Congregations
Dennis Myers, Terry A. Wolfer, and Maria L. Hogan
A complex web of attitudinal, cultural, economic, and structural variables condition the decision to respond to communications promoting healthy behavior and participation in risk reduction initiatives. A wide array of governmental, corporate, and voluntary sector health-related organizations focus on effective messaging and health care options, increasing the likelihood of choices that generate and sustain wellness. Researchers also recognize the significant and multifaceted ways that religious congregations contribute to awareness and adoption of health-promoting behaviors. These religiously based organizations are credible disseminators of health education information and accessible providers of venues that facilitate wellness among congregants and community members. The religious beliefs, spirituality, and faith practices at the core of congregational cultural life explain the trustworthiness of their messaging, the health of their adherents, and the intention of their care provision.
Considerable inquiry into the impact of religion and spirituality on health reveals substantive correlations with positive psychological factors known to sustain physical and psychological health—optimism, meaning and purpose, hope, well-being, self-esteem, gratefulness, social support, and marital stability. However, the beliefs and practices that create receptivity to health-related communications, care practices, and service provision can also be a deterrent to message impact and participation in healthy behaviors. When a productive relationship between spirituality and health exists, congregational membership offers rituals (e.g., worship, education, mission) and relationships that promote spiritual well-being. Research demonstrates increased life satisfaction and meaning in life, with health risk reduction associated with a sense of belonging, enriched social interactions, and shared experiences.
Congregations communicate their commitment to wellness of congregants and community members alike through offering a variety of congregationally based and collaborative wellness and risk reduction programs. These expressions of investment in individual and community health range across all age, gender, and ethnic demographics and address most of the prominent diagnostic categories. These programs are ordered along three dimensions: primary prevention (health care messaging and education), secondary prevention (risk education), and tertiary prevention (treatment). Applying the dimensions of sponsorship, goal/mission, focus, services, staffing, and intended outcome highlights the similarities and differences among them. Several unique facets of congregational life energize the effectiveness of these programs. Inherent trust and credibility empower adherence, and participation decisions and financial investment provide service availability. These assets serve as attractive contributions in collaborations among congregations and between private and public health care providers.
Current research has not yet documented the best practices associated with program viability. However, practice wisdom in the planning, implementation, and evaluation of congregationally based and collaborative health-related programs suggests guidelines for future investigation. Congregational leaders and health care professionals emphasize well-designed needs assessment. Effective congregational health promotion and risk reduction may be linked to the availability and expertise of professionals and volunteers enacting the roles of planner/program developer, facilitator, convener/mediator, care manager/advocate, health educator, and direct health care service provider.
Article
Lifespan and Developmental Considerations in Health and Risk Message Design
Jon F. Nussbaum and Amber K. Worthington
Health and risk message design theories do not currently incorporate a lifespan view of communication. The lifespan communication perspective can therefore advance theorizing in this area by considering how the fundamental developmental differences that exist within and around individuals of different ages impact the effectiveness of persuasive message strategies. Designing health messages for older adults therefore requires an examination of how theoretical frameworks used in health and risk message design can be adapted to be age sensitive and to effectively target older adults. Additionally, older adults often make health decisions in conjunction with informal caregivers, including their adult children or spouses, and/or formal caregivers. Message design scholars should thus also consider this interdependent influence on health behaviors in older adults. Strategic messages targeting these caregivers can appeal to, for example, a caregiver’s perception of responsibility to care for the older adult. These messages can also be designed to not only promote the older adults’ health but also to alleviate caregiver stress and burden. Importantly, there is an unfounded stereotype that all older adults are alike, and message designers should consider the most beneficial segments of the older adult audience to target.
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