Journal of Health Communication: 2025 Year in Review

In the early eighties, a popular prime time drama serial Zeg eens A was being broadcast in the Netherlands. Health communication professionals who saw this series regarded it as an interesting setting in which to introduce and deal with health communication messages (see for example Bouman, 1984). At that time, however, collaborating with scriptwriters of popular television programmes was a problematic issue, due to the fact that health organizations had great reservations about using a popular medium like a tabloid, a gossip magazine, a soap opera or other drama series to communicate serious health messages (Dekker, 1985 personal conversation). Apart from their unfamiliarity with popular culture, health organizations feared losing their respectable image and, as a possible ultimate consequence, their funding. Although understandable, this showed an explicit tension between the goals of health communication and the goals of public relations and fundraising. Health communication professionals however saw that the messages of health organizations have to compete with thousands of other communication messages. If the attention of the target audience is to be caught and held, and more especially if that audience is not spontaneously interested in health messages, it is no longer sufficient to rely solely on the rationality of the message: other, more emotionally appealing and popular communication methods must also be brought into play. Some health organizations acknowledged this, but did not yet accept its consequences. Zeg eens A became the most popular Dutch drama serial of the eighties, but never carried a purposively designed and eloquently interwoven health message1.As time went by, the climate for using entertainment television for health communication purposes changed however, and worldwide a number of ways were found to incorporate health promotion messages into popular television entertainment. This approach is now known as the entertainment-education (E&E) strategy (Coleman & Meyer, 1989). In the Netherlands also, some challenging experiments were carried out in the late eighties, such as the drama series Familie Oudenrijn in 1987 (Verbeek, 1990), the Way of Life Show in 1988 (Nederlandse Hartstichting, 1988; Bouman, 1989) and Villa Borghese in 1991 (Bouman & Wieberdink, 1993).The first experiments with E&E television programmes initiated a lively discussion and debate about norms and values in the Dutch health communication field. This provided an impetus for the creation of new and experimental ways of reaching the so-called 'hard to reach' groups. Because of the many still unanswered questions, research in the field of the entertainment-education strategy is both necessary and rewarding.In the next four sections, some matters that need to be explicated will be touched upon. Section 1.1 defines some concepts frequently used in this thesis. Section 1.2 lists the research questions of the thesis. Section 1.3 gives a short overview of the health communication field, divided into organizations, health communication professionals and health communication strategies. Section 1.4 briefly describes the field of television in the Netherlands. Section 1.5 gives an overview of the thesis chapters, and section 1.6 summarizes this chapter.DefinitionsThe subject of this thesis is collaboration for prosocial change; the entertainment-education strategy on television. The concepts in the title of this thesis are defined as follows:In this thesis, collaboration refers to two different professional fields working together to design and produce a television programme in which entertainment and education are combined. The two professional fields concerned are the field of health communication and that of television production. In a wider sense these represent national health organizations on the one hand and broadcasting companies and independent production companies on the other; in a narrower sense they are the health communication professionals and television professionals working within these respective organizations.The term prosocial denotes 'that which is socially desirable'. From a critical theory perspective, questions can be raised about what is socially desirable (see also Chapter 2, section 2.4.). In this thesis, health is the object of prosocial change. Health is defined by the World Health Organization (WHO) as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (WHO, 1986). The goals of prosocial and health communication, as referred to in this thesis, are directly derived from policy papers as formulated and formalized by national governments, and indirectly by international organizations, such as the WHO.In this thesis, change agencies are national health organizations. National health organizations as change agencies are defined here as either government related agencies or non-governmental organizations (NGOs) and the change agents are health communication professionals who work within these organizations. Health communication is regarded here as an essential element of the wider concept of health promotion. Some of the researched projects in this thesis also concern broader health related issues, such as environmental communication or road safety, but the term 'health communication' will be used as an overall concept for all forms of prosocial communication with which this thesis deals.Entertainment-education (E&E) strategy refers to the combination of entertainment and education in order to promote prosocial change. In Chapter 2 the definition of the entertainment-education strategy will be elaborated. The E&E strategy can be applied to different popular media: theatre, music, film, radio, television, etc. This thesis focuses on the use of the E&E strategy in television.Research questionsTelevision entertainment as a potential vehicle for health promotion is regarded as a challenging concept. A study into the use of the E&E strategy in television refers to such questions as: 'What are the characteristics of television programmes in which education has been or can be combined with entertainment?' 'How effective is the E&E strategy?' 'Which facilitating or hindering factors play a role in the collaboration between health communication and television professionals when making an E&E television programme?' 'Is it possible to develop a working model that helps practitioners to decide if and how an entertainment-education programme can be designed and produced successfully?' These - and other - questions have led to the central research question, which is twofold:A) What are the characteristics of entertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour, and what is known about their effects and conditions for success?B) How do health communication and television professionals collaborate in the design and implementation of an E&E television programme and what recommendations can be made for the management of E&E collaboration in the future?Anderson and Meyer (1988) indicate that the motives of a researcher to investigate a certain topic can be epistemological in nature, but the results and implications of the research can be ideological and economic. In this study all these components play a part. As E&E practice is ahead of E&E theory, the aim of this research is to transpose the experiences of E&E practice into a theoretical framework and to add new concepts to the discourse of E&E communication professionals. In order to answer the questions posed in this thesis, the following research has been undertaken:A review of the literature on the theory and practice of health communication, mass media (television) and the entertainment-education strategy;An analysis of the quantitative data of Dutch E&E research;An analysis of E&E television programmes worldwide;A review of the literature on television production and collaboration;An in-depth qualitative study into the collaboration process between health communication professionals (N=18) and television professionals (N=12) on twelve Dutch E&E television programmes.As the E&E strategy is not yet widely known, let alone implemented in Dutch health communication and television practice, a rather broad scope has been chosen in this thesis. The disadvantage of this is that not all related subjects can be given an exhaustive treatment. The advantage, however, is that a solid basis is created for further analysis and research.Epilogue IConclusions and lessons learned (Summary part I)The purpose of this section is to summarize some of the experiences and lessons of the E&E television programmes studied here in order to assist the design of E&E television programmes in the future and to answer the first part of the central research question in this thesis:A)What are the characteristics of entertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour, and what is known about their effects and conditions for success?CharacteristicsEntertainment-education (E&E) television programmes which are purposively designed to enhance prosocial behaviour are not just regular television programmes. In order to be effective, the design of E&E television programmes (drama, comedy and soaps, or quizzes, gameshows and talkshows/magazines) should be based on the principles of vicarious learning and social modelling. The actual modelling and observational learning process is governed according to Bandura (1986) by four interrelated subprocesses: attention, retention, production and motivation (see Chapter 2, section 2.3.5). Based on these four processes, combined with the research results of the design and effects of E&E television programmes worldwide, the following characteristics can be identified as important for the design and success of E&E television programmes:Attention processFirst, the socially desirable television model must catch the attention of the audience (observer). In entertainment-education television, this is achieved by using a popular programme genre. Other variables, such as the perceived credibility and attractiveness of the model, also come into play. It is important to use spokespersons (show host, stars, actors) that the audience will trust and believe. Entertainment-education television must be of high quality, using skilled and talented professionals. The production quality has to meet or exceed media standards. It is important to keep entertainment in the foreground and education in the background. First the audience has to get involved in the programme, later messages can be introduced and incorporated. It is important to cater for both the head and the heart and to be dramatic and moving. Although different kinds of programme formats have been used in E&E television studies, varying from talk and gameshows and variety shows to popular soap and drama series, realistic social drama is especially successful in involving people emotionally. There is much inconsistancy about the effectiveness of humour. Studies concluded that in order to be an effective aid to learning, humour must be at least meaningfully related to the material to be learned. The humour should coincide perfectly with the critical learning opportunity.Retention processIn order to reproduce the behaviour without the presence of the model, it is necessary to retain the image and verbal symbols that are provided. Retention of modelled information is enhanced when viewers perceive the model and the circumstances to be similar to themselves and significant in their lives. The programme has to involve a variety of problems which are eventually solved to the benefit of positive role modelling characters.It is necessary to present role models who exchange ideas and opinions about the prosocial issue involved. In this way, different segments of the population will be able to identify with the issue at hand. Vicarious learning can best take place when viewers identify with and relate to these role models and when viewers recognize issues as relevant for their daily lives. This way, television programmes can serve as touchstones for experiences which viewers have and which they see reflected in the programme. The programme has to be realistic, set in todays world, include events in different settings (urban and rural), and depict characters who are regarded by the viewers as 'people like us'.Depicting lifelike situations and portraying social models who are 'people like us' is an essential part of E&E television programming to create the circumstances necessary for social learning and to enhance a feeling of involvement. A realistic programme does not mean that every detail must conform to reality, but that it has a contemporary setting, that it concerns itself with secular action (human action described in exclusively human terms) and that it is socially extended, which means that it deals with the lives and experiences of ordinary people. With reference to the latter, to avoid feelings of embarassment or stigmatization, it is advised to depict positive role models with a slightly higher aspiration level. Domestic productions with outdoor scenes at well known sites, using colloquial language, make E&E television more realistic.The essence of the entertainment-education strategy is to use television characters as models of behaviour and to encourage audience members to talk each other into practising the desirable behaviour they see portrayed. Entertainment-education programmes are designed to stimulate and enhance parasocial interaction between viewers and television personalities and characters and encourage talking with neighbours, family and friends about what they have seen on television. Memorable images and the acting out of prosocial behaviour are remembered better and longer than dialogues and lectures about such behaviour. E&E television programmes have to link in with what is already part of public awareness. The influence is problably greater when a message evokes recognition and then adds an idea or concrete information to that, rather than when it is contradictory to the prevailing opinion. It is important that E&E television programmes address their objectives by associating them with pre-existing human values and dramatizing how specific role models learn to actualize these values in their lives by practising the prosocial behaviour.Production processThe third subprocess that influences the degree of modelling is called the production process. This process addresses the ability of the individual to replicate the observed behaviour, or the translation of retained symbols into guides for future behaviour. In order to reproduce the modelled behaviour it is important to tell audiences what they can do now, referring them to sites (e.g. address, telephone, Internet page) for answers on questions or to services or service providers that are familiar, available and ready. Some ways to do this are: (1) by using several 'reality reminders' epitomizing appropriate behaviour; (2) by 'advising' viewers how to deal with specific situations; and (3) by introducing epilogues to programmes to summarize the main educational points and to provide specific information about the services and infrastructure needed for viewers to convert an intention, motivated by the television programme, into action. Direct messages work best, especially with hard to reach audiences. Researchers report that respondents with lower levels of education gained more from factual information and knowledge about health issues than from more subtle messages conveying particular attitudes from which they were sometimes unable to draw appropriate inferences. Respondents with higher levels of education, however, gained most from the inferential messages tackling prejudice and attitudes. This confirms that different audiences demand different kind of message frames. Clear cut factual information and practical advice seems to meet especially the needs of the less well educated, while implicit contextual information suits more highly educated audiences. It is also suggested that a more direct approach may be more successful in addressing issues where attitude change is likely to be particularly difficult. It is important to focus on so-called 'personal efficacy', or the extent to which people think that they have the skills to change their behaviour. Focusing on imparting skills to handle different situations seems to offer a better prospect for changing behaviour than emphasising the damaging effects for health. Another approach which does not place too heavy an emphasis on the transfer of information and does not become too serious, is to depict how ordinary people deal with dilemmas in everyday life: how they share emotions, exchange ideas and arguments about a certain issue and how they make their final choice for one or the other behaviour.Message framing based on a 'consumer approach' supports and empowers lay people, in contrast to a 'medical approach', which underlines and supports the central role of the educated health care professional. Message framing according to a 'look after yourself' approach focuses on individual lifestyle determinants of health problems, and an 'environmental approach' stresses the socio-economic determinants and conditions of health problems.Motivation and reinforcement processThe most important and decisive subprocess is motivation and reinforcement. An individual may observe, retain and have the ability to translate the retained symbols into specific behaviour, yet not do so unless favourable incentives are introduced. Motivational processes address incentives to exhibit modelled behaviour, including direct and vicarious rewards. There are three types of modelling characters with whom the audience needs to identify closely in order to vicariously experience the rewards (or punishment) for practising the promoted behaviour: (1) those who support the prosocial behaviour (positive role models), (2) those who reject it (negative role models), and (3) those who move from antisocial to prosocial behaviour (transition models). In entertainment-education television programmes, the observer or viewer learns vicariously by watching a television model being visibly rewarded or punished immediately after the model engages in prosocial or antisocial behaviour. These rewards or punishments must be realistic and can vary from subtle gestures to more explicit moral statements.EffectsIn general can that, from a social perspective, the use of entertainment television formats has been programmes both the need for entertainment and education and a in ways that be achieved by The programmes had favourable prime time which are never given to more health education television The most of E&E television programmes was at the of and awareness. results have also been in attitude and in some a change of behaviour the prosocial The of E&E television programmes especially in social social reinforcement and Some E&E television programmes were also successful in and the direct effects of most E&E programmes were the effects the of can be the social processes of social parasocial interaction and which take place particularly when audience members the of an E&E message in Although E&E television successful in the attention of the audience in of the prosocial issue and in the message as has to be in certain The entertainment education strategy is not of did not identify with the characters and it was sometimes to the between entertainment and In many research had by itself can sometimes about social and certain conditions combination with other of it can create a climate for social are several contextual between and that may some E&E projects are more successful than such as in available and and other for the entertainment-education strategy is based on a social a focus on the social of prosocial messages and a In order to the and to be to research and is of of social are used in the design of entertainment messages (e.g. audience needs knowledge about the needs and of the target audiences can and support the design of entertainment-education programmes. This may be by the of E&E television programmes by of the target by audience to in the design or by focus to get actual information and from the specific target In order to realistic the sites and where the target audience lives and talking with them about their to problems and experiences have to be of In are or the issue involved is in the of the programme and in positive and role the messages and the process of audience analysis and also in a sense of in the collaboration process between television professionals and health communication professionals. Some report that by the and on the from the potential the collaboration all the more to the that communication is a not a however, more time and the design of an E&E television programme than television programmes. This for in and with the television professionals in order to meet the of the production implementation the creation of solid in order to programme The research shows that E&E television programmes that are part of a and are combined with a variety of other and educational to and influence target are the most E&E television alone change without the support of other and The of services to support E&E is In order to be effective E&E television programmes need to be well researched and but the most research and do not time, a applied by a of able people using based on is also communication a high of and The in which collaboration in a is important for and (Summary part this an overall of the experiences and lessons of the E&E collaboration processes as studied in of this thesis will be and an answer will be provided to the part of the central research question of this do health communication and television professionals collaborate in the design and implementation of an E&E television programme and what recommendations can be made for the management of E&E collaboration in the the E&E collaboration between health communication and television professionals was as general theory of practice (see Chapter may be of in more into the and of the of the E&E collaboration process. The concept in this theory is that of The is sometimes also described as a for the a that agents to and in specific situations in a that is not but the of its of the It is that health communication and television professionals to different fields and a different In however, where fields more or less have to in order to reach a like in E&E it is necessary that both their to that of their collaboration the E&E collaboration processes health communication and television professionals a of they had different of the the collaboration professionals about and and health communication professionals about and With to programme television professionals at potential in of and the attention of the these as goals in Health communication professionals were interested in the potential for vicarious social learning and attitude and behaviour. What was an in itself for television professionals was a means for health communication professionals. both to and the E&E collaboration process. Health communication professionals to work the principles of behaviour change and to have influence on all programme however, a of health communication professionals to and to take care of the of the and television professionals to design the in which the health message be best it that of (or both fields first just their the question as to was the and the other to with its to in order to be by a field be one must the which one to that field. recognition of the a field will reject or to new Although television organizations the for the E&E and in that sense were the with to health organizations, practice showed an social health communication professionals were more or less to incorporate the in order to be and to health communication especially when they were to the television field, this to be a and that made them they were from their field. In their working the television of reference an of This was not what they had in when they the this of the of the television field their relations with their they not the of their at but also its of their health losing their respectable damaging their Health communication this, became to the television and in between the two in field also a significant role in the of the to the field with the and will other the for high the the E&E television programme was In this the television field the health communication field. Health communication professionals had to that an effective E&E television programme not be made without their professional and with to behaviour change. of was by the fact that the collaboration motives of national health organizations from and to behaviour change. In where behaviour change was not an specific behaviour change was not professionals in such situations just their knowledge and design E&E television programmes, however, their knowledge and are not and is a for the specific of health communication professionals about the the programme can be to the of prosocial behaviour and the of professional Because of all this, entertainment and education in the television field means working within a high for of the will in all fields and working together in have to be to stimulate the of one with the other and to an E&E based on of What is is a of reference which of the of both professional have to a new that in an E&E television programme with specific and working and which is by both The next important question is how both types of professional can be of the of collaborating on The answer to this question is not yet but in some may provide a health organizations experience the of in the collaboration as a hindering they may ways to their to the television field does not collaborate on they have or This will health communication professionals to and stimulate the of their It be an strategy however, which in the in effects on the of new incentives to create a of reference can be to have and the best will be the of a new television which is both challenging and Health organizations as well as television organizations, are to in the for this and to stimulate the of relevant to an social and can be by professional and by and social where a of knowledge and is acknowledged and by a of professionals. is by In order to this, a is from both health organizations must become more television television organizations must with social and both must move from a to a

Evolution and transformation of JVS-CIT

The extensive impact of social media on modern society has transformed the landscape of health communication, by introducing novel techniques, strategies, and best practices. This chapter investigates the connection between social media and health communication, researching successful techniques that promote public health and well-being globally. Such an exploration is significant as it investigates the intricate relationship between social media and health communication, exploring successful techniques that promote public health and well-being globally. With enormous users worldwide, digital platforms like Facebook, Instagram, and Twitter serve as powerful tools for circulating health information and encouraging community engagement. Social media health communication requires adapting and reshaping content to various audiences, incorporating multimedia formats for convenience, and leveraging influencers to enhance messages. The ability to reach large and diverse demographics in real time enhances the dissemination of preventive measures, health education, and crisis communication.

On 11 March 2020, the World Health Organization announced that COVID-19 was characterised as a pandemic—a global first for coronavirus.1 Coronaviruses are a large family of viruses that cause illness such as the common cold to more severe diseases such as Severe Acute Respiratory Syndrome.2 A novel coronavirus is typically a new strain of the infectious disease that has not been previously identified in humans.2 COVID-19 is the most recent version of a novel coronavirus.2 COVID-19 has received significant public and government attention over the past weeks after it was first detected in the Wuhan province of China in December 2019, with subsequent epidemics in China, Italy, Republic of Korea and Iran.1 As of 12 March 2020, 125 000 cases were reported from 118 countries and territories globally, with predictions this will continue to rise rapidly.3 This has led to an array of public health measures being advocated by the WHO, including four critical areas for action—(a) prepare and be ready; (b) detect, protect and treat; (c) reduce transmission; and (d) innovate and learn.3 This has been complemented, to varying degrees, through concurrent action by local, state and national governments worldwide. There can be a tendency in the health promotion profession to think of infectious diseases from a biomedical viewpoint. As such, the prevention and treatment of infectious diseases is sometimes perceived to be the responsibility of the clinical realm. Yet, the reality is that both nonclinical and clinical public health responses are required—and sometimes we need to relax professional boundaries to work collaboratively for the health and wellbeing of our communities. We need to work in partnership with health surveillance teams, epidemiologists, environmental health scientists, public health physicians, infectious disease physicians, general practitioners, nurses, allied health professions, health policy-makers, health planners, health geographers and many others, to reduce the risks associated with pandemics. We also need to work across sectors to achieve the best possible outcomes. The health promotion profession plays a vital role in pandemics, and this has been abundantly evident in the responses to COVID-19. Messaging about health and hygiene, particularly hand-washing, is one example of the role that health promotion has played—ultimately drawing on our expertise in delivering health education, and implementing health-related mass media and social marketing campaigns. Over the last two decades, information technology and social media have transformed the way we can reach people during pandemics. Indeed, social media has catapulted the ability to reach large populations, while also simultaneously targeting vulnerable and at-risk populations, to deliver health messages, such as those associated with hand-washing. Over the past few weeks, there has been a steady flow of memes urging people to wash their hands, often with thoughtful use of graphics alongside a successful use of humour. JS's personal favourite, was an online post from Round Rock Texas that read: 'Texas Coronavirus Protection—wash your hands like you just got done slicing jalapenos for a batch of nachos and you need to take your contacts out (that's like 20 seconds scrubbing, y'all)'. It delivers an essential public health message in a factual, yet contextually relevant and humorous way. However, social media can also have its pitfalls. Misinformation and fake news are rampant. This has the potential to stifle health promotion efforts in times of need, such as during the current COVID-19 pandemic. Therefore, it is important to know who is saying what, why, and with what level of authority. As mentioned above, we also need to be mindful of cross-sectoral communication efforts during pandemics. As an example, JS received 12 emails from his children's schools and 14 from his current workplaces about COVID-19—a total of 26 emails from educational institutions in both Australia and the United States. Email topics ranged from: hygiene issues such as hand washing and sanitiser use; social distancing, self-isolation and self-quarantining strategies such as cancellation of school activities and fundraisers; proposed adoption of online learning options, and flexibility about attendance at school/work, including possible closures; travel restrictions imposed by schools and universities associated with concerts, plays, public events/seminars and conferences; guidance to limit travel on public transport; and advice about when to seek help and access local health services if myself or my family members experience symptoms associated with COVID-19. This bombardment of communication, albeit extremely useful, emphasises the importance of coordination in key messaging between health, education and various other sectors, when planning and implementing effective pandemic responses. In health promotion, we need new strategies to communicate important health messages in a concise and meaningful way that makes it easy and accessible for citizens to understand, navigate and take action. We also need to be careful how we convey content through electronic communication channels and consider an appropriate level of frequency of such communication to achieve optimal impact. Without doing so, there is potential to reinforce community ambivalence at one end of the spectrum and create panic at the other. The recent toilet paper saga in Australia, whereby stocks of toilet paper were rapidly depleted from grocery stores in response to the perceived likelihood of home quarantining measures, is one such example (albeit somewhat humorous and embarrassing). Panic buying like this reinforces the powerful ramifications of communication gone wrong. Health literacy research that embraces new and emerging technologies will be particularly important to guide online health promotion efforts of this nature in the future. To emphasise the importance of getting health communication right, the Australian Medical Association were particularly critical of the mixed-messaging of public health directives between the Australian, State and Territory Governments concerning COVID-19.4 There was concern about how this mixed-messaging was being interpreted by the Australian public, but also how it was likely to impact health professionals and the use of Australia's hospitals and health care system more broadly. The Australian Government has since committed a $2.4 billion health package to protect all Australians from COVID-19, including vulnerable groups such as the elderly, those with chronic conditions and Indigenous communities.5 The US Government pledged $50 billion on the same day. Importantly, the Australian health package includes $30 million for implementing an information campaign to provide people with practical advice on how they can play their part in containing the virus and staying healthy.5 We trust health promotion professionals with expertise in health literacy, health communication, and social marketing will be consulted throughout its development. We also trust that health promoters will be involved in the multi-million dollar primary care and research responses outlined by the Australian Prime Minister. At this juncture, it is worth reflecting on who is most vulnerable in pandemics. While COVID-19 has the potential to impact everyone in society, these impacts will be felt differentially. That is, the way we prepare, protect, treat, reduce transmission and innovate, needs to be viewed from a health equity lens. It is essential to recognise that pandemics—and the respective Government and corporate decisions that emanate—both influence and are influenced by social, economic and political determinants of health. As the WHO Director-General has recently stated—'all countries must strike a fine balance between protecting health, preventing economic and social disruption, and respecting human rights'.3 However, knowing what this 'fine balance' constitutes can be difficult. As such, it helps to reflect on what we know. While we do not know much about COVID-19, we do now how pandemics can impact vulnerable populations. We know that many developing countries do not have the surveillance systems, health resources and health infrastructure to respond in a manner that can slow the harms of COVID-19 in the way we would like.6-8 We know that there are vulnerable populations, such as: the elderly, those with disabilities, people in prison, Aboriginal and Torres Strait Islander communities, people with chronic conditions, and people from Culturally and Linguistically Diverse (CALD) backgrounds, that will be impacted disproportinately by COVID-19, particularly if assertive health promotion action is absent.9-13 We know that people from low socio-economic backgrounds, those who work in casual employment, and many racial and ethnic minorities, are unlikely to have the necessary financial resources to make self-distancing and self-isolation a viable option within the context of their daily livelihoods.12-14 We know that access to health services in some countries, including basic primary health care, is contingent upon insurance and user-pays systems that already make them inaccessible to the people most at-risk.15, 16 We know that the elderly and people with disabilities rely on public transport to access essential services, including food shopping and health services that are required during pandemics.17, 18 We know that vulnerable populations may not have the necessary language and literacy skills to understand and appropriately respond to pandemic messaging.19 We know that mental health concerns among the most vulnerable within our communities will be exacerbated by expectations to self-isolate if not approached sensitively.20, 21 We know that governments have trouble implementing strategies focused on reducing health inequities through action on social determinants of health.22 We know all these things, but what do we do about them? Most of the evidence-based discussion presented above demonstrates the power of privilege in a pandemic. It indicates that those most vulnerable will be the hardest hit. The health promotion community must ensure that considerations of health equity and social justice principles remain at the forefront of pandemic responses.12, 14 This will not be easy at a time when neoliberal forces pitch population health against national economic stability. While hand-washing is a significant health promotion intervention, it can also act as a useful façade for advancing actions that enhance equitable social and economic outcomes for those most vulnerable during pandemics. The WHO has encouraged us to think innovatively.1, 3 The health promotion profession can lead this charge and advocate for a national public health social media campaign and other pragmatic measures that reach people most in need. This will help support them to get accurate and timely information to prepare and reduce the risk to themselves, their families, friends and their community.

The COVID-19 pandemic highlighted the role of social media for official health communication, especially for young people who rarely engage with other public health agency channels. This study explored the social media health communication experiences of health communicators and young people, during and outside the COVID-19 emergency. Semi-structured interviews were conducted with professional health communicators responsible for social media communication of Australian government health departments and young people aged 18–24 years (n = 21). Interviews were analyzed thematically using Framework Analysis. The results revealed health communicators faced challenges in their work, including organizational barriers and misinformation. Whilst the COVID-19 pandemic amplified these challenges, it also brought opportunities like innovation, streamlined approval systems and increased followership. Health communicators targeted young people by using channels popular with the age group and using trendy and engaging formats. Young people found these communications straightforward but not consistently engaging or humorous and recommended involving young people in future messaging to increase appeal. These findings highlight the need for further improvements in social media health communication to youth. Health communicators require increased support and mechanisms allowing innovation in future pandemics.

Background: Health promotion is an important part of the health services strategy in hospitals around the world, including in Indonesia. Hospitals can contribute to improving Indonesians’ health by complying with regulations and following government plans. Al Islam Hospital is a type B hospital in Bandung that has adopted diverse health promotion and communication programs. RS Al Islam Bandung is committed to improving the community’s health status through various programs. Purpose: This study aimed to understand how the hospital’s health promotions (PKRS) installation implements advocacy, community empowerment, and partnership programs through communication activities and media. Methods: We employed a qualitative method that included interviews, observation, and a review of relevant literature. Results: The results showed that RS Al Islam Bandung had integrated the principles of effective health communication into its PKRS program. Firstly, hospital management engages in health advocacy by issuing policies in various media that support health promotion programs; secondly, Al Islam Bandung Hospital equips the community with the information, willingness, and skill necessary to tackle the different health issues by involving patients and their families, hospital human resources, and the community; and thirdly, RS Al Islam Bandung establishes collaboration with educational institutions, local communities, and mass media. Conclusion: For the sustainability and effectiveness of health promotion programs, hospitals must ensure continued cooperation with stakeholders and continue to improve their health communication media. Implication: The study suggests that hospital management can conduct a continuous evaluation of health promotion activities carried out at Al Islam Bandung Hospital so that the health promotion and communication activities are not limited to the hospital area. The hospital can achieve this by optimizing its communication media. Hospitals can start using social media analytics and SEO campaigns to produce messages that cater to the needs of their audience.

Predictors of confidence and trust in government and institutions during the COVID-19 response in Australia

Purpose This study challenges the social media-centric view of influencers, arguing that health communication benefits from diverse strategic influencers beyond commercial figures. Trust, credibility and cultural resonance are essential for effective public health messaging, yet contemporary approaches often prioritise engagement metrics over strategic influence. Design/methodology/approach This paper employs a multi-case study approach to examine the strategic use of influencers in health communication across Indonesia, the United Arab Emirates and Australia during the COVID-19 pandemic. It explores how health professionals, royal representatives and a politician shaped public health messaging within culturally specific contexts. A mixed-methods approach, incorporating ethnographic research and thematic analysis, was used to analyse media coverage, social media posts, public statements, policy documents and verbal briefings. Findings The definition of “influencer” has been increasingly narrowed to social media figures, sidelining long-established strategic approaches. Findings from three culturally distinct case studies highlight the value of strategic influencer leadership (SIL), where credibility, suitability and cultural context take precedence over a narrow focus on social media metrics. Social implications Health communication performs a crucial role in distributing vital information, promoting public health, preventing disease and enhancing well-being. SIL helps overcome communication barriers such as mistrust, low health literacy and language differences, ensuring equitable access to critical information. Strategic influencers are particularly vital in diverse, multilingual societies. Originality/value By examining “traditional” influencers, this study challenges the dominant focus on social media influencers and vanity metrics. It encourages a more nuanced, context-driven approach to (health) communication via the use of SIL.

Social media has become a vital tool for facilitating health communications, particularly during emerging health crises such as the COVID-19 pandemic. This systematic literature review aims to synthesize evidence regarding the benefits and barriers associated with the utilization of social media by health communicators in India for disseminating health-related information. A comprehensive search of databases like CINAHL, Google Scholar, PubMed, and WHO Global Index Medicus databases yielded a total of 13 relevant studies. The narrative analysis revealed six key benefits attributed to the usage of social media by health communicators, including the widespread adoption of social media platforms for health communications, health communicators leveraging social media as an information source, fostering the development of protective behaviors, aiding prompt and transparent health communication, promoting participatory communication and empowerment, and employing social media as a tool for monitoring public sentiments and mental well-being. Conversely, challenges such as the proliferation of misinformation and communication inequalities were identified as significant barriers in social media health communications. While social media platforms hold immense potential in advancing crisis communication agendas, health communicators are advocated to adopt a multifaceted approach by prioritizing digital inclusivity, combating misinformation, and fostering synergetic collaborations between governmental bodies and community entities.

– As information technology advances, the requirement for accurate and up-to-date health information grows. The worldwide efforts to promote health have demonstrated the significance of social media. As a result, the purpose of this study is to answer three questions: 1) the urgency of using social media in health promotion; 2) the type of social media used and its shortcomings; and 3) the role of health professionals in using social media to promote health. Search engine entries for international journals include Google Scholar, Sage Publications, and Othervier Publications. 35 journals on social media use, 33 journals on the characteristics of social media used and their weaknesses, and 17 journals on the role of health professionals in promoting health-based social media were selected from a search of 100 international publications. Social media have a positive impact on health promotion efforts, according to search results, but they also have some drawbacks, including: a lack of outreach to a passive audience, information that is false and inaccurate, a lack of interaction with the audience, and health professionals' limited capacity to use social media, which prevents program sustainability. Health professionals must incorporate social media into health communication and promotion strategies in order to create social media-based health promotion models.

Figures of social media users have been amplifying drastically in the past decade. The last two years have seen the additive role of social media particularly in the domain of health communication. This platform is being used by healthcare professionals, patients, caregivers for fulfilling their diverse health-related needs. The option of instant penetration, overcoming shortcomings of time and distance enabled this channel of communication to gain fuel in the field of health care. Health communication along with social media sprouted as a multifaceted approach used to reach different audiences fulfilling their assorted needs and requirement, and percolate deeper creating behavioural changes. Social media crafted a path for innovation of terms such as e-health, digital health, etc. This paper is a secondary review paper understanding the reach and potential of the diverse changes being brought in by social media in the arena of health communication. The Paper further expounds on the role of social media in health communication particularly in the lives of critically ill, like cancer patients. It also draws inferences between social media and health communication concluding its importance in the domain of health care.

Introduction to “Psychology, Global Threats, Social Challenge, and the COVID-19 Pandemic: European Perspectives”

BACKGROUND The burgeoning rise in social media use has revolutionized information dissemination, rendering social media a vital tool for promoting health campaigns and enhancing 2-way health communication between senders and users. Health planners and policy makers consider social media platforms (SMPs) vital for transferring useful health information to the public. However, there are important concerns about the decision makers’ perceptions of the evolving role of social media in health promotion and education campaigns. OBJECTIVE This qualitative study explored how decision makers perceive the role of social media in health promotion and education. We aimed to shed light on strategic efficacy, real-world challenges, and valuable prospects of using social media for health communication. METHODS We adopted a qualitative research method involving in-depth, semistructured, face-to-face interviews. We included 13 participants from government and private health care sectors in the Al-Qassim region of Saudi Arabia, who were key players and decision makers in health care programs and reforms. Data were recorded, transcribed verbatim, and analyzed using thematic analysis to identify key themes and patterns. RESULTS Five main themes were identified: (1) use of social media (frequency, type of content, target audience, purpose of communication), (2) perceptions of decision makers (how social media influences public health behavior), (3) benefits, (4) challenges, and (5) implications for future use. Participants recognized the positive role of SMPs in spreading health information, particularly in health promotion and awareness campaigns. Communication emerged as a key concept, and WhatsApp, X (Twitter), and Facebook were recognized as major platforms for digital health literacy. The participants used these applications extensively for communication with colleagues, patients, and the public, intending discussion, information exchange, and health promotion campaigns. Content inaccuracy and reliability were identified as major challenges. Furthermore, misinformation and social inequalities were identified as barriers to effective communication. Participants suggested that social media influencers play a more effective role in information dissemination than the health care staff. Far-reaching audiences, visually appealing and engaging content using videos and graphics, and assessing campaign effectiveness using metrics, such as views, shares, likes, and comments, were recognized as major benefits of social media. Participants stressed the promising role of social media in the future as technological advancements in eHealth could revolutionize health care. CONCLUSIONS SMPs play a vital role in sharing information about health-related initiatives. This research highlights the complexities and potential challenges of using social media for health promotion in Saudi Arabia. It emphasizes the need to develop strategies to combat misinformation, address privacy and confidentiality concerns, and ensure compliance with legal and ethical standards. Encouraging communication among key stakeholders, including health promotion experts, government organizations, social media companies, and the general public, can help establish effective guidelines and protocols to overcome the challenges.

Social media has become a platform often used for health communication in Indonesia. The age group that uses it the most is adolescents who at that age are having acne problems. It has led to the emergence of the phenomenon of increasing health communication about acne on social media, from the need for curing information to psychological support. However, not all social media can be used by adolescents with acne to get the right health communication. Therefore, this research will examine the use of social media in conducting effective health communication by adolescents with acne using the theory of Computer-Mediated Communication along with health communication scope. This study aimed to determine the choice of social media use and the forms of health communication activities conducted by adolescents with acne on social media. The method used is descriptive qualitative, by conducting interviews with adolescents with acne in Indonesia. The results of this study are that there are six social media used by adolescents with acne. Instagram is mainly used as well as considered the most effective. The scope of health communication is around information related to healing, support and motivation, and health promotion by interacting interpersonally and uploading content to a broad audience. These findings can be a consideration for adolescents with acne and the general public using social media based on the intended use and characteristics. Several aspects that are considered will affect the information obtained.

BackgroundWith the popularization of the Internet, it has become possible to widely disseminate health information via social media. Medical staff's health communication through social media can improve the public's health literacy, and improving the intention of health communication among nursing undergraduates is of great significance for them to actively carry out health communication after entering clinical practice.ObjectiveTo explore the relationship among eHealth literacy, social media self-efficacy, and health communication intention and to determine the mediating role of social media self-efficacy in the relationship between eHealth literacy and health communication intention.DesignA cross-sectional descriptive correlation design was used in this study.ParticipantsStratified cluster sampling was used to select 958 nursing students from four nursing colleges in Jiangsu Province, China, from June to July 2021.MethodsData were collected using the eHealth Literacy Scale, the Social Media Self-efficacy Scale, and the Health Communication Intention Questionnaire. Sociodemographic data were also collected. Correlation analysis and regression analysis were used to determine the relationship between eHealth literacy, social media self-efficacy, and health communication intention.ResultsHealth communication intention is positively correlated with eHealth literacy and social media self-efficacy. There is a significant positive correlation between eHealth literacy and health communication intention (β = 0.57, p < 0.001), and social media self-efficacy played a mediating role in the influence of eHealth literacy on health communication intention (the mediating effect accounted for 37.2% of the total effect).ConclusionThe study found that eHealth literacy and social media self-efficacy had an impact on health communication intention. Because there is a correlation between eHealth literacy and social media self-efficacy and health communication intention, in order to promote health communication intention of nursing students, it is also important to cultivate eHealth literacy and social media self-efficacy of nursing students. In view of these results, targeted educational programs must be developed to improve eHealth literacy and social media self-efficacy among nursing undergraduates, thereby promoting their health information transmission.