Health Communication Interventions Research Articles

Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan

Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.

Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies

Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban-rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban-rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.

Foetal Alcohol Spectrum Disorder Among Native Americans: A Proposed Community- Based Intervention

Foetal alcohol spectrum syndrome (FAS) is characterized by craniofacial dysmorphology, growth deficiencies, and central nervous system dysfunction. The results of FAS are generally mild to moderate retardation, as well as social dysfunction and lack of social attainment. FAS is entirely preventable by not consuming alcohol during pregnancy. Despite this, FAS remains a factor within the general population, with abnormally high rates among Native Americans. This paper proposes a community health intervention for reducing alcohol consumption by pregnant women through community-based and healthcare provider education programs, as well as community referral to alcohol counselling programs. However, programs that wish to address FAS in Native American communities must address the lack of community resources, such as alcohol abuse counselling, needed to support educational efforts. In addition to this, long-term studies must address how to effectively implement such programs, as well as addressing underlying economic needs that have been shown to be related to alcohol abuse.

Community Health Program Evaluation Using Accreditation as a Framework

Increasingly, health system leaders seek to determine whether community health interventions make a difference to individuals in the community. However, community health improvement is difficult to measure, and health system staff may not be familiar with evaluation research methods. Health care organizations can improve their evaluation efforts relatively easily by building on what they already know: the Joint Commission accreditation process. By using accreditation as a framework, community health evaluation may be seen as more approachable when viewed through that lens. This article provides a framework for practical approaches to program planning, evaluation, and sustainability. Joint Commission accreditation functions (chapters) are similar to health program goals. Standards are similar to program objectives. Elements of performance are similar to activities or methods. Scoring comparisons are similar to measures.

Preferences for Perinatal Health Communication of Women in Rural Tibet

To describe the most acceptable methods for educating women in Medrogongkar County, Tibet, about healthy pregnancy and safe motherhood. Focus group discussions with key informants were used to develop a quantitative, orally administered random sample survey. Thirty-two randomly selected villages in Medrogongkar County. One hundred and forty-eight multigravida over the age of 18 living in Medrogongkar County. Most participants reported receiving pregnancy-related information either from family members (n=85, 57.4%) or from community health workers (n=81, 54.7%), while very few reported group teaching or radio/television/videos as sources. When asked what modalities of health communication are most effective for them, participants preferred discussions with family members (n=59, 39.8%), specifically their mothers (n=34, 23.0%). Community health worker teaching (n=15, 10.1%) or group teaching (n=7, 4.7%) were reported as less effective. Despite recent efforts in Tibet to use group teaching, television/radio programs, and health professionals visiting patients' homes as health communication modalities, participants preferred to learn pregnancy-related health messages from their close family, especially their mothers. Future health communication interventions in rural Tibet and similar communities should consider targeting close family members as well as pregnant women to maximize acceptability of advice on healthy pregnancy and delivery.

From temple to table: an innovative community health and lifestyle intervention aimed at a South Asian community

This paper describes the early development of a health and lifestyle initiative, the Apnee Sehat project, located at the heart of a South Asian community and developed in partnership with them. The project aims were to promote behaviour change in a sensitive and culturally acceptable manner and had a Sikh temple in the United Kingdom (UK) as its focus. Working in partnership with the community was implemented and sustained by key enthusiastic ‘health champions’. Participants welcomed the Apnee Sehat project as a health promoting initiative and were supportive of its chosen venue and the simple visual and narrative format of the health messages. Participants reported lifestyle changes at both individual and household levels. An evaluation of the Apnee Sehat project reports raised awareness, understanding, satisfaction and engagement. Elements of the Apnee Sehat project create a toolbox that has the potential for transfer to other communities in the UK.

The Effect of Community-Based Reproductive Health Communication Interventions on Contraceptive Use Among Young Married Couples in Bihar, India

The Effect of Community-Based Reproductive Health Communication Interventions on Contraceptive Use Among Young Married Couples in Bihar, India

Use of Health Communication and Social Marketing Principles in Planning Occupational Safety and Health Interventions

This study reviewed health communication and social marketing designs used in occupational safety and health interventions over the last 15 years in the United States. After an extensive literature review, 50 studies were identified that self-reported use of health communication and/or social marketing principles and practices to design occupational safety interventions. Nineteen of these studies were selected for analysis based on the following factors: the inclusion of a behavioral theory, strong study design, an intervention was conducted, and an evaluation was completed. Results indicated that all of the interventions met the criteria to be classified as a health communication intervention, but none met the complete criteria to be considered a true social marketing intervention. Limitations in the evaluation designs made it difficult to assess the impact of these interventions; however, results suggest that health communication principles have been applied widely, while social marketing techniques are poorly understood and underutilized in planning occupational safety programs.

Abstract SS02-01: How Health Communications Turned Cardiovascular Prevention into a Reality

Abstract SS02-01 Health communication involves creating shared meaning about health care and conditions. The crucial role of effective communication in medical care, disease prevention, health promotion and education, and all other efforts to improve health has gained increasing recognition in recent years since the Health Communication and Informatics Research Branch (HCIRB) was created as a part of the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute (NCI). Another mark of this new prominence is the inclusion of health communication as a focus area in Healthy People 2010. The 2006 Prevention Report: Making Better Health Communication a Reality: A Midcourse Check on the Healthy People 2010 Objectives http://odphp.osophs.dhhs.gov/pubs/revrpt states that the major objectives in this rapidly developing field cross disciplinary boundaries in research, teaching, training, and practice like never before. Such objectives cover a range of topics including the impact of technologies and health information, health literacy, and interpersonal skills. All promote better health by making accurate, appropriate, and effective health information more available, accessible, and useful to consumers. Health communication has achieved success in areas surrounding cardiovascular prevention (e.g., Minnesota Heart Study) that are in recent years moving into the direction of cancer prevention. It took nearly three decades for the US National Heart, Lung and Blood Institute (NHLBI) to not only place hypertension on the national agenda but also to educate Americans about high blood pressure, embedded salt in the American diet, and subsequently choose ideal evidence based health communication strategies and interventions (see e.g., Ratzan, 2007). In particular, the NIH/NCI Centers of Excellence in Cancer Communication Science (CECCRs) initiative funded the second round for four major centers of excellence that are developing systematic evidence based health communication research programs for cancer prevention in an effort to reduce the nation’s cancer burden (U Michigan, U Wisconsin, U Penn, & St. Louis U). One of the priorities in NCI’s Strategic Plan for Leading the Nation is to integrate social, psychological, and communication research with biological research. The CECCRs are dedicated to reducing the cancer burden in the United States through increasing the reach, effectiveness, and efficiency of communication pertinent to cancer prevention, decision-making, in diagnosis and treatment, and the quality of life for survivors. Foci include subtracting health behaviors from one’s lifestyle such as smoking, and adding health behaviors to one’s lifestyle such as fruit and vegetables as well as informed decision making where no particular behavioral direction is advised such as a decision to undergo tamoxifen prophylaxis for breast cancer prevention using either raloxifen or tamoxifen http://cancercontrol.cancer.gov/hcirb/ceccr/pdfs/CECCRmidcourseupdate.pdf Health literacy is an emerging and extremely important area of health communication around the world, and is rapidly becoming an important health communication issue receiving national and international attention. Health literacy is an important construct for understanding patients’ needs for health information, as well as their abilities to access and utilize such health information and messages for critical health decision-making. Health literacy includes the concepts of accessing and understanding information and services, with a comprehensive skill set of literacy that potentially includes visual (graphs and charts), computer (operate and search), information (obtain and apply relevant information), and numeracy (calculate and reason numerically) skills required to make appropriate health decisions. Health literacy and health communication messages go hand in hand as an important part of the prevention puzzle from cardiovascular to cancer prevention. These initiatives support the emerging idea that interdisciplinary approaches to cancer prevention can greatly reduce the nation’s cancer burden. We must begin to broaden our view of prevention to include such important components if we are to truly make a difference in people’s lives. Clearly, those of us in health communication realize the long term investments necessary to impact public health and in particular, cancer prevention. It is truly up to all of us to begin the discourse and dialogue with the ultimate health of the public in mind. Our work can change lives in dramatic ways from the biological and medical side to the complementary social and behavioral side. It is only through research and evaluation will the quality of health communication activities improve and knowledge of effective practices increase. Citation Information: Cancer Prev Res 2008;1(7 Suppl):SS02-01.

Testing the Long-Term Effects of theGo Sun SmartWorksite Health Communication Campaign: A Group-Randomized Experimental Study

This study examined the long-term effects of the Go Sun Smart (GSS) campaign, a large-scale health communication intervention designed to promote sun safety to employees at 26 ski areas in western North America. Employees were enrolled in a pair-matched group-randomized pretest-posttest controlled design with 2 follow-up surveys. Half of the ski areas were randomly assigned to implement GSS in the winter. This article reports analyses of a hierarchical linear design with responses from 1,463 employees who completed the second follow-up survey at the end of the following summer (69% of those who completed the first posttest). GSS continued to have positive effects on employees who worked at intervention ski areas into the summer. Employees exposed to GSS reported less sunburning, engaged in more sun safety behaviors, were more aware of the program, and had more discussions of sun safety at home than employees at matched control group resorts. The long-term effects of GSS support recommending that sun protection programs be implemented at workplaces, but such programs should be implemented with high fidelity to achieve maximum benefits. Despite limitations due to nonresponse, geography, measurement, and ethnicity, the hierarchical clustered design improved the internal validity and generalizability of the findings.

A Systematic Review of COPC: Evidence for Effectiveness

This systematic review was conducted to assess the evidence for effectiveness of the community oriented primary care (COPC) model and discuss alternative approaches to community medicine practice and education. A literature search for all articles referring to COPC was conducted. Articles were categorized by type, and the extent of the use of elements of the COPC model, and the level of community involvement. The majority of articles on COPC (60% of those reviewed) describe the general theory or educational use of the methodology. Many published studies are project descriptions not utilizing the complete model as initially described. Few of project descriptions include all elements of COPC or document community participation. Evidence for or against the effectiveness of the COPC model in improving community health outcomes (using the Strength of Recommendation Taxonomy (SORT) classification system as evidence) was found to be limited. Most publications related to COPC do not use the complete COPC model as originally described and evidence for its effectiveness is lacking. Further research with evaluation of community health outcomes and community participation is needed. Diverse models of community health intervention can be considered for training and collaborative practice with underserved populations.

Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care

This study describes the information needs of adult cancer survivors, identifies sociodemographic, health, and healthcare-related factors associated with information needs, and examines the relationship between information needs and survivors' perceived mental and physical health. One thousand forty survivors 2-5 years post-diagnosis who were identified via two cancer registries were included in the present analysis. Self-report questionnaires assessed six categories of information needs, sociodemographic, health, and healthcare-related variables, and perceived mental and physical health. Information needs were prevalent and varied; most survivors need more information about tests and treatments, health promotion, side effects and symptoms, and interpersonal and emotional issues. Multivariate analyses suggested that survivors who were younger, who reported non-White race/ethnicity, who reported less than excellent quality of follow-up cancer care, and who had more comorbid health conditions had more information needs. After adjustment for sociodemographic and health-related variables, more information needs were associated with worse perceived mental and physical health. Most cancer survivors needed more information about maintaining good health outcomes during survivorship. Health communication interventions, such as Survivorship Care Plans, have excellent potential to address survivors' information needs while improving quality of follow-up cancer care and health-related quality of life.

CBPR as Community Health Intervention: Institutionalizing CBPR Within Community Based Organizations

A community-academy partnership was created with a commitment to developing a program for institutionalizing community-based participatory research (CBPR) capacity within community-based organizations (CBOs), with the intention to enhance CBOs' existing capabilities to understand and improve community health. This article presents the design and conceptual foundations for a year-long CBPR education and training program in which CBO teams learn research design, discuss the principles of CBPR, design and implement a community health-related research project tailored to their program and community, conduct analyses, and initiate integration of the results into the organization and community. One objective is to integrate a commitment to and the practice of CBPR within CBOs' program and policies. An initial partnership was created between the Center for Border Health, El Paso, and Texas A&M University School of Rural Public Health, College Station. Three additional CBOs then joined the partnership and participated in the CBPR education and training program consisting of four stages: (1)3 intensive months devoted to learning about and creating a research design; (2) 6 months for implementation of the design; (3) 2 months for analyses, interpretation, and consolidation of results into one or more final products; and (4) 1 month for development of protocols for integrating research results into community health development. In the first iteration, an interactive process evaluation was conducted during each program stage, plus a final year-end exit interview with each participating CBO. Evaluation demonstrated strong positive results and specific lessons learned. A proposal incorporating the lessons learned was presented to the funding source. A second iteration has been funded, with monies included to develop a formal outcome evaluation.

Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars.

BackgroundThe persistent gap between research and practice compromises the impact of multi-level and multi-strategy community health interventions. Part of the problem is a limited understanding of how and why interventions produce change in population health outcomes. Systematic investigation of these intervention processes across studies requires sufficient reporting about interventions. Guided by a set of best processes related to the design, implementation, and evaluation of community health interventions, this article presents preliminary findings of intervention reporting in the published literature using community heart health exemplars as case examples.MethodsThe process to assess intervention reporting involved three steps: selection of a sample of community health intervention studies and their publications; development of a data extraction tool; and data extraction from the publications. Publications from three well-resourced community heart health exemplars were included in the study: the North Karelia Project, the Minnesota Heart Health Program, and Heartbeat Wales.ResultsResults are organized according to six themes that reflect best intervention processes: integrating theory, creating synergy, achieving adequate implementation, creating enabling structures and conditions, modifying interventions during implementation, and facilitating sustainability. In the publications for the three heart health programs, reporting on the intervention processes was variable across studies and across processes.ConclusionStudy findings suggest that limited reporting on intervention processes is a weak link in research on multiple intervention programs in community health. While it would be premature to generalize these results to other programs, important next steps will be to develop a standard tool to guide systematic reporting of multiple intervention programs, and to explore reasons for limited reporting on intervention processes. It is our contention that a shift to more inclusive reporting of intervention processes would help lead to a better understanding of successful or unsuccessful features of multi-strategy and multi-level interventions, and thereby improve the potential for effective practice and outcomes.

Meeting the health literacy needs of immigrant populations

Objective Immigrant populations are vulnerable to serious health disparities, with many immigrants experiencing significantly worse health outcomes, such as higher rates of morbidity and mortality, than other segments of society. Immigrants disproportionately suffer from heart attacks, cancer, diabetes, strokes, HIV/AIDS, and many other serious diseases. These health risks demand effective health communication to help immigrants recognize, minimize, and respond effectively to potential health problems. Yet, while the need for effective communication about health risks is particularly acute, it is also tremendously complicated to communicate effectively with these vulnerable populations. Methods A literature review using online databases was performed. Results Immigrants often have significant language and health literacy difficulties, which are further exacerbated by cultural barriers and economic challenges to accessing and making sense of relevant health information. Conclusion This paper examined the challenges to communicating relevant information about health risks to vulnerable immigrant populations and suggested specific communication strategies for effectively reaching and influencing these groups of people to reduce health disparities and promote public health. Practice implications Communication interventions to educate vulnerable populations need to be strategic and evidence-based. It is important for health educators to adopt culturally sensitive communication practices to reach and influence vulnerable populations. Community participative communication interventions are a valuable strategy for integrating consumers’ perspectives into health education efforts and building community commitment to health communication interventions.

Decline in Incident Coronary Heart Disease

In the fall of 1979, the National Heart, Lung, and Blood Institute held a conference on the decline in coronary heart disease (CHD) death rates. It was apparent that in the previous 10 to 15 years, the epidemic crested and began to fall.1 The reasons for this decline were unclear, but many hypotheses were offered. Explanations ranged from death classification artifact, new coronary care units, and coronary surgery to broad social change. Many were more than willing to take credit for this change, but few data were available. A search for explanations began. Article p 598 Three major themes emerged as possible explanations: (1) primary prevention through risk factor reduction, including public health measures such as reduction in cigarettes and clinical approaches such as lipid and blood pressure management; (2) modern care for acute coronary syndromes, including emergency services, coronary care units, and revascularization strategies; and (3) secondary prevention in those with known CHD, including revascularization, medications, and lifestyle approaches. Each of these has substantial clinical trial evidence to support its utility in reducing new cases (incidence), recurrent events, and/or death. Early attempts to understand the causes were hampered by a lack of data. Stern2 suggested that a decline in mortality was related to improved diet, reduced smoking, …

Lifestyle dominates cardiovascular risks in Malaysia

Cardiovascular problem is one of the leading cause of death in Malaysia and now invaded to the sub-urban and rural areas. To prevent and control of this problem, several main risk factors needed to be known and shall be reexamined and ranked according to the priority. The objectives of this research paper was to identify several dominant risk factor related to cardiovascular problem. A cross sectional study was carried out from March 2000 – June 2001 on a total of 8159 rural population aged 18 and above to measure the prevalence of the common cardiovascular risk factors. Those risk factors are systolic blood pressure, diastolic blood pressure, serum cholesterol level, obesity index, blood glucose level, smoking, physical activity and mental stress. Overall prevalence of common cardiovascular risk factors were higher, dominated by physical inactivity (65.7%), hypercholesterolemia – TC:HC (62.3%), mental stress (55.5%) and obesity (53.7%). Smoking was also high at 49.9% especially among men. However systolic hypertension, diastolic hypertension and diabetes mellitus; although increased by age, its prevalence is relatively low at 23.7%, 19.2%, and 6.3% respectively. Cardiovascular risk factors related to lifestyle are much evidenced as compared to risk factors related to the biological influence. Therefore, all initiatives in community health intervention should be mobilized specifically on prevention and control of lifestyle-related risk factors. (Med J Indones 2008; 17: 50-6) Keywords: cardiovascular problem, community intervention, lifestyle-linked risk factors

Applying Health Behavior Theory to Hearing-Conservation Interventions

The knowledge and experience gained by effective health behavior research programs can be applied to adolescent hearing-loss prevention programs to address the public lack of awareness and concern about the risks of hearing loss. Informative conceptual theories can be found in the health behavior literature. These theoretical models have been tested in a variety of settings over many decades. Continuing health communication interventions that examine changes in awareness levels, attitudes, and risky behaviors have supported the key constructs described in these behavior theories. Intrapersonal-level theories predict how knowledge, attitudes, beliefs, and other traits within the individual will affect health behaviors. Interpersonal-level theories predict how our relationships with significant others affect our social identity and normative expectations and how these in turn will affect our health behaviors. The Transtheoretical Model (also called Stages of Change) focuses on an individual's readiness to make a change in behavior. The underlying principle of this model is that behavior change is achieved through various stages. Research driven by the Theory of Reasoned Action and the Theory of Planned Behavior demonstrates that there is substantial evidence that behavioral intentions are highly predictive of future behavior. These theories explain the importance of subjective norms and perceived behavioral control. The Health Belief Model identifies five important factors that may influence an individual's decision to practice a health behavior, including perceptions of susceptibility and severity, perceived benefits and barriers to making a change, and environmental cues to action. Finally, the Social Cognitive Theory attempts to predict behavior by understanding the interactions that take place within an individual's social environment. In addition, new models of behavior change have been introduced that are dynamic and far-reaching. It is time for hearing-conservation interventions to reap the benefits of research driven by behavioral theory.

Use of Signal Detection Methodology to Identify Subgroups of Dietary Supplement Use in Diverse Populations

Despite widespread use of dietary supplements, little is known about correlates and determinants of their use. Using a diverse sample from 7 interventions participating in the Behavior Change Consortium (n = 2539), signal detection methodology (SDM) demonstrated a method for identifying subgroups with varying supplement use. An SDM model was explored with an exploratory half of the entire sample (n = 1268) and used 5 variables to predict dietary supplement use: cigarette smoking, fruit and vegetable intake, dietary fat consumption, BMI, and stage of change for physical activity. A comparison of rates of supplement use between the exploratory model groups and comparably identified groups in the reserved, confirmatory sample (n = 1271) indicates that these analyses may be generalizable. Significant indicators of any supplement use included smoking status, percentage of energy from fat, and fruit and vegetable consumption. Although higher supplement use was associated with healthy behaviors overall, many of the identified groups exhibited mixed combinations of healthy and unhealthy behaviors. The results of this study suggest that patterns of dietary supplement use are complex and support the use of SDM to identify possible population characteristics for targeted and tailored health communication interventions.

An evaluation of a community health intervention programme aimed at improving health and wellbeing

Objective The objective of this evaluation was to examine the extent to which participants in the Tailor Made Leisure Package programme experienced any improvement in their health and wellbeing. Design A quantitative survey. Setting The Healthy Living Centre initiative is an example of a community-based intervention which was formalized as part of the British government's health policy. The purpose of this initiative is to reduce inequalities in health and promote good health and wellbeing. The programme was offered by a Healthy Living Centre located in Scotland. Method The benefits of the initiative were investigated through the use of a postal questionnaire which was used to examine the perceived benefits of the Tailor Made Leisure Package programme. This was distributed to a total of 177 people who had applied to take part in the programme during the period February 2004 to February 2005. Results Of the 177 people surveyed 90 returned completed questionnaires giving a response rate of 51 per cent. Of these, 70 people started the programme. Those who started the programme took part in a variety of activities including the gym, GP Referral programme and complementary therapies. The reported benefits were that individuals felt fitter and healthier, they were taking part in additional leisure activities and that they were socializing more frequently. Those participants who had complementary therapy reported a relief of symptoms associated with their particular health condition. All of these benefits are important in the process of improving health and wellbeing. The 20 individuals who did not start their programme reported that personal circumstances, health reasons, transport problems, financial difficulties and the activities/programme being inappropriate were the main reasons for not starting the programme. Conclusion The results of the evaluation suggest that an initiative such as this is worthwhile in promoting positive health and wellbeing.