Health Communication Messages Research Articles

Introduction: Language and Communication Related to COVID-19

The occurrence of COVID-19 has a strong impact on individuals’ as well as public life. This Special Issue brings together research on language and communication addressing the challenges resulting from the Corona virus situation. Seven original papers followed by a discussion, address research on language and communication related to COVID-19 using different theoretical backgrounds, methodological approaches, as well as different foci on individual, interpersonal, and intergroup perspectives. The foci addressed in the contributions of the Special Issue stretch from discrimination and intergroup stigmatization to the laypeople's perception and evaluation of science and health communication messages.

The First Random Observational Survey of Barrier Gestures against COVID-19.

In the context of COVID-19 in Belgium, face-to-face teaching activities were allowed in Belgian universities at the beginning of the 2020–2021 academic year. Nevertheless, several control measures were established to control COVID-19 transmission on the campuses. To ensure compliance with these measures, a random observational survey, based on five barrier gestures, was implemented at the University of Liege (greetings without contact, hand sanitisation, following a one-way traffic flow, wearing a mask and physical distancing). Each barrier gesture was weighted, based on experts’ elicitation, and a scoring system was developed. The results were presented as a diagram (to identify the margin of improvement for each barrier gesture) and a risk management barometer. In total, 526 h of observations were performed. The study revealed that some possible improvements could be made in the management of facilities, in terms of room allocation, the functionality of hydro-alcoholic gel dispensers, floor markings and one-way traffic flow. Compliance with the barrier gestures reached an overall weighted score of 68.2 (between 0 and 100). Three barrier gestures presented a lower implementation rate and should be addressed: the use of hydro-alcoholic gel (particularly when exiting buildings), compliance with the traffic flow and the maintenance of a 1.5 m physical distance outside of the auditoriums. The methodology and tool developed in the present study can easily be applied to other settings. They were proven to be useful in managing COVID-19, as the barometer that was developed and the outcomes of this survey enabled an improved risk assessment on campuses, and identified the critical points to be addressed in any further public health communication or education messages.

Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment.

BackgroundSupporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement.ObjectiveThis study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation.MethodsA discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model.ResultsThere was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons.ConclusionsA discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs.

On the Relationship Between Skepticism Towards and Reactance to Health Messages: The Special Case of Online Communication on Tick-Borne Encephalitis

In general, health communication messages intend to change individuals’ behaviors, applying both cognitive reasoning and increasingly personal accounts to achieve these changes. Nonetheless, against the background of increasing skepticism towards scientific findings and patronizing message claims, health messages fail to achieve their intended results. By use of a quantitative survey with Austrian respondents (n = 271), the study at hand intends to uncover individuals’ level of skepticism towards Tick-Borne Encephalitis (TBE) as well as their evaluations of online vaccination-related information on TBE. Moreover, as skepticism is likely to lead individuals to reject health message content altogether, we also test for the relationship between skepticism and reactance. Results indicate that there is only a marginal relationship between the two variables in the TBE communication context. For this reason, other variables might have to be included in future research to derive more comprehensive results and recommendations. Since skepticism has proven to be of lesser importance in TBE message reception, government or health officials are recommended to prioritize additional constructs, such as trust, which can be elevated through more affective communication.

Development of Personas to Communicate Narrative-Based Information About the HPV Vaccine on Twitter.

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents.Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with adolescents ages 9–14, we used both qualitative and quantitative data (e.g., the National Immunization Survey—Teen, focus groups, and social media) to create personas. These data sources were used to identify and develop key characteristics for personas to reflect a range of parents and their diverse understandings and experiences related to HPV vaccination. A parent advisory board provided insight and helped refine persona development.Results: Four personas emerged and were characterized as the (1) Informed Altruist, (2) Real Talker, (3) Information Gatherer, and (4) Supporter. Characteristics differed across personas and provided insights into targeted narrative strategies. Described attributes included demographics, psychographics, communication style, vaccine goals and aspirations, vaccine challenges and frustrations, and vaccine hesitancy.Discussion: This work demonstrates how multiple data sources can be used to create personas to deliver social media messages that can address the diverse preferences and needs of parents for HPV vaccine information. With increasing usage of social media for health information among parents, it is important for researchers to consider marketing and design thinking to create health communication messages that resonate with audiences.

Factors associated with women's exposure to mass media for Health Care Information in Ethiopia. A case-control study

IntroductionMass media are often essential to communicate health messages. Women's exposure to mass media remained low in Ethiopia. Evidence was scarce on underlined factors for enhancing women's exposure to mass media. ObjectiveThis study aimed to assess factors associated with women's exposure to mass media in Ethiopia. MethodsThe study was a secondary data analysis of the Ethiopian demographic and health survey 2016. A case-control study applied with frequency matching by place of residence and women's educational levels using a 1:1 ratio. A total of 9885 participants (4824 cases and 5061 controls) were involved in the study. Cases were women who had exposure and controls were who did not have exposure to mass media. Women's exposure to mass media is defined as the total number of women aged 15–49 who report exposure to either radio, television, newspapers, or magazines at least once a week. Logistic regressions analysis was conducted and the level of statistical significance was determined by a p-value of less than 0.05to identify factors associated with women's exposure to mass media. ResultBeing in Women's age group 30–34 years (AOR = 1.19,95% C.I:1.04–1.35), having own mobile phones (AOR = 1.92,95% C.I:1.71–2.15), women ever used internet (AOR = 1.56,95% C.I:1.13–2.13), Women in the female-headed household (AOR = 0.76,95%C.I:0.68–0.86), Women in middle (AOR = 1.48,95%C.I:1.25–1.76), richer (AOR = 2.13,95%C.I:1.82–2.49) and richest (AOR = 2.67,95% C.I:2.22–3.21) wealth index, and women visited by health care provider (AOR = 1.41,95% C.I:1.17–1.71) were factors affecting women's exposure to mass media. ConclusionWomen's access to mobile phones, internet, and care provider counseling were facilitating factors for exposure to mass media. Younger age women, lower wealth quantile, and female headship in the household were risk factors for the non-exposure of women to mass media. Empowering household wealth and improving access to ICT could improve women's exposure to mass media.

Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity

ABSTRACT Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.

The Role of Self-Efficacy and Injunctive Norms in Helping Older Adults Decide to Stay Home During the COVID-19 Pandemic.

Purpose: Because older adults are at elevated risk of COVID-19-related adverse health outcomes, and staying at home is an effective strategy to avoid unnecessary exposures, the current formative study used the Reasoned Action Approach (RAA) to identify the beliefs underlying older adults' decision to stay home for the next month.Methods: The participants (weighted n = 206, age 65-94) for the current study were selected from a nationally representative online survey of US adults from April 10-20, 2020. We used multiple linear regression to estimate the relative contribution of the four RAA global constructs (instrumental attitude, injunctive norms, descriptive norms, and self-efficacy) in explaining intention to stay home after controlling for demographic covariates. We also conducted a content analysis to identify beliefs about advantages, disadvantages, and facilitators of staying home.Results: After controlling for demographic characteristics, injunctive norms (b = 0.208; SE = 0.059; B = 0.213, p < 0.01) and self-efficacy (b = 0.532; SE = 0.058; B = 0.537, p < 0.001) showed statistically significant independent associations with intention to stay home. The specific beliefs underlying the decision to stay home spanned across health and wellness dimensions and suggested interpersonal, mental health, and leisure/recreational facilitators.Conclusions: These findings suggest three public health intervention targets. First, self-efficacy building interventions could enhance older adults' perceptions of their ability to stay home to avoid unnecessary exposures. Second, health communication messages to address injunctive norms could emphasize that people important to older adults think they should stay home. Third, for the youngest of the older adults, health communication messages could emphasize the advantages of staying home.

Evaluating Cigarette Pack Insert Messages with Tips to Quit

Canada is the only country that currently uses cigarette pack inserts to communicate health messages to smokers, including tips to quit. Messages about strategies for quitting smoking are also central to the US Food and Drug Administration's (FDA) Every Try Counts (ETC) campaign. This study assessed US smokers' responses to Canadian and ETC-based messages formatted for pack inserts. US adult smokers (N = 524) were recruited from an online consumer panel and rated 8 insert messages: 4 based on Canadian inserts and 4 based on ETC. Participants randomly viewed each message accompanied by an image of either a person or a symbolic representation of the topic. Participants rated the perceived effectiveness (PE) of each message. Paired t-tests were used to assess mean differences in PE across topics, image types, and quit intentions. ETC messages were consistently rated as more effective than Canadian messages regardless of quit intentions. Image types did not significantly influence PE. Messages from ETC are perceived as more effective than messages used in Canada. The FDA has the authority to communicate with smokers through inserts and should consider adopting inserts to promote smoking cessation.

The Intervening Role of Conversational Frequency and Valence in a School-Based Health Intervention

ABSTRACT School-based health interventions are potentially an effective method to communicate health messages to adolescents. Unfortunately, effectiveness of such interventions is limited. Research in other contexts has shown that interpersonal communication can influence the effectiveness of health programs, but this has not been thoroughly tested for school-based health interventions. Therefore, our study investigated interpersonal communication (i.e., conversational valence and frequency) in a school-based intervention context. We used a three-wave randomized-controlled trial with 1056 students to study three aims. The first aim was to investigate the influence of a health intervention on conversational frequency and valence about drinking, snacking, and exercising. Our second aim was to investigate the influence of conversational frequency and valence on (predictors of) drinking, snacking, and exercising. Our third aim was to investigate whether the health intervention indirectly influenced the program outcomes through conversational frequency and valence. Findings showed that conversational frequency and valence were related to (predictors of) the three behaviors. Additionally, findings showed that the intervention did not influence conversational frequency and valence. Accordingly, findings showed no indirect influence of the intervention on program outcomes through conversational frequency and valence. Our findings show the potential of interpersonal communication for health behaviors and predictors; however, they also stress the importance of a health intervention to properly influence interpersonal communication. If health interventions can successfully influence interpersonal communication, intervention effectiveness can be improved.

An Assessment of Communication Challenges during COVID-19

Communication for COVID-19 is to educate the public about protecting themselves from infections. Having sprung wildly from Wuhan, China, the virus has spread from the United States and 31 territories. Strazewski (2020) writes, “How Science Communication is failing during Covid-19,” published in the Journal of American Medical Association, regrets prevalent inadequacy of reporting. Organizations such as World Health Origination (WHO) and Centers for Disease Control (CDC) admit communication is important, asserting that trust, transparency, public interest, and planning are crucial in messaging. Companies should, therefore, rethink advertising and promotion strategies and reassure shareholders and stakeholders of the volatility of the epidemic. In “Evolving Outbreaks and Evolving Communication,” the authors acknowledge that before an outbreak is recognized and an investigation begins, a limited number of persons might be exposed to health risks without experiencing illness. Unlike yesteryears, communicating health messages today during an outbreak calls for a mix of channels that include social media management. Furthermore, partnerships should be developed between the science community and communications specialist from a global perspective.

Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (β=-0.119**) and sanitization practices (β=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.

COVID-19 and Gaza: The Ideal Time to Establish a Medical Reserve Corps of Public Health Preventive Medicine Specialists.

COVID-19 and Gaza: The Ideal Time to Establish a Medical Reserve Corps of Public Health Preventive Medicine Specialists.

Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial.

BackgroundHuman papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM).ObjectiveThe primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory–based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group.MethodsA 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese–speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny’s methods were used to test the mediation hypothesis.ResultsThe participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3% vs 15/208, 7.2%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5% vs 15/208, 7.2%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect.ConclusionsTheory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes.Trial RegistrationClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907

Going Viral: The 3 Rs of Social Media Messaging during Public Health Emergencies.

Going Viral: The 3 Rs of Social Media Messaging during Public Health Emergencies.

Enhancing FDA's Reach to Minorities and Under-Represented Groups through Training: Developing Culturally Competent Health Education Materials.

Health communications may not reach intended populations due to cultural and language barriers. These barriers may prohibit consumers from understanding information needed to make informed health decisions. It is important to ensure everyone—especially racial and ethnic minorities and under-served and under-represented populations—has access to information on medical products. One strategy to address this issue is to develop trainings and resources to better understand how cultural competency affects the ability to communicate effectively with racial/ethnic minorities. The FDA’s Office of Minority Health & Health Equity developed a 3-module training to (1) increase staff knowledge of the role that cultural competency plays in determining health communication messages and channels and (2) provide tools to assist them in creating culturally-competent strategies and action plans. Offered on 4 occasions, the 4.5-h interactive training, grounded in adult learning and project-based learning theories, and used curricula, case studies, and multimedia to guide the discussion and group work. Participants also completed an action plan to guide their current work. Cultural competency knowledge was assessed pre- and post-training and training satisfaction was assessed post-training. Among the 53 individuals who completed the training, average knowledge increased by 13.6%. The training was a success based on anecdotal and evaluation feedback. The majority of participants indicated that they would refer their colleagues to the training and apply what they learned in their work. Participants felt the training was meaningful, applicable to their work, and provided an opportunity to learn and engage with their peers. Becoming culturally competent is a process that should be supported through ongoing training to help build a strong communications and health educator workforce with expertise in developing culturally competent messages to meet their constituents’ needs.

Using Social Media as a Survey Recruitment Strategy for Post-Secondary Students During the COVID-19 Pandemic.

The COVID-19 pandemic rapidly forced Canadian post-secondary students into remote learning methods, with potential implications on their academic success and health. In recent years, the use of social media to promote research participation and as a strategy for communicating health messages has become increasingly popular. To better understand how the pandemic has impacted this population, we used social media platforms to recruit students to participate in a national bilingual COVID-19 Health Literacy Survey. The purpose of the survey was to assess the health literacy levels and online information-seeking behaviors of post-secondary students in relation to the coronavirus. This paper outlines the social media recruitment strategies used for promoting participation in the survey among Canadian post-secondary students during the pandemic. Facebook, Twitter, and Instagram accounts were created to promote the online survey. The objective of this paper is to examine the use of Instagram, Facebook, and Twitter as survey recruitment strategies tailored to students. Data analytics from these platforms were analyzed using descriptive statistics. We found that the most commonly used platform for survey dissemination was Twitter, with 64800 total impressions recorded over 3 months. The use of social media as a survey recruitment strategy showed promise in the current context of COVID-19 where many students are participating in online learning and for a study population that actively uses these platforms to seek out information.

İş Güvenliği İletişim Mesajlarında Korku Çekiciliğinin Kullanımı: Deneysel Bir Çalışma

Persuasive communication messages are important in order to inform and motivate workers and encourage them to take work safety precautions. Fear appeals are broadly used to persuade individuals in public health and work safety communication messages. This experimental study compares attitudes, perceived ethicality, fear emotions, and behavioral intention of workers when exposed to a stimulus containing the threat of physical injury message, compared to a stimulus without such a message. Findings reveal statistically significant differences in terms of attitude toward the message and perceived ethicality when comparing two treatments. However, no significant differences emerged in fearful emotions and behavioral intention. Therefore, associations on work safety, governmental organizations, social marketers, and occupational safety specialists should be cautious about the effectiveness of threat of injury messages.

Tailoring Temporal Message Frames to Individuals’ Time Orientation Strengthens the Relationship between Risk Perception and Behavioral Intention

While health behavior theories conceptualize risk perception as a major factor motivating protective action against risk, empirical support for this widely-assumed proposition has been inconclusive. Given the inherent issue concerning the delay of desired outcomes in most health behaviors, this research proposes the congruence between temporal frame and individuals’ trait time orientation (i.e., consideration of future consequences; CFC) as an important moderator in the risk perception-behavioral intention relationship. Findings from two experiments concerning messages promoting adequate sleep (N = 227; Study 1) and plastic bottle recycling (N = 223; Study 2) showed that the relationship between risk perception and behavioral intention was significantly stronger when temporal frames and CFC were more congruent (i.e., tailored). Nuanced differences in the moderating effects of frame-CFC congruence were observed depending on how risk perception was operationalized (i.e., susceptibility only, severity only, or combination of the two). Implications for health communication message design are discussed.

Young People's Experiences and Perceptions of YouTuber-Produced Health Content: Implications for Health Promotion.

The growing diversity and uptake of social media has increased the sources of health information available to young people. YouTube is one of the most popular social media platforms for young people in the United Kingdom, and YouTubers are the most important influencers on the platform producing diverse health content. They are increasingly recognized by popular media and public health organizations as a potentially influential source of health information for young people. This study aimed to qualitatively explore young people’s experiences and perceptions of YouTuber health content. Focus groups (November 2017 to January 2018) with 85 young people (13–18 years) were recruited from schools in a single county in North West England. The findings suggest young people’s engagement with YouTuber health content is dependent on how they encounter it, YouTubers’ motivations for producing it, and the perceived relatability, sincerity, and generalization present in this content. The study confirms YouTuber health content was one of the many sources of health information used by young people and was most frequently encountered during young people’s routine viewing. Collaboration between public health organizations and YouTubers could be promising in communicating health messages to young people already engaged with these YouTubers, as part of wider campaigns or interventions. These messages could be particularly effective if they focused on experiences and norms rather than advice, remained consistent with YouTubers’ existing health content, incorporate clear indicators of accuracy into their narrative, and state their intention to benefit young people.