Cynthia Baur

Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review

CONTEXT Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. EVIDENCE ACQUISITION Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products. EVIDENCE SYNTHESIS Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns. CONCLUSIONS Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.

Toward a Systems Approach to Health Literacy Research

Implementing the Affordable Care Act (ACA) requires a new commitment to “person-centeredness” as a central feature of health care. Person-centered health care means people have both the knowledge required to make decisions about their care and the support of providers and family who respect their needs and preferences (Hurtado, Swift, & Corrigan, 2001). To realize a person-centered health care system, the ACA and the HITECH Act,1 two federal laws, promote new health care service delivery models and health information technologies that emphasize teams and people’s engagement in information seeking, decision-making and self-management. These changes reflect the growing priority of health literacy.

Back to Basics: Why Basic Research Is Needed to Create Effective Health Literacy Interventions

Limited health literacy is increasingly recognized as a public health problem. Growing recognition of the problem—and the need for solutions—creates an imperative for the field of health literacy research to identify effective interventions. The National Action Plan to Improve Health Literacy (U.S. DHHS, 2010) recommends increased basic research in health literacy. This paper elaborates on this call by explicating what is meant by basic research and describing several of the ways in which basic research will benefit the field of health literacy research and, particularly, progress toward designing successful interventions.

The Assessment of User Engagement with eHealth Content: The eHealth Engagement Scale

A scale for measuring the engagement properties of eHealth content was adapted from commercial advertising research. We define engagement as the process of involving users in health content in ways that motivate and lead to health behavior change. Complete responses were obtained from 230/260 participants exposed to health content from seven content areas in online remote testing. After viewing each of three randomly assigned health content areas, the participants completed two questionnaires. The first one assessed the appropriateness, applicability, motivation, and intentions to change or engage in health behaviors relevant to the set of content components displayed for that health topic. The second questionnaire was the eHealth Engagement Scale in which participants rated each of 12 descriptors on a 5-point Likert scale. Internal reliability of each of the two multi-item subscales of the Engagement Scale was .878 for Involving and .805 for Credible. A 4-factor solution eliminating three of the original 12 word descriptors was found to be the superior in the subsequent analysis of predictive validity. The eHealth Engagement Scale may prove to be an important mediator of user retention of information, intentions to change, and ultimately efforts to undertake and achieve behavior change.

The CDC Clear Communication Index Is a New Evidence-Based Tool to Prepare and Review Health Information

This article presents the Centers for Disease Control and Prevention Clear Communication Index (the Index), a tool that emphasizes the primary audience’s needs and provides a set of evidence-based criteria to develop and assess public communication products for diverse audiences. The Index consists of four open-ended introductory questions and 20 scored items that affect information clarity and audience comprehension, according to the scientific literature. A research team fielded an online survey to test the Index’s validity. Respondents answered 10 questions about either an original health material or one redesigned with the Index. For 9 out of 10 questions, the materials revised using the Index were rated higher than the original materials. Regardless of education level, respondents rated the revised materials more favorably than the original ones. The results indicate that the Index performed as intended and made it more likely that audiences could correctly identify the intended main message and understand the words and numbers in the materials. The results also support the widely held view that audiences are more positive about clearly designed materials. The Index shows that an evidence-based scoring rubric can assess and improve the clarity of health materials.

New Directions in Research on Public Health and Health Literacy

Numerous calls for a public health approach to health literacy and visions of a health literate society have appeared in recent years. Yet, many gaps in what we know about and do to improve health literacy remain. Major developments at the national level in the last decade help define the role of health literacy in creating better public health and have set the stage for new investigations in public health and health literacy. Four frameworks are examined for their usefulness in posing new questions about public health and health literacy: Healthy People, the Ten Essential Public Health Functions, health promotion, and health disparities. Each of the frameworks generates questions and uses methods that can produce new findings about health literacy. Using the frameworks will open new investigations into population health and health literacy improvement at multiple levels.

Calling the nation to act: Implementing the national action plan to improve health literacy

The National Action Plan to Improve Health Literacy is a framework that all clinical and public health professionals, including nurses, can use to identify and address health literacy barriers that negatively affect patient care and individual and community health outcomes. Of all the clinical disciplines, nursing has a unique relationship to health literacy because nurses are responsible for the majority of patient, caregiver and community health education, and communication. The information in the Action Plan is applicable to many fields and disciplines, such as healthcare, public health, communication, and education. Leading educators, researchers, practitioners, and administrators in each relevant discipline have a responsibility to be informed about health literacy issues and identify the most promising practices to improve health literacy in their domains. The Action Plan includes goals and strategies that nursing leaders can adapt and use to develop organization-specific action plans for health literacy improvement. The Action Plan is a call to action for all clinical professionals, especially nurses, to choose, implement, and evaluate one or more health literacy strategies so that patients will be more informed and prepared to protect, promote, and manage their health.

Crisis and emergency risk messaging in mass media news stories: is the public getting the information they need to protect their health?

ABSTRACT The mass media provide an important channel for delivering crisis and emergency risk information to the public. We conducted a content analysis of 369 newspaper and television broadcast stories covering natural disaster and foodborne outbreak events and coded for seven best practices in crisis and emergency risk messaging. On average, slightly less than two (1.86) of the seven best practices were included in each story. The proportion of stories including individual best practices ranged from 4.6% for “expressing empathy” to 83.7% for “explaining what is known” about the event’s impact to human health. Each of the other five best practices appeared in less than 25% of stories. These results suggest much of the risk messaging the public receives via mass media does not follow best practices for effective crisis and emergency communication, potentially compromising public understanding and actions in response to events.

Testing rules of thumb and the science of health literacy.

In this issue, the study by Woloshin and Schwartz suggests that lay people understand percents better than natural frequencies when considering information about drug therapies, and Berkman and col...

How CDC is promoting a clear communication culture

Both the federal Plain Writing Act and the mission of the US Centers for Disease Control and Prevention (CDC) to protect and promote peoples health require CDC to communicate clearly so that people can understand and act on the important health information it provides. Decades of research shows that health information and services are often unfamiliar, complicated, and technical, even for people with many years of formal education. Although individual skills are important, the actions of health professionals in communicating health information are influential as well. In response to both the challenges faced by those who need health information and the opportunities for improvement among those who provide health information, CDC is taking steps to promote a clear communication culture to make its health information and services accessible and understandable by the different audiences it serves.