Holley A. Wilkin

You Have an Important Message! Evaluating the Effectiveness of a Text Message HIV/AIDS Campaign in Northwest Uganda

There is a growing interest in the effect of mobile phones in health care (mHealth) service delivery, but more research is needed to determine whether short message service (SMS)–based campaigns are appropriate for developing countries. This pilot study explored the efficacy of an mHealth campaign using SMS as a platform to disseminate and measure HIV/AIDS knowledge, and to promote HIV/AIDS testing at clinics in rural Uganda. Over a 1-month period, 13 HIV/AIDS quiz questions were sent to 10,000 mobile subscribers. Despite participation incentives, only one-fifth of the mobile subscribers responded to any of the questions. The campaign had proportionately limited success in increasing knowledge levels on a mass scale. Furthermore, the program design may be reinforcing entrenched knowledge gaps. The results suggest that it is important to be conservative when considering the potential overall effect of SMS-based programs. However, the authors recognize the potential of mHealth tools when extended to millions of mobile phone users as part of an integrated health campaign approach. The authors propose several steps to improve the program design to reach a larger portion of the intended audience and increase campaign effectiveness.

Reaching at risk groups The importance of health storytelling in Los Angeles Latino media

Latinos are at high risk for many health problems, but are often missed by traditional health communication campaigns aired through general audience channels. This article explores Latinos’ connections to communication channels for health goals - both mediated and interpersonal and media that is general audience and geo-ethnic (targeted toward a specific ethnicity and/or community). Data from a random digit dial telephone survey of Latinos in two Los Angeles communities are analyzed. The results indicate that Latinos have strong connections to media that target their ethnic group or community, to interpersonal networks of friends and family, and to health professionals. The implications of these findings are discussed and recommendations made for increased health storytelling about the dominant health risks facing Latino communities.

Vulnerabilities in mHealth implementation: a Ugandan HIV/AIDS SMS campaign

HIV prevalence in Uganda has leveled off, however trends indicate that incidence is on the rise and disproportionately affects certain vulnerable groups, such as women. There is growing support for using mobile health (mHealth) programs to reach vulnerable populations. Using the Extended Technology–Community–Management model for mHealth, we examined a text message campaign in Arua, Uganda, that disseminated and measured HIV/AIDS knowledge and promoted HIV/AIDS testing at clinics. Empirical data from this campaign illustrated that mHealth campaigns need to address socio-cultural, informational, economic and individual vulnerabilities. We found, for example, that the interactive SMS quiz design motivated recipients with the correct HIV/AIDS knowledge to respond (and thus become eligible for free HIV screening). In doing so, however, the more vulnerable sections of the population, such as those with incorrect knowledge, were further put at risk. We discuss the programmatic implications and provide strategic recommendations for campaign focus, particularly to reach young women.

How Low-Income Residents Decide Between Emergency and Primary Health Care for Non-Urgent Treatment

Overcrowding in U.S. emergency departments (ED) is a growing national problem that results in delayed or obstructed care and costs taxpayers billions of dollars each year. Studies show that access to a primary health care home reduces ED use, but more research is needed to determine how to best redirect vulnerable populations to primary care. Using data from forum group discussions with residents in a low-income, urban community, this study examined the decision processes residents used to decide whether to seek primary versus emergency care. Although residents exhibited high levels of knowledge about the primary health care resources available to them, they voiced a number of negative attitudes toward the services and identified barriers that discouraged them from taking advantage of these resources. The implications of these findings for campaigns aimed at discouraging non-emergency use of emergency services and promoting primary health care use, and studies of vulnerable populations’ access to primary health care more generally are discussed.

Using Communication Infrastructure Theory to Formulate a Strategy to Locate “Hard-to-Reach” Research Participants

In health-communication research, participants who are disproportionately affected by health disparities are often “hard-to-reach,” making them difficult to identify for formative research. This study used communication infrastructure theory (CIT) to create a strategy for locating a specific subset of residents—those who use 911 for healthcare—within a low-income Atlanta community. Findings suggest the need for strategies that involve employing both the communication channels that are part of the neighborhood storytelling network and the communitys discursive spaces, more specifically the communication hot spots and community comfort zones located within the communitys built environment.

Communicative Social Capital and Collective Efficacy as Determinants of Access to Health-Enhancing Resources in Residential Communities

This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents’ access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital—that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media—plays a significant role in access to health resources. This relationship is complicated by individuals’ health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research.

When Patients Are Impatient: The Communication Strategies Utilized by Emergency Department Employees to Manage Patients Frustrated by Wait Times

Studies have documented the frustrations patients experience during long wait times in emergency departments (EDs), but considerably less research has sought to understand ED staff responses to these frustrations. In-depth interviews were conducted with 18 ED social workers, patient navigators, and medical staff members at a large urban hospital regarding their experiences and interpersonal strategies for dealing with frustrated patients. Staff indicated that patients often attribute delays to neglect and do not understand why their health problem is not prioritized. They voiced several strategies for addressing wait time frustrations, including expressing empathy for patients, making patients feel occupied and wait times seem more productive, and educating patients about when health issues should be treated through primary care. All staff members recognized the need for engaging in empathic communication with frustrated patients, but social workers and patient navigators were able to dedicate more time to these types of interactions.

Applications of Communication Infrastructure Theory

Communication infrastructure theory (CIT) offers a unique perspective on communication and health by investigating how neighborhood communication patterns are intertwined with the health of communities and their residents. Developed by Ball-Rokeach and colleagues, CIT proposes that neighborhoods have unique multilevel communication infrastructures that impact the capacity for resident health (Kim & Ball-Rokeach, 2006). These communication structures, known as storytelling networks (STNs), consist of three key players: community organizations and local/ethnic media (constituting the meso-level), and neighborhood residents (constituting the micro-level). The strength of a STN is affected by the communication action context in which it operates, consisting of neighborhood factors that can facilitate or impede communication, such as street safety, presence of meeting and greeting places, and quality of local services. When a communication action context facilitates a strong neighborhood STN, positive health outcomes are

Communication Resources for Obesity Prevention Among African American and Latino Residents in an Urban Neighborhood

African Americans and Latinos are at disproportionately high risk for obesity and for the chronic conditions and diseases associated with it. This study uses communication infrastructure theory to explore how connections to neighborhood communication resources and communication with family members can affect residents’ regular exercise and healthy eating behaviors—two of the most direct strategies for achieving or maintaining a healthy weight. Regression analyses revealed that connections to the neighborhood storytelling network and family interaction predicted residents’ regular exercise and that family interaction had the strongest effect on the likelihood of exercising regularly. Family interaction was the only independent variable that predicted residents’ daily intake of fruits and vegetables. Implications of these findings for community health programs and theory development are discussed.

Evaluating Health Storytelling in Spanish-Language Television from a Communication Infrastructure Theory Perspective

Latinos are at high risk for many health problems, yet they are often missed by traditional health communication campaigns that tend to deploy messages through general audience channels. New immigrant Latinos living in Los Angeles indicate a strong connection to Spanish-language television for health and medical information, but the quantity and quality of health information provided through such programming has not been systematically evaluated. Grounded in communication infrastructure theory, a content analysis of Spanish-language television news and talk shows was conducted to examine the nature of health coverage. As a primary health source for the Los Angeles Latino community, Spanish-language television could serve an important role in helping Latinos overcome health disparities by connecting them to a health storytelling network. However, findings show that the programs analyzed do not adequately connect viewers to other health storytellers or personalize information in such a way that may prompt interpersonal discussion and the dissemination of health information.