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Understanding what health communicationcan and cannot do is critical tocommunicating successfully. Healthcommunication is one tool for promoting orimproving health. Changes in health careservices, technology, regulations, and policyare often also necessary to completelyaddress a health problem.Communication alone can: Produce sustained change in complexhealth behaviors without the support of alarger program for change, includingcomponents addressing health careservices, technology, and changes inregulations and policy Be equally effective in addressing allissues or relaying all messages becausethe topic or suggested behavior changemay be complex, because the intendedaudience may have preconceptions aboutthe topic or message sender, or becausethe topic may be controversialCommunication Can Affect MultipleTypes of Change Increase the intended audience’sknowledge and awareness of a healthissue, problem, or solution Influence perceptions, beliefs, andattitudes that may change social norms Prompt action Demonstrate or illustrate healthy skills Reinforce knowledge, attitudes,or behavior Show the benefit of behavior change Advocate a position on a health issueor policy Increase demand or support forhealth services Refute myths and misconceptions Strengthen organizational relationshipsHealth communication programs canaffect change among individuals and alsoin organizations, communities, and societyas a whole:Communication combined with otherstrategies can: Cause sustained change in which anindividual adopts and maintains a newhealth behavior or an organization adoptsand maintains a new policy direction Overcome barriers/systemic problems,such as insufficient access to careCommunication cannot: Compensate for inadequate health care oraccess to health care services Individuals—The interpersonal level is themost fundamental level of health-relatedcommunication because individualbehavior affects health status.Communication can affect individuals’awareness, knowledge, attitudes, selfefficacy, skills, and commitment tobehavior change. Activities directed atother intended audiences for change mayalso affect individual change, such asinvolving patients in their own care. Groups—The informal groups to whichpeople belong and the community settingsthey frequent can have a significantimpact on their health. Examples includerelationships between customers andemployees at a salon or restaurant,exercisers who go to the same gym,students and parents in a school setting,employees at a worksite, and patients andhealth professionals at a clinic. Activitiesaimed at this level can take advantage ofthese informal settings.Making Health Communication Programs Work3INTROWhat Health Communication Canand Cannot Do

Organizations—Organizations are groupswith defined structures, such asassociations, clubs, or civic groups. Thiscategory can also include businesses,government agencies, and health insurers.Organizations can carry health messagesto their constituents, provide support forhealth communication programs, andmake policy changes that encourageindividual change. Communities—Community opinionleaders and policymakers can be effectiveallies in influencing change in policies,products, and services that can hinder orsupport people’s actions. By influencingcommunities, health communicationprograms can promote increasedawareness of an issue, changes inattitudes and beliefs, and group orinstitutional support for desirablebehaviors. In addition, communicationcan advocate policy or structural changesin the community (e.g., sidewalks) thatencourage healthy behavior. Society—Society as a whole influencesindividual behavior by affecting norms andvalues, attitudes and opinions, laws andpolicies, and by creating physical,economic, cultural, and informationenvironments. Health communicationprograms aimed at the societal level canchange individual attitudes or behaviorand thus change social norms. Effortsto reduce drunk driving, for example,have changed individual and societalattitudes, behaviors, and policies throughmultiple forms of intervention,including communication.Multistrategy health communicationprograms can address one or all ofthe above.4IntroductionCommunication Programs Can IncludeMultiple Methods of InfluenceHealth communicators can use a wide rangeof methods to design programs tofit specific circumstances. Thesemethods include: Media literacy—teaches intendedaudiences (often youth) to deconstructmedia messages so they can identify thesponsor’s motives; also teachescommunicators how to composemessages attuned to the intendedaudience’s point of view Media advocacy—seeks to change thesocial and political environment in whichdecisions that affect health and healthresources are made by influencing themass media’s selection of topics and byshaping the debate about those topics Public relations—promotes the inclusionof messages about a health issue orbehavior in the mass media Advertising—places paid or public servicemessages in the media or in public spacesto increase awareness of and support fora product, service, or behavior Education entertainment—seeks toembed health-promoting messages andstorylines into entertainment and newsprograms or to eliminate messages thatcounter health messages; can also includeseeking entertainment industry support fora health issue Individual and group instruction—influences, counsels, and provides skills tosupport desirable behaviors Partnership development—increasessupport for a program or issue byharnessing the influence, credibility, andresources of profit, nonprofit, orgovernmental organizations

INTROCHARACTERISTICS OF EFFECTIVE HEALTH COMMUNICATION CAMPAIGNSCertain attributes can make health communication campaigns more effective.Use the guidelines in this section to plan your campaign.Define the communication campaign goal effectively: Identify the larger goal Determine which part of the larger goal could be met by a communication campaign Describe the specific objectives of the campaign; integrate these into a campaign planDefine the intended audience effectively: Identify the group to whom you want to communicate your message Consider identifying subgroups to whom you could tailor your message Learn as much as possible about the intended audience; add information about beliefs,current actions, and social and physical environment to demographic informationCreate messages effectively: Brainstorm messages that fit with the communication campaign goal and theintended audience(s) Identify channels and sources that are considered credible and influential by theintended audience(s) Consider the best times to reach the audience(s) and prepare messages accordingly Select a few messages and plan to pretest themPretest and revise messages and materials effectively: Select pretesting methods that fit the campaign’s budget and timeline Pretest messages and materials with people who share the attributes of theintended audience(s) Take the time to revise messages and materials based upon pretesting findingsImplement the campaign effectively: Follow the plans you developed at the beginning of the campaign Communicate with partners and the media as necessary to ensure the campaignruns smoothly Begin evaluating the campaign plan and processes as soon as the campaignis implementedNote. Adapted from the University of Kansas Community Toolbox, CommunityWorkstation, available at /outline.htm.Accessed March 7, 2002.Making Health Communication Programs Work5

THEORIES GUIDE ACTION TO INCREASE MAMMOGRAPHY USEFox Chase Cancer Center, in cooperation with area managed care organizations, designeda program that was based on key elements of the health belief model to encourage womento have regular mammograms. Selected women received educational materials explainingthat virtually all women are at risk for breast cancer, regardless of the absence ofsymptoms, and that risk increases with age (susceptibility). The materials stressed thatearly detection brings not only the best chance of cure but also the widest range oftreatment choices (benefit). Women received a letter stating their physician’s support (cueto action) and a coupon for a free mammogram (to overcome the cost barrier). Those whodid not have a mammogram within 90 days received different forms of reminders (cues toaction). In the most intensive reminder, a telephone counselor called selected women toreview their perceptions about susceptibility, benefits, and barriers. Program evaluationshowed that mammography use increased substantially.The Fox Chase program also applied social learning theory in developing interventions toencourage physician support of mammography and to improve clinical breastexaminations (CBEs). The planners examined the environmental and situational factorsthat might affect physician behavior and tried to change the low expectations ofphysicians about the benefits of breast screening. The interventions includedobservational learning by watching an expert perform a CBE, an opportunity to increaseself-efficacy by practicing CBE with the instructor, and the use of a feedback report andCME credits to reinforce physician skills.In taking a community approach to change, a UCLA mammography program used adiffusion of innovations model. Community analysis showed that women who were earlyadopters (leaders) already had a heightened awareness of the value of mammography. Toreach middle adopters, the program mobilized the social influence of the early adopters byusing volunteers who had breast cancer to provide mammography information. Theprog

health communication program planning made this revision possible, as well as Lynne Doner, whose broad-based consumer research and evaluation expertise has enhanced the book’s content and quality. Both have provided hours of review and consultat