Pushing the Boundaries of Health Communication: Trends and Challenges

Rafael Obregon, Ph.D.

School of Media Arts & StudiesCommunication & Development Studies

Ohio University

Roskilde University, DenmarkMay 4th, 2010

Pushing the Boundaries of Health

Communication: Trends and Challenges

Rafael Obregon School of Media Arts & Studies

Communication & Development StudiesWe Have Met the Enemy and He Is PowerPoint

Ohio University, USA

Communication for social change: Lessons learned from public health

Roskilde University, DemarkMay 4th, 2010

We Have Met the Enemy and He Is PowerPoint

““When we understand that slide, we’ll have won the war,” General McChrystal, NY When we understand that slide, we’ll have won the war,” General McChrystal, NY Times, April 27Times, April 27thth, 2010, 2010

Outline of Presentation A quick tour of international

health communication experiences

Health Communication and Communication for Social Change

•Trends and ChallengesTrends and Challenges•ConclusionsConclusions

A quick tour of international health communication

experiences

Public Debate and Social Mobilization on HIV/AIDS and Children’s Rights in

Southern Africa Theory and research-driven process Multimedia / multi-strategy /multi-

communication channel platform - contributes to addressing health issues in southern Africa

Change at individual, community, social and policy levels

•Promotion of public debate and discussion•Changes in social norms•Focus on community engagement

Community Dialogue and Women’s Rights and Empowerment in the Amazon

• Constructivism, interculturality and dialogue to address gender-based violence and promote women’s rights

•Radio magazine Bienvenida Salud, education, and income generation – focus on voice and social determinants; long-term approach

Minga PeruMinga Peru

Positive deviance and nutritional improvement of children in Asia and

Africa

Positive deviance (PD) - approach to social and organizational change that enables communities to discover wisdom they already have, and act on it

Focus on local/within community solutions and resources

Complexifying social mobilization in health communication: learning from polio

communication Activist SM - community participation

and empowerment - bottom-up approach: communities express demands, define goals, make key decisions

Pragmatist SM - means to strengthen health services and achieve goals

• Competing understandings of SM• Media as social and political

institution • Interpersonal comm as dialogue

and engagement • Gender

ICTs and access to information in South Africa – Cell Life

Mass messaging for prevention;

Mass information for positive living;

Linking patients and clinics;

Peer-peer support and counselling; Building organisational capacity of HIV-related organisations; Monitoring and evaluation.

News agendas and children’s rights in Brazil - ANDI

Media monitoring

Social mobilization

Capacity strengthening and editorial analysis

Accountability Social control Media, democracy

and governance

What key concepts emerge from those experiences?

•Voice•Public debate and dialogue•Participation and engagement•Empowerment and agency•Rights and citizenship•Social mobilization

Health Communication and Public Health

The Public Health SystemThe Public Health System

Assuring the Assuring the Conditions for Conditions for

PopulationPopulationHealthHealth

Employersand Business

Academia

GovernmentalPublic Health Infrastructure

Media/Communicati

on

Healthcare delivery

system

Community

Institute of Medicine, Public Health in the 21st Century, 2003

Health Communication

Health Communication

Promotion of public health

Health care delivery

Mediated Communication

Interpersonal Communication

From: http://www.drrangarajan.com/comm5000_6000/Class1-Notes.ppt.

Health Promotion Principles

- Developing personal skills- Building healthy public policy- Creating supportive environments- Support/promote community action - Re-orientation of services

COMMUNICATION

Social determinants of health

Over the life span

Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999).

Health communication can… Increase intended audience’s knowledge and

awareness of a health issue, problem, or solution; Influence perceptions, beliefs, attitudes 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 issue or policy; Increase demand or support for health services; Refute myths and misconceptions; Strengthen organizational relationships

Freimuth, 2004

Conceptual trends in communication for social

change and health communication

C4D Continuum: Approaches/Theories/Models

(adapted from Obregon & Mosquera, 2005)

Diffusion/Individual

Participatory/Structural

Diffusion/Persuasion/

Social Marketing

Information/Education/

Communication

BehaviorChange

Communication

Social Ecological Approach

Communication For SocialChange

Convergence modelNo magic formula

New conceptual approaches + diversity of frameworks + diversity of strategies

+ multiplicity of interventions = (Growth of the field)

Health Communication Continuum: Approaches/Theories/Models

Diffusion/Individual

Participatory/Structural

• While the field is largely dominated by two theoretical models, its ability to generate new conceptual approaches to development is the result of a creative convergence of diverse frameworks, strategies and interventions.

Diffusion/Persuasion/

Social Marketing

Behavior Change

Communication

CommunicationFor SocialChange

SocialEcologicalApproach

Diffusion/Persuasion/

Social Marketing

Information/Education/

CommunicationC4D/HC

(Adapted from Obregon & Mosquera, 2005(Adapted from Obregon & Mosquera, 2005))

Communication for social change and health promotion

People as objects Agents of own change

Delivering messages Supporting dialogue/debate

Individual behaviour focus Social norms/policies/culture and supportive environments

Persuading people Negotiating the best way forward

Away from technical experts People affected in central role

Context & the UNAIDS HIV/AIDS Communication

Framework

CULT URE G ENDER

SOCIO-ECONOM ICST AT US

G OVERNM ENT &POLICY

SPIRIT UALIT Y

FIVEDOM AINS:

Communication, Culture and Health

Communication campaigns with common-denominator messages relevant to most audiences

Unified campaigns with systematic variations in messages to increase relevance for different audience segments, retaining one fundamental message

Developing distinctly different messages or interventions for each audience segment

Communication, Culture and Health

Culture as a central element in health communication

Two approaches (Dutta, 2009)

– Cultural sensitivity– Culture-centered

Two levels (Resnicow and Braithwaite, in Freimuth 2004)

– Surface structure– Deep structure

Audiences and Health Communication

•Powerful media assumptions in many health communication campaigns•Effects of health messages•Limited attention to audience reception and negotiation of meanings•Analysis of reception of health messages – an audience perspective•Media ethnography and reception studies

Trends in healthcommunication practice

Trends in HC practice– Evaluate communication strategies and

tactics and identify under which conditions they function more effectivelyMaximize resources/impact

– Identify strategies for synthesis and integration of multiple data sources Epi data – PolioSocio-demographic data-marketing –

audiences/lifestylesQualitative / ethnographic data /sense-making

Trends in HC practice– Integrate communication strategies into

broader public health initiatives – Evaluate aspects related to cost, reach,

impact, etc.Interdisciplinary teams

– Create trust and credibility Prepare audiences

– Ethical Considerations

Challenges in healthcommunication theory and practice

Challenges

Incorporating increasing theoretical growth and interdisciplinarity – from public

health, communication, and other disciplines

Reflecting trends toward theoretical and methodological convergence– strategic

and catalyzing; participatory; multimedia; change at different levels

Challenges

Addressing structural issues that determine people’s health or create

vulnerability Responding to increased (donor) pressure

on demonstrating impact of interventionsIncorporating innovative evaluation

methodologies - ethnographic approaches that provide deeper understanding of

complexity of public health issues

Challenges

Positioning itself as a legitimate field through professional and graduate level

training (i.e. MPH/SBCC program at Univ of Witwatersrand)

Emphasis on competency-based training

Final thoughts

Growth of health communication as field – different approaches

Expansion of health communication thinking and integration into broader

development and social change issues

Social change starts with public debateAmartya Sen

Thank you…time for questions…