A
10-Year Retrospective of Research in Health Mass Media Campaigns: Where Do We
Go From Here?
---Seth M. Noar
Mass media campaigns have long been a tool for promoting public health. How
effective are such campaigns in changing health-related attitudes and behaviors,
however, and how has the literature in this area progressed over the past decade?
The purpose of the current article is threefold. First, I discuss the importance
of health mass media campaigns and raise the question of whether they are capable
of effectively impacting public health. Second, I review the literature and
discuss what we have learned about the effectiveness of campaigns over the past
10 years. Finally, I conclude with a discussion of possible avenues for the
health campaign literature over the next 10 years. The overriding conclusion
is the following: The literature is beginning to amass evidence that targeted,
well-executed health mass media campaigns can have small-to-moderate effects
not only on health knowledge, beliefs, and attitudes, but on behaviors as well,
which can translate into major public health impact given the wide reach of
mass media. Such impact can only be achieved, however, if principles of effective
campaign design are carefully followed.
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A
Decade of Research on Health Content in the Media: The Focus on Health Challenges
and Sociocultural Context and Attendant Informational and Ideological Problems
---Kimberly N. Kline
There is a burgeoning interest in the health and illness content of popular
media in the domains of advertising, journalism, and entertainment. This article
reviews the past 10 years of this research, describing the relationship between
the health topics addressed in the research, the shifting focus of concerns
about the media, and, ultimately, the variation in problems for health promotion.
I suggest that research attending to topics related to bodily health challenges
focused on whether popular media accurately or appropriately represented health
challenges. The implication was that there is some consensus about more right
or wrong, complete or incomplete ways of representing an issue; the problem
was that the media are generally wrong. Alternatively, research addressing topics
related to sociocultural context issues focused on how certain interests are
privileged in the media. The implication was that competing groups are making
claims on the system, but the problem was that popular media marginalizes certain
interests. In short, popular media is not likely to facilitate understandings
helpful to individuals coping with health challenges and is likely to perpetuate
social and political power differentials with regard to health-related issues.
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A
10-Year Retrospective of Research in New Technologies for Health Communication
---L. Suzanne Suggs
The use of new technologies is growing in virtually all areas of health communication,
including consumer, patient, and provider education; decision and social support;
health promotion; knowledge transfer; and the delivery of services. Many applications
have the potential to make major contributions in meeting the needs of an unhealthy
and aging population. Key questions confronting health communication research
reflect long-standing concerns about effects of new technology on health knowledge,
health behavior, health delivery, and health outcomes. A review of the literature
provides useful insights about how technology has been used to communicate health
messages and their associated outcomes. Focus is placed on effective health
communication, lessons learned, and implications for the future. During the
next 10 years, the application of new technologies in health communication will
be enriched by a tradition that has evolved to reflect a more dynamic connection
between health users and providers. Future applications have the potential to
provide cost-effective communications tailored to large numbers of individuals
and achieve positive health outcomes. Consequently, we should strive to answer
research questions about tailoring communication content, the channel used to
deliver the message, and evaluation models that are best suited for examining
outcomes of multicomponent tailored, technology-based communication.
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Defining
Moments in Risk Communication Research: 1996-2005
---Katherine A. McComas
Ten years ago, scholars suggested that risk communication was embarking on a
new phase that would give increased attention to the social contexts that surround
and encroach on public responses to risk information. A decade later, many researchers
have answered the call, with several defining studies examining the social and
psychological influences on risk communication. This article reviews risk communication
research appearing in the published literature since 1996. Among studies, social
trust, the social amplification of risk framework, and the affect heuristic
figured prominently. Also common were studies examining the influence of risk
in the mass media. Among these were content analyses of media coverage of risk,
as well as investigations of possible effects resulting from coverage. The use
of mental models was a dominant method for developing risk message content.
Other studies examined the use of risk comparisons, narratives, and visuals
in the production of risk messages. Research also examined how providing information
about a risk's severity, social norms, and efficacy influenced communication
behaviors and intentions to follow risk reduction measures. Methods for conducting
public outreach in health risk communication rounded out the literature.
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Understanding
Interpersonal Communication Processes Across Health Contexts: Advances in the
Last Decade and Challenges for the Next Decade
---Ashley Duggan
Interpersonal communication processes are central to the provider-patient
interaction and in relationships with someone who is ill or needs care. The
last decade of research has documented the ways communication processes predict
better outcomes in the provider-patient interaction and key constructs for consideration
in close relationships in which a health issue in some way defines the relationship.
The current article highlights findings from the previous decade and the ways
previous findings serve as a theoretical and methodological foundation for more
sophisticated analysis of interpersonal communication processes in health contexts.
A relational perspective serves as a link between the provider-patient relationship
and close relationships with someone with a health issue. Implications for provider-patient
contexts, medical education, and close relationships highlight future directions
for theory building, health literacy, health outcomes, family communication,
developmental issues, and a life span perspective.
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Relationship
of Internet Health Information Use with Patient Behavior and Self-Efficacy:
Experiences of newly diagnosed cancer patients who contact the National Cancer
Institute's Cancer Information Service
---Sarah Bauerle Bass, Sheryl Burt Ruzek, Thomas F. Gordon, Linda Fleisher,
Nancy McKeown-Conn, and Dirk Moore
Growth in technology
has created a communications revolution that allows people instant and equal
access to previously unavailable or difficult-to-find information. New media
reportedly empower people to become active participants in their own health
care by giving them necessary information to make informed decisions, and to
engage in behaviors that will improve their health. This availability has the
potential to significantly change the relationship between patient and provider,
alter the ways patients and providers communicate, and help create a consumer
base of power in health policy and decision-making. Little is known empirically,
however, about how Internet use correlates with patient behavior characteristics,
perceived self-efficacy or other psychosocial variables, especially when a person
is diagnosed with a serious or life threatening disease. A study is described
that established baseline data on self-reported use of Internet health information
by a group of patients newly diagnosed with cancer by assessing self-reported
use of Internet health information among 498 newly diagnosed cancer patients,
to better understand the relationship among Internet use, patient task behavior
in medical encounters, and perceived self-efficacy. These patients were callers
to the Atlantic Region office of the Cancer Information Service, a service provided
by the National Cancer Institute (1-800-4CANCER). Subjects were classified by
types of Internet use: Direct Use (used Internet health information themselves),
Indirect Use (used information accessed by friends or family), and Non-Use (never
accessing Internet information). They were classified by type of Internet use
at enrollment and interviewed by telephone after eight weeks. There were significant
relationships among Internet use and key study variables: subject characteristics,
patient task behavior, and self-efficacy. Subjects' Internet use changed significantly
from enrollment to eight-week follow-up; 19% of Non-Users and Indirect Users
moved to a higher level of Internet use. Significant relationships were also
found among Internet use and perceived patient-provider relationship, question
asking, and treatment compliance. Internet use was also significantly associated
with self-efficacy variables (confidence in actively participating in treatment
decisions, asking physicians questions, and sharing feelings of concern). The
results of this study show that patients who are newly diagnosed with cancer
perceive the Internet as a powerful tool, both for acquiring information and
for enhancing confidence to make informed decisions.
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Contributing
Factors to the Use of Health-Related Web Sites
The plethora of health-related information on the Web is a double edge sword
for public health. While the ubiquity of the Web can empower the health information-seek,
the increasing number of documented cases of inaccurate information on Websites
suggest that it can pose a serious concern to public health. Underscoring this
is that the majority of Web use entails revisiting previously viewed sites.
Thus, understanding the underlying process for the intention to revisit a health-related
Website is important in that it has both immediate and long-term health-related
consequences. In the current study, as participants physically search the Web
for health-related information, the computer unobtrusively recorded the number
of pages assessed and the page viewing time. To capture the context of online
health searches, two distinct search tasks that differed in task difficulty
were assigned to participants - general and specific search task. Based on the
theoretical work on media use and Elaboration Likelihood Model, results from
the Structural Equation Modeling suggest a three-step model in which perceptions
of Website credibility mediate the effects that Internet reliance and health-related
knowledge have on the intention to revisit a site. For the search task that
was less difficult, the results suggest that perceptions of credibility mediate
the intention to revisit a site such that Web users who rely on the Web for
health-related information tend to find Websites which are high trust/expertise
and are in-depth. In contrast, in the more difficult search task, those who
rely on the Web for health-related information tend to find Websites which they
perceived to be high in only trust/expertise. In addition, in the more difficult
search task, perceptions of credibility mediate the intention to revisit a site
such that Web users who reported being more knowledgeable on health issues tend
to find Websites that they perceived to be high in trust/expertise and be more
in-depth.
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The
Role of Physician Characteristics in Clinical Trial Acceptance: Testing Pathways
of Influence
---Barbara Curbow, Linda A. Fogarty, Karen A. McDonnell, Julia Chill,
and Lisa Benz Scott
The low acceptance of participation in cancer clinical trials (CTs) is an issue
of continuing importance. Lacking in the literature, to date, are theory generated,
experimental studies that explore the underlying cognitive and affective processes
that influence decision making when individuals are exposed to cancer clinical
trial information. 262 women (161 survivors and 101 controls) were randomly
assigned to view one of eight videos describing a breast cancer clinical trial
that varied on three physician variables (community versus academic-based affiliation,
enthusiastic versus neutral presentation of the trial, and new versus previous
relationship with the patient). The manipulated variables primarily influenced
the intermediary variables of post-test CT beliefs and satisfaction with information
rather than knowledge or information processing. Multiple regression results
indicated that CT acceptance was associated with positive post-CT beliefs, a
lower level of information processing, satisfaction with information, and control
status. Based on these results, CT acceptance does not appear to be based solely
on a rational decision making model. The results suggest that stronger positive
physician cues (e.g., having a previous relationship) may lead to greater acceptance
of a trial while impeding processing of information. This possibility has implications
for both the ethics of informed consent and research conceptual models of patient
decision making.
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Interpersonal
Issues Surrounding HIV Counseling and Testing, and the Phenomenon of "Testing
by Proxy"
---Allison C. Morrill, Carey Noland
HIV counseling and testing (C&T) is an essential component in preventing
the spread of HIV; however, women in close heterosexual relationships who decide
to test for HIV may face significant obstacles to implementing recommendations
for safer sex and partner testing. This article explores these experiences through
interviews with 81 women who sought HIV counseling and testing and had a regular
male sexual partner at the time, and four focus group with a subsample of 18
women, and 15 men whose female partners had tested for HIV. Findings reveal
a dangerous practice of "testing by proxy." Many participants, believing
that transmission of HIV is virtually instantaneous, assumed that if one partner
tests negative for HIV after having unprotected intercourse, the untested partner's
serostatus must also be negative. It may be that public health messages, in
emphasizing the life-threatening nature of the disease and the urgency and epidemic,
have contributed to this phenomenon. Public health campaigns must refute this
misconception and help couples understand the unpredictability of transmission,
and why one partner's negative result does not establish the absence of HIV.
The research also found that it is difficult for couples to communicate about
safer sex and partner testing because these topics suggest suspicions of infidelity.
Also, male partners' resistance is a significant obstacle to testing and adopting
safer sexual practices. Requests may be better received if they are based on
concern about previous partners, or emphasize positive feelings of taking ongoing
proactive responsibility for one's own health. To promote couple communication
about HIV prevention in spite of such obstacles, modeling could be used to help
normalize HIV testing and condom use even within the context of an established,
loving relationship. Programs aiming to reduce heterosexual HIV risk for women
should include their male partners, and incorporate effective interpersonal
communication skills. In addition, programs need to develop ways to convey information
so that men will apply it to themselves, and not dismiss it. Future research
should take into account these challenges that women in close relationships
face and the significance of male resistance, and should further investigate
"testing by proxy." Such endeavors would constitute important contributions
to the national goal of prevention through HIV counseling and testing.
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Web Chatter Before and After the Women's Health
Initiative Results: A Content Analysis of Online Menopause Message Boards
---Tara M. Cousineau, Traci Craig Green, Diana Rancourt
Women are avid online health information seekers. Surveys show that significantly
more women than men report that the Internet helped them cope with a major health
issue, particularly among those aged 50-64. The purpose of the present study
was to retrospectively observe, via online message board archives, the health
information sought by women experiencing the menopausal transition. We sought
to determine what has changed in online health communication among menopausal
women in response to the premature end of the Women's Health Initiative (WHI)
study, which revealed that the benefits of hormone replacement therapy do not
outweigh the health risks. The study goals included exploring what online observations
might inform health promotion programming for midlife women today. By applying
a conceptual framework for content analysis that integrates qualitative and
quantitative methods in Internet-based research, this article examines the message
board communications on two popular menopause message boards before and after
the WHI announcement. A content analysis of 785 messages revealed significant
differences in the types of messages posted on the menopause boards. The type
of message board, medical versus community, predictably reflected the type of
information women seek, e.g., there were proportionally more postings for specific
answers to medical questions on the medical board and proportionally more emotional
support postings on the community board. Notably, the majority of message board
postings over the 18-month time period consistently reflected inquiries about
basic questions-and reassurance-about women's menopausal transition. There was
a linear trend indicating an increase over time in messages about pharmaceutical
advice, with a jump immediately after WHI regardless where such messages were
posted. This may indeed reflect immediate reactions to the publicity around
the WHI results and a heightened sensitivity of women to their own menopausal
transition. It appears that the Internet offers a unique opportunity for researchers
to observe health-specific inquiries, as well as the shifts in Internet communication
in response to publicized medical events. That women actively seek menopausal
advice on the Internet, beyond what women might want, expect or have received
from their own physicians, suggests that online health programs may be an innovative
and feasible approach for this audience.
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