UP FRONT

Volume 5, Number 3
July-September 2000

Vol. 5, Num. 3: Contents | Editorial | Up Front | Abstracts

From this Issue | From Other Sources | Upcoming Events and Conferences | Internet Sources | Publications | Prescriptions | Call for Information

Vital Data

From This Issue

In the first article of this issue, Vaughan and Rogers examine the effects of an entertainment-education radio soap opera in Tanzania in the context of four theoretical perspectives: the hierarchy-of-effects model, the stages-of-changes model, social learning theory, and the diffusion of innovations model.  These theories discuss the stages that individuals pass through during the process of adopting a health innovation, the internal and external influences on adoption of a new idea, how the adoption of a health behavior diffuses through interpersonal networks, and how an intervention influences these processes.  Synthesizing these four perspectives into a six-staged model to measure the effects of communication messages on individual behavior change, the authors studied a Tanzanian entertainment-education radio soap opera discussing family planning methods.  Analysis of  the program within the six-staged model framework found that the radio soap opera had strong effects in changing family planning behavior.  The authors conclude that the Tanzanian radio soap opera contained specific characteristics that past interventions had not which helped it succeed in promoting behavior change.  The authors discuss the details of the effective communication messages and dissemination techniques as well as implications for future research. Vaughan, P. W. and Rogers, E. A Staged Model of Communication Effects: Evidence from an Entertainment-Education Radio Soap Opera in Tanzania.

The second article assesses a smoking cessation intervention communicating feedback of lung cancer susceptibility to smokers.  Past research has shown that risk factor screening and feedback can be an effective method to motivate behavior change.  However, research has not been conducted on the feasibility of genetic biomarkers measuring a person’s susceptibility to the harms of smoking as a means for motivating behavior change such as smoking cessation.  McBride, et al. employed a two-by-two factorial designed study to assess two possible motivating factors in smokers’ desire to quit: method of communicating the biomarker result (by mail with telephone follow-up or in-person) and carbon monoxide (CO) feedback (yes or no).  Participants were tested for the GSTM1 enzyme, indicating if they could be at increased risk for lung cancer, and for carbon monoxide (CO) present after smoking a cigarette.  Subjects were randomized to one of four intervention groups: telephone counseling with a CO test, telephone counseling without a CO test, in-person counseling with a CO test, and in-person counseling without a CO test.   Participants received an eight-page booklet that included background information on the genetic biomarkers and answers to common questions about the test.  Results show that smokers who received their result in person were significantly less likely to have read the result booklet than those in the telephone counseling group.  Comparisons by counseling method and CO testing indicated no differences in changes in perceived risk for lung cancer, belief that quitting smoking could reduce risk of lung cancer, or depression. However, at the counseling session those who received in-person counseling were significantly less frightened by the test result than those who receive telephone counseling.  Significant group effects were observed by race, with African American smokers more likely to increase their perceived benefits of quitting smoking for reducing risk for lung cancer and to report that the susceptibility test result increased their desire to quit than white smokers.  The authors conclude that while susceptibility testing may not increase smokers’ already perceived risk for lung cancer, detailed explanations of exposure to carcinogenic chemicals along with personalized susceptibility testing may increase fear about health consequences, perceived benefits of smoking cessation and smokers’ desire to quit. McBride, C. M., Halabi, S., Bepler, G., Lyna, P., McIntyre, L., Lipkus, I., Albright, J. and O’Briant, K. Maximizing the Motivational Impact of Feedback of Lung Cancer Susceptibility on Smokers’ Desire to Quit.

Focusing on the effects of grassroots participation in health interventions, the third article in this issue examines the case of the Health Action Fund, a community-based social marketing program.  Health programs are often based on needs assessments conducted by professionals.  Taking a different approach, the Health Action Fund in Dayton, Ohio, is a health communications model that encourages members of a neighborhood, community group, or church to identify a problem and then develop a way to address the problem for their specific group.  The fund serves as a small grants program and was designed to encourage the development and implementation of health promotion and disease prevention activities within the community.  The goal of the program was to reach groups for whom health promotion activities were sometimes developed, but who did not traditionally take the leadership role in interventions. Since the first proposal was funded in February 1993, 41 projects have received Health Action Fund grants.  Most of these funded projects targeted adolescents and family health, focusing on issues such as self-esteem, nutrition, antiviolence, and sexual health.  Discussing two of the projects in more detail, the authors elaborate on the positive effects funded programs have had on the community.  The authors explain the challenges and innovations revealed from the Health Action Fund experience and how the program can serve as a model for other communities.  Maurana, C. A. and Clark, M. A. The Health Action Fund: A Community-Based Approach to Enhancing Health.

In the Forum article, MacStravic analyzes the gaps that exist in the current implementation of social marketing programs.  In practice, social marketing programs involve three primary functions: research to identify and understand the determinants of the behavior to be changed and barriers, development to devise the concept for influencing people towards a change in behavior, and communication to create messages and select delivery vehicles to communicate the information. But it typically omits three additional functions that make a significant difference to whether converts maintain the new behavior: monitoring, then reminding converts of the differences the change has made to their lives, and enlisting them in the cause of converting others. Examples are offered of the use of these missing functions and the effects they have had, together with suggestions for intiating and evaluating them in practice.  MacStravic, S. The Missing Links in Social Marketing.

The last article in this issue, a Notes from the Field piece, discusses the effects of tailored health campaigns to encourage physical activity.  While many health groups use mass media campaigns to promote physical activity, the authors assert that these campaigns contain major weaknesses because 1) only single campaign messages are developed, rather than tailored messages for specific populations and 2) few evaluations are conducted on the effects of the intervention.  To develop and evaluate tailored message to promote increased walking, a randomized control trial design was used.  For the study, 181 white-collar employees were randomly allocated by quota to the campaigns or control group for one week.  Pre- and post-test questionnaires were completed by 136 subjects.  Self-efficacy was the only variable to differentiate between the chosen audience segmentation based on stage of change for physical activity.  In the article, the authors discuss the experimental design and how this model can serve as a “teaching example” for the process of campaign development and evaluation.  The authors conclude that uncovering audience segmentation variables in research is vital to successfully tailor mass media messages to specific populations.   Kerr, J. and McKenna, J. A Randomised Control Trial of New Tailored Walking Campaigns in an Employee Sample.

From Other Sources

In the American Journal of Health Behavior, Bosworth, et al. investigate the relationship between participation in a computer-based, conflict resolution intervention and adolescents’ attitudes towards violence, self-efficacy, and aggressive behavior.  In the study, 558 middle school students were randomly assigned to either an intervention or control group and completed assessments before and after implementation.  A computer-based intervention was used because adolescents report a high rate of electronic media use (television, video games, etc.) and interactive computer-based multimedia interventions have been successful in the past in teaching complex interpersonal and prevention strategies for health-related behaviors.  Grounded in social learning theory, the intervention employed in the study has three major components: Anger Management, Perspective Taking, and Dispute Resolution.  After analyzing the surveys students completed immediately after participating in the intervention as well as four months after, the authors conclude that the intervention was successful in diminishing students’ beliefs supportive of violence and increasing their intentions to use nonviolent strategies.  No outcome differences were found for gender, race, or socioeconomic status.  Results indicate that multimedia might be useful in changing some of the mediating factors associated with violence.  Multimedia interventions may provide a unique delivery method to engage a population at risk for violence that may be disenfranchised from traditional prevention approaches.  Bosworth, K., Espelage, D., DuBay, T., Daytner, G., Karageorge, K. (2000). Preliminary Evaluation of a Multimedia Violence Prevention Program for Adolescents.  American Journal of Health Behavior 24(4), 268-280.

In Health Communication, Baur discusses the limiting powers of email in patient-physician relationships.  The author examined evidence from published literature on doctor-patient relationships and doctor-patient communication, empirical studies of uses of the Internet by doctors and patients, and commentaries about the Internet’s role in health care.  Past researchers have purported that email communication between doctors and patients could change communication practices; it has been conceptualized as a mechanism to extend the visit beyond the office, to clarify topics raised in face-to-face appointments, and to seek additional information.  In addition, email has been thought of as a way for patients and physicians to increase their interpersonal communication about values and beliefs. However, the author discusses that these conceptualizations may never be realized because of the current nature of the health care system.  Existing research does not adequately account for the technical, professional, and economic forces that are shaping doctor-patient use of email.  The author concludes that physicians’ preferences for technical, instrumental exchanges with patients and the market-driven model of health care will likely mitigate the positive influence that email could have on the doctor-patient relationship, and that doctor-patient communication is unlikely to improve as a result of the use of email.  Bauer, C. (2000). Limiting Factors on the Transformative Powers of E-Mail in Patient-Physician Relationships: A Critical Analysis. Health Communication 12(3), 239-259.

Upcoming Conferences and Events

The World Federation of Public Health Associations is sponsoring its 6th International Congress Session entitled, “Challenges for Public Health at the Dawn of the 21st Century” in Beijing, China from September 2-6, 2000.  Global health and its related themes—the economy, high tech communications, the role of the public and private sectors, and the environment—will be highlighted.  For more information, contact Brooke Lundquist of WFPHA in Washington, DC at brooke.lundquist@apha.org or 202-777-2506.

The MEDICOM telemedicine conference entitled “Emerging Technologies and Life Sciences: Medicine and Communication” will take place September 28-29, 2000 in Bonn/Remagen, Germany.  The conference will bring together scientific, medical, and application experts from university, clinical, and commercial sites from both medicine and communication.  For more information, visit the website http://www.rheinahrcampus.de/medicom/home.html.

The National Communication Association’s 86th Annual Convention will occur November 9-12, 2000 at the Washington State Convention Center in Seattle, WA.  This year’s conference theme will be “Communication: The Engaged Discipline.”  For more information, visit the NCA Convention website at http://www.natcom.org/convention/2000/convention.htm

The American Public Health Association’s 128th Annual Meeting, “Eliminating Health Disparities,” will occur on November 12-16, 2000 in Boston, MA. For more information, visit the conference website at http://www.apha.org/meetings/.

Internet Sources

The CDC has launched its Spanish language website, CDC En Español, on the Internet at http://www.cdc.gov/spanish.  It is also accessible from the left navigation side bar of the CDC home page. CDC En Español is not a translation of the English language website, but is a site tailored to Latino populations.  It provides health-related information to Latino health professionals and the Spanish-speaking community.  The site also includes information directed at special groups, such as adolescents, students, teachers, patients, health-care providers, women, and men.  Questions related to CDC En Español can be sent to spanish@cdc.gov.

The Health Advocates Guide to the Internet is a resource sponsored by the National Health Law Program (NHeLP).  The guide describes the Internet and its functions in basic terms, as well as providing a number of web site resources on various health issues such as reproductive health, consumer resources, cultural issues, and immigrant health.  The resource can be downloaded from the National Health Law Program’s website at http://www.nhelp.org.

Publications

The Alliance for Health Reform has published a sourcebook for journalists entitled Covering Health Issues: Campaign 2000 & Beyond.  The resource provides substantial discussion of health policy issues in the context of this election year and various polls and surveys that reveal health care as a top concern for the American public. Chapters include: “Health Care as a Campaign Issue,” “Is Demography Destiny?” and “Story Ideas.”  The publication can be obtained on-line at http://www.allhealth.org/sourcebook or by contacting the Alliance for Health Reform.

Prescriptions

Vaughan and Rogers examine a Tanzanian radio soap opera program promoting family planning behaviors and how its effects can be evaluated in a six-staged behavior change model.  The authors suggest that:

The effects of health intervention programs can be evaluated by audience individuals' movement through a four or five or six-staged model of health behavior change. We should conduct formative evaluation research in designing a health communication intervention so as to determine which stage in a behavior change model our intended audience is at.

Communication messages that are highly emotional contribute to the entertainment appeal of an entertainment-education program, thereby increasing audience exposure to and involvement with the message.

Messages that are framed to emphasize the negative concerning a contemplated behavior change (such as the risks of not adopting a family planning method) may be more persuasive than messages that are framed to emphasize the positive consequences of the new behavior  (the benefits of adopting a family planning method).

Individuals often change their health behavior, such as by adopting an innovation like family planning or AIDS prevention, when stimulated to engage in interpersonal communication with peers by a mass media message.

-P. W.  Vaughan and E. Rogers

 McBride, Halabi, Bepler,  Lyna, McIntyre, Lipkus, Albright, and O’Briant assess the effects of the motivational impact of communication of lung cancer susceptibility on smokers’ desire to quit.  The results of their experiment suggest the following:

Providing feedback of test results of personal susceptibility to lung cancer by mail with telephone follow-up can be as effective as in-person counseling.

Mail approaches may have some advantages because curiosity about the test result may motivate smokers to read accompanying written materials that, in turn, may help them better understand the meaning of the result.

Providing exposure feedback in the form of carbon monoxide testing does not appear to improve understanding or the motivational impact of susceptibility testing.

-C. M. McBride, S. Halabi, G. Bepler, P. Lyna, L. McIntyre, I. Lipkus, J. Albright, and K. O’Briant

 Maurana and Clark discuss a new model program, the Health Action Fund, created by the Center for Healthy Communities (CHC) at Wright State University in Dayton, Ohio.  Important points to highlight are:

Traditionally health and social service agencies define community problems and fund health promotion and prevention programs to meet those needs.  The Health Action Fund took a different approach in which community individuals and groups defined their needs, created strategies to meet those needs and were given resources to implement their strategies. The community group became a designer in contrast to a receiver.

This program demonstrates new communications and marketing strategies that lead to community groups defining and designing health promotion/prevention programs to meet their community’s needs.

The program proved invaluable to the partnership-building process by providing an entry into the community by the CHC, built trust between the community and the CHC, helped assess the needs and strengths in the community, and identified true community leaders and groups for future partnership endeavors

Trust developed between the CHC and the community when funds were made available to the community to meet needs they identified.

-C. A. Maurana and M. Clark

 In an analysis of the current social marketing framework, MacStravic discusses how additional functions would add value to “customers” and increase the impact of social marketing efforts.  He makes the following recommendations for future social marketing programs:

Monitoring if a program’s intended effects have been received is crucial.  It is important to discover whether the value of a program intended by the sponsors was delivered through the new behavior and to what extent the promised value of the new behavior was realized.

To confirm and perpetuate the conversion to an improved behavior, it is helpful to reinforce consumer perceptions of the value they have gained by this behavior change, to heighten their awareness and appreciation of how their quality of life is better, and their attribution of that improvement to the new behavior.  One approach is to encourage converts to track their own status using diaries, charts, or new technologies like the Internet.

If the other stages of the program have been successful, then converts to new behavior changes should be encouraged to support the sponsor’s continuing efforts to convert more people to the new behavior.

-S. MacStravic

 Kerr and McKenna study the effects of tailored health campaigns to encourage physical activity and recommend the following guidelines when dealing with audience segmentation issues:

Time must be invested in defining a specific audience and developing clear campaign objectives. Different campaigns are required for each stage of change, and each campaign should have a single message that can be refined by consulting with advertising specialists.

New campaigns to promote walking need to focus on specific targets. Once these have been clearly identified advertising professionals can develop a range of credible campaign alternatives, even within a short time.

It is difficult to target solely to stage. Even within a single stage of change there is considerable diversity of attitudes, beliefs, barriers, and readiness for further change.

Different paper-based campaigns delivered to inactive people have unique change effects, though, a consistent effect was reduced confidence in managing the barriers to regular walking.

Measurement devices should evaluate psychological processes as well as behavioural outcomes of physical activity promotions. Small scale studies that lack statistical power cannot use multivariate analyses to help identify the predictors of change (that remain unknown).

-J. Kerr and J. McKenna

Call for Information

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Journal of Health Communication The GW Center for International Health Department of International Public Health School of Public Health and Health Services The George Washington University 2175 K Street, NW, Suite 820 Washington, DC 20037 Phone: 202-416-0426 Fax: 202-467-2290/202-994-0900

The UpFront section was edited by Lisa Shusterman, Assistant Editor of the Journal of Health Communication and Health Communication Research Associate at the Academy for Educational Development in Washington, DC.