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

Up Front 3,3

Vital Data

Announcements
 The Journal of Health Communication has relocated its editorial offices to the Academy for Educational Development in Washington, DC.  The new address of the Journal is: 1255 23rd Street, NW, Fourth Floor, Washington, DC 20037.  The Editor-in- Chief can be reached at 202-884-8145 (phone), 202-884-8844 (fax), and sratzan@aed.org.

A new Education and Evaluation Section in the Journal will highlight teaching, assessment, and feedback efforts in the fields of communication, medicine, and public health.  Gregory Makoul, Ph.D.,  from Northwestern University Medical School will edit this section. Submissions for consideration include articles on health communication curricula, communication skills training for health professionals, and strategies for teaching public health practitioners about topics such as social marketing.

From This Issue
The first three articles in this issue are a mini-series about the HIV/AIDS crisis and prevention efforts in Thailand.  The first article provides the background for the following two articles by describing government and community responses to the problem.  Makoul and Coan also delineate relevant cultural issues such as Thai distrust of Westerners and the importance of the commercial sex industry in the economics of Thailand.  The article also discusses how theory and practice can be integrated to produce effective AIDS prevention strategies.  The article ends with a current profile of
AIDS in Thailand which serves as a backdrop for the second article.  Makoul, D. E., Coan, D. L., Asia – The New Epidemic Zone for HIV/AIDS. (p. XXX)

In keeping with the practical emphasis of the Journal, the second article examines the application of the theories of diffusion of innovation and social marketing to HIV/AIDS prevention in Bangkok, Thailand.  The research showed that the 55 HIV/AIDS outreach programs in Bangkok did little targeting to unique populations.  The ten most unique programs targeted their audience on the basis of an average of 4.7 characteristics or high-risk factors. The ten most unique prevention programs in
Bangkok used audience segmentation, communication channel variety, resource management, and program development strategies in their operation.  Three additional concepts of diffusion – homophily, opinion leadership, and the innovation-decision process – were used to a greater extent by the more effective, uniquely targeted programs.  Socio-cultural factors that influenced the program effectiveness included environmental constraints, lack of visibility of HIV/AIDS, economic factors, and lack of local policy initiatives.  Svenkerud, P. J., Singhal, A., Enhancing the Effectiveness of HIV/AIDS Prevention Programs Targeted to Unique Population Groups in Thailand: Lessons Learned from Applying Concepts of Diffusion of Innovation and Social
Marketing.  (p. XXX)

 Also focusing on HIV/AIDS in Thailand, the third article provides a dialectical analysis of how Thai ideologies interact to perpetuate the sex industry and the transmission of HIV/AIDS. Chay-Nemeth explores how sex/women as a commodity implies freedom and un-freedom, equality and inequality, property and property-less, and Bethamism and exploitation.  The five prongs of the Thai National AIDS Program – sentinel surveillance, health education and public relations campaigns, condom-use
promotion, medical services to HIV/AIDS patients, and clinical, epidemiological  and social-behavioral research -- are described.  Finally, the author proposes solutions to the HIV/AIDS crisis including the use of low-risk populations to lobby for change, the formation of commercial sex worker unions, and the legalization of prostitution.  Chay-Nemeth, C., Demystifying AIDS in Thailand: A Dialectical Analysis of the Thai Sex Industry.  (p. XXX)

The fourth article turns the focus to physician-patient interactions in Oxford, England.  Makoul addresses the explanatory value of reliance and perceived control in medical encounters.  Data from 271 encounters between general practitioners and patients in Oxford were collected via videotapes, patient questionnaires, medical record reviews, and physician questionnaires.  The analysis indicates that physician-reliant patients tend to be older and from a more “working class” background than self-reliant patients.  The physician-reliant patients also had more externally-oriented outcome
expectations and tended to see physicians more often than did their self-reliant counterparts. The study also showed reciprocal determinism operating in medical encounters.  Despite their preference for patients who feel in control of their health, physicians tended to adapt to patients’ reliance orientation, sharing decisions with self-reliant patients and making decisions for physician-reliant patients.  Makoul, G. Perpetuating Passivity: Reliance and Reciprocal Determinism in Physician-Patient Interaction. (p. XXX)

The Forum piece presents an entertainment-education strategy used to influence Hollywood prime-time and daytime television programs to add story-lines on the importance of immunizations to their shows.  The strategy described by Glik et al., involves giving “log lines” and true stories about immunizations that could be used to inspire scripts that included immunization themes.  The authors gained entree and some air-time for their campaign agenda.  Embedded messages have aired on eight popular shows in the 1996-98 broadcast season, with five scheduled to air in the 1997-
98 season.  Glik, D., Berkanovic, E., Stone, K., Ibarra, L., Jones, MC, Rosen, B., Schreibman, M., Gordon, L., Minassian, L., Richardes, D. Health Education Goes to Hollywood: Working with Prime-time and Daytime Entertainment Television for Immunization Promotion.  (p. XXX)

From Other Sources
In the July 9 New England Journal of Medicine,  Timothy Johnson investigates the relationship between medicine and the media.  This article provides a brief history of medicine in the media, including some cases of misrepresentation.  The release of information to the media by the scientific and medical community and the role of journals in this information exchange is explored.  Next, the article examines the role of the medical journalist as a gatekeeper who controls the dissemination of medial information to the public.  Johnson concludes that the fraternity of medical journalists
should develop a system to ensure that future medical journalists have a certain knowledge base and are certified in a way that is recognized by employers and the public. Johnson, T. (1998) Shattuck lecture – Medicine and the media.  New England Journal of Medicine.  339(2): 87-92.

According to the June 3, JAMA, health behaviors only account for a small portion of the observed mortality differences between socioeconomic groups.  The study looked at the impact of education, income, and health behaviors –  including smoking, alcohol consumption, body weight, and degree of physical activity –  on mortality.  Controlling for age and other sociodemographic variables, the researchers found that those in the lowest-income category were more than three times as likely to
die during the follow-up period of the study than those in the highest income group.  They also found that while education was strongly related to health behaviors, income was more predictive of mortality than education.  Thus, the finding that health risk behaviors do not account for the higher mortality rate in lower socioeconomic groups suggest that interventions focused exclusively on individual risk behaviors have limited potential for reducing socioeconomic disparities in mortality.  Socioeconomic differentials in mortality would persist even with improved health behaviors.  Lantz,
P.M, et al. (1998) Socioeconomic Factors, Health Behaviors, and Mortality: Results from a nationally representative prospective study of US adults.  Journal of the American Medical Association.  279: 1703-1708

Social conversation during physician visits has a positive effect on patient satisfaction.  Some sick patients interpret reluctance to engage in social conversation as a lack of regard for them, leaving them less satisfied with a doctor’s visit.  These are the findings of a recent study supported by the Agency for Health Care Policy and Research.  The study showed that illness directly produced dissatisfaction, but it also showed that physicians’ use of social conversation seemed to be a mediating link between health and patient satisfaction.  Patients in better health received more social
conversation, which in turn influenced their higher rating of the physician’s psychosocial responsibleness and their satisfaction.  Hall, J.A., Milburn, M.A., Roter, D.L., Daltroy L.H. (1998).  Why are sicker patients less satisfied with their medical care? Tests of two explanatory models.  Health Psychology 17(1):70-75.

Internet Resources
HeartPoint is a comprehensive, useful, and attractive source of high-quality patient information on heart disease.  The goal of the site is to increase consumers’ understanding of the heart and to help prevent or reverse the complications of heart disease.  HeartPoint has seven major features: InfoCenter, Commentary, Food You Will Love, HeartPoint Gallery, In The News, Health Tips, and What's New.  The HeartPoint Gallery is a multimedia collection of presentations about the heart in health and in disease.  The Food You Will Love provides recipes for quick and easy heart-
healthy foods. The Commentary section contains professionals’ views on health care topics.  The Health Tips are information about managing one's health and health care.  HeartPoint can be found online at http://www.heartpoint.com/.

The Center for AIDS Prevention Studies’ (CAPS) website contains descriptions of AIDS prevention programs and research projects, fact sheets, news, and events.  The site is affiliated with the University of California, San Francisco, and sponsors and reports on multidisciplinary, community-based prevention programs and research.  Monographs and reports from the research are available on the site. A special feature of the site is a “Prevention Toolbox” which contains information on developing and evaluating prevention programs and survey instruments.  The site also has abstracts and some full-text articles about HIV prevention interventions and an overview of current behavioral research on risk-taking and risk-factors.  CAPS can be found online at
http://www.epibiostat.ucsf.edu/capsweb/.

The Health Commons Institute's website has tools, resources, and links for informed shared medical decision making.  HCI’s mission is to promote medical care that incorporates computerized information tools to improve collaboration between patients and doctors.  The site contains a discussion of different tools that facilitate shared decision making.  The site includes a newsletter, an online forum, and links to other health sites including: healthy communities, self-help, organization, project, and telemedicine sites.  HCI can be found at http://www.maine.com/hci/.

Upcoming Conferences and Events
The 126th annual American Public Health Association (APHA) meeting and exposition will be held November 15-19, 1998 in Washington, DC.  This year's theme “Public Health and Managed Care” focuses on how to provide quality care and assure access for all in today's changing health delivery environment.  Specific topics to be addressed include: ethical challenges, health economics, promoting consumer health and education, providing health care for all, and managed care and public health.  For more information, please visit the APHA Internet site at http://www.apha.org or call 202- 789-5620.  Information can also be obtained by writing to the APHA Convention
Services, 1015 Fifteenth St., NW, Washington, DC  20005.

The theme of the 1998 Society for Public Health Education (SOPHE) annual meeting is “Improving Health Through Advances in Education, Policy, Science, and Technology.”  The meeting will be held November 13-15, 1998 in Washington, DC.  Plenary and other thematic sessions will focus on the following topics: health policy and technology programs/evaluations, public health and media advocacy, ethical issues, advances in the prevention sciences, policy development, innovative communication strategies in health promotion, technology transfer/sharing, innovative policies for
health promotion practice, successful community/institutional partnerships.  For more information, please contact Aria Crump by phone at 301-405-2468 or by e-mail at adcrump@mindspring.com. 

TExpo’98 is hosting Inter@ctive Health, a Canadian telehealth conference focusing on quality care and improving access to health information and expertise.  The conference will be held in Fredericton, New Brunswick on October 4-7, 1998.  The four major themes of the conference are “Serving Community Needs,” “Canadian Experiences,” “Industry Perspectives,” and “Solutions to Issues.”  For more information, please call 1-888-701-7788 or visit TExpo’98 online at http://www.canarie.ca/health/texpo.

Publications
The First Amendment Center recently published Worlds Apart: How the Distance Between Science and Journalism Threatens America's Future.  This book by Hartz and Chappell provides a background on both science and journalism and discusses their strengths and weaknesses.  Through case analysis and discussions with the experts, the authors formulate recommendations for scientists and journalists to help close the growing gap between them.  Copies are available from the First Amendment Center by calling 1-800-830-3733 (publication #98-F02).

The Henry J. Kaiser Family Foundation recently released the results from their National Survey of Latinos on HIV/AIDS.  Results from this survey include that 46% of all Latinos say they are very worried about becoming infected with HIV, a level of worry which far exceeds that among a national sample of all Americans (24%) and 41% say their personal worry has grown in recent years.  In addition, 50% of Latinos rate AIDS as the nation's most urgent health problem and a third say they personally know someone who has HIV or AIDS or who died from AIDS.  Free copies of this publication in English (#1392) and in Spanish (#1393) are available by calling the Foundation's
publication request line at 1-800-656-4533.

The National Survey of African-Americans on HIV/AIDS results have also been released by the Henry J. Kaiser Family Foundation.  The study looked at the help and information needs of African-Americans.  Three-quarters of African Americans want help talking with kids about AIDS prevention.  Most (55%) want to know more about where to go for help if exposed to HIV. Close to half (46%) say more information about testing is needed.  Two in five (40%) want help with talking to partners about sex.  A quarter (27%) need to know more about how to properly use a condom.  Free copies of this publication (#1372)  are available by calling the Foundation's publication request line at 1-800-656-4533.
 

Prescriptions
 Svenkerud and Singhal’s study of the application of the theories of diffusion of innovation and social marketing to HIV/AIDS prevention in Bangkok, Thailand, led to the following suggestions.  To create effective HIV/AIDS outreach programs for unique population groups, program managers should:
              A.   consider the following about their target audience:
                         1.   the relationship between their socio-demographic characteristics
                               and high-risk behaviors.
                         2.   the communication channels (mass, group, interpersonal) they
                               have access to and consume on a day-to-day basis.
                         3.   individuals and organizations they respect and trust.
               B.   pay special attention to the following diffusion principles:
                         1.   ensuring homophily between the outreach workers and the clients.
                         2.   identifying opinion leaders among the client audience and
                               integrating their inputs in designing, conducting, validating, and
                               reinforcing the outreach efforts.
                         3.   assessing the innovation-decision stage of an individual to help
                               decide what channels would be most effective.

The dialectical analysis of how different Thai ideologies interact to enable the perpetuation of the sex industry and the transmission of HIV/AIDS by Chay-Nemeth resulted in the following procedures for designing a community-based AIDS education program:
               •    Collect data about local knowledge and daily behavioral practices that
                      directly or indirectly contribute to high-risk behaviors.  In-depth interviews
                      and focus groups conducted with members of the community are useful
                      during this data collection stage.
               •    Analyze the relationship between local concepts and behaviors, and the
                      spread of AIDS.  Pay close attention to how local groups form concepts of
                      gender, sexuality, and pleasure.  Focus also on family or community
                      practices that tend to exploit their members, placing them at high risk.
               •    List the groups directly or indirectly involved in perpetuating concepts and
                      practices that are related to high-risk behaviors.
               •    Through these focus groups, select community leaders who are respected
                      and credible.  Create messages and plan community projects with the
                      help of these leaders to educate the community about AIDS and reduce
                      high-risk related concepts and behaviors.  Whenever possible, use the
                      leaders to convey these messages and mobilize other community
                      members in projects that can reduce high-risk behaviors.

Makoul’s investigation of the explanatory value of reliance and perceived control in medical encounters resulted in the following prescriptions;
              •    Measuring patients’ reliance orientation (the extent to which they rely
                      upon physicians to make decisions for them) will enable researchers to
                      better understand the role of perceived control in the medical encounter
                      and to predict key aspects of health care such as degree of shared
                      decision-making and frequency of physician visits.
               •    Despite their preference for patients who feel in control of their health,
                      physicians tended to adapt to patients’ reliance orientation, sharing
                      decisions with self-reliant patients and making decisions for physician-
                      reliant patients.  Reliance was more strongly related to shared-decision
                      making than were physician attitudes or patient sociodemograpics.
               •    In terms of predicting utilization, physician-reliant patients made an
                      average of 82% more visits to their physicians than did self-reliant
                      patients.  These different utilization patterns were not related to health
                      status or problem seriousness, suggesting that reducing physician-
                      reliance has implications for both perceived control and actual cost.
               •    Physicians should be able to increase participation (i.e., reduce
                      physician-reliance) by encouraging patients to ask questions and offer
                      opinions, and by reinforcing these behaviors.  While the process of
                      encouraging participation may be associated with a short-term increase in
                      anxiety, it is likely to result in long-term health benefits.
               •    A dialogue between people involved in medical encounters, those
                      studying communication in the health context, and those focusing on
                      health outcomes will help advance research on reliance and reciprocal
                      determinism, an important step toward understanding and, perhaps,
                      breaking the cycle that perpetuates passivity.

From their experience in influencing Hollywood prime-time and daytime entertainment television to include messages about the importance of immunizations in their programming, Glik et al. developed guidelines for health communicators trying to influence the entertainment media to integrate specific health content into their shows.
               1.   Health communicators must study the unique structure, operation, and
                      interpersonal relationship networks that comprise the culture of the
                      entertainment field where entree is sought.
               2.   The health communicator must have something to contribute that is useful
                      to entertainment production workers.  In this case it was stories about
                      immunization that were used to stimulate the creative imagination of show
                      personnel, so they could write their own stories.
               3.   Health communicators cannot expect to have specific public health
                      messages or slogans portrayed literally in the entertainment media.
               4.   People like to think they are contributing to the greater good.  A public
                      health mission or agenda can fulfill this need.
              5.   Health communicators working in this area must document what they do,
                      who they have met, and what they have accomplished because this
                      becomes the basis for program evaluation and their ticket for credibility
                      among public health professionals, the entertainment community, and
                      potential funders.

If you would like to suggest materials for this section, please send your name,
email address, and fax and phone numbers to:
          Journal of Health Communication
          Academy for Educational Development
          1255 23rd Street, NW
          Washington, D.C. 20037
          Phone: 202-884-8145
          E-mail: jhc@aed.org
          Fax: 202-884-8844