Journal of Health Communication: International Perspectives
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for Information From This Issue The first article in this issue evaluates the effects of the Radio Communication Project (RCP) in Nepal on health-worker interpersonal skills and on the contraceptive behavior of clinic clients. Implemented in 1995, the RCP was designed to satisfy the large unmet need for contraception in Nepal and to improve the quality and utilization of reproductive health services. Entertainment-education radio programs were chosen as the main vehicles with which to address these goals. In this article, the authors discuss the effectiveness of the radio soap operas and distance education serials. The authors implement a variety of techniques for evaluating the program, including three-wave observations of female client-provider interactions at service delivery sites, pre- and post-panel surveys of married women, and client exit interviews at clinics. The authors conclude that both clients and providers appear to have learned how to interact more effectively with each other from listening to the radio entertainment-education programs, and indirectly, contraceptive use has increased. The messages promoted in the radio programs reinforced the acceptability of family planning in the community and positively enhanced the perceptions of health care workers. Storey, D., Karki, Y., Heckert, K., Karmacharya, D.M., Boulay, M. Impact of the Integrated Radio Communication Project in Nepal, 1994-1997. The second article examines audience responses Mexican-American and Anglo college-age men and women to certain types of televised drinking and driving warnings. Individualist versus collectivist messages (emphasizing risks to self versus risks to family and friends) and high or low power distance in messages (acceptance of an authoritative power, such as the Surgeon General in alcohol messages) were studied to measure the relationship between gender and ethnicity in the response to the warnings. Despite the individualistic nature of the U.S. and among participants, respondents, regardless of gender or ethnicity, responded more positively to collectivist drinking and driving warnings (those that mentioned consequences to family and friends over self). Females rated their concern of the risk from others’ alcohol use higher than males after both types of warnings, while males rated their concern higher after individualist warnings. Mexican-Americans rated alcohol warnings more believable with the Surgeon General as the source (high power distance) than without, while Anglo respondents rated the warnings with the Surgeon General as the source as less credible. The authors conclude that the context in which risk messages are framed has a significant impact on their effectiveness. Perea, A., Slater, M. Power Distance and Collectivist/Individualist Strategies in Alcohol Warnings: Effects by Gender and Ethnicity. In the third article, the authors assess how various formats for disseminating information on the risks of colorectal cancer (CRC) affect older men’s and women’s perceptions of the disease. Participants in the study received information on the nature of CRC, different screening tests, and the absolute lifetime risk of getting CRC. Some participants randomly received information comparing the incidence of CRC to other cancers, while other participants received risk factor information for CRC. The older men and women who received risk factor information increased their perceived absolute risk of getting CRC and were more likely to believe age was related to getting CRC than those who did not receive this information. Nonetheless, results indicated that none of these experimental information manipulations affected participants’ anxiety about getting CRC or their screening intentions. The authors conclude that CRC screening interventions can be made more trustworthy by including specific risk factor information, and thus would lead to increased awareness. Lipkus, I.M., Crawford, Y., Fenn, K., Biradavolu, M., Binder, R.A. Testing Different Formats for Communicating Colorectal Cancer Risk. The authors in the fourth article provide insight into the job market for health communication practitioners. Employers of health communication practitioners were interviewed by phone and asked to identify employment outlook, desired knowledge and skills, and necessary training for the field. According to the respondents, health communication practitioners will enjoy an expanded and more diverse job market before the year 2000. Employers anticipate the need to hire more people and to add new responsibilities to existing departments. Good oral communication skills and writing skills are the most important characteristics for the field; however, additional, more specialized skills may be strongly desired depending on the particular job’s responsibilities. In addition, employers emphasized that entry-level candidates consider volunteer work or internships before applying for permanent positions because workers with multiple years of experience are in higher demand. Fowler, K, Celebuski, C., Edgar, T., Kroger, F., Ratzan, S. An Assessment of the Health Communication Job Market across Multiple Types of Organizations. In the forum article, the impact of the mass media on consumer perception and behavior is highlighted. During 1995-1999 in Belgium, numerous messages linking meat consumption with dangerous health risks pervaded in the media. Consequently, fresh meat consumption fell considerably during that period of time. The authors surveyed meat consumers on their consumer behavior, attitude toward mass media and health information, and health concerns related to meat consumption. Results indicated that mass media coverage has a highly negative influence on consumer behavior and decision-making. The authors argue that mass media has a social responsibility to spread accurate information to the public. In addition, the meat industry should be obligated to supply the public with a safe product and should reorient itself to restoring its image. The authors advocate a health communication “systems” approach—a collaboration with the meat industry and government—for dealing with any crises in the future. Verbeke, W., Viaene, J., Guiot, O. Health Communication and Consumer Behavior on Meat in Belgium: From BSE until Dioxin. Cultural conceptions play a vital role in how the public views certain health issues. In the American Journal of Public Health, Link, et al. examine the public conceptions related to mental illnesses and the perceived causes, dangerousness, and desired social distance. The authors use nationwide survey data from a 1996 General Social Survey from a vignette experiment. Respondents were randomly assigned a story that described a psychiatric disorder and then queried about the potential causes of the situation, labels for the problem, perceived violence risk, and willingness to interact with the described person. The authors conclude that the majority of the public identifies schizophrenia and major depression as mental illnesses, caused by multiple factors including stressful circumstances and genetic factors. A much smaller number of respondents associated alcohol or drug abuse with mental illness. While the public’s recognition of mental illness and its causes are reason for optimism, a strong stereotype of dangerousness and desire for social distance persist. Bruce, B.G., Phelam, J.C., Bresnahan, M., Stueve, A., and Pescosolido, B.A. Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. American Journal of Public Health 89(9), 1328-1333. In Tobacco Control, Perry, et al. evaluates an entertainment-education theater program to teach children about the dangers of smoking. The “2 Smart 2 Start” intervention consists of two 30-minute plays performed for children in grades K-3 and 4-6, respectively. The plays emphasize the negative consequences of smoking. After the plays, the teachers worked with the students on follow-up activities, and materials were sent home with the children to work on with their parents. Perry, et al. evaluates the impact of the plays with a pre- and post-intervention questionnaire. The results indicated that after the intervention the students in grades 4-6 were more likely to respond that they would never smoke than before. Students in grades 4-6 also had significantly more negative attitudes and expected outcomes of smoking, and more reasons not to smoke as a result of the production. While the results reported are short term, psychosocial factors such as attitudes towards smoking form the basis of beliefs that increase a child’s risk of smoking in the future. Perry, C., Komro, K.A., Dudovitz, B., Veblen-Mortenson, S., Jeddoloh, R., Koele, R., Gallanar, I., Farbakhsh, K., and Stigler, M.H. An Evaluation of a Theatre Production to Encourage Non-Smoking among Elementary Age Children: 2 Smart 2 Smoke. Tobacco Control 8, 169-174. In Morbidity and Mortality Weekly Report, a framework for program evaluation in public health is outlined. The report emphasizes the importance of integrating evaluation with routine program practices. The steps in a good evaluation practice, which are described in more detail in the report are to engage the stakeholders, describe the program, focus the evaluation design, gather credible evidence, justify conclusions, and share the lessons learned from the evaluation. The framework described is a practical approach to evaluation that is based on steps and standards applicable in public health settings. Most importantly, it provides a guide for designing and conducting specific evaluation projects across many different program areas. Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health. MMWR, 48 (No. RR-11). Upcoming Conferences and Events The Healthy People Consortium and Partnerships for Networked Consumer Health Information will be sponsoring a conference, January 24-28, 2000, to launch the Nation’s prevention agenda, Healthy People 2010. The conference, “Partnerships for Health in the New Millennium: Launching Health People 2010,” will be held at the Omni Shoreham Hotel in Washington, DC. The four themes of the conference are partnering for health improvements, eliminating health disparities, increasing quality and years of health life, and harnessing technology for health. For more information, visit the conference's website at http://www.health.gov/partnerships/. The Seventeenth Annual Intercultural Communication Conference (ICC2000) will take place on February 4-5, 2000 at the University of Miami in Coral Gables, Florida. For more information, contact Gayle Remer at gremer@miami.edu. The “QHR2000: The Sixth Annual Qualitative Health Research Conference” will be held on April 6-8, 2000 in Banff, Alberta, Canada. The conference is sponsored by the International Institute for Qualitative Methodology and the University of Alberta. For more information, visit http://www.ualberta.ca/~iiqm/qhr2000/index.html. The Centers for Disease Control is sponsoring the International Conference on Emerging Infectious Diseases on July 16-19, 2000 at the Atlanta Marriott Marquis Hotel in Atlanta, Georgia. For information on the conference and call for abstracts, contact ICEID management at 202-942-9248 or meetinginfo@asmusa.org or visit the conference website at http://www.cdc.gov/ncidod/iceid2k.htm. A new exhibit, “The Changing Face of Women’s Health,” is on display starting October 9, 1999 at SciTrek in downtown Atlanta. The Atlanta location is kicking off the exhibit’s five-year national tour to nine major U.S. cities. The national sponsors of the exhibit are the Centers for Disease Control and Prevention, National Institutes of Health, Metropolitan Life foundation, and Pfizer Women’s Health. Among other topics, the exhibit focuses on the latest in modern health care advances for women, historical landmarks in women’s health, and women in medicine. The exhibit, the first major touring presentation dedicated solely to women’s health issues, embraces the concepts that women’s health issues are created and shaped by society, biology, and personal behavior. The journal, Tobacco Control, is now on-line. Tobacco Control is a quarterly scientific journal which publishes articles on all aspects of tobacco control and prevention, including the evaluation of smoking prevention programs and the effectiveness of industry advertising. At this time, the full-text of the articles from the Spring 1998 issue to the present is available free on-line. Information on the journal, access to the articles, and keyword search capabilities can be found at http://www.tobaccocontrol.com/. The United Nations Development Programme (UNDP) has recently added its Technology Revolution Study on the Internet. The study highlights the state of information technology and telecommunications worldwide. While technology holds great promise for progress in the future, an enormous divide among industrialized and developing countries exists in technology resources. The study, Communications and Knowledge-Based Technologies For Sustainable Human Development, can be read at http://www.undp.org/comm/index.html. The Kaiser Family Foundation has released its findings from focus groups it conducted this past year on perceptions of minority groups and the health care system. The report, Perceptions of How Race and Ethnic Background Affect Medical Care: Highlights from Focus Groups, describes how minority consumers with experience in the health care system in the last two years believe that several forms of discrimination exist in the health care system. The minority consumers perceive that health care professionals hold negative stereotypes of minority patients and that health care professionals have a lack of concern for these patients. Doctors, nurses, and hospital administrators interviewed place value on cultural competency training and hiring a bilingual staff, but not all hospitals could afford these. A copy of this report can be obtained by calling the Kaiser Family Foundation publication request line at 800-656-4533. The Centers for Disease Control and Prevention has recently released
two state-specific reports on tobacco use, one highlighting the severity
of the public health problem and the other presenting recommendations
for programs to solve it. The first report, State Tobacco Control
Highlights, 1999, summarizes information on tobacco use in all 50 states
and the District of Columbia, while the second report, Best Practices
for Comprehensive Tobacco Control Programs, provides states with recommended
strategies for prevention programs. The Best Practices guidelines
address nine components of comprehensive tobacco control programs: community
programs, chronic disease programs, school programs, enforcement, statewide
programs, counter-marketing, cessation programs, surveillance and evaluation,
and administration and management. Copies of the reports are available
free of charge from the Office on Smoking and Health at 770-488-5705 or
on-line at http://www.cdc.gov/tobacco.
Storey, Karki, Heckert, Karmacharya, and Boulay analysed the impact of the first year of two complementary reproductive health radio dramas in Nepal, one for the general public aimed at increasing demand for higher quality health services and another distance education serial for rural health workers aimed at increasing their interpersonal communication and counseling skills. Analysis of the project suggests the following recommendations for health communication campaigns:
—D. Storey, Y. Karki., K. Heckert, D. M. Karmacharya, and M. Boulay Perea and Slater examine how gender and ethnicity affect the responses of college-age men and women to televised drinking and driving warnings. From their results, they make the following recommendations for health messages on television:
—A. Perea and M. Slater Lipkus, Crawford, Fenn, Biradavolu, Binder conduct research on various formats of information dissemination on colorectal cancer. The following implications are derived from their study:
—I. M. Lipkus, Y. Crawford, K. Fenn, M. Biradavolu, and R. A., Binder Fowler, Celebuski, Edgar, Kroger, and Ratzan studied the health communication job market across multiple types of organizations to determine the employment outlook for health communication practitioners and to gain insight into the knowledge, skills, and academic training necessary to be a competent health communication practitioner. The results of the study suggest:
—K. Fowler, C. Celubuski, T. Edgar, F. Kroger, and S. Ratzan In the forum article, Verbeke, Viaene, and Guiot discuss the role of mass media in spreading health information about meat and its impact on consumer behavior. Based on insights from literature, recent empirical research and the Belgian experience with the BSE- and dioxin-crisis, the authors suggest the following:
—W, Verbeke, J. Viaene, and O. Guiot The Up Front section is edited by Lisa Shusterman, Assistant Editor of the Journal of Health Communication and Program Associate in Health, Nutrition, and Population at the Academy for Educational Development in Washington, DC. You are enthusiastically invited to suggest items for inclusion in "Up Front!" Please adhere to our guidelines by providing the following information:
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