Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon, Ph.D. School of Media Arts

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Pushing the Boundaries of Health Communication
Trends and Challenges Rafael Obregon, Ph.D.
School of Media Arts StudiesCommunication
Development StudiesOhio UniversityRoskilde
University, DenmarkMay 4th, 2010
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Pushing the Boundaries of Health
Communication Trends and Challenges Rafael
Obregon School of Media Arts
StudiesCommunication Development StudiesWe
Have Met the Enemy and He Is PowerPointOhio
University, USACommunication for social
change Lessons learned from public
healthRoskilde University, DemarkMay 4th, 2010
We Have Met the Enemy and He Is PowerPoint
When we understand that slide, well have won
the war, General McChrystal, NY Times, April
27th, 2010
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Outline of Presentation

• A quick tour of international health
  communication experiences
• Health Communication and Communication for Social
  Change

• Trends and Challenges
• Conclusions

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A quick tour of international health
communication experiences
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Public Debate and Social Mobilization on HIV/AIDS
and Childrens 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

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Community Dialogue and Womens Rights and
Empowerment in the Amazon
Minga Peru

• Constructivism, interculturality and dialogue to
  address gender-based violence and promote womens
  rights

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

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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
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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

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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.
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News agendas and childrens rights in Brazil -
ANDI

• Media monitoring
• Social mobilization
• Capacity strengthening and editorial analysis

• Accountability
• Social control
• Media, democracy and governance

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What key concepts emerge from those experiences?

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

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Health Communication and Public Health
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The Public Health System
Institute of Medicine, Public Health in the 21st
Century, 2003
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Health Communication
Health Communication
Promotion of public health
Health care delivery
Mediated Communication
Interpersonal Communication
From http//www.drrangarajan.com/comm5000_6000/Cl
ass1-Notes.ppt.
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Health Promotion Principles
C O M M U N I C A T I O N

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

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

• Increase intended audiences 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
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Conceptual trends in communication for social
change and health communication
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C4D Continuum Approaches/Theories/Models (adapted
from Obregon Mosquera, 2005)
Diffusion/ Individual
Participatory/ Structural
Diffusion/ Persuasion/ Social Marketing
Information/ Education/ Communication
Behavior Change Communication
Communication For Social Change
Social Ecological Approach
Convergence model No magic formula
New conceptual approaches diversity of
frameworks diversity of strategies
multiplicity of interventions (Growth of the
field)
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Health Communication Continuum
Approaches/Theories/Models
(Adapted from Obregon Mosquera, 2005)

• 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/ Individual
Participatory/ Structural
Behavior Change Communication
Social Ecological Approach
Information/ Education/ Communication
C4D/HC
Communication For Social Change
Diffusion/ Persuasion/ Social Marketing
Diffusion/ Persuasion/ Social Marketing
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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

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Context the UNAIDS HIV/AIDS Communication
Framework
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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

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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

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• 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

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Trends in health communication practice
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Trends in HC practice

• Evaluate communication strategies and tactics and
  identify under which conditions they function
  more effectively
• Maximize resources/impact
• Identify strategies for synthesis and integration
  of multiple data sources
• Epi data Polio
• Socio-demographic data-marketing
  audiences/lifestyles
• Qualitative / ethnographic data /sense-making

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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

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Challenges in health communication theory and
practice
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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

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Challenges

• Addressing structural issues that determine
  peoples health or create vulnerability
• Responding to increased (donor) pressure on
  demonstrating impact of interventions
• Incorporating innovative evaluation methodologies
  - ethnographic approaches that provide deeper
  understanding of complexity of public health
  issues

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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

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Final thoughts

• Growth of health communication as field
  different approaches
• Expansion of health communication thinking and
  integration into broader development and social
  change issues

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• Social change starts with public debate
• Amartya Sen

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• Thank youtime for questions