Samenvatting literatuur Gezondheid, Media en Publiek:
Schiavo – Health Communication From Theory to Practice (2013):
Defining Health Communication
There are several definitions of health communication. For the most part, all of them point to a
similar role of this approach in the process of advocating for and improving individual or public
health outcomes.
What Is Communication?
Communication is defined in this way: ‘1. Exchange of information, between individuals, for example,
by means of speaking, writing, or using a common system of signs and behaviors; 2. Message – a
spoken or written message; 3. Act of communicating; 4. Rapport – a sense of mutual understanding
and sympathy; 5. Access – a means of access or communication, for example, a connecting door’.
In fact, all of these meanings can help define the modalities of well-designed health communication
programs. Health communication should be based on a two-way exchange of information that uses a
‘common system of signs and behaviors’. It should be accessible and create ‘mutual feelings of
understanding and sympathy’ among members of the communication team and intended audiences
(all audiences the health communication program is seeking to influence and engage in the
communication process; also referred to as target audiences). Finally, communication channels (the
means or path used to reach intended audiences with health communication messages and
materials) and messages are the ‘connecting doors’ that allow health communication interventions
to reach intended audiences.
Health Communication Defined
One of the key objectives of health communication is to influence individuals and communities. The
goal is admirable since health communication aims to improve health outcomes by sharing health-
related information. In fact, the Centers for Disease Control and Prevention (CDC) define health
communication as ‘the study and use of communication strategies to inform and influence individual
and community decisions that enhance health’. The word influence is also included in the Healthy
People 2010 definition of health communication as ‘the art and technique of informing, influencing,
and motivating individual, institutional, and public audiences about important health issues’.
Another important role of communication is to create a receptive and favorable environment in
which information can be shared, understood, absorbed, and discussed by the program’s intended
audiences. This requires an in-depth understanding of the needs, beliefs, taboos, attitudes, lifestyle,
and social norms of all key communication audiences. It also demands that communication is based
on messages that are easily understood. This is well characterized in the definition of communication
by Pearson and Nelson, who view it as ‘the process of understanding and sharing meanings’.
In communication, understanding the context of the communication effort is interdependent with
becoming familiar with target audiences. This increases the likelihood that all meanings are shared
and understood in the way communicators intended them. Therefore, communication, especially
about life-and-death matters such as in health care, is a long-term strategic process. It requires a true
understanding of target audiences as well as the communicator’s willingness and ability to adapt and
redefine the goals, strategies, and activities of communication on the basis of audience feedback.
,Health communication interventions have been successfully used for many years by nonprofit
organizations, the commercial sector, and others to advance public, corporate, or product-related
goals in relation to health. Health communication draws from numerous disciplines, including health
education, mass and speech communication, marketing, social marketing, psychology, anthropology
and sociology. It relies on different communication activities or action areas, including interpersonal
communications, public relations, public advocacy, community mobilization, and professional
communications.
Another important attribute of health communication should be ‘to support and sustain change’. In
fact, key elements of successful health communication programs or campaigns always include long-
term program sustainability, as well as the development of communication tools and steps that make
it easy for individuals, communities, and other audiences to adopt or sustain a recommended
behavior, practice, or policy change. If we integrate this practice-based perspective with many of the
definitions, the following new definition emerges: ‘health communication is a multifaceted and
multidisciplinary approach to reach different audiences and share health-related information with
the goal of influencing, engaging, and supporting individuals, communities, health professionals,
special groups, policymakers and the public to champion, introduce, adopt, or sustain a behavior,
practice, or policy that will ultimately improve health outcomes.
Health Communication in the Twenty-First Century: Key Characteristics and Defining Features
Health communication theory draws on a number of additional disciplines and models. Health
communication and its theoretical basis have evolved and changed in the past 50 years.
Most important, communicators are no longer viewed as those who write press releases and other
media-related communications, but as fundamental members of the public health or health industry
teams. Communication is no longer considered a skill but a science-based discipline that requires
training and passion and relies on the use of different vehicles (materials, activities, events, and other
tools used to deliver a message through communication channels) and channels.
As a result, there is an increasing understanding that ‘the level of technical competence of
communication practitioners can affect outcomes. A structured approach to health communications
planning, a spotless program execution and a rigorous evaluation process are the result of adequate
training. In health communication, the learning process is a lifetime endeavor and should be
facilitated by the continuous development of new training initiatives and tools’. Training may start in
the academic setting but should always be influenced and complemented by practical experience and
observations, as well as other learning and training opportunities, including in-service training and
continuing professional education.
Health communication can reach its highest potential when it is discussed and applied within a team-
oriented context that includes many other health care and public health professionals.
Finally, it is important to remember that there is no magic bullet that can address health issues.
Health communication is an evolving discipline and should always seek to incorporate lessons
learned as well to use a multidisciplinary approach to all interventions. This is in line with one of the
fundamental premises of this book that recognizes the experience of practitioners as a key factor in
developing theories, models, and approaches that should guide and inform health communication
planning and management.
Audience Centered
,Health communication is a long-term process that begins and ends with the audience’s desires and
needs. In health communication, the audience is not merely a target but an active participant in the
process of analyzing the health issue and finding culturally appropriate and cost-effective solutions. It
is a common practice in health communication not only to research intended audiences and other
key constituencies but also to strive to engage them in defining and implementing key strategies and
activities. This is often accomplished by working together with organizations and leaders who
represent them.
Research Based
Health communication is grounded in research. Successful health communication programs are
based on a true understanding not only of the intended audience but also of the situational
environment. This includes existing programs and lessons learned, policies, social norms, key issues,
and obstacles in addressing the specific health problem.
The overall premise of health communication is that behavioral change is conditioned by the
environment in which people live, as well as by those who influence them. Creating a receptive
environment in which the target audience can discuss a health issue and be supported in its intention
to change by key influential is often one of the aims of health communication programs. This requires
a comprehensive research approach that relies primarily on traditional research techniques for the
formal development of a situation analysis (a planning term that describes the analysis of individual,
social, political, and behavior-related factors that can affect attitudes, behaviors, social norms, and
policies about a health issue) and audience profile (a comprehensive, research-based, and strategic
description of all key audiences’ characteristics, demographics, needs, values, attitudes, and
behavior). Situation analysis and audience profile are fundamental and interrelated steps of health
communication planning.
Multidisciplinary
Health communication is ‘transdisciplinary in nature’ and draws on multiple disciplines. Health
communication recognizes the complexity of attaining behavioral and social change and uses a
multifaceted approach that is grounded in the application of several theoretical frameworks and
disciplines, including health education, social marketing, and behavioral and social change theories. It
draws on principles successfully used in the private and commercial sectors and also on the
audience-centered approach of other disciplines. It is not anchored to a single specific theory or
model. With the audience always at the core of each intervention, it uses a case-by-case approach in
selecting those models, theories, and strategies that are best suited to reach people’s hearts; secure
their involvement in the health issue, and, most important, its solutions; and support and facilitate
their journey on a path to better health.
Piotrow, Rimon, Payne Merritt, and Saffitz identify 4 different ‘eras’ of health communication: ‘(1) the
clinic era, based on a medical care model and the notion that if people knew where services were
located they would find their way to the clinics; (2) the field era, a more proactive approach
emphasizing outreach workers, community-based distribution, and a variety of information,
education, and communication product; (3) the social marketing era, developed from the commercial
concepts that consumers will buy the products they want at subsidized prices; and, (4) today, the era
of strategic behavior communications, founded on behavioral science models that emphasize the
need to influence social norms and policy environments to facilitate and empower the iterative and
dynamic process of both individual and social change’.
, However, even in the context of strategic behavior communications, many of the theoretical
approaches of the different eras of health communication still find a use in program planning or
execution. For example, the situation analysis of a health communication program uses primarily
commercial and social marketing tools and models to analyze the environment in which change
should occur. Instead, in the early stages of approaching key opinion leaders and other key
stakeholders (individuals and groups who have an interest or share responsibilities in a given health
issue), keeping in mind McGuire’s communication for persuasion steps may help communicators gain
stakeholder support for the importance or the urgency of adequately addressing a health issue. This
theoretical flexibility should keep communicators focused on their audiences and always on the
lookout for the best approach and planning framework to influence people’s core beliefs and
behaviors and engage them in the communication process. In concert with the other features
previously discussed, it also enables the overall communication process to be truly fluid and suited to
respond to audiences’ needs.
The importance of a somewhat flexible theoretical basis, which should be selected on a case-by-case
basis, is already supported by reputable organizations and authors. These theories, models, and
constructs include several theoretical concepts and frameworks that are also used in motivating
change at an individual level, interpersonal level, or organizational, community, and societal level by
related or complementary disciplines.
The goal here is not to advocate for a lack of theoretical structure in communication planning and
execution. On the contrary, planning frameworks, models, and theories should be consistent at least
until preliminary steps of the evaluation phase of a program are completed. This allows
communicators to take advantage of lessons learned and redefine theoretical constructs and
communication objectives (the intermediate steps that need to be achieved in order to meet
program goals and outcome objectives) by comparing program outcomes, which measure changes in
knowledge, attitudes, skills, behavior, and other parameters, with those that were anticipated in the
planning phase. However, the ability to draw on multiple disciplines and theoretical constructs is a
definitive advantage of the health communication approach and one of the keys to the success of
well-planned and well-executed communication programs.
Strategic
Health communication programs need to display a sound strategy and plan of action. All activities
need to be well planned and respond to a specific audience-related need.
Communication strategies (the overall approach that is used to accomplish the communication
objectives) need to be research based, and all activities should serve such strategies. Therefore,
program planners should not rely on any workshop, press release, brochure, video, or anything else
to provide effective communication without making sure that their content and format reflect the
selected approach and is a priority in reaching the audience’s heart. For this purpose, health
communication strategies need to respond to an actual need that has been identified by preliminary
research and confirmed by the intended audience.
Process Oriented
Communication is a long-term process. Influencing people and their behaviors requires an ongoing
commitment to the health issue and its solutions. This is rooted in a deep understanding of target
audiences and their environments and aims at building consensus among audience members about
the potential plan of action.
