The Drum Beat 324 - Health Communication vs. Related Disciplines

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This Drum Beat is one of a series of commentary and analysis pieces. Renata Schiavo, Healthcare Communications Consultant and Adjunct Assistant Professor of Public Health at New York University, compares "health communication" to related disciplines such as "health education" and "social marketing", suggesting that one of the distinctive features - as well as a definitive advantage - of the health communication approach is its multidisciplinary nature. This commentary draws on Dr. Schiavo's extensive experience in health communication. What follows is Dr. Schiavo's perspective - NOT that of any organisation or institution with which she is affiliated or that of The CI Partners collectively or individually.

We are interested in featuring a range of critical analysis commentaries of the communication for change field. These will appear regularly on the first Monday of each month and are meant to inspire dialogue throughout the month. Though we cannot guarantee to feature your commentary, as we have a limited number of issues to be published each year, if you wish to contribute please contact Deborah Heimann dheimann@comminit.com Many thanks!

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HEALTH COMMUNICATION VERSUS RELATED DISCIPLINES

[Copyright (c) 2005 by Renata Schiavo. May not be used without permission of the author. An iteration of this article will be included within a book by the author to be published in the future.]

Health communication is about improving health outcomes by encouraging behavioural modification and/or social change. It is increasingly considered an integral part of most public health interventions (Healthy People 2010; Bernhardt, 2004). However, there are a number of alternative or complementary approaches that also seek to have behavioural or social impact. In some cases, these approaches are part of the theoretical basis for health communication.

One of the most common inquiries by my students at New York University is related to the difference between health communication and health education or social marketing. This is also a very important question for neophytes in the field especially considering that the literature is quite ambiguous and somewhat controversial on this topic.

In my many years of health communication practice, I have observed that some of the academic definitions for health communication and other related disciplines become less distinct in their application in the private, non-profit and commercial worlds. In many cases, there is overlap of definitions and related applications.

I also believe that health communication practitioners should have a team oriented mindset while working with health educators, social marketers, and all other public health professionals who can contribute to the attainment of the social or behavioural goals of their communication intervention. Teamwork and mutual agreement on the intervention's ultimate objectives and expected results are keys to the successful design, implementation and impact of any programme. Still, there are a few fundamental differences between health communication and other related disciplines such as health education and social marketing. These differences are particularly important in programme planning and evaluation.

In my opinion, the most important difference - which is also the primary focus of this commentary - is that health communication is "transdisciplinary in nature" (IOM, 2003) and, as noted by other authors, draws upon multiple disciplines (Bernhardt, 2004; World Health Organization, 2003). Health communication recognises the complexity of attaining behaviour and social change and uses a multi-faceted approach that is grounded in the application of several theoretical frameworks and disciplines, including but not being limited to health education, social marketing, behavioural and social change theories. It draws upon principles that have been successfully used in the private and commercial sectors but also upon the audience-centred approach of other disciplines, such as psychology, sociology and anthropology (World Health Organization, 2003). It is less 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: 1) reach "people's hearts;" 2) secure their involvement in the health issue and, most importantly, its solutions and, 3) support and facilitate their journey on a path to better health.

This audience-centred approach is also common to health education and social marketing but perhaps goes a step further in health communication. Unlike health educators who focus primarily on changing health beliefs (Andreasen, A.R., 1995), communicators feel that educating target audiences about health issues is only the first step of a long-term audience-centred process. This process often requires theoretical flexibility to accommodate the needs of interested groups and audiences. It demands that communicators focus not only on channels, messages and tools but actually attempt to persuade, involve and create consensus and feelings of true ownership among interested audiences.

As in social marketing, target audiences and/or their reputable representatives are or should be involved in all steps of planning, testing and implementing key strategies, messages and activities. However, differently from social marketing, the planning framework for this process does not rely only on marketing techniques and theories but also on the application of more traditional communication models, such as the communication for persuasion theory (McGuire, W.J., 1984) and several other social science, mass communication and health education theories (NCI/NIH, 2002; IOM, 2003; Health Communication Partnership; World Health Organization, 2003). Finally, communication "products" are always intangible (for example, behavioural and/or social change in relation to immunisation or AIDS prevention practices), while social marketing products often include actual goods (for example, condoms, mosquito nets, vaccines, etc.) to be distributed, marketed and, in some cases, subsidised (Kotler, P. and Roberto, E.L., 1989).

Piotrow P.T. et al. (2003) 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 their clinics; 2) The field era, a more proactive approach emphasising outreach workers, community-based distribution, and a variety of information, education, and communication (IEC) products 3) The social marketing era, developed from the commercial concepts that consumers will buy the products they want at subsidised prices; and, 4) today, the era of strategic behavior communications, founded on behavioral science models that emphasise the need to influence social norms and policy environments as to facilitate and empower the iterative and dynamic process of both individual and social change." (Piotrow, P.T., et al., 2003, pages 1-2).

However, even in the context of strategic behaviour communications, many of the theoretical approaches of the different "eras" of health communication still find a use in programme planning or execution. For example, the situation analysis of a health communication programme uses primarily commercial and social marketing tools and models to analyse the environment in which change should occur. Instead, in the early stages of approaching key opinion leaders and other key stakeholders, keeping in mind McGuire's communication for persuasion steps (McGuire, W.J., 1984) may help communicators gain stakeholder support for the importance and/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 reach people's hearts and engage them in the communication process. It also sets health communication apart from other related disciplines and 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 organisations and authors. For example, a publication by the US National Institutes of Health, National Cancer Institute, rightly points to the importance of selecting planning frameworks - which could include social marketing, or the precede-proceed approach or others - that "can help [communicators] identify the social sciences theories most appropriate for understanding the problem and the situation (NIH/NCI, 2002)." These theories, models and constructs include several theoretical concepts and frameworks that are also used in motivating change at an individual level, interpersonal level, and/or organisation, community and societal level (NCI/NIH, 2002) by related or complementary disciplines.

With this, I am not advocating 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 programme are completed. This would allow communicators to take advantage of lessons learned and redefine theoretical constructs and communication objectives by comparing programme outcomes 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, in my experience, one of the keys to the success of well planned and executed communication programmes.

Renata Schiavo, Ph.D., M.A. Healthcare Communications Consultant Adjunct Assistant Professor of Public Health, New York University, Steinhardt School of Education, Department of Nutrition, Food Studies and Public Health, New York, NY, USA< renata@renataschiavo.com

Copyright (c) 2005 by Renata Schiavo. May not be used without permission of Author.

References

• Andreasen, A.R., (1995). Marketing Social Change: Changing Behavior to Promote Health, Social Development and the Environment. San Francisco, CA: Jossey- Bass, A Wiley Imprint.
• Bernhardt, J.M., (2004). Communication at the Core of Effective Public Health. American Journal of Public Health, 94 (12), 2051-2053.
• Health Communication Partnership (2005).
• Institute of Medicine (2003). Who Will Keep the Public Healthy? Washington DC: National Academy Press.
• Kotler, P. & Roberto, E.L., (1989). Social Marketing: Strategies for Changing Public Behavior. New York: The Free Press.
• McGuire, W.J., (1984). Public Communication as a Strategy for Inducing Health- Promoting Behavioral Change. Preventive Medicine, 13 (3), 299-313.
• National Cancer Institute, National Institute of Health (2002). Making Health Communication Programs Work.
• Piotrow, P.T., Rimon, J.G., Payne Merritt, A., & Saffittz, G., (2003). Advancing Health Communication: The PCS Experience in the Field. Center Publication 103. Baltimore: Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs.
• US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2005). Healthy People 2010. Chapter 11: Health Communication.
• World Health Organization, Mediterranean Center for Vulnerability Reduction (2003). Mobilizing for Action, Communication for Behavioral Impact (COMBI).

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Please participate in a Pulse Poll related to this commentary.

The main difference between health communication and health education or social marketing is that health communication is transdisciplinary in nature.

Do you agree or disagree?

VOTE and COMMENT

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RESULTS of past Pulse Poll

A global communication campaign will only be successful if there is already political activism and engagement on the issues being addressed.

Agree: 73.68%
Disagree: 21.05%
Unsure: 5.26%
Total number of participants = 19

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This issue of The Drum Beat is meant to inspire dialogue and conversation among the Drum Beat network.

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This issue of The Drum Beat is an opinion piece and has been written and signed by the individual writer. The views expressed herein are the perspective of the writer and are not necessarily reflective of the views or opinions of The Communication Initiative or any of The Communication Initiative Partners.

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