What Works in Health
Communications?
A Prevention Works! Resource Kit for the
National Prevention Network
Diffusion of Innovation
“Diffusion is the process by which an
innovation is communicated through
certain channels over time among the
members of a social system.”
—Everett M. Rogers, Diffusion of Innovations, 1983, p. 3
What Is Health Communications?
“The art and technique of informing, influencing,
and motivating individual, institutional, and public
audiences about important health issues. The scope
of health communication includes disease
prevention, health promotion, health care policy, and
the business of health care as well as enhancement of
the quality of life and health of individuals within the
community.”
Source: Healthy People 2010
What Is Health Communications?
“The study and use of communication
strategies to inform and influence individual
and community decisions that enhance
health.”
Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
What Is Social Marketing?
“The application of marketing principles and
techniques to program development,
implementation, and evaluation to promote
healthy behaviors or reduce risky ones.”
Source: Social Marketing Institute, www.social-marketing.org
What Is Social Marketing?
“Social marketing is...the design, implementation,
and control of programs developed to influence the
social acceptability of a social idea or cause by a
group. It has its roots in both commercial marketing
and social reform campaigns, such as the abolition of
slavery and campaigns for government regulation of
the quality of food and drugs.”
Source: CSAP’s Prevention Primer,
http://ncadi.samhsa.gov/govpubs/phd627/smarket.aspx
What’s the Difference?
• Social marketing typically encompasses
more extensive consumer market research,
with behavior change as the goal.*
• Communication can promote improved
health. But by itself it cannot cause
sustained behavior change.*
*Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
Social Marketing and Prevention
“Prevention practitioners working to communicate messages
to reduce alcohol, tobacco, and drug problems have embraced
techniques of social marketing as well as media advocacy as
part of an overall environmental approach to problem
reduction. In a society with heavy reliance on mass media and
a crowded message environment, the art of social marketing
can make a valuable contribution to prevention efforts.”
Source: CSAP’s Prevention Primer,
http://ncadi.samhsa.gov/govpubs/phd627/smarket.aspx
Importance of Health
Communications
“Health communication can contribute to all aspects
of disease prevention and control, health promotion,
and medical…care.
“Communication is critical to the work of health
professionals and their interactions with each other,
their patients, and the information they create and
use.”
Source: Communicating Health: Priorities and Strategies for Progress, Office of Disease
Prevention and Health Promotion, DHHS, July 2003
Importance of Working With Media
“The media’s powerful influence and ‘reach’
are indispensable for raising awareness,
altering beliefs and behavior, changing
community ‘norms,’ and affecting policy
decisions.”
Source: Strategizer 42, Building Public Support Through Media Relations, Community AntiDrug Coalitions of America, (undated)
The Bad News: What Communications
Cannot Do
• Make up for inadequate health care services
or access to services
• Produce sustained behavior change without
the support of other programs for change
• Be equally effective in addressing all issues
or relaying all messages.
Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
Why Communications Cannot
Be Equally Effective With All Issues...
Some topics or proposed behavior change may be
complex (e.g., use of disulfaram/antabuse); the
intended audience may have preconceptions about
the topic (e.g., “alcoholic”) or the messenger (e.g.,
Women’s Christian Temperance Union); the topic
may be controversial (e.g., methadone maintenance).
Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
What Communications Can Do
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Increase audience knowledge, awareness
Influence perceptions, beliefs, attitudes
Prompt action
Demonstrate/illustrate healthy skills
Reinforce knowledge, attitudes, behavior
Show benefits of behavior change.
What Communications Can Do
•
•
•
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Advocate a position on an issue/policy
Increase demand or support for services
Refute myths, misconceptions
Strengthen organizational relationships.
Communications Combined With
Other Strategies Can…
• Cause sustained change in individual
behavior, organizational policy
• Overcome barriers/systemic problems, such
as insufficient access to care.
Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
Communications Can Affect Multiple
Types of Change
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•
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•
Individuals
Groups
Organizations
Communities
Society.
Communications Can Include
Multiple Methods of Influence
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•
•
•
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Media literacy
Media advocacy
Public relations
Advertising
Educational entertainment
Individual/group instruction
Partnership development.
Source: Making Health Communication Programs Work, Rev. September 2002,
National Institutes of Health/National Cancer Institute
“The Four Ps”
of Social Marketing
• Product: Create an enticing product (the package
of benefits associated with the desired action)
• Price: Minimize the price the target audience
believes it must pay in the exchange
• Placement: Make the exchange and its
opportunities available in places that reach the
audience and fit its lifestyles
• Promotion: Promote the exchange opportunity
with creativity and through channels and tactics
that maximize desired responses.
Source: Social Marketing Institute, www.social-marketing.org
Four More “Ps” for
Social Marketing in Prevention
• Partnerships: Teaming up with other community
organizations that have similar goals
• Public relations: Fostering a public image that increases
public recognition of an agency, organization, or program
• Policy: Creating an environment that supports change over
the long term
• Politics: Building support within all sectors of the
community.
CSAP’s Communications Programs
and Initiatives
CSAP’s communications programs and
initiatives have both strong communications
and social marketing underpinnings.
CSAP follows the four-stage communications
planning process.
Rogers’s “Diffusion of Innovation”
Theory
6
5
4
3
2
1
1.
2.
3.
4.
5.
6.
Creating awareness.
Getting the facts.
Thinking about changing the behavior.
Examining the social consequences.
Changing the behavior.
Making a lifetime commitment to behavior change.
Some Audience Members Adopt
Change Sooner Than Others
34%
34%
Percentage of Adopters
35
30
25
20
16%
13.5%
15
10
5
2.5%
0
Innovators
Early
Adopters
Early
Majority
Time
Late
Majority
Laggards
Another Way To Visualize the Rate of
Change Among Audience Members
Four-Step Planning Process
1. Planning and Strategy Development
2. Developing and Pretesting Concepts,
Messages, and Materials
3. Implementing the Program
4. Assessing Effectiveness and Making
Refinements
Four-Step Planning Process Wheel
#1 Priority for Communications:
Make a Plan
“Alice came to a fork in the road. ‘Which
road do I take?’ she asked. ‘Where do you
want to go?’ responded the Cheshire cat. ‘I
don’t know,’ Alice answered. ‘Then,’ said the
cat, ‘It doesn’t much matter. If you don’t
know where you are going, any road will get
you there.’”
—Lewis Carroll, Alice in Wonderland, 1865
Put it in Writing!
A written plan helps identify and resolve gaps,
identifies available and needed resources, and
provides a roadmap to help you see where and
when to adjust your strategy over time.
Questions the Plan Should Answer
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What is the communications goal?
Who is the target audience?
What is the message for this audience?
Does the message/material work?
How will this plan be implemented?
How will you know if it works?
(evaluation)
Communications Successes in
Prevention
“Nearly half of all living adults who ever smoked
have quit. The anti-smoking campaign has been a
major public health success…. This achievement
has few parallels in the history of public health. It
was accomplished despite the addictive nature of
tobacco and the powerful economic forces
promoting its use.”
Source: “History of the 1964 Surgeon General’s Report on Smoking and Health,” CDC,
2004, http://www.cdc.gov/tobacco/30yrsgen.htm
Communications Successes in
Prevention
The National Youth Anti-Drug Media Campaign:
• The percentage of teens seeing/hearing messages
rose from 32 percent in 1998 to 52 percent in
2003.
• The number of teens who “learned a lot” from
anti-drug ads increased 65 percent, from one in
five to one in three, between 1998 and 2003.
Source: Partnership Attitude Tracking Study: Teens 2003, Partnership for a Drug-Free
America, http://www.drugfreeamerica.org/acrobat/Full_Report_PATS_Teens_2003.pdf
Communications Successes in
Prevention
In 1997, the Massachusetts Bureau of Substance Abuse
Services sponsored a paid radio public service announcement
to encourage parent-child communication about alcohol use.
In a followup study, respondents who recalled the spot were
much more likely to have three or more discussions about
alcohol with their children.
Source: Surkan, P.J.; DeJong, W.; Herr-Zaya, K.M.; Rodriguez-Howard, M.; Fay, K. A paid
radio advertising campaign to promote parent-child communication about alcohol, Journal
of Health Communication, Volume 8: 489-495, 2003
Communications Successes in
Prevention
The Washington State Division of Alcohol and Substance
Abuse targeted parents of kids ages 3–10 with a 1994–1995
media campaign. The results include the following:
• Nearly three in four parents recalled seeing or hearing
one of the three campaign ads.
• Parents who recalled the ads reported more frequent
discussions with their kids about alcohol than nonrecallers.
Source: GMA Research Corporation, Talking to Your Kids About Alcohol Ad Tracking
Study, Wave 2, Final Report, February 1995
Key Resources for Planning
Health Communications
“The Pink Book”
Making Health Communication Programs
Work, National Institutes of Health, National
Cancer Institute, Office of Cancer
Communications (2001)
http://cancer.gov/pinkbook
Key Resources for Planning
Health Communications
“Social Marketing Skills Training”
CSAP’s Central Center for the Application of
Prevention Technologies (CAPT)—offered as
an online training at:
www.ccapt.org/sm_skills.html
or on a CD-ROM:
www.ccapt.org/products.html
Key Resources for Planning
Health Communications
CDCynergy—an interactive training and
decision-support tool (CD-ROM format)
Centers for Disease Control and Prevention
(CDC), Office of Communication:
www.cdc.gov/communication/cdcynergy.htm
Key Resources for Planning
Health Communications
The Community Toolbox
Web site created and maintained by the Work Group
on Health Promotion and Community Development
at the University of Kansas in Lawrence, KS, in
collaboration with AHEC/Community Partners in
Amherst, MA, at:
http://ctb.ku.edu/