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A Public Health Communication Planning Framework Claudia Parvanta 71157_CH02_019_038.qxd 9/8/10 2:12 PM Page 19 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION CHAPTER 2 A Public Health Communication Planning Framework Claudia Parvanta In this chapter, we introduce the example of the national LEARNING OBJECTIVES folic acid* campaign managed by the CDC and the National By the end of this chapter, the reader will be able to: Council on Folic Acid. The CDC and its partners launched ad- • Understand how health communication fits into the broader vocacy, health provider education, community partnerships, ecological model. and mass media efforts to increase the availability of foods for- • Select an overall approach to planning. tified with folic acid, as well as to increase consumption of folic • Identify the key elements of each core strategy based on best practices. acid supplements by any woman capable of becoming preg- • Identify stakeholder partnerships for a communication nant. We will come back to the national folic acid program intervention. throughout the textbook as an ongoing example that is un- • Create a macro plan for a health communication intervention. usual in scope and longevity. At the opposite end of the spectrum, many community or- ganizations or public health departments plan and execute INTRODUCTION: HEALTH COMMUNICATION IN small scale interventions on their own. These smaller efforts THE ECOLOGICAL MODEL must work within the limits set by their organizations (chiefly Referring back to the ecological model in Chapter 1, our budgetary), and address limited populations defined by specific health is affected by our physical environment and limiting factors (e.g., geography, health status, age, maternity status, or enabling factors created by our society, as well as our own ethnic identity, sexual orientation, church affiliation, school behavior and biology. Reciprocally, our physical condition attendance, sports team fans, etc.). Table 2–2 illustrates the and behavior affect the health and social welfare of others, levels of the ecological model and how communication might and we obviously affect the physical environment. Public be used to create or support a public health intervention. health experience has demonstrated that interventions con- Whether planning for a multilevel, multi-population com- ducted on multiple levels of the model are more effective munication program or a highly focused one, the basic plan- than those focusing solely on one level. Table 2–1 shows some ning process is the same. of the ways that the CDC used health communication to sup- port interventions directed at the different levels of the eco- logical model. A good example of a multilevel intervention is the tobacco *Folic acid is a B-vitamin that is essential to human health. It is required for the policy that addresses taxes on cigarettes, national advertising, body to make DNA and RNA, the blueprints for development of all cells. It is especially vital to a developing embryo because rapid cell division occurs early worksite activities, and the availability of medical cessation in fetal development. Consuming folic acid before conception and through the aids (e.g., nicotine gum, patches), presented in Chapter 1. first months of pregnancy will prevent 50-75% of neural tube defects. 71157_CH02_019_038.qxd 9/8/10 2:12 PM Page 20 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION 20 Chapter 2 A Public Health Communication Planning Framework TABLE 2–1 Health Communication at Different Ecological Levels in CDC Folic Acid Program Ecological Level Primary Intervention Communication Intervention Environmental Increase number and availability of foods forti- Advocacy to U.S. Food and Drug Administration fied with folic acid. (FDA). Increase fortification level to 400 µg of folic acid Education and advocacy to private-sector food in fortified cereals, bread, pasta, and other and vitamin supplement manufacturers. prepared foods. “Promotional support” for foods and vitamins Folic acid supplements or multivitamins could be containing 400 µg of folic acid. provided at low or no cost to all women. Societal Policies to promote consumption of folic acid Partner advocacy to federal and state decision prior to conception. makers. Regulations to define adequate fortification levels Partnership recruitment with national and com- in foods. munity organizations. More funding and resources should be committed Community, local health department support; to neural tube defect (NTD) prevention and media outreach. education. Health communication normative campaign to promote daily consumption of folic acid supplements—food sources inadequate. Organizational Educational and technical outreach to obstetri- Partnership training materials; educational mate- cians and gynecologists and pediatricians, con- rials for healthcare professionals, managed care, cerning reduced risk of NTDs with proper intake and insurance companies, and health advocacy of folic acid. Healthcare providers could encour- organizations. age women to consume folic acid, regardless of their plans for future pregnancies. Individual Health communication: education and persua- Multimedia campaigns using entertainment, sion to begin consuming 400 µg of folic acid daily public service announcements (PSAs), and print if pregnancy is possible. to reach target audiences. AN OVERALL APPROACH TO PLANNING: •A macro plan that includes analysis of the problem, the BIG WHEEL KEEP ON TURNING ecological setting, the core intervention strategy, and Health communication planning, execution, and evaluation the target population. are often depicted together as a circle to emphasize the ongo- – This stage of planning is normally undertaken after ing nature of program improvement. The National Cancer epidemiological data indicate there is a health prob- Institute1 uses the format shown in Figure 2–1. lem that affects specific groups of people. If there is Another way to look at this is to break down the complex evidence that a specific intervention has worked to planning process into several sub-plans, each with an inherent reduce this problem elsewhere, feasibility testing research task: might be conducted to adapt the intervention to the 71157_CH02_019_038.qxd 9/8/10 2:12 PM Page 21 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION An Overall Approach to Planning: Big Wheel Keep on Turning 21 TABLE 2–2 Communication Interventions in the Ecological Model Ecological Model Level Primary Intervention Communication Support State, national, global Policies, laws, treaties, “movements,”emergencies. Advocacy to create or maintain policy or law; na- Examples: U.S. seat belt law; EMPOWER tobacco tional and state specific reinforcement advertising; policy (World Health Organization); food fortifi- incentive programs; package warnings and labels; cation or enrichment regulations; small pox or government educational campaigns; social mobi- polio vaccination programs; border closing or lization, e.g., national immunization days; multi- quarantine to control epidemiological outbreak. media emergency information campaign to advise and calm public. Living and working Environmental conditions; hours; policies. Citizen or worker advocacy (multimedia) to im- conditions Examples: worker safety; time off and vacation prove conditions; awareness and promotion cam- policies; creation of walking paths; elimination of paigns for improved facilities, services; state or lead in gasoline, paint; availability of healthy food local lead education campaigns; private-sector choices, healthcare services. advertising for healthy food choices, services. Social, community, Social norms; elimination of social disparities; Grass roots campaigns; radio, TV, Internet, print family provision of community health and social ser- or locale- (e.g., church, bar) based social market- vices; cultural “rules” for group behavior. ing or promotional campaigns; opinion leaders Examples: Community Watch, day care, church and role models; PSAs; health fairs, small media ministries of health, volunteers. educational materials; reinforcement of norms through group processes. Individual behavior Acquisition of beliefs, attitudes, motivation, self- Multimedia decision aids; educational materials; efficacy, products, and services through social guidelines; promotional advertising; reinforce- marketing, behavior change communications, ment through home, healthcare providers, paid advertising, or psychological counseling. community. Individual biology, Prevention or treatment of illness; healthcare Behavior change communication to maintain or physiology provider visits; screening tests. establish good health habits; reminders for screen- ing; healthcare provider communication during office visits. new population. The less we know about the problem, precede finalization of the implementation plan that potential solution, or the intended audience, the more comes next. formative research must be done before taking the •An implementation (or tactical) plan that says what next planning steps. will be done, when, where, how, with what money, and •A strategic health communication plan that focuses who is responsible for every piece. on specific change objectives, audiences, messages, and – Process research is often conducted shortly after media. the launch of a program to make sure all operations – Concepts, messages, materials, and media strategies are running smoothly and that messages are get- are tested at this stage of planning. This “pretesting” ting out and being interpreted as planned. Cor-
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