Schiavo.ffirs 2/19/07 1:34 PM Page iii Health Communication From Theory to Practice Renata Schiavo John Wiley & Sons, Inc. Schiavo.ffirs 2/19/07 1:34 PM Page ii Schiavo.ffirs 2/19/07 1:34 PM Page i Health Communication From Theory to Practice Schiavo.ffirs 2/19/07 1:34 PM Page ii Schiavo.ffirs 2/19/07 1:34 PM Page iii Health Communication From Theory to Practice Renata Schiavo John Wiley & Sons, Inc. Schiavo.ffirs 2/19/07 1:34 PM Page iv Copyright © 2007 by Renata Schiavo. All rights reserved. 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W 84.1 S329h 2007] R118.S33 2007 610.1'4—dc22 2006101792 Printed in the United States of America FIRST EDITION PB Printing 10987654321 Schiavo.ftoc 2/19/07 1:35 PM Page v Contents Tables, Figures, Exhibits, and Numbered Boxes vii Preface xi Acknowledgments xv About the Author xvii Introduction xix PART ONE: INTRODUCTION TO HEALTH COMMUNICATION 1 1 What Is Health Communication? 3 2 Current Health Communication Theories and Issues 30 3 Cultural, Gender, Ethnic, Religious, and Geographical Influences on Conceptions of Health and Illness 71 PART TWO: HEALTH COMMUNICATION APPROACHES AND ACTION AREAS 89 4 Interpersonal Communications 91 5 Public Relations and Public Advocacy 121 6 Community Mobilization 147 7 Professional Medical Communications 175 8 Constituency Relations in Health Communication 198 PART THREE: PLANNING, IMPLEMENTING, AND EVALUATING A HEALTH COMMUNICATION PROGRAM 213 9 Overview of the Health Communication Planning Process 215 10 Situation Analysis and Audience Profile 237 v Schiavo.ftoc 2/19/07 1:35 PM Page vi vi CONTENTS 11 Identifying Program Objectives and Strategies 281 12 Developing Tactical and Evaluation Plans 298 13 Implementing, Monitoring, and Evaluating a Health Communication Program 336 Appendix A: Examples of Worksheets and Resources on Health Communication Planning 353 Appendix B: Selected Online Resources on Health Communication 363 Glossary 371 References 379 Name Index 413 Subject Index 419 Schiavo.ftoc 2/19/07 1:35 PM Page vii Tables, Figures, Exhibits, and Numbered Boxes Tables 1.1 Health Communication Definitions 8 1.2 Key Characteristics of Health Communication 12 1.3 What Health Communication Can and Cannot Do 27 3.1 A Comparative Overview of Ideas of Health and Illness 79 3.2 Examples of Disease-Specific Ideas of Illness 83 4.1 Comparing Cultural Norms and Values 94 4.2 Barriers to Effective Provider-Patient Communications: Patient Factors 111 5.1 Public Relations Functions in Health Care 123 5.2 Characteristics of Types Relevant to Public Relations 125 5.3 Key Characteristics of Ethical Public Relations Programs 130 5.4 Dos and Don’ts of Media Relations 136 5.5 Mass Media Channels and Related Public Relations Tools 139 7.1 Key Audiences of Professional Medical Communications 178 7.2 Key Obstacles to Clinician Change 184 7.3 Communication Approaches and Tools and Their Effects 188 7.4 Key Communications Tools and Channels in Professional Communications 193 vii Schiavo.ftoc 2/19/07 1:35 PM Page viii viii TABLES, FIGURES, EXHIBITS, AND NUMBERED BOXES 8.1 Guidelines for Establishing and Preserving Long-Term Relationships 205 8.2 Potential Drawbacks of Partnerships 208 9.1 Key Elements of an Effective Health Communication Program 227 10.1 Qualitative Versus Quantitative Research Methods 266 10.2 Frequency of Explicit Criteria for Evaluation of Health-Related Web Sites by Criteria Groups 271 12.1 Examples of Communication Concepts for a Program on Childhood Immunization 309 12.2 Key Elements of a Partnership Plan 321 12.3 Drawbacks of Evaluation 328 13.1 Examples of Areas of Monitoring with Related Data Collection and Reporting Methods 344 Figures 1.1 Health Communication Environment 23 2.1 Attributes of the Audience 34 2.2 Ideation Theory 42 4.1 The Potential Impact of Interpersonal Communications on Behavior: A Practical Example 99 9.1 Health Communication Cycle 221 9.2 Key Steps of Health Communication Planning 223 10.1 Key Steps of Situation Analysis 241 Exhibits 9.1 Examples of Outcome Objectives for a Program on Pediatric Asthma 234 10.1 Audience Segmentation Example 250 10.2 SWOT Analysis for the Caribbean Cervical Cancer Prevention and Control Project 264 Schiavo.ftoc 2/19/07 1:35 PM Page ix TABLES, FIGURES, EXHIBITS, AND NUMBERED BOXES ix 11.1 Sample Communication Objectives: Understanding the Connection with Other Program Elements 286 Numbered Boxes 2.1 Diffusion of Innovation Theory: A Practical Example 35 2.2 Raising Awareness of Infant Mortality Disparities in San Francisco 48 4.1 Personal Selling Case Study 102 4.2 The Impact of Effective Provider-Patient Communications on Patient Outcomes: A Pediatric Nurse Practitioner’s Perspective 106 4.3 Impact of Physician Attitudes on Patient Behavior: A True Story 108 5.1 Johnson & Johnson’s Campaign for Nursing’s Future Initiative 127 5.2 Using the Internet as a Key Public Relations Channel: The Schepens Eye Research Institute 131 6.1 Social Mobilization to Fight Ebola in Yambio, Southern Sudan 155 6.2 How Bingwa Changed His Ways 158 6.3 Gay Men’s Health Crisis HIV/AIDS Timeline 162 7.1 National Foundation for Infectious Diseases Flu Fight for Kids: Case Study 189 8.1 How Constituency Relations Can Help Advance an Organization’s Mission: A Practice-Based Perspective 206 8.2 National Cancer Institute Guidelines for Considering Commercial Partners 210 10.1 Audience Profile: Got a Minute? Give It to Your Kids! 252 12.1 NCI’s Cancer Research Awareness Initiative: From Message Concepts to Final Message 311 12.2 Community Theater in Benin: Taking the Show on the Road 315 Schiavo.ftoc 2/19/07 1:35 PM Page x For my daughters, Oriana and Talia, and, of course, my husband, Roger Ullman Schiavo.fpref 2/19/07 1:35 PM Page xi Preface When my child will grow up, he will walk on his own, he will walk on his own two feet, and that is the greatest gift of all. A MOTHER WHOSE CHILD RECEIVED THE POLIO VACCINE AS PART OF THE ONGOING POLIO ERADICATION CAMPAIGN IN INDIA (WORLD HEALTH ORGANIZATION AND GLOBAL POLIO ERADICATION INITIATIVE, 2004A) “I first became familiar with the importance and impact of health communication while working on the polio eradication campaign in India,” relates one of my students, Prarthana Shukla, who holds a medical degree from Ahmedabad, India, and moved to the United States to complete a master’s in public health at New York Univer- sity (interview with the author, 2006). As a member of one of the medical teams that administered the oral polio vaccine to infants and unimmunized children in India, she attributes the long lines of people waiting to be immunized to a widespread and well- designed communication campaign that used multiple channels to convey the importance and safety of immunization. Despite her lack of experience in health communication, several analyses and postintervention evaluations (Waisbord, 2004; Favin, 2004) agree with her observation and contribute to the bulk of evidence in many disease areas that has recently propelled health communi- cation to the forefront of the public health arena.