DOCOeEVT.Bissuaz- OM 151 51% -eE 014718 ,AUTHOR larshall, Carter_ L. Toward as Edidated- Health, Consumer; Masa -CoMainitatida and Quality -Medical Care. Pogarti. /iteriatiCail Series on the Teadhinq of Preventive Medicine. NO lap&-7. INSTITUTION Pogaity International. Center lbativpitt) , Bethesda, :REPORT NO kti-178-817 ,i)(16 DATE 77 iipTE, 70p41Buperintendent' Of Documents,,'W.S. ,Goverment printingtiffice, -Naihington, D.C. .440: /Btoci *amber 017-040-00406-1) 0 :BOBS,' PRICE MP-46483 HC-$3'..0',Plus:-Postage. ,DJIscrtz,PToBs ehavior Patteint; c64414ty Health:. CoPOMer BCOnaiiCs; Consumer---Education;- *Consumer, Protection; Consumer Bdience;.-IdadatiOnal,:0004; "Wide tiOnal Strategies_; Bditcational Federal iegiSiatiOn; *Health idticatid14 -Bea InforMatiOn, DiSseiiaationl- instruction -Media:- *Mats Media: iedidal Cari,4valiuition: *Prevent Preventive-..kedicine"; _Prilarf -Health Caret- Public Health; iPublid: potion ; Publis Television_t Ittitud'eS; Social Values- ;_ 'State of the Art ReVieirs; TeledomiuMidatiOnl TeleviSion. IDENTIFIERS United States ABSTRACT _Focus in this preventive Medicine monograph for :health- prOfessionals is on consumer health. education and the current andpotential -effects of mass-dOsianidatiOn, on the 4140X-iti of medical -Caiei, -Following an introduction, the content is presented in fOUr :.chapters.- Chapter 1 covers the state\of the art in consumer. health . -; education and discUsaes three- Models \of lealth, edadation, the bases, of health edacatiOn4 attitudes ,and-knd.010d4fiabout :both -health and illness, Allneas Tbehaii.cLand, ii010140tii4 Programs ',of preventive Medicine. The second chapter ,W704---z-611-0000A-#Ous7 revolution first _presents an aireiview Of: the cdaiunication- prodess laSs media and then disOuSses rise -of specialise, consUmerisiv_ and the Message of the media (particulatlY television), and health behavior and mass commerication.LChapter 3 on- quality medical care covers the origins of the health 'consumer;. legislatiie. such as national health insurance, professional Standard& review ;organizations, and health maintenance Otgaiiiiations;- and quality. ',assessment including the establishment of a phySician-constimer alliance and outcome measures. The last chapter briefly preientsa strategy for health education. Each of the four chapters concludes with an extensive bibliography. (EN: 4**********,*********************************************************** Reproductions supplied by pRs are the best that .can be made froi the original document. 1********************************************************************** AN ED:OPTED CONSUMER: MASS COMMUNICATIONAND I QUALITY.INMEDICAL CARE By Carter L. Marshall, M.D. S. -- It'A Report of Conferences Sponsored by the John E. Fogarty International Center for Advanced Study in the Health Sciences National-Institutes of Health Bethesda, Maryland U.S DEPARTMENT OF HEALTH, EDUCATION & WELFARE NATIONAL INSTITUTE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO" DUCED EXACTLY AS aECEIVEO FROM THE PERSON OR ORGANIZATION ORIGIN, ATING IT POINTS OF VIEW OR OPINIONS STATED DO NOT NECESSARILY REPRE. SENT OFFICIAL NATIONAL INSTITUTE OF EDUCATION POSITION OR POLICY DHEW Publication No. (NIH) 77-881 U.S: -DEPARTMENT OF HEALTH, EDUCATION, AND WELF/ARE Public Health Service \National Institutes of Health \.)s 2 This monograph is the seventh in a serieson the TEACHING OF, PREVENTIVE MEDICINE sponsored by the JOHN E. FOG ARTY :INTERNATIONAL CENTElOar"--g- ,; ADVANCED STUDY IN THE HEALTH SCIENCES - For sale by tb:-. SUperintendent of Dovments, U.S. Government Printing Office, Washington, D.C. 20402 Stick Number 017:040-00406-1 -141E.FACE-4. TheFogarty -Internatiiinal Center was established in-.1968- as a Memorial the late. Congressman lohnr.H._,FOgarty from Rhode had been Mr. -Fogarty's desire to create -Within the National Institutes of-, Health a center for research in hiolOgy and/ inedicine-.dedicated_ to international cooperation and collaboration in the interest of the health_ of mankind The Fogarty InternatiOnal Center is a unique resource within the:Federal -lisinnen4.1provid in& a i?,iie.,for expansion of Amerioa's health research- and health bringing the, talents- and resources of other nationa.to ...beartupon* Many-and varied,liealthprobiems of the=tnited States. As an institution` for-.advanced stiidy;The 'Fogarty _Intemitional -Center has einhracid,:thei major themes of mediCal education; .envitOnmental-health, societal factors influencing. health and disease, geographic hedlth. Problenis, international= 'health -iesearch and education; and preventive medicine. Our commitment -to the Study, of _Preventive aapeCts of human disease 'Is expressed in the forthcoming Fogirtyjiiternitional Center Serieson Preventive Medicine. InipiOyernept in the health status of _the-Amerizan.peOple will depend, in 'great measUre;,_.on the design and application of programs whiCh place major:emphasis on the-Preventive- aspects of human disease: Although- health authorities generally- agreei,I,ith-ithia--thesis; there is need-for more precise definition of effective methods and programs of prevention, financial resOurfes required to implement these -prograrntjand_priotities to be assigned to research in preventive methodology. The need-toes` expertise in this field to elucidate mecha_nisnis whereby the full *Pact of preventive medicine maybe brought to\bear on the solution of America' ,Major health:problems has been expressed repe,dly in publip :statement' by leat-ders throughout the health field. /In to this need; the -Fogarty International Center initiated a series of ,comprehensive studies-of.preventive medicine in order, to review and evaluate. the Istate of the art' of prevention any control of human diseases, to identify deficiencies in knowledge requiring further research,-inclifdingran.alysis of financial resources, preventive techniques, and manpower, and to recognize problems in 'application of -preventive methods and suggeSt corrective action. This monograph, Toward an Educated Health Consumer, is one in the Fogarty International Center series on the Teaching of Preventive Medicine. It deals with health education and the current and potential effects of mass communication on the-quality Of Medical care. The growth of the consumer movement is dismissed 41, along with-the technological advancements which have Occurred, in the communi- cations field- and the interplay betv.-;en_ the two (that is, consuerism and mass le media) as They affect the adoption of preventive measures for` maintenance of lifetime well-being. As the need for individuali to take. greater responsibility for their own-health is increasingly recognized, prosvider-consumer-coritinintication and -':"----oroeration,become ._eker more- important. It is hoped that this monograph will-be .influential not only in producing e 1-14-fed-health-consumers, but in promoting an -alliance-,between consumer interest groups and health professional---niftlirattain--- -----ment of their mutual goal: high-quality medical care for everyone; iii 4 Aw' ,.1 :CONTENTS PREFACE ACKNOWLEDGMENTS vii ODUCtON ix Chapter 1CONSUMER HEALTH EDUCATION: THE STATE OF THE ART 1 - . Reiearch Bases -of Health Education- 4 Attitudes and ICnowledge'Abotit.Hepith 4 Attitudes and Knowledge AbOtit Illness 5 , illness Behavior. 7 Implementation , 10- '7-Chapter 2 THE COMMUNICATIONS 'REVOLUTION 15 An Overview.of the Communication Process and Mass Media 15 The Rfi,,c. of Specialism . 18 Consumerism: The Message of the.Media 19 Health.BehaViiirand,Mass Communication 24 Chapter 3 QUALITY IN MEDICAL CARE: CONSUMERISM AND CADUCEUS 33 Origins of the Health Conlumer 33- . The Legislative Initiative 38 Quality-Assessment: Toward a Physician-Consumer Alliance 42 re' Chapter 4 A STRATEGY FOR HEALTH EDUCATION 55 INDEX _61 MIIMEMM=1! ACKNOWLEDGMENTS J. ;In may 1973, -the Subcommittee- on -Cornmunications in thvEducation of .the Public for Health of the 'Association ofTeachers of Preventive*Tiviedichie:.(ATPM) -met at- the-Mbunt- Sinai- School' of:Medicine of the City University of New York fOra Symposium Coordinated by-the Medical School's Department of Community 'Mediaine-and=fUndeci by =the.,Fogarty International tenter. The Symposium dealt with-_bqth theoretical. and practical-issues in health education via prekentationk on .health iaucation; for the public and :physicians, advertiking, mask media, and Terson-to-person-Prograins in health education-. It concluded withia recognition by participatkthat_effectiVe Lea lth education-requires improvcdievaluation of current efforts- as well as establiihinent of Priorities for the iOttire.. This -- monograph' grew .Mit of-someOahe issues raised by-the ATPM Syriipoiium,--foauSinLo) the currnt- .nitil potential. role' of communications tun!: Of consuiiiaiisncNeeffective health education for our tithes. In, the preparation, of this docuient; .the author, was assisted by Helen. A. Bronheim,_who prepared Chapter -1 and edited the overallmanuscript,and by all -members of the Division-of Cominunication of the Department of Community Mediebie, who _read; reread, cffered advice abbut; and debated 'the substantive issues and recommendations embodied in the manuscript. I- am indebted to all of 'them for their.tintiting= efforts and unflagginenthusiasm.,The wisdom and interest of Dr. Kurt Densehle, -Chairman of the Department of Community Medicine, were invaluable assets in the preparation of the- final manuscript. In additiOn, intensive discussions of the Task Force on Consumer Health Education of-