Showing papers in "Journal of Health Communication in 1998"

Health communication on the Internet: an effective channel for health behavior change?

Abstract: This article presents a theoretical rationale for using the Internet to conduct persuasive public health interventions. Through an examination of the conceptual bases of persuasion, it is posited that the World Wide Web and other Internet-based resources have many of the characteristics necessary for persuasive communication and may, in fact, constitute a hybrid channel that combines the positive attributes of interpersonal and mass communication. The notion that the Internet features many of the persuasive qualities of interpersonal communication makes it a prime candidate for the application of key behavioral science theories and principles to promote healthier behaviors. The broad reach that the Internet shares with many mass communication channels indicates an economy to Internet-based efforts to communicate with large audiences. It is concluded that if the Internet can be used for persuasive health communication and its reach continues to expand, it is time for public health professionals to explore the design and evaluation of Internet-based interventions directed at health behavior change.

The power of a frame: an analysis of newspaper coverage of tobacco issues--United States, 1985-1996.

Abstract: For more than three decades, public policy makers and public health officials have had conclusive evidence of the hazards of tobacco use, yet tobacco products remain legal, accessible, and acceptable in our society. Public health advocates have been unable to develop a consistent, coordinated message powerful enough to combat the influence of the tobacco industry. Studying the way in which the tobacco issue has been framed in the mass media over the past decade may provide important clues as to why public health efforts to overcome the tobacco industry's influence on public policy and on tobacco use have not been entirely successful. This paper describes and analyzes the predominant framing tactics used by the tobacco industry and by tobacco control advocates for the last 11 years by reviewing 179 front-page articles from the New York Times and the Washington Post during this period. We conclude that while the tobacco industry has created a central message and theme which has been used constructively and consistently over time, the tobacco control movement has not developed a consistent, powerful, and compelling message. Developing such a message may be important if the nation is to restore progress in reducing tobacco use.

A theoretically based evaluation of HIV/AIDS prevention campaigns along the trans-Africa highway in Kenya.

Abstract: Print HIV/AIDS prevention campaign materials (e.g., posters, pamphlets, stickers) from 10 public health organizations in Kenya were evaluated according to the Extended Parallel Process Model (EPPM), a health behavior change theory based on the fear appeal literature, at various sites along the Trans-Africa Highway in Kenya. Three groups each of commercial sex workers (CSWs), truck drivers (TDs) and their assistants (ASSTs), and young men (YM) who live and work at the truck stops participated in focus group discussions where reactions to the campaign materials were gathered according to this theoretical base. Reactions to campaign materials varied substantially, according to the poster or pamphlet viewed. Overall, most participants wanted more detailed information about (a) the proper way to use condoms, (b) ideas for how to negotiate condom use with reluctant partners, and (c) accurate information on symptoms of AIDS and what to do once one contracted HIV. Both quantitative and qualitative analyses of the campaign materials are reported.

Perpetuating Passivity: Reliance and Reciprocal Determinism in Physician-Patient Interaction

Abstract: This study introduces, profiles, and tests the explanatory value of reliance, a construct that emerged from, and is expected to illuminate, consideration of perceived control in medical encounters. The investigation also links communication science with the truly interactive perspective of reciprocal determinism, highlighting the impact of personal relations and the significance of perceived control. Data from 271 encounters between general practitioners and patients in Oxford (England) were collected by means of videotapes, patient questionnaires, medical record reviews, and physician questionnaires. The analysis indicates that physician-reliant patients (i.e., those who rely on physicians to make decisions for them) tend to be older and from a more working-class background than were self-reliant patients (i.e., those more interested in participating in choices about their health care). The physician-reliant patients also had more externally oriented outcome expectations and tended to see physicians more often than did their self-reliant counterparts. In addition to defining reliance at the conceptual and operational levels, this study provides preliminary evidence that reciprocal determinism is operating in medical encounters: Despite their preference for patients who feel in control of their health, physicians tended to adapt to patients' reliance orientation, sharing decisions with self-reliant patients and making decisions for physician-reliant patients. Accommodating the passive orientation of physician-reliant patients is likely to diminish patients' chances for maintaining control in the medical encounter, which has implications for health outcomes, cost, and compliance.

The use and selection of sources in information seeking: the Cancer Information Service experience. Part 8.

Abstract: The Cancer Information Service (CIS), the voice of the National Cancer Institute (NCI) for more than 20 years, disseminates information through two channels: a toll-free telephone service (1-800-4-CANCER) and an outreach program which develops partnerships with organizations that reach underserved populations. In 1996, the telephone service handled approximately 500,000 calls on a range of topics, including cancer treatment, clinical trials, coping issues, referrals to services, prevention, causes, and symptoms of cancer. As part of a national telephone service user survey, conducted in 1996, that examined the impact of the CIS program, callers were asked what additional sources they went to for the same information that they requested from the CIS. The survey revealed that the CIS plays a critical role for information seekers. Almost 59% of surveyed callers contacted no other sources to address the topic they discussed with the CIS. Almost half of the callers who contacted other sources made all of those...

Diffusion of Innovations Theory and Work-Site AIDS Programs

Abstract: Four case studies of the adoption of work-site AIDS programs are investigated, two of which were modifications of the Centers for Disease Control and Prevention's Business Responds to AIDS (BRTA) program. AIDS work-site programs were mainly initiated by the four study companies as a result of the efforts of a champion (defined as an individual who gains attention and resources for an issue in a system) or the occurrence of a tragic event, such as a company employee contracting AIDS. The BRTA program is an innovation that has not yet reached critical mass, which is the point after which further rates of adoption occur rapidly in a self-sustaining process.

Enhancing the effectiveness of HIV/AIDS prevention programs targeted to unique population groups in Thailand: lessons learned from applying concepts of diffusion of innovation and social marketing.

Abstract: Diffusion of innovations theory and social marketing theory have been criticized for their limited applicability in influencing unique population groups (e.g., female commercial sex workers (CSWs) working in low-class brothels). This study investigated the applicability of these two theoretical frameworks in outreach efforts directed to unique populations at high risk for HIV/AIDS in Bangkok, Thailand. Further, this study examined Thai cultural characteristics that influence communication about HIV/AIDS prevention. The results suggest that certain concepts and strategies drawn from the two frameworks were used more or less by effective outreach programs, providing several policy-relevant lessons. Cultural constraints, such as the lack of visibility of the disease and traditional sexual practices, influenced communication about HIV/AIDS prevention.

Health Education Goes Hollywood: Working with Prime-Time and Daytime Entertainment Television for Immunization Promotion

Abstract: This article presents an entertainment education strategy used to influence Hollywood prime-time and daytime television programs to add storylines on the importance of immunizations to their shows. Rather than giving information about immunizations to show producers, directors, actors, and writers, we furnished "log lines" and true stories about immunizations that could be used to inspire scripts that included immunization themes. By working through personal contacts within the entertainment television industry's closed system of networks, we were able to gain entree and some airtime for our campaign agenda. Embedded messages aired on eight popular shows in the 1996-1997 broadcast season, with five scheduled to air in the 1997-1998 season. These efforts were evaluated qualitatively, focusing on issues of personal networks, content of aired messages, and comparative costs for paid airtime. The strategy developed can be adapted for a range of entertainment education interventions.

Tailoring outdoor tobacco advertising to minorities in Los Angeles County.

Abstract: This study provides the erst longitudinal comparison of the frequency and content characteristics of tobacco ads that appeared along thoroughfares running through four types of Los Angeles ethnic neighborhoods. Tobacco ad density (tobacco billboards per mile), concentration (proportion of billboards with tobacco content), and content were compared from 1990 to 1994 across four neighborhoods at multiple time points. Compared with White neighborhood thoroughfares, African American and Hispanic neighborhoods contained greater tobacco ad density, and all minority neighborhoods contained greater tobacco ad concentration along the roadsides. Initial differences in tobacco ad frequency decreased signiecantly over time. However, the age, race, and gender of billboard characters remained different among the different ethnic neighborhood thoroughfares, with greater ethnicity-speciec content in African American neighborhood thoroughfares than in other neighborhood thoroughfares. These data are consistent with the assertion that tobacco companies target ethnic minorities with higher rates of advertising and ethnically tailored campaigns. This may be used in order to expand the total market of minority consumers.

Impact of Mass Media and Interpersonal Health Communication on Smoking Cessation Attempts: A Study in North Karelia, 1989-1996

Abstract: This article summarizes an impact evaluation of the North Karelia Project (Finnish CINDI program) on smoking cessation attempts. During the period 1989-1996, data were collected by annual surveys, with response rates varying from 66% to 76%. This study included 1,694 adult current smokers or persons who had quit smoking during the past year, out of a total of 6,011 respondents. Smoking cessation attempts during the past 12 months were examined as a dependent variable. Reported exposures to mass media and interpersonal health communication were examined as possible determinants of smoking cessation. Weekly exposure to mass media health messages was significantly associated with cessation attempts among men only. In contrast, interpersonal health communication, or social influence, was a significant determinant of cessation attempts among both sexes. Exposure to both mass media and interpersonal health communication had an even stronger impact on cessation attempts. Thus, interpersonal communication appears to be an important catalyst of community programs, and its inclusion should be emphasized to obtain a higher impact with community programs.

The quality of interactive computer use among HIV-infected individuals.

Abstract: This study examined how HIV-infected individuals used an interactive health software package called CHESS (Comprehensive Health Enhancement Support System) CHESS packages information and support in a variety of ways ; the research examined how a subset of users whose posttest scores in a larger randomized trial showed significant improvement in quality of life compared on use patterns of CHESS with those who did not improve The evidence presented here points to the nature of CHESS use more than it does to the amount of CHESS use Those whose quality of life improved were among the most involved in their use of CHESS information tools That is, even though Discussion Group accounted for the majority of all CHESS uses and time spent with the system, total use and Discussion Group use appeared less important than use of the information tools, especially if that use was at least somewhat sustained and involved

The value and impact of the Cancer Information Service telephone service. Part 4.

Abstract: The Cancer Information Service (CIS) of the National Cancer Institute (NCI) is a health communications program that disseminates information through two channels: to individuals through a toll-free telephone service and to organizations (serving primarily underserved populations) through an outreach program. People call the 1-800-4-CANCER line to meet a variety of information needs. The information specialists who respond to these calls are prepared to answer questions ranging from cancer prevention to early detection, treatment, and survivorship. In a 1996 random sample survey, 2,489 callers were asked why they called, how they valued the information, and what health-related actions they took or decisions they made since their call. Results show the CIS is highly valued by its users, with satisfaction high across gender, age, education, and racial/ethnic groups. While differences in satisfaction were observed by caller type and subject of inquiry, nearly all respondents reported that contact with the CIS increased knowledge, provided reassurance, and influenced decisionmaking and health behavior. Overall, 95% were satisfied with CIS information, 98% trusted the information, 92% reported an increase in knowledge, 69% felt reassured, and 73% said the information helped them to better cope with their concerns. Eight out of 10 callers reported the information they received had a positive impact, with 56% reporting taking a positive health action. Results demonstrate that health communications programs like the CIS can fill information gaps consumers must bridge to make informed health care decisions and can play an important public health role in motivating people to take actions to reduce risks and/or make decisions that lead to improved health status.

Portraying stigmatized conditions: disabling images in public health.

Abstract: In promoting people's good health, health communication may help reduce the incidence of disabling injuries. Yet little is known about the broader question of how health communication efforts contribute to the production of stigma and the negative implications for effective and ethical health promotion. In the United States alone, as many as 49 million people have a physical or a cognitive disability. This article considers the paradox that health communication approaches to prevent injury--with the implicit message "Don't let this happen to you!"--may portray people with disabilities in a stigmatizing way. The psychosocial consequences of stigma heighten the stakes for people with disabilities who strive for fair treatment in employment, social interaction, and policy outcomes. In an era in which health communication is hailed as a remedy for an unprecedented array of health conditions, this article poses a starting point for critically examining how health communication may better prevent the many ailments of humankind.

Evaluating the Cancer Information Service: a model for health communications. Part 1.

Abstract: The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to meet the information needs of cancer patients, their families, health professionals, and the public. As the nation's foremost source for cancer information, the CIS applies a unique health communications model to bring the latest research findings on cancer prevention, detection, treatment, and supportive care to the nation. It does this through two main program components: a toll-free telephone service (1-800-4-CANCER) and an outreach program that focuses on providing technical assistance, specifically to partners reaching minority and underserved audiences. During its 22-year history, more than 7.5 million callers have reached the CIS telephone service. In addition, 100,000 requests are received each year from 4,500 organizations nationwide seeking cancer-related outreach expertise. This overview describes the CIS model for health communications, describes the program's impact in broad terms, and defin...

Peripheral cues and involvement level: influences on acceptance of a mammography message.

Abstract: The elaboration likelihood model (ELM) suggests that some communication elements are processed differently depending on a receiver's involvement with the message topic. We hypothesized that women with high levels of breast cancer involvement would be more influenced by a mammography message's arguments than by the message's peripheral cues and, conversely, that women with low levels of involvement would be more influenced by a mammography message's peripheral cues than by the message's arguments. We exposed 89 low-income African American women aged 40 to 65 years to two repetitions of a mammography promotion public service announcement embedded as a commercial within a television talk show. We used a 2 (involvement level) x 2 (argument strength) x 2 (peripheral cue favorability) factorial posttest-only design. The analysis detected a significant main effect for involvement and an interaction between peripheral cue favorability and involvement. High-involvement women reported stronger intentions than did low-involvement women to seek additional mammography information, regardless of argument strength or cue favorability. Low-involvement women reported stronger intentions to seek more mammography information only when exposed to the favorable cue condition. The analysis detected no effect for argument strength in high- or low-involvement women. The ELM appears useful for designing mammography messages. As many women may have low involvement with breast cancer, mammography promotion messages that include favorable peripheral cues may be more likely to impact mammography information seeking than argument-based-only messages.

Public communication campaigns in the destigmatization of leprosy: a comparative analysis of diffusion and participatory approaches. A case study in Gwalior, India.

Abstract: This was an experimental study designed to determine the relative effectiveness of diffusion and participatory strategies (in health campaigns) and the effect of caste on the dependent variables of knowledge, perception of risk, and behavioral involvement that were conceptualized as contributing to leprosy destigmatization in Madhya Pradesh state, India. The multivariate analysis of covariance (MANCOVA) procedure found significant difference between the communication treatments on the dependent variables. The discriminate analysis procedure was used to locate the source of the difference. This procedure identified two significant discriminant functions: cognitive-affective and behavior-affective dimensions. The participatory treatment showed higher knowledge and lower perception of risk on the cognitive-affective dimension, and higher behavioral involvement on the behavior-affective dimension, but the diffusion treatment showed only lower self-perception of risk on the behavior-affective dimension. The study concluded that participatory strategies promoting dialogue and interaction and incorporating people's knowledge and action component result in increased knowledge, lower perception of risk, higher behavioral involvement, and, hence, destigmatization.

Coping with cancer: the impact of the Cancer Information Service on patients and significant others. Part 6.

Abstract: The Cancer Information Service (CIS) has been the voice of the National Cancer Institute (NCI) for more than 20 years. In 1997, the CIS telephone service received 14,689 inquiries from the public about coping with cancer and its consequences (total calls = 500,000). In a random sample survey of 2,489 CIS callers conducted in 1996. respondents who stated they called the CIS for coping information were asked to evaluate the information provided by the CIS, overall satisfaction with this information, and what impact this information had on patients and significant others. Most of those who called about coping were not the patients (33%) themselves; rather, they were significant others of patients (spouses/partners [21%], parents [16%], friends/coworkers [11%], other family [19%], other [9%]). The information received was new to most callers(≥93%). Respondents were satisfied with the information (92%) and felt the CIS information specialist was knowledgeable (95%) and trustworthy (96%). Respondents (patients/...

Treatment and clinical trials decisionmaking: the impact of the Cancer Information Service. Part 5.

Abstract: The Cancer Information Service (CIS) provides accurate, up-to-date information to cancer patients, their families, the general public, and health professionals. In 1996, the CIS telephone service received 208,971 calls from people with questions about cancer treatments and clinical trials (total calls = 500,000). Cancer information specialists are trained and certified to access the PDQ database of treatment options and clinical trials, to translate medical information into understandable terms in order to help callers make treatment decisions, and to discuss clinical trials proactively. A telephone service user survey was conducted to assess the satisfaction and impact of the assistance and information provided to CIS callers. Almost half of the callers (46% of those calling for treatment information, 50% calling for clinical trial information) discussed the CIS information with a physician. Over half (55% treatment, 54% clinical trial) said the information helped them make a treatment decision. Twenty-four percent of treatment and 64% of clinical trial callers had enrolled in or had considered a clinical trial. Almost all (95%) were satisfied with information received from the CIS. The authors find that the CIS is fulfilling its role in disseminating information on cancer treatment and clinical trials through its telephone service. The CIS proactively educates treatment callers about clinical trials. However, the CIS needs to apply other strategies to reach medically underserved populations. Although most callers were able to understand the information, clinical trial callers found the information more difficult than did treatment callers. The CIS is working to simplify written clinical trial information.

Promoting Cancer Prevention and Screening: The Impact of the Cancer Information Service. Part 7

Abstract: Cancer Information Service (CIS) inquiries about cancer prevention and screening are an important opportunity to educate callers about primary or secondary cancer prevention, facilitate their decision-making, and, where appropriate, encourage action. An evaluation was conducted to assess whether these callers' information needs are being satisfied and to determine if the information provided facilitates decisionmaking and subsequent risk reduction actions. A random sample of 2,489 callers was surveyed during a 5-week period, 3 to 6 weeks after their initial call to CIS; prevention or screening was stated as the main reason for calling by 331 respondents. A series of questions was asked regarding level of satisfaction with CIS's performance and how helpful the information provided was in terms of feeling more knowledgeable, making decisions, and taking action. The vast majority of respondents were satisfied with the information received, found it to be helpful, felt more knowledgeable as a result, and would call CIS again with subsequent questions. Although demand characteristics are a possible source of bias, nearly three-quarters of the respondents reported subsequently discussing the information provided with someone else, and almost half sought additional information recommended by CIS. Nearly two-thirds of primary prevention respondents and about half of secondary prevention respondents indicated that they had taken some risk-reducing action subsequent to their interaction with CIS. The CIS is effectively satisfying the information needs of prevention and screening callers; information it is providing is effectively facilitating decisionmaking and stimulating callers to take action.

Childbirth and infant development knowledge gaps in interpersonal settings.

Abstract: The knowledge gap hypothesis predicts that infusions of information into an environment will lead to knowledge gain by groups with higher socioeconomic status (SES) at rates that outpace the knowledge gain of lower SES groups, leading to a growing relative gap between them. Four information source variables were examined in the present study: education, baby care experience, friend and relative networks, and interpersonal communication in a parent education setting. Study subjects were mothers and fathers in Minneapolis, Minnesota, and mothers in Belfast, Northern Ireland. In the sample, the classic pattern of widening gaps due to education was not supported by time trend data, although one-time data showed gaps. The interpersonal communication condition contributed most to knowledge levels and to widened knowledge gaps.

Building effective partnerships: a national evaluation of the Cancer Information Service outreach program. Part 2.

Abstract: The Cancer Information Service's (CIS) nationally coordinated, regionally focused outreach program establishes partnerships with government, nonprofit, and private organizations to reach underserved and minority populations. A national random sample telephone survey, conducted with 867 partner organizations who had contact with the CIS in early 1996, assessed the types of CIS assistance used, satisfaction with and usefulness of these services, organizational characteristics, and the overall impact on partners' cancer-related programs. CIS partners provide programs for the medically underserved (79%) and specific racial and ethnic groups (72%) and address a range of cancer control issues. Partners use and highly value an array of CIS assistance. Over 90% are satisfied with the CIS services. Diffusion of accurate and science-based information, materials and resources is a key element of the outreach assistance. Two out of three partners are receiving late-breaking news and scientific information from the CIS and 86% are disseminating it to their constituents. The majority of those partners surveyed reported that they rely on the CIS to assist with their most important cancer programs. Sixty-eight percent of the partners rated the CIS assistance as important or very important to their cancer-related programs. These survey results indicate that the CIS outreach program provides key support to partners' cancer programs and has an impact on their efforts. The results support the effectiveness of a regionally based outreach program working in partnership with existing organizations at the state, county, and local level who are addressing the needs of underserved populations.

IEC interventions for health: a 20 year retrospective on dichotomies and directions.

Abstract: In January 1997, the World Health Organization's Family Planning and Population Unit (WHO/FPP) commissioned a retrospective qualitative study of 20 years of experience in information, education, and communication (IEC) as it had been applied to public health initiatives globally. The purpose of the study, which relied on a literature search, a field survey, and in-depth interviews, was to examine lessons learned from two decades of experience in applying IEC interventions in support of public health in order to improve the integration of reproductive health services through IEC initiatives. While the focus of the study was on ways in which IEC can support reproductive health strategies, the discourse surrounding this effort pointed to a number of generic issues of interest or concern to all health education, communication, and promotion practitioners. An analysis and synthesis of "best practices" as perceived by IEC program managers, field implementers, donors, and evaluators revealed significant dichotomies and differences of opinion that have emerged in the field of IEC in recent years and helped to identify several areas for future operations research. This article articulates those divergent opinions, cites major areas for further research, and highlights a strategic approach to partnerships aimed at improving the delivery of health and communication programs.

Reaching Minority and Underserved Populations: The Impact of the Cancer Information Service's Outreach Program. Part 3

Abstract: Through its regional outreach program, the Cancer Information Service (CIS) develops partnership with organizations that reach minority and underserved populations and connects them with accurate cancer information and an array of support services and resources. To evaluate the usefulness, satisfaction, and impact of the CIS outreach program on partner organizations, a national random sample survey was conducted by an independent research firm in 1996. This paper focuses on the survey results of 359 special population partner organizations that identified their main audience as a specific racial or ethnic group and/or the underserved. Almost all (84% to 93%) rated the services provided by the CIS outreach program to be very important or important to meeting the goals of their projects. A large majority of these special population partners stated that the CIS provided them with the latest cancer information (67%) and National Cancer Institute (NCI) resources (83%), and more than half (57%) utilized CIS expertise to develop and plan programs. Special populations partners were more likely to use an array of CIS assistance than other CIS partners. Furthermore, they were more likely to be heavy users of CIS assistance and more likely than other CIS partners to indicate that the CIS had an important impact on their programs. The results indicate that the CIS's nationally coordinated, regionally focused outreach program provides critical support and has an important impact on the cancer-related programs of partner organizations that reach minority and underserved audiences.

Demystifying AIDS in Thailand: a dialectical analysis of the Thai sex industry.

Abstract: The AIDS pandemic throughout the world , and particularly in Thailand , is not just a physical disease that has evaded much of our control . It is symptomatic of a chronic , more pervasive and sinister plague that governs modern societies . This plague is social and political in nature . In the case of Thailand's AIDS pandemic , this paper argues that the underlying sociopolitical plague that further aggravates the AIDS crisis may be found in the internal contradictions that govern the Thai sex industry and its commodification of women and sex . It further suggests that current Thai management of the AIDS pandemic , though effective in terms of increasing the public's awareness about AIDS , its transmission modes and preven tive measures , is less effective in the long run , because it fails to adequately address structural formations , contradictions , and practices that constitute and reproduce the Thai sex industry . Two objectives are attempted in this paper: first , a dialectical analysis of the inte...

Asia--the new epidemic zone for HIV/AIDS.

Abstract: Despite considerable prevention efforts HIV infection continues to spread in populations around the world. While sub-Saharan Africa remains the region thus far hardest hit by the HIV/AIDS pandemic recent epidemics have been identified in Southeast Asia. Unless effective prevention measures are quickly put into place by 2000 half of all adults worldwide infected with HIV will be in Southeast Asia compared with 25% in sub-Saharan Africa. Southeast Asian countries which have been substantially affected by the epidemic include India Thailand Cambodia Vietnam and Myanmar. The epidemic is a relatively recent phenomenon in Thailand although HIV has spread rapidly. The current profile of HIV and AIDS in Thailand the government and community response cultural issues in AIDS prevention in Thailand and integrating theory and practice in effective communication strategies against AIDS are discussed.