UNIT 4 HEALTH COMMUNICATION: SCOPE AND
CHALLENGES
*
M. Tineshowri Devi
Contents
4.0 Objectives
4.1 Introduction
4.2 What is Health Communication?
4.3 Functions of Health Communication
4.4 Models of Health Communication
4.5 Scope of Health Communication
4.6 Challenges of Health Communication
4.7 Lets Us Sum Up
4.8 Suggested Readings
4.9 Answers to Check Your Progress
4.0 OBJECTIVES
On completion of this Unit, you should be able to:
Explain health communication and its function;
Describe different models of health communication;
Explain scope of health communication; and
Understand the challenges and addressing the concern of health communication.
4.1 INTRODUCTION
International Communication Association officially recognized health communication in 1975; in
1997, the American Public Health Association categorised health communication as a discipline
of Public Health Education and Health Promotion. Communication is essential to successful public
health practice at every level: intrapersonal, interpersonal, group, organizational, and societal.
*
Dr. M. Tineshowri Devi, Assam University, Silchar
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There must be careful deliberation concerning the appropriate channel for messages to best reach
the target audience, ranging from face-to-face interactions to television, Internet, and other forms
of mass media. Thus, communication is more than mere exchange of information.
4.2 WHAT IS HEALTH COMMUNICATION?
Health communication is the study and use of communication strategies to inform and influence
people to make choices about their health. Messages are spread through different channels such as
mass media, print materials, social media, and face-to-face conversations.
According to Healthy People 2010 guidelines, health communication encompasses the study and
use of communication strategies to inform and influence individual and community decisions that
enhance health. It links the domains of communication and health. Health communication
encompasses the study and use of communication strategies to inform and influence individual and
community knowledge, attitudes and practices (KAP) with regard to health and healthcare.
There is interface between communication and health which is increasingly recognized as a
necessary element for improving both personal and public health. Health communication is often
used synonymously with health education which can contribute to all aspects of disease prevention
and health promotion. The most obvious application of health communication has been in these
areas of health promotion and disease prevention. There has been improvement of interpersonal
and group interactions in hospitals and other clinical situations such as between provider and
patient, provider and provider and among members of a healthcare team, through the training of
health professionals and patients in effective communication skills. Thus, health messages through
public education campaigns can help in changing the social climate in order to encourage healthy
behaviours, create awareness, change attitudes, and motivate individuals to adopt recommended
behaviours.
Health communication has become an accepted tool for promoting public health. Health
communication principles are often used today for various disease prevention and control
strategies including advocacy for health issues, marketing health plans and products, educating
patients about medical care or treatment choices, and educating consumers about healthcare
quality issues (US Office of Disease Prevention and Promotion, 2004). At the sametime, the
availability of new technologies and computer-based media is expanding access to health
information, and effective use of these new tools.
4.3 FUNCTIONS OF HEALTH COMMUNICATION
1) Information
The main function of health communication is to provide scientific knowledge or information
to people about health problems and how to maintain and promote health. Thus information
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should be easily accessible to the people so that we can remove or eliminate social and
psychological barriers of ignorance, prejudice and misconceptions people may have about
health matters; increase awareness of the people to the point that they are able to perceive
their health needs; and influence people to the extent that unfelt needs become felt needs, and
felt needs become demands (Park, 2015). It will help in refuting myths and misconceptions.
2) Education
Education plays a very important role in prevention oriented approach to health and disease
problems; and the basis of all education is communication. Health education can bring about
changes in life styles and risk factors of disease. It can help to increase knowledge and to
reinforce desired behaviour patterns. It can also increase knowledge and awareness of a health
issue, problem, or solution which influence perceptions, beliefs, attitudes, and social norms.
The Alma-Ata Declaration, 1978, has given the concept of health education. According to
this declaration, health education is
Promotion of healthy lifestyles,
Modification of social environment in which the individual lives,
Community involvement
Promotion of individual and community self-reliance.
The main aims and objectives of health education are stated below:
a) To encourage people to adopt and sustain health promoting lifestyles and practices;
b) To promote the proper use of health services available to them;
c) To arouse interest, provide new knowledge, improve skills and change attitudes in
making rational decisions to solve their own problems and
d) To stimulate individual and community self-reliance and participation to achieve health
development through individual and community involvement at every step from
identifying problems to solving them.
It is clear that education is necessary but education alone is not sufficient, thus health care
providers need to play important roles, they are:
Provide opportunities for people to learn how to identify and analyze health and health
related problems, and how to set their own targets and priorities;
Make health and health related information easily accessible to the community;
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To indicate to the people alternative solutions for solving the health and health-related
problems they have identified; and
People must have access to proven preventive measures (Park, 2015).
3) Motivation
One of the goals of health communication is to motivate individuals so that they can apply
the health information into personal behaviour and lifestyle which will bring the benefit of
behavior change for their own health. Motivation includes the stages of interest, evaluation,
decision making, etc. For proper success of programme implementation at individuals and
society at large, motivation assist in passing from the stake of awareness and interest to the
final stage of decision making and adoption of the new ideas.
4) Persuasion
Persuasion is a conscious attempt by one individual to change or influence the general
benefits, understanding, values and behaviour of another individual or group of individuals in
some desired way (Park, 2015). It can change life style as it is employed deliberately to
manipulate feelings, attitudes and beliefs. It is also a kind of force that reinforces knowledge,
attitudes, and behaviour.
5) Counselling
Counselling relies heavily on communication and relationship skills. Counselling is the
service offered to the individual who is undergoing a problem and needs professional help to
overcome it. Therefore, counselling is a process that can help people understand better and
deal with their problems and communicate better with those with whom they are emotionally
involved. It can improve and reinforce motivation to change behaviour and helps to reduce
or solve problems. Thus, counselling needs an expert as a counsellor to extend assistance to
a needy person. Therefore, a counsellor should be able to communicate information properly;
to gain the trust of the people; to listen sympathetically to people who are in distressed; to
understand other person’s feelings and to respond to them in such a way that the other person
can feel free to express his/ her feelings and to help people reduce or resolve their problems.
6) Health Development and Organization
Communication can play a powerful role in health development by helping to diffuse
knowledge in respect of the goals of development and preparing the people for the roles
expected of them. Further communication is an important dimension of health organization.
It is a means of intra and intersectoral coordination. There are vertical communications which
can be downward or upward that include top administrator to the beneficiaries; and horizontal
or cross communications which takes place usually between equals at any level.
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4.4 MODELS OF HEALTH COMMUNICATION
Health communication can take place through different models. They are:
1) Medical Model
The medical model is primarily relied on the recognition and treatment of disease and
technological advances to facilitate the process. The emphasis is on dissemination of health
information based on scientific facts but the medical model did not bridge the gap between
knowledge and behaviour as there is little or no intervention on social, cultural and
psychological factors.
2) Motivational Model
Motivation acts as the main force to translate health information into desired health action.
But it needs a long procedure to convince an individual, group and society at large.
Motivation includes the stages of interest, evaluation and decision-making. Initially
individual has to go through awareness or getting information about the subject. If he is
interested he will seek more detailed information about the subject, then he will evaluate the
various aspects of the information received and later decision making will be done based on
the evaluation whether he accepts or rejects the information. Sometimes the mentioned stages
are not necessarily rigid; there may be skipping of stages depending on the adoption process
of individuals, groups and society. Thus, effective communication strategy should be evolved
to help the individual in passing from one stage to another.
3) Social intervention Model
The motivation model ignored the fact that in a number of situations, it is not the individual
who needs to be changed but the social environment which shapes the behaviour of individual
and the community. Thus, there is an importance of group or social support in helping
reaching the decisions and taking action. Therefore, an effective health communication is
based on precise knowledge of human ecology and understanding of the interaction between
the cultural, biological, physical and social environmental factors.
Check Your Progress I
Note: a) Use space given below for your answer.
b) Compare your answer with the one given at the end of this unit.
1) What do you understand by Health Communication?
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4.5 SCOPE OF HEALTH COMMUNICATION
The Individual
The individual is the most fundamental target for health-related change, since it is individual
behaviours that affect health status. Communication can affect the individual’s awareness,
knowledge, attitudes, self-efficacy, and skills for behaviour change. Activity at all other levels
ultimately aims to affect and support individual change.
The Social Network
An individual’s relationships and the groups to which an individual belongs can have a significant
impact on his or her health. Health communication programs can work to shape the information a
group receives and may attempt to change communication patterns or content. Opinion leaders
within a network are often a point of entry for health programs.
The Organization
Organizations include formal groups with a defined structure, such as associations, clubs, and civic
groups; worksites; schools; primary healthcare settings; and retailers. Organizations can carry
health messages to their membership, provide support for individual efforts, and make policy
changes that enable individual change.
The Community
The collective well-being of communities can be fostered by creating structures and policies that
support healthy lifestyles and by reducing or eliminating hazards in social and physical
environments. Community-level initiatives are planned and led by organizations and institutions
that can influence health such as schools, worksites, healthcare settings, community groups, and
government agencies.
The Society
Society as a whole has many influences on individual behavior, including norms and values,
attitudes and opinions, laws and policies, and the physical, economic, cultural, and information
environments. Clearly, the more levels a communication program can influence, the greater the
likelihood of creating and sustaining the desired change.
Health communication alone, however, cannot change systemic problems related to health, such
as poverty, environmental degradation, or lack of access to health care, but comprehensive health
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communication programs should include a systematic exploration of all the factors that contribute
to health and the strategies that could be used to influence these factors.
4.6 CHALLENGES OF HEALTH COMMUNICATION
Health communication faces many challenges. While problems can be attributed to many factors,
some of the most challenging issues are discussed below:
1) One of the most pertinent challenges health communication faces is the general gap that
has formed between the population’s health literacy and the use of health communication.
There are instances that professionals’ use of unexplained medical jargon, ill-formed
messages, that lead to create a general educational gap. It is also seen that even the mass
have difficulty understanding written health materials, understanding health care and
policies, and generally do not comprehend medical jargon. Such short fallings of health
communication may lead to increased hospitalizations, the inability to respond to and
manage a disease or medical condition, and a generally declining health status.
2) Mass communication is used to promote beneficial changes in behaviour among members
of populations. A major criticism of the use of mass media as a method of health
communication is large amounts of information that may be misleading, inaccurate, or
inappropriate, which may put consumers at unnecessary risk. This issue may generate
unwarranted panic amongst those customers. One is related to the risks associated with
consumers’ use of poor quality health information to make decisions. These concerns are
driving many people to distrust health services which have caused an immediate public
health concern.
3) A one-dimensional approach to health promotion, or other single-component
communication activities, has been shown to be insufficient to achieve program goals.
Thus for making a successful health promotion programme, multidimensional
interventions such as community-based programs, policy changes, and improvements in
services and the health delivery system has to be planned to reach diverse audiences. An
important factor in the design of multidimensional programs is to allot sufficient time for
planning, implementation, and evaluation to support the elements of the program. Public-
private partnerships and collaborations can leverage resources to strengthen the impact of
multidimensional efforts.
4) Communication occurs in a variety of contexts (for example, school, home, and work);
through a variety of channels (for example, interpersonal, small group, organizational,
community, and mass media) with a variety of messages; and for a variety of reasons. In
such an environment, people do not pay attention to all communications they receive but
selectively attend to and purposefully seek out information (Freimuth et al., 1989). One of
the main challenges in the design of effective health communication programs is to identify
the optimal contexts, channels, content, and reasons that will motivate people to pay
attention to and use health information.
5) The environment for communicating about health has changed significantly. The dramatic
increases in the number of communication channels and the number of health issues vying
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for public attention as well as consumer demands for more and better quality health
information, and the increased sophistication of marketing and sales techniques over the
Internet. People have more opportunities to select information based on their personal
interests and preferences.
6) Limitations of printed materials in different languages lead to affect the health
communication. Direct translation of health information or health promotion materials
should be avoided. For different social- cultural, ethnic populations who have different
languages and sources of information, it is required to adopt audience-centered perspective
for effective health promotion and communication. In these cases, public education
campaigns must be conceptualized and developed by individuals with specific knowledge
of the cultural characteristics, media habits, and language preferences of intended
audiences. Television and radio serving specific ethnic populations can be effective means
to deliver health messages when care is taken to account for the language, culture, and
socioeconomic situations of intended audiences. Thus, an audience-centered perspective
also reflects the realities of people’s everyday lives and their current practices, attitudes
and beliefs, and lifestyles. Some specific audience characteristics that are relevant include
gender, age, education and income levels, ethnicity, sexual orientation, cultural beliefs and
values, primary language(s), and physical and mental functioning.
7) Generalising the programme policy and generalising the health information to the mass
will limit the audience from health communications. It is therefore required to target
specific segments of a population and tailoring messages for individual use to make health
promotion activities relevant to audiences. Examples adolescents at increased risk of
smoking, etc.
8) The other challenge is related to the protection of privacy and confidentiality of personal
health information. It is so happened that the personal privacy and the confidentiality of
health information of consumers are magnified when information is collected, stored, and
made available online. In the near future, personal health information will be collected
during both clinical and nonclinical encounters in disparate settings, such as schools,
mobile clinics, public places, and homes, and will be made available, so it is required to
have policies and procedures to protect privacy and to ensure confidentiality.
9) Even with access to information and services, however, disparities may still exist because
of many factors such as illiteracy, lack health literacy, levels of knowledge and
understanding, customs, beliefs, religion, attitudes and social class differences. Health
literacy is increasingly vital to help people navigate a complex health system and better
manage their own health. Differences in the ability to read and understand materials related
to personal health as well as navigate the health system appear to contribute to health
disparities. Well-designed health communication activities can help individuals better
understand their own and their communities’ needs so that they can take appropriate
actions to maximize health.
10) Health communication alone, however, cannot change systemic problems related to health,
such as poverty, environmental degradation, or lack of access to health care, but
comprehensive health communication programs should include a systematic exploration
of all the factors that contribute to health and the strategies that could be used to influence
these factors. Well-designed health communication activities help individuals better
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understand their own and their communities needs so that they can take appropriate actions
to maximize health.
Check Your Progress II
Note: a) Use space given below for your answer.
b) Compare your answer with the one given at the end of this unit.
1) What are some of the challenges of communication?
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4.7 LET US SUM UP
Health communication is rarely used as an independent strategy in community health because
knowledge is not enough to improve the health of a community. Instead, health communication is
an integral part of all health promotion strategies. You have also understood the different functions
and models of health communication. You also have got an insight of barriers and challenges of
health communication where campaign messages needed to reach and influence target audiences.
You need to develop strategies from the audience perspective for effective strategic health
communication interventions.
4.8 SUGGESTED READINGS
Brug, J., Glanz, K., Van, A. P. (1998). The impact of computer-tailored feedback and iterative
feedback on fat, fruit, and vegetable intake. Health Education Behavior 25:517-531.
PubMed; PMID 9690108
Freimuth, V.S., Stein, J.A., and Kean, T.J. (1989). Searching for Health Information: The Cancer
Information Service Model. Philadelphia, PA: University of Pennsylvania Press.
Hiramani, A.B. and Sharma, N. (1992). Health Communication in India: A Policy Perspective in
S. R. Mehta (ed.) Communication and Development: Issues and Perspectives, (pp. 262-
263). Jaipur: Rawat Publications
Kim, P., Eng, T.R., Deering, M.J. (1999). Published criteria for evaluating health-related Web
sites: Review. British Medical Journal 318:647-649. PubMed; PMID 10066209
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Kreps, G. L., & Barbara C. Thornton. (1992). Health communication: Theory and practice
(2nd ed.). Long Grove, IL: Waveland Press.
Kreuter, M.W., Strecher, V.J., and Glassman, B. (1999). One size does not fit all: The case for
tailoring print materials. Society of Behavioral Medicine 21:276-283. PubMed; PMID
10721433
Lalonde, B., Rabinowitz, P., Shefsky, M.L. (1997). La Esperanza del Valle: Alcohol prevention
novel as for Hispanic youth and their families. Health Education & Behavior 24:587-602.
PubMed; PMID 9307895
Park, K. 23rd edition. (2015). Park’s Textbook of Preventive and Social Medicine. Jabalpur: M/s
Banarsidas Bhanot publishers.
Rice, R. E., & Atkin, C. K. 3rd edition (2000). Public communication campaigns. Thousand Oaks,
CA: Sage.
Robinson, T.N., Patrick, K., Eng, T.R. (1998). Science Panel on Interactive Communication and
Health. An evidence-based approach to interactive health communication: A challenge to
medicine in the Information Age. Journal of the American Medical Association 280:1264-
1269. PubMed; PMID 9786378
Science Panel on Interactive Communication and Health (1999). Eng, T.R., and Gustafson, D.H.,
(eds.) Wired for Health and Well-Being: The Emergence of Interactive Health
Communication. Washington, DC: HHS.
Simons-Morton, B.G., Donohew, L., and Crump, A.D. (1997). Health communication in the
prevention of alcohol, tobacco, and drug use. Health Education & Behavior 24:544-554.
PubMed; PMID 9307892
The Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st
century. Washington: National Academies Press.
Thornton, Barbara C., and Gary, L. Kreps. (1992). Perspectives on health communication. Long
Grove, IL: Waveland Press.
US Office of Disease Prevention and Health Promotion. (2004). Health Communication, Healthy
People 2010 (vol. 1). Retrieved from URL: [Link]
[Link]/Document/HTML/volume1/11 [Link]# edn4.
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Worden, J.K., Flynn, B.S., Solomon, L.J. (1996). Using mass media to prevent cigarette smoking
among adolescent girls. Health Education Quarterly 23:453-468, PubMed; PMID
8910024
Scott, S.A., Jorgensen, C.M., and Suarez, L. (1998). Concerns and dilemmas of Hispanic AIDS
information seekers: Spanish-speaking callers to the CDC National AIDS hotline. Health
Education & Behavior 25(4):501-516. PubMed; PMID 9690107
Wright, A.L., Naylor, A., Wester, R. (1997). Using cultural knowledge in health promotion:
Breastfeeding among the Navajo. Health Education & Behavior 24:625-639. PubMed;
PMID 9307898
4.9 ANSWERS TO CHECK YOUR PROGRESS
Check Your Progress I
1) Health communication is the study and use of communication strategies to inform and
influence people to make choices about their health. Messages are spread through different
channels such as mass media, print materials, social media, and face-to-face conversations.
Health communication encompasses the study and use of communication strategies to
inform and influence individual and community knowledge, attitudes and practices (KAP)
with regard to health and healthcare.
Check Your Progress II
1) The challenges of health communication are the following:
a. The general population has difficulty in understanding the medical jargons used by
medical professionals, health care and policies. Such short fallings of health
communication may lead to the inability to respond to a medical condition, and a
generally declining health status.
b. Large amounts of information used by mass media as a method of health
communication may be misleading, inaccurate, or inappropriate, which may put
consumers at unnecessary risk.
c. A one-dimensional approach to health promotion, or other single-component
communication activities, has proved to be insufficient to achieve program goals.
d. One of the main challenges in the design of effective health communication programs
is to identify the optimal contexts, channels, content, and reasons that will motivate
people to pay attention to and use health information.
e. Limitations of printed materials in different languages lead to affect the health
communication.
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f. Generalization of the health policy and related health information limit the audience
from health communications.
g. The other challenge is related to the protection of privacy and confidentiality of
personal health information.
h. Factors such as illiteracy, inadequate health literacy, levels of knowledge and
understanding, customs, beliefs, religion, attitudes and social class differences
contribute to health disparities.
i. Health communication is not comprehensive enough to include a systematic
exploration of all the factors that contribute to health and the strategies that could be
used to influence these factors.
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