Claudia F. Parvanta, PhD Professor

Director, Florida Prevention Research Center College of Public Health

University of South Florida Tampa, Florida

Sarah Bauerle Bass, PhD, MPH Associate Professor

Director, Risk Communication Laboratory Department of Social and Behavioral Sciences

College of Public Health Temple University

Philadelphia, Pennsylvania

Health Communication

Strategies and Skills for a New Era

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Library of Congress Cataloging-in-Publication Data Names: Parvanta, Claudia F., author. | Bass, Sarah Bauerle, author. Title: Health communication: strategies and skills for a new era / Claudia Parvanta, Sarah Bauerle Bass. Description: Burlington, Massachusetts: Jones & Bartlett Learning, [2020] | Includes bibliographical references and index. Identifiers: LCCN 2018009707 | ISBN 9781284065879 (pbk.) Subjects: | MESH: Health Communication | Health Education Classification: LCC RA423.2 | NLM WA 590 | DDC 362.101/4dc23 LC record available at https://lccn.loc.gov/2018009707

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Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Case Study Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . xi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Chapter 1 Your World, Your Health . . . . . . . . . . 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Major Factors Affecting Health Outcomes . . . . . . . . . . . 1 Socially Defined You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 How to Change This Picture . . . . . . . . . . . . . . . . . . . . . . . .14 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Chapter 2 Communication 101: Whats Health Got to Do with It? . . . . . . . . 21

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Communicating About Health . . . . . . . . . . . . . . . . . . . . .26 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Chapter 3 Getting It Right: Words, Numbers, and Meaning . . . . . . . . . 37

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 Health Literacy Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 What Creates Good or Poor Health Literacy? . . . . . . .40 Determinants of Health Literacy . . . . . . . . . . . . . . . . . . .42 Tools to Enhance Health Literacy . . . . . . . . . . . . . . . . . . .49 Developing and Assessing Materials . . . . . . . . . . . . . . .51 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

Appendix 3A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Appendix 3B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 Appendix 3C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Chapter 4 Health Communication Practice Strategies and Theories . . . . . . . . . 69

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Core Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Selecting a Practice Strategy: The Behavioral

Economics ofChoice . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 Working with Theory in Health

Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Theory Used to Guide Informing . . . . . . . . . . . . . . . . . . .73 Theory Used to Persuade . . . . . . . . . . . . . . . . . . . . . . . . . .75 Applying Theory to Practice Strategies . . . . . . . . . . . . .78 Media Channel Selection . . . . . . . . . . . . . . . . . . . . . . . . . .81 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82

Chapter 5 Creating Meaningful Health Communication . . . . . . . . . . . . . . . . 85

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85 Understanding Your Audience . . . . . . . . . . . . . . . . . . . . .85 McGuires Hierarchy of Effects . . . . . . . . . . . . . . . . . . . . . .91 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Appendix 5A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Chapter 6 Media and Communication Channel Selection and Planning: The Plot Thickens . . . . 107

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 The Big Media Picture . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Contents

vi Contents

Communication Channels . . . . . . . . . . . . . . . . . . . . . . . 108 Communication Channel Selection . . . . . . . . . . . . . . 121 A Final Word: How Media Use and Health

Disparities Are Related . . . . . . . . . . . . . . . . . . . . . . . . . 122 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Appendix 6A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Appendix 6B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Appendix 6C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Appendix 6D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Chapter 7 Planning Health Communication Interventions . . . . . . . . . . . . . . . . . 149

Introduction: Form, Storm, Norm, or Inform? . . . . . 149 The Planning Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Planning Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Formative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Ok, Now What? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 From the Creative Brief to Concepts, Messages,

and Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Next? Choosing Settings andChannels . . . . . . . . . . 166 Final Thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Appendix 7A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Appendix 7B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Appendix 7C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Appendix 7D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Appendix 7E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Chapter 8 Implementation and Evaluation . . . . . . . . . . . . . . . . . . . 201

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Preparing a Logic Model . . . . . . . . . . . . . . . . . . . . . . . . . 202 Final Strategy Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Production and Dissemination Factors . . . . . . . . . . . 210 The Implementation Plan . . . . . . . . . . . . . . . . . . . . . . . . 211 Monitoring and Evaluating Your Program . . . . . . . . 220

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Appendix 8A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Chapter 9 Communication in the Healthcare Setting . . . . . . . . . . . . 241

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Effective Interpersonal Communication . . . . . . . . . . 241 Communication Strategies for Difficult

Conversations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

Chapter 10 School Health . . . . . . . . . . . . . . . 259 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Schools Are a Logical Site for Health

Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Leading Health Issues and the Youth Risk

Behavior Surveillance System . . . . . . . . . . . . . . . . . . 261 Promoting Movement and Physical Activity in

AllAcademic Classrooms . . . . . . . . . . . . . . . . . . . . . . 263 Systems Approaches to Promoting Health in

Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 National Initiatives to Support Health Promotion

forStudents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Resources for . . . 269 Health Communication Specialists in Schools . . . . 271 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272

Chapter 11 Workplace Health . . . . . . . . . . . . 275 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 Why Workplace Health? . . . . . . . . . . . . . . . . . . . . . . . . . . 276 A Word About Terminology . . . . . . . . . . . . . . . . . . . . . . 276 Evolution of Workplace Health Programs . . . . . . . . . 277

Contents vii

Setting the Stage: The Relationship Between Health Insurance and Workplace Health Programs . . . . . . . . . . . . . . . . . . . 279

Common Workplace Health Program Elements: Where We Are with Workplace Health . . . . . . . . . . 281

Diabetes, Tobacco, and Physical Activity . . . . . . . . . . 282 Stress in the Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . 282 Health Coaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Tools and Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Emerging Trends: Where Workplace

Health Is Going . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Creating a Culture of Health Within

the Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

Return on Investment . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 Conclusion: The WorkHealth Connection . . . . . . . 297 Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Appendix 11A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Appendix 11B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Appendix 11C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317

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The authors of chapters not written solely by the lead authors are listed below in alphabetical order.

Linda Fleisher, PhD, MPH, is a Senior Scientist at the Research Institute at the Childrens Hospital of Philadelphia. She is also adjunct faculty at Fox Chase Cancer Center and Perelman School of Medicine at University of Pennsylvania in Philadelphia. Dr. Fleisher is co-author of Chapter 6.

Heather Gardiner, PhD, MPH, is Associate Professor and Director of the Health Disparities Laboratory in the Department of Social and Behavioral Sciences at Temple University, College of Public Health. Dr.Gardiner is author of Chapter 9.

Alesha Hruska, MPH, MS, MCHES, is Adjunct Instructor at the University of the Sciences, Department of Behavioral and Social Sciences. Ms. Hruska is co-author of Chapter 11.

Laurie Maurer, PhD, MA, recently completed her doctoral studies at Temple University in the Department of Social and Behavioral Sciences, College of Public Health and was a Research Assistant in the Risk Communication Laboratory. Dr. Maurer is co-author of Chapter 5.

Elisa Beth McNeill, PhD, MS, is Clinical Associate Professor and Coordinator of Health and Physical Education Teacher Certification in the Department of Health and Kinesiology at Texas A&M University. Dr. McNeill is author ofChapter 10.

Jeannine L. Stuart, PhD, is President of AREUFIT Health Services, Inc., in West Chester, Pennsylvania. Dr.Stuart is co-author of Chapter 11.

Contributors

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Authors of case studies that appear in chapter boxes or appendices are listed below in the order in which their case material first appears in the book.

Appendix 3A: Use of Patient Activation Tool (PAT) for Shared Decision Making in Pediatric Appendicitis

Dani O. Gonzalez, MD Center for Surgical Outcomes Research, The Research Institute, Nationwide Childrens Hospital, Columbus, Ohio Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

Katherine J. Deans, MD, MHSc Center for Surgical Outcomes Research, The Research Institute, Nationwide Childrens Hospital, Columbus, Ohio Department of Pediatric Surgery, Nationwide Childrens Hospital, Columbus, Ohio

Peter C. Minneci, MD, MHSc Center for Surgical Outcomes, The Research Institute at Nationwide Childrens Hospital, Columbus, Ohio

Appendix 5A: Demographic and Behavioral Target- ing to Encourage Colonoscopy in Low-Literacy Afri- can Americans

Thomas F. Gordon, PhD Professor, Department of Psychology, University of Massachusetts-Lowell, Lowell, Massachusetts

Box 6-3: Reaching Adolescents for HPV Immuniza- tion Using Facebook

Salini Mohanty, DrPH, MPH University of Pennsylvania, Philadelphia, Pennsylvania

Emily Gibeau, MPH Pennsylvania Department of Health, Harrisburg, Pennsylvania

Ayla Tolosa-Kline, MPH Philadelphia Department of Public Health, Philadelphia, Pennsylvania

Caroline Johnson, MD Philadelphia Department of Public Health, Philadelphia, Pennsylvania

Appendix 6A: Los Angeles Countys Sugar Pack Health Marketing Campaign

Noel Barragan, MPH Chronic Disease and Injury Program, Department of Public Health, Los Angeles County Health Agency, Los Angeles, California

Tony Kuo, MD, MSHS Chronic Disease and Injury Program, Department of Public Health, Los Angeles County Health Agency, Los Angeles, California

Appendix 6B: Text4baby as a Surveillance/Informa- tion Dissemination Tool During Zika Outbreak

Jodie Fishman, MPH, MCHES Zero to Three, Washington, DC

Appendix 6C: The Use of Virtual Worlds in Health Promotion

Joan E. Cowdery, PhD Michigan University, Ypsilanti, Michigan

Sun Joo (Grace) Ahn, PhD Grady College of Journalism & Mass Communication, University of Georgia, Athens, Georgia

Case Study Contributors

xii Case Study Contributors

Appendix 6D: Health Promotion and Social Change Through Storytelling Across Communica- tion Platforms

Hua Wang, PhD, MA University of Buffalo, Buffalo, New York

Arvind Singhal, PhD The University of Texas at El Paso, El Paso, Texas

Appendix 7A: Using PhotoVoice in Formative Research

Rickie Brawer, PhD, MPH Thomas Jefferson University, Philadelphia, Pennsylvania

Ellen J. Plumb, MD Thomas Jefferson University, Philadelphia, Pennsylvania

Melissa Fogg, MSW Mural Arts Philadelphia, Philadelphia, Pennsylvania

Brandon Knettel, PhD, MA Duke University Global Health Institute, Durham, North Carolina

Margaret Fulda, MSW, LSW, MPH JFK Behavioral Health Center, Philadelphia, Pennsylvania

Abbie Santana, MSPH Thomas Jefferson University, Philadelphia, Pennsylvania

Melissa DiCarlo, MPH, MS Thomas Jefferson University, Philadelphia, Pennsylvania

James Plumb, MD, MPH Thomas Jefferson University, Philadelphia, Pennsylvania

Appendix 7B: Steps in Tailoring a Text Messaging Based Smoking Cessation Program for Young Adults: Iterative Intervention Refinement

Michele L. Ybarra, PhD Center for Innovative Public Health Research, San Clemente, California

Appendix 7C: Better Bites

Brian J. Biroscak, PhD, MPH Yale University, New Haven, Connecticut

Ashton Potter Wright, DrPH, MPH City of Lexington, Lexington, Kentucky

Anita Courtney, MS, RD Lexington Tweens Nutrition and Fitness Coalition, Lexington, Kentucky

Carol A. Bryant, PhD, MS University of South Florida, Tampa, Florida

Appendix 7D: Social Marketing to Increase Partici- pation in WIC

Tiffany Neal, MPH, MCHES Thomas Jefferson Health District, Virginia Department of Health, Richmond, Virginia

Appendix 7E: Asthma Self-Management Mobile Application for Adolescents: From Concept Through Product Development to Testing

Tali Schneider, MPH, CHES Florida Prevention Research Center, University of South Florida, Tampa, Florida

Jim Lindenburger Center for Social Marketing, University of South Florida, Tampa, Florida

Appendix 8A: The Challenges of Evaluating a Supplemental Nutrition Education Program for Low-Income Families

Kami J. Silk, PhD Michigan State University, East Lansing, Michigan

Evan K. Perrault, PhD University of Wisconsin-Eau Claire, Eau Claire, Wisconsin

Caroline J. Hagedorn, MA Independent Researcher, Washington, DC

Samantha A. Nazione, PhD Berry College, Mount Berry, Georgia

Case Study Contributors xiii

Lindsay Neuberger, PhD University of Central Florida, Orlando, Florida

R. Paul McConaughy, MA Michigan Fitness Foundation, Lansing, Michigan

Khadidiatou Ndiaye, PhD George Washington University, Washington, DC

Box 9-4: Shared Decision Making: Decision Counseling Program at Thomas Jefferson University

Ronald E. Myers, DSW, PhD Division of Population Science and Center for Health Decisions, Department of Medical Oncology, Sidney

Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

Anett Petrich, RN, MSN Division of Population Science and Center for Health Decisions, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA

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As with anything, it truly takes a village, and in this case, it took a village of dedicated and incredible peo- ple who helped us make this book happen. Many of the people who helped with ideas or materials for this book are credited where their contributions appear. We thank them for as well as examples of health communication in action. Their work represents some of the best of the best, and we truly appreciate being able to showcase it in this textbook.