Transcript

[TEXT: Young African Leaders Initiative: Online Training Series]

Hi, I am Dr. Austin Demby, deputy director in the Office of Global Health at the Health Resources and Services Administration at the U.S. Department of Health and Human Services.

[TEXT: Austin Demby, Deputy Director in the Office of Global Health, Health Resources and Services Administration, U.S. Department of Health and Human Services]

I was a founding member of the Centers for Disease Control and Prevention’s Global AIDS Program. I have worked with teams to establish AIDS education, prevention, treatment and care programs in Ethiopia, Rwanda, Tanzania, Zambia and the Democratic Republic of Congo. During the Ebola outbreak in West Africa, I was part of CDC’s leadership team that worked with international and domestic partners to contain the outbreak in Sierra Leone.

This lesson is Health Communications: The Message, the Messenger & the Audience.

In this lesson we will discuss the three key pillars of reporting and communicating health information. We’ll talk about the importance of accurately reporting health information. And we will look at the consequences of distributing and promoting inaccurate health information.

Accurately reporting on health issues in a balanced way is critical to improving health outcomes. It is important to report such health information with due regard to the impacted populations, ensuring that the reporting results in good outcomes and does not result in stigmatization and unforeseen consequences.

The absence of reporting accurately on health issues and in a timely manner creates unacceptable room for rumors, which, when allowed to have a foothold, may have devastating consequences that may be very difficult to reverse. It can mean the difference between someone seeking the proper lifesaving prevention care or not. Reporting and communicating health information for appropriate action is an issue that we should consider very carefully. It is indeed a partnership between three fundamental pillars, what I will refer to as the “Health Communications Triangle” — the message, the messenger and the audience.

Let us start with the message.

For populations to take health messages seriously, messages have to be important and relevant to the impacted populations. This should not just be the opinion of the health experts. The population you are trying to reach should be able to understand how the health issues affect them as individuals, their families, their neighbors or others they care about. The timing of
messages is very important as it will determine their acceptance and the urgency with which the population responds.

Messages are not intended for the benefit of the health experts but instead are directed at specific populations. Care must be taken to make sure that the messages are not presented in hard-to-understand medical jargon but in clear, succinct, simple and understandable language that people could comprehend irrespective of their knowledge of the issue. In an era where information could be obtained from many sources, especially unregulated social media accounts, it is important that the sources of health information for public communications are credible, reliable and verifiable. Such information should be based on data and plausible science which a reasonable individual or community could understand. Messages should not create fear and panic, or stigmatize populations based on association, geography or lifestyle. Most importantly, communities usually want to know what they need to do to reduce their exposures and risks, and improve health outcomes. Every health message is therefore incomplete without an appropriate actionable component for your primary audience.

Consider that you are not just relaying information to your audience, you are also working to increase their health literacy as well. Health literacy is defined as the degree to which a person has the capacity to obtain, communicate, process and understand basic health information and what services are available to make appropriate health decisions. By crafting messages that follow these guidelines, individuals and communities will be better able to make informed healthcare decisions for themselves.

Let’s talk next about the messenger.

When we talk about the health messenger, we’re referring to any individual who attempts
to relay health information. And I mean anyone — a family member, a friend, a colleague, a neighbor. And, of course, properly trained and licensed health care professionals. People share health messages with friends and family because they feel a communal responsibility. With a relevant, timely and credible message, the community can become important advocates for your efforts.

For effective health communication, the “messenger” is as important as the “health message” itself. The messenger has to be a good listener, credible and trustworthy. They should be straightforward, honest and nonjudgmental. They must have a proven track record of dealing with similar issues and providing reliable information in the past. The messenger’s credibility stems from an in-depth knowledge or expertise in the subject area — no matter who they are. If the person serving as the primary messenger does not have a proven track record on the topic, then their partners on the project must. Either way, you should not expect audiences to listen to your message if you cannot demonstrate that you have the knowledge to speak on the subject.

And for the messenger to have the desired impact, they have to be approachable, culturally sensitive, using appropriately nuanced language, and be perceived as a dependable partner who will be there for the long haul.

As populations tend to be skeptical of health messages in today’s world of the internet, where misinformation and rumors are easily spread, it is important that there is a perception that the messenger really cares about the health of a population, and has the knowledge and expertise to be that messenger. The notion of a partnership between the health communications expert and the population, working together towards achieving a common goal of good health outcomes, with both parties contributing in their respective ways, is vital.

Let us now talk about the audience.

The intended audience is an equal partner in this communications triangle. For them to participate effectively, they have to feel that the health issue affects them or has the potential to affect them, their families, or their communities, directly or indirectly. It is important that they don’t feel blamed for the health effects that are being addressed, but more as partners in bringing solutions to the health problem. A key component of this is ensuring that the audience understands and agrees that their views will be factored into developing solutions. In addition, for many community members, knowing that their local leadership is on board with a particular message and messenger can help build trust, and they may be more willing to listen and act accordingly.

Because the audience may have different backgrounds, beliefs or cultures, and different groups may receive and react to messages differently, every effort should be made to direct messages to the different groups within an audience, considering factors such as age, gender, tribe and socioeconomic status. Since these groups will tend to ask about what actions they should take to influence health outcomes, deliberate efforts should be made to provide actionable messages relevant to a specific group based on these same factors.

This communications triangle is best illustrated by our efforts that started in 2011 to get pregnant women in Malawi to test for HIV and, if they tested positive for the virus, to immediately access lifelong treatment to protect their health and the health of their unborn child. We launched a new campaign that focused our message on protecting the health of both the mother and her baby. The new program was a deviation from prior prevention-of-mother-to-child-transmission programs that just focused on protecting the baby, with little or no consideration for the mother. The new program appealed to and motivated the mothers to actively participate. New messengers were recruited to supplement the health care workers and to work with the pregnant women as peers. These new messengers were mothers themselves, some of whom were HIV-positive and had benefitted from the treatment program and had delivered healthy babies despite their HIV status. These women were very effective, believable and trustworthy messengers.

Prior research had shown that fathers were a major impediment to having their wives tested for HIV and getting treatment in Malawi. For this program to be effective, it was important that fathers understood the program and the benefits it brought to their families. Male counselors were recruited and included in the program at every step of the way. In determining the primary audience for delivering the message of a healthy mother and healthy baby, pregnant women and their husbands were specifically targeted. The net result of this program with a carefully crafted message, effective messenger and targeted audience was very impressive. For the first 12 months of the program, there was a dramatic increase of 700 percent in the number of pregnant women in Malawi who got tested, learned their status and enrolled in the national treatment program.

In another example to illustrate this phenomenon, during the 2014/2015 Ebola outbreak in West Africa, the initial efforts at getting community cooperation to contain the outbreak failed because messages were scientific facts that were not tailored to the audiences impacted by the virus, the initial messengers were not trusted, and the tools used to deliver messages were inappropriate.

The message then was; “Ebola is the deadliest viral disease in the world. Over 95 percent of infected people die. There is no vaccine or medicine to treat the virus.” Yet communication experts asked people to go to hospitals when they were ill. And when nearly 100 percent of people who presented to hospitals died, healthcare workers were surprised when the communities revolted and accused them of killing patients who presented to hospitals. Reversing that perception was a major challenge. For us to achieve success, we needed to create a partnership between the health care providers and the communities impacted. To do so meant understanding the communities’ concerns, identifying trusted subject-matter experts and utilizing the preferred medium for message delivery, which in this case was radio broadcasts by the health care workers. Together, we developed actionable and appropriate messages for various target audiences. The net result of those actions in Sierra Leone was 100 percent safe burials, a sharp increase in reported cases, early referral to treatment centers, higher survival rates and a final containment of the outbreak.

Health communication and reporting to achieve desired health outcomes should not be a single event. It should be an ongoing activity that utilizes all available tools, such as mobile applications, social media, print, radio, text messaging and TV. These are powerful tools when combined with the correct message, adapted to the right media and delivered by the right messenger, whose message is directed at the appropriate audience. To ensure effectiveness, measurements have to be in place to guarantee that the messages are delivered appropriately, the intended audience received the credible message and then took actions to address the health issue.

This dynamic process should result in adjustments to each pillar of the Health Communications Triangle — the message, the messenger and the intended audience — until the desired health outcomes are achieved.

After you have completed all the lessons in this course at YALI.state.gov, you can test your knowledge and earn a YALI Network Certificate.

[TEXT: Test your knowledge … YALI.state.gov … YALINetwork]

[TEXT: Produced by the U.S. Department of State]

[TEXT: Photo credits: USAID, HRSA at U.S.
Department of Health and Human Services,
Centers for Disease Control and Prevention]