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Join the Conversation: #healthcomm Communicating Public Health: Message Design Strategies to Promote Awareness and Action to Address Social Determinants.

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Presentation on theme: "Join the Conversation: #healthcomm Communicating Public Health: Message Design Strategies to Promote Awareness and Action to Address Social Determinants."— Presentation transcript:

1 Join the Conversation: #healthcomm Communicating Public Health: Message Design Strategies to Promote Awareness and Action to Address Social Determinants of Health Jeff Niederdeppe, Ph.D. Associate Professor Department of Communication Cornell University jdn56@cornell.edu

2 Collaborators Sarah E. Gollust – University of Minnesota SPH Colleen L. Barry – Johns Hopkins SPH Michael A. Shapiro, Hye Kyung (Kay) Kim, Helen Lundell, Sungjong Roh – Cornell University Funding Support RWJF Healthy Eating Research Program (69173, 68051) RWJF Health and Society Scholars Program RWJF Grant to University of Wisconsin Population Health Institute – Mobilizing Action Toward Community Health

3 What are we trying to communicate, to whom? What are we trying to change? What are we up against? Three lessons learned 1.Education and awareness may not be enough 2.Connect messages to broader values 3.Opposing messengers are a challenge Some concluding thoughts Presentation Outline

4 Traditional Health Communication Focus has largely been on changing individual behavior, BUT… Behaviors and health outcomes are largely shaped by larger social, political, economic environments Need different message strategies, may be at odds with a focus on individual behavior

5 Features of Many Health Issues Strong sense of personal responsibility for health in public opinion and discourse

6 Public Opinion about Factors that Very Strongly Influence Health Source: Robert, S. A., & Booske, B. C. (2011). U.S. opinions on health determinants and social policy as health policy. American Journal of Public Health, 101, 1655-1663.

7 Strong sense of personal responsibility for health in public opinion and discourse Powerful industries promoting health-harming products, incredible $ resources to fight regulation Features of Many Health Issues

8 For Example…

9 Strong sense of personal responsibility for health in public opinion and discourse Powerful industries promoting health-harming products, incredible $ resources to fight regulation Wide body of evidence on the influence of the larger social, economic, physical, and built environment Features of Many Health Issues

10 Ecological Model of Healthy Eating

11 Strong sense of personal responsibility for health in public opinion and discourse Powerful industries promoting health-harming products, incredible $ resources to fight regulation Wide body of evidence on the influence of the larger social, economic, physical, and built environment Complex mechanisms linking these factors to health outcomes and behaviors Features of Many Health Issues

12 Factors that Cause Obesity: A Systems View (105 variables)

13 Who is the Target of the Message / Campaign? Healthier Environments to Improve Health and Reduce Health Disparities Policies To Create Healthy Environments Policymaker Action Public Opinion (persuade the opposition) Public Opinion (mobilize issue publics)

14 What are the Targeted Outcomes for Effective Communication about Population Health?

15 1.Increase awareness of health disparities 2.Increase belief that disparities are worth addressing 3.Heighten belief that societal forces and actors cause, and are responsible for, poor health and disparities 4.Promote support for policies with potential to improve social determinants and reduce disparities 5.Mobilize action to advocate for social change

16 Lesson 1: Raising Awareness is Not Sufficient

17 Priming group differences

18 Priming Group Differences Public support for government intervention depends on type of group difference –Economic disparities: greatest support –Racial disparities: least support Perceptions of the causes of group differences matter –Relates to underlying attitudes about causality, responsibility, and fairness –Behaviors vs. social structure vs. genetics Sources: Rigby et al. (2009); Lynch & Gollust (2010)

19 Lesson 1: Raising Awareness is Not Sufficient Priming group differences Pre-existing awareness and values lead to “biased processing”

20 Democrats Independents Republicans Source: Gollust, Lantz, Ubel; AJPH (2009) Biased Processing of SDH Messages

21 Focus group insight Without concrete mechanisms for how SDH produce disparities, people fill in the blanks with preconceptions In response to a chart showing the bivariate association between education and life expectancy: “Maybe somebody didn’t go on to school or even didn’t finish high school but they might have gotten a good education at home in terms of how to be a healthy person.” Source: Lundell, Niederdeppe, & Clarke, 2013

22 Lesson 2: Connect Messages to Larger Values

23 Lesson 2: Connect Messages to Broader Values Acknowledge personal responsibility –BUT… Proceed with caution

24 Insights from Mall Experiment Methods 500 participants, 4 conditions, summer 2010 Michele’s story – environmental and economic causes of obesity, neighborhood development as an effective solution Niederdeppe, J., Shapiro, M., Kim, H. K., Bartolo, D., & Porticella, N. (2013). Narrative persuasion, causality, complex integration and support for social policy. Health Communication, doi:10.1080/10410236.2012.761805. MALL EXPERIMENT

25 Three groups were exposed to Michele’s story about (1) the causes of obesity and (2) neighborhood development as one solution MALL EXPERIMENT

26 Insights from Mall Experiment Methods 500 participants, 4 conditions, summer 2010 Research Question: How strongly should a story emphasizing SDH as causes and solutions for obesity Acknowledge personal responsibility To increase complexity of thinking about obesity’s causes, and Maximize support for obesity policies? MALL EXPERIMENT

27 Example of Condition Differences High Responsibility Here, she feels comfortable getting out of the house and exercising outside – activities Michele sees as tremendously important for improving her health. This has helped Michele to develop healthier lifestyle habits. Moderate Responsibility Here, she feels more comfortable getting out of the house and getting outside. This has helped Michele to have more options for improving her health – even though following through on them is a challenge. Low Responsibility Here, she feels more comfortable getting out of the house, even if she’s not intending to exercise. MALL EXPERIMENT

28 Condition Effects on Support for Obesity- Reducing Public Policies MALL EXPERIMENT Niederdeppe, J., Shapiro, M., Kim, H. K., Bartolo, D., & Porticella, N. (2013). Narrative persuasion, causality, complex integration and support for social policy. Health Communication, doi:10.1080/10410236.2012.761805.

29 Condition Effects on Intentions to Engage in Diet and Exercise MALL EXPERIMENT Niederdeppe, J. et al. (2013). Effects of emphasizing environmental determinants of obesity on intentions to engage in diet and exercise behaviors. Preventing Chronic Disease, http://dx.doi.org/10.5888/pcd10.130163.

30 … BUT Proceed with Caution Personal narratives can shift emphasis to individual responsibility Stories about individual children can increase blame to children for obesity Policymakers counterargue individual narratives unless combined with broader statistics or a story told about the community Sources: Barry, Brescoll, Gollust (2013); Niederdeppe et al. (2014b)

31 Lesson 2: Connect Messages to Broader Values Acknowledge personal responsibility –BUT… Proceed with caution Identify novel values related to population health improvement to reach broader coalitions

32 Identify novel values (1) Source: Gollust, Niederdeppe, Barry, 2013

33 Source: Lynch and Gollust (2010) Fairness and equal opportunity, not equal outcomes Identify novel values (2)

34 Lesson 3: Opposing Messages(-ers) are a Challenge

35 It can be useful to anticipate and try to offset counter-arguments from opponents of social change

36 Content analysis of arguments used to support and oppose the tax in public discourse Niederdeppe et al., AJPH, 2013 Public opinion poll gauging response to discrete pro- and anti-tax arguments Barry et al., AJPM, 2013 In-depth interviews with SSB tax proponents and advocates in jurisdictions where taxes proposed Jou et al., AJPH, 2014 How tackling opposing arguments can be useful NATIONAL EXPERIMENT

37 Surveys to Identify Resonant Frames – Pro-Tax NATIONAL EXPERIMENT

38 Surveys to Identify Resonant Frames – Anti-Tax NATIONAL EXPERIMENT

39 Strongest pro-tax arguments focus on: Largest driver of obesity (“softening the ground”) Provides funds for childhood obesity prevention Beverage industry outspends pro-tax advocates by a large margin; anti-tax arguments resonate strongly Inoculation Theory Protect from subsequent (persuasive) attack by highlighting source motives and countering weak arguments (“industry demonization”) Theoretical Rationale NATIONAL EXPERIMENT

40 Randomized experiment conducted from October- December, 2012 using the survey research firm GfK Group (Knowledge Networks) 3,118 completed baseline survey and follow-up (sent 1-week later and completed within 2 weeks) National Randomized Experiment NATIONAL EXPERIMENT

41 Overview of Experimental Conditions ArmApproachTime Period 1Time Period 2 Arm 1Control conditionNo exposure Arm 2Control conditionNo exposureStrong con-message 1 Arm 3 Single message (not countered) Strong pro-message 1No exposure Arm 4 Single message (countered at time 2) Strong pro-message 1Strong con-message 1 Arm 5Multi-message Strong pro-message 1, strong con-message 1 Strong con-message 2 Arm 6 Multi-message (w/repeat pro-message) Strong pro-message 1, strong con-message 1 Strong con-message 2, strong pro-message 2 Arm 7Inoculation frame Inoculation (weak con- message with refutation) Strong con-message 1 Arm 8 Inoculation frame (w/repeat pro-message) Inoculation (weak con- message with refutation) Strong con-message 1, strong pro-message 1 NATIONAL EXPERIMENT

42 A Strong Pro-Tax Argument Supporters of a tax say that sugary drinks may be the single largest driver of obesity in the United States. More children are obese today than in previous generations. Rates of obesity have tripled among children and teens over the past 30 years. Children and teens drink twice as much soda and other sugary drinks as they did 30 years ago. Supporters of a tax say drinking a 20-oz soda is equivalent to eating 16 packets of sugar. That’s 240 empty calories in a single bottle. When people consume sugary drinks, they do not feel full, so they tend to eat more food. Children who drink sugary beverages also prefer foods with higher calories, leading to worse overall nutrition. NATIONAL EXPERIMENT

43 A Strong Anti-Tax Argument Opponents of a tax say obesity is a matter of how many calories people consume, not where those calories come from. A tax on sugary drinks is arbitrary because it does not affect other unhealthy foods like donuts, cookies, and candy bars. Obesity is a complex problem that cannot be solved by focusing on just one small part of a person’s diet. Sugary drinks account for only 7 percent of calories in the average American's diet. Science shows that obesity is caused by an imbalance between the calories we consume through food and drinks and those we burn through daily activities and exercise. NATIONAL EXPERIMENT

44 Inoculation Treatment Soda companies will try to convince you that a tax on sugary drinks is arbitrary because it does not affect foods like donuts, cookies, and candy bars. They will say that they are an unacceptable intrusion of government into people’s personal choices. They will call them “food taxes” to try to confuse people. But sugary drinks are not food – they have no nutritional value. In fact, research suggests that sugary drinks are the single largest driver of obesity in the United States. Nobody is telling anyone what to drink. But, by adding a few pennies to the price of a soda, many people will choose differently. NATIONAL EXPERIMENT

45 Tackling opposing arguments can be useful… * * Denotes p<.05; **p<.01 vs. no exposure control NATIONAL EXPERIMENT

46 … At Least in the Short-Term. NATIONAL EXPERIMENT

47 … At Least in the Short-Term.

48 Lesson 3: Opposing messages(-ers) are a challenge It can be useful to anticipate and try to offset counter-arguments from opponents of social change BUT… Strategies to neutralize the opposition may not work across all social groups

49 Politically Polarizing Message Effects Significant interaction term (β=-0.83, p=0.02) for Republican x inoculation % difference from the no-exposure control group; †p<0.10; *p<0.05 from OLS regression

50 Lesson 3: Opposing messages(-ers) are a challenge It can be useful to anticipate and try to offset counter-arguments from opponents of social change BUT… Strategies to neutralize the opposition may not work across all social groups AND… It’s not always good to wake a sleeping giant

51 AND… It’s not always good to wake a sleeping giant (industry) Source: Harwood et al., 2005

52 Some Concluding Thoughts

53 Also Need to Consider: Who Delivers the Message? Traditional news

54 Growing capacity to cover disparities, but Covering them is still relatively uncommon

55 Also Need to Consider: Who Delivers the Message? Traditional news Novel messengers

56 Novel Messengers Violating expectations of a source can be powerful Partisan labels increase policy support when they take an unexpected position on a partisan issue E.g., Republican endorsing same-sex marriage E.g., Democrat opposing abortion rights Source: Bergan (2012)

57 Military leaders speaking to policymakers and the public “When it comes to children’s health and our national security, retreat is not an option.” “Retreat is Not an Option: Healthier School Meals Protect Our Children and Country” Novel Messengers

58 What We Need to Know Need more work on the messenger Need more work on actions vs. opinions/perceptions –What are the actions that individuals can take to influence policy?

59 Direct Democracy in CA and Other Places… But Limited Results

60 The Policy Process is Complex… Source: Bulletin of the WHO (2006)

61 BUT Changes in Public Sentiment can Set the Stage for Changes in Policy Source: Gallup (2012)

62 Questions? Comments? Thank you! Contact me at jdn56@cornell.edujdn56@cornell.edu


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