Category: Health Communication

Networking the New Normal: Confronting Illness through Social Media

GUEST BLOGGER: Terri Beth Miller, PhD

This is not how you expected life to be. You’re run down. You’re hurting. You’re physically and emotionally drained. And it feels as though those closest to you are a million miles away, as though you’ve suddenly found yourself stranded on a desert island with no hope of rescue.

This is what it can feel like when you are confronting illness, when a diagnosis suddenly transports you to a new world you never wanted to visit, let alone permanently inhabit.

The truth is that illness, whether physical or psychological, chronic or acute, can be one of the most frightening, disorienting, and isolating experiences a person can face. And yet, if we live long enough, we will all confront this experience. After all, ain’t none of us getting out of this life alive.

But diagnosis doesn’t have to mean disaster. Our 21st century world offers resources once unimaginable to those seeking health information and support. Few are more potent than the vast social media networks available to connect people in the most far-flung corners of the globe with the simple click of a button.

This seemingly limitless connection can be an infinite comfort for those who are suffering from illness, allowing survivors to reach out to fellow survivors, who often can understand illness in a way that those who haven’t experienced it simply cannot. After all, family and friends may empathize. They certainly can provide a love and comfort that the virtual world cannot replace. But there is a special and necessary connection shared by those have felt the gnawing at the bones, the torment of the mind—by those who have the visceral, intimate experience of real, bloody, hand-to-hand combat with illness. This is the connection that social media can offer to those suffering from illness, a means to overcome the isolation that can cut as deeply as sickness itself.

In addition to the opportunity to connect with fellow survivors, social media is an exceptional outlet for sharing health information and resources, from exploring treatment options to connecting with care-providers. After all, an informed patient is an empowered patient. Because those who are suffering from ill health often feel a tremendous lack of control and a vast feeling of uncertainty for the future, this access to knowledge can restore the sense of self-determination and understanding that survivors knew before diagnosis. These resources can restore some normalcy, or at least something of a return of the survivor’s sense of self.

Nevertheless, extreme caution must be practiced. We are perhaps never more vulnerable than when we are battling illness, and unfortunately those who would prey on the hopes and fears of the desperate are legion. So while it is healthy—and, indeed, essential—to seek out all the knowledge and resources possible when battling illness, it is equally essential to be wary of promises that are simply too good to be true. Vet the company you keep and the treasures you store up in the virtual world just as you do in the physical one.  Avail yourself of the immense resources available to you online as you wage your battle with sickness. But do so from a position of strength and discernment. This is your body. This is your mind. This is your spirit and your life. Harness the best and highest powers of social media. There is tremendous solace, solidarity, and support to be found online for those battling illness, but only for those who use it wisely.

For more information on the most beneficial mental health online resources, please visit:

Terri Beth Miller completed a PhD in English Language and Literature at the University of Virginia. She has taught writing and literature courses for more than a decade and is a regular contributor to the mental health self-help portal. View her profile on LinkedIn at

What’s culture got to do with it?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

What happens when a cultural and political sociologist teams up with health researchers? Answer: some really fascinating work and advancement of how we think about the influence of culture on health.

Meet Andrew Perrin, Ph.D. He is a professor in the Department of Sociology at the University of North Carolina in Chapel Hill.


While his work focuses mostly on “what people need to know, be and do to make democracy work”, his family has opened up the opportunity to share his expertise with the public health arena. Does culture influence health? If so, how, and to what extent?

Dr. Perrin suggests that although the public health and health communication world may be able to measure certain aspects of culture well, there is a lack of breadth and depth of conceptualizing culture. This could mean we, public health and communication groups, are missing or misinterpreting a big piece of the health puzzle. He offered context of the contemporary synthesis of culture as presented by Johnson-Hanks and colleagues. A cyclical interaction between culture in the world and culture in our mind influences our individual and collective decisions and actions, but how can we robustly measure this?


Fortunately, Dr. Perrin and an interdisciplinary crew are working to develop tools to measure culture in the world and culture in the mind within the context of obesity. Once measured, they will work to interpret the effects of culture on health. One project looks to explain variations and health outcomes in a county in North Carolina using a combination of geocoded photographs (culture in the world) and focus groups (culture in the mind). Results for this are forthcoming. Another project looked at obesogenic behaviors and stigma in children’s movies. You may or may not be surprised to learn that unhealthy behaviors are represented more than healthy behaviors, and movies contain messages that encourage weight-related teasing or bullying. For more information and results about this, review the paper on Pass the Popcorn.

Thanks to Dr. Perrin for sharing his time and expertise with our class! He highlighted the value interdisciplinary teams bring to thinking about problems in a more holistic manner that could ultimately benefit the public’s health.

 You can learn more about Dr. Perrin’s work at his website.

Dr. Clinton vs. Dr. Trump

By: Shauna Ayres MPH: Health Behavior candidate 2017

Who would you rather have as a doctor? Hillary Clinton? Or, Donald Trump? Yale researchers found that primary care physicians address politically sensitive health issues different depending on political affiliation. They surveyed 20,000 primary care physicians across the nation to obtain their political affiliation and professional recommendations for nine patient vignettes. These vignettes highlighted real-life situations related to abortion, marijuana, helmet use, obesity, cigarette use, alcohol use, depression, sex work, and firearm safety. Republicans and Democrats did not significantly differ regarding helmet use, obesity, cigarette use, alcohol use, depression, and sex work. However, Republican were more concerned about abortion and marijuana use, and Democrats were more concerned about firearm safety (Hersh, 2016). This makes sense as these health issues are the most hotly-contested, politically-charged health topics right now in the US.

What does this mean as a patient? Should a doctor’s political affiliation be a factor when a patient is determining who will provide them healthcare? Do patients have a right to know their doctor’s political leanings? The research suggests that in respect to politicized health issues, patients should be cognizant of their doctor’s reactions and recommendations, and if necessary, seek a second opinion. There is no algorithm for healthcare and what works for one patients, does not mean is will work for another. I would argue the most important factors in a patient-doctor relationship are mutual respect and trust, not necessarily political homogeneity.

What does this mean as a doctor? Should a doctor disclose his/her political affiliation to patients? Researchers suggest that doctors should be aware of their political biases on health issues. Doctors should attempt to provide the best treatment in the interest of each patient and not in the interest of a political agenda. Likewise, doctors who cannot do this should recommend that patients seek a second opinion or direct patients to informational resources with depoliticized facts, recommendations, and healthcare options.

Political bias in healthcare is not to be feared or overly criticized, just recognized and responsibly examined by both the provider and patient. After all, doctors are humans just like the rest of us.

Remember to vote next Tuesday, November 8th!



Cummings, M. (2016, Oct 4) Care differs if your doctor is a democrat or republican. Futurity.

Hersh, E. D., & Goldenberg, M. N. (2016). Democratic and republican physicians provide different care on politicized health issues. Proceedings of the National Academy of Sciences of the United States of America, doi:201606609 [pii]

It’s Not Me, It’s You: Signs that its time to Break Up With Your Doctor

By: Aria Gray MPH: Maternal and Child Health candidate 2017

I recently broke up with one of my doctors, and while it was a difficult decision, I felt much better once I decided not to see that provider anymore. The doctor was recommended to me as a great expert in the field, but I never felt that they were truly listening to me, which is why I ultimately left.

However, finding a new doctor can be difficult. Learn more below to see if it is time to make a change in your health care.

Poor Communication: It is important to understand your condition and diagnosis as well as the recommended course of treatment. Make sure to ask follow-up questions and to communicate to your doctor that you do not understand. However, if communication issues are still not resolved, it may be time to make a change.

Poor Listening Skills: Patient care should be adjusted based on the needs and experiences of each individual patient. If there is a medication or treatment plan you have tried without success or are not willing to pursue, your doctor should listen to your thoughts and feelings and make a treatment plan accordingly. If you feel your doctor isn’t listening to you, find one that will.

Long Wait Times & Limited Access to Care: If it commonly takes you weeks or months to get an appointment with your doctor or if you consistently face long wait times in the office, it may be time to find a new doctor. It is important to receive prompt treatment and also to have your valuable time respected.

As I mentioned, making the decision to change doctors is not easy, and the process of finding a new doctor is often not easy (not to mention all of the paperwork!). Follow these tips for an easy transition to a new provider.

Fearful of Food?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

I started following the Conscienhealth blog years ago. The organization aims to “advance sound approaches to health and obesity…(and) advocate evidence-based prevention and treatment”. Part of their approach is to provide a daily reflection about how a hot topic might influence our view of obesity or health policy.

A recent post got me thinking about whether fear-based messages are an effective or appropriate way to speak to consumers about food and nutrition. A meta-analysis published last year pooled 127 articles to look at the effect of fear appeals on attitudes, intentions, and behaviors. [Notes: Meta-analysis is a technique that aims to provide a conclusion based on statistical evidence about a large number of studies. Fear appeals are messages designed to persuade people to take action by sparking fear.]

Interestingly enough, fear appeals were found to have generally positive effects but less so for repeated behaviors. We eat multiple times each day, definitely a repetitive behavior, so perhaps fear-based messages are not the best way to communicate food-related lifestyle messages.


So how should talk about food? Headlines often pose negative or sensational statements to entice us to read. An example of this: Why Sitting is Killing You. But evidence suggests it might be more useful to share gain-framed messages. That is, focus on action people can take and what the positive outcome would be.An example of this: Review suggests eating oats can lower cholesterol as measured by a variety of markers.

Two decades ago, a study reported that Americans perceived food to be mostly associated with health and least associated with ple
asure. Americans reported more action to change diet to support health, yet they were also less likely to consider themselves healthy eaters. What would it look like if we talked in a more positive, less fearful or restrictive manner about food?



Rozin P, Fischler C, Imada S, Sarubin A, Wrzesniewski A. Attitudes to food and the role of food in life in the U.S.A., Japan, Flemish Belgium and France: possible implications for the diet-health debate. Appetite, 1999 Oct; 33(2): 163-180.

Tannenbaum MB, Hepler J, Zimmerman RS, Saul L, Jacobs S, Wilson K, Albarracin D. Appealing to fear: a meta-analysis of fear appeal effectiveness and theories. Psychol Bull, 2015 Nov; 141(6): 1178-204.

Wansink B, Pope L. When do gain-framed health messages work better than fear appeals? Nutr Rev, 2015 Jan; 73(1): 4-11.

October is Domestic Violence Awareness Month

By: Aria Gray MPH: Maternal and Child Health candidate 2017

What is Domestic Violence? Domestic violence is the willful intimidation, physical assault, battery, sexual assault, or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It can include physical violence, sexual violence, psychological violence, and emotional abuse. Domestic violence affects individuals in every community regardless of age, economic status, sexual orientation, gender, or other demographic factors. However, domestic violence is most commonly experienced by  women between the ages of 18-24.

Domestic violence is preventable. Part of domestic violence prevention includes talking about this issue and reducing the stigma associated with it as a community. While all of October is Domestic Violence Awareness Month, the National Network to End Domestic Violence is hosting a week of action from October 16-October 22.

Here are some ways that you can get involved during the week of action and throughout all of October. You can also search for events that may be happening in your community with local organizations.

  • Wear purple for #PurpleThursday on Thursday October 20
  • Speak Out: Talk with a friend, family member, or colleague about domestic violence to help eliminate stigma and show survivors that they are supported.
  • Follow the National Network to End Domestic Violence on social media (Facebook, Twitter, and Instagram and change

For anonymous, confidential help available 24/7, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE) or 1-800-787-3224 (TTY) now.

Are you prepared?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

Zika virus. Flooding. Hurricanes. Wildfires. Earthquakes. What do these have in common? They are all examples of public health emergencies that have impacted our nation and world in just the last few months. While not all emergencies can be predicted, we can take steps to have an emergency response plan in place.

The Centers for Disease Control and Prevention is promoting National Preparedness Month this September.



Preparedness is important not only for the international, national, regional, and local agencies and organizations that help people overcome disasters, but also for individuals and the communities they are part of.

One simple step you can take is to create a preparedness kit. Basics of an emergency kit include:

  • At least a 3-day supply of food and water
  • Health supplies
  • Personal care items
  • Safety supplies
  • Electronics
  • Documents
  • Extra cash
  • Extra house and car keys



You can learn more about being prepared for all kinds of situations through a Twitter chat Tuesday, September 27th at 1pm EST with @CDCemergency. And by checking out the resources below.



ASPCA. General Pet Care.

Boehrer, Katherine. 10 Disaster Preparedness Tips You Can Really Use. Huffington Post.

Prepare. Plan. Stay Informed.


Putting the Pieces Together

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

Making decisions for our health can feel like putting together a 1,000-piece puzzle – time-consuming or perhaps frustrating – and that’s if you have all the pieces.

When it comes to health decisions, we first have to find trustworthy resources, then we need to be able to interpret and apply that information to make what is hopefully the best decision. This process is called Health Literacy, and it is of national concern. How big of a concern? 9 out of 10 people, to no fault of our own, do not have the skills needed to find or interpret health information.9-out-of-10-health-literacy

What is being done about this?

The National Action Plan to Improve Health Literacy recognizes it will take a mass effort of organizations, professionals, policymakers, communities, and individuals to change how our nation communicates health information. The plan highlights 7 goals and accompanying strategies.

Additionally, since 2010, federal law requires federal agencies to provide training for staff and use plain language when communicating with the public. Plain language means the audience is able to understand something the first time they read or hear it.

Click here for a before-and-after comparison. Which version do you think is easier to understand?

What can you do?

  • Find training in health literacy, plain language, and culture and communication
  • Work with people who specialize in communicating with plain language
  • Make use of existing tools to evaluate and/or plan materials

The Centers for Disease Control and Prevention offers a Clear Communication Index that is a short, evidence-based form to use when developing or evaluating a communication product. I look forward to giving this a try


Let’s help our fellow citizens put all the pieces of their health puzzle together.


References and Resources:

Boston University. Health Literacy Tool Shed.

Centers for Disease Control and Prevention. The CDC Clear Communication Index.

Center for Plain Language.

National Network of Libraries of Medicine. Health Literacy.

Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy.

Brain Drain

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

We are bombarded with nutrition and other ‘healthy’ lifestyle information from friends, family, news stories, social media, and online content on a daily basis. In an attempt to stay up-to-date with topics of conversation, I receive a daily email of a wide range of nutrition-related headlines. I often just scroll without clicking – it can be a real brain drain to filter through everything.

But The Hunger in Our Heads (how physical activity might quell the eating binges that follow intense mental activity) piqued my interest enough for a click. I’ve always wanted to believe the reading, writing, and critical thinking associated with being a grad student was the cause of my brain drain come day’s end. But was there really evidence to support this, or was I just being dramatic? I immediately went to the source of inspiration of the story to do some fact checking. [Side note: there IS evidence that mentally demanding tasks can lead to fatigue and even overeating.]


Headlines are headlines for a reason, and they can lead to confusion about what to do to lead a healthy lifestyle. A few reasons nutrition headlines are confusing include:

  • Research is a process and it is usually designed to answer a very specific question. But what is reported often extends beyond what the study actually showed.
  • Research studies have different results. This is an important part of the research process, and there may be good reasons why.
  • Not all studies are created equal. The quality with which a study was done plays a major part on how the results should be interpreted.

Fortunately the Harvard T.H. Chan School of Public Health’s Nutrition Source offers 7 questions to help put health news in context and the International Food Information Council Foundation offers a quick guide to evaluating evidence.

The bottom line is, take a moment to see if the evidence really supports all the hype. Your brain just might thank you.



Harvard T.H. Chan School of Public Health. Deciphering Media Stories on Diet.

International Food Information Council. Hot Off the Presses: 5 Key Takeaways for Evaluating Nutrition in the Media.

Reynolds, Gretchen. The Hunger in Our Heads.


Stop, drop, or enroll?

By: Shauna Ayres MPH: Health Behavior candidate 2017

You have probably gotten numerous emails recently stating that the deadline to waive or enroll in the UNC Student Health Insurance Plan is Monday, September 12, 2016 for this Fall semester, but what does this mean? Does it apply to you? The short answer is, yes. All students need to pay attention because all students must have some type of health insurance to attend UNC. Check out Campus Health for more information.

There are several options for health insurance that I will briefly outline and provide additional links to more information. Due to the complexity of health insurance, I encourage you to explore these resources and do your own research as well.

  1. Stay on your parents’ health insurance plan. This option is best if you are 26 years old or younger. However, make sure that you understand your coverage and options for in-network providers on your parents’ plan, especially if your parents reside in another state. Out-of-network doctors’ visits can be extremely costly and emergency visits may not be covered at all. One strategy could be to schedule routine doctors’ appointments during your vacations home, but this requires some planning as many doctors’ offices are booked several weeks or months in advance.

  1. Be automatically enrolled in the UNC Student Health Insurance Plan. This option is best if you are older than 26 years of age and/or have a TA or RA position. The UNC plan is convenient because it is charged like tuition and can be paid off as a part of a student loan rather than monthly premiums. However, make sure that you check the health plan’s coverage options to ensure it covers the doctors you wish or need to see.

BlueCross BlueShield of NC

  1. Enroll in a ObamaCare or MarketPlace plan. This option is best if you have a modest income from part-time work; with the help of the tax credit, most plans are affordable. Tax credits or subsidies are available to those making less than 400% of the poverty level and meet other criteria such as not being offered insurance through an employer. It is important to note that the open enrollment for the MarketPlace runs from November 1st, 2016 to January 31, 2017. However, if you have recently experienced a life event such a moving, getting married, or losing health insurance, you may qualify for a Special Enrollment Period and can enroll now.

  1. Sign up for a catastrophic plan via the MarketPlace. This may be appealing to you if you are young and healthy because it is initially cheap, but the high deductible can deter you from receiving routine care. If you get sick, a large out of pocket healthcare costs can potentially disrupt your student and career plans. Thus, I strongly encouraged you to check out more comprehensive plans through MarketPlace and how subsidies can lower monthly costs.

  1. Enroll in Medicaid. North Carolina has not expanded Medicaid, but you may still qualify if you are low-income or your family is low-income. Due to the nuances of Medicaid, I encourage you to contact a representative to discuss this option if you think it is right for you.

NC Dept. of Health and Human Services

  1. Lastly, enroll in an individual plan or be included on a spouse’s plan from another source. This option is highly individual and you will need to seek out information from the health insurance provider specifically to understand your coverage and monthly premiums. Check out Aetna, Assurant Health, Cigna, Celtic, Coventry, Humana, United HealthCare, or other insurance companies.

Getting health insurance coverage takes time and patience. You likely do not have adequate time to change health insurance for this Fall semester, remember these options and take action for Spring semester (deadline January 31st, 2017). Yes, unfortunately this tiresome, but extremely important task occurs each semester. If you do have health insurance, make sure to waive the UNC Student Health Insurance Plan before Monday so that you don’t get charged extra for insurance you don’t need and won’t use.

List of health insurance options and helpful resources can be found on the UNC Campus Health website:

Additional resources: