Tag: Health Communication

Breaking Rural Health Barriers

For those of us that are fortunate to live near hospitals and primary care clinics, that question of rural vs. urban care is unlikely to even cross our minds. But for those living in remote locations, lack of access is a common issue. Unfortunately, what many of us take for granted is another person’s struggle, especially if they are plagued with chronic conditions, such as asthma or diabetes. And in many cases, most folks in this situation often go without treatment.

The National Rural Health Association reports that while a quarter of the U.S. population lives in rural areas, only one-tenth of our nation’s physicians choose to practice in these areas. And while only a third of automobile crashes occur in rural locations, two-thirds of deaths attributed to those accidents occur on rural roads, indicating a shortage in acute trauma care.

These figures certainly give rise to the need for increased access to care within rural communities. Another factor that contributes to this issue is that Medicare reimburses rural hospitals at a lower rate than urban hospitals, resulting in fewer physicians choosing to practice in such locations. Over the last 25 years, nearly 500 hospitals have closed, many of which were located in rural communities.

Fortunately, this is the age of digital know-how. Technology is king, and health care is one of the leading industries taking advantage of such innovation and wisdom. General Electric (GE) is doing its part to improve women’s health in remote areas like Wyoming, where the average woman has to commute 70 miles just to receive a mammogram.

In 2014, the company started the GE healthymagination program, to expedite cancer innovation and improve cancer care to 10 million patients, over the next six years (until 2020). One of the program’s most influential aspects is the GE Mammovan, equipped with mammography technology to provide free mammograms to all women living in remote areas.

GE chose to pilot the program in Wyoming, which has the lowest number of citizens and lowest population density (after Alaska). Many of the women using the van cited it was their first time having ever received a mammogram, stating that travel time or insurance requirements had precluded them from being screened for breast cancer. GE’s website reports that because of Wyoming’s uneven population distribution, a third of women living in that state over age 40 never receive a mammogram.

Since nearly two years ago, the mobile unit has traveled throughout the state, setting up in locations where women can receive a mammogram within an hour, allowing them to avoid the hassles of taking off from work and/or driving long distances. In many ways, the van serves a dual purpose—by eliminating the barriers rural residents previously faced and improving access to preventative care. By detecting breast cancer as early as possible saves the health care industry billions and ultimately, saves lives.

While North Carolina isn’t as rural as Wyoming, you might be surprised to learn that 85 percent of our state’s counties are, in fact, considered to be rural. And with nearly 2 million people receiving Medicaid, access to care is certainly an issue of interest among health care workers and lawmakers. And while mobile units are pricey to create and maintain, the progress the GE Mammovan has made in Wyoming is a good example of how health information technology can work to address some of our most pressing issues that impede quality health for everyone.


Mike Newton-Ward, MSW, MPH, of the Gillings School of Global Public Health, at the University of North Carolina at Chapel Hill (UNC), spoke with the Upstream writing team recently to share his lifelong experiences working with social marketing and how this form of communication is effective in public health.

Newton-Ward, an adjunct professor, received both a Masters in Social Work and a Masters in Public Health from UNC, and spent many years working with the N.C. Division of Public Health and the N.C. Department of Health and Human Services helping to create and implement various social marketing campaigns aimed at populations across the state. He retired in 2015 and is now an independent consultant with RTI International.

He spoke to the class to highlight the importance of social marketing campaigns in public health and discussed what steps are needed to ensure optimal effectiveness with selected target audiences.

One of the most valuable aspects of social marketing is that it takes feedback generated from the target audience (the group the campaign is intended for) and uses that data to help determine the layout of the campaign itself. Using this approach is key for garnering participant interest and ensuring improved outcomes.

Newton-Ward also discussed other aspects of social marketing, such as its interdisciplinary approach, and how the input of several fields is effective at campaign development, as well social marketing’s unique ability to influence behaviors in all directions. Since public health is primarily geared toward prevention at the population level, social marketing can be used to influence behaviors upstream through social or policy change. Likewise, it can also be used to produce changes downstream (hence, the name of our blog!), by treating or educating populations to change negative behaviors. Finally, social marketing can work sidestream, by allowing partner organizations to collaborate for promoting the best environment possible to ensure a continuum of positive outcomes.

Newton-Ward concluded his talk by answering questions from the audience and discussing the “simplified elicitation methodology,” a strategy used in many public health campaigns, which seeks to identify determinants of behavior by asking three pairs of questions, including:

  • “What makes a behavior harder or easier to do?”
  • “What are the good things and bad things that happen when one does the behavior?”
  • “Who would approve or disapprove of the behavior?”

 The answers generated from these questions are strong indicators for discovering and learning about target audience reactions, and are key drivers for developing successful campaigns.

Is Health Advertising Worth the Cost? You Be the Judge.

From a small printed flyer to a 30-second T.V. spot during the Super Bowl, there’s no question that advertising is expensive. And while there are many different forms of getting the word out, there are different reasons we advertise as well. It’s safe to say most advertising or marketing, particularly on a large scale, is done for competitive reasons—to boost sales and detract potential customers from going someplace else. But what about when the product being advertised isn’t actually for sale? What’s the goal of marketing something if you aren’t going to profit financially?

In the health communication field, organizations choose to advertise as a means of communicating something to the general public. This could be a health message to get tested for HIV or a celebrity testimonial to stop domestic violence. Either way, in health communication, the the “seller” or advertiser doesn’t stand to gain a profit on their effort in the financial sense, but rather, to promote healthy behaviors that in the long term, save lives. But these ads aren’t cheap. As health communicators, how do we know when the message we’re promoting is effective at producing change for the better?

That’s just what research economist Paul Shafer is trying to determine. A doctoral student in health policy and management, Shafer is working to determine the effectiveness of tobacco cessation advertisements from the Tips From Former Smokers campaign. The ads aired from March 4 to June 21, 2013. To determine effectiveness, Shafer and his colleagues looked at web traffic and determined the number of unique visitors the site had during the time the ads were aired.

The federally funded national tobacco education campaign resulted in the Centers for Disease Control’s (CDC) campaign website having over 900,000 total visits and nearly 1.4 million page views. There were an additional 660,000 unique visitors, meaning users returned to the site after their initial visit.

In his paper, published online Feb. 17, in the Journal of Medical Internet Research, Shafer seeks to demonstrate the relationship between the amount of advertising and the resulting numbers in web traffic. He attempts to show that by increased advertising leads to increased traffic, for both new and returning visitors, thus, implying the advertisements are effective at least getting people’s attention.

Shafer explains the uniqueness of his study is that he and his researchers were able to record the variation of media dose over time and across markets, as opposed to comparing aggregated traffic before, during, and after the campaign.

In addition, he and his team were able to determine fluctuation between the two types of ads, both aimed at providing resources to smokers desiring to quit. The ads used different tagging methods, such as a URL or a telephone hotline number, with results showing that the URL ads were more effective at driving users to the website, but that the hotline ads were also effective at increasing web views.

While Shafer’s study makes it difficult to determine the number of individuals who quit smoking as a direct result of the ads, the study does imply that such campaigns not only serve as a call to action, but also are effective at linking people to resources they would otherwise likely not know about. Finally, the results of the study imply the potential researchers have at more accurately forecasting the impact such ads will have at increasing web usage and interest in online resources that promote healthy behaviors.

So, aside from the fact that health campaigns can be quite expensive to implement, and there are no guarantees of success, with careful formative research and a targeted approach, such campaigns are valuable for the potential they have at impacting populations on a large scale at changing behaviors for good.

Appointments From Home? Embracing the Digital Doctor

For many Americans on the go, getting sick means more than dealing with aches and pains and feeling under the weather. For most, it can also mean having to take time off from work or school to visit the doctor — an event that most of us would consider less-than pleasant in our busy schedules.

But technology has given us an option to make the pain of getting sick a bit easier. Now, smartphone users can login to a mobile app to not only schedule their next primary care appointment, but they can also been seen and treated by a doctor — all from the convenience of the patient’s own home.

This form of medical treatment, known as cybermedicine, appeals to patients not only for its simplicity, but also for its value. Many users have found embracing a “digital doctor” ends up costing less than their usual co-pay associated with a traditional appointment. The form of treatment has proven so successful, several major hospitals and mainstream health insurers are now covering digital consultations to offset the shortage of primary care physicians. Users also cite far shorter wait times, as well as the convenience of being treated 24 hours a day, seven days a week.

In 2015, there were close to 7.2 million doctor-patient video consultations, but predictions estimate this form of treatment to reach 124 million in just three years.

However, many in the medical world remain skeptical. Some organizations say cybermedicine can prevent patients from forming lasting relationships with providers — an element they feel is key to correcting the overarching issue of improved care coordination between patients and providers. Some critics also feel misdiagnoses are more common with this particular form of treatment.

A final reason the healthcare industry is opening an eye to cybermedicine is money. Predictions indicate that it could save employers around $6 billion per year. And while recent data indicates only about 385 of insurance plans cover it, 81% of carriers plan to include it in their coverage plans by 2018.

So if you’re feeling ill and are just too tired to make it off the couch, consider making your next appointment using your phone or tablet. You don’t even have to change clothes or freshen up.

My Final Post & Reflections

For my final blog as a contributing writer on Upstream, I’d like to reflect back on the last two semesters and what I’ve learned completing my Interdisciplinary Certificate in Health Communications. First and foremost: communication really is key.

In my Masters of Public Health program, we learn the ins and outs of nutrition basics –what the recommendations are throughout the the life cycle, how to treat difficult medical conditions with food, how to plan impactful public health programs, how to analyze the latest research, and more. In the first part of my internship to become a Registered Dietitian, I also learned firsthand how communication can make or break health promotion efforts, the success of a grant proposal, or a one-on-one counseling session. A recurring theme in all of this is that the communication has to be exceptional in order to see a favorable outcome.

Health communication is a rigorous social science. There are theories (more than I’m able to wrap my head around) trying to predict how communication strategies will affect behavior change. Research looks at how images may affect attitudes and self-efficacy, how visual appeal dictates our trust, how tailoring communications helps make them more effective, how the media promotes but can also combat stigma, and how interpersonal communication can enhance large-scale campaigns. The list goes on.

What I’ve come to find in my short time in the health comm world is that human beings are very complicated creatures, and how (or when or who or why) you communicate health messages to them is extremely important to the success of that message getting through.  Applying this to my future profession in nutrition, you can’t just tell someone to eat healthy and expect results! The same goes for public health efforts attempting to reach people at the population level. This is especially important to remember as a health professional, because the way we think about these topics may diverge from how the general public thinks of them. We should always trust the audience and know that however a message resonates with them is important to the way we design our campaigns and messages.

So thank you, health communication world, for letting me get a glimpse into your complex and necessary world. I hope the things I’ve learned can help me become a better nutrition professional where I can make lasting changes for people who need it.



Photo source: Virginia Sea Grant via Flickr.com


Dr. Maria Leonora “Nori” Comello is an assistant professor here at UNC in the School of Media and Journalism as well as a teacher so much loved by students.

Having expertise in public relations and health communication, Dr. Comello’s research has focused on intersection of strategic communication, health, and identity.

Especially, Dr. Comello is an insightful researcher fascinated by “identity.” She was first inspired for the concept by a quote of William James, a psychologist in the late 1800s: “Neither threats nor pleadings can move a man unless they touch some one of his potential or actual selves.”

She has worked on a variety of health communication research exploring effects of valued and activated identities on behavioral decision-making, including tobacco-prevention research among Mexican-American youth audiences and substance-prevention research incorporating ideas of self-concepts and behavioral willingness to use substances.

Her recent research interest includes the potential for games to support identities in a health communication context (e.g, how cancer survivors or patients with chronic diseases use games to achieve meaning in life). In one of the relevant studies, she looked at if game playing had beneficial effects on cancer survivors who often experience physical symptoms as well as emotional symptoms, such as anxiety, fatigue, and fear of recurrence. She found that intrinsic motivation cancer survivors has while playing games was positively associated with cancer self-efficacy, resilient coping, and flourishing; sense of community was also positively associated with resilient coping and flourishing.

Cosmic Mihaiu “Physical therapy is boring — play a game instead

What’s the main problem of current physical therapy? The therapy is boring and painful so that patients are not able to follow the prescription to do repetitive movements for recovery. As a result, patients need more time to recover. Most of the patients feel boring, frustrating, and confusing for the exercise.

Screen Shot 2015-12-03 at 9.08.19 PMHowever, Mihaiu declared that video game can fix this problem by making the exercise more interesting and engaging.

When he was a child, he climbed a tree but fell from the tree and broke his arm. At first, his physical therapist worked with him, but then it’s up to him to do the exercises at home. At that time, he thought doing repetitive movements was boring, so he barely did it. As a result, he had to have another six weeks to regain the range of movement lost due to the injury.

In order to fix this problem, Mihaiu created a software — MIRA to make physical therapy interesting and engaging. This software is a platform where physicians are able to change prescription for physical exercises to digital video game. On this platform therapists can easily program video games in accordance with different needs from various patients. By making the physical extension and flexion more interesting, patients feel more engaged and more confident so that they are more likely to do the exercise.

In addition to the customization, this software also has three different categories targeting at different patients: children, adult, and senior. Most importantly, this platform provides data collected during patient’s exercise. The gathered data not only gives patients a sense of achievement, but provides valuable information for the physical therapist to adapt patient’s treatment.

Photo credit: http://www.takingonthegiant.com/2013/05/17/can-physical-therapy-be-fun-and-fast-romanian-entrepreneur-cosmin-mihaiu-proves-it-can/


who contributes to the poor care coordination in the U.S. health system?

The organization of the private health sector contributes to the poor care coordination in the United States health system.

Firstly, with different purposes to provide health care service, it’s difficult for public and private health sector to cooperate. Unlike public health care providers, the purpose of private providers is to make a profit. The payment of private providers is not transparent and the health care costs rise rapidly, leaving patients with little choice but to go into debt to pay for the care. As a result, private health care is too expensive for Americans. Some patients may decide not to seek help because of the financial problem. However, with the goal of promoting health status of entire population, the payment for public health sector is relatively law with the comparison to private health sector. Due to the existing inconsistency of the payment, the care coordination is a serious challenge.

Secondly, due to the disparate competitors, the cooperation between public and private health sector is difficult. Private health care provider needs to compete with other providers. Thus, in order to attract more consumers, several health services with low price but poor health care quality will be created. However, the competitor for public health care sector is health problem. With the purpose of addressing health problem successfully, the public provider will provide high health care quality with relatively high price. Therefore, a potential competition of price between private and public health care may harm the care cooperation.

In general, the private health sector makes care coordination a serious challenge by largely fragmenting the health care delivery system. This fragmenting leaves patients with poor-quality health care outcomes. Medical errors can occur as a patient moves from one care setting to another, or is prescribed different medications that interact.

James R. Knickman and Anthony R. Kovner (2011). Jonas and Kovner’s health care delivery in the United States. Springer Publishing Company.

Photo credit: http://svlg.org/policy-areas/health-policy/health-policy-committee

5 Gaps in Clinical Preventive Services for Women

The U.S. Preventive Services Task Force (USPSTF) recently released its fifth annual report to Congress on high-priority evidence gaps for clinical preventive services. This report is a requirement of The Patient Protection and Affordable Care Act, Sec. 4003 (F):

“The submission of yearly reports to Congress and related agencies identifying gaps in research such as preventive services that receive an insufficient evidence statement, and recommending priority areas that deserve further examination, including areas related to populations and age groups not adequately addressed by current recommendations.”

The USPSTF does not conduct it’s own research, but reviews existing peer-reviewed evidence to make these recommendations. These recommendations are not based on costs or insurance coverage decisions. For more information on the Task Force process for making recommendations, please see the full report here.

The five gaps the Task Force identified the following as areas in need of improvement:

  1. Screening for Intimate Partner Violence, Illicit Drug Use, and Mental Health Conditions
  2. Screening for Thyroid Dysfunction
  3. Screening for Vitamin D Deficiency, Vitamin D and Calcium Supplementation to Prevent Fractures, and Screening for Osteoporosis
  4. Screening for Cancer
  5. Implementing Clinical Preventive Services


Drunk driving: completely preventable crime (2)!

The high rate of death related to drunk and drugged driving can be dramatically reduced by the installation of ignition interlock device (IID) for all convicted drunk drivers, including first-time offenders with a blood alcohol concentration (BAC) of .08 or greater. States with this restrictive law have witnessed a significant decline in drunk driving deaths compared to states with laws requiring only repeat offenders or first-time offenders with a  BAC of .15 or greater to install IID. With the implementation of this more restrictive law, drunk driving fatalities of Arizona and Oregon decreased 43.2% and 42.7% respectively. To the contrary, states with law requiring the installation of IID among only repeat offenders or first-time offenders with a BAC of .15 or higher had slow declines. The fatality reductions concerning DUI in Florida and Nevada were 21.7% and 26.8%.

A report published by the Insurance Institute for Highway Safety also confirmed the effectiveness of IID for all convicted drunk drivers, including first-time offenders with a BAC of 0.08 or higher. It also found that focusing on convicted drunk drivers with .15 BAC or greater is a bad policy because the target population of this bad policy is too narrow to make sense. Moreover, the research from Centers for Disease Control and Prevention (CDC) indicated that first-time offenders have driven drunk for at least 80 times before being arrested. Therefore, asking all convicted drunk drivers including first-time offenders with a BAC of .08 or greater to install IID is an effective way to reduce the fatality rate related to drunk driving.

Photo credit: http://news.onlineautoinsurance.com/consumer/labor-day-car-insurance-98023