Talking About Health; Why Health Communication Matters

What’s in the numbers — how does public health data reflect you and me?

January 13, 2011

Pennsylvania’s Department of Health online site tells us a lot about numbers and how communication adds up to a lot of data. There is a link in the form of an image for newborns near the bottom of the homepage that tells the story about data collected at the time of a birth in Pennsylvania [http://www.portal.state.pa.us/portal/server.pt?open=514&objID=558226&mode=2].

Linking from the general overview, there is an image of a block — one of several — to click on for answers to ‘parents frequently asked questions.’ It describes what screening tests will be conducted on each newborn, and tells us — that the results will be reported to the Department of Health. And so it begins… information about each one of us contributing to public health priorities…

Why does communicating about health matter?

January 10,2011

When talking about health, we form ideas about responsibility… Who do we blame for our cold, our cancer, our heart disease, our low vision? At one end of the blame continuum is personal responsibility and at the other end — societal responsibility. In between, we have friends, family, co-workers, and media –including advertisements that make it seem that if we could only take the right medication, all would be well. Or, movies that make it seem as if there are more solutions available to us than there are in reality. Or news reports that do the same…

What a surprise when I walked into my classroom for the semester and found a student desk positioned near the podium with a sign posted overhead: FOR STUDENT WITH SPECIAL NEEDS. DO NOT MOVE. The same message was taped to the desktop. Hmm, what’s wrong with this picture? What does it communicate? Who and what is responsible for a student not using the desk?

What happens when mothers talk to daughters about HPV vaccines?

January 6, 2011

This will not be the first time I have focused on HPV… In fact, about a year ago, I posted on this topic. Today, I want to mention that Janice Krieger and some of her colleagues at Ohio State published an article in Human Communication Research about the importance of mothers talking to daughters about HPV [http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2958.2010.01395.x/abstract]. Another article published in the Spring of 2010 has similar conclusions [http://pediatrics.aappublications.org/cgi/content/abstract/125/5/982].

Mothers’ confidence about talking to their daughters about HPV — believing that they had knowledge and could answer their daughter’s questions — had an important effect on the likelihood of talking. Also, mothers’ belief that the HPV vaccine is an effective response in preventing cervical cancer motivated them to have these conversations. Both findings emphasize the need to communicate about HPV and the HPV vaccine to form knowledge. The findings, as the authors note, also bring to light a need to observe these actual conversations and their effects. For example, mothers may talk about HPV as being a common and easily transmissible virus. Or, mothers might say that HPV causes cervical cancer. The latter might lead daughters to assume that brothers and male friends are not at risk for HPV. That would be an inaccurate conclusion.

puzzlepic3 I have a granddaughter who is seven years old. She happens to live in Texas. This is one of the states that considered making the HPV vaccine mandatory in order to be in public school [http://politifact.com/texas/statements/2010/feb/06/rick-perry/perry-says-hpv-vaccine-he-mandated-would-have-been/]. It didn’t happen … for various reasons. For one, the vaccine is really a series of three shots — not one. The cost for the three shots is about three hundred dollars [http://cancer.about.com/od/hp1/f/hpvvaccinecost.htm]. Time and money… and debate about sexuality.. and religion… then there is the belief that government should not mandate anything… How do we communicate strategically to build mothers’ confidence to talk about those things? And what do we say to boys as well?

http://www.nytimes.com/2010/10/29/us/29vaccine.html

What if… I only had a short time to live?

January 5, 2011

I added a blog link today. It goes to my sister’s blog. She started it as she faced disturbing mammogram results this past fall. Disturbing? Well, what do we say in communicating about test results that lead to more tests and raise lots of questions about the meaning of what they find?

Isn’t this yet another reason why it is so hard to talk about our health? It raises the truth before us that life as we know it is a timebound condition. And so, rather than talk about it, we avoid talking about it.

In the midst of health care reform, conversations about the cost of end-of-life care and failure to make end-of-life decisions about when to terminate care emerged. And they reflected that all too often, we don’t have these conversations. All too often, the pat phrase is, ‘do all you can…’ And that is one way to avoid thinking about ‘what if… I only had a short time to live…’

Why is it hard to talk about our health?

January 4, 2011

A new year. After trekking from PA to Texas, I feel … excited about the year ahead. Yes, I sat in the airport with John on our journey to and from for many hours more than we expected to linger. Yet, through all of the waiting, it was remarkable to see all the families and all the strangers just working together to get along. Not that there weren’t frustrations. We saw one father, mother, and teenage daughter who just missed a connecting flight… as in, the plane was still sitting just outside the big plate glass window but had already closed the door.

girlpups1 I noticed something during the waiting in the airport. Whether I wanted to eavesdrop or not, the crowded conditions and the accessbility of cell phones presented me with endless conversations among family members. Mostly they were keeping each other posted on flight delays and revised plans. But in so many cases, there was talk about how someone in the family was feeling now or whether someone in the family was well enough to be present for the holiday or if there was any news about a loved one’s recovery. In one case, a distressed young woman was talking to someone close to her about a mother’s drug and alcohol recovery. We got up and moved out of the mass of people in this case to avoid hearing so much of what was clearly painful to her. She moved as far as she could from the throngs. But there was just only so much space.

It’s personal. That is why it is so hard to talk about our health… and yet, that is why we must…. In this new year, we will take a closer look at some of the ways we can cope with talking about our health when it is… personal.

“Women’s” Reproductive Health–What’s Wrong with This Expression?

156_09041

November 2, 2010

Yesterday, I asked my undergraduates in a health communiction class that question. And I got…nothing in response. “Really?” Almost a whole semester of conversation about how we communicate about health, beginning with a discussion about “science” as a starting place for what we “know” and talk about when it comes to health, and — nothing?

Celeste Condit and I talked about this issue in our book, “Evaluating Women’s Health Messages,” and I continue the discusssion in the chapter devoted to, “What’s politics got to do with it?” in my book, “Talking about Health.” The bottom line: Groups of activists have been working to expand attention and information about health care for women since the birth of the contemporary women’s movement. This contributed to the formation of the Office of Research on Women’s Health.

A Women’s Health Caucus formed in Congress and a woman-oriented political task force led by Representatives Patricia Shroeder and Olympia Snowe, and Senator Barbara Mikulski published a report on women’s issues. Five criteria were use to categorize a health conditon or disease as a woman’s issue for funding purposes: unique to women or some subgroup of women; more prevalent in women or some subgroup of women; more serious in women or some subgroup of women; one for which risk factors are different for women or some subgroup of women; and/or one for which interventions are different for women.

These criteria emphasize women’s reproductive health, the most apparent area where women differ from men. Reproductive health issues are important to women. However, these are not the only health focus that demand attention with regard to women’s health. And the flurry of research about women’s reproductive health also breeds a paradox for men: men have babies, too. A focus on women’s reproductive health ignores the interaction of effects owing to the father’s behavior. It may in fact perpetuate knowledge gaps and a sense of confusion about what is missing in the expression…”women’s reproductive health…”

Why did it take until 1991 to start emphasizing women in medical research?

109_0925 October 24, 2010

Another topic I introduce in the chapter, ‘What’s politics got to do with it?’ is funding for medical research. In many countries, U.S. included, government has a budget for medical research. For far too long, women were excluded from medical research funded by the National Institutes of Health in the U.S.

Several reasons supported this exclusion and biological sex inequity in United States health care research. Celeste Condit and I discuss these more fully in our book, ‘Evaluating women’s health messages.’ First, scientific research traditionally had been conducted by men. The questions they formed for research related to other men.

A second reason has to do with the predominant scientific method. It involves the testing of hypotheses, typically involving the relationships between two to four variables and attempting to control for differences. Women’s lives include obvious and continuous biologic transitions, leading scientists to prefer to use men as research subjects. This was the case even when the medications and techniques being tested were designed for women.

The most often cited reason to exclude women from medical research study populations was the potential for pregnancy. The possibility of causing harm to a fetus deters research for both moral and financial reasons.

A fourth reason–funds for health care research are scarce, creating intense competition among all researchers, which brings the discussion full circle. Men were primarily responsible for selecting the individuals who conducted the research and granted preference to other men conducting research about men.

Let’s hope that in this era of most stringent competition for research dollars, biological sex inequities do not again emerge.

Does drinking diet soda cause osteoporosis?

October 11, 2010

As I observe in the chapter, ‘What are my risk factors?’, we have a lot of competing goals in life that put being healthy in competition with other things going on. I was attending a conference and met a graduate student who was on crutches. I asked her what happened. She said that she had a fractured pelvis and it was blamed on osteoporosis. She told me that her osteoporosis was caused by drinking too many diet sodas. I decided that I would find a research review article about osteoporosis to share with my undergraduate health message design class. I did. And it reported that the evidence is inconclusive about a link between diet soda and osteoporosis. There was a collective sigh of relief from my students about that statement. Until I asked them, “How would we draw a conclusive link between drinking diet soda and osteoporosis? Why isn’t the research finding considered to be conclusive?”

And so, we launched into another discussion about self-report data and relationships based on having a condition versus not having the condition. “How much diet soda do you drink each day?” I asked. Some were able to answer, while others said, “It depends…” “On what?” I asked. “How hot it is outdoors.” “How much money I have.” “…you know.”

“I do.” imgp1303 I know that we often build an understanding about health conditions based on asking people questions. As a form of communication, asking people health questions is both an art and a science. How do we ask a question in a way that someone can give us an accurate and complete answer? If asked about how much diet soda you drink on an average each day, how do you decide to respond if you only drink diet soda when it is hot? Do you say, “none,” because it is winter? Do you respond “less than one a day” because you divide it out and even though you may drink a six-pack a day in the summer, summer is only really two months long…so it seems to average out to…less than one a day?

Trying to answer a question about how much diet soda has been consumed for a survey that may later be used to relate to participant responses about whether they had been diagnosed with osteoporosis or not may give some evidence to support a relationship. But the evidence is not…strong. If there are enough survey participants to consider all those who consume large quantities of diet soda and divide them into two groups–those with osteoporosis and those without osteoporosis, one might find that there are significantly more with the condition than without… This provides another kind of evidence.

If we think about what bones are made from…and we take diet soda and soak a bone in it…either or both may also provide some evidence that drinking large quantities of diet soda weakens one’s bones and contributes to osteoporosis. But we are not going to have a medical research study in which we give a randomly selected group large quantities of diet soda in order to see if their bones become weak… So, yes, this story of a student whose doctor was willing to tell her, “Stop drinking a six-pack or more of diet soda a day. In fact, stop drinking diet soda–period–and maybe we can prevent more bone deterioration,” imgp13045 suggests that her doctor used the evidence of a patient before him to guide a recommendation that the published medical research says was based on inconclusive data… And I say, “Let’s be truthful about what we mean when we talk about the data and the evidence. Let’s be willing to consider the ethical boundaries of research studies. Let’s realize that ‘inconclusive data’ sometimes means that a clinical trial, the gold standard of medical research, is not appropriate and so, there will never be “conclusive data”…

Does your family have copies of or know where to find your advance directive?

161_10623 August 28,2010

Even though I did not live near my grandmother and didn’t get to see her very often, she greatly influenced me. Even in death, she became a role model. She had copies of her advance directive in places where her family and others could not miss them. She had one on her refrigerator door, held there by those little plastic fruit magnets. And she had talked to her daughters about her wishes. She did not want extreme means to be applied to try to save her life. She wanted to have the quality life that she had lived. She remained independent until her death, which was well into her 80s. She lived in her own home. She lived on property that she walked everyday of her life except when she was recovering from hip surgery or the snow was too high to navigate with snow shoes. She read even though it meant using magnifying lenses and a magnifying light. She did handwork…even though it meant using magnifying lenses and a magnifying light. She drove her own car…to have a meal in town with her family each week, to church on Sundays, to a general store to buy yarn or fabric to continue or start another project…. She made the best chocolate bundt cake ever…from scratch. She could turn the toughest piece of meat into the most tender, pounding it with a kitchen hammer designed for that task, and cooking it in the oven on a low temperature for a long time… She would say, ‘have an advance directive… ‘

So for the next couple of weeks, I will pursue conversations with family about having an advance directive. I will let you know how it goes. Perhaps you might do the same…

How does Bret Michaels manage life-on-the-road and Type I diabetes?

August 9, 2010

I attended Bret Michaels concert at the Clearfield, PA county fair on Friday night. resized_bret_michaels_1_3059 It was a celebration of life. He thanked fans for their prayers and support for him during the past year. He literally seemed to breathe in the positive energy and well wishes of the fans at the concert. Which communicated something about health…. http://gantdaily.com/2010/08/07/bret-michaels-rocks-at-the-clearfield-county-fair/

As covered in the news and entertainment media, Bret had some life-threatening health events this year. He appeared on the show, ‘Celebrity Apprentice’ and, in fact, won… but during the season, he revealed his nearly lifelong efforts to manage diabetes. And he talked about the emotions he felt while waiting for news about whether his daughter had the disease.

I don’t know Bret or his daughter. But I do know that one of the reasons we don’t talk about health in our families is that we feel a sense of blame for the ‘bad’ things that got passed on to us through our genetic pool and a sense of responsibility about passing them along to our own biological children.

Try this: for every so called bad thing, make a list of the good things that were passed on to us and that we may pass on to others. When having those family health history conversations, balance the good with the not so good news.

It might be, for example, that Bret’s positive and affirming way of looking at life has a genetic component and that he will or has already passed on such resilience to his children. I suspect that at the very least, that attitude goes a long way toward helping him to manage life with a chronic condition like diabetes…