Talking About Health; Why Health Communication Matters

Could a cold shower reduce depressive symptoms?

November 29, 2011

I cannot say where I heard this recently. Something in the background while I was working at my computer. But it stuck in my brain. It was a report indicating that research had shown that taking a cold shower could improve mood. It didn’t say what research. Nothing new there…

I began to think about all the camping trips when showers were unavailable but a cold lake or river was nearby and provided a bathing experience. I thought about jumping into swimming pools with cold water. And I remembered camping facilities where the showers offered only cold water. Funny. As I thought about it, in every case I was in a better mood coming out than going in. I thought it was because I got the day’s sweat and dirt off me or had a nice workout swimming, but maybe not.

Since this stayed with me over the past several weeks while I have been buried under papers and research and teaching, I decided to take a break and look up the research. I found a journal that presented a research question and rationale in 2008: http://www.sciencedirect.com/science/article/pii/S030698770700566X The researchers argue for a study to systematically consider the possible relationship. I cannot find where such a study has been conducted. If you find it, let me know… Inquiring minds want to know.

In the meantime, here is something beautiful to behold:

How might communication–including access to the internet–relate to health disparities?

butterfly-picture May 19, 2010

Health disparities…differences in the health status of some of us compared to others–have many links to communication. We could place more emphasis on efforts to address some of these as part of health care reform.

One communication contributor to health disparities is a lack of equal access to health information. In particular, a digital divide has been identified as leading to differences in people’s awareness and understanding of ways to promote health and treatments for various diseases.

The digital divide has been discussed for years in terms of the affordability and availability of computers. This contributed to programs to increase access to computers in public schools and public libraries. Access to sources of health information is an important goal–one that may be enhanced by improving the nation’s infrastructure. I was struck by a colleague’s recent revelation on our way to a meeting in a rural community in Pennsylvania. He said that he seldom uses the internet from home. In his location, internet access still depends on the use of a dial-up modem. The slow and painful effort to get online just isn’t worth it. Libraries and schools in his area suffer from the same challenges.

The effort to reduce the digital divide by increasing access to online health resources is a good start but reminds me of the ‘just build it and they will come’ fallacy. Once we get on the computer, and we use our favorite search engines to look for health information, how do we decide whether the information is useful and relates to us? How do we understand the information? How do we harness resources to apply the information when we do understand it? That includes having sites for care and providers for care. …that includes having the ability to pay for care, time off to receive care, and transportation to sites for care.

Health disparities becomes a communication issue with many facets and many audiences to consider. If we approach health disparities as only an issue relating to access to information, we risk placing blame for continuing and/or growing disparities on people experiencing the disparities.

In a world where access to health information was supported by access to services, products, and care–our individual perceptions still may lead to disparities. Understanding related to the information and choices to apply the content depends on some knowledge of health terms and ability to translate the metaphors so often used to commmunicate in health information. Understanding also depends on the cultural and social lens through which we view the information. And on our own goals–including where we place responsibility for health.

Some of us assume more personal responsibility for our health than others. Some of us believe more in the role of family history and genetics than others. Some of us believe that the environment plays a greater role in our health than our own behavior. And some of us believe in a role for spirituality and religious faith. When we combine these into our health perspective, sometimes health disparities emerge… Can erasing a digital divide make a difference in these issues? Perhaps if we communicate about them directly, online and in other settings where we talk about health.

What is Dr. Besser telling us when he says, “There is no ‘evidence’ that herbs work for a cold”?

March 30, 2010

Spring is in the air and hopefully, you are not suffering from a spring cold. Or allergies. This morning on, “Good Morning America,” Dr. Besser talked about health information and social media–offering cautions about ‘advice’ that might appear on Facebook or other outlets, or health information sent via tweets.

After offering the general advice to be careful about what we believe, he focused on an example relating to the use of an herb to fight a cold. He made the statement I used in the title for this post: “There is no evidence that herbs work for a cold.” O.K. What’s wrong with that statement?

From a health communication perspective, this kind of comment is made often. If Dr. Besser or another source of the comment is someone we trust and believe to be an expert, we may accept the comment without further thought. We are usually not expert in health. Not surprisingly, we look to experts in health to guide our understanding.

But here is the problem I have with such statements. They do nothing to help us become more competent in making decisions for ourselves about health information. Dr. Besser could explain that there is no evidence and also explain what he means by evidence. For him, evidence = scientific data. Those numbers are usually the result of carefully conducted clinical trials. Those carefully conducted clinical trials cost — well a lot of money. And relatively few dollars are spent on research to study complementary and alternative medical practices–such as the use of herbs to fight colds.

The traditional approaches to health in the U.S. are prescription and over-the-counter drugs, and surgery, and the use of medical devices–many device relate to surgery and others that boost some of our ability to manage our own health. There are many expensive funded studies to evaluate the effects of these approaches. Based on the results, evidence is published and then disseminated to guide our doctors’ knowledge and our care.

We should realize that the research by pharmaceutical companies sometimes looks at herbs and works to understand how they might work to help or harm human health. Finding that an herb works may lead the drug company to produce synthetic versions of the herb and conduct research to see how they work. After all, we and our doctors do not live in the era of Dr. Quinn, Medicine Woman and cannot go into nearby woods to pick herbs to make teas or other potions to heal us. Medicine generally needs products that can be sold in mass quantities.

So, what does a lack of evidence mean when it comes to Dr. Besser’s statement? It means that no scientific clinical trials have shown the use of the ‘natural’ herb to be effective in reducing the effects of a cold.

Dr. Besser’s statment is not considering that your friend, your neighbor, or a thousand friends and neighbors on a social media site have used the herb and tell their stories about how it worked for them. It is not addressing the fact that we often trust the stories of others as ‘evidence.’ But it is not the same kind of evidence as science would provide. That is something he did not say. From a health communication perspective, we want to know this to help us better understand health information.

He also did not say whether the herb being promoted for a cold is one that drug companies may have or may be studying in some form. From a health communication perspective, we also want to know this to help us better understand health information…

What is math anxiety and what’s it got to do with my health?

117_1754 March 16, 2010

Math anxiety is the tendency to feel anxious at the thought of doing math. This feeling may happen when faced with making change, calculating a tip for the waiter or waitress, balancing a checking account, figuring out how much of an over the counter medicine to take, or adding up how many calories or other nutrients food contains. Not surprisingly, if we feel anxious about these everyday tasks, the prospect of trying to understand health statistics seems even more daunting and causes even greater anxiety.

Math anxiety causes people to avoid situations that might lead to the feeling. In other words, if math makes us feel anxious, we avoid numbers and statistics and any situation where we might have to face dealing with math. Of course, such avoidance means that we miss opportunities to practice math and succeed, which would reduce our anxiety and increase our confidence in our ability to do math.

This reality is particularly alarming when it comes to our health. To make informed decisions, we will probably have to consider some information that is presented as health statistics. It may be information about our risk for a disease, or it may be information about our benefit from a treatment. In either case, it is information that would help us make a more informed decision.

What is the solution? Don’t avoid math. Make the extra effort in whatever situation it might be to understand the statistics and practice the math. In the end, it will pay off. Make the extra effort to be sure your doctor knows you want to know the numbers and what they mean. Make the extra effort to be sure that your local school system is providing opportunities for students to practice math, reduce, their anxiety, increase their confidence in doing math, and improve their skills…

What can maps tell us about health?

115_04112

March 13, 2010

A map is a wonderful example of a visual health communication tool that tells us so much with so little text. The notion that “one picture is worth a thousand words” more than applies. Mike Mackert discusses a new resource, a map, on his health communication research blog [http://blog.healthcommunicationresearch.com/2010/03/new-interactive-tobacco-map.html]. If you click on his link to the overall map resource, you can use a slide bar on the right side to display which states have passed which laws and policies relating to tobacco and smoking. A great example of giving citizens and elected representatives points for comparison. From a communication perspective, several thoughts come to mind.

First, this is a great way to illustrate a role for visual literacy as part of health literacy. In terms of our understanding, when we have a visual image to tell us something, it saves us a step in our thinking and understanding. We don’t “think” in words. For example, when I say “snow,” you “think” an image — something likely related to your own experience with snow. You do not think “s”–“n”–“o”–“w” and try to get meaning from thinking and forming these letters in your head. When you see a picture of snow, there is an instant connection to your mental picture.

Second, this process I have just described assumes, of course, that you have experience with snow to draw on in forming a mental picture. I am reminded of a test that my daughter was given in order to start public school “early.’ Her birthday is September 14th. She thus missed the September 1 cutoff date. We requested that she be tested to start, as we felt that she was more than ready. The test validated our opinion. It also showed that she could not give a name to a picture of a “snow shovel.” She was born in Tucson, Arizona, and she had never seen snow let alone a snow shovel. So, she could not make a match in memory between the picture and a name or label for it.

So, third, any visual form used to communicate–and there are many in health communication, ranging from photos to bar graphs to pie charts to maps and more–depends on a user’s ability to connect experience and skill to an intended meaning. In the case of the map Dr. Mackert identifies, it aids the user who moves a mouse over the geography by having the names of different states ‘pop-up’ to help a user who may not remember the name or location of any given state. It offers a series of folder options across the top for a user to click on, so that there is not too much information presented in any one map. It does rely on a number of colors in the maps that are somewhat close on a color wheel and might be difficult for some users to distinguish. It also identifies two sources of the information at the bottom of the map that are not easily navigated to gain insights about the method used to gather the information. It is, however, what policymakers often seek to help them wade through all the mounds of information related to decision-making.

Maps can, therefore, tell us what is happening in one location as compared to another, giving us a location hypothesis or explanation for health and health care…

What is a “competent” health communicator?

119_1944a February 9, 2010

I received a ‘smileworthy’ email from my friend and colleague, Ed Maibach, on Monday. He had received word that one of the articles we co-authored had been named to the 50 most read articles in the Sage journal, the American Behavioral Scientist. In fact, the article is #5 on the list, as you can see if you visit http://abs.sagepub.com/reports/mfr1.dtl

The article’s title, “Competencies for the health communication specialist of the 21st century,” gives some idea why it has been one of the most read publications. The importance of this area both theoretically and in application has been widely recognized. This has contributed to a surge in adding health communication classes to undergraduate and graduate programs around the world. And in adding these programss, the debate continues about the focus of education and training.

As I looked back at the lessons learned to develop the article, I realize that many of these competencies are ones that we all need in order to successfully navigate the health information that might only be described as overwhelming in quantity and sometimes questionable in quality. One of the competencies that health communication specialists may choose as a focus focuses on gaining access to and using various electronic databases. As we’ve discussed on this site before, we all need to harness the skills to do this. One of the most important issues remains the ability to identify the sources of these messages in order to consider the validity of their claims.

The emphasis in the article reflects the importance of understanding the role of both media and interpersonal communication on our health habits. To continue the conversation from yesterday, we too often do not seek formal health care because our family or friends don’t support doing so. And we frequently substitute care from our support networks for formal health care. In fact, one of the roles that many faith-based organizations assume relates to providing support to members sruggling with illness or recovering from events that limit their well-being. This may include injuries on the job or the death of a loved one.

Perhaps one of the most surprising and least considered areas of health communication competence relates to impression management. This, too, flows from the knowledge generated from research and practice in interpersonal communication. I reflect on my own hesitation to reveal my failure to behave in ways that I know I should. I want others to form a positive impression of me and to like me. And it carries over into health realms. Besides wanting to present our own best image, we often–with little thought–help others project their own best image. So we may fail to ask our doctor about something we thought we would be talking about in our appointment because we are thinking that to do so might seem to imply that we are ‘criticizing’ our doctor.

Other competencies related to the 21st health communication specialist that we identified more than 15 years ago that all of us will benefit from include media literacy skills associated with understanding gatekeeping relating to content. As discussed in the former post, media stories about medical research likely appear far ahead of therapies to benefit our well-being related to the research findings. Understanding that media seek to give us novel content supports our ability to reflect on the gap between a story and its translation to our care.

So a competent health communicator likely begins with our intention…to understand, to reflect, and to participate in making decisions about our health in informed ways guided by our efforts and experiences. 119_1914

Why don’t our doctors recommend ‘it’?

117_1749 February 8, 2010

The fourth chapter of my book, ‘Talking about health…why communication matters,’ provides some answers to the question, ‘Why don’t we get care?’ The discussion goes beyond the vital limitation–we don’t have access–to consider what happens when we do have access and we still don’t get health care.

The first topic discussed in response to the question, ‘why don’t we get care’ is: our doctors don’t recommend it. There exist several answers to the question, ‘Why don’t our doctors recommend it?’

One reason our doctors don’t recommend a treatment that we might expect reflects the reality that no treatment yet exists. The media story bringing to our attention a scientific discovery published in a leading journal such as the Journal of the American Medical Association or Lancet or the New England Journal of Medicine may set our expectation that the discovery translates to new treatment. It is a long journey between scientific discovery and health care.

The National Institutes of Health–which includes the National Cancer Institute, the National Eye Institute, the National Heart, Lung, & Blood Institute, and others [see http://www.nih.gov/icd/index.html ] emphasizes the importance of translating discoveries to benefits for the people. But the process follows a series of steps. So, in short, our doctor cannot recommend what is not yet available. Still, it never hurts to ask in case there might be some clinical trials going on in efforts to develop treatment based on the new science. And, it can’t hurt to do a bit of sleuthing of our own on the internet to see whether the media story relates to the possibility for new treatment.

Other reasons that doctors may not recommend a treatment have to do with such realities as: time slips away during an appointment and it just didn’t get brought up. Or, the doctor planned to talk with you about a treatment but–forgot. Perhaps your doctor even said in your last appointment that she would talk with you about some other options for care at the next appointment, but then doesn’t. In all of these cases, if it is important to you, bring it up. These are ways that communication can indeed matter when talking about health.

How fear appeals affect our motivation to practice healthy habits?

A winter walk

February 7, 2010

Fear is something most of us would rather not experience. Especially when it comes to our health. Yet, so much communication about health aims to make us fearful. Why is that?

Over time, research has shown that fear can be motivating. Because we don’t want to be fearful when it comes to our health, we may take action. That is, if we know how and believe the action will actually benefit our health.

The problem with too many fear appeals aimed at our health is that they do not fulfill the task of telling us what action to take, why the action will be effective, and how we can develop the skills or gain the resources to take the action.

Take the example of skin cancer. Most of us know that too much exposure to the sun can cause this deadly disease. We also know that some sun or UV exposure helps our body make vitamin D. So how much sun is too much sun? What if we like to stay healthy by being outdoors in the sun? What if our job requires us to be in the sun? An effective fear appeal communicates about these issues and doesn’t just make us fearful about being in the sun.

So if communication about health makes you feel fearful, look for the response recommended to reduce the threat. If the message doesn’t contain that information, it’s not a very good message. But at least you will know that what to look for to control the danger posed in the message and your fear as well. A response to the threat and ways you can carry it out.

Until next time, talk about health with the ones you love. It really might be a matter of…life and death.

Who is the source of that information about health on the internet?

119_1916 January 19, 2010

Surveys show that most of us go to the internet to search for health information and we do it fairly often. I was reminded of that as I had one of my infrequent flair-ups of pseudogout. It has been years since I’ve had the pain and swelling in my knees and this time it affected my fingers, my wrists, and even my back. And it didn’t go away after a few days. So I went online. And I found lots of information.

How we search for health information on the internet and what we do with the information once we have it is likely to predict whether the information is going to help or harm us. We can conclude that we are not at risk based on the information and be wrong. We can conclude that we are at risk based on the information and also be wrong. So a good place to start thinking about health information found on the internet is to consider the source of the information.

First, consider the motivation of the source. In the broadest sense, .com sites are commercial, while .org sites identify organizations, and .gov sites come from the government. We usually start with a search engine such as Google to seek answers to our questions. When I did, Google health came up as the first link to information. With so many people searching for health information, I guess it isn’t too surprising that the owners of a search engine like Google might want to get in on the act…

Second, consider the expertise associated with a site. Just ‘who’ is the author of the content you are reading and applying to your health? Is it a doctor or a nurse or a physical therapist? Is the doctor speaking on behalf of research or based on experience as a doctor? Is the information just presented, so the source is just the internet with no way of knowing if there is medical research to support the claims, particular researchers presenting the claims, or doctors supporting the research conclusions. I followed the Google health link and I searched for information about the expertise. I found some information at the bottom of a loooooooong page of information. But I couldn’t trace it back to any research. So I couldn’t find out much about where all the conclusions were coming from. Health communication researchers find this to be the case time and again. Not just on the internet. In newspapers, magazines, and broadcast news reports, the expert source on which information is being based is too seldom mentioned.

Third, what part of the information is the author of the content emphasizing, and what part is not being discussed? Is the author providing information for an organization that wants them to present a particular point of view? So, they might be describing the benefits of getting care at the organization whose site they represent but not tell you that it cost more than your insurance is likely to pay. Or, they might be telling the benefits related to one type of treatment for the drug company who has paid for the site you are reading, and they likely believe in those benefits, but there may be no discussion of the risks for the treatment. So, consider not only what content is included in the information but what content might be missing as well.

Doing so should help to make the information we find useful and help us to frame additional searches for more information to fill in the missing content…

Why don’t we ask doctors to clarify information when we don’t understand it?

January 15, 2010

I’ve done it. Have you? Walked out of the doctor’s office scratching your head, telling your waiting family member or friend, or running to the nearest computer to get online…and figure out what the doctor was talking about. Why don’t we just ask?

First, it is a bit embarrassing if the doctor says something and doesn’t ask us if we have any questions. It seems like we should know what is going on. So, we don’t ask because we feel embarrassed that we don’t understand. These days, I try to ask myself, “Do I literally want to ‘die’ from embarrassment?” If I don’t understand and I don’t ask a question, what are the chances I could…fail to follow advice, fail to understand my diagnosis, and well—harm my health…

Second, we have to admit to ourselves that we don’t quite understand what’s going on. Cholesterol called good cholesterol and bad cholesterol…what does that mean? Isn’t it all bad? If I at least ask the doctor to spell it or write it out, I find that most of the time, I get more information and I get it reinforced in writing.

…two ways to help myself out when I don’t understand……