Talking About Health; Why Health Communication Matters

What’s in an egg?

February 9, 2011

I heard it on the morning news. I heard it on the evening news. … Eggs are healthier. Remember the days when eggs were responsible for clogging our arteries and leading to high cholesterol levels? Well, the soundbites suggested that things are much improved… I was happy, as I like eggs. Boiled eggs. Scrambled eggs. Omelettes… French toast. One of my fondest memories is having brunch at home on a lazy day…with an omelette as the main course. But with high cholesterol in the family, I have avoided eggs.

And then I listened closely. And the story said, “cholesterol in eggs has been reduced 14%…” Hmm, that didn’t sound like much. And then, “so if you eat two in one day, you are still over your daily recommended level for cholesterol.”

Well, there it is again. A headline. And the news story. They don’t exactly contradict each other. But close. So, sigh. I still won’t be eating many eggs…

What did Dr. Besser say about the HPV vaccine?

February 1, 2011

Today, on ‘Good Morning America,’ Dr. Besser–the show’s medical expert and reporter–talked about recommendations for vaccines that older teens should get. http://abcnews.go.com/GMA/OnCall/video/new-vaccine-guidelines-for-older-children-teens-12810738 He recommended three vaccines, including one to prevent whooping cough,meningococcal booster to prevent meningitis, and a hepatitis B vaccine.

Dr. Besser was talking about the American Academy of Pediatrics new recommendations for older teens. The Academy recommended other vaccines as well, including the HPV vaccine. http://abcnews.go.com/Health/w_ParentingResource/vaccinate-child-time/story?id=12806514&page=1

Interestingly, Dr. Besser did NOT recommend this vaccine…for teen boys specifically, saying that he wouldn’t, “get it for my sons.” When asked why, he said for boys, it is a preventive for genital warts which are he noted “easily treatable.” When pushed for more information, he added, “It’s very expensive.”

Interesting. We have discussed HPV in this forum before and in the past week, had quite a discussion relating to HPV. http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=376&action=edit That discussion built on an earlier one. http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=33&action=edit

It is important to remember the limitations of the vaccine for females and cervical cancer prevention noted on the National Cancer Institute’s site, “The vaccine tested in this study has several limitations, noted NCI’s Hildesheim. For one thing, the vaccine offers no protection against other types of HPV that can also cause cervical cancer. In addition, it’s unknown whether the vaccine’s protection against HPV-16 is long-lasting. Finally, it does not prevent HPV-16 infections already present at the time of vaccination from progressing to cancer.” http://www.cancer.gov/clinicaltrials/results/summary/2002/cervical-cancer-vaccine1102

Let’s not forget an important message then… still get a pap test as an early detection strategy for cervical cancer…

What did Michelle Obama have to say about WalMart today?

January 20, 2011

Michelle Obama spoke today standing in front of fresh produce at a WalMart. She talked about the initiative that WalMart will undertake to make healthy food more accessible.

http://www.youtube.com/watch?v=TwMsh8vaYvE

WalMart will reduce the sodium in their products and get rid of products with trans fats. They will lower the prices for fresh fruits and vegetables. In short, they will work to make it possible for more of us to afford to eat healthy… Let’s hope it is a model that others follow…

How do we know what health message to trust about autism and vaccines?

January 7, 2011

121_2191b Well, the issue that one of the students in my undergraduate students focused on last semester — in the designing health messages class — was autism and vaccines. She explained how the medical research that led to media stories about vaccines and autism was based on a small sample size of 12 children and that 10 of 13 of the original researchers who authored the study no longer stand behind its conclusion that there is a link between autism and vaccines. Now, we have a new story in a medical journal — telling how the results in the original publication were ‘made up’. See http://kottke.org/11/01/autism-study-fraudulent

As consumers of news and health information, we can question samples sizes. We can question the ways that studies are conducted, including whether there were too few or too many control variables. We can question the lack of representativeness of a study — the failure to include males and females, or the absence of different age groups and various sociodemographic audiences, for example. But we do have to ‘trust’ that the researchers accurately represent what actually happens in the conduct of a study. Just as we trust grocers to put expiration dates on our food labels that reflect actual dates, that bankers take precautions to safeguard our accounts, that pilots and bus drivers and auto mechanics are honest when they say they have been trained to do the work that we trust them to do. And for the most part, in all of these cases, and in medical research as well — we can trust… But it doesn’t mean that we shouldn’t ask questions. And it doesn’t mean that we shouldn’t look for the credentials to support our trust…

What does the “food pyramid” tell us about health communication and ‘old science’, ‘new science’, ‘conflicting science’, and no science’?

143_07811 May 3, 2010

I cannot recall the first time I heard about the ‘food pyramid’ but it was decades ago. The United States Department of Agriculture [USDA] online site at http://www.mypyramid.gov/ provides an overview of the research in this area. Right under the image of the pyramid on the homepage, the follow sentence is bolded: “One size doesn’t fit all.” Over to the left of the pyramid, the heading, ‘Specific Audiences,’ includes ‘Preschoolers’, ‘Kids’, ‘Pregnant & Breastfeeding’, and ‘General Population’–giving us a sense of groups whose needs vary. Skimming through some of the information, it doesn’t take long to affirm one of the points that I make in my book, Talking about health…

When communicating about health, sometimes there is no science to guide prevention guidelines, diagnosis, or treatment. A quick review of the history of the food pyramid shows that even before vitamins and minerals had been discovered, the USDA provided dietary guidelines–the first time appearing in 1894. The first food pyramid was published in the 1960s. The goal is to help us know how to talk about food and nutrition without having to be an expert. So food is divided into groups and we gain a sense of how much of each group adds up to a more versus less healthy diet.

Often, what we know in any area relating to health is based on ‘old science’ that we learned in school several years or even decades ago–forgetting the simple fact that times change. New knowledge is generated everyday. If asked, we know this truth. The trick is to apply it when we are communicating about health. ‘New science’ may support the ‘old science’ or build on its core idea. ‘New science’ may also conflict with ‘old science’ creating doubt and indecision. It is helpful when talking about health to consider the ‘age’ of the science we are using and also the characteristics of the people the science is based on. As suggested by the latest food pyramid, when science takes into account the ‘age’ of and audience, the food pyramid looks slightly different for different groups…

Does wearing a mini-skirt affect female reproductive health?

copy-of-ij-women8-bridge April 25, 2010

Media reports often ask a provocative question to get our attention. Sorting through all the endless media clutter makes efforts to get our attention all the more challenging. And if it is a provocative question that got our attention in the first place, well–we’ve all played or heard of the old ‘telephone’ game where a statement that reaches the last person in the party usually is quite different from the statement made by the first person. Shorter. Interpreted through the lens of all the ‘hearers’/listeners along the way to the end… So, do we repeat the provocative question to others and even give it a bit of a twist to make it, well, even more provocative?

As best, I can tell, the question posed in the title of this post emerged from an article that appeared in a Russian news story. Here is the link to the story I found: http://english.pravda.ru/society/family/10-11-2009/110401-mini_skirt-0.

In a nutshell, the article–which has been translated into English so it may include some translation biases–asserts that “Mini-skirts should be worn sensibly.” The physician interviewed in the article says she herself has experience wearing min-skirts and has never experienced health problems as a result. She also goes on to note that mini-skirts can increase the risk for some conditions due to exposure to metal benches, stone steps, or cold weather. Near the end of the article, it is noted that women wearing min-skirts without wearing stockings should not sit down when using mass transportation in order to avoid infections. The article includes the statement that, “In rare cases such carelessness may lead to infertility.” So there is the seed.

In sum, as with using public toilets and any other situation in which we might encounter an infection, taking care to avoid infection is the best path to avoiding illness. In terms of talking about health, track down the source of surprising statements like the question posed here and see what the message might be that could promote our health…

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.