Category: Health Communication

“The Angelina Effect”

In this day of age celebrities dominate our world. They hold elected office, they are activists, they are social media entrepreneurs, they are everywhere. Whether we like to believe it or not they have influence over our behaviors and how we make decisions. I’m guilty that most of the accounts I follow on Instagram are former Bachelor contestants and catch myself wanting to mimic their fashion and fitness routines. In fact, there has been research that has examined this phenomenon. Back in 2013, esteemed actress Angelina Jolie announced that she carries the a genetic mutation that greatly increases your risk of breast and ovarian cancer (BRCA1). In her New York Times opt ed piece, Jolie reveals that she lost her mom, aunt and grandmother to cancer and that influence her decision to undergo preventive surgery to remove both of her breasts (mastectomy) and ovaries. After this announcement, several researchers explored what came to be known as “The Angelina Effect” and how her decision influenced other women’s decisions about their own health. In a study published in Health Services Research journal, hospital data from both New York and the UK revealed that three months after Jolie’s announcement there was a significant increase in preventive mastectomies prior to the announcement. This trend has been seen with other celebrities after announcements of diagnoses and provides incentives for both public figures and healthcare providers to use these instances as teachable moments and bring awareness to employ preventive healthcare.

To learn more about the BRCA1 gene visit the following site: https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1

 

 

 

Africa Vs. Big Tobacco

Lowering tobacco use has been one of the great successes of public health in the past 50 years, and continues to be a focus of research and intervention. This was achieved through policy and health communication. This journey has shown us that it is possible to change the culture and narrative around behavior, despite steady corporate influence. While tobacco is still a significant public health hurdle in the U.S., there is confidence in the direction we’re headed given what we’ve accomplished.

Unfortunately, tobacco companies are infiltrating other countries with less developed infrastructure for tackling this issue. Currently, low and middle income countries represent 80% of the world’s smokers, as well as smoking-related deaths. Africa in particular is falling victim to extremely powerful tobacco marketing campaigns – smoking prevalence in Lesotho rose from 15% to 52% just between 2004 and 2015, and the industry even manipulated public health policy in Nigeria. Big tobacco is no stranger to targeting advertising strategies to vulnerable groups.

In order to reverse this, we need to support strategies that African countries have already begun to administer. Ghana and Madagascar have implemented tobacco advertising bans; several nations have introduced graphic labels on cigarette packs; South Africa has increased tax on tobacco products; and Kenya has implemented a system for tracking and tracing illicit tobacco product sales.

Already having the knowledge of the danger of tobacco will hopefully help other countries prevent the industry’s hold from strengthening. We must support their efforts before it’s too late.

Sources:

https://medicalxpress.com/news/2018-03-big-tobacco-world-vulnerable-profits.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105326/

https://tobacco.ucsf.edu/how-tobacco-industry-manipulated-public-health-policy-nigeria

https://medicalxpress.com/news/2018-03-big-tobacco-world-vulnerable-profits.html

https://www.thecommunityguide.org/findings/tobacco-use-and-secondhand-smoke-exposure-mass-reach-health-communication-interventions

https://betobaccofree.hhs.gov/

https://www.rwjf.org/maketobaccohistory

 

“If your mother says she loves you, check it out”, Stephanie Brown’s guide to identifying false new stories

On Monday, our class had the pleasure of hearing UNC’s own Stephanie Brown discuss her most recent article “New Stories Credible or Clickable: Schema of Fake News to Corrections” featured in Communication: Journalism Education Today. Stephanie Brown is the director of the Parks Library at UNC’s School of Media and Journalism and is expert in news literacy and how to detect false news. Her presentation focused on the best ways to detect if an article is considered credible or in today’s newly coined phrase “fake news”. She began her presentation with an exercise “Would you share” to get our class thinking about the creditability of articles and if we would feel comfortable sharing them on our own social media platforms. This lively discussion brought up some of the consequences of sharing inaccurate news information and how we go addressing others who share these types of stories. Then she moved on how ways to identify articles that are “fake news” and unreliable sources through a comprehensive checklist. She went through the checklist with a few example articles that captive our class’s attention. The checklist was originally developed by the News Literacy Project and includes about seven items. A few examples of the items on the checklist include looking out for articles that are overly emotional, that use excessive punctuation, make a claim about a secret that the media is hiding from you and the types of sources the article cites. One interesting item on the checklist that she harped on was looking at the advertisements and sponsored content on the sides of the article. That can be a telling item if the advertisement is featuring “Lose 5 lbs in a week with this new pill” vs. “Visit Florida” in determining the credibility of the content.

Here is the full News Literacy project checklist: http://www.thenewsliteracyproject.org/sites/default/files/DontGetFooled_FINAL_020518.pdf

 

Medicaid Expansion and the Opioid Epidemic in the U.S.

As the United States continues to be embattled in an ongoing opioid overdose epidemic, new research is showing the benefits that Medicaid expansion has had under the Patient Protection and Affordable Care Act (ACA). According to a recent study out of the Center on Budget and Policy Priorities, the rate in which patients who were hospitalized due to opioid-related health issues, who were uninsured dropped in states that expanded Medicaid, from 13.4% in 2013 to 2.9% the following year. The same study also showed that Medicaid expansion had not contributed to the ongoing opioid crisis, showing that opioid-related hospitalizations were higher in states that expanded Medicaid three years before expansion occurred, and that the rates had been steady in expansion and non-expansion states. As we can see, Medicaid expansion has had a profound impact in reducing the rate of uninsured, and in the case of the ongoing Opioid epidemic, Medicaid plays a key and vital role in working to help curb the epidemic. For more information on this study from the Center on Budget and Policy Priorities, please check out the link below.

Sources:

Center on Budget and Policy Priorities, Medicaid Expansion Dramatically Increased Covered for People with Opioid-Use Disorders, Latest Data Shows – https://www.cbpp.org/research/health/medicaid-expansion-dramatically-increased-coverage-for-people-with-opioid-use

What Can We Learn from PR Theories

Let’s talk about these persuasion techniques from the fields of PR and advertising. They don’t just need to apply to consumer marketing or branding—they can inform health campaigns.

Mendelsohn’s Three Assumptions for a Successful Campaign

  1. Target your messages
  2. Assume target audience is uninterested in messages
  3. Set reasonable, mid-range goals & objectives

How to best “assume” (without making an a** out of you and me):

  • Research to understand target audience & inform goals
  • Theory to develop strategies

Thankfully these receiver-oriented sequential steps are based on dominos and not a house of cards:

McGuire’s Hierarchy of Effects (aka Domino Model)

  1. Exposure: Get the message out; alas, if only was enough
  2. Attention: Production values; color; involuntary (orienting response) vs. voluntary (enjoyment)
  3. Interest: Perception of relevance; throw in novelty/something unusual
  4. Comprehension: More attention, more learning; misinterpretation a barrier
  5. Skill Acquisition: Intention doesn’t matter if don’t know how to do the thing
  6. Attitude Change: Opinion-based; attitudes and behaviors don’t always correspond
  7. Memory Storage: Key takeaways of message need to stand out
  8. Information Retrieval: Provide reminders/memory devices (e.g. jingles, slogans, miscellaneous swag)
  9. Motivation: More likely to act if behavior perceived as easy/important/realistic/beneficial
  10. Behavior: Facilitate (e.g. supply, access) brand/behavior loyalty
  11. Reinforcement: Minimize buyer’s remorse/behavior regret
  12. Routine: Assimilate into target audience’s preexisting worldview; become a part of their life (i.e. ultimate goal, difficult)

BRB, I’m going to keep these in mind forever.

Austin, E. W., & Pinkleton, B. E. (2006). Strategic public relations management: Planning and managing effective communication programs. Mahwah, NJ: Lawrence Erlbaum Associates.

Dear Apple, Keep doing what you are doing

The new Apple Watch commercial “Dear Apple” has the world talking after its debut during this year’s Winter Olympics. It’s personal, heart wrenching and most importantly highlights the incredible impacts of it’s less advertised features. This commercial emphasizes that this technology could revolutionize healthcare and provide life-changing health support. It features anecdotes of a car accident survivor using the feature on the watch to call 911 after their phone was thrown from the vehicle and a child with Type 1 diabetes pairing the watch with her glucose monitor that alerts her when her blood sugars are at low levels. While the ad still features its more traditional feature of tracking physical activity, it was nice to see that the more innovative features of its products and it’s direct benefits. While I love a good selfie, it’s reassuring to know that Apple and other technology companies are using their technology for just more than just three dimensional emojis and higher quality selfies. I look forward to seeing what other technology these companies come up with in the future to help us lead healthier lives.

If you haven’t seen the commercial check it out here: https://www.youtube.com/watch?v=N-x8Ik9G5Dg

 

 

Just Trust Me (Part IV)

In the past few weeks, I have illustrated how trust (or lack thereof) shapes the relationship between individuals and healthcare, and how mistrust is historically justified. In this last segment, I want to talk about potential solutions from a social justice standpoint.

Trust is often cited in public health from the angle of paternalism, something that public health is often associated with. When we think of optimal paternalism – using scientific knowledge to influence the health decisions of the general public – we ask ourselves: are we abusing trust, or using it for good?

Public health, while sometimes paternalistic, already stresses to its students the importance of working with oppressed communities as equals to identify and solve problems. Medicine needs to catch up. Many medical students already participate in racial and cultural training, but they need to be trained from a structural angle – to gain an understanding of oppression and policy – too.

We need to support training for healthcare providers that doesn’t shy away from the tough stuff. Hands-on learning, such as tactful poverty simulations, can help. This will allow them to understand things like how the cycle of poverty makes some patients less talkative with authority figures (such as doctors) than others. We need to support minority students in medicine, so that patients can see representation of themselves and feel understood. We need to provide incentives for students to stay in their own communities for residencies. Of course, broad class mobility-enabling policy is the ultimate solution.

Many times, our work seeks to increase trust, but that puts the burden on the patient instead of addressing the reasons behind mistrust. Teaching trust in and of itself is a paternalistic objective: we should instead focus on deserving it.

Sources:

http://commonhealth.legacy.wbur.org/2012/02/minority-doctors-diversity

https://campus.fsu.edu/bbcswebdav/institution/academic/social_sciences/sociology/Reading%20Lists/Social%20Psych%20Prelim%20Readings/IV.%20Structures%20and%20Inequalities/2002%20Lareau%20-%20Invisible%20Inequality.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2156058/

It doesn’t beep at the backseat

In 1993, the National Highway Traffic Safety Administration launched the catchy “Click It or Ticket” campaign to increase seat belt usage by emphasizing the legal consequences of “freeriding” (which is also catchy and I just coined). The campaign was considered largely successful.

In our 21st century, the CDC puts 18-24 year olds as less likely to wear seat belts than older age groups, especially in the backseat. I painfully point out that these youths were likely not cognizant, maybe not even born yet, at the height of “Click It or Ticket.” It may be time for a reboot.

Enter “Buckle Up, Backseat,” a campaign idea to increase seat belt usage in backseat passengers. Tyler Lee, a first-year master’s student studying Strategic Communication, was kind enough to present this proposal to our class today. He described how a strong focus would be on ridesharing vehicles (like Uber, Lyft, or your average taxi) since they are widely used by 18-24 year olds. Tyler and team’s formative research found that attitudes on backseat passenger seat belt usage were notably laxer when in the context of rideshares.

So don’t “freeride” (wink wink, trademark pending), and instead remember to “Click It or Ticket” and “Buckle Up, Backseat.” Catchy phrases have power.

 

Source: https://www.cdc.gov/motorvehiclesafety/seatbelts/facts.html

Just Trust Me: Part III

“You can’t health care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.” -Raegan McDonald-Mosley

Last week, my post scratched the surface of the history of oppression disguised as medical treatment. Today, I want to talk about how this mistreatment, and the historical trauma that ensues, exhibits itself in patient-practitioner relationships.

Many of us have experienced the helplessness of not knowing how much a medical procedure will cost until it’s over. It’s a terrible feeling: it feels like everyone is communicating without you; ‘above’ you. For many non-white and immigrant patients, this feeling lasts for the entire appointment: from scheduling to decision-making to discharge.

Traditionally, there are four types of patient-physician relationships, each with varying levels of patient power and involvement in decision-making. There is also a distinction between patients preferring an active or passive role in decision-making. Acknowledging the relationship between trust and decision-making preference, these researchers suggest that, for black patients, race may impact both: such that a patient who trusts her individual physician “may have residual mistrust of the health care system that limits [her] ability to relinquish decision-making control.” Cultural differences, as well as fear that the doctor does not have one’s best interests at heart, can influence the relationship between patients and their physicians in Hispanic populations as well.

Racial bias, conscious or otherwise, has been found to influence treatment decisions. Black patients are systematically under-treated for pain due to false beliefs of biological differences between blacks and whites: such as black people’s skin being thicker, or blood coagulating more quickly. This is exacerbated by existing power structures between whites and non-whites, as well as between doctors and patients. In over 200 personal stories from black women of their childbirth experiences, NPR found a constant theme of being devalued and dismissed by medical providers.

Read Part IV here.

Sources:

https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why

http://www.pnas.org/content/113/16/4296

https://www.theatlantic.com/health/archive/2014/05/why-many-latinos-dread-going-to-the-doctor/361547/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766485/

http://www.antoniocasella.eu/salute/Emanuel_1992.pdf

Are Mobile Mental Health Apps User-Friendly?

by Kat Caskey

Currently, only about half of those affected by mental illness in the United States will receive any kind of treatment[1]. In the past few years, however, experts have begun to look to remote healthcare options that could improve access to mental health treatment. Perhaps most promising is the growing consensus that mental health apps, or mHealth apps, “have unprecedented potential for improving quality of life and public health outcomes” for the tens of millions of people affected by mental health conditions in the U.S. each year.[2]

Mobile apps have the unique potential to reduce many of the traditional barriers to mental health treatment. For example, mHealth apps can be significantly less expensive than traditional treatment and may be accessed anytime, including during times of crisis, without an appointment. In addition, apps can reduce cultural barriers to care as they provide a “discrete mobile environment” free from social stigma.[3]

Evidence-based mHealth apps have been proven effective at treating a variety of mental health conditions, including posttraumatic stress disorder[4], anxiety[5], depression[6], obsessive compulsive disorder[7], bipolar disorder, borderline personality disorder, and substance abuse[8]. Unfortunately, however, although patients frequently download any of the myriad of mental health apps available in the App store, many are deleted after only a few uses, and a staggering 26% are used only once. One study that surveyed mental health app users found that among the most common reasons for deleting mental health apps included “not engaging” and “not user friendly,” with “ease of navigation” being the top feature that makes eHealth apps for mental health favorable.[9]

What good are evidence-based mental health apps if people won’t use them? These results indicate trouble in the realm of user experience, which considers “user emotions, affects, motivations, and values” as well as “ease of use, ease of learning and basic subjective satisfaction.”[10] Understanding user experience has been identified as “a key step in realizing the role of mental health apps”[11] and reminds us that it is not enough to understand the clinical basis of new health technologies; equally significant is consideration of the best ways to design and implement apps for people with mental health conditions. Ideally, user experience and usability testing evaluations should involve all relevant stakeholders, including patients and providers.[12]

Especially considering the wide reach of mHealth apps, “even minor efforts to further refine the usability and utility of the app” have the potential to decrease app attrition rates and increase user exposure to evidence-based treatment recommendations.[13] As apps designed to improve mental health continue to proliferate, app designers and researchers should continue to investigate how an emphasis on user experience can improve mHealth tools for mental health.

[1] National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/index.shtml.  Accessed February 4, 2018.

[2] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[3] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[4]Rodriguez-Paras, C., Tippey, K., Brown, E., Sasangohar, F., Creech, S., Kum, H. C., … & Benzer, J. K. (2017). Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR mHealth and uHealth5(10).;
Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[5] Sucala, M., Cuijpers, P., Muench, F., Cardoș, R., Soflau, R., Dobrean, A., … & David, D. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and anxiety.

[6] Lattie, E. G., Schueller, S. M., Sargent, E., Stiles-Shields, C., Tomasino, K. N., Corden, M. E., … & Mohr, D. C. (2016). Uptake and usage of IntelliCare: a publicly available suite of mental health and well-being apps. Internet interventions4, 152-158.

[7] Ameringen, M., Turna, J., Khalesi, Z., Pullia, K., & Patterson, B. (2017). There is an app for that! The current state of mobile applications (apps) for DSM‐5 obsessive‐compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depression and anxiety.

[8] Rizvi, S. L., Dimeff, L. A., Skutch, J., Carroll, D., & Linehan, M. M. (2011). A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behavior therapy42(4), 589-600.

[9] Smith, D. Motivating Patients to use Smartphone Health Apps. Consumer Health Information Corporation. http://www.consumer-health.com/motivating-patients-to-use-smartphone-health-apps/. Published 2014. Accessed February 4, 2018.

[10] Abrahão, S., Bordeleau, F., Cheng, B., Kokaly, S., Paige, R. F., Störrle, H., & Whittle, J. (2017, September). User Experience for Model-Driven Engineering: Challenges and Future Directions. In 2017 ACM/IEEE 20th International Conference on Model Driven Engineering Languages and Systems (MODELS) (pp. 229-236). IEEE.

[11] Lemon, Christopher. “The User Experience: A Key Step in Realizing the Role of Mental Health Apps.” Psychiatric Times, 7 Feb. 2018, www.psychiatrictimes.com/telepsychiatry/user-experience-key-step-realizing-role-mental-health-apps.

[12] Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014). mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical psychology & psychotherapy21(5), 427-436.

[13] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).