Tag: Health Communication

What’s going on with the HPV vaccine?

HPV is the most common STI, and 9 of every 10 people will have an infection at some point in their lives (1).  This virus can cause cancers in the cervix, penis, mouth, and oropharynx (2), and it also causes genital warts (3).  Even though a vaccine exists against HPV, less than half of teens are up to date on all of their doses of these shots (2).

Part of the reason behind these low vaccination rates are due to parents concerns regarding vaccine safety and fear that vaccination will encourage sexual activity (4).  Though all vaccines, including this one, have potential side effects, the HPV vaccine is considered safe (4). Additionally, studies have shown that the HPV vaccine does not make teens more likely to start having sex (4).

The way providers approach talking about the HPV has also influenced vaccine rates, and strong provider endorsement seems to improve vaccinations (5).  On Monday, March 19, Chris Noronha spoke with the Interdisciplinary Health Communications Class about the work he is doing with Noel Brewer on provider communication regarding the HPV vaccine.  They have found that when providers mention the HPV vaccine in the same list as other vaccines that are due at age 11, vaccination rates increase.

If you’re interested in the HPV vaccine, it may not be too late.  You can receive the series through age 26 (1).  Contact your provider if you’re interested.

 

Works Cited
  1. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine Safety. Centers for Disease Control and Prevention. [Online] January 30, 2018. https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html.
  2. Aubrey, Allison. This Vaccine Can Prevent Cancer, But Many Teenagers Still Don’t Get It. National Public Radio. [Online] February 19, 2018. https://www.npr.org/sections/health-shots/2018/02/19/586494027/this-vaccine-can-prevent-cancer-but-many-teenagers-still-dont-get-it.
  3. Centers for Disease Control and Prevention. What is HPV. Centers for Disease Control and Prevention. [Online] December 20, 2016. https://www.cdc.gov/hpv/parents/whatishpv.html.
  4. —. Talking to Parents About HPV vaccine. Centers for Disease Control and Prevention. [Online] December 2016. https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf.
  5. Narula, Tara. HPV vaccine: Why aren’t children getting it? CBS News. [Online] July 23, 2017. https://www.cbsnews.com/news/hpv-vaccination-cancer-prevention-dr-tara-narula/.

 

 

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/

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

Just Trust Me (Part I)

Well I’m not trained medically, so I’m taking a lot of what they say on faith.”

This was the response of a 47-year-old man, whose interview was part of a study on patients’ trust in hospitals.

There is no universal definition of trust that will apply to every scenario. Physician training, patient’s racial and cultural background, personalities, and expectations all come into play as their relationship evolves. One recurring theme in the study cited above was “sensing that you are in good hands.” Some mentioned that their trust developed from knowing the sheer amount of training required to be a medical provider. Other patients pointed out that being desperate, or having few other options, accelerates the formation of trust.

The Trust Project at Northwestern emphasizes the role that vulnerability plays in forming trust. Generally, once we come to trust someone, we open up to them; we expose vulnerability. In the healthcare system, it works backwards: being sick, worried, or simply confused by jargon (this is called information asymmetry), the patient often begins her relationship with her provider in a state of vulnerability.

Trust can also vary in different facets of the healthcare system. When we say that a patient has mistrust in the healthcare system, are we referring to his relationship with his provider, institutions like his hospital and insurance company, or the notion of Western medicine to begin with? One study suggests that repeated interactions are a key to building trust, and that patients do not see their providers as interchangeable. These findings suggest that we should enhance continuity, not just access.

Patients with low health literacy may reveal trust in a number of ways. One extreme is blind faith in the expertise of the provider, and another is mistrust and suspicion. One study found that blind trust in physicians was stronger in patients who were older, perceived their prognosis to be uncertain, or sometimes of low SES. Trust in the healthcare system tends to be lower among racial minorities, due to a history of unethical treatment. Could race moderate the relationship between SES and trust? Can these two extremes be reconciled, or even coexist in a single patient?

Read Part II here.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696665/

http://bmjopen.bmj.com/content/2/5/e001389.short

http://www.annfammed.org/content/8/5/440.short

http://www.kellogg.northwestern.edu/trust-project/videos/michelson-ep-2.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518638/

Research Spotlight: Dr. Noel Brewer

Last week, Upstream Writers were joined by Noel Brewer, PhD, professor of Health Behavior in the UNC Gillings School of Global Public Health and affiliated scholar with UNC’s Interdisciplinary Health Communication program. Dr. Brewer gave an interesting and informative talk about his recent tobacco research involving the effect of cigarette pack messages. His findings showed that pictorial cigarette pack warnings increased smoking quit attempts and 7-day quitting. Additionally, the pictorial warnings were found to work better than text warnings, as they led to more attention, negative affect, social interactions and thinking about the warnings. Finally, because the study’s findings did not fit existing models of health behavior, Dr. Brewer developed the new Tobacco Warnings Model.

Dr. Brewer received his PhD in psychology from Rutgers University and joined the faculty in the Department of Health Behavior at the University of North Carolina at Chapel Hill in 2004. He studies how people make risky health decisions, and he currently directs the UNC Health Cognition & Behavior Lab where he conducts his research. Furthermore, in addition to Dr. Brewer’s tobacco research involving smoking risk communication, his work also focuses on HPV vaccine communication and increasing HPV vaccine uptake, and he currently serves as Chair of the National HPV Vaccination Roundtable. More information about his research can be found here.

In the spirit of Public Health Thank You Day, thank you, Dr. Brewer, for the work that you do to promote and protect public health! 

Emerging Emojis–the fight for a seat at the table

Do you sometimes feel like an emoji is the only way to perfectly embody the message, or the face, you are trying to convey?

It’s no secret that emojis are changing the way we communicate. They don’t just appear on our phones, either. Popularized emojis are iconic, appearing on clothing, in advertisements, and other outlets. They allow for a creation of meaning and personalization, as a readily accessible tool with which to join a dialogue.

Marla Shaivitz, a communication specialist at Johns Hopkins University’s Bloomberg School of Public Health, and Jeff Chertack, a malaria expert with the Bill & Melinda Gates Foundation, are appealing to the Unicode Consortium–an organizing body that approves characters an emojis for standardized usage–to consider adding a female mosquito to the list of emojis that will be added to smartphones next year. Apparently, the mosquito is among a list of 67 finalists that will be further considered.

Anticipated uses of the emoji include pairing the image with other symbols–a rain cloud, for instance, to encourage people to stay dry indoors and to encourage insecticide application–or to indicate that eradication efforts are under progress. As mosquitoes are key in infectious disease transmission (for viruses including dengue, Zika, malaria, and yellow fever), a recognizable symbol might encourage more dialogue about preventative behaviors or information-seeking behaviors.

Shaivitz and Chertack make their case by estimating seven times more usage of the mosquito emoji than of the beetle emoji on Twitter. In fact, they claim there is a pretty high demand for it.

When you think about the truly random emojis that do exist, it would seem far-fetched not to include one that has the potential to actually make a  positive change. Time will tell if Unicode bites.

Sources:

http://www.latimes.com/science/sciencenow/la-sci-sn-moquito-emoji-health-20170922-story.html

hhtps://ccp.jhu.edu/2017/09/18/creating-buzz-proposing-mosquito-emoji-public-health/

 

The Voice of Public Health

People get in to public health because they want to help others. They want to share their wealth of knowledge in a way that makes a difference.

So then why don’t people hear public health messages?

Jim Garrow offers a fun, yet thoughtful read about why public health is boring.

One reason, messages go unnoticed is that public health has relied heavily on data and presenting rational arguments in an effort to persuade people to change behavior. Facts are important, I’m not denying that. But what really speaks to people?

Matthews and colleagues offer up the notion of speaking to deeper, moral values that connect us. Some practical, if not obvious, suggestions include:

  • Avoiding that intrinsic tendency of self-righteousness
  • Find common ground or at least empathy
  • Foster personal relationships, particularly with those who have different values than you
  • Tell stories that incorporate 6 moral foundational values (Care, Liberty, Fairness, Loyalty, Authority, and Sanctity)
  • Understand your target community

People are more than numbers, and life is constantly going on around them. A wise teacher once told me we need to see people, know people, and care about people. We need to communicate, and then try again in different ways, over and over.

Dr. Anoop Kumar has a provocative post claiming “…this historic time is when your (public health) voice is most needed…You are being called to a higher purpose – to say what you know, to speak up for the good of our communities and our country…”

How will your voice be heard?

 

Sources:             

Garrow, Jim. Public Health is Boring. May 13, 2015. https://medium.com/rebel-public-health/public-health-is-boring-d7c9b9792787

Kumar, Anoop. A Clarion Call to Publich Health Mavens. May 19, 2014. https://medium.com/healthcare-and-public-health/a-clarion-call-to-public-health-mavens-c9775456ea7

Matthews G, Burris S, Ledford SL, Baker E. Advocacy for leaders: crafting richer stories for public health. J Public Health Manag Pract. 2016;22(3):311-315.

 

Fake Health News

Fake news has been dominating headlines over the past year. Although much of the publicity has been related to politics, fake news about health may be more widespread and difficult to identify.

But what exactly is fake news?

By definition, fake news is the deliberate spread of misinformation with the intention of making political or financial gain. Ultimately it may cause individuals to make health decisions that lead to harm or suffering.

How do you identify fake news?

HealthNewsReview.org is a health news watchdog at the University of Minnesota School of Public Health that offers 10 benchmarks to evaluate the truthfulness of health care reporting.

Before taking any article at face value, ask yourself the following questions. Answering no indicates a red flag for truthfulness or accuracy.

Does the story…

  1. sufficiently discuss the costs of the health intervention?
  2. adequately quantify the benefits of the intervention?
  3. avoid exaggerating potential benefits or ignoring potential harms?
  4. acknowledge the quality of evidence?
  5. avoid over-selling or exaggerating the findings?
  6. include comment from independent sources and identify potential conflicts of interest?
  7. compare the new intervention with those already available?
  8. clearly state how available the intervention is for consumers?
  9. show what is truly new or different about the intervention?
  10. mostly repeat a news release?

Kelly McBride, vice president of the Poynter Institute, acknowledged in an article in the Atlantic – “In science, good information is really boring. Science doesn’t leap ahead the way journalists like to cover it.”

Bottom Line: If it sounds too good to be true, it probably is.

 

Next Level Data Presentation

By Arshya Gurbani

It’s probably safe to guess that lot of people studying Health Communication feel strongly about data, how it’s presented, and the “story” it has to tell. I thought it was about time to re-watch this, one of my favorite TED talks, about using statistics effectively. Hans Rosling presents data on child mortality, but in doing so he layers it with context and bias and paints a picture that is remarkably clear and moving.  It’s good stuff–seriously, get some popcorn and a handkerchief before you watch/re-watch it!

What’s culture got to do with it?

By: Courtney Luecking MPH, MS, RD Doctoral candidate: Nutrition

What happens when a cultural and political sociologist teams up with health researchers? Answer: some really fascinating work and advancement of how we think about the influence of culture on health.

Meet Andrew Perrin, Ph.D. He is a professor in the Department of Sociology at the University of North Carolina in Chapel Hill.

perrin

While his work focuses mostly on “what people need to know, be and do to make democracy work”, his family has opened up the opportunity to share his expertise with the public health arena. Does culture influence health? If so, how, and to what extent?

Dr. Perrin suggests that although the public health and health communication world may be able to measure certain aspects of culture well, there is a lack of breadth and depth of conceptualizing culture. This could mean we, public health and communication groups, are missing or misinterpreting a big piece of the health puzzle. He offered context of the contemporary synthesis of culture as presented by Johnson-Hanks and colleagues. A cyclical interaction between culture in the world and culture in our mind influences our individual and collective decisions and actions, but how can we robustly measure this?

culture

Fortunately, Dr. Perrin and an interdisciplinary crew are working to develop tools to measure culture in the world and culture in the mind within the context of obesity. Once measured, they will work to interpret the effects of culture on health. One project looks to explain variations and health outcomes in a county in North Carolina using a combination of geocoded photographs (culture in the world) and focus groups (culture in the mind). Results for this are forthcoming. Another project looked at obesogenic behaviors and stigma in children’s movies. You may or may not be surprised to learn that unhealthy behaviors are represented more than healthy behaviors, and movies contain messages that encourage weight-related teasing or bullying. For more information and results about this, review the paper on Pass the Popcorn.

Thanks to Dr. Perrin for sharing his time and expertise with our class! He highlighted the value interdisciplinary teams bring to thinking about problems in a more holistic manner that could ultimately benefit the public’s health.

 You can learn more about Dr. Perrin’s work at his website.