Mark et al., 2000; Ryan and DeStefano, 2000) and the evaluation of communications (Schriver, 1990; Spyridakis, 2000); the paucity of information available regarding both formative (e.g., the Food and Drug Administration focus groups) and summative (e.g., overall effects on attitudes or consumption) evaluation of national seafood consumption advisories suggests that agencies should devote additional attention and resources to evaluation. The committee touches on the importance of evaluation in the context of partnerships, to assess whether communications are appropriate and effective for target populations.

STEP 3: DESIGNING COMMUNICATIONS TO SUPPORT INFORMED DECISION-MAKING

Interactive Health Communication

In seafood consumption, “one size does not fit all,” and messages about consumption often have to be individualized for different groups. There is a need to consider developing tools for consumers such as web-based, interactive programs that provide easy-to-use seafood consumption decision tools. Real-time, interactive decision support that is easily available to the public has the potential to increase informed actions for some portion of the population. In the absence of federal investment in such tools, some organizations have invested in online mercury calculators or consumption guides (Table 6-1). Many of these focus solely on risks from seafood consumption, and while well-intentioned, may be providing misleading information, for example, by interpreting the Reference Dose (RfD) as a “bright line” to determine whether consuming seafood puts a consumer at risk.

One model for developing comprehensive consumer tools is a health risk appraisal (HRA) that would allow individuals to enter their own specific information and would provide feedback in the form of appropriate information or advice to guide the user’s health actions, such as seafood consumption. There are a myriad of health risk appraisal tools commercially available; of those in the public domain the Centers for Disease Control and Prevention (CDC) has extensive experience in the development and use of HRAs (SOURCE: http://www.cdc.gov). In order to be most useful and appropriately directed, tools such as the HRA must be based on a body of knowledge that substantiates both benefits and risks. This kind of approach can be seen in the Clinical Guide to Preventive Services from the Agency for Healthcare Research and Quality (AHRQ), which adopted recommendations based on medical evidence and the strength of that evidence in practice (USPSTF, 2001–2004).

The Clinical Guide to Preventive Services is an example of an interactive health communication approach to providing one-on-one guidance, along



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