William Holzemer, dean of the School of Nursing at Rutgers University and a member of the Committee on the Science of Changing Behavioral Health Social Norms, introduced the luncheon speaker, Nathaniel Kendall-Taylor, vice president for research at the Frameworks Institute. Kendall-Taylor’s work has concentrated on culture and health disparities, decision making, routes of addiction, and early childhood development. His presentation focused on the rationale and methods used by the Frameworks Institute to improve communications for public understanding and policy change. He spoke about work done over the past 5 years with the National Scientific Council on the Developing Child and the Harvard Center on the Developing Child that examines how the public understands child mental health. His work also is examining how, through communication, science, and expert perspectives, information about child mental health can be communicated more effectively to shift the public’s understanding and increase its support for evidence-based policies. The institute’s theory is that creating change in communications can lead to change in the public discourse, which has the effect of changing public thinking, which in turn creates space, demand, and public will for more effective policy.
Kendall-Taylor explained that the difference between what experts say and what the public thinks is that messages are mediated or translated through culture. Culture, he suggested, is a set of mental models that people
share at a deep level and use to process and make sense of information. He noted that this is not a novel concept, but the result of almost 50 years of social and behavioral science. People are not empty vessels that accept whatever is received, he underscored. Rather, there are complex sets of existing understandings and cultural models that lie just below the surface and are waiting to interact with and be used to make meaning out of messages.
Among the many principles of effective communication, Kendall-Taylor discussed three in particular. The first, he said, is that effective communication is not just about saying the message louder or giving more information or data. The second is that effective communication does not happen only through myth busting and correction of misperceptions. Kendall-Taylor described a study on fact sheets about flu vaccines conducted by researchers at the University of Michigan 10 years ago to examine people’s understandings, attitudes, and behavioral intentions. Results from numerous studies show that people tend to misremember the myths as true, that this effect intensifies the more time has elapsed since exposure to the fact sheets, and that people attribute the false information to the source of the information. Kendall-Taylor added that these results have been replicated. A third principle, he said, is not to rely on an assumption that all one needs to do is make the message resonate with the public. Resonance is certainly important, he argued, but practices can be misguided when resonance is viewed as the ultimate goal. In the context of this workshop, he suggested the ultimate goal would be to change public understanding, decrease stigma, and create support for different policies. Resonance is good, he asserted, only if it aligns with that goal.
To summarize, Kendall-Taylor said that effective communication comes, first, from knowing those cultural models that become active when one engages people’s thinking about the topic of interest, and, second, from having proven strategies for communicating one’s messages. He then described the research process carried out by the Frameworks Institute to discover the cultural models that shape people’s thinking about children’s mental health. The researchers began by looking at the way people make sense of child mental health using open-ended questions. Kendall-Taylor showed a series of short videos of street interviews conducted in four different locations throughout the United States. The interviewer asked, “What is child mental health?” “What shapes it?” “Why does this issue matter?” and “What can be done to improve or promote positive mental health in children?” Kendall-Taylor said the objective was to uncover the cultural assumptions behind the patterned ways in which people answered the open-ended questions.
Kendall-Taylor explained that the research revealed that when asked about mental health, people are thinking about mental illness—two very discrete domains that yield two sets of understandings. The public assumptions the research found behind the term “mental health” included
- mental health is about emotional states;
- individuals are responsible for controlling their emotions; and
- therefore, individuals need to take more responsibility.
The assumptions found behind the term “mental illness” included
- mental illness is a chemical imbalance;
- chemicals are the product of genes;
- genes are set in stone (determinism); and
- therefore, drugs are the only answer, and other solutions are difficult to think of.
According to Kendall-Taylor, the street interviews also revealed that people do not acknowledge that children can even have states of mental health. They also believe that children are little adults, which obscures a developmental perspective on child mental health.
With the public’s cultural models in hand, Kendall-Taylor continued, the next step was to take the perspective that experts want to communicate and compare it with those models that the public uses to understand the issue. The objective, he said, was to identify the primary targets for reframing the issue, or introducing new ways of communicating about it, that can make the expert understanding available to the public. This process, he explained, involved “mapping the gaps” by comparing the experts’ perspective and the public’s understanding of the
- concept of child mental health and causes of child mental illness;
- contexts of importance/responsibility (i.e., society, family, individual);
- impact of genes;
- appropriate treatment; and
- existence of the issue of child mental health and mental illness.
Kendall-Taylor introduced reframing tools that have been used to address gaps in the public’s understanding. He described them as cognitive tools derived from a variety of different disciplines and individual studies that have identified features of communication that can change the way
people think and understand so as to ultimately support changes in attitudes and policies. He listed five such reframing tools:
- Context, which establishes the nature of the problem as either a public “issue” that concerns everyone or a private “trouble” affecting only those individuals experiencing the problem;
- Values, or goals, to remind people of what is at stake or a principle they hold that is connected to the issue;
- Metaphors, to place issues in people’s everyday action scenario, enhance their understanding of processes and mechanisms, and increase agency;
- Examples, to show process, anchor explanation, and assist with recall and transmission; and
- Narrative, to override people’s default patterns of expectation about a complex, abstract issue by substituting the expectations of a well-known narrative structure.
Kendall-Taylor then discussed two of these in greater detail.
Kendall-Taylor explained that values provide orientating perspectives available to members of a culture that help answer the question of why an issue matters. On child mental health, he said, values will serve the function of helping people formulate a perspective, or an orientation, that helps them see why this is an important issue. However, he cautioned, it is important to decipher which of a set of values will be most effective in creating the kind of understanding or attitude shift desired. He described this as an example of an empirical question he has studied through “framing experiments” that test the effect of exposing people to different values. Does exposure to value A lead to better understanding, different attitudes, more support?
Using the child mental health example, one framing experiment used a nationally representative sample of more than 5,000 online respondents and randomly assigned each to a message with one of four different values—prosperity, ingenuity, prevention, or vulnerability—and a control condition. The participants were surveyed using a set of randomly rotated policy, attitude, and understanding measures. For example, Kendall-Taylor elaborated, one item stated, “Mental health and substance abuse services should be available and affordable for all parents, caregivers, and children who need them.” Participants would rate their support/agreement for that statement on a seven-point Likert-type scale.
According to Kendall-Taylor, it was found that exposure to the values of prosperity and ingenuity was associated with statistically significant increases in people’s support for those policy/attitude measures compared with controls. Based on these results, he said, Frameworks has been working with child mental health experts and advocates to use these two values to fill specific parts of the communications frame. For example, he noted, collective prosperity is being used to address the question of why children’s mental health matters, while ingenuity/innovation in problem solving is used to help people think about solutions.
Kendall-Taylor next discussed the reframing tool of metaphors that are used as specific translation devices to communicate particular conceptual points. For example, a complex topic such as brain development might be compared with building architecture using such concepts as “what happens early matters,” “materials that are used matter,” and “form dictates function.” The communication goals on the child mental health project were to make people understand that children can indeed have states of mental health; understand that mental health is the result of the interplay of genes, biology, and environments; and understand that these positive states can be protected and promoted; as well as to inoculate against the idea that the child is responsible for or tasked with addressing these states. The researchers developed and tested several metaphors using on-the-street interviews, quantitative experiments, and tests to determine how certain metaphors would either hold up or degrade to become unrecognizable when passed on to different people.
Kendall-Taylor closed by saying that his presentation was intended to illustrate how the research methods and tools employed by the Frameworks Institute can help in addressing some of the challenges in effective communication aimed at changing attitudes and policy. He provided a link to the institute’s website for more information and references.1
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