Speaking of Health Assessing Health Communication Strategies for Diverse Populations (2002) / Chapter Skim
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179 6 New Communication Applications and Technologies and Diverse Populations THE CHANGING HEALTH COMMUNICATION LANDSCAPE1 Communication applications and technologies changed dramatically over the 20th century. The telephone did not become a routine means of communication in the United States until World War I (Mandl, Kohane, and Brandt, 1998)
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180 SPEAKING OF HEALTH ters for Disease Control and Prevention Comparability of Data, http://www.cdc.gov; Behavioral Risk Factor Surveillance System, 2000)
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New Communication Applications 181 ing prevention information, finding appropriate care, and gaining follow-up advice. This chapter will explore the use of new health communication technologies and new uses of current technologies, with a focus on diverse audiences.
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182 SPEAKING OF HEALTH Tailored Print Communication TPCs are printed materials created especially for an individual based on relevant information about that person, usually from the person (e.g., by telephone interview or self-administered questionnaire) with or without other data (such as medical records)
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New Communication Applications 183 should be appropriate to particular audiences. Like any good intervention, tailored interventions should reflect participation of potential users at every stage.
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184 SPEAKING OF HEALTH TABLE 6-1 Evidence for the Effectiveness of Tailored Print Communications Significant Outcome by Authora Impact Yes No More likely to be read, Brinberg and Curry et al., 1995 recalled, rated more highly, Axelson, 1990 Bull et al., 1999a discussed with other people, Campbell et al., and perceived as 1994,b 1999,b 2002b interesting and relevant Skinner et al., 1994 Dijkstra et al., 1998a Strecher, 1999 Brug et al., 1996, 1998 Lipkus et al., 1999,b 2000 Kreuter et al., 1999, 2000b Rimer et al., 1999,b 2002 DeBourdeaudhuij and Brug, 2000 Etter and Perneger, 2001 Nansel et al., 2002b Blalock et al., 2002 McBride et al., 2002b Significant main effect or Dijkstra et al., 1999 Curry et al., 1995 subgroup effect on smoking Strecher, 1999 Dijkstra et al., cessation Lipkus et al., 1999,b 1998b 2000 Campbell et al., Velicer et al., 1999 2002b Orleans et al., 2000 Prochaska et al., 2001 Becona and Vazquez, 2001b Etter and Perneger, 2001 Lennox et al., 2001 McBride et al., 2002b
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New Communication Applications 185 Significant decrease in Brinberg and Axelson, Siero et al., 2000b dietary fat intake 1990 Bowen et al., 1992 Campbell et al., 1994,b 1999,b 2002b Kreuter and Strecher, 1996 Brug et al., 1996, 1998 DeBourdeaudhuij and Brug, 2000 Significant increase in fruit and Brug et al., 1998 Campbell et al., vegetable intake Campbell et al., 1999,b 1994b 2002b Brug et al., 1996 Kristal et al., 2000 Lutz et al., 1999 Delichatsios et al., 2001 Significant effect on Burnett et al., 1985 weight reduction Significant effect on exercise Kreuter and Strecher, Bull et al., 1999b behavior or main effect on 1996 Blalock et al., those not exercising at baseline Bull et al., 1999a 2002 Marcus et al., 2000b Bock et al., 2001 Campbell et al., 2002b Increased adoption of home Nansel et al., 2002b and car safety behaviors among parents of young children Increase use of calcium Blalock et al., 2002 supplements to prevent osteoporosis among persons thinking about but not appropriately performing the behaviors TABLE 6-1 Continued Significant Outcome by Authora Impact Yes No continued on next page
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186 SPEAKING OF HEALTH Improve decision making McBride et al., in pressb about HRT Significant main effect or Skinner et al., 1994 Meldrum et al., subgroup effect on use of Rakowski et al., 1998 1994b mammography Rimer et al., 2001, Drossaert et al., 2002 1996 Valanis et al., 2002 Rimer et al., 1999b More accurate assessment of Lipkus, Rimer, Strigo, breast cancer risk 1996 Rimer et al., 2002 McBride et al., in pressb Skinner et al., in press Improved completion of Harpole et al., 2000b multiple tests needed by women Increased adherence to early Myers et al., 1999b detection for prostate cancer Increased adherence to Campbell et al., 2002 cervical cancer screening Improved knowledge about Skinner et al., in press genetic testing and related issues and increase accurate assessment of risk of being a mutation carrier aNote: Only first or first and second author(s) listed here in order to conserve space, co-authors can be found in reference list.
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New Communication Applications 187 press)
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188 SPEAKING OF HEALTH that tailored letters about mammography had a significant subgroup effect on African-American women. Lipkus and colleagues (Lipkus, Lyna, and Rimer, 1999)
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New Communication Applications 189 one of the few studies that showed an ethnic group disadvantage, McBride et al. (in press)
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190 SPEAKING OF HEALTH spondent, and the extent to which each subsequent call takes into account what was learned in previous calls or other encounters with an individual. The number, length, and timing of calls range from single contacts to multiple calls over a 12-month period.
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New Communication Applications 191 Interactive voice response (IVR) systems are a newer variant of TDIs that allow users to call a computer to report their status and to receive information; in addition, they can be used to initiate proactive calls (Piette, 2000)
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192 SPEAKING OF HEALTH surprising cases, TPCs performed worse than usual care, while the combination of TPC and TDI was highly effective (e.g., Rimer et al., 2001)
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New Communication Applications 193 blush of technological appeal passes, there may be some tendency to reduce use. These concerns are particularly relevant in the context of diverse audiences that may vary sharply in their habits of actively seeking health information.
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194 SPEAKING OF HEALTH reason people said they went online was to get information quickly (U.S. Department of Commerce, 2002)
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New Communication Applications 195 • Internet access from home for racial/ethnic groups is as follows: Asian Americans/ Pacific Islanders, 56 percent; whites, 44 percent; African-Americans, 24 percent; and Hispanics, 24 percent (U.S. Department of Commerce, 2001)
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196 SPEAKING OF HEALTH we understand the potential of the Internet and other computer applications for health communication with and among diverse populations. Use of the Internet for Health Communication The phenomenal increase in use of the Internet for health information can be attributed to many factors, several of which have particular implications for health communication for diverse audiences.
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New Communication Applications 197 mation on the Web said it helped them improve the way they take care of themselves (Pew Internet & American Life Project, 2000b)
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198 SPEAKING OF HEALTH For some health topics, such as HIV/AIDS, the anonymity afforded by the Internet may be perceived as a strong asset (DeGuzman and Ross, 1999)
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New Communication Applications 199 that prevention will not work online, but rather that it poses unique challenges, particularly in creating awareness and demand where none is inherently present. For example, a person's disease condition (or that of a friend or relative)
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200 SPEAKING OF HEALTH more: a spirit of community, a level of candor rarely broached in polite conversation, and a warehouse of information, often routinely monitored by medical specialists." While acknowledging the questionable information on the Internet, she argued persuasively for the power and the permanence of these new Net-inspired citizen scientists who are changing not only the search for health information, but the practice of medicine and research (Solovitch, 2001)
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New Communication Applications 201 their patients (Journal of the Mississippi State Medical Association, 2000; Cyber Dialogue, 2000b)
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202 SPEAKING OF HEALTH information they find on the Internet. Unfortunately, physicians have been slow to adopt e-mail for communication with patients.
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New Communication Applications 203 information, difficulty finding high-quality information because of the vagaries of commercial search engines, lack of access, and concerns about privacy (Eng et al., 1998)
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204 SPEAKING OF HEALTH tion will be met in this way in practice is the hard question. It is likely to vary sharply by domain and by audience characteristics.
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New Communication Applications 205 IHC applications operate through telephones, personal digital assistants, Internet appliances, personal computers, and public kiosks. As wireless computers become more available, there will be even more delivery options.
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206 SPEAKING OF HEALTH promotion programs. Social support and guidance during early periods of personal change and maintenance increase long-term success.
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New Communication Applications 207 full-length articles drawn from the scientific and/or popular press available on other Web sites. The Consumer Guide provides descriptions of 150 services to help users visualize what it will be like to receive the service, learn to identify a good provider, and become an effective consumer.
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208 SPEAKING OF HEALTH ner-city African-American women. They used CHESS as much as affluent white women with breast cancer (Gustafson et al., 2000)
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New Communication Applications 209 disorders often refuse preventive or remedial health services, but some may pursue online individualized behavioral guidance. In several studies, participants reduced their dissatisfaction with their weight and body shape, and they positively altered dysfunctional attitudes and disordered eating behavior by this means (Winzelberg et al., 2000)
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210 SPEAKING OF HEALTH tional status, reduced pain, confidence in asking questions, body image, decisional confidence, self-efficacy, and knowledge. Krishna et al.
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New Communication Applications 211 eral reasons for not participating in e-mail exchanges and what have been referred to as e-encounters. The reasons include not being reimbursed, concern about professional liability, and concern about volume (MacDonald, Case, and Metzger, 2001)
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212 SPEAKING OF HEALTH and found that few of them employed interactive tools. Ideally, the new communication technologies will expand choices for how people get health information, not constrain them.
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New Communication Applications 213 they operate should be examined. Today, most research on behavioral interventions using new communication technologies relies on "kitchen sink" approaches that do not permit an assessment of the individual and combined contributions of intervention components.
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214 SPEAKING OF HEALTH on wireless devices. Mobile systems have particular appeal because of their portability, privacy, and other features.
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New Communication Applications 215 researchers and practitioners should pay attention to this issue. The Internet is a bit like the Wild West: It has vast amounts of unregulated territory and no one in charge.
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216 SPEAKING OF HEALTH more accessible and appealing to diverse populations. Promising examples include devices such as Web Pads, which are now being used in some hospitals to provide Internet access to patients and their families (Bennett, 2001)
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New Communication Applications 217 cess to information by poor, illiterate people (Ward, 2001)
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218 SPEAKING OF HEALTH The evolving information technologies increasingly will serve as a vehicle for building social networks. Online transactions transcend the barriers of time and space (Hiltz and Turoff, 1978; Wellman, 1997)
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New Communication Applications 219 vacy issues that must be confronted, among other challenges. Nevertheless, some early data suggest that diverse populations can participate in their own self-management through Internet-based assessment and capture of spirometric data (Patel, 2001)
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220 SPEAKING OF HEALTH videos, to enhance understanding. What the authors failed to point out was that many of the Web pages in their sample were the personal anecdotes of melanoma survivors, and did not purport to be either comprehensive or medically rigorous.
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New Communication Applications 221 these recommendations. Most important, we support the goal of universal access as articulated by SciPICH (see Eng et al., 1998:1374)
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222 SPEAKING OF HEALTH partnerships, such as that developed by the NCI and the Markle Foundation to fund digital divide projects, can be productive. • Increase access of diverse populations to health care information through new technologies.
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New Communication Applications 223 that the new technologies create new environments, new kinds of use, and new communities, research methods must be adapted. Provide some fast-track funding to enable researchers to use new technology as developed and to obtain answers quickly.
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