[TEXT: Young African Leaders Initiative: Online Training Series]
Hi, I am Dr. Austin Demby, Deputy Director in the Office of Global Health at the Health Resources and Services Administration at the U.S. Department of Health and Human Services.
[TEXT: Austin Demby, Deputy Director in the Office of Global Health, Health Resources and Services Administration, U.S.
Department of Health and Human Services] I was a founding member of the Centers for Disease Control and Prevention’s Global AIDS Program.
I have worked with teams to establish AIDS education, prevention, treatment and care programs in
Ethiopia, Rwanda, Tanzania, Zambia, and the Democratic Republic of Congo. During the Ebola outbreak in
West Africa, I was part of the CDC’s leadership team that worked with international and domestic partners
to contain the outbreak in Sierra Leone. This lesson is Health Communications: The Message, the Messenger & the Audience
[TEXT: Effective Communication for Healthy Outcomes: The Message, the Messenger & the Audience]
In this lesson we will discuss the three key pillars of reporting and communicating health information.
[TEXT: Learning Objectives … Key pillars in health communications] We’ll talk about the importance of accurately reporting health information.
[TEXT: Accurately reporting health information … Consequences of reporting inaccurate information] And we will look at the consequences
of distributing and promoting inaccurate health information. Accurately reporting on health issues in a balanced way
is critical to improving health outcomes. It is important to report such health information with due regard to the
impacted populations, ensuring that the reporting results in good outcomes and does not result in stigmatization
and unforeseen consequences. The absence of reporting accurately on health issues and in a timely manner creates unacceptable room for rumors,
[TEXT: Rumors can have devastating effects and be difficult to stop.] which when allowed to have a foothold, may have devastating consequences that may
be very difficult to reverse. It can mean the difference between someone seeking the proper lifesaving preventative care or not.
Reporting and communicating health information for appropriate action is an issue that we should consider very carefully.
[TEXT: Health Communications Triangle] It is indeed a partnership between three fundamental pillars,
what I would refer to as a “Health Communications Triangle” – [TEXT: Message … Messenger … Audience]
the message, the messenger, and the audience.
[TEXT: Part One: The Message]
Let us start with the message. For populations to take health messages seriously, messages have to be
important and relevant to the impacted populations. This should not just be the opinion of the
health experts. The populations you are trying to reach should be able to understand how the health issue
affects them as individuals, their families, their neighbors or others they care about. The timing of
messages is very important, [TEXT: Timing of the message affects the acceptance and urgency of the
audience’s response.] as it will determine their acceptance and the urgency with which the population
responds. Messages are not intended for the benefit of the health experts but instead are directed at
specific populations. Care must be taken to make sure that the messages are not presented in
hard-to-understand medical jargon but in clear, succinct, simple, and understandable language that people
could comprehend irrespective of their knowledge of the issue. In an era where information could be
obtained from many sources, especially unregulated social media accounts,
[TEXT: Health information must … be credible, reliable and verifiable.] it is important that the sources of health information
for public communication are credible, reliable, and verifiable.
[TEXT: be based on data.] Such information should be based on data and plausible science which a reasonable
individual or community could understand.
[TEXT: not create fear and panic, or stigmatize.] Messages should not create fear and panic, or stigmatize populations
based on association, geography, or lifestyle.
[TEXT: include a call to action.] Most importantly, communities usually want to know what they need to do to reduce their
exposures and risks, and improve health outcomes. Every health message is therefore incomplete
without an appropriate actionable component for your primary audience. Consider that you are not just
relaying information to your audience, you’re also working to increase their health literacy as well.
[TEXT: Health Literacy: capacity to obtain, communicate, process, and understand basic health
information and make decisions.] Health literacy is defined as the degree to which a person has the
capacity to obtain, communicate, process, and understand basic health information and what services are
available to make appropriate health decisions. By crafting messages that follow these guidelines, individuals
and communities will be better able to make informed healthcare decisions for themselves.
[TEXT: Part Two: The Messenger]
Let’s talk next about the messenger. When we talk about the health messenger,
we’re referring to any individual who attempts to relay health information. And I mean anyone –
[TEXT: Family members … Friends … Colleagues … Neighbors] a family member, a friend, a colleague, a neighbor.
[TEXT: Trained health care professionals] And of course, properly trained and licensed health
care professionals. People share health messages with friends and family because they feel a communal
responsibility. With a relevant, timely, and credible message, the community can become important
advocates for your efforts. For effective health communication, the “messenger” is as important as the “health message” itself.
[TEXT: Messengers must be good listeners, credible and trustworthy.] The messenger has to be a good listener, credible, and trustworthy.
They should be straight-forward, honest, and non-judgmental. They must have a proven track record of dealing with
similar issues and providing reliable information in the past. A messenger’s credibility stems from an in-depth knowledge
or expertise in the subject area - no matter who they are.
[TEXT: Primary messengers or their partners must have an in-depth knowledge of the topic.]
If the person serving as the primary messenger does not have a proven track record on the topic,
then their partners on the project must. Either way, you should not expect audiences to listen to your message
if you cannot demonstrate that you have the knowledge to speak on the subject.
And for the messenger to have the desired impact, they have to be
[TEXT: Approachable … Culturally sensitive … Use appropriate language] approachable, culturally sensitive, using
appropriately nuanced language,
[TEXT: Be a dependable partner … Show long-term commitment] and be perceived as a dependable partner who will be there for the long haul.
As populations tend to be skeptical of health messages in today’s world of the internet, where misinformation
and rumors are easily spread, it is important that there is a perception that the messenger really cares
about the health of a population, and has the knowledge and expertise to be that messenger.
The notion of a partnership between the health communications expert and the population, working together towards
achieving a common goal of good health outcomes, with both parties contributing in their respective ways, is vital.
[TEXT: Part Three: The Audience]
Let us now talk about the audience. The intended audience is an equal partner in this communications triangle.
For them to participate effectively, they have to feel that the health issue affects them or has the potential to affect them,
their families, or their communities, directly or indirectly. It is important that they don’t feel
blamed for the health effects that are being addressed but more as partners in bringing solutions to the health problem.
[TEXT: Audience members should understand that their views will be included.] A key component of this is ensuring that
the audience understands and agrees that their views will be factored into developing solutions. In
addition, for many community members, knowing that their local leadership is on board with a
particular message and messenger, can help build trust, and they may be more willing to listen and act accordingly.
[TEXT: Each unique audience reacts differently … Backgrounds … Beliefs … Culture] Because the audience may have
different backgrounds, beliefs, or cultures, and different groups may receive and react to messages differently,
every effort should be made to direct messages to the different groups within an audience,
[TEXT: Age … Gender … Tribe … Socioeconomic status] considering factors such as age, gender, tribe, and socioeconomic status.
Since these groups would tend to ask about what actions they should take to influence health outcomes,
deliberate efforts should be made to provide actionable messages relevant to a specific group based on these same factors.
This communications triangle is best illustrated by our efforts that started in 2011 to get pregnant women in Malawi to test for
HIV, and if they tested positive for the virus, to immediately access lifelong treatment to protect their
health and the health of their unborn child.
[TEXT: 2011 HIV Efforts in Malawi … The Message … Protect the health of both mothers and their babies] We launched a new campaign that
focused our message on protecting the health of both the mother and her baby. The new program was a deviation from prior
Prevention-of-Mother-to-Child-Transm ission programs that just focused on protecting the baby with little or
no consideration for the mother. The new program appealed to and motivated the mothers to actively participate.
[TEXT: The Messenger … Fellow mothers who had benefitted from the treatment] New messengers were recruited
to supplement the health care workers and to work with the pregnant women as peers. These new messengers
were mothers themselves, some of whom were HIV positive and had benefitted from the treatment program and had
delivered healthy babies despite their HIV status. These women were very effective, believable, and trustworthy messengers.
Prior research had shown that fathers were a major impediment to having their wives tested for HIV
and getting treatment in Malawi. For this program to be effective, it was important that fathers understood the program
and the benefits it brought to their families. Male counselors were recruited and included in the program at every
step of the way.
[TEXT: The Audience … Both pregnant women and their husbands] In determining the primary audience for delivering
the message of a healthy mother and healthy baby, pregnant women and their husbands were specifically targeted.
The net result of this program with a carefully crafted message, effective messengers, and targeted audience, was very impressive.
For the first twelve months of the program, there was a dramatic increase of 700 percent
[TEXT: 700 percent increase in the number of pregnant women who got tested and treated.] in the number of pregnant women in Malawi
who got tested, learned their status, and enrolled in the national treatment program. In another example to
illustrate this phenomenon, during the 2014/2015 Ebola outbreak in West Africa, the initial efforts at
getting community cooperation to contain the outbreak failed because the messages were scientific facts
that were not tailored to the audiences impacted by the virus. The initial messengers were not trusted,
and the tools used to deliver messages were inappropriate. The message then was; “Ebola is the deadliest viral disease in the
world. Over 95% of infected people die. There is no vaccine or medicine to treat the virus.” Yet communication experts asked
people to go to hospitals when they were ill. And when nearly 100 percent of people who presented to hospitals died,
healthcare workers were surprised when the communities revolted and accused them of killing patients who presented to hospitals.
Reversing that perception was a major challenge.
[TEXT: Create partnerships] For us to achieve success, we needed to create a partnership between the health care providers
and the communities impacted.
[TEXT: Understanding community concerns … Identifying trusted experts] To do so meant understanding the
communities’ concerns, identifying trusted subject-matter experts,
[TEXT: Utilizing preferred media] and utilizing the preferred medium for message delivery which in this case
was radio broadcasts by health care workers. Together, we developed actionable and appropriate messages
for various target audiences. The net result of those actions in Sierra Leone was 100 percent safe burials,
a sharp increase in reported cases, early referral to treatment centers, higher survival rates, and a final
containment of the outbreak. Health communication and reporting to achieve desired health outcomes
should not be a single event.
[TEXT: Health Messaging Tools] It should be an ongoing activity that utilizes all available tools such as
[TEXT: Mobile applications … Social media … Print … Radio … Text messaging … Television] mobile applications, social media,
print, radio, text messaging, and TV. These are powerful tools when combined with the correct message, adapted to the right medium,
and delivered by the right messenger whose message is directed at the appropriate audience. To ensure effectiveness,
measurements have to be in place to guarantee that the messages are delivered appropriately, the
intended audience received the credible message, and then took actions to address the health issue.
This dynamic process should result in adjustments to each pillar of the Health Communications Triangle - the
message, the messenger, and the intended audience - until the desired health outcomes are achieved.
[TEXT: Test your knowledge … YALI.state.gov … YALI Network] After you have completed all the lessons in this course at
YALI.state.gov, you can test your knowledge and earn a YALI Network Certificate.
[TEXT: Produced by the U.S. Department of State] [TEXT: Photo credits: USAID, HRSA at U.S. 140 00:15:57,165 --> 00:00:00,000 Department of Health and Human Services, Centers for Disease Control]