# data[].attributes.headline
Communication and the impact in public health

# data[].attributes.subject
Communication and the impact in public health

# data[].attributes.attachment_link.readable_text
IDepartment of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States of America (USA)
II Department of Communication, Michigan State University, East Lansing, MI, USA

For the first time, health communication was allocated a chapter in the United States of America (USA)'s Healthy People 2010 objectives, illustrating its growing importance, according to Parrott. ¹ In these objectives, set by the United States Department of Health and Human Services, health communication is seen to have relevance for virtually every aspect of health and well-being, including disease prevention, health promotion and quality of life. This increase in the prominence of the field, externally, is happening contemporaneously with important developments taking place, internally, one of which is the focus on the study of environmental, social and psychological influences on behaviour and health. Given the global challenges posed by major threats, health communication scholars and practitioners recognize the importance of prevention and, with it, the need to understand human behaviour through the prism of theory. This has given rise to theorizing about the role of risk perceptions, 2,3 social norms, 4,5 emotions 6,7 and uncertainty ⁸ in health behaviours.

Communication is at the heart of who we are as human beings. It is our way of exchanging information; it also signifies our symbolic capability. These two functions reflect what James Carey characterized as the transmission and ritual views of communication, respectively. ⁹ Carey recognized that communication serves an instrumental role (e.g. it helps one acquire knowledge) but it also fulfils a ritualistic function, one that reflects humans as members of a social community. Thus, communication can be defined as the symbolic exchange of shared meaning, and all communicative acts have both a transmission and a ritualistic component.

Intervention efforts to change behaviours are communicative acts. By focusing mostly on the transmission function of information exchange, such efforts often neglect ritualistic processes that are automatically engaged through communication. In adopting the transmission view of communication, it is reasonable to think carefully about the channels through which intervention messages are disseminated, to whom the message is attributed, how audience members respond and the features of messages that have the greatest impact. These considerations reflect the essential components of the communication process: channel, source, receiver and message, respectively. In the ritual view, however, target audiences are conceptualized as members of social networks who interact with one another, engage in social ceremony and derive meaning from the enactment of habitual behaviours.

Three important intervention considerations emerge from this dual view of communication. First is the realization that communication interventions do not fall into a social vacuum. Rather, information is received and processed through individual and social prisms that not only determine what people encounter (through processes of selective exposure), but also the meaning that they derive from the communication (known as selective perception), depending upon factors at both the individual (prior experience, efficacy beliefs, knowledge, etc.) and the macro-social (interpersonal relationships, cultural patterns, social norms) levels.

Second, it is reasonable to expect discrepancies between messages disseminated and received. They arise not only due to differential exposure to the intervention but also because of the differences in interpretation in decoding information. A careful study of the correspondence between messages as they are sent and received is thus of great importance to avoid unintended (and worse, counterproductive) effects. ¹⁰

Third, communication is a dynamic process in which sources and receivers of information continuously interchange their roles. One of the central tenets of health communication interventions - the need to conduct extensive formative evaluation, audience needs assessment and message pretesting - is the direct offshoot of this understanding.

Use of these health communication principles in public health presents challenges. First, the evaluation of communication interventions, especially those using national mass media (e.g. radio), does not usually lend itself to randomized trials. Hence, innovative methodological and statistical techniques are required for attributing observed outcomes to intervention efforts. The responsive and transactional nature of health communication interventions also means that modification in intervention content may occur, adding an additional challenge to the evaluation process. Second, the recognition among behavioural scientists - that causes of human behaviour reside at multiple levels that reinforce each other - poses difficulties in designing and testing multilevel interventions. This complexity of health behaviour determinants also requires a multidisciplinary approach for effectively promoting change, which further means that interventions need to incorporate expertise from a variety of professional backgrounds. Finally, because of the rapidly changing communication channels, health communication interventions need to make extra efforts to meet their audiences at their level of technology use.

Health communication has much to celebrate and contribute. The field is gaining recognition in part because of its emphasis on combining theory and practice in understanding communication processes and changing human behaviour. This approach is pertinent at a time when many of the threats to global public health (through diseases and environmental calamities) are rooted in human behaviour. By bringing together researchers and practitioners from diverse disciplines and adopting multilevel theoretical approaches, health communicators have a unique opportunity to provide meaningful input in improving and saving lives. We are optimistic.

[Editor's note: Read more about health communication in the upcoming special theme issue of the Bulletin in August 2009.]

Available at: http://www.who.int/bulletin/volumes/87/4/08-056713/en/index.html

1. Parrott R. Emphasizing "communication" in health communication. J Commun 2004;54:751-87. doi:10.1111/j.1460-2466.2004.tb02653.x

2. Witte K. Fear control and danger control: a test of the Extended Parallel Process Model (EPPM). Commun Monogr 1994;61:113-34.

3. Rimal RN, Real K. Perceived risk and efficacy beliefs as motivators of change: use of the risk perception attitude (RPA) framework to understand health behaviors. Hum Commun Res 2003;29:370-99 doi:10.1111/j.1468- 2958.2003.tb00844.x

4. Lapinski MK, Rimal RN. An explication of social norms. Commun Theory 2005;15:127-47. doi:10.1111/j.1468-2885.2005.tb00329.x

5. Rimal RN, Real K. How behaviors are influenced by perceived norms: a test of the theory of normative social behavior. Communic Res 2005;32:389-414. doi:10.1177/0093650205275385

6. Nabi RL. A cognitive-functional model for the effects of discrete negative emotions on information processing, attitude change, and recall. Commun Theory 1999;9:292-320. doi:10.1111/j.1468-2885.1999.tb00172.x

7. Mitchell MM, Brown KM, Morris-Villagran M, Villagran PD. The effects of anger, sadness and happiness on persuasive message processing: a test of the negative state relief model. Commun Monogr 2001;68:347-59. doi:10.1080/03637750128070

8. Brashers DE. Communication and uncertainty management. J Commun 2001;51:477-97. doi:10.1111/j.1460-2466.2001.tb02892.x

9. Carey JW. Communication as culture: essays on media and society. Winchester, MA: Unwin Hyman; 1989.

10. Cho H, Salmon CT. Unintended effects of health communication campaigns. J Comm; 57:293-317.

*Correspondence to Rajiv N Rimal (e-mail: rrimal@jhsph.edu).

# data[].attributes.attachment_link.title
SciELO - Saúde Pública - Why health communication is important in public health Why health communication is important in public health

# data[].attributes.attachment_link.description
IDepartment of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States of America (USA) II Department of Communication, Michigan State University, East Lansing, MI, USA For the first time, health communication was allocated a chapter in the United States of America (USA)'s Healthy People 2010 objectives, illustrating its growing importance, according to Parrott.

# data[].attributes.headline
The impact of open access upon public health 

# data[].attributes.subject
The impact of open access upon public health 

# data[].attributes.body
I think the story told by Arthur define the importance of free access to information

# data[].attributes.attachment_link.readable_text
Virginia Barbour¹; Paul Chinnock; Barbara Cohen; Gavin Yamey

PLoS Medicine, Public Library of Science, 185 Berry Street, Suite 3100, San Francisco, CA 94107, USA

Arthur Amman, President of Global Strategies for HIV Prevention ( www.globalstrategies.org), tells the following story:

"I recently met a physician from southern Africa, engaged in perinatal HIV prevention, whose primary access to information was abstracts posted on the Internet. Based on a single abstract, they had altered their perinatal HIV prevention program from an effective therapy to one with lesser efficacy. Had they read the full text article they would have undoubtedly realized that the study results were based on short-term follow-up, a small pivotal group, incomplete data, and were unlikely to be applicable to their country situation. Their decision to alter treatment based solely on the abstract's conclusions may have resulted in increased perinatal HIV transmission."

Amman's story shows the potenttially deadly gap between the information-rich and the information-poor. This gap is not the result of lack of technology or of money, but of a failure of imagination. We live in the most information-rich era of history, when the Internet allows immediate global dissemination of crucial health information, and the inter-linking of online information creates an integrated, living body of information — the ultimate vision of which is the semantic web. ¹

What is preventing such a living web? For scientific and medical information, two obstacles are vested interests and traditions. Central to these traditions is the role of copyright, which was developed when the dissemination of work was on paper. Initially, applying copyright to medical articles protected both the intellectual investment of authors and the commercial investment of publishers. Authors of scientific articles handed over their copyright to the publishers to prevent unauthorized print copying. Thus, the prevention of unauthorized copying helped to disseminate information, by providing a valid business model for publishers. But the proliferation of subscription-based medical and scientific journals led to readers having to pay more and more to publishers in order to keep up with current knowledge, and an increasing fragmentation of knowledge between different publishers.

Print is no longer the most efficient way to disseminate information. The Internet provides the means to revolutionize publishing in two crucial ways. First, it makes it possible to disseminate health information at no charge to anyone in the world with online access. Although it costs money to peer review, edit, produce, and host an online article, this is a one-time, fixed cost. If research funders are willing to pay this cost, then the published work can be made freely available to all readers worldwide, and there would be no need for journal subscriptions. This is one way of financing an open-access model of publishing. ²

Second, because the Internet allows not just ease of access but ease of reuse, an article's usefulness is limited only by a user's imagination. To allow this, the traditional role of copyright has to change. Instead of publishers using copyright to restrict use, authors can retain copyright and grant the public the right to creatively reuse their work. Licences such as those developed by the Creative Commons, ³ which facilitate rather than prohibit reuse, are used by the open-access publishers Public Library of Science (PLoS) ⁴ and BioMed Central (BMC). The result is that: "... copyright can be used for what it is meant to in science, not to make the artticles artificially scarce and in the process restrict their distribution, but instead, to ensure that their potential for maximum possible dissemination can be realised." ⁵

The potential benefits of such a change are vast. No longer will physicians have to base their practice on half truths. Instead, everyone from patients to policy-makers can read for themselves the evidence on which crucial science and health policy decisions are made. One example of a paper with potentially profound public health implications is the first randomized trial of male circumcision to prevent HIV infection; ⁶ having this paper and all related discussions freely available has allowed a lively, informed debate to flourish.

Will poorly funded researchers be excluded from publishing in open-access journals? This concern is addressed head on by publishers such as PLoS and BMC who waive fees for authors who cannot pay and who strictly separate decisions on publication from ability to pay. This is not a radical departure into subsidies, but an accepted part of distributing publishing costs across the scientific community.

Increasingly, funders of research also realize the benefit of an open-access model of publishing. The UK's Wellcome Trust ⁷ mandates its funded authors to make their work publicly available; the United States National Institutes of Health are encouraging it, ⁸ and increasing numbers of governments and funding bodies are signing up to declarations on open access. ⁹

It may be uncomfortable for those with interest in the status quo, but by regaining control of copyright the medical and scientific communities could ensure that publishing is no longer driven by the interests of publishers, but rather by the needs of society.

Competing interests: The authors are employed by the Public Library of Science, an open-access publisher.

This editorial is being co-published in PLoS Medicine (www.plosmedicine.org).

References prefixed 'W' appear in the web version only, avaliable at: http://www.who.int/bulletin/volumes/84/5/339.pdf

1. W3C The World Wide Web Consortium Available from: http://www.w3.org/

2. Suber P. Open Access Overview. Available from: http://www.earlham.edu/~peters/fos/overview.htm

1 Correspondence to Virginia Barbour (email: medicine_editors@plos.org).

# data[].attributes.attachment_link.title
SciELO - Saúde Pública - The impact of open access upon public health The impact of open access upon public health

# data[].attributes.attachment_link.description
Virginia Barbour1 ; Paul Chinnock; Barbara Cohen; Gavin Yamey PLoS Medicine, Public Library of Science, 185 Berry Street, Suite 3100, San Francisco, CA 94107, USA Arthur Amman, President of Global Strategies for HIV Prevention ( www.globalstrategies.org), tells the following story: "I recently met a physician from southern Africa, engaged in perinatal HIV prevention, whose primary access to information was abstracts posted on the Internet.

# data[].attributes.attachment_link.description
Global Strategies empowers communities in the most neglected areas of the world to improve the lives of women and children through healthcare.

# data[].attributes.headline
Arthur Amman, Founder of Global Strategies

# data[].attributes.subject
Arthur Amman, Founder of Global Strategies