Category Archives: Communication Research and Evaluation Series

23Jul / 2018

10 Health Literacy Tips for Reporting Data

A social worker and senior woman seated on a couch, looking at a tablet device.

We live in a complex world. Just as humans have left an impact on the environment, the environment also leaves an impact on us. Being exposed to certain physical and social environmental factors, like chemicals in the water, secondhand smoke, or poverty, can affect our health.

Understanding oral health data in MinnesotaCDC’s National Environmental Public Health Tracking Program helps to better understand the connections between our health and the environment by bringing together data and information about the population, the environment and related health effects.

The Minnesota Department of Health (MDH) Oral Health Program is committed to communicating data in a way that is understandable and easy to use. As part of the CDC’s Tracking Program, the MN Tracking Program allows us to do that by hosting our Minnesota Oral Health Statistics System (MNOHSS) data on the Minnesota Public Health Data Access portal.

The MN Data Access portal allows users to quickly find, interact, download, and visualize data through charts, infographics and maps. We also have been able to shed light on oral health disparities and use chronic disease data about diabetes, heart disease and cancer from the portal to look at shared risk factors with dental disease.

Oral health is key to overall health and the MN Public Health Data Access portal has brought greater visibility to this hidden chronic disease.

Taking health literacy into account

Nearly 90% of people struggle to understand health communication messages. This means that the data and reports we publish from our data tracking systems should take health literacy into account and provide health information that is easy to find, understand, evaluate, communicate, and use. Based on my experience, I have compiled 10 easy ways you can consider health literacy when you’re reporting data.

 

  1. Consider audience and outcome. Think about what actions or interventions you are hoping to achieve from your data and who needs to know about the data in order to make those changes. Your data should be presented in a way that is understandable, relevant and action-oriented for your target audience. This could include the media, policymakers, educators, researchers, students, clinicians and other health professionals, as well as the general public.

 

  1. Use storytelling to convey key messages. Think about your favorite novel, television show, or website. What keeps your attention and motivates you to tune in for more? I am learning a lot from communications and behavior change theories and from professionals such as Dr. Neil deGrasse Tyson, Alan Alda, and Dr. Randy Olson who are able to bring science to life through storytelling. Communicating data is a science, as well as an art. We can all take cues from Hollywood’s narrative structure to tell compelling stories that humanize our data and drive action.

 

  1. Reach people where they are. Research your target audience to find the best outreach strategies. You will need to use different strategies depending on their existing level of knowledge, motivating factors, and whether or not they are information seekers and early adopters. Does your audience prefer to receive information verbally (e.g. town hall meeting, webinar, television, radio or podcast), in writing (e.g. website, data brief, social media), or both? As an example, the Minnesota Department of Health’s MN Tracking Program developed a social media campaign that communicates data on the MN Public Health Data Access portal — Land of Healthy Kids — targeting public health professionals, schools, parents/guardians and caregivers of school age children.

 

  1. Make data digestible. When communicating your findings present data in bites, snacks, and meals. Not everyone who looks at your data is going to have the time or expertise to read your entire report so you need to make sure they can find information that is relevant and understandable.
    • Bite: Use anchors and headers to help users quickly find data and information. Brief headers that use a declarative statement to interpret a chart or map helps with data literacy.
    • Snack: Develop simple charts and maps with clear titles, legends, and axes. Charts and maps should be standalone features that do not require additional text to understand. They should communicate the who, what, where and when of the data you are presenting. Do not overwhelm viewers with p-values and confidence intervals. These can be added to accompanying tables and information pages.
    • Meal: Tables, data downloads, and information pages should be added for researchers, health professionals, and those who want to dig deeper into the data. You might include additional information about study design, sample and weighting methodologies, indicator definitions, sample or population size, confidence intervals, unreliable estimates or data suppression to help this audience to further analyze and interpret the data.

 

  1. Numbers count. Adults in the United States have lower numeracy skills than adults in other developed countries. Many do not understand percentages or ratios, have difficulty making comparisons (across years, geographies, or against a target goal), and do not know the difference between absolute versus relative risk. Dashboards, infographics or icon arrays, risk tables, ladders and scales help to visually display data, the magnitude of effect or risk, and can help individuals make comparisons if presented on the same scale.

 

  1. Think about accessibility. To ensure everyone has the same access to your data, familiarize yourself with 508 Standards for Electronic and Information Technology. People with visual, auditory, and motor skill impairments may not be able to access information on the web, even using assistive devices. Simple modifications can make a big difference, such as:

 

  1. Report data in meaningful, culturally, and linguistically appropriate way. Analyzing and presenting data by geography, sexual orientation and gender identity (SOGI), age, race/ethnicity, preferred language, disability, and chronic disease status helps to identify health disparities and prioritize resources. This should be done in concert with the affected community to ensure that data is collected, analyzed, interpreted, and reported accurately, meaningfully and in a culturally and linguistically appropriate way.

 

  1. Conduct audience testing. The best way to ensure your data can be found, accessed, and understood is to test your communication product with your target audience. Generally 5-8 people will suffice. The key is to make sure the group is representative.
    • Usability testing identifies whether or not your audience can find data and information, successfully complete specified tasks, and helps you to understand how your audience searches for information or completes tasks. You can also observe how long it takes them to complete tasks and determine ways to modify or enhance user experience.
    • Accessibility testing determines whether or not online content is 508 compliant. Using a screen reader or only a keyboard (not mouse), can you still navigate and access web content? Consider testing products with individuals who use assistive devices.
    • Health literacy testing identifies whether or not your data and information is understandable. Can your audience easily interpret the data in charts, tables, and maps? Is your narrative description of the data clear?

 

  1. Evaluate your work. To improve future communication about data, you should always evaluate your work.
    • Web and digital analytics applications allow you to monitor audience reach and user engagement. They can help you set goals, tell you what search engine terms are common, and whether or not users are accessing your page directly or are being directed from a different website. It can also tell you which pages are popular and which are not. Infrequent traffic or high bounce rates on a particular page may indicate lack of interest, lack of awareness, or perhaps a usability or health literacy issue.
    • Track different modes of communications. How many presentations, webinars, social media posts, etc. have you delivered in a specified amount of time? Who was the audience? Are there groups you have not yet reached?
    • Monitor how your data is being used. User surveys, in-person interviews, and external communications such as articles, reports, website links, and social media posts can tell you how your data is being used and if it is being used appropriately.

 

  1. Share best practices. Talking and listening to others is a great way to discuss new methods, share resources, and spark inspiration.
    • Join professional organizations and working groups on surveillance, epidemiology, and health literacy and discuss the importance of data literacy.
    • Engage with programs, like CDC’s Tracking Program, who use health literacy and numeracy principles to inform how they communicate about data.

Communicating data can be difficult and takes time and practice. But remember, we all appreciate clear communication. When you address health literacy, you improve data quality and consumer satisfaction and make data truly accessible to everybody.

The Minnesota Public Health Data Access portal is managed by the Minnesota Environmental Public Health Tracking Program (MN Tracking). MN Tracking is part of the CDC’s National Environmental Health Public Health Tracking Program, which collects, integrates, and analyzes environmental hazard and public health data from a nationwide network of partners.

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The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted by in Communication Research and Evaluation Series, General, health literacy, minnesota department of health, oral health, public health

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02Apr / 2018

Evaluating Communication Campaigns

Black man holding belly of his pregnant wife making heart. Pregnant woman and loving husband hugging tummy at home. Heart of hands by multiethnic couple on pregnant belly.

Health communication and marketing campaigns that promote positive behavior change are a cornerstone of public health and behavioral science. Designing and implementing quality campaigns on a tight budget and in an urgent timeframe is a challenge that most health communication professionals share. Research and evaluation are critical for a successful campaign. CDC is using leading research and evaluation methods to develop quality campaigns, while keeping costs low and sticking to tight timelines.

A great example is CDC’s design and implementation of The Domestic Readiness Initiative on Zika Virus Disease, also Domestic Zika Campaign: By the Numbers. Since its launch in early summer 2016, the campaign has generated over 350 million impressions and nearly 555,000 clicks across search, social, and display in the United States. In Puerto Rico, the campaign got over 10 million impressions, and 26,000 clicks on a range of media buys that covered the entire island.known as the Domestic Zika Campaign. This bilingual digital campaign sought to increase Zika awareness among the general population and expectant parents in the United States and its territories. Campaign messages were also developed to change knowledge and attitudes regarding Zika transmission, beliefs about the risks of Zika, and the perceived ability (self-efficacy) to protect oneself against Zika.

CDC identified several methods to get tailored messaging to our target audiences. Based on the work for this campaign, there are 10 methods that can help you reduce costs and improve the efficacy of your communication or health marketing campaign.

Formative Research

  1. Use “mixed” methods or alternative approaches. When feasible, mixed assessment techniques can enhance and complement different types of data collection. Your budget may not allow you to conduct in-depth formative research, but you can use one primary research or evaluation method and then supplement with other methods that are less costly. For example, conducting qualitative focus groups might not account for all of your audience segments, but you could perform a literature search to complement your qualitative data. Additionally, when circumstances dictate, sometimes substituting one evaluation activity for another may be just as effective (or close to it). During the Domestic Zika Campaign we used “triad” interviews, which only involved three participants, when we did not have the time or the budget to conduct a full suite of focus groups, and this was supplemented with previous survey data on closely related topics.
  2. Invest in market data. Public, non-proprietary market data, such as data from the US Census, PEW, and Gallup, allow you to get to know your audience at no cost. Outside marketing firms may also be willing to share “older” proprietary data that may be from a year or two ago at little or no cost. During the Domestic Zika Campaign, secondary data donated from Annenberg surveys(?) were key to our analysis of each of our target demographics’ media habits and informed the mass media and digital media strategies and plans. The cost is your time in building relationships with like-minded partners and analyzing the data for a specific purpose.
  3. Identify alternative data. When traditional surveying of knowledge, attitudes, and behaviors is not feasible, sometimes you can use alternative data (usually less expensive). During the Domestic Zika Campaign, we did not have sufficient time to get approval for our survey from the Office of Management and Budget (OMB) and field a traditional campaign evaluation survey. Instead, to meet our tight timeline, we acquired data about our audiences’ insecticide purchasing behavior in the stores where our advertisements had been placed, and compared them to similar product purchasing data from stores that did not display our advertisements. Building partnerships with organizations who have data, even from related issues, that can offer insights to you is a great long-term investment in both implementing and evaluating programs—especially when we have a shared commitment to protecting people from diseases.

Monitoring & EvaluationDigital Media in an Emergency. During a public health emergency or disease outbreak, even a small number of strategically placed, paid digital media spots can deliver messages to those who need them most. This type of message can often be placed within 24 – 48 hours. During the Zika response, CDC developed and executed behavioral intent studies using data collected by Google Health and Nielsen to study the effect of media exposure on audiences’ intent to take action to protect themselves from Zika. • We monitored exposure to digital campaign banners on the Google Display Network and compared those exposures to an increase in internet search for specific Zika-related terms. • We employed channel-targeted messaging, which helped to amplify CDC’s weekly Zika theme content on Facebook to reach audiences beyond the people who were already following the CDC page. This cost-efficient strategy extended the reach of posts to tens of thousands more people within the specific geographic areas.

  1. Take advantage of social media analytics. Social media platforms like Facebook, Twitter, Instagram, and Google AdWords allow you to target specific geographic areas and have built-in analytics tools that the user has access to at no additional cost. The Domestic Zika Campaign used data analytics to look at the performance of specific advertisements and the corresponding click-through rate to Zika-related campaign websites. Using social media platforms as a primary channel for the campaign allowed for more precise audience targeting, rapid message modifications, and real-time metrics. Using the data, we developed tailored advertisements that engaged key audiences and encouraged them to take preventive actions. For example, one of our treatments, the “carousel advertisement format” on Facebook, had the highest engagement with our target audience and provided a platform to communicate in-depth information about actions people could take to prevent Zika infection. Most organizations have access to someone who specializes in web analytics who can offer their insight.
  2. Conduct A/B testing. A/B testing is a way to compare two versions of something to figure out which performs better. A/B testing is used to assess different options of campaign messages or creative concepts in real time and measures which one people actually use more among different channels, such as Facebook and Twitter. The Domestic Zika Campaign tested messages and materials on a number of social and digital platforms to determine which channels our audience preferred. For example, we conducted an A/B test of an existing “Cover Your Body and Use Repellent” advertisement against two new advertisements that presented the “Cover” and “Repellent” content as two separate messages. We conducted a qualitative analysis of user comments on the advertisements and found that users had a negative reaction to the “Cover” action step given the high temperatures in areas with risk of Zika.
  3. Refresh your materials. Build in regular measurements to track and observe public response and evaluate public complacency towards your campaign to avoid a decrease in behavioral change outcomes. This can occur for two reasons: 1. Message fatigue, when the attention of your target audience is reduced because they have had repeated exposures to the campaign messages; or 2. Risk fatigue, when your audience no longer receives or responds to messages about the health threat.  You can refresh and adjust your campaign messages without creating new messages from scratch. During the second phase of the Domestic Zika Campaign we revised materials that were targeted towards men by adding images of males with their pregnant partners because we were informed by both women and men that they had become complacent about behaviors men could perform to protect both themselves and their partners from Zika virus infection and transmission.

General Rules of Thumb

  1. Do not reinvent the wheel. Know what is available in your organization.  Do you have existing contracts in place to purchase things quickly.  If you have to get permissions to do research, do you have processes in place to navigate them efficiently? As a federal agency, anytime we want to ask more than 9 people a question, we have to get approval from the Office of Management and Budget, which typically takes many months. Knowing this, CDC set up a process called the Health Message Testing System, which is generic request set up in advance with OMB that programs can use to quickly get permission to test a specific message with a specific audience. These approvals can be obtained in days instead of months.
  2. Track current events. Scan and track prominent news and social media. Be aware of current events and issues that arise over the course of your campaign. The news media will cover what is timely, and you can take advantage of this coverage to enhance your campaign efforts. During the initial phase of the Domestic Zika Campaign, the proposed use of the chemical pesticide Naled in Puerto Rico created a controversy for public health and government officials on the island. Tracking the controversy allowed us to address this issue by adding a media relations effort to the campaign and provided more opportunities to disseminate the most effective prevention messages.
  3. Partner with influential bloggers. Influential bloggers can help enhance and further disseminate your campaign messages, increasing the reach to and saturation of your target audience. One of the main goals of the Domestic Zika Campaign was to amplify CDC’s Zika prevention messages. We worked with a well-known television news celebrity who was pregnant and chose not to attend the summer Olympics in Rio de Janeiro, Brazil. We pitched the story to mom and parenting bloggers and packaged it with CDC-branded messaging and the opportunity for an interview with a CDC subject matter expert. The cost of working with a blogger can vary, and you need to vet them carefully, but there can be great benefits by partnering with someone who is a natural fit for your cause and/or message content AND who is already reaching your target audience.
  4. Welcome donated media. Opportunities may arise for you to take advantage of “value-added” or donated media, which can help extend your communication efforts and increase the number of measurement points to evaluate. If you purchase a large number of services, the outside vendor might be willing to add additional advertising or other activities so the campaign will not incur any additional costs. For instance, we acquired donated time for the public service announcements developed by the Domestic Zika Campaign to run in movie theaters in Puerto Rico.

Do you have any other suggestions to improve the quality and timeliness of health marketing and communication campaigns on a budget? Please leave a comment below.

Fred Fridinger is a Senior Health Communications Specialist in the Office of the Associate Director for Communication (OADC). During his 22- year career at CDC, he has worked on various campaigns and communication efforts, including those addressing moderate physical activity and healthy eating, genetics, chronic fatigue syndrome, and Zika prevention. In his current position, he oversees the market research function for OADC, which involves the Porter Novelli Styles and Nielsen Scarborough syndicated data bases.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted by in communication, communication campaigns, Communication Research and Evaluation Series, Domestic Zika Campaign, evaluation, formative research, health communication, health marketing, message testing, monitoring, Prevention/Vaccination, public health, Research, zika

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26Mar / 2018

Assessing Community Needs in Real-time

Group photo of a Community Assessment for Public Health Emergency Response (CASPER) Team in the U.S. Virgin Islands.

What if there was a way to evaluate the needs of a community after a natural disaster? Or understand a community’s attitudes and beliefs about a specific public health behavior? Enter CASPER: Community Assessment for Public Health Emergency Response, a tool for health departments and public health professionals to assess community needs in real-time.

What is CASPER?

CASPER is a type of rapid needs assessment that allows you to gather information about households in a community. It can be used to gather information during all phases of a disaster or to learn about household health status in a community. It is a quick, inexpensive, and flexible method of data collection that helps to guide response and recovery efforts after a disaster when needs may be changing and there are a lot of unknowns.

CASPER uses two-stage cluster sampling, which is a valid and reliable survey methodology. The first stage of sampling identifies 30 U.S. Census blocks. The second stage selects seven households from each block. Volunteers conduct face-to-face interviews with the household. The survey asks questions about household demographics, status (e.g. utilities, damage, etc.), communications, knowledge and beliefs, and physical and behavioral health. The interview concludes with an open-ended item asking about the household’s greatest need at the time of the interview.

CASPER data is typically collected over the course of two weekday afternoons. Information from a CASPER can be used to allocate resources, target programs, and meet the needs of community. Results have also been used to target communication messages and community education programs. The methodology also allows health and safety information to be disseminated during the interview process, so you can gather information about a community while also providing them with information.

How has CASPER been used?

Interactive CASPER map
Click on this interactive map to learn about CASPERS conducted in different states.

CASPER has been used over 150 times across the United States in the past 10 years. Every CASPER is unique and questions are written based on a community and their specific needs. However, there is a question bank, so you can use questions that have already been tested in the field. Examples include the following:

  • 2017 Hurricane Response and Recovery: U.S. Virgin Islands conducted two CASPERs after Hurricanes Maria and Irma to help guide the response efforts. A follow up CASPER was conducted 4 months later to determine if the community’s needs were being met and help guide continued recovery efforts.
  • Zika Virus Response: U.S. Virgin Islands also used CASPER to understand household knowledge, attitudes, and beliefs about Zika virus transmission and prevention. Results from the CASPER informed awareness campaigns, community workshops, and online materials about Zika prevention, particularly related to the sexual transmission of Zika and the use of mosquito repellent.
  • Flint Michigan Water Crisis: Public health officials and community leaders used CASPER in Flint, Michigan to understand behavioral and physical health concerns for households and the impact of the water crisis on the community. Results from the CASPER were used to focus behavioral health interventions and communication messages, as well as continued support for mental health services in the Flint community.

You can find where CASPER has been used across the U.S. using this interactive map. If you have conducted a CASPER be sure to use the CASPER Map Request Form to have it added to the map.

How can I do a CASPER?

You can conduct a CASPER any time you need to collect population-representative data, as  long as the sampling frame has at least 800 households. A response CASPER may be initiated when at least one of the following conditions occurs:Volunteers are an important part of CASPER CASPER interviews are conducted almost entirely by volunteers – health department staff, students, and volunteers from organizations like Medical Reserve Corps. Volunteers conduct interviews in pairs and are able to make a direct and immediate impact on their communities. The data collected by CASPER volunteers is analyzed and results are presented to key decision makers and leaders within 36 hours.

  • the effect of the disaster on the population is unknown,
  • the health status and basics needs of the affected population are unknown, or
  • when response and recovery efforts need to be evaluated.

If you work in a state or local health department and are interested in conducting a CASPER you can download the CASPER toolkit or email ghu5@cdc.gov to discuss if it is the appropriate tool for your needs. The Disaster Epidemiology and Response Team will provide technical assistance and training to help you identify objectives, provide expertise about sampling and mapping, and review questionnaires.

Amy Helene Schnall is an Epidemiologist on the Disaster Epidemiology and Response Team in the National Center for Environmental Health. She started her career at CDC in adolescent and school health, and took over the CASPER training program in 2010. Amy’s background in behavioral science and health education makes her a natural fit to lead disaster epidemiology trainings and work with state and local partners. Her work with the CASPER program has given the opportunity to travel around the country to conduct trainings and participate in response and recovery efforts.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted by in CASPER, Communication Research and Evaluation Series, Community Assessment for Public Health Emergency Response, community needs assessment, data collection, needs assessment, public health, recovery, Response

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05Mar / 2018

Tackling eHealth Literacy

A female doctor discussing records with a senior female patient.

Photo of Lourdes M. Martinez, PhD, Health Communications Specialist, Office of the Associate Director for Communication
Lourdes M. Martinez, PhD, Health Communications Specialist, Office of the Associate Director for Communication

As I waited in the exam room on a recent visit to my doctor’s office, I noticed there was a large wall display with an interactive screen. It resembled a smartphone and I could use the touchscreen to scroll and learn about various conditions, diabetes, heart disease, Alzheimer’s, and colon health. Each menu included signs and symptoms of illness, and information on diagnosis, treatment, and prognosis. The designs were bright, jargon was kept to a minimum and defined when used, and navigating was simple for routine smartphone users. The display also included short videos supporting the on-screen text.

“Great!” I thought, “But what about patients who don’t have strong English skills or those who don’t feel confident engaging with the display? How do they get the information if they don’t directly ask for it?”

As a health communication specialist in CDC’s health literacy program, my job requires me to think about answers to those questions. Findings from the 2003 National Assessment of Adult Literacy suggest limited health literacy is a problem for many people and an issue that public health and health care professionals can take action to improve.

Understanding eHealth

These days it seems like everyone has a smartphone. Health services are increasingly being delivered through web-based and mobile resources. Examples of electronic health (eHealth) services include electronic communication between patients and providers, electronic medical records, patient portals, and personal health records. Mobile health (mHealth), a subcategory of eHealth, includes using tablets and phones to access apps and wearable tracking devices.

Health literacy refers to a person's ability to find, understand, and use health information to make informed decisions about their health.As these technical advancements increase so do the demands on a person’s health literacy. As a result, people with limited health literacy may have more challenges accessing health information. It is important to understand how a person’s level of health literacy can influence use. Equally important is how health professionals and communication specialists can provide support for those who may have difficulty using eHealth systems.

Learning from research

We recently posted a research summary called eHealth literacy: Playing catch-up with eHealth on CDC’s Health Literacy website. There are a few important lessons from these studies, including

  • A growing number of studies are exploring the use of eHealth resources and self-management of chronic conditions.
  • Three common characteristics that may limit use of eHealth resources were older age, lower household income level, and limited health literacy.
  • Even when research participants reported high confidence in knowing where to go to find health information, they did not report the same level of confidence in assessing the quality of materials or using them to make health-related decisions.

Taking action

As organizations continue to develop and promote use of eHealth resources we must consider how health literacy and eHealth literacy influence how they are being used.

Health professionals can:

  • Ask your patient how confident they feel managing their own health
  • Identify the knowledge or skill gaps and create a plan with your patient
  • Give your patient a recommendation for top sources of health information on the web
  • Ask your patient about their preferred and available communication options – in person, email, apps, patient portal
  • Be familiar with your organization’s language translation services
  • Evaluate your office’s web content

Communication professionals can:

  • Use plain language strategies
  • Assess readability of all materials
  • Use Health Literacy Online recommendations
  • Incorporate images and graphics that complement and reinforce text
  • Design materials for people with limited English skills
  • Consider demographic characteristics when determining the channel and source for different audience segments

People can:

  • Ask questions and repeat information when talking to your doctor or nurse to make sure you understand what they are telling you
  • Bring all of your medicines, including vitamins and herbal medicine, to your next doctor’s visit to review how to take them
  • Let the doctor’s office know if you need an interpreter if you don’t speak or understand English

Lourdes M. Martinez, PhD is a health communication specialist in the Office of the Associate Director for Communication. In her role, Dr. Martinez leads staff training on plain language principles to facilitate understanding and application of clear health communication for web, social and digital media projects, and print materials. She also assists programs across the agency to develop and implement strategic communication plans to advance clear communication practices.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted by in Behavioral science, Communication Research and Evaluation Series, eHealth, health communication, health information, health literacy, mHealth, public health

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26Feb / 2018

Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted by in Behavior, behavior change, Behavioral science, Communication Research and Evaluation Series, ebola, Epidemiology, polio, Preparedness, Prevention/Vaccination, public health, Response, social norms, zika

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