# Presentation: 841931

## Persuasive Communication:Issues, Evidence and Ideas

**Linda Neuhauser, DrPH**
**University of California, Berkeley**
**FDA Risk Communication **
**Advisory Committee**
**Rockville, MD**
**August 14-15, 2008**

## Does communication change behavior?

**Does communication change behavior?**
**What are the barriers?**
**How can the FDA improve communication?**

## Impact of Mass Communication on Behavior Change

**• ****Modest, positive impacts**
**• ****Less effective among vulnerable groups**
**• ****Less effective for complex issues**
**• ****More effective with multiple channels**
**• **_**Little information re: FDA communication**_

## Scientific			Expert Rational, 
Findings			Generic Messages
					delivered to the public					
          Knowledge		  Action                Evaluate(?)

Health Belief Model
Theory of Reasoned Action, etc.

- <date/time>

**Scientific****	****	****	****Expert Rational, **
**Findings****	****	****	****Generic Messages**
**	****	****	****	****	****delivered to the public****	****	****	****	****	**
**          ****Knowledge****	****	****  Action                Evaluate(?)**
**	**
- Health Belief Model
- Theory of Reasoned Action, etc.

**Traditional Model of Health Communication **

## “Socialize” Informationto be deeply relevant & influential

- The Persuasion Challenge

## Context: Social-Ecological Model

**Context: Social-Ecological Model**

## What is Health Literacy?

**	**The ability to access, read, understand and act on health information

## National Assessment of Adult Literacy (NAAL) 2003

## NAAL Findings 2003

## Difficulty of selected health Healthy Literacy Skills by Level

**Below Basic**	Circle the date of a medical appointment on a hospital 		appointment slip.
**Basic**		Give 2 reasons a person should be tested for a specific 		disease, based on information in a clearly written 			pamphlet.
**Intermediate**	Determine what time a person can take a prescription 			medication, based on information on the drug label that 		relates the timing of medication to eating.  *  **	**	**	*
**Proficient**	Calculate an employee’s share of health insurance 			costs for a year, using a table.

## What is it like?

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## • The average American reads at the 7th-8th   grade level   • 20% read below the 5th grade level• Most health information is written at the  10-12th grade level. 

**US Reading Levels Compared to**
**Health Information Readability**

- Risk Communication Issues:

- • Hard to understand, changeable
- • Often requires quantitative skills
- • Requires trusted, 2-way communication
- • Emotions may overrule science in decisions
- • Perceptions may vary by culture, education

## In High Concern Situations, People Want to Know That You Care Before They Care What You Know  (Vincent Covello)     

**In High Concern Situations, People Want to Know That You Care **_**Before**_** They Care What You Know****  **(Vincent Covello)_**     **_

**Assessed **
**in first 9-**
**30 seconds**

**Listening/Caring/**
**Empathy**
**50%**

**Persuasive Risk Communication Messages**

- • Communicate threats clearly and strongly
- • Recommend a few specific, practical actions

## Tips to Improve Communication

-  _**CO-DESIGN WITH THE TARGET AUDIENCES**_
- Use photos and stories
- Acknowledge emotions
- Write information at appropriate user level
- Put info in small “chunks”
- Focus on behavior rather than facts
- Make information culturally sensitive

## Designing Better Communication

**1.  Define communication objectives and audiences, **
**2.  Assess audiences’ knowledge, attitudes, behaviors**
**	****(surveys, focus groups, etc.)**
**3.  Set up a ****PARTICIPATORY DESIGN**** process with audiences (groups and individuals)**
**4.  Iteratively develop and test communication**
**5.  Engage audiences & stakeholders to plan delivery**
**6.  Evaluate impact and revise**
**7.  Adapt for other language and cultural groups**

## Recommendations #1:Assess Risk Communication

**	****Assess current risk communication among diverse groups:**
**       • ****Reading levels, Internet navigation, **
**	****   ****linguistic & cultural relevance ****	****	**
**  • ****Impacts on users’ knowledge**
**  • ****Impacts on users’ attitudes and confidence**
**	****• ****Impacts on users’ actions**

## Recommendation #2: Build Communication Capacity 

**• ****Identify internal expertise and gaps; add staff**
**• ****Identify, train and publicize FDA spokesperson**
**• ****Convene a strategic planning meeting to set a communication research and action agenda**
**• ****Form partnerships with other federal, state and professional organizations**
**• ****Seek federal funding and other resources**

## Recommendation #3:Improve Communication

**• ****Set standards:**
**	****Readability - 6th grade**
**	****Website meets DHHS usability guidelines**
**	****Linguistic and cultural relevance**
**	****Accessibility for people with disabilities **
**• **_**DESIGN & TEST WITH DIVERSE GROUPS!**_

## Recommendation #3 (cont.):Improve Communication

**• ****Develop new delivery channels:**
**	****Public Information Officers **
**	****News media, including ethnic media**
**	****Grocer’s Associations**
**• ****Research communication impacts**

## References (page 1)

**Social-ecological model:**
- Stokals, D. (2000). The social ecological paradigm of wellness promotion. In M.S. Jamner & D. Stokals (Eds.), *Promoting human wellness: New fronteirs for reseach, practice and policy* (pp.21-37). Berkeley, Los Angeles, London: University of California Press.
**Health communication and behavior:**
- Hornik, R.D. (Ed.) (2002). *Public health communication: Evidence for behavior change*. Mahwah, NJ: Lawrence Erlbaum Associates.
- Emmons, K. M. (2000). Behavioral and social science contributions to the health of adults in the United States. In B. Smedley & S. L. Syme (Eds.), *Promoting health: Intervention strategies from social and behavioral research* (pp. 254-321). Institute of Medicine, Washington, DC: National Academy Press.
- Neuhauser, L. and Kreps, G. (2003). Rethinking communication in
- the e-health era. *Journal of Health Psychology, 8*(1) 7-23.

## References (page 2)

**Health literacy:**
- Kutner, M., Greenberg, E., Baer, J. National Assessment of Adult Literacy (NAAL): *A First Look at the Literacy of America’s Adults in the 21st Century*, Washington, DC: US Department of Education, National Center for Education Statistics, 2005.
- The National Institutes of Health (NIH) Plain Language Initiative: The Plain Language Initiative. Available at: http://execsec.od.nih.gov/plainlang/. Accessed June 15, 2007.
- Doak, L., Doak, C., Meade, C. Strategies to improve cancer education materials. *Oncol Nurs Forum*. 1996;23:1305-1312.
- Zarcadoolas, C., Pleasant, A. Greer, D.C. Understanding health literacy:an expanded model. *Health Promot Int.* 2005;20:195-203.
- Neuhauser, L*.* & Kreps, G. Online cancer communication interventions: Meeting the literacy, linguistic and cultural needs of diverse audiences. *Patient Education and Counseling, 71(3), 365-377, Jun 2008.** *

## References (page 3)

**Internet communication impacts and design recommendations:**
- Lynch P, Horton S. *Web Style Guide*. 2nd ed. Available at: http://www.webstyleguide.com/. Accessed November 20, 2006. U.S. Department of Health & Human Services Web site. Your guide for developing usable and useful Web sites. Usability.gov. Available at: http://www.usability.gov. Accessed June 15, 2007.
- Koyani SJ, Balley RW, Nall JR. *Research-Based Web Design and Usability Guidelines*. Washington, DC: US Department of Health and Human Services, National Cancer Institute; 2006.
- Nielsen J. *Designing Web Usability*. Indianapolis: New Riders Publishing; 2000.
- Neuhauser, L, Rothschild, R, & Rodriquez, FM. MyPyramid.gov: Assessment of Literacy, Cultural and Linguistic Factors in the USDA Food Pyramid Website. (2007). *Journal of Nutrition Education and Behavior*, 39(4) 219-225.

## References (page 4)

**Risk Communication:**
- Covello, V. T.  (2003).  Best practices in public health risk and crisis communication.  *Journal of Health Communication, 23, 164-193.*_*8*_*, 5-8.*
- Eggers, S.L. & Fischoff, B. Setting policies for consumer communication: A behavioral decision research approach. (2004). *Journal of Public Policy and Marketing*, 23(1), 14-27.
- Rudd, R.E., Comings, J.P., & Hyde, J.N.  (2003).  Leave no one behind:  Improving health and risk communication through attention to literacy.  *Journal of Health Communication, 8, 104-115.*