Communication in health and Public Participation


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the role of communications and public relations in health services, including community participation

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  • Health is a very complex environment with many players. Each of these organisations or sectors is made up of many parts, for instance community includes Aboriginal and Torres Strait Islander people, CALD communities, rural and urban, churches, schools, etc. Then if we are looking at specific issues, other sectors come in: Workforce – includes education and higher education sectors Planning for a new facility brings in relevant departments such as planning, finance etc as well as local government, and the community as potential neighbours of the facility. IT related includes National E-Health Transition Authority, software and hardware vendors, Privacy Watchdog Probably most of you could draw a similarly complex playing field for your industries as well, but I think it is important to keep this level of complexity in mind when considering communications in the health sector. Everyone has an opinion on health, it affects all of us, it is very emotive and often involves drama so the media are also very interested.
  • Health promotion includes trying to change people’s behaviours, increasing public awareness and covers areas such as social marketing which includes advertising and promotional campaigns you may see for cervix screening, breastscreen, five veg and two fruit etc
  • Project or activity evaluation v. outcome evaluation NB. Project evaluation is often cheaper and easier to measure Outcome evaluation is difficult, time consuming and costly and given how difficult it is to implement change, may not be a powerful argument is (for instance) funding is riding on the results. Usually opt for a mix of both.
  • Also we tend to use a carrot and/or stick approach to change people’s behaviours, when in actual fact people and their life circumstances are too complicated for simplistic change management
  • I would also add, only if they feel the negative aspects of the disease or ocndition are relevant to them
  • And internally, people’s attitudes and resistance to change also hinders
  • IAP2 handout
  • Communication in health and Public Participation

    1. 1. Communication in Health & Public Participation Louise Miller Frost University of SA October 2006
    2. 2. NGOs politicians Consumer Groups SA Dept Health Emergency Services Federal DoHA Accreditat’n Boards Private Hosps GPs Unions media Drug Companies Professional Colleges Divs of GPs SA Ministers Fed Ministers Private providers Non-clinical staff specialists community Clinical staff Health
    3. 3. Policy Environment COAG Federal Parliament & Ministers Dept of Health & Ageing SA Parliament & Ministers Dept of Health Social Inclusion Unit Mental Health Unit Health Regions
    4. 4. Dept Health Strategic Directions <ul><li>Increase community inclusion and participation </li></ul><ul><li>Collaborate and work in partnership </li></ul><ul><li>Direct resources to ensure access and equity </li></ul><ul><li>Strengthen and reorient resources for prevention, early intervention and primary health care </li></ul><ul><li>Improve the quality and safety of services </li></ul>
    5. 5. Communication Aims <ul><li>Public Health / Health promotion </li></ul><ul><li>Community support for programs / facilities </li></ul><ul><li>Developing and sustaining partnerships </li></ul><ul><li>Managing demand </li></ul><ul><li>Provide good news stories for Minister </li></ul><ul><li>Influence policy </li></ul><ul><li>Implement change / new programs </li></ul><ul><li>Promoting facilities / programs </li></ul>
    6. 6. Levels of criteria for evaluating public relations objectives. Figure 4.1, p51, Quarles and Rowlings, Practising Public Relations a Case study approach, Longman, 1993, Australia
    7. 7. NSW Centre for Public Health Nutrition. Report of the Consumption of Vegetables and Fruit in NSW 2003. Adapted from Hawe et al 1990. Health Promotion Planning Framework
    8. 8. Examples of Communication Strategies <ul><li>Immunisation </li></ul><ul><li>Folate in pregnancy </li></ul><ul><li>Cancer screening </li></ul><ul><li>Harm Minimisation: Safe sex, drugs, drink driving </li></ul><ul><li>Healthconnect </li></ul><ul><li>Mental health (Beyondblue etc) </li></ul><ul><li>Pandemic Planning </li></ul><ul><li>SNAP (Smoking, Nutrition, Alcohol, Physical Activity) </li></ul>
    9. 9. Implementing Change <ul><li>Engaging with numerous stakeholders in ways that are meaningful to them </li></ul><ul><li>Broad consultation to develop a sense of ownership and commitment to the process and to the end result / product </li></ul><ul><li>Ensuring stakeholders feel heard </li></ul>
    10. 10. Change Management Principles <ul><li>valuing the input of stakeholders </li></ul><ul><li>recognising diverse viewpoints </li></ul><ul><li>ownership of the process by stakeholders </li></ul><ul><li>make solutions simple and intuitive </li></ul><ul><li>policy and best-practice underpinning </li></ul><ul><li>education process </li></ul>
    11. 11. Change Management Principles <ul><li>Identify some early-adopters (leaders) </li></ul><ul><li>physical reinforcement to support model and serve as reminders (shared facilities, agreed documentation and communication) </li></ul><ul><li>evaluation : regular review with fine-tuning </li></ul><ul><li>ensure some early wins - and celebrate them </li></ul><ul><li>empower stakeholders by asking for ongoing feedback in managed way </li></ul>
    12. 12. So why is change so hard? <ul><li>Max </li></ul><ul><li>Likelihood that benefit will occur </li></ul><ul><li>Min </li></ul>Never Often Frequency of action required (John Moss, University of Adelaide, Personal Communication) <ul><li>Examples </li></ul><ul><li>Hot water scalds </li></ul><ul><li>Fitness campaigns </li></ul>
    13. 14. Why don’t the interventions work? <ul><li>Health Belief Model : </li></ul><ul><ul><li>A person will take a ‘health related action’ if: </li></ul></ul><ul><ul><ul><li>they feel the health condition is negative </li></ul></ul></ul><ul><ul><ul><li>they have a positive expectation that taking the action will avoid the condition </li></ul></ul></ul><ul><ul><ul><li>they believe they can successfully take the required action </li></ul></ul></ul>Hochbaum, Rosenstock and Kegels, quoted in
    14. 15. Sallis JF, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine 1998;15(4):379-397.
    15. 16. Organisational culture – a change barrier Carroll, J S et al. Qual Saf Health Care 2004;13:ii16-21ii Copyright ©2004 BMJ Publishing Group Ltd.
    16. 17. Public Participation <ul><li>In mental health, national principle state that best practice is for consumers to be involved in service design, planning and delivery. </li></ul><ul><li>Mental health has the additional challenge of huge stigma </li></ul>
    17. 18. Stigma <ul><li>Prevents people seeking help (Helen Mayo House example) </li></ul><ul><li>People don’t want facilities ‘in their back yard’ </li></ul><ul><li>People don’t employ consumers </li></ul><ul><li>Consumers can be socially isolated </li></ul><ul><li>Media misinformation and sensationalism inflames ignorance </li></ul>
    18. 19. Communication Theory revision <ul><li>Grunig </li></ul><ul><li>Press Agentry </li></ul><ul><li>Public information </li></ul><ul><li>Two way assymetric </li></ul><ul><li>Two way symmetric </li></ul>Quarles J, Rowlings B, Practising Public Relations, A case study approach. 1993, Longman, Australia, p8, figure 1.2 Source Receiver Medium Feedback
    19. 20. More sophisticated <ul><li>There are different levels of communication and consultation that you might choose to employ in different situations. </li></ul><ul><li>Each of these forms of communication comes with unspoken understandings and promises between you and your ‘publics’ </li></ul>
    20. 21. Inform: Bird Flu Pandemic <ul><li>Message: stay home! </li></ul><ul><li>Aim: to inform public of crisis and what they need to do </li></ul><ul><li>Secondary: to inform them of symptoms, tell them how to seek help </li></ul>
    21. 22. Bird Flu <ul><li>Generally one-way communication with public </li></ul><ul><li>Strong instructional ‘voice’ to deal with panic, coordinated messages </li></ul><ul><li>Many vectors for communication – media, community based health services eg: GPs, information also to schools, workplaces, etc </li></ul><ul><li>Some feedback through crisis lines / hotlines to gather information </li></ul><ul><li>Backed up by health service planning done prior to crisis </li></ul>
    22. 23. Consult : CALD population <ul><li>Message: are these planned services going to meet your needs </li></ul><ul><li>Aim: to inform the planning process and to gain ‘ownership’ from the community for the decision </li></ul><ul><li>Two way communication but facilitated (ie : limited options) </li></ul><ul><li>Sometimes a late stage in the planning process </li></ul>
    23. 24. Involve : Mental Health planning <ul><li>Message: we want your opinions and input into the planning process </li></ul><ul><li>Aims: to ensure the planned facilities or services meet the needs of the stakeholders </li></ul><ul><li>Two-way communication, Less structured, more open response </li></ul><ul><li>Often an early stage of the process </li></ul>
    24. 25. Collaborate: Shared Care <ul><li>Message: this is a partnership where both parties have equal stakes in the result </li></ul><ul><li>Aim: to develop an agreed plan with commitment and ownership from all stakeholders </li></ul><ul><li>May involve representatives of stakeholder groups </li></ul><ul><li>More equal </li></ul>
    25. 26. Empower: Citizen Juries <ul><li>Message: this is your service, you need to inform us what you want </li></ul><ul><li>Aim: to ground the decision making process in the community </li></ul><ul><li>Eg: Gavin Mooney (Health economist at UWA) </li></ul><ul><li>Unspoken promise: we will implement what you decide </li></ul>
    26. 27. Multi-methods : Immunisation <ul><li>GPs – incentives to reach a certain % immunised in their patients, provision of immunisation nurses / practice nurse education etc </li></ul><ul><li>childcare centres – posters, brochures etc </li></ul><ul><li>child health (CYFS) – policies to encourage immunisation </li></ul><ul><li>Parents – child care rebates dependent on immunisation status, information campaigns, meetings </li></ul><ul><li>Divisions of GPs : funding for an immunisation nurse </li></ul><ul><li>Councils : funded for immunisations </li></ul><ul><li>Immunisations days provided at schools, kindies and childcare </li></ul>
    27. 28. Task : Type II Diabetes prevention <ul><li>Design a campaign to prevent diabetes Type II in the western suburbs of Adelaide </li></ul><ul><li>Assumptions: evidence has established that physical activity and diet can prevent the onset of Type II Diabetes. </li></ul><ul><li>Your population has been studied and has shown to have inadequate levels of physical exercise and poor diet compared to national standards. </li></ul>