Building Credence and Trust via Health Communication

Please note that I am not a medical professional and this is not medical advice. It is for informational purposes only. For health advice, see your doctor. 

Introduction - why is health communication so important?

Why is health communication so important?  The broad answer is that it improves health outcomes for the public. As I said in my last post, it is in the name “public health!”. Vaccines, antibiotics, handwashing, and multiple other public health interventions have saved hundreds of millions of lives at minimum. 

But let`s be contemplative (thoughtful) about this. To sustain these health benefits into the future, the public needs to continue to trust these health interventions. That means that they need to trust the healthcare providers, institutions, and policymakers that recommend them.

According to a paper published in 2022,  “the main justification for caring about public trust is that, if there is no public trust in health system actors and their activities, these actors lack public legitimacy to act and the level of public participation in collective health system activities such as vaccination drops low.”

Communication is a key component of building trust, and this is why communication has a pivotal role in public health. This is a key way of building a rapprochement (relationship) between the public and health professionals, institutions and policymakers. 

With that, it is important to ask the question - what makes good communication in healthcare? 

In this post, I will discuss some further features of good health communication that assist in building credence and a rapprochement between the public and health authorities

What makes good communication in healthcare?

• Word and Action Alignment

• Trust and credence grow when communication aligns with tangible improvements in service quality, accessibility, or outcomes. More specifically, it should align with improvements in what is important and relevant to the specific community in question. 

• For instance, across research, it is found that pregnant women have concerns about COVID-19 vaccine side effects or adverse events, because pregnant women were initially excluded from nearly all COVID-19 vaccine trials, and a majority of treatment trials. 

Concerns about adverse effects to the fetus or neonate (newborn) are widely reported. Concern about the pregnant individual themselves is also common. In response to this, research has been carried out on hundreds of thousands of people globally, and has not found any evidence that maternal vaccinations cause such effects. Further, in many studies they have been found to lower the risk of contracting SARS-CoV2 and related adverse events during pregnancy, including preterm birth and stillbirth. 

Communicating this in a way that will be received well involves understanding a key principle of building credence. Actions should match words. This is similar to any rapprochement- be it friendship, family, romantic relationships, and so on. Credence grows and becomes more stable when words and actions consistently align. This principle can be scaled from from a rapprochement between two people, up to to the public`s rapprochement with health authorities.  To put it more practically, communication that outlines follow-through and integrity (e.g., “You told us X, so we did Y”) strengthens credence

In summary, it's not just about what we say. It is not simply about having a catalogue of myths to refute. How we say it can also make or break credence in the public`s eyes. Further, a trusted messenger delivering health messaging is much more likely to have a positive impact. Transparent, culturally sensitive, and empathetic communication creates a foundation for lasting trust between healthcare institutions and the people they serve.

• Preparation and Mobilisation of Communities in Crises

This next point will be quite intuitive for most people. When people understand what to expect and what to do, they can respond more effectively in times of crisis. This may be a health crisis, climate, or any other kind of crisis. Effective communication:

• Inspires public collaboration throughout outbreaks, disasters, or health emergencies. These are understandably stressful circumstances. However, being informed and prepared during these periods. makes it much easier to respond effectively and efficiently. It also prepares the public for local or global health events that may occur in the future, including epidemics or pandemics. 

• Ensures people know where to get help, what steps to take, and when. Establishing a clear process during different types of emergencies adds some degree of structure and order to what is otherwise a very chaotic and frightening situation.  This, in turn, maximises the probability of survival of as many people as possible. Consider basic fire drills at schools and workplaces. This isn't to make comparisons between these and something like a pandemic preparation strategy. It is simply to illustrate the point that preparation for stressful times is important. 

• Helps communities develop resilience to false information. False and inaccurate information is spreading exponentially through various channels. These are both online and in-person. They may include newspapers and more traditional media, social media, discussion forums, among many others. Many people spreading false information will use multiple  channels, or even all of them. 

With this, communication has a crucial role to play in building the credence of healthcare professionals and institutions

However, this climate of exponential information spread poses unique challenges that require new solutions.

Given the scale of misinformation spread and the practical challenges of fact-checking, “prebunking” is an area of research being explored. Although definitions and specifics vary across sources, it is generally defined as presenting corrections to misinformation preemptively. 

“Prebunking” has been shown to be effective in some studies, however others have found that it does not confer any significant benefits. 

Prebunking strategies have been shown to reduce the probability that misinformation will persuade people, or that it will be circulated further. Further, research has also found benefits from informing people about  “red flags” that can indicate incorrect information. Balanced social referencing cues (that is, information on who is sharing and also not sharing specific content) can substantially reduce misinformation sharing and improve overall content quality. A 2021 study examined whether the longer-term impact of fact-checks depends on when people receive them. The authors found that  “prebunking could direct attention to a headline`s questionable features (e.g. sensational details). 

However, on the other hand people might ignore the content entirely and miss an opportunity to encode it as “false.”” Further, factors such as pre-existing beliefs, cognitive biases, whether information is shared by an “in-group” or an “out-group”, among others, can influence the likelihood of misinformation being shared. 

People can be very diverse, even within the same group. No group of people is a monolith. Therefore, there is no one catch-all answer. 

For these reasons and others, findings on the best strategies to combat misinformation vary across studies. Some studies find that attempts to dispel myths, while reducing misperceptions, can actually increase skepticism. Therefore, further research is needed across different social media platforms and other communication channels.

4. Overtakes and Combats Misinformation

One principle that should be clear from the last paragraph; information spreads exponentially in our digital world. However, lies spread even faster. An important quote comes to mind for me here - “a lie is halfway around the world while the truth is still putting its boots on.”

It is unclear who originally stated this as well as what the specific quote is. However, when you are contemplative about it, it does show an important principle. Lies often spread much, much more quickly than the truth, which isn't always as effective at generating likes, clicks and other forms of engagement. 

With this said, effective health communication aims to keep pace with this using several strategies - ideally in combination with each other;

• When targeting a specific audience, a simple but helpful question to ask is; where are they?  In our digital age, the answer to this, for many people, is social media. We essentially live our lives online today, be that for work, socialising, consuming content and so on. 

            It therefore makes sense that social media and influencers are common channels used to share health messages. The idea is to meet people where they are on an everyday basis.

• Addressing emerging myths and rumours quickly. When dealing with misinformation that can cause large-scale harm, the best strategy is addressing myths and rumours as early as possible, as opposed to doing damage control when harm has already been done. This may involve monitoring social media platforms and other channels for trends in discussion. Some important questions to ask are; what myths and rumours are emerging? What ones could emerge in the near future? What actions could be taken to pre-emptively address this? And why?

When such rumours are identified, public health messaging can then be distributed to groups that such rumours are spreading in - or, that they could spread in the future. Not only this, observing trends in what rumours spread in specific regions in times of crisis can aid pandemic preparation efforts. 

Reducing uncertainty by providing a consistent presence - a key way to build credence is maintaining a consistent presence. This strategy, while not sufficient alone, helps health authorities to reinforce important health messages over time. It is well-known in psychological research that repetition is a key way to increase the perceived reliability of messages. This is called the “illusory truth effect.” While it can lead to misinformation spread when used by those with bad intenions, it can, again, be used to increase the credence of important health messages.

Summary:

To summarise, good health communication is a pillar of building credence with the public for multiple reasons. It allows accurate messages to outpace misinformation, addresses rumours and myths quickly, as well as allowing health authorities to maintain a consistent presence of the eyes of the public. Combined, these strategies allow health authorities to build and maintain credence and trust with the public.

5. Encourages Health Literacy

To make a decision, you have to understand what the decision is about. In this instance, making well-informed decisions hinges on comprehending how the healthcare system works, and taking time to be contemplative about information one is learning.

Effective health communication:

• Guides people through the healthcare system. Healthcare is more digitised, interconnected and complex than ever before. With that, it is crucial that patients receive guidance at every stage of a medical decision. It is particularly important for patients who may not speak the native language, live in remote areas, or have disabilities inhibiting mobility, cognition, or other skills needed to navigate healthcare systems. This is true regardless of whether these are online or in-person systems. 
  
  

• Helps the public develop skills in interpreting data and information To get more specific about supports needed, interpreting data and information is crucial in any healthcare setting. Think about reading labels on medication or supplements, instructions on medical equipment used at home (eg. blood pressure monitors), prescriptions, or interpreting test results. It is therefore clear that understanding health-related data, information, symbols, abbreviations, among other things need to be prioritised in public health education. 

It promotes questions and being contemplative, rather than passive acceptance

Most of us, in school and college, heard about “active learning” more times than we can count. What that means is, questions, being contemplative, engaging in in-depth conversations, and thinking critically about what we've learned. This principle can also be applied to the health education of patients, despite the context being different. There is significant benefit to be had from more active approaches to understanding. As mentioned, these can include conversations, questions and critical thinking - but also visuals and charts, interactive digital learning among others. 

Conclusion

With that, what makes good communication in healthcare? Good health communication takes a holistic approach to building trust and credence in the public's eyes. That is, there are many different aspects to it, outlined here and in my last post. Quality messaging involves being contemplative and thorough. These principles I've talked about can be expanded on, and there are also likely elements to it that I have not addressed. Health communication is an entire field in itself, separate from science or healthcare. It is a much broader and more complex area than it seems on the surface. Thank you for reading.