The Importance of Health Communication in an era where people promulgate (share) misinformation and disinformation

What are some good public health communication strategies?

The first point is in the name - or, more specifically,  “public health.” It involves protecting the health of the public, and that's the first of several principles of health communication that I`ll discuss

1. Safeguarding health

I`ve spoken about the differences between misinformation and disinformation before, but I`ll briefly summarise here. The key difference is the intent. 

Misinformation is incorrect or inaccurate information that people accidentally promulgate (spread). Consider an individual or organisation deciding to promulgate (share) an article that has incorrect information contained in it, unknownst to them.

Disinformation is more sinister. There is intent behind it. This involves an individual or organisation being aware of incorrect or inaccurate information, but deciding to promulgate it anyway for financial, political or other reasons. 

Deciding to promulgate either information type can cause people to make decisions that will have serious health consequences, such as rejecting or delaying vaccines, or any other well-established public health intervention. They may also promulgate uninformed advice to others through various channels. This can promulgate harm further 

Good health communication prevents these consequences in a number of ways

• It promulgates (shares) clear, correct, research-based information. Of course,  this doesn`t completely solidify trust in healthcare practices and institutions. With that said, it does provide a good knowledge base from which to begin the long process of building trust.
  
  
• Encouraging prophylactic measures like vaccines, screening tests, and good hygiene practices. This is especially true in communities that are at high risk of certain infections. These include pregnant women, healthcare workers, infants, young children, the elderly due to immunosenescence, and those who are immunosuppressed (eg. those who are HIV-infected).
  
  
• Reinforcing the importance of getting prompt medical attention when needed. This is especially true in emergencies and those in high risk groups for severe health effects.   Promoting adherence to treatment prescribed also shows care about public health from a longer term perspective. 

2. Dispels false beliefs and discourages bad decisions

Accepting, believing, or deciding to promulgate false information can have serious health consequences, up to and including widespread death and disability. 

Good public health communication:

• Clarifies why certain behaviours are discouraged (eg. delaying or rejecting vaccination or other public health interventions, using alternative cures, and so on)
  
  
• Promotes safe health practices such as handwashing, regular physical exams and screenings, masking and distancing during pandemics and epidemics, and so on

To give an example of this, many scientific and medical professionals are blogging, on podcasts and various social media sites reassuring the public of the safety of vaccination, and imparting information about the serious risks of side effects.  A variety of social media campaigns have also attempted to dispel myths. With that said, these initiatives have variable effectiveness. Also, further research on different social media platforms is needed. 

3. Encourages healthy decisions

The amount of information people are imparting online is vast. It is also increasing exponentially. Thus, the amount of misinformation and disinformation is increasing exponentially, not linearly. Online groups can gather up to thousands or even millions of followers. This means that trust or mistrust of healthcare institutions can be mass propagated- depending on the intent of those running the groups. 

Our ability to detect and correct false information, however, is not scaling proportionally. Low digital or health literacy, or both, can be factors contributing to this. 

Therefore, making an effort to promulgate accurate information has an important role to play both online and offline. Some strategies that can be applied are;

• Using accessible language when imparting detailed medical or scientific information. Not understanding medical or scientific topics makes it likely that health or scientific information will be mistrusted and / or not believed. This, in turn, might lead some to promulgate incorrect information. Therefore, using clear language aids understanding and in turn, trust in public health measures. 

• Use relatable and culturally relevant examples. For instance, the “I immunise” campaigns in Fremantle in Western Australia used a values-based approach to encourage vaccination within the community. In other words, the researchers took the culture of the community into account when promoting vaccination to them. I won`t go into detail here, however I have discussed in previous posts.
  
  

4. Fosters Trust in Medical and Scientific Institutions

Trust is crucial in times of crisis- people will look for guidance. Consider how turbulent COVID-19 lockdowns were. Many people looked to health authorities for guidance (and indeed, still do).  When public health officials communicate clearly and consistently, they:

• Reassure and alleviate concerns. In turn, this may reduce anxiety and resistance to public health interventions. Of course, there is never a one-size-fits-all approach to complex issues like this. But it does provide an avenue to talking about difficult issues like vaccination.
  
  
• Build an environment where people are more likely to follow public health recommendations. We are much, much more likely to take advice from someone, or a group, that we have trust in. That is, we trust our “in-groups. ”This statement is probably quite intuitive to most readers. So, when public health professionals put time and effort into building trust, the public are more likely to trust their recommendations.
  
  

I used the word “trust” a lot in the last paragraph because it's a pillar of any good health communication. I`ll delve more into how we build trust in the next paragraphs. 

5. Sincerity and openness

• There is a significant amount of research showing how vaccines and other public health interventions have saved hundreds of millions of lives. In the broadest sense, they do work. It is crucially important to emphasize this. 

 However, it is not accurate to say that no one has ever had a side effect from a vaccine or any other medication or medical procedure. Certain vaccines are contraindicated (not recommended) in rare cases, including those who have had previous reactions to vaccine ingredients. .

• Open communication about medical errors or policy changes also builds credibility. Imparting and promulgating information about mistakes and policy changes shows the integrity of health authorities and policymakers. It also shows a willingness to be slightly vulnerable, which is a critical part of building long-term trust.
  
  

6. Consistent Messaging

• Stated simply, messages to the public should be the same over time. Health authorities such as the Centre of Disease Control and Prevention (CDC) and the World Health Organisation (WHO) are reputable, for example. However, trust in healthcare providers and health authorities has been eroded within some communities. This underlines the importance of building trust. Conflicting messages, or messages that change over time, is a factor that can erode trust in this way. 

7. Empathy and Compassion

One of the most impotant principles of heatlh communication. 

• Active listening to concerns or anxieties is a crucial part of empathic and compassionate communication. The reason is that individuals may have very specific concerns, or specific sets of concerns. This idea can also be scaled up to groups and communities. Certain health concerns are common in specific communities (eg. ethnic minorities). This variability between people and groups is why active listening is so important. Clarifying what their main concerns are allows tailored approaches to be developed for the person/ group in question.
  
  
• Patients are more likely to trust providers who show they understand their experiences and values. If a patient does not trust their provider, it may result in them not sharing something sensitive that might be crucial to their diagnosis and/or treatment. For instance, this could apply to addictions, sexually transmitted infections, mental health issues among other issues.
  
  

8. Empowerment

• A key goal of health communication is to promulgate accurate information. This, in turn, helps people make well-informed choices and take control of their health under the guidance of their healthcare provider. This guidance-based approach rather than being authoritarian is found to be hugely effective in promoting healthy behaviours. A strategy known as Motivational Interviewing (MI) has been shown to be particularly effective in hundreds of controlled clinical trials. This is a counselling style used to overcome the common issue of ambivalence about behavioural changes by exploring intrinsic motivations and values. It has been applied successfully to smoking cessation, medication adherence, and weight loss.
  
  
• Clear explanations of procedures, treatments, and health risks foster shared decision-making. 

This is an important one. 

It can make a life-changing diagnosis less overwhelming. Or, on the less extreme end of the spectrum, it may simply help clarify confusing information. In either case, it fosters shared decision-making. Another point to add here is that this might promote a sense of autonomy in the patient, because they are actively involved in the decision-making process. They are not passively following instructions.  

9. Engagement and Discussion

• Bidirectional communication (that is, two-way conversation) is a very important part of fostering accountability and engagement. This can occur in various mediums, including online discussion forums and social media, telehealth apps where patients and providers can communicate, community-level meetings to discuss local health concerns, and traditional in-person consultations between patients and providers. This makes patients stakeholders in important conversations across different settings. This, in turn, fosters engagement and accountability on a large scale.

• Community- based health communication. This has been shown to be effective across research. Communities generally share a strong sense of identity, and so peer influence has significant potential to shape behaviours,  in either a positive or negative way. We are significantly more likely to trust and take advice from people within a community of people that shares our values and beliefs. 
• It also allows for efficient and widespread information-sharing among community members. This can include multiple channels, such as social media and online discussion forums, community media, newspapers and more traditional channels, and in-person discussions. These features combined, can make community-based approaches to health powerful in terms of mobilising people to take preventative action. 

10. Conclusion

It is clear that good health communication is multifaceted and dynamic. Despite these general principles of health communication, what “good” health communication is can significantly vary from person to person, and from group to group. Therefore, there is no one answer to the question I posed at the start of the article - "what are some good public health communication strategies?". With this said, these principles can act as a framework to guide healthcare providers, policymakers, patients and other important stakeholders in health communication. Thank you for reading.