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Practical theory in health communication

Gestalt psychologist Kurt Lewin is famously known to have said, "There is nothing so practical as a good theory." Theoretical approaches to the study of health communication are crucial to the accumulation of empirical research and the ability to make useful recommendations to health practitioners and consumers. On the one hand, a theory allows researchers to make meaning of their results by providing a systematic framework with which to interpret, connect, and make meaning of findings across studies. On the other hand, variable analytic research-research that assesses relationships between variables in the absence of theory-often leads to a long list of findings that sometimes coalesce, sometimes contradict, and sometimes simply do not relate. For an amusing satirical article about the futility of variable analytic research, consider reading Michael Pacanowsky's review of studies about why people "pass the salt" (citation below, written under the pseudonym of Murdoch Pencil).

I was reminded of theory's importance after reading Rui's blog post from October 25 in which she mentioned how her recent paper's findings contradicted what one might intuitively expect. Not only that, but her results also (importantly) opposed what many previous studies have found about the beneficial effects of subsequent communications after exposure to a health advertisement. Theory can ultimately reconcile these findings and account for the conditions under which communication can help or hinder health campaign effects. Without a theory to make sense of contradictory research, recommendations that researchers make to health practitioners will ebb and flow without a consistent direction, subject to the most recent study's findings that do not clearly inform or sensibly add to what is already known.

Health communication researchers are in the business of investigating important issues that have implications to many people's well-being. These are practical problems that necessitate good theories.

Pencil, M. (1976). Salt passage research: The state of the art. Journal of Communication, 26, 31-36. doi:10.1111/j.1460-2466.1976.tb01932.x

Adam Richards
Department of Communication at the University of Maryland
2011 CCRC Doctoral Fellow

Written by CCRC at 13:00

Implementation and Dissemination at the American Public Health Association Annual Meeting

While implementation and dissemination did not play a starring role at this year's APHA meeting, one session that called for more "practice-based evidence" reviewed a variety of approaches relevant to cancer prevention within community and organizational settings. Each presenter on the panel highlighted the role practice-based evidence plays in complementing traditional research-based evidence. Jennifer Leeman described a valuable online database available via the Center for Training and Research Translation. The website--www.center-trt.org-- offers trainings and intervention translation resources to improve nutrition and physical activity programming reach, effectiveness, adoption, and sustainability. The center aims to overcome the challenge of the practical "how" that is often lacking in descriptions of interventions in peer-reviewed literature. Staff at the center work with intervention developers to create standards templates that detail core intervention elements, steps for implementation, required resources, underlying theory, evidence of effectiveness, and potential health impact using the REAIM framework along with links to intervention materials and trainings.

In addition to this valuable online resource, Brenda Henry from the Robert Wood Johnson Foundation discussed the need to develop practical guidance on the process of local intervention adaptation. She talked about a color-coded adaptation guide her team has developed to help practitioners tease out components of programs that are thought to be necessary for effectiveness and those that are optional or less important for intervention impact. She also used a fun analogy to allrecipes.com that really stuck with me, as a food-lover. She described how great it would be if we had a resource out there that listed interventions just like we list recipes online: contributors could post their intervention just like recipes for a dish with step by step instructions and ingredients (or required materials, staff etc.), other folks could add comments describing how they adapted the intervention to fit the needs of their population/program/setting just as people comment on the extra vegetables they add or spices they substitute in a recipe. Meanwhile, all participants could rate the interventions and their adaptations once they try them out. I'd love to see how researchers and practitioners could come together to produce a user-generated resource like this or even how the Center for Training and Research Translation might be able to integrate some of these ideas into their existing site!

Rebekka Lee
Harvard School of Public Health
2011 CCRC Doctoral Fellow

Written by CCRC at 13:01

Promote health using social media?

Information in the age of Internet no longer flows one way from media to audience. Instead audiences create media as well as comment on it. Social media like Facebook have been around for seven years; various news websites have started to allow for comments to virtually every news story; Amazon not only allows potential buyers to read prior buyers' reviews of the product, but also recommend to them books that they may be interested in based on what "people like you" have bought.

It is important to understand the social impact online recommendation system because whatever media product it accompanies - a piece of news, a music video, a commercial, or an anti-smoking public service announcement - the information carried by the recommendation system synchronizes with the media product and thus becomes a part of the message sent to the audience.

I got the feeling when attending to various health related conferences that everyone in our field is excited about social media and the interactivity that internet allows. Health campaigners as well as intervention practitioners constantly talked about the social buzz they created with Facebook fan page, twitter, blogs, and YouTube with the assumption that the "buzz", especially the positive buzz is a good thing. However plausible this assumption sounds intuitively, there is very little empirical evidence. In fact, our recent study (presented as a poster at the Annual CECCR Grantee Meeting two weeks ago) found quite the opposite: not only negative comments but also positive comments significantly decreased smokers' perceived effectiveness of high-quality anti-smoking ads.

Health practitioners need to raise some caution when adopting social media to promote health. Interactivity is a double edged sword. Sometimes it helps to send the message to more people, but sometimes it twists the message during the diffusion process and creates unintentional effects that backfire.

Rui Shi
Annenberg School of Communication at the University of Pennsylvania
2011 CCRC Doctoral Fellow

Written by CCRC at 13:02

The Importance of Mixed Methods in Cancer Communication Research

Increasingly acceptable in many scientific disciplines, mixed methods research presents many opportunities for the field of cancer communication to gain a richer and more complex understanding of the topic of inquiry. Among its many benefits, integrating quantitative and qualitative methodologies enables researchers to balance the weaknesses of one methodology with the strengths of another and vice versa.

The National Institutes of Health's Office of Behavioral and Social Science Research recently commissioned a group of leaders in the field of mixed methods research to develop best practices. Their report, Best Practices for Mixed Methods Research in the Health Sciences, issued in August 2011, serves as an important resource for budding mixed methods researchers. The creation of formal guidelines is an encouraging step towards acceptance of this emergent research paradigm that holds great potential to yield useful, applicable and more nuanced research findings. The NIH press release and a link to the report can be found at: http://www.nih.gov/news/health/aug2011/od-23a.htm

Currently immersed in dissertation work, I'm learning firsthand the benefits of engaging my topic from both qualitative and quantitative perspectives. The quantitative portion of my research enables me to test whether hypotheses that I've developed are statistically significant, but really, there's more to the big picture. Since my work focuses on leukemia and lymphoma survivors, it seems equally important to capture their experiences and psychosocial needs as they articulate them, not just as I theorize and hypothesize. By using mixed methods, I've learned the value of not only testing my own hypotheses using statistics, but also delving into interviews with cancer survivors to see if they echo my findings, offer suggestions as to why certain findings weren't statistically significant, or offer entirely new suggestions that can guide future research. All in all, I'm encouraged and excited about the possibilities that abound with the increasing use and acceptance of mixed methods research in cancer communication.

Whitney Jones
University of Colorado Denver School of Health and Behavioral Sciences
2011 CCRC Doctoral Fellow

Written by CCRC at 13:03

Recent headlines have been inundated with a new recommendation by the U.S. Preventive Task Force suggesting that healthy men should not undergo prostate cancer screening. I also recently learned from a special nutrition issue of Time Magazine that when you take all the fat out of milk, you're left with too high a concentration of natural sugars, which interacts like candy with your hormones, especially insulin (directly quoted).

Recommendations for engaging in healthy behaviors are constantly evolving with the advancement of science and new knowledge. As researchers, we are trained in contributing to these advancements and building the evidence-base. As a regular consumer of information who may typically drink a glass of fat free milk, new, and almost conflicting health recommendations can be daunting for individuals trying to maintain healthy lifestyles. The many avenues in society through which information is disseminated further complicate the task of disentangling these messages.

Evolving health recommendations based on new examinations of the evidence increase the importance of communication between health practitioners and consumers. This need not be exclusive to clinicians, but also may encompass strengthening the capacity of community health workers and health educators. If the end goal entails assurance that people sustain healthy behaviors, two-way communication with the opportunity to build trust and rapport with someone, may be a better resource for people in the face of rapid mixed messaging.

Minal Patel
University of Michigan School of Public Health
2011 CCRC Doctoral Fellow

Written by CCRC at 13:03

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