PPN 302 Class 9: Health education, health communication and health literacy

social media: toxic infodemic or valuable public health tool? 

• Is social media a source of a toxic "infodemic" or a valuable tool for public health communication?

  • Social media messages can achieve widespread exposure

  • Social media can apply pressure and motivate resource allocation to support of public health messages

• BUT there can be challenges in using social media to communicate health messages

  • Public trust in evidence-based public health messages and interventions

  • Public resistance to social media messages

Social marketing is one of many of HP strategies

• Advocacy 

• Healthy public policy 

• Mutual support 

• Community development/empowerment 

• Organizational change 

• Intersectional collaboration 

• Individual and collective capacity building 

• Health communication/social marketing 

What is social marketing origin 

• Social marketing was "born" as a discipline in the 1970s,  when Philip Kotler and Gerald Zaltman realized that the same marketing principles that were being used to sell products to consumers could be used to "sell" ideas, attitudes and behaviors

What is social marketing 

• Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society

• The planning and implementation of programs designed to bring about social change using concepts from commercial marketing

• Social Marketing is an integrated part of health promotion strategies. . . It is used to deliver health promotion messages to specific Canadian populations and is designed to help individuals make decisions related to maintaining and improving their health and well-being and that of their families and communities. (Health Canada, 2005)

Social marketing defined 

• Social marketing is the practice of utilizing the philosophy, tools, and practices of commercial marketing for health and/or social Programs.

  • Accept a New Behavior

  • Reject a Potential Behavior

  • Modify a Current Behavior

  • Abandon an Old Behavior

Purposes of social marketing/ what it can do 

• Influence

• Dispel

• Increase

• Advocate

• Facilitate

Influence (purposes of social marketing)

• Perceptions, beliefs, and attitudes that may change behaviours 

Dispel (purposes of social marketing)

• Myths and misconceptions (anti-stigma campaigns – HIV etc) 

Increase (purposes of social marketing)

• The intended audience’s knowledge and awareness of a health issue, policy, problem, or solution 

Advocate (purposes of social marketing)

• For a position on a health issue or policy 

Facilitate (purposes of social marketing)

• Access to services (e.g advertising mental health services) 

When is social marketing appropriate 

• When the primary goal is voluntary behavior change

• When you want a audience-focused program

• When you want to make "upstream" changes, such as the adoption of environmental or policy changes.

• Social marketing is not appropriate if you just want to educate or raise awareness without a behaviour or systemic change or if the 

What social marketing cannot do

• Cannot compensate for inadequate health care provision or lack of access to care 

• Cannot sustain desirable changes in health practices without the support of a larger program for change (e.g adequate resource distribution & public policy) 

12 step process for social marketing campaigns 

1. Identify key stakeholders and partners

2. Decide on the Social Marketing & other HP strategies

3. Define your ‘target’ audience and get to know your audience

4. Develop an inventory of communication resources

5. Define campaign objectives

6. Identify channels / vehicle

7. Establish the sequence of campaign activities

8. Develop key messages

9. Identity a project identity or branding

10. Develop and produce materials

11. Implement campaign

12. Campaign evaluation

The 4 Ps of social marketing (Kolter & Zaltman, 1971) 

• Product

• Price

• Promotion 

• Place 

Product (4 Ps of social marketing, Kotler & Zaltman, 1971)

• What are you promoting to consumers?

• What belief habit do you want your target audience to buy into?

Price (4 Ps of social marketing Kotler & Zaltman, 1971)

• What are consumers willing to give in order to get the assumed benefit?

Promotion (4 Ps of social marketing Kotler & Zaltman, 1971)

• How are you going to communicate to consumers?

• What benefits are you going to tell them about?

Place (4 Ps of social marketing Kotler & Zaltman, 1971)

• Where and how are you going to reach the consumer?

Products (key components of 4 Ps of social marketing for HP):

• Behaviours, materials or resources (e.g physical exercise, condoms, cancer screening) 

Price (key components of 4 Ps of social marketing  for HP):

• What the audience has to pay or give up to achieve the desired behaviours 

Place (key components of 4 Ps of social marketing  for HP)

• Where the audience is reached (e.g schools, malls, on TV, clinics, etc) 

Promotion (key components of 4 Ps of social marketing  for HP)

• Advertising, public relations, community outreach

Additional Ps of social marketing

• public/participation

• Partnership

• Purse strings

• Policy

public/participation (additional Ps of social marketing)

• External & internal groups involved in the program 

Partnership (additional Ps of social marketing)

• Strategic relationships with others to deliver your program/mssages to the target 

Purse strings (additional Ps of social marketing)

• Funds needed to actually create & implement the program 

Policy (additional Ps of social marketing)

• Often, policy is needed to create environmental conditions for change; sustain change 

Healthy public policy (strategies used to promote booster seat use)

• May 2005-Bill 73: an act to enhance the safety of children and youth on Ontario’s roads 

Public education (strategies used to promote booster seat use)

• Public health units 

• Hospital for Sick Children: Safe Kid Canada

Intersectional collaboration (strategies used to promote booster seat use)

• Transport Canada: sets required standards 

• Mass media: news reports- consumer reports

Social marketing campaign (strategies used to promote booster seat use)

• Ontario government 

What increases overall program effectiveness

• Using multiple HP strategies 

Social marketing campaigns 

• ‘Integrated’– NOT a stand-alone strategy

• ‘specific populations’

  • define target populations

  • reaches a large number of people at once

• ‘make decisions’– informed choices & not coercion

Social marketing campaigns help people by supplying:

• The right information 

• In the right way 

• At the right time

Social marketing decisions include

• Goal of campaign

• Medium

• Health communication principles

• Timing of the message

• Definition of the target group

• Demographics of target population

• Media channels

• Spokesperson

• Pilot test the message

Goal of campaign (Social marketing decisions include)

• Desired knowledge or behaviour change

• Target 

Medium (Social marketing decisions include)

• When & where

Health communication principles (Social marketing decisions include)

• Font 

• Language

• Images 

Timing of the message (Social marketing decisions include)

• Time of day, season, etc 

Definition of the target group (Social marketing decisions include)

• An entire population or a sub-population

Demographics of target population (Social marketing decisions include)

• Visuals (font, picture, colours, typeset, etc) 

• Language of message (terms used, simple/complex; issues with translation)

Media channels (Social marketing decisions include)

• One or several 

Spokesperson(Social marketing decisions include)

• expert/non-expert; actual person/ cartoon/etc

Pilot test the message (Social marketing decisions include)

• Pilot group should be representative of the target 

• Ensure that message is clear, does not have unintended interpretations 

  • e.g if translating into different languages, make sure to test with native speakers

Beyond techniques: Ethical social marketing 

• When using social marketing, remember to: 

  • Act with the spirit of ‘critical health promotion 

  • Consider messages through a lens of social justice & equity 

  • Be mindful of power relations

  • Be aware- individual/society are intertwined 

  • Use a socio-political lens in developing messages 

Social marketing: A critical appraisal includes

• The novelty of social marketing

• The effectiveness of social marketing

• The ethics of social marketing

• The health literacy of social marketing

• Ethical considerations, including

The novelty of social marketing (Social marketing: A critical appraisal)

• Are they offering anything new or are the familiar ideas repackaged in marketing jargon? 

The effectiveness of social marketing (Social marketing: A critical appraisal)

• Are these principles more effective than current health promotion practices? 

The ethics of social marketing (Social marketing: A critical appraisal)

• Tactics used to persuade/influence people, often without their awareness

The health literacy of social marketing (Social marketing: A critical appraisal)

• Can people understand and apply the message?

Ethical considerations, including (Social marketing: A critical appraisal)

• Does your message stereotype, perpetuate or create bias or disadvantage? Is the benefit of stereotyping worth the cost? 

• Are you asking people to do something realistic? Are there available supports for follow-through

Canada’s expert panel on health literacy definition 2008

• The ability to access, understand, evaluate and communicate information as ways to promote, maintain and improve health in a variety of settings across the life span

Kwan, Frankish, & Rootman's definition of health literacy, 2006

• “The degree to which people are able to access, understand, appraise and communication information to engage with the demands of different health contexts in order to promote and maintain good health across the life-course

Literacy 

• It is not only the individual’s ability to read and write but the individual’s ability to put those skills to work in shaping the course of her or his own life

Health literacy 

• The cognitive & social skills which determine the motivation & ability of individuals to gain access to, understand, & use information in ways which promote & maintain good health.

• It means more than being able to read pamphlets & successfully make appointments.

•  Health literacy is crucial to empowerment.

3 levels of health literacy

• Basic /functional

• Communicative/interactive

• Critical literacy

Basic /functional (3 levels of health literacy)

• Basic reading, writing and literacy skills & the knowledge of health conditions and health systems

Example (Basic /functional (3 levels of health literacy)

• Presenting health information in plain everyday language

Communicative/interactive (3 levels of health literacy)

Communicative and social skills that can be used to derive meaning from different forms of communication, and to apply new information to changing circumstances

Example (Communicative/interactive (3 levels of health literacy)

• Supporting clients, families and communities to reflect on, translate, and apply their knowledge and new skills 

Critical literacy (3 levels of health literacy)

• Higher level cognitive skills and social skills to critically analyse information & use this information through individual and collective action to address the social, economic and environmental determinants of health

Examples (Critical literacy (3 levels of health literacy)

• Critically analyze available information to identify its relevance, biases, and credibility 

How can a CHN support health literacy? 

• Incorporate understanding of links between health literacy and SDH

  • Integrating a social justice lens in relation to HL

• Ensure relevant, appropriate, respectful communication re health information

  • Plain language, easy-to-read fonts, clear diagrams, no jargon

• Recognize inherent power dynamics in how health information is communicated

• Incorporate understanding of indigenous knowledge, social, economic and historical context

• Teach people to critically assess health information & health education

• Create opportunities for collective learning

Health literacy strategies 

• Engage your audience

• Use plain language and clear design 

• Focus on key messages 

• Promote teach-back techniques 

• Use patient friendly resourcs to enhance teaching 

Health literacy: where does Canada stand? 

• Level 3 defined

• It is estimated that among Canadians aged 16 to 65: 

• Prose scale

• Document scale

• Numeracy scale

Level 3 defined (Health literacy: where does Canada stand?)

• ability to complete high school requirements 

Prose scale (Health literacy: where does Canada stand?)

• 42% (about 9 million) score below level 3 

• The knowledge and skills needed to understand and use information from texts

Document scale (Health literacy: where does Canada stand?)

• 43% score below level 3 

• The ability to locate and use information contained in materials 

Numeracy scale (Health literacy: where does Canada stand?)

• 50% score below level 3

• The knowledge and skills required to apply arithmetic operations embedded in printed materials

Literacy, health literacy and aging

• Estimates of literacy & HL among Canadians over age of 65:

  • 48% (about 12 million) score below Level 3 on the prose and document scales

  • 55% score below Level 3 on the numeracy scale (Statistics

  • Canada, 2005; Canadian Literacy & Learning Network, 2014)

  • 88% of people over 65 have lower than ideal health literacy (Canadian Literacy & Learning Network, 2014)

Bourdieu & Wacquant, 1992, Dei,2008; hooks, 2000 on SDofHL: Class and socioeconomic status

• Children experiencing poverty, racism, homophobia, ableism and other forms of discrimination are often disadvantaged by the education system which privileges ‘middle class’ and dominant cultural practices

Migration, language barriers & ML: SD of HL 

• Critical Considerations – Context Matters:

  • Literacy level in country of origin and/or in first language HL level

• Language barriers in settlement society:

  • Do language barriers = illiteracy?

  • Do language barriers= low health literacy?

Social stigma, literacy & health 

• Social stigma and discrimination towards people experiencing illiteracy or lo literacy create barriers to health and access to health

Considerations (social stigma, literacy and health) 

• What are some of these barriers?

• How do these barriers affect access to health and health resources?

• What can CHNs do to minimize or eliminate these barriers?