Communication in the Health Care Context
The World Health Organizations’ first International Congress for health promotion produced the Ottawa charter (1986) and stated health promotion as being “the process of enabling people to increase control over and to improve their health”. The promotional poster in this report has been developed for the physical activity health area, with a segmented target audience of women aged 40 to 60 years. The poster aims to communicate and reinforce the benefits of physical fitness. Whilst evaluating the poster approach to health communication, other forms of health communication, and their effectiveness, are also discussed.
The Wanless report (2004) described the “Fully Engaged Scenario” whereby unless there is substantial support of the public in pursuit of their health and well-being, the cost of treatment of chronic conditions by the National Health Service will become untenable. Current Welsh Government policy promotes physical activity in line with the report of the 2004 White paper. The recommended level of physical activity should be 30 minutes of moderate activity on at least 5 or more days per week. Research conducted by Sport Wales (2012), in their “state of the nation” paper, indicate that by age 45, only 36% of women are physically active and continue to be 14 percentage points lower than men until after age 65. Therefore, based on a needs assessment developed from the respective reports, the promotional poster for this assignment has been designed to target women aged 40 to 60 years. Health challenge Wales (2013) was developed to promote the prevention of ill health in order to focus resources on treating unavoidable disease. This campaign states that for women, “Heart and circulatory diseases are the most common cause of death in Wales”. There is numerous epidemiological evidence indicating the positive effects of exercise, including reducing these risks. Kreuter & McClure (2004) found that interaction patterns are also influenced by consumers’ unique backgrounds and should be accounted for in health promotion. The poster therefore communicates the Health Challenge Wales website for credibility as well as their phone number for women of lower socio-economic means with limited internet access.
Bandura (2004) states “To help people reduce health impairing habits by health communications requires a change in emphasis from trying to scare people into health to enabling them with the self-management skills and self-beliefs to enable them to take charge of their health habits.” The poster acknowledges this by communicating the positive message ‘Be healthier and happier’, as the target audience may be facing hormonal changes associated with menopause that can lead to depression. Thirlaway & Upton (2009) found that people with high self-efficacy are more likely to take up physical activity and maintain the change in behaviour. Whilst a poster can initiate a contemplation of change, ‘face-to-face’ communication can be more effective in promoting an active uptake of a change in health lifestyle. An example of a ‘face-to-face’ technique would be motivational interviewing. “Motivational interviewing is a collaborative, person-centered [sic] form of guiding to elicit and strengthen motivation for change” (Miller & Rollnick, 2009, p137). Using this technique in collaboration with other forms of health promotion, such as print media, could allow for a more effective outcome.
Poster campaigns can be a motivator for people already considering health behaviour change. For example, Kerr, Eves & Goodwin (2000) found in their robust study of the impact of a poster at the point of use ( i.e. bottom of stairs), that the people who were already thinking about increasing exercise were more likely to take the stairs. The size of the poster was also significant in promoting the desired behaviour change namely posters of size A1 and A2 had more impact than A3. Posters need to have a vivid eye-catching message, thus the slogan ‘Fit for Life’ was used. Parrot (1995) found that novel messages tend to involve the audience more. Whereas persuasive messages that influence positive emotions tend to increase attention (Monahan, 1995). However, Thirlaway & Upton (2009) found that health messages focus on ‘future-oriented’ long-term outcomes, whereas the majority of people are focused on the present. This is an inherent problem in many health campaigns.
Social and group support increases the likelihood of adhering to an active lifestyle, therefore the poster depicts women physically active with companions. Bidonde, Goodwin & Drinkwater (2009) found that older women form new social networks through group fitness and go on to become supportive of each other outside of the physical activity. Health campaigns that involve multi-faceted interventions, such as self-help groups, have been found to be more likely to change behaviour (Khan et al., 2002). Also Leary, Tchividjian & Kraxberger (1994) refer to Impression management, where people control their behaviour to influence how they are perceived by others. People often become physically fitter to make a better impression on others and this can result in better health. Conversely concerns with judgement by others and embarrassment can prevent the uptake of exercise. Leary (1992) states that providers need to be mindful of “self-presentational concerns of individuals that affects willingness to exercise”. The poster in this report acknowledges these point by depicting women that are socially accepting of each other and are varied in body size.
The poster would be displayed in General Practitioners’ surgeries and primary care centres prompting patients to enquire with their doctor regarding the content. Ward and Hawthorne (1994) found that posters displayed in waiting rooms at general practice surgeries were effective in health promotion and that of 319 patients attending a doctor during the study period, 82% had noticed the posters, 95% of whom reported they had also read them. In a study by Stephens, Blanken, Greiner & Chumley (2008) involving 386 patients with obesity who had viewed a poster, found that the 60% recalled seeing the poster. They concluded that the “simple poster prompt may prove effective at promoting weight loss conversations if the poster was part of a longer, multifaceted study” During ‘face-to-face’ consultations patients and physicians negotiate for relational control, however physicians are twice as likely to take control of a conversation (O’Hair 1989). When a patient concedes control to the physician, there is the possibility of not meeting the patients’ needs. Relationship awareness theory, proposed by Elias Porter (1976) states that “one's behaviour traits are consistent with what one finds gratifying in interpersonal relations and with concepts or beliefs one holds about how to interact with others to achieve those gratifications.” By increasing awareness of an individual’s beliefs and motivations then communication is enhanced through understanding their behaviour. Another consideration in communication is Transactional Analysis, developed by Eric Berne (1964). This stresses the capacity of the person to change decisions and is oriented toward increasing self-awareness to enable people to make new decisions. A message in a health promotion, such as a poster (‘transactional stimulus’), is received by the respondent (‘transactional response’) who can feel nurtured if the message is positive.
Increased access to internet and electronic media also has an impact on health. The Pew internet and American life project (2000) found that 55% of people with internet access, fifty two million American adults, used the internet to seek health information, with 92% of those finding the information useful (Fox & Rainie, 2000). More recently, the Pew project found the number rose to 61% of total American adults used the internet to seek health information (Fox & Jones, 2009). Prochaska & Velicer (1997) found that computer-based interactive and individualized interventions are effective in health promotion. Although, Rice & Katz (2006) found information acquired by patients has changed the interaction between providers and patients. For example, doctors spend more time answering questions about online information, some of which could be misinformation, leading to distraction during the face-to-face consultation (Sundar, Rice, Kim, & Sciamanna, 2011). Posters have a low richness when viewed from the perspective of Media Richness theory, which proposes that all communication channels have varying richness. Based on this theory, ‘Face to face’ communication is the richest form of communication, as multiple cues such as facial expression and tone of voice, natural language and emotion are conveyed (Daft & Lengel, 1986). Media Richness theory suggests that a task’s information processing needs to be matched with a medium's ability to convey information richness. The poster’s message was briefly stated as the message needed to be unambiguous with this form of communication channel. Furthermore, Channel Expansion theory proposes that richness perception is subject to social influence, experience with the channel and the message topic and context (Carlson & Zmud, 1999). Posters are a common media experience for the target audience with their everyday prevalence.
The use of mass media namely, television, radio, newspapers and direct mail, in health communication is also more successful if there are multiple interventions in place. Wakefield, Loken & Hornik (2010) found that where the health behaviour addressed is episodic rather than habitual, such as physical activity, then mass media is effective. They also found that “access to key services and products are crucial to persuade individuals motivated by media messages to act on them”. Cavill & Bauman (2004) found that mass media can increase awareness of the health issues relating to physical inactivity, but in the long term, strategies involving policy and environmental change were necessary. Cultivation theory explains the influence of mass media over an extended period of time. Perceptions change as a message which is repeatedly heard becomes normalised and more desirable (Shrum, 1999). Television and social media often promote unhealthy food and large commercial budgets lead to competing choices for individuals (Brownell & Horgen, 2004).
Poster campaigns promoting a health related issue have limitations when aimed at a subgroups of the population that are at different stages of readiness to change. Any episodic media health promotion campaigns are limited in their impact on the population, especially with small budgets but with ambitious behavioural change targets. In this instance promotion of physical activity with more extensive community based strategies and environmental change may be needed over a longer period of time.

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