The main objective of prevention is to avoid diseases by reducing risks that may negatively affect health. The prevention approach complements the health promotion approach. While prevention intends to avoid disease and reduce risks, health promotion focuses on resources that sustain the opportunity of healthy living. Even though the two concepts are sometimes used synonymously, lately the prevention approach has been proffered as independent of the health promotion concept. Both prevention and health promotion aim at a modification of attitudes and behavior by specific communication strategies to raise the empowerment of individuals. The problem is that not all individuals are interested in health-related topics per se. In most cases, information is sought when people are directly or indirectly (e.g., through a family member or friend) concerned with a disease.
Types of Prevention
There exist different typologies of prevention classified by either stages of health or illness or by target audience. For example, some have differentiated between behavioral and/or Prevention and Communication environmental prevention. While behavioral prevention concentrates on personal factors that influence health-related behaviors of an individual, environmental prevention focuses on factors that are external to the individual, such as living conditions and the opportunities to enact health behaviors such as legislation (e.g., with regard to drug use), economic and ecological preconditions for healthy living and so forth.
Another popular and often cited typology is the trichotomy of primary, secondary, and tertiary prevention, which considers different stages of health and/or illness. Primary prevention aims at people who are not yet affected by a disease and encompasses broad population-wide communication strategies. Secondary prevention strategies address people in a very early stage of a disease to minimize and/or avoid health risks. Tertiary prevention measures are as a general rule targeted at those who already have established diseases to avoid aggravation and complications.
In 1994, a similar classification system was proposed by the Institute of Medicine (IOM) in the United States. This classification makes the distinction between universal, selective, and indicated prevention interventions. In comparison to the former classification, the IOM classification focuses on the general target group of a prevention intervention, not on the underlying objective. Universal prevention concentrates on the broad population to prevent risky and unhealthy behavior. The main objective is to provide information and improve the individual skills for healthy living. Selective prevention addresses special risk groups. Indicated prevention aims at individuals with existing risky and/or unhealthy behavior, e.g., drug abuse.
Media in Health Context
Apart from different typologies of prevention, different levels of communication strategies can be differentiated: interpersonal communication, communication in and/or from health organizations, and communication via mass media. Most people talk about health-related issues with their doctor and/or family members and have the highest confidence in personal advisers (Identity Foundation 2001). But also the media have become a very important source of health-related information and a communication platform for health-related problems and support. In particular, health-related information TV programs are of high interest and are attributed with a high level of trust, followed by the pharmacist and health-related books (Identity Foundation 2001). Even health organizations (e.g., hospitals) are important for preventive strategies.
The role of media in health has been a subject of controversy. Media are an important source of information on health, and casual or incidental use of media is associated with people’s knowledge, attitudes, and behavior (Finnegan & Viswanath 2002, 328). On the other hand, some have focused on the harmful effects of media, such as the effects of video games and media violence on aggressive behavior in children. The role of media in health promotion through health campaigns has also been widely studied.
One important problem in connection with health communication strategies is that health information is often not sought until a health-related problem has occurred. Some media, such as the Internet, assist in active seeking of health information, while others, such as television and radio, may expose people to health information through routine use (Dutta-Bergman 2004). Media that lead to passive or casual use, nonetheless, are useful in reaching individuals who may be either uninterested in or not actively seeking health information. A major goal and challenge of prevention is to reach individuals with preventive or health-related information before a disease has developed. Media, with their broad reach and appeal, can draw attention, arouse interest, and provide alternative ways of enacting behaviors.
In recent times, the amount and range of health information has increased enormously in a variety of media, such as television and the Internet, and in different genres, such as soap operas, telenovelas, comedy programs, music videos, talk shows, and public service advertisements, among others. These programs address a variety of topics, such as nutrition and eating disorders, cancer, HIV/AIDS, and alcohol and tobacco, among others. But the presence of health-related information in the media is no guarantee that individuals will change their attitudes or behaviors. A number of individual and situational characteristic influence media effects.
Examples for Communication Strategies
Different preventive communication strategies can be distinguished: public information campaigns, health journalism, and entertainment education, among others.
Information campaigns encompass different communicative activities to influence individual knowledge, attitude, meaning, and/or behavior. Social marketing is an example of an activity that promotes social or health messages in the same way as commercial marketing. Different promotional activities and media channels are combined to reach the target audience. Typical vehicles are posters at public places, public service announcements in different media, as well as hotlines and events. Information campaigns offer the opportunity to reach a broad target group, but it is difficult to communicate complex and sophisticated information. To get the attention of the audience, it is necessary to promote consonant and creative messages in a cumulative way. A related strategy is “media advocacy,” which addresses not individuals but decision-makers such as legislators, policymakers, and media personnel, among others. For example, the Harvard Alcohol Project, which promoted the concept of the designated driver, is often cited as a successful example of media advocacy.
Health journalism has an important role with regard to the communication of healthrelated or preventive messages. Journalists “translate” relevant scientific information for a broad audience under an enormous time pressure (Viswanath 2005, 833). They also influence the agenda concerning health-related and preventive topics. Media coverage of health is often criticized by scientists as superficial or inaccurate and often suffers from the disadvantage of reaching only the educated and those who are already interested in the topic.
Entertainment education (E-E) combines entertainment and education to promote prosocial messages drawing from such theories as social cognitive theory. Using long-running entertainment programs, the E-E approach uses positive and negative role models to promote the desired and/or the undesired attitudes and/or behavior. Transitional characters represent the viewer’s perspective, which changes over time in the desired direction. In E-E programs the health relative message is mediated in an indirect, almost subtle way. Parasocial interaction and identification with the positive or transitional character might raise the viewer’s sense of self-efficacy to solve problems or to change individual behavior. Several evaluation studies have shown that the implementation of health relative, preventive messages is successful and might change attitudes under certain circumstances (Singhal et al. 2004). The idea is to encourage interpersonal discussion and reflection about the presented topics and positions as a precondition for attitude change and behavior modification. The E-E strategy offers the opportunity to reach especially those who are not interested in health-related topics and who are often hard to reach with preventive messages, e.g., adolescents or persons with a lower level of education, who are generally less information oriented. Relevant factors for the success of an E-E project are the viewer preferences (preferred medium, format, and genre) and the accurate implementation of the intended message. Media offer many opportunities for preventive purposes (Papa et al. 2000). As yet, there is no evidence that the integration of pro-social or health-related messages in entertainment generates negative reactions among the audience.
Success in prevention requires several considerations. First, the access to valid health information for different social groups has to be assured. There still exist both health and information disparities with regard to socio-economic status. Therefore, special communication strategies are needed to reach the different groups and to close the gap between them (Viswanath 2005).
Second, the perception of the message as the most important precondition for following cognitive processes has to be considered: age, gender, socio-economic status, educational background, and health conditions are relevant factors which have influence on media use, and access to and perception of health-related messages (Viswanath 2005). Third, individual understanding and interpretation of a message have to be taken into account. There has been a shift to an individual perspective and qualitative studies that give important hints for the construction of preventive messages. Even participative approaches offer great potential and should be regarded in the future (Singhal et al. 2004).
Communication strategies have to be seen in a context of a varied media landscape, which consists of different and sometimes inconsistent, contradictory messages (Sherry 2002; Viswanath 2005). The success of a strategy might increase if the program is embedded in a media environment that is hospitable to the communicated message. Apart from intentional communication measures, also the unintended effects of media programs have to be considered. The resonance they generate can only be investigated in long-term media effect studies.
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