Transcript Risk Communication in Health Promotion

Risk Communication in Health
Promotion
S. Thavaraj
Pengarah R&D
Malaysian Health Promotion Board
(MySihat)
Health Promotion
• Health promotion is the process of enabling people to
increase control over, and to improve their health
(Ottawa Charter for Health Promotion. WHO,
Geneva,1986).
• The Ottawa Charter for Health Promotion identifies
basic prerequisites for health (e.g. education, shelter,
etc) and outlines priority action areas (e.g. building
healthy public policy).
• The Ottawa Charter follows a structural approach to
promoting health, driven by the core values of social
justice and equity (Raphael, 2003; in Hofrichter Health
and Social
Health Promotion
• Health promotion represents a comprehensive
social and political process
• It not only embraces actions directed at
strengthening the skills and capabilities of
individuals, but also action directed towards
changing social, environmental and economic
conditions so as to alleviate their impact on
public and individual health.
Health Promotion
• Health promotion is the process of enabling
people to increase control over the
determinants of health and thereby improve
their health. Participation is essential to
sustain health promotion action (World Health
Organization Health Glossary 1988).
Health Promotion
• In 1984 the World Health Organization (WHO)
Regional Office for Europe defined health
promotion as "the process of enabling people
to increase control over, and to improve, their
health”.
Health Promotion: WHO
• In addition to methods to change lifestyles,
the WHO Regional Office advocated
"legislation, fiscal measures, organisational
change, community development and
spontaneous local activities against health
hazards" as health promotion methods.
Health Promotion and Behavior Risk
Factors (relevance to Risk
Communication)
• There is a tendency among public health
officials and governments—and this is
especially the case in liberal nations such as
Canada and the USA—to reduce health
promotion to health education and social
marketing focused on changing behavioral risk
factors.
Health Communication
• Health communication can be defined as "where
health promotion and communication meet"
(Hershfield & Rootman, 1996).
• Health communication involves the dissemination of
health information through the media via the use of
various communication techniques (Nutbeam, 1998).
• It aims to improve the health status of both
individuals and populations by informing,
influencing, and motivating the public about
important health issues, as well as ensuring that key
health concerns are on the public agenda (Nutbeam,
1998).
•
Risk Communication
• Risk Communication is defined as an
interactive process of exchange of information
and opinion among individuals, groups and
institutions
• It expresses messages about risk, concerns,
opinions or reactions.
• Risk communication is helping people
understand the nature and seriousness of a
risk so that they can make an informed
decision about how to deal with the risk.
Risk Communication
• Ideally, risk communication is “an interactive
process of exchange of information and
opinion among individuals, groups, and
institutions” .
• The goal of risk communication could also be
defined as the need to align risk perceptions
of the public with that of the risk experts and
to reduce fear of risk related technology.
Risk Communication and Health
Promotion
• With respect to public health, risk can be
separated into two main perspectives.
– First risk as a health danger to individuals as a
result from environmental hazards (i.e. pollution,
nuclear waste and toxic chemical residues).
Specifically, risk is "a health threat that is regarded
as a hazard which is external, over which the
individual has little control“ .
RC and HP
• The second view conceptualizes risk as a
consequence of "lifestyle" choices that individuals
make, thus placing the emphasis upon self-control
(i.e. the individuals ability to manage the self
)(Lupton, 1995).
Risk as a Consequennce of Lifestyle
Choices: Behavior Risk factors
• The vast majority of NCD risk factors are
environmental or lifestyle-related, thus NCDs
are largely preventable. Greater than 30% of
cancer is preventable via avoiding risk factors
including: tobacco (6 million die a year), being
overweight or obesity, low fruit and vegetable
intake, physical inactivity, alcohol, sexually
transmitted infections, and air pollution.
(WHO)
Behaviour Risk Factors
• A trend has emerged, particularly in the early
2000s, in which numerous studies have
revealed a link between fast food and an
increase in heart disease.
• Many major fast food chains, particularly
McDonald's, have protested the methods used
in these studies and have responded with
“healthier menu” options.
• Consumers continue to patronise
Behaviour Risk Factors
• Diabetes mellitus is an NCD which is largely
preventable and manageable but difficult to cure.
• Patient education, understanding, and participation
is vital since the complications of diabetes are far less
common and less severe in people who have wellmanaged blood sugar levels.
• Wider health problems may accelerate the
deleterious effects of diabetes. These include
smoking, elevated cholesterol levels, obesity, high
blood pressure, and lack of regular exercise.
Behavior Risk factors
• Chronic Kidney Diseases, diabetes and
cardiovascular disease are closely associated
conditions that often coexist; share common
risk factors and treatments; and would benefit
from a coordinated global approach to
prevention and control.
Others Risk Factors
• Thus, CKD, diabetes and cardiovascular
disease are closely associated conditions that
often coexist; share common risk factors and
treatments; and would benefit from a
coordinated global approach to prevention
and control.
Communicating the Risk to High Risk
Individuals to Manage their Risk
• When there is risk it is important to communicate with the high risk group
or vulnerable group (Haze, Melamin, Nitrofuran, Dioxin, SARS, Avian Flu,
Recycled cooking oil ) as we have a Duty of Care. Communicating risk to
the general public is often challenging due to a variety of issues including:
• increased emotion,
• limited access,
• availability of facts,
• clutter,
• distorted facts,
• speculation,
• assumptions,
• translating technical information into something understandable and
• sometimes incomplete knowledge.
Communicating Risk
• The manner in which information is
communicated must be genuine and attempt
to address both perceived ( may not be real)
and real risk concerns
Incorporating Risk Communication in
Health Promotion
• Integrate with health promotion components
of the existing programs of the MOH
• Risk Communication has already been
incorporated in our existing programs
• It need not stand on its own
• Nevertheless they are certain prerequisites
Prerequisites: The Risk
Communication Process
• Epidemiological assessment of Risk
• Identifying the Risk Group
• Behaviour risk factor surveillance along the lines of the
Morbidity Survey
• Educational Assessment
• Setting Risk Communication Objectives
• Formulating Strategies
• Executing Strategies
• Developing Risk Communication Messages
• Disseminating the messages through the effective Channels
• Impact Evaluation
Risk Communication Settings
•
•
•
•
•
Clinic
Hospital
Workplace
School
Community
Strategies
• Planned Media Activities
– Electronic
– Print
– Social
– Face to Face
Strategies
•
•
•
•
•
•
Planned Community Intervention, NGOs.
Brief Intervention; Incidental Unplanned
Community Health Promotion Centre
Lobbying
Environmental Support
Social Support
Evaluation
•
•
•
•
•
•
•
•
Evaluating the strategies : Formative Evaluation
Evaluating the Objectives/ Goals : Impact Evaluation
Evaluating Messages conveying Risk and Risk Reduction
Educational Efforts as to Risk : Knowledge and Attitude on
Risk
Behaviour Changes as to Risk Reduction
Morbidity Mortality Statistics as a result of Risk Reduction
Policy Changes
Environmental and Social changes
Behaviour Change Theories: Common
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1. Yale Attitude Change Approach
2. Developmental Theory
3. Group Dynamics Approach
4. Perception Theory
5. Motivation Theory
6. Learning Theory
7. Force Field Theory
8. Group Dynamics
7. Cognitive Dissonance Theory
8. Attribution Theory
9. Social Learning Theory
10. Social Cognitive Theory
11. Health Belief Model
12. Theory of Reasoned Action
13. Diffusion of Innovation Theory
14. Precede-Proceed Model
15. Kelman
Health Belief Model
• The 7 major beliefs that influence the likelihood of
taking action that is relevant to a given disease or
condition are
–
–
–
–
–
–
–
Perceived susceptibility to disease
Perceived severity of disease
Perceived threat of disease
Perceived benefits of action
Perceived barriers to action
Cues to action
Self efficacy
RC in Malaysia
• Action plans eg Pandemic Flu, Emergency
Response
• Simulation Exercises
• Training Modules and Training Key Personnel
• Research Centre
• Research: FGDs
• ASEAN and Local Strategic Plan of Action
Example: Obesity Risk
Communication : Prerequisites
• Epidemiology of Obesity
• Behaviour Factors contributing to Obesity:
Walking less common now
• Knowledge and Attitude towards Eating
• Socio Cultural factors contributing to Obesity
• Availability and convenience of cheap calorie
densed food
• Existing Policies and Regulations
Obesity Risk Communication: Who
are the Main and Major Players?
• Risk Assessment (Epidemiological Assessment):
NCD
• Behaviour Risk Factor Surveillance, and
Educational Assessment: IPTK
• Developing the Strategies HECC/IPTK/NCD
• Developing Messages: HECC/ IPTK
• Dissemination of Messages: HECC/NCD/MySihat
• Impact Evaluation: HECC/IPTK/MySihat
• Policies/Regulations/Enforcement: Program
Managers
•
•
•
•
•
•
•
High Risk Group: From Epidemiological
Assessment and Behaviour Risk Factor
Surveillance
Family history/Family Lifestyle
Sedentary
Smokers who quit
Pregnant mothers
Age: Middle to Old
Medical cases
Identify risk groups within various categories
Risk Factors for Obesity
•
•
•
•
•
•
•
•
•
•
•
•
Genetic predisposition.
Inactivity.
Unhealthy diet and eating habits.
Family lifestyle.
Quitting smoking.
Pregnancy.
Lack of sleep.
Certain medications.
Age.
Social and economic issues.
Medical problems.
You can counteract most risk factors through diet, physical activity and
exercise, and behavior changes.
Formulating Objectives of Risk
Communication
• Need to know
– Knowledge Gap of the Risk
– Existing Attitude and Perception to
the Risk
–Current lifestyle
Formulating Objectives for Risk
Communication for the Obese
• Increase in Awareness and Knowledge of the
Risk involved ie. to narrow the gap
• Instill changes in Perception to the Risk
– Susceptibility
– Severity
– Threat
– Benefits
Engineer changes in Behaviour
Eg. Sedentary to active lifestyle.
Strategies for NGOs: Providing the
cues to effect changes in Behaviour
• Community Intervention through NGOs (Profesional
and non Profesional) Empowering them by doing
– Risk Appraisal through Screening: Opportunities for Brief
Intervention
– Normal, Risk Group, Cases
– Experiential learning, personal and situational
Cases will be referred and messages on complication and
quality of life
Risk Group (overweight and obese): Planned activities to
reduce K gap, changes to perception and above all to
reduce weight
Normal weight same as above for maintenance of weight
Strategies for NGOs: Strengthening Skills
and Capabilities of the Community
• Providing them the technological know how
through:
– Jointly Developing Risk Communication Modules
– Jointly conducting training for Community leaders
and appointed Trainers
– Conduct Training for the Members
NGO
NGO
Screening
NGO activity
NGO: Persatuan Pesara Kerajaan
Malaysia
Aktiviti
NGO: on Obesity
Exercise
Persatuan Ibu Tunggal
Kelab Sukan &Kebajikan Jinjang
Persatuan Ibu Tunggal
Holos Centre
Holos Centre
Empowering NGOs
Empowering NGOs
Empowering NGOs
Capacity Building
Capacity Buiding
Capacity Building
Meeting the Community Leaders in
Putrajaya
Strategy for Policy Makers:Lobbying
• Communicating Risks to Law Makers/
Legislators by Lobbying
• Creating Policies at various settings
• Regulations
• Enforcements
No Smoking Zone
Strategy : Risk Communication
Messages through the Media
• Conveying messages on Healthy Lifestyle (Normal)
• Conveying messages on Risk Factors and how to reduce
Risk (Risk Group)
• Messages on complications and lifestyle changes
(cases)
• Overcoming obstacles to Healthy Lifestyle
• Avoiding conflicting messages
• Information Management: Who is the authority?
• Lobbying the risk to Policy makers to create a
supporting environment
Outdoor Ads
Banners
Media Channels and Vehicles
• Existing Channels and Networks
• Perhaps utilising the ever growing social
media to a greater extent
• Incidental learning/Piggy riding
• Face to Face intervention
Evaluating the Risk Communication
Efforts
•
•
•
•
Knowledge and Perception changes
Behaviour change: Life style changes
Reduction in weight
Mental Appraisal
Overseas Examples: Environmental
Support
• The walkability of neighbourhoods and access to
recreational facilities in and around neighbourhoods
may also assist in promoting healthy weights (John
Spence from the U of A's Faculty of Physical Activity)
• (In Malaysia we are creating pathways, (KLCC-Bt
Bintang Walkway, Bintang Walkway) and many others
in cities and towns) but inadequate, with gaps, poorly
maintained and above all often unsafe in terms
manhole covers removed and cement slaps missing,
reckless motorists who drive on the walkways and park
their cars and snatch thieves who prowl and their
likes).
Examples
• Education and Recreation. "Conversely, factors
such as urban sprawl, lack of physical and
recreational facilities favour sedentary
behaviour and lower physical activity levels
and promote obesity.” (University of Alberta
2008 Urban Planning a Factor in Rising Obesity
Rates, in Science wise, 18th March 2008.)
Examples: Policy to reduce
Obesity In Wales
Large-scale policies ranging from urban development to
transport policy. For instance the Welsh Assembly
Government has launched a four-year blueprint to get more
people to walk and cycle as part of their daily lives. The
Walking and Cycling Action Plan identifies a number of
actions, including:
• Prioritizing walking and cycling in public transport investments
• Ensuring that local authorities provide and maintain high
quality routes and facilities for cyclists
• Increasing provision of safe traffic free walking routes to
schools and workplaces through continuation of the
“Assembly Government’s Safe Routes in Communities
Programme”
cont: In Wales
• Opening an all Wales Coast Path, including
provision for bikes in appropriate places, which
will be completed in time for the 2012 Olympics
• Implementation of Rights of Way Improvement
Plans by all local authorities
• Introduction of the Sustainable Travel Town
project in Wales.
• In the same vein the BBC reported on radical
proposals to boost children’s health by creating
car-free housing developments in Wales.
Policy on Obesity: In The UK
• Authority needs to be shared among many public,
private and non-for-profit bodies in the UK. The
Foresight report has promoted the view that obesity
is a societal challenge, therefore calling for active and
structural policies. As with other large-scale efforts
(e.g. climate change) the UK strategy for tackling
obesity entails the building of partnerships
between government, science, business and
civil society. This approach has underpinned the
development of a UK-wide campaign, called
Change4Life.
UK
• The strategy, sponsored by the Department of
Health and involving the co-branding of a
large array of initiatives relies on “grassroots
involvement from local supporters who will
encourage at-risk families in their community
to trial and adopt the desired behavior The UK
Change4life initiative has sought the active
involvement of neutral third parties, for
example:
Change for Life Initiative UK
• Prominent scientists
• Three NGOs who have produced a major communication campaign
in support of Change4life, local voluntary and community
organisations (over 20,000 of whom have signed up as Change4life
partners and are using the Change4life resources)
• GPs and other health professionals who have endorsed and channel
messages (nearly 4 million items for communication have been
ordered by health care professionals)
• Schools, who have been active distributor of the How Are The Kids
(HATKs) questionnaires. Head teachers have written to parents and
planned Change4life assemblies.
• ur”. Change4Life focussed on prevention, and developed messages
about lifestyle changes. Communication on treatment of individuals
in a clinical setting (e.g. drugs and surgery) has been developed by
the NHS (e.g. under NHS Choices).
UK
• This approach could help to address the challenge of a coherent
and acceptable message. Opinion leaders, NGOs and independent
scientists, when they are trusted sources of expertise, may
contribute to build trust and change behaviour. Provided they are
good communicators, they may also develop narratives that speak
to people. To make an impact scientists and opinion leaders would
need to spread simple messages about healthier lifestyles. Their
communication may be supported by the simple framing of the
Change4life key messages, “eat well”, “move more”, “live longer”.
An evaluation of the impact made on the public by the messages
released could help to adapt future communications.
• (Löfstedt, R.E. 2005. Risk Management in Post-Trust Societies,
Basingstoke: Palgrave.)
UK
• One major advantage of involving companies is that it avoids
exposing the government to a top-down presentation of the risks of
obesity. In modern “post-trust” societies, one-way communication
from the Government down to the people is unlikely to deliver the
desired behavioural change. For example, poor messages from
government sources have contributed to amplify the MMR scare
controversy. On the other hand, the format of the communication
developed by commercial companies should also take account the
level of trust vested in them. In this case the Department of Health
assumed that they would be seen as credible sources of
information:
• Bouder, F. 2006. ‘A Contribution to Transnational risk analysis:
comparative
• analysis of risk perception related to human health issues’, in
Richter, I.K., Sabine Berking, S. and Müller-Schmid, R. (Eds.) Risk
Comparing Anti Smoking to Obesity
• “Using tobacco as a model is an interesting (and maybe
not optimal) choice, since so much of the action in
reducing smoking has come from making cigarettes
expensive and making smoking inconvenient (e.g.,
through bans in different locations). Only a little
traction was gained by raising awareness of the risks,
and in some ways smoking behaviour is easier to
understand since the goal (zero cigarettes) is clear.
With eating and exercise, having a conscious goal
means that people are doing some sort of calculus
about how many calories they are consuming and
expending every single day, an unreasonable
expectation in general”.
Smoking and Obesity
• Slovic has also shown that cigarette smoking is very
high in perceived risk and very low in perceived
benefits, which helps achieve behavioural change. It is
unlikely that food intake could be treated the same
way. Even restricted to the stigmatised category of
“junk food” individual risk-benefit assessment is likely
to be much more positive. Using tobacco as a model is
a problematic choice, since so much of the action in
reducing smoking has come from making cigarettes
expensive and making smoking inconvenient (e.g.
through bans in different locations).
Govt. Efforts V Non. Govt.
• Govt. Campaigns may also backfire, especially when
levels of trust for the government are declining. Critical
media reporting has already suggested that health
authorities’ plans for an ‘obesity tour’ may not be seen
positively: The tours were aimed to “help people
understand labelling in a familiar environment”.
Critiques saw it as a waste of money and a prime
example of the government acting as a ‘nanny state’.
• Martin, D. (2009), Health Chief’s ‘Obesity Tour’ of
supermarkets backfires – as no one turns up to take
part, The Daily Mail, 19th February
Key Messages for Policy Makers on
Risk Communication for Obesity
• Reflect on the risk itself, including perceptions.
Define obesity risk communication on the basis of
the evidence and perceptions directly related to the
issue. Close parallels with other public health issues,
like smoking, are likely to be misleading
• Continue to ensure that, despite the complexity of
the issue, evidence-based messages are presented
and discussed. This implies a responsible approach to
avoid spreading quack or biased theories and at the
same time over simplification (e.g. ‘junk food is the
cause of obesity’)
Key Messages for Policy Makers on
Risk Communication for Obesity
• When developing public campaigns always
keep in mind that trust is a critical factor of
acceptance. Make sure that regular
evaluations take place looking at how well key
actors are trusted, including government and
private sponsors. Loud messages from
distrusted actors may breed cynicism and are
counter-productive.
Key Messages to Policy Makers
• Ensure that the financing of government’s
campaign is well understood, especially when
it involves commercial sponsors.
• Ensure that neutral third parties (opinion
leaders, scientists etc.) are invited to express
their views as often as possible. Ensure that
their involvement also targets those most
affected and not only the general population.
Key Messages to Policy Makers
• Obesity is multi-factorial and is likely to result
in many policy interventions involving various
parts of government. Co-ordination of the risk
communication should focus on avoiding
conflicting messages. A first step could be to
develop a holistic evaluation of the totality of
prevention and weigh control mechanisms
e.g. Change4Life, Why Your Weight Matters,
the NCMP letters, the NHS Choices content on
weight etc.
Operations Room: Bilik Gerakan
•
•
•
•
•
•
•
•
Soft Skills
What should one know
What should one do
Counter Rumours
SOP
Health Education materials
Circulars and Guidelines
Frequently Asked Questions
.
Thank You