Health communication is about all aspects of human communication that relate to health. More formally, health communication has been defined as referring to any type of human communication whose content is concerned with health (Rogers, 1996), where the focus is on health-related transactions and the factors that influence these. The health communication field studies several aspects of human health and the healthcare environment. Studying health communication can help improve patient and provider communication, that will result in better health results for the patients. It can also help improve communication within a healthcare organization, providing a smoother system where both providers and patients have a better experience. Health communication is studied from a multidisciplinary approach from fields like public health, health sciences, psychology and communication.
The most obvious application of health communication has been in these areas of health promotion and disease prevention. Research has uncovered improvement of interpersonal and group interactions in clinical situations, between provider and patient, provider and provider, and among members of a healthcare team through the training of health professionals and patients in effective communication skills. A subsection of health communication that I am interested in is health campaigns. Campaigns traditionally have relied on mass communication and educational messages in printed materials to deliver health messages. Other campaigns have integrated mass media with community-based programs and incorporated social marketing techniques. For the last year I have been interested in oral health. I have helped as a coder and co-author in a study about oral health in Appalachia Kentucky. The Appalachian region faces oral health disparities that require continued attention to address a “silent epidemic,” where over 98% of the population suffers from tooth decay by age 44 and more than 50% of adults have destructive periodontal disease (Ebersole, Souza, Gordon, & Fox, 2012). Rural, low-income, Appalachian residents are less likely than urban, wealthier residents to visit a dentist, are more likely to have no dental insurance, and suffer disproportionate rates of missing teeth (Office of Oral Health, 2003). The relationship of health-related behaviors with socioeconomic position and oral health implies that behaviors play an important role in the socioeconomic disparities in oral health (Sabbah et al., 2009). Milgrom and Reisine (2000) provide compelling national data that show tooth decay, periodontal diseases, and loss of teeth are disproportionately highest among those who live in rural areas.
Good oral health and dental hygiene are crucial for overall health. Dental caries and periodontal diseases are among the most prevalent and costly chronic diseases around the world (Puska, Porter, & Petersen, 2003). Dental caries affects between 60% and 90% of school children worldwide, and is untreated in one out of five American adults (Dye, Li, & Beltran-Aguilar, 2012). According to the American Academy of Periodontology, brushing teeth after meals, flossing at least once a day, and seeing the dentist at least once a year are the three main prevention drivers to obtain good dental health (American Academy of Periodontology, 2014). Fear and anxiety is the most usual reaction that is popularly referred to when the topic of dentists or dental visits are brought up (Finch, Keegan, Ward, Senyal Sen B S) There are many reasons why people do not go to the dentist, lack of insurance, fear and anxiety, lack of dentist in their area, and more. Young adults have a harder time scheduling their dental checkup. As young adults move to college away from their family and stop being in their parents' insurance, they struggle to keep up with their dental hygiene.
Oral health is important because it decreases quality of life and harms social life (Locker, 2000). Having poor oral health can exacerbate systemic conditions, such as diabetes and respiratory and cardiovascular diseases (Mattila, 1993). For example, poor oral health has been associated with higher risk of coronary heart disease and increased risk of cardiovascular and cancer mortality (Cabrera, 2005). If young adults change their perception and behavior towards oral health it will be the start to a healthier life.
Dental anxiety and fear plays a role in explaining delayed dental care and the underuse of dental services (McNeil & Berryman, 1989). Those who delay dental care often forego preventive care, which is less intensive, expensive, and severe than corrective care (Crego et al. 2014). Many patients with dental fear seek treatment only when orofacial pain is unbearable (Armfield et al., 2007). This brings me to my research interest, creating effective health campaigns to persuade people to visit the dentist more often. Especially for preventive care and not only going to the dentist when they have oral health issues. Nemeth et al. (2012) conducted a study in rural Appalachia and found that residents are knowledgeable about proper dental care but are discouraged to act on their knowledge due to stereotypes that already exist about their oral health. The media often selects stereotypical representations of Appalachians that include images of people with broken, damaged, or missing teeth (Zschaebitz & Gordon, 2013).
Another big reason that people have poor oral health is their diet and eating behaviors. Diet (Neiswanger et al., 2015) and heavy soda consumption (McDaniel & Strauss, 2006; Savage, Scott, Aalboe, Stein, & Mullins, 2015) are important factors related to oral health that reveal the strong influence of family on oral health in the region. Schoenberg, Howell, Swanson, Grosh, and Bardach (2013) studied perceptions of healthy eating among Appalachian residents and found that many participants identified gaps in nutrition knowledge as a persistent challenge, and discussed problematic influences from family, friends, and media on perceptions of healthy food choices. Nemeth et al. (2012) reports that women in Appalachia commonly cook heavily fried foods, increasing risk of diabetes.
One of the theories used in health communication campaigns is the theory of reasoned action. The theory of reasoned action explains volitional human behavior, proposing that one's intention to perform or not perform a behavior is the most critical determinant of human behavior. Behavioral intention is dependent on the individual's attitude toward the specific behavior, and his or her perception of the evaluation of the behavior by important others. The attitude of the individual, in turn, results from his or her salient beliefs about the outcomes of the behavior. Similarly, the individual's motivation to comply with salient others in his or her social network accompanied by the normative beliefs regarding the target behavior ascribed to these salient others produce his or her subjective norms (Fishbein, 1990; Fishbein & Ajzen, 1975).
When creating a health campaign, researchers have to create messages to disseminate to their population. Several researchers play with the idea of loss vs. gain framed messages when creating ads. A loss-framed persuasive appeal emphasizes the disadvantages of failing to comply with the communicator's recommendation. The contrast is a gain-framed appeal, which emphasizes the advantages of compliance (O\'Keefe & Jensen, 2009). Research suggests that potential losses are more motivating than potential gains when risky actions are contemplated, whereas gains are more motivating than losses for low-risk behaviors (Kahneman & Tversky, 1979).
Another theory I am interested in using with the theory if reasoned action is Bandura's theory of self-efficacy. Bandura (1977) claims that perception of self-efficacy is an important factor in determining human behavior. A person self-efficacy determines whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences.
McCaul, O'Neil, and Glasgow (1988) tested the self-efficacy model for oral hygiene behaviors and compared the usefulness of self-efficacy expectations with theory of reasoned action. In his study, McCaul et al. found that self-efficacy added significantly to the prediction of intentions, beyond the attitude and subjective norm components of the theory of reasoned action. Bandura's self-efficacy theory establishes that humans are going to perform behaviors they feel they can cope with and avoid behaviors they feel they cannot manage. In addition to good self-efficacy perception, appropriate skills and incentives are also needed if an activity is going to be performed (Bandura, 1977).
Several health campaigns use fear appeal messages. I do not think fear appeals are the most effective when trying for people to adopt or change a behavior. A great example is FDA's smokeless tobacco campaign. The extended parallel process model (EPPM) of fear appeals is an example of a recent model of fear appeals. The EPPM maintains that when receiving a fear appeal, people engage in two appraisal processes: threat appraisal and perceived coping appraisal. Threat appraisal involves judging the severity of the danger and one's susceptibility to the danger. Coping appraisal incorporates judgments of the efficacy of the proposed response and self-efficacy judgments. If the perceived threat results in an at-risk judgment and the efficacy judgment suggests the individual can respond to the threat, that person should be motivated to engage in danger control process (Witte, 1995). Fear appeals have proven not be as successful during the years. I believe is more effective to give information that just creating fear on people mind.
...(download the rest of the essay above)