Health communication encompasses the study and use of communication strategies to inform and influence individual and community decisions that enhance health. It links the domains of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health (National Cancer Institute (NCI), 1989; Jackson and Duffy, 1998; Piotrow, et al., 1997).
Health communication can contribute to all aspects of disease prevention and health promotion.
For individuals, effective health communication can help raise awareness of health risks and solutions provide the motivation and skills needed to reduce these risks, help them find support from other people in similar situations, and affect or reinforce attitudes (NCI, 1989).Health communication also can increase demand for appropriate health services and decrease demand for inappropriate health services. For the community, health communication can be used to influence the public agenda, advocate for policies and programs, promote positive changes in the socioeconomic and physical environments, improve the delivery of public health and health care services, and encourage social norms that benefit health and quality of life (Piotrow, 1997).
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It is used to prevent morbidity and mortality and to promote a notion of holistic health and wellbeing (Nova, 2008).
Communication in health takes place on many levels, including individual, group, organisation, community or mass-media. Health practitioners have an important role in the improvement of individual, group, or community health by “encouraging people to commence or increase health promoting behaviours and to cease or decrease health damaging behaviours” (Jones and Donovan, 2004).Communication process is a multi-dimensional transaction (Nova,2008).
Health promotion aims to reduce adverse health risks in an entire population by targeting those at high, low and no risk. Review of the literature suggests that mass media communications campaigns increase awareness, information seeking, knowledge and intent to change behaviours, improve attitudes and result in behaviour change (Freimuth and Taylor, 1996).
Theory is defined as a set of interrelated concepts, definitions, and propositions that present a systematic view of phenomena by specifyÂÂing relations among variables, with the purpose of explaining and predicting the phenomena (Kerlinger, 1973). It presents a systematic way of understanding events or situations. Using theory as a foundation for program planning and development is consistent with the current emphasis on using evidence-based interventions in public health. For the purpose of this assignment, I will be addressing the issue of arthritis focusing on the theoretical and practical management, leadership and communication issues to be addressed for the effective execution of a health campaign to prevent arthritis and promote lifestyle modification, including physical activity, weight loss, and reduction in consumption of saturated fats and alcohol.
Background to the health issue
Definition of Arthritis
Arthritis and other rheumatic conditions are among the most common chronic conditions and the leading cause of disability in the United States (CDC, 2003a) .These conditions frequently lead to limitations in work, recreation, and usual activities, including basic self-care. Three of the most common forms of arthritis are osteoarthritis, rheumatoid arthritis, and fibromyalgia.
- Osteoarthritis or “degenerative joint disease. Degeneration of joint cartilage and changes in underlying bone and supporting tissues lead to pain, stiffness, movement problems, and activity limitations (CDCP, 1999).
- Rheumatoid arthritis is characterized by chronic inflammation of the joint lining.
- Symptoms include pain, stiffness, and swelling of multiple joints. This lead to bone and cartilage erosion, joint deformities, movement problems, and activity limitation (CDCP,1999).
- Fibromyalgia is a pain syndrome involving muscle and muscle attachment areas. Common symptoms include widespread pain throughout the muscles of the body, sleep disorders, fatigue, headaches, and irritable bowel syndrome and occur more commonly in women than men((Helmick et al., 2008).
The Arthritis Burden
Approximately 27 million people in United State have osteoarthritis, 5 million have fibromyalgia, and another 2.1 million have rheumatoid arthritis (Helmick et al., 2008).In addition, arthritis has a significant effect on quality of life, not only for those who experience its painful symptoms and resulting disability, but also for their family members and care givers.Arthritis prevalence increases with age. Prevalence of arthritis is higher among women (28.3%) than men (18.2%) (CDC, 2003b).
Arthritis annually results in 36 million ambulatory care visits, 744,000 hospitalizations, 9,367 deaths, 19 million people with activity limitations (Helmick et al., 2008).
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Thus, arthritis has become one of the most pressing public health problems in the world, a problem that is expected to worsen unless prompt and responsible action is taken.
Effects of arthritis:
Arthritis is a threat to a person's physical, psychological, social, and economic wellbeing. It often deprives people of their freedom and independence and can disrupt the lives of family members and other care givers.
Physical symptoms of arthritis include pain, loss of joint motion, and fatigue.
Psychological stress, depression, anger, and anxiety often accompany arthritis.
Social well-being is affected by arthritis. People with arthritis frequently experience decreased community involvement, difficulties in school, and sexual problems.
Economic implications of arthritis include inadequate access to care, and financial burdens due to health care costs and income loss resulting from work limitations.
Arthritis is second only to heart disease as a major cause of missed work. (La Plante, 988).
Risk factors for arthritis
Three of these factors are:non-modifiable female sex, older age, and genetic predisposition. Although these factors cannot be changed, knowledge of their presence helps identify groups at higher risk for arthritis so that intervention efforts can be targeted accordingly.
- Women aged 15 years and older account for 60% of arthritis cases. At least 26.4 million women have arthritis, the leading chronic condition among women, (Callahan et al., 1996; CDC, 1995).
- Age is also associated with increased risk of arthritis. Half of the elderly population is affected by arthritis, and risk increases with age.
- Genetic predisposition. Certain genes are known to be associated with a higher risk of some types of arthritis. Modifiablerisk factors are also associated with increased risk of arthritis. These include
- Obesity. (CDC, 1996)
- Joint injuries.
- Certain occupations (for example, farming, heavy industry, and occupations with repetitive knee-bending (Felson et al., 1991; Felson and Zhang, 1998).
Health promotion Approach
This concept encompasses three levels:
- Primary prevention is designed to prevent a disease or condition (arthritis) from occurring in the first place. Physical activity to reduce the risk of arthritis is an example of primary prevention measure.
- Secondary prevention attempts to identify a disease in its earliest stage so that prompt and appropriate management can be initiated. Successful secondary prevention reduces the impact of the disease.
- Tertiary prevention focuses on reducing or minimizing the consequences of a disease once it has developed. The goal of tertiary prevention is to eliminate, or at least delay, the onset of complications and disability due to the disease.
Primary prevention strategies that exist for arthritis
Only a few primary prevention strategies are considered effective for arthritis. These include:
- Weight control: Maintaining an appropriate weight or reducing weight to a recommended level lowers a person's risk for certain common forms of arthritis. Obesity is a risk factor for osteoarthritis of the knee (Felson and Zhang, 1998; Roubenoff et al., 1991).
- Occupational injury prevention: Taking precautions to avoid repetitive joint use and resulting joint injury in the occupational setting can help to prevent arthritis (Felson, 1991).
- Sports injury prevention: Using recommended injury prevention strategies (for example warm-ups, strengthening exercises, and appropriate equipment) help to avoid joint injuries and damage to ligaments and cartilage, all of which can increase the risk of osteoarthritis (Felson and Zhang, 1998).
- The secondary prevention strategies for arthritis condition
- Early diagnosis. Early diagnosis of all types of arthritis is important (Rao et al., 1997)
- Medical treatment. Antibiotic treatment for early Lyme disease can prevent later stage disease (Steere, 1990; Schoen, 1994). Reduction of uric acid levels in gout and early use of disease modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis can improve long-term outcomes.
The tertiary prevention strategies for Arthritis condition
Tertiary prevention strategies can reduce pain and disability, increase a person's sense of control, and improve quality of life.
- Weight control and physical activity: are important components of a disease management program. Being overweight is associated with increased risk of osteoarthritis, and weight loss reduces the risk of knee osteoarthritis (Felson, 1992).
- PACE (People with Arthritis Can Exercise) is one such community-based recreational exercise program.
- Education: is another effective self-management intervention for people with arthritis.
- Rehabilitation services: Physical and occupational therapy can remediate impairments and diminish activity limitations.
- Medical and surgical treatment: Many different drugs are used to treat arthritis. Medications for some types of arthritis can limit disease progression, control symptoms, and prevent serious complications.
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Joint replacement therapy is most appropriate for people with chronic, severe pain or activity limitations.
Strategies for the success of the communication program
The following activities will be carried out to ensure the success of the communication program:
Thorough situation analysis
This is one of the first steps in designing an effective communication program. Determination of the current burden of arthritis, the level of awareness of the health issue by the public, and the kind of communication strategy in place are vital.
Also, a thorough understanding of the target audience is necessary. It is important to know their demographic, social, political, cultural and economic characteristics.
This can be carried out through key interviews, observations, and focus group discussions surveys.
The overall goal of this Plan is to stimulate and strengthen a national coordinated effort for reducing the occurrence of arthritis and its accompanying disability.
Specific goals are to
- Establish a solid scientific base of knowledge on the prevention of arthritis and related disability.
- Increase awareness of arthritis, its impact, the importance of early diagnosis and appropriate management, and effective prevention strategies.
- Implement effective programs to prevent the onset of arthritis and its related disability.
- Increase public awareness of arthritis as the leading cause of disability and an important public health problem.
- Promote early diagnosis and appropriate management for people with arthritis to assure them the maximum number of years of healthy life.
- Minimize preventable pain and disability due to arthritis.
- By developing and accessing the resources they need to cope with their disease.
- Ensure that people with arthritis receive the family, peer, and community support they need.
The objectives must be SMART that is it should be specific, measurable, achievable, realistic and time bound (Naidoo and Wills, 2009). The objectives will include:
- To increase the level of awareness and knowledge of arthritis
- To promote positive attitudes towards lifestyle modification.
- To improve activities of daily living and rehabilitation.
Communication Strategies for the Public
This target audience, the broadest of the three, includes all Americans. These priority audiences include(CDCP,1999)
- People with arthritis symptoms.
- At-risk populations (for example, ethnic groups, medically underserved populations, and groups with low socioeconomic status).
- Family members of people with arthritis.
- Non-traditional partners (for example, co-workers, neighbours, faith communities, Meals on Wheels programs, and local merchants).
- Federal, state, and community government leaders.
Three major strategies should be used to deliver these messages to the priority public audiences:
1. Promote partnerships to deliver consistent messages that reach entire populations.
Because of the breadth of the audience needing arthritis-related messages and the diversity of subpopulations within that audience, organisations and agencies must pool their resources and efforts to deliver a consistent message.
- Identify national and state coalitions that address risk factors for arthritis.
- Strengthen collaborations among government agencies, voluntary health agencies, and professional organizations.
- Coordinate a communication campaign on behalf of all partnership network members.
- Seek and build on reliable sources of arthritis information, actions, and services.
2. Conduct market research to shape the messages.
Because arthritis potentially affects all community members, arthritis-related messages and delivery channels need to be tailored to appeal to different segments of the community. This degree of specification requires market research to both shape the message and delivery channels and test their effectiveness as awareness campaigns are developed.
- Identify subpopulations within target groups for arthritis messages.
- Design and implement behavioural research to determine the health practices and media preferences of each target group.
- Develop and test arthritis and disability messages for physical activity campaigns, nutrition and weight control programs.
- Develop messages about the importance of weight maintenance and physical activity.
- Produce materials that can be used by agencies and organisations that serve target groups.
3. Increase awareness throughout all communities.
It touches people throughout the community: children in schools, employees in the worksite, participants in senior centres, members of all faiths, and isolated individuals living alone.
- Tailor messages and develop campaigns to reach people with undiagnosed arthritis and to prompt them to seek early diagnosis and appropriate management.
- Tailor messages about community norms for weight and physical activity.
- Develop messages about injury prevention.
- Add to existing physical activity campaigns messages about the role of physical activity in minimizing arthritis disability.
- Increase awareness of the link between arthritis and weight control, physical activity, and nutrition.
- Ensure that messages effectively counteract prevailing misconceptions.
- Include arthritis prevention messages in health education/healthy lifestyle programs in schools and workplaces.
Incorporate arthritis into chronic disease prevention, health promotion and education, and other programs of state and local health departments.
Several prevention strategies for arthritis are similar to risk-factor reduction strategies for other chronic conditions. Many state and local health departments already have programs directed toward increasing physical activity, promoting a healthy diet, and reducing obesity. All of these programs could be modified to incorporate an arthritis-specific message. In addition, state and local health departments have the opportunity to design programs directed at reducing arthritis disability through appropriate prevention messages.
- Encourage state and local health departments to make arthritis patient education materials available at all treatment sites.
- Facilitate partnerships between public health agencies and managed care organisations to provide appropriate arthritis education across the natural disease spectrum, from prediagnosis through disability management, and in all types of care settings (for example, community-based care, and in-home care)(CDCP,1999).
Communication Strategies for Health Professionals
This audience includes all clinical, community, and public health professionals who potentially affect the health and well-being of people with or at risk for arthritis(CDCP,1999).
Subgroups of the health professional audience include
- Primary health care providers, including paediatricians, who see the majority of arthritis patients.
- Rheumatologists, physiatrists, orthopaedic surgeons, paediatrics, rheumatologists, and other physicians.
- Physical therapists and occupational therapists.
- Social workers and mental health workers.
- Exercise and fitness professionals, teachers, and coaches.
- Alternative medicine practitioners.
- Public health community members (for example, educators, public health nurses, and program managers).
- Although the specific message will vary for different types of providers, all of these professionals must know
- The prevalence of arthritis and its impact on disability and quality of life.
- The most common myths about arthritis and accurate information to dispel them.
- Preventive strategies.
- The importance of early diagnosis of the type of arthritis and appropriate management strategies.
- Referral sources (that is when and where to refer).
- Sources of support.
- The value of self-management and other non pharmacological interventions.
To be able to intervene early and appropriately to reduce disability, health professionals must have accurate, up-to-date information about arthritis. The following approaches should be tailored, based on behavioural research, to each type of health professional(CDCP,1999).
- Improve the knowledge, attitudes, and practices of primary care practitioners and other physicians through undergraduate and graduate education, continuing medical education, and in-service education.
- Improve the knowledge, attitudes, and practices of other health professionals through undergraduate and graduate education, continuing education, and in-service education.
- Extend the reach of arthritis-related messages by using communication vehicles such as state and county medical societies, state and national professional organizations, professional newsletters and conferences, and websites of professional organizations and advocacy groups.
Evaluation and Feedback
A baseline assessment would be carried out and indicators would be set. For example, the program may be assessed based on changes in the levels of awareness, and the proportion of people with arthritis who can now manage the symptoms on their own. This will serve as feed back for improvements in future interventions.
Although health communication is an integral component of quality care (Vahabi, 2007), developing and managing an effective health communication campaign is no easy task. In light of empirical evidence supporting the benefits of health promotion and the premise that effective health communications can affect preventive health practices (Vahabi, 2007), and in the context of health promotion practice ethics, it is essential to ensure that the delivery of optimal health communication is deemed a high-priority health promotion issue. By contrast, poor health communication leading to less-than-optimal care delivery and outcomes (Aitkens et al., 2005) and inadequate understanding of self-care behaviours can result in legal ramifications and reduced life quality (Betancourt et al., 2000). Vahabi (2007) stated that miscommunications or failures to communicate health risks can also jeopardize people's safety and their health status. In addition, spending time on some issues and not on others and not taking people's capacities or situations into account may affect their ability to access health care and their dignity and rights to the benefits of optimal health education. A thorough understanding of the theoretical issues underlying behavioural change and the various strategies for effective implementation are important issues to consider. However theory alone cannot guarantee the success of any program. An effective manager must also understand the practical issues involved and know how best to deal with these issues for successful outcomes.
Also adequate program planning is essential, but even the best laid plans may not be well executed if the people do not have the right managerial skills. Development of effective leadership and management skills are therefore important and must also be considered in the success of the program.