Department of Health, Behavior and Society, Johns Hopkins University (Rimal), Department of Communication, Michigan State University (Lapinski)

According to this article from The Bulletin of the World Health Organization (BLT), one of the developments taking place in health communications is the focus on the study of environmental, social, and psychological influences on behaviour and health. Given the global challenges posed by major health-related threats, health communication scholars and practitioners recognise the importance of prevention and, with it, the need to understand human behaviour through the "prism of theory". This has given rise to theorising about the role of risk perceptions, social norms, emotions, and uncertainty in health behaviours.

The authors define communication as the symbolic exchange of shared meaning and state that all communicative acts have both a transmission and a ritualistic component. "Intervention efforts to change behaviours are communicative acts. By focusing mostly on the transmission function of information exchange, such efforts often neglect ritualistic processes that are automatically engaged through communication. In adopting the transmission view of communication, it is reasonable to think carefully about the channels through which intervention messages are disseminated, to whom the message is attributed, how audience members respond and the features of messages that have the greatest impact. These considerations reflect the essential components of the communication process: channel, source, receiver and message, respectively. In the ritual view, however, target audiences are conceptualized as members of social networks who interact with one another, engage in social ceremony and derive meaning from the enactment of habitual behaviours."

Three intervention considerations selected as important are:

1. "First is the realization that communication interventions do not fall into a social vacuum. Rather, information is received and processed through individual and social prisms that not only determine what people encounter (through processes of selective exposure), but also the meaning that they derive from the communication (known as selective perception), depending upon factors at both the individual (prior experience, efficacy beliefs, knowledge, etc.) and the macro-social (interpersonal relationships, cultural patterns, social norms) levels.
2. Second, it is reasonable to expect discrepancies between messages disseminated and received. They arise not only due to differential exposure to the intervention but also because of the differences in interpretation in decoding information. A careful study of the correspondence between messages as they are sent and received is thus of great importance to avoid unintended (and worse, counterproductive) effects.
3. Third, communication is a dynamic process in which sources and receivers of information continuously interchange their roles. One of the central tenets of health communication interventions - the need to conduct extensive formative evaluation, audience needs assessment and message pretesting - is the direct offshoot of this understanding."

Challenges presented by the use of these principles include:

• ..."the evaluation of communication interventions, especially those using national mass media (e.g. radio), does not usually lend itself to randomized trials. Hence, innovative methodological and statistical techniques are required for attributing observed outcomes to intervention efforts....[M]odification in intervention content may occur, adding an additional challenge to the evaluation process.
• ...the recognition among behavioural scientists - that causes of human behaviour reside at multiple levels that reinforce each other - poses difficulties in designing and testing multilevel interventions. This complexity of health behaviour determinants also requires a multidisciplinary approach for effectively promoting change, which further means that interventions need to incorporate expertise from a variety of professional backgrounds.
• ...because of the rapidly changing communication channels, health communication interventions need to make extra efforts to meet their audiences at their level of technology use."

The authors conclude that the field of health communication "is gaining recognition in part because of its emphasis on combining theory and practice in understanding communication processes and changing human behaviour. This approach is pertinent at a time when many of the threats to global public health (through diseases and environmental calamities) are rooted in human behaviour."

The Bulletin of the World Health Organization (BLT) Volume 87, Number 4, April 2009, pages 245-324; and AHILA - NET listserv on April 20 2009.