communication in health and public participation
DESCRIPTION
the role of communications and public relations in health services, including community participationTRANSCRIPT
Communication in Health & Public Participation
Louise Miller FrostUniversity of SA
October 2006
NGOs
politicians
Consumer Groups
SADept Health
Emergency Services
Federal DoHA
Accreditat’n Boards
Private Hosps
GPsUnions media
Drug Companies
Professional Colleges
Divs of GPs
SA Ministers
Fed Ministers
Private providers
Non-clinical staff
specialists
communityClinical
staff
Health
Policy Environment
Federal Parliament & Ministers
Dept of Health & Ageing
SA Parliament & Ministers
Dept of Health Social Inclusion
Unit
Mental Health Unit
Health Regions
COAG
Dept Health Strategic Directions
Increase community inclusion and participation
Collaborate and work in partnership Direct resources to ensure access and
equity Strengthen and reorient resources for
prevention, early intervention and primary health care
Improve the quality and safety of services
Communication Aims
Public Health / Health promotion Community support for programs /
facilities Developing and sustaining partnerships Managing demand Provide good news stories for Minister Influence policy Implement change / new programs Promoting facilities / programs
Levels of criteria for evaluating public relations objectives. Figure 4.1, p51, Quarles and Rowlings, Practising Public Relations a Case study approach, Longman, 1993, Australia
NSW Centre for Public Health Nutrition. Report of the Consumption of Vegetables and Fruit in NSW 2003. Adapted from Hawe et al 1990.
Health Promotion Planning Framework
Examples of Communication Strategies Immunisation Folate in pregnancy Cancer screening Harm Minimisation: Safe sex, drugs,
drink driving Healthconnect Mental health (Beyondblue etc) Pandemic Planning SNAP (Smoking, Nutrition, Alcohol,
Physical Activity)
Implementing Change
Engaging with numerous stakeholders in ways that are meaningful to them
Broad consultation to develop a sense of ownership and commitment to the process and to the end result / product
Ensuring stakeholders feel heard
Change Management Principles
valuing the input of stakeholders recognising diverse viewpoints ownership of the process by
stakeholders make solutions simple and intuitive policy and best-practice
underpinning education process
Change Management Principles Identify some early-adopters (leaders) physical reinforcement to support model
and serve as reminders (shared facilities, agreed documentation and communication)
evaluation : regular review with fine-tuning
ensure some early wins - and celebrate them
empower stakeholders by asking for ongoing feedback in managed way
So why is change so hard?
Max
Likelihood that
benefit will occur
Min
Never Often
Frequency of action required
(John Moss, University of Adelaide, Personal Communication)
Examples
•Hot water scalds
•Fitness campaigns
Why don’t the interventions work?
Health Belief Model:
A person will take a ‘health related action’ if:
they feel the health condition is negative
they have a positive expectation that taking the action will avoid the condition
they believe they can successfully take the required action
Hochbaum, Rosenstock and Kegels, quoted in www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20communication
Sallis JF, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine 1998;15(4):379-397.
Organisational culture – a change barrier
Carroll, J S et al. Qual Saf Health Care 2004;13:ii16-21ii
Copyright ©2004 BMJ Publishing Group Ltd.
Public Participation
In mental health, national principle state that best practice is for consumers to be involved in service design, planning and delivery.
Mental health has the additional challenge of huge stigma
Stigma
Prevents people seeking help (Helen Mayo House example)
People don’t want facilities ‘in their back yard’
People don’t employ consumers Consumers can be socially isolated Media misinformation and
sensationalism inflames ignorance
Communication Theory revision
Grunig Press Agentry Public information Two way assymetric Two way symmetric
Quarles J, Rowlings B, Practising Public Relations, A case study approach. 1993, Longman, Australia, p8, figure 1.2
Source ReceiverMedium
Feedback
More sophisticated
There are different levels of communication and consultation that you might choose to employ in different situations.
Each of these forms of communication comes with unspoken understandings and promises between you and your ‘publics’
Inform: Bird Flu Pandemic
Message: stay home! Aim: to inform public of crisis and what
they need to do Secondary: to inform them of symptoms,
tell them how to seek help
Bird Flu
Generally one-way communication with public
Strong instructional ‘voice’ to deal with panic, coordinated messages
Many vectors for communication – media, community based health services eg: GPs, information also to schools, workplaces, etc
Some feedback through crisis lines / hotlines to gather information
Backed up by health service planning done prior to crisis
Consult : CALD population
Message: are these planned services going to meet your needs
Aim: to inform the planning process and to gain ‘ownership’ from the community for the decision
Two way communication but facilitated (ie : limited options)
Sometimes a late stage in the planning process
Involve : Mental Health planning
Message: we want your opinions and input into the planning process
Aims: to ensure the planned facilities or services meet the needs of the stakeholders
Two-way communication, Less structured, more open response
Often an early stage of the process
Collaborate: Shared Care
Message: this is a partnership where both parties have equal stakes in the result
Aim: to develop an agreed plan with commitment and ownership from all stakeholders
May involve representatives of stakeholder groups
More equal
Empower: Citizen Juries
Message: this is your service, you need to inform us what you want
Aim: to ground the decision making process in the community
Eg: Gavin Mooney (Health economist at UWA)
Unspoken promise: we will implement what you decide
Multi-methods : Immunisation GPs – incentives to reach a certain % immunised in
their patients, provision of immunisation nurses / practice nurse education etc
childcare centres – posters, brochures etc child health (CYFS) – policies to encourage
immunisation Parents – child care rebates dependent on
immunisation status, information campaigns, meetings
Divisions of GPs : funding for an immunisation nurse
Councils : funded for immunisations Immunisations days provided at schools, kindies
and childcare
Task : Type II Diabetes prevention
Design a campaign to prevent diabetes Type II in the western suburbs of Adelaide
Assumptions: evidence has established that physical activity and diet can prevent the onset of Type II Diabetes.
Your population has been studied and has shown to have inadequate levels of physical exercise and poor diet compared to national standards.