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.