Promoting Immediacy in Health Communication

Gary L. Kreps, Ph.D., Gary L. Kreps, Ph.D.,

University Distinguished ProfessorUniversity Distinguished Professor

Director, Center for Health and Risk CommunicationDirector, Center for Health and Risk Communication

George Mason UniversityGeorge Mason University

Fairfax, VA 22030, USAFairfax, VA 22030, USA

gkreps@gmu.edugkreps@gmu.edu

How can we communicate to build meaningful and collaborative health promoting relationships?

Effective health communication depends more on the quality of the messages we exchange than on the media we use to convey health messages!

Too many health messages are: Too many health messages are:

Boring & unimaginative (just the facts m’aam)Overly technical (medicalese)Overly complex & formal (bureaucratic)Insulting/disempowering (clean up your act)Directive/prescriptive (we know what’s best for you)Static (our way or the highway)Not much fun (limited entertainment value)One-way (limited interaction)

Health communication is often too Health communication is often too artificialartificial to achieve health goals: to achieve health goals:

♦ How engaging are most HC messages?

♦ Do we capture audience attention (exposure)?

♦ Do we communicate clearly (literacy)?

♦ Do we communicate humanely (sensitivity)?

♦ Do we communicate persuasively?

♦ Do we adapt well to unique individuals?

♦ Do we promote immediacy?

ImmediacyImmediacy refers to communication refers to communication that promotes:that promotes:

♦ Physical and emotional closeness

♦ Comfort

♦ Engagement and caring

♦ Personal involvement

♦ Intensity and enthusiasm

♦ Authenticity

♦ Enjoyment

Where is the Where is the PassionPassion in Health in Health Communication Programs (HCPs)?Communication Programs (HCPs)?

♦ Do HCPs Do HCPs movemove you? you?

♦ Do HCPsHCPs provide both the sizzle and the steak?

♦ Are HCPs HCPs robotic?

♦ Are HCPs HCPs soulful or soul-less?

♦ Are HCPs HCPs alienating or encouraging?

♦ Are HCPsHCPs emotionally provocative & engaging?

♦ Are HCPsHCPs interesting/relevant to users?

Immediate communication can enhance health promotion::

♦ Increase access (exposure) to health information

♦ Improve quality of communication & care

♦ Increase consumer participation/involvement

♦ Promote coordination of care/services

♦ Relieve demands on health care staff

♦ Reduce costs/increasing efficiency

♦ Influence health behaviors/outcomes

Demonstrated Demonstrated outcomesoutcomes derived derived from immediate communication: from immediate communication:

Brings communicators closer togetherEnhances expression of affect Increases cognitive and affective learningIncreases perceptions of credibility & identificationEnhances motivation & participationEncourages communication and feedbackReduces resistance & verbal aggression

NonverbalNonverbal aspects of immediacy aspects of immediacy can demonstrate:can demonstrate:

Friendliness (smiling, congruence, proximity)Animation (movement, gestures, vocal variety)Involvement (eye contact, touch, direct orientation)Excitement (vocal intensity, expressions, design)Comfort (relaxed body posture, proximity, touch)Caring (congruent expressions, appropriate touch)

VerbalVerbal aspects of immediacy can aspects of immediacy can demontrate:demontrate:

Familiarity (refer to person by name, experience) Involvement (use collective terms like “we” and “us”)Clarity (familiar terms, explain complex concepts)Interest (personal interaction, relevant small talk)Reinforcement (specific and appropriate feedback)Shared Control (input, feedback, and preferences) Caring (congruence, concern, and empathy)

Immediacy can help meet Immediacy can help meet reciprocal reciprocal interpersonal needsinterpersonal needs::

Inclusion (need to include others and to be included)Control (need to exert control and let others control)Affection (need to express and receive affection)

(Schutz, W. (1958) FIRO: A Three Dimensional Theory of Interpersonal Behavior. NY: Holt, Rinehart and Winston.)

The best health interventions use The best health interventions use immediacy to immediacy to engageengage audiences audiences

♦ Use relevant communication messages

♦ address personal concerns

♦ are dramatic and interactive

♦ Develop involving messages

♦ tie in to values and concerns

♦ adjust to unique needs/issues

Immediate health interventions are Immediate health interventions are responsiveresponsive to users’ to users’Beliefs, values, norms, & expectationsExperiences and concernsLanguage skills and orientationsHealth literacy levels (language & numbers)Levels of motivation to seek health informationMedia use patternsSocial network memberships

Immediacy helps to capture Immediacy helps to capture audience audience attentionattention::

Connects users on a personal level (empathy)Engages users dramatically (dynamism)Provides vivid, relatable, models (identification)Adapts messages to specific users (personal)Uses multiple complimentary messages (reinforce)Illustrates key concepts (visual/narrative)Provides subconscious encouragement (motivate)Tailors messages to individual needs (adapt)

The immediacy of information The immediacy of information sourcessources is influenced by: is influenced by:

Credibility (believable)Familiarity (comfortable)Expertise (knowledgeable)Engagement (friendly/convivial/interesting)Trust (consistent & fair)Reliability (available when needed)Sensitivity (caring & appropriate)

The most immediate health The most immediate health messagesmessages are: are:

Close and familiar (comfortable for users)Easy to understand (makes sense to me)Dramatic and memorable (emphatic)Embedded in compelling stories (narrative)Easy to apply (builds self-efficacy)Reviewable (take-away media & messages)Interactive (provides feedback loops)Reinforcing (motivating)

Communication Communication research/planningresearch/planning is key for promoting immediacy!is key for promoting immediacy!

♦Audience analysis/needs analysis (foundation for intervention design)

♦Participative design (work with audience members)

♦Message and media testing (develop/refine communication strategies)

♦Usability testing (key user response data)

♦Formative, Process, and Summative evaluation (adapting strategies, what works & why)

References to immediacy and References to immediacy and instructional outcomes research:instructional outcomes research:

Andersen, J.F. (1979). Teacher immediacy as a predictor of teaching effectiveness. In D. Nimmo (Ed.), Communication Yearbook, 3 (pp.543-559). New Brunswick, NJ: Transaction.

Arbaugh, J. B. (2001). How instructor immediacy behaviors affect student satisfaction and learning in web-based courses. Business Communication Quarterly, 64: 42-54.

Chesebro, J.L. and McCroskey, J.C. (2001). The relationship of teacher clarity and immediacy with student state receiver apprehension, affect, and cognitive learning. Communication Education, 50, 59-68.

Gorham, J. (1988). The relationship between verbal teaching immediacy behaviors and student learning. Communication Education, 17, 40-53.

Kelley, D.H. and Gorham, J. (1988). Effects of immediacy on recall of information. Communication Education, 37, 198-207.

Pogue, L. and AhYun, K. (2006). The effect of teacher nonverbal immediacy

and credibility on student motivation and affective learning. Communication

Education, 55, 331-344.

References to immediacy and References to immediacy and health communication:health communication:

Kreps, G.L. (2014). Achieving the promise of digital health information systems. Journal of Public Health Research 3:471, pp. 128-129.

Kreps, G.L., & Neuhauser, L. (2013). Artificial intelligence and immediacy: Designing health communication to personally engage consumers and providers. Pt. Ed. & Counseling, 92, 205-210.

Neuhauser, L., Kreps, G.L., Morrison, K., Athanasoulis, M., Kirienko, N., & Van Brunt, D. (2013). Using design science and artificial intelligence to improve health communication: ChronologyMD case example. Patient Education and Counseling, 92, 211-217.

Kreps. (2012). Consumer control over and access to health information. Annals of Family Medicine, 10(5). http://www.annfammed.org/content/10/5/428.full/reply#annalsfm_el_25148

Kreps. (2012). Engaging health communication. In T.J Socha and M.J. Pitts. (Eds.). The positive side of interpersonal communication (pp. 249-258). New York: Routledge.

Neuhauser & Kreps. (2011). Participatory design and artificial intelligence. In Green, Rubinelli, & Scott. (Eds.). Al and Health Communication (pp. 49-52). AAAI Press.

Kreps & Neuhauser (2010). New directions in ehealth communication: Opportunities and challenges. Pt Ed & Counseling, 78, 329-336.

Kreps & Neuhauser (2010). E-Health and health promotion. Journal of Computer-Mediated Communication, 15(4), 527-529.