MESSAGE STRATEGIES TO RAISE PUBLIC AND POLICYMAKER AWARENESS OF POPULATION HEALTH DETERMINANTS AND DISPARITIES

• Sponsoring Institution: State Agricultural Experiment Station
• Project Status: TERMINATED
• Funding Source: STATE
• Reporting Frequency: Annual
• Accession No.: 0218260
• Project No.: NYC-131320
• Project Start Date: Jan 1, 2009
• Project End Date: Sep 30, 2009

Project Director
Niederdeppe, J.

Recipient Organization
CORNELL UNIVERSITY
(N/A)
ITHACA,NY 14853

Performing Department
Communication

Non Technical Summary
The field of population health has been characterized by attention to (1) multiple determinants of health, recognizing medical care and individual behavior but highlighting the importance of social determinants of health (SDH), and (2) health disparities between population groups. One major component of the RWJF-funded project entitled, "Mobilizing Action Toward Community Health (MATCH)" is to conduct and disseminate county rankings for each county in the United States. These rankings are likely to be based on multiple determinants of health (including social, structural, and environmental factors) and incorporate information about the distribution of health (health disparities) in communities. Increasing awareness of and concern about social determinants and health disparities will be essential to ensure that these efforts are successful in promoting multi-sectoral investments to improve population health and reduce disparities. The goal of this research is to develop and test messages to raise public awareness of and concern about SDH and health disparities. Ultimately, we aim to identify a series of messaging best practices and disseminate a message design "toolkit" for use in local communities to support efforts to mobilize action toward community health. These goals will require the development and empirical testing of innovative strategies that highlight non-medical and non-behavioral determinants of health.

Animal Health Component

(N/A)

Research Effort Categories

Basic

100%

Applied

(N/A)

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
610	6099	3030	33%
723	6099	3030	34%
724	6099	3030	33%

Knowledge Area
610 - Domestic Policy Analysis; 724 - Healthy Lifestyle; 723 - Hazards to Human Health and Safety;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3030 - Information and communication;

Keywords

health

policy

dissemination research

public opinion

Goals / Objectives
The goal of this research is to develop and test messages to raise public awareness of and concern about SDH and health disparities. Ultimately, we aim to identify a series of messaging best practices and disseminate a message design "toolkit" for use in local communities to support efforts to mobilize action toward community health. These goals will require the development and empirical testing of innovative strategies that highlight non-medical and non-behavioral determinants of health. Different messaging strategies may be needed for different stakeholders, which include both the general public (via public opinion) and policymakers (across sectors). A recent review, published in Milbank Quarterly, suggests that the use of personal stories and evocative visual imagery may be uniquely influential for policymakers, the general public, and actors from non-health sectors in highlighting the importance of social determinants and health disparities. At the same time, specific narrative and visual strategies to maximize the effectiveness of these approaches have not yet been identified. In other words, not all stories or images were created equal. Key questions to be addressed with this project are as follows: 1) Are messages that incorporate personal stories, visual imagery, or both, more effective than standard research summaries or statistical data about SDH and health disparities at raising concern for and motivating effort to address these issues 2) What specific characteristics of personal stories (plot, character) and images (inviting generalizations, suggesting causal interpretations, highlighting contrasts, and/or creating analogies) are most effective in raising awareness of SDH and health disparities 3) Are message strategies that are effective for the general population (e.g., voters) equally effective for policymakers, or are wholly different strategies necessary for each population

Project Methods
This project proposes a series of focus groups, in-depth interviews, and message testing studies to clarify specific message strategies that hold the greatest promise for mobilizing action toward community health. In Year 1 we will conduct a systematic content analysis of message strategies that have been used to support public education efforts about the social determinants of health. These analyses will be used to identify a variety of promising message strategies for subsequent empirical testing in focus groups and field experiments. We will continue in Year 1 with a series of focus groups, to be held in upstate NY, designed to explore open-ended message concepts among members of the general public. We will begin by asking respondents about their perceptions of health determinants and disparities. Then we will begin the discussion about message strategies by soliciting feedback on strategies used in previous county health rankings (e.g., the logic model; visuals used in the Healthiest State project). We will also solicit reactions to a series of messages identified in the content analysis, with the goal of identifying effective strategies and improving the messages for subsequent empirical testing. In year 2 we will interview policymakers through established contacts in Wisconsin and identify actors from one of five case study states. The sequence of questions will closely mirror that used in the general public focus groups. We will also begin a series of message testing experiments among the general public in year 2. We will randomly assign residents of upstate NY to one of four conditions: (1) a series of personal stories, (2) a series of photo-essays or other images, (3) both, or (4) no messages (control). We will use multiple messages within condition and ask respondents to respond to each, with the goal of identifying characteristics of the most highly-rated messages. We will also compare groups in terms of their (1) beliefs about the weight of different health determinants, (2) attributions about who is responsible for improving population health, (3) awareness of and concern about health disparities by various social groups, and (4) intentions to engage in community mobilization to improve population health and reduce health disparities. In year 3, we will conduct a series of message testing experiments among policymakers, following the same general logic of the general public message experiments in year 2. We will also spend the first part of year 3 analyzing results from the general public message testing experiments. Based on these data, we will develop a "message design toolkit" for dissemination along with the county health rankings to community officials. This toolkit will be developed in collaboration with the communications team at RWJF and will identify a series of best practices for the use of personal stories and visual images to accompany county health rankings. We will spend the latter part of year 3 analyzing the policymaker experiment data and preparing peer-reviewed publications based on study findings.

Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: Activities completed in this reporting period include: 1) Focus group data collection with 100 respondents for a 2-hour discussion about messages to raise awareness of health determinants and disparities (in November 2009); 2) Analysis of these data to produce the following papers, currently being prepared for publication: Clarke, C., & Niederdeppe, J. (in draft). Message strategies used by public communication campaigns about social determinants of health and health disparities: An exploratory study. 3) Survey data collection with 500 respondents for a mall intercept survey in the Binghamton, NY area (in April, 2009); 4) Analysis of these data to produce the following conference presentation: Niederdeppe, J. (2009). Message design strategies to raise public awareness of social determinants of health and population health disparities. Presented at the Third Annual National Conference on Health Communication, Marketing and Media, Atlanta, GA, August 13, 2009. This conference featured researchers, government agency representatives and commercial advertising and public relations agencies engaged in health communication and social marketing. Estimated attendance = 125. 5) Analysis of these data to produce the following guest lectures: Niederdeppe, J. (2009). Public awareness of individual and societal causes of obesity. Guest lecture presented to Prof. Tarleton Gillespie's "Cases in Communication" course (COMM 1101), a required introductory course for communication majors. Estimated audience = 200. 6) Analysis of these data to produce the following papers, currently being prepared for publication: Niederdeppe, J., Shapiro, M. & Porticella, N. (in draft). Effects of a narrative and a summary of scientific evidence on attributions of responsibility for rates of overweight and obesity in the United States. TARGET: Human Communication Research. Niederdeppe, J., Porticella, N., & Shapiro, M. (in draft). Beliefs associated with support for policies to increase the price of high-fat and high-sugar foods. TARGET: American Journal of Public Health. Shapiro, M., Niederdeppe, J., Jiang, C., & Porticella, N. (in draft). Empathy, identification, and realism in predicting responses to stories about individual and social causes of obesity. TARGET: Communication Research. Events in this reporting period include: Niederdeppe, J. (2009). Message design strategies to raise public awareness of social determinants of health and population health disparities. Presented at the Third Annual National Conference on Health Communication, Marketing and Media, Atlanta, GA, August 13, 2009. (see above) Products in this reporting period include: Niederdeppe, J. (2009). Dataset: Public awareness of individual and societal causes of obesity. N=500 respondents. Niederdeppe, J. (2009). Dataset: Focus group responses to messages designed to raise awareness of health determinants and disparities. N=100 respondents. Niederdeppe, J. (2009). Public awareness of individual and societal causes of obesity. Guest lecture presented to Prof. Tarleton Gillespie's "Cases in Communication" course (see above). Guest lecture slides which can be re-used for other public education purposes. PARTICIPANTS: Not relevant to this project. TARGET AUDIENCES: Not relevant to this project. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Outcomes in this reporting period include: Change in knowledge among attendees to the workshop entitled, "Message design strategies to raise public awareness of social determinants of health and population health disparities" presented at the Third Annual National Conference on Health Communication, Marketing and Media, Atlanta, GA, August 13, 2009. Respondents are now able to identify critical issues in communicating to raise public awareness of health determinants and disparities. Change in knowledge and action among graduate students Chris Clarke and Helen Brown, both of whom have been working as a research assistant for the project. Both Chris and Helen are now able to identify and actively research critical issues in communicating to raise public awareness of health determinants and disparities. Chris and Helen have gained substantial knowledge about the subject area by virtue of their work on the project. Chris has experienced a change in action by continuing to work on a paper for eventual journal submission. Helen has experienced a change in action by focusing her second-year research project on this topic.

Publications

• No publications reported this period