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cities’ appeal to a variety of ethnic and socioeconomic groups and migrant popu- lation. Therefore, it is important that training interventions provide participants with skills and methods to segment relevant audiences/key groups of health communication interventions so that such segmentation not only informs health communication programs but also allows organizations to evaluate their ability to reach and engage different groups vis-à-vis past experiences, organizational capacity, budgets, and other key items to be considered as part of communication planning.
• Population density is an increasingly important factor in planning and managing health communication interventions. In fact, “cities are exerting growing influ- ence on the health of both urban and non-urban residents” while at the same time are shaped by “municipal determinants and global and national trends” (Galea et al. 2005, p. 1017). For example, population density is a key factor affecting rehospitalization and outcomes of people with severe mental illnesses (Husted and Jorgens 2000). Because of the limited number of support services and day hospitals, high population density has been associated with relapse of severe and persistent mental illnesses (Muijen et al. 1992). Moreover, “as Scott and Dixon pointed out, one of the difficulties in treating individuals with serious and persistent mental illness may be the lack of similarity between the stimuli that occur in treatment and those that occur in everyday living. In rural areas, where there is a relative absence of distracting stimuli in daily life, whatever happens in therapy may be assimilated more effectively” (Husted and Jorgens 2000 p. 604).
Outside of mental health, population density may also affect the ability of people to adopt and sustain health and social behaviors promoted by health commu- nication programs during outbreaks of infectious diseases. For example, high population density—which may result in crowded living conditions and high patient numbers in hospitals and other clinical facilities—may be an obstacle to the implementation of public health emergency measures such as social distan- cing and/or may undermine the adoption of safety behaviors in taking care of patients and loved ones (Schiavo 2009). Therefore, population density should be explored as one of the topics to be featured as part of case studies and other rele- vant sections of training modules and efforts on health communication in urban settings.
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characteristics of specific urban cities if training efforts have a regional or city- specific connotation.
Health Communication Theory: Focus on Behavioral and Social Results
Since the alleviation and prevention of health-related ailments is often related to the adoption and sustainability of individual, community, social, and organizational behaviors that support changes in health outcomes, health communication—with its focus on behavioral, social, and organizational results (Schiavo 2013)—has been contributing over the years to a variety of public health goals. While the scope of this chapter does not include a discussion of communication theory and models, it is still worth to remember here that health communication is a “multidisciplinary and multifaceted field” (Schiavo 2013, p. 9). Some of the main theoretical influ- ences of health communication include, but are not limited to, social and behavioral sciences theories and models, marketing, mass communication theories, “and other theoretical influences, including medical models, sociology and anthropology. In addition several planning frameworks and models have been developed to reflect or incorporate key principles from some or all of these categories” (Schiavo 2007, p. 32). While planning frameworks may evolve over time to incorporate lessons learned and to reflect the organizational culture, brand, strengths, areas of exper- tise, and/or terminology of the organizations or leaders that develop them, there are some commonalities in many communication models and lessons learned that are reflected or should be reflected in training efforts and inform their content and key messages. These include but are not limited to (Schiavo 2013; USAID, UNICEF and AI.COMM 2009; Hosein et al. 2009):
• Increased awareness and knowledge on a given health issue among key groups are important but not sufficient outcomes of health communication interventi- ons. Increases in knowledge do not always translate into effective behavioral and social change.
• Regardless of the framework being used, behavioral outcomes at different levels of society (individual, community, policymakers, health workers, organizations, etc.) are the ultimate results of health communication interventions and also lead to social outcomes.
• Health communication planning is a systematic and strategic process that leads to tailored and evidence-based interventions and not a miscellaneous of activities and materials that are designed as an afterthought. Early integration of commu- nication teams with other public health and healthcare teams is important to take advantage of program’s synergies.
• Community participation and mobilization are key components of well-designed health communication interventions since they encourage community invest- ment in recommended health and social behaviors as well as help create societal
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ownership of all programs, which may lead to the sustainability of behavioral and social results.
• The integration of different communication areas, channels (for example, mass media, community-based/traditional, interpersonal, and new media), and other platforms is more likely to reproduce the kind of environment in which people actually communicate in their everyday life.
• Monitoring and evaluation components should be considered and included early in program planning (including a detailed plan of action and related budget).
Key Training Needs and Areas
Communication capacity is increasingly recognized as an important focus of train- ing interventions intended for public health and community development profes- sionals from a variety of organizations, settings, and health and social areas. For example, “there is a need to incorporate communication training into the curriculum for all stakeholders involved in preparedness and response activities. This would include strategies for communicating the needs of relevant communities to policy- makers. There is a need to educate all relevant stakeholders on how to communicate risk before, during, and after an emergency with the general public” (Berger et al.
2009). Moreover, respondents from a UNICEF study on community- and house- hold-based communication to prepare and respond to pandemic flu (Schiavo 2009) identified capacity building on key communication areas (for example, interperson- al communication, community dialogue, advocacy, and the overall communication planning, implementation, and evaluation cycle) as a key priority for pandemic flu preparedness among key groups including governments, social mobilization part- ners (for example, local nonprofit organizations, schools, community, and religious leaders), and other key influencers (for example, health workers).
However, building adequate communication capacity may still be an ongoing process in many organizations and settings, including urban contexts. For example, it can be deducted from the responses to a 2009 survey on health communication in urban settings of those participants who reported having received some training on urban health communication that the training did not adequately cover the entire health communication planning, implementation and evaluation cycle, but instead focused on specific topics, such as risk communication, cardiovascular disease, so- cial networking, public relations, language barriers, communicating with adoles- cents about sexual health, etc. This points to a very fragmented level of knowledge and training among the professionals who completed the survey. Most importantly, there was no reference to any training on understanding, engaging and mobiliz- ing relevant groups and publics—one of the key pillars of strategic health com- munication planning (Schiavo 2007). This is instrumental to addressing issues of diversity and disparities, as it allows average citizens and communities to become involved and participate in program development as well as in achieving health and social results (Schiavo and Ramesh 2010). Respondents also identified a few
61 5 Strategic Health Communication in Urban Settings: A Template for Training …
topics and key training needs (see Table 5.1). While training interventions should be tailored to the specific urban settings and needs of the participants, Table 5.1 may serve as preliminary guidance on some of the areas to be covered as part of more comprehensive training interventions and modules on health communication in ur- ban settings. Of notice, many of the questions and needs highlighted by respondents could be easily addressed if professional development programs and other training interventions had adequately focused on the overall health communication process.
Therefore, while the topics in Table 5.1 should be considered for inclusion as part of case studies, interactive exercises, special sessions, or training updates, the main focus of training interventions should be on the overall communication cycle and not on select aspects of planning, implementation, and evaluation.
Table 5.1 Key training needs on health communication in urban settings
Communication topics Sample respondent responses
Diversity: tailoring communication to diverse
audiences Developing interventions for diverse groups
(e.g., as defined by ethnicity and socioeco- nomic level)
Dealing with culturally diverse audiences Tailoring communication to specific
populations
Development of effective communication stra- tegies for racially/ethnically diverse commu- nities that are credible and trustworthy Technical guidance: communication planning
and evaluation methods Message development
Grassroots communication Use of new media
Measuring communication uptake Behavior change communication methods Impact assessment
How to conduct formative research
How to evaluate findings and modify program How to tap social networks
Health disparities Learning about racial and ethnic health disparities/racism
Environmental issues (asthma in public hou- sing, lack of access to fresh food/vegetables, unsafe neighbourhoods)
Addressing health disparities in urban settings
Other Challenges and specific problems associated
with urban health settings Cost-effectiveness of interventions Funding of communication interventions Key issues in health literacy
(Source: Unpublished table from Schiavo and Ramesh (2010). All rights reserved. Copyrights © 2010 by Renata Schiavo/Strategic Communication Resources, New York, NY. Used by permission)
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Training Venues
The advent of new media has provided trainers with additional venues for capa- city building interventions. Several studies and organizations are in the process of analyzing the effectiveness and suitability of new media-based training sessions (for example, Webinars and online courses) for a variety of audiences. While con- clusive evidence may not be available in relation to health communication training, results on other kinds of training (for example, research update courses) “indicate that online and face-to-face courses can be equally effective in delivering profes- sional development materials” (Dillon et al. 2008). However—in addition to ef- fectiveness—cultural- and group-specific preferences as well as cost-effectiveness analyses should also be taken into account in selecting adequate training venues.
For example, “94 % of respondents” to a 2009 survey of public health and health communication professionals who work or plan to work in strategic health commu- nication in urban settings “favored in-person interactive training and 69 % preferred a mentoring program (that may include in-person or online training, followed by periodic update sessions and follow up during the first 6 months to 1 year after training). Only 44 % of respondents preferred webinars and 31 % voted for online training, revealing that while new media and social media-based interventions are increasingly allowing communities and professionals to overcome geographical, cost- and time-related barriers and ultimately have access to some training, interper- sonal communication settings and strategies may continue to be the preferred train- ing modality” (Schiavo and Ramesh 2010). While these findings would need to be validated by larger studies and group-specific observations, some of the criteria that more generally apply to channels selection (for example, task appropriateness; cost- effectiveness; audience characteristics, needs, and preferences; cultural relevance;
and access.) should also apply to the selection of training venues and channels so that training interventions could be customized to specific participant groups.