Risk Communication in Health Promotion S. Thavaraj Pengarah R&D Malaysian Health Promotion Board (MySihat)
Health Promotion • Health promotion is the process of enabling people to increase control over, and to improve their health (Ottawa Charter for Health Promotion. WHO, Geneva,1986). • The Ottawa Charter for Health Promotion identifies basic prerequisites for health (e.g. education, shelter, etc) and outlines priority action areas (e.g. building healthy public policy). • The Ottawa Charter follows a structural approach to promoting health, driven by the core values of social justice and equity (Raphael, 2003; in Hofrichter Health and Social
Health Promotion • Health promotion represents a comprehensive social and political process • It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health.
Health Promotion • Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action (World Health Organization Health Glossary 1988).
Health Promotion • In 1984 the World Health Organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health”.
Health Promotion: WHO • In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organisational change, community development and spontaneous local activities against healthhazards" as health promotion methods.
Health Promotion and Behavior Risk Factors (relevance to Risk Communication) • There is a tendency among public health officials and governments—and this is especially the case in liberal nations such as Canada and the USA—to reduce health promotion to health education and social marketing focused on changing behavioral risk factors.
Health Communication • Health communication can be defined as "where health promotion and communication meet" (Hershfield & Rootman, 1996). • Health communication involves the dissemination of health information through the media via the use of various communication techniques (Nutbeam, 1998). • It aims to improve the health status of both individuals and populations by informing, influencing, and motivating the public about important health issues, as well as ensuring that key health concerns are on the public agenda (Nutbeam, 1998).
Risk Communication • Risk Communication is defined as an interactive process of exchange of information and opinion among individuals, groups and institutions • It expresses messages about risk, concerns, opinions or reactions. • Risk communication is helping people understand the nature and seriousness of a risk so that they can make an informed decision about how to deal with the risk.
Risk Communication • Ideally, risk communication is “an interactive process of exchange of information and opinion among individuals, groups, and institutions” . • The goal of risk communication could also be defined as the need to align risk perceptions of the public with that of the risk experts and to reduce fear of risk related technology.
Risk Communication and Health Promotion • With respect to public health, risk can be separated into two main perspectives. • First risk as a health danger to individuals as a result from environmental hazards (i.e. pollution, nuclear waste and toxic chemical residues). Specifically, risk is "a health threat that is regarded as a hazard which is external, over which the individual has little control“ .
RC and HP • The second view conceptualizes risk as a consequence of "lifestyle" choices that individuals make, thus placing the emphasis upon self-control (i.e. the individuals ability to manage the self )(Lupton, 1995).
Risk as a Consequennce of Lifestyle Choices: Behavior Riskfactors • The vast majority of NCD risk factors are environmental or lifestyle-related, thus NCDs are largely preventable. Greater than 30% of cancer is preventable via avoiding risk factors including: tobacco (6 million die a year), being overweight or obesity, low fruit and vegetable intake, physical inactivity, alcohol, sexually transmitted infections, and air pollution. (WHO)
Behaviour Risk Factors • A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease. • Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with “healthier menu” options. • Consumers continue to patronise
Behaviour Risk Factors • Diabetes mellitus is an NCD which is largely preventable and manageable but difficult to cure. • Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. • Wider health problems may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.
Behavior Risk factors • Chronic Kidney Diseases, diabetes and cardiovascular disease are closely associated conditions that often coexist; share common risk factors and treatments; and would benefit from a coordinated global approach to prevention and control.
Others Risk Factors • Thus, CKD, diabetes and cardiovascular disease are closely associated conditions that often coexist; share common risk factors and treatments; and would benefit from a coordinated global approach to prevention and control.
Communicating the Risk to High Risk Individuals to Manage their Risk • When there is risk it is important to communicate with the high risk group or vulnerable group (Haze, Melamin, Nitrofuran, Dioxin, SARS, Avian Flu, Recycled cooking oil ) as we have a Duty of Care. Communicating risk to the general public is often challenging due to a variety of issues including: • increased emotion, • limited access, • availability of facts, • clutter, • distorted facts, • speculation, • assumptions, • translating technical information into something understandable and • sometimes incomplete knowledge.
Communicating Risk • The manner in which information is communicated must be genuine and attempt to address both perceived ( may not be real) and real risk concerns
Incorporating Risk Communication in Health Promotion • Integrate with health promotion components of the existing programs of the MOH • Risk Communication has already been incorporated in our existing programs • It need not stand on its own • Nevertheless they are certain prerequisites
Prerequisites: The Risk Communication Process • Epidemiological assessment of Risk • Identifying the Risk Group • Behaviour risk factor surveillance along the lines of the Morbidity Survey • Educational Assessment • Setting Risk Communication Objectives • Formulating Strategies • Executing Strategies • Developing Risk Communication Messages • Disseminating the messages through the effective Channels • Impact Evaluation
Risk Communication Settings • Clinic • Hospital • Workplace • School • Community
Strategies • Planned Media Activities • Electronic • Print • Social • Face to Face
Strategies • Planned Community Intervention, NGOs. • Brief Intervention; Incidental Unplanned • Community Health Promotion Centre • Lobbying • Environmental Support • Social Support
Evaluation • Evaluating the strategies : Formative Evaluation • Evaluating the Objectives/ Goals : Impact Evaluation • Evaluating Messages conveying Risk and Risk Reduction • Educational Efforts as to Risk : Knowledge and Attitude on Risk • Behaviour Changes as to Risk Reduction • Morbidity Mortality Statistics as a result of Risk Reduction • Policy Changes • Environmental and Social changes
Behaviour Change Theories: Common • 1. Yale Attitude Change Approach • 2. Developmental Theory • 3. Group Dynamics Approach • 4. Perception Theory • 5. Motivation Theory • 6. Learning Theory • 7. Force Field Theory • 8. Group Dynamics • 7. Cognitive Dissonance Theory • 8. Attribution Theory • 9. Social Learning Theory • 10. Social Cognitive Theory • 11. Health Belief Model • 12. Theory of Reasoned Action • 13. Diffusion of Innovation Theory • 14. Precede-Proceed Model • 15. Kelman
Health Belief Model • The 7 major beliefs that influence the likelihood of taking action that is relevant to a given disease or condition are • Perceived susceptibility to disease • Perceived severity of disease • Perceived threat of disease • Perceived benefits of action • Perceived barriers to action • Cues to action • Self efficacy
RC in Malaysia • Action plans eg Pandemic Flu, Emergency Response • Simulation Exercises • Training Modules and Training Key Personnel • Research Centre • Research: FGDs • ASEAN and Local Strategic Plan of Action
Example: Obesity Risk Communication : Prerequisites • Epidemiology of Obesity • Behaviour Factors contributing to Obesity: Walking less common now • Knowledge and Attitude towards Eating • Socio Cultural factors contributing to Obesity • Availability and convenience of cheap calorie densed food • Existing Policies and Regulations
Obesity Risk Communication: Who are the Main and Major Players? • Risk Assessment (Epidemiological Assessment): NCD • Behaviour Risk Factor Surveillance, and Educational Assessment: IPTK • Developing the Strategies HECC/IPTK/NCD • Developing Messages: HECC/ IPTK • Dissemination of Messages: HECC/NCD/MySihat • Impact Evaluation: HECC/IPTK/MySihat • Policies/Regulations/Enforcement: Program Managers
High Risk Group: From Epidemiological Assessment and Behaviour Risk Factor Surveillance • Family history/Family Lifestyle • Sedentary • Smokers who quit • Pregnant mothers • Age: Middle to Old • Medical cases • Identify risk groups within various categories
Risk Factors for Obesity • Genetic predisposition. • Inactivity. • Unhealthy diet and eating habits. • Family lifestyle. • Quitting smoking. • Pregnancy. • Lack of sleep. • Certain medications. • Age. • Social and economic issues. • Medical problems. • You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.
Formulating Objectives of Risk Communication • Need to know • Knowledge Gap of the Risk • Existing Attitude and Perception to the Risk • Current lifestyle
Formulating Objectives for Risk Communication for the Obese • Increase in Awareness and Knowledge of the Risk involved ie. to narrow the gap • Instill changes in Perception to the Risk • Susceptibility • Severity • Threat • Benefits Engineer changes in Behaviour Eg. Sedentary to active lifestyle.
Strategies for NGOs: Providing the cues to effect changes in Behaviour • Community Intervention through NGOs (Profesional and non Profesional) Empowering them by doing • Risk Appraisal through Screening: Opportunities for Brief Intervention • Normal, Risk Group, Cases • Experiential learning, personal and situational Cases will be referred and messages on complication and quality of life Risk Group (overweight and obese): Planned activities to reduce K gap, changes to perception and above all to reduce weight Normal weight same as above for maintenance of weight
Strategies for NGOs: Strengthening Skills and Capabilities of the Community • Providing them the technological know how through: • Jointly Developing Risk Communication Modules • Jointly conducting training for Community leaders and appointed Trainers • Conduct Training for the Members