20.4 Communication Strategies

Four Stages of the Health Communication Cycle

HHS (2014) provides a workbook to assist the program team throughout four stages of health communication planning and implementation (see Figure 20.4).

Figure 20.4 The nurse and program team use the health communication program cycle to systematically develop and implement health communication. (See HHS, 2014; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

First, the program team decides how to use communication, defines the intended target population, determines communication objectives, plans for evaluation of communication, and drafts communication activities.

Second, they develop messages and materials and collaborate with members of the intended target audience to get feedback and revise messages and materials as needed. The team answers the following questions during the planning stages (HHS, 2014):

• Will this type of communication reach and influence the intended target population?
• Are the chosen types of communication acceptable and trusted by the intended target population?
• Is the type of communication appropriate for the message?
• What is the reach of the type of communication? How many of the target population might be exposed?
• What is the cost of this type of communication?
• Are the resources available to create, maintain, and fund this type of communication?

Third, they implement the message, track exposure of the intended target audience, and continue to solicit feedback to revise the message as needed. Finally, they assess the effectiveness of the message and communication plan and revise them if needed. Strategies for effective health communication include the following:

• Use a variety of communication tools to increase reach (HHS, 2014; RHIhub, 2018a)
• Select evidence-based methods to develop materials and messages (RHIhub, 2018a)
• Incorporate health literacy and cultural needs of the intended target population (HHS, 2014; RHIhub, 2018a)
• Define the goal of the program (HHS, 2014)
• Pretest and revise materials and messages (HHS, 2014)
• Evaluate communication at delivery and throughout implementation (HHS, 2014)

Creating a Communication Plan

The Center for Rural Health provides a communication toolkit to guide the program team to focus “the right message on the right audience at the right time” (Center for Rural Health, 2023, para 1). A systematic communication planning and implementation method leads to efficient and effective communication delivered using the resources of the program budget. The steps of communication plan development include the following:

1. Analysis: Summarize the overarching and communication goals of the program, resources available for communication, and the effectiveness of current communication strategies.
2. Goals & Objectives: Create SMART objectives for communication. Planning Health Promotion and Disease Prevention Interventions describes SMART objectives.
3. Key Messages: Create three to five central messages for the program.
4. Target Audience: Identify the intended target population and assess communication needs and barriers.
5. Tactics: Choose communication tools and technologies to deliver the message.
6. Implementation Timeline: Set target dates for communication implementation, establish accountability for communication activities, and allocate finances and resources for implementation.
7. Evaluate & Revise: Set dates for evaluation throughout implementation to assess the effectiveness of the communication plan and revise if needed.

Cultural and Linguistic Communication Needs

The program team incorporates cultural and linguistic needs of the intended target population into communication to enhance communication effectiveness. Assessment of the target population will provide some information, but inviting key members of the target population to assist with program planning and communication planning will increase the likelihood that the team will identify barriers and meet cultural and linguistic needs. The program team should consider the target population’s access to the internet and potential for media exposure as well as what communication technologies members use most often. Various communication tools that are used by the intended target population should be incorporated into the communication plan in order to increase reach (RHIhub, 2018a). Additionally, messages and materials should be available in English and languages most commonly used by the target population and should include concepts, priorities, images, and language that represent the target population. Culturally and Linguistically Responsive Nursing Care discusses how the nurse incorporates communication and language assistance services and translates written material for community health programs. Culturally and Linguistically Appropriate Program Design discusses national standards for culturally and linguistically appropriate services and tools to incorporate those standards into community health programs.

Health Literacy and Plain Language

The nurse and program team must also consider the health literacy of the target population. Assessment, Analysis, and Diagnosis discusses tools to assess health literacy. One method to account for community health literacy is using plain language in messages and materials. Plain language is communication that is visually appealing, logically organized, appropriate for the intended audience, and understandable at the first reading (Smith & Wallace, n.d., para 1). The team should follow these principles when using plain language (National Archives, 2023):

• Write for the intended target audience.
• Begin with the key message.
• Keep it short.
• Write in the active voice.
• Use common language, not medical terminology.
• Omit words that are not needed to convey the message.
• Use headings, lists, and tables.
• Proofread and have a member of the intended target audience review.