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Population Health for Nurses

20.4 Communication Strategies

Population Health for Nurses20.4 Communication Strategies

Learning Outcomes

By the end of this section, you should be able to:

  • 20.4.1 Compare information and communication technologies used in the community setting.
  • 20.4.2 Describe various communication tools and culturally and linguistically responsive communication strategies.
  • 20.4.3 Explain the use of multimedia applications to communicate outcomes.

The nurse uses effective and appropriate verbal and written communication strategies to promote health programs and healthy behaviors, increase awareness of health issues and health programs, recruit and retain program participants, share information with community partners, and disseminate program evaluation findings. The program team strategically develops and employs messages using a variety of tools and technologies. They also determine communication strategies prior to sending any health-related or program message, considering the intended target population’s communication needs.

Communication Tools and Technologies Used in the Community Setting

A variety of community tools and technologies are used in the community setting. The program team must weigh the advantages and disadvantages of each when developing a communication plan. They should use multiple communication tools and methods to reach a larger number of the intended target population (Center for Rural Health, 2023; RHIhub, 2018a; U.S. Department of Health and Human Services [HHS], 2014). Table 20.8 lists the types of communication tools and technologies and their advantages and disadvantages.

Communication Tool Examples Advantages of Use Disadvantages of Use
Broadcast media
  • Television
  • Radio
  • Podcast
  • Broad audience reach
  • Message conveyed faster
  • Opportunity to replay message
  • Script is used for consistent and controlled messaging
  • Multiple delivery of message is most effective
  • May be limited to single message or to one time per day
  • One-time communication not always effective
  • Costly if paid advertisement
  • Limited reach to some populations (those who do not have access to broadcast media)
Print media
  • Newspaper
  • Magazine
  • Brochures or flyers
  • Mail
  • Email
  • Broad audience reach
  • Message conveyed faster
  • Opportunity to reread message
  • Script is used for consistent and controlled messaging
  • May be limited to single message or to one time per day
  • One-time communication not always effective
  • Costly if paid advertisement
  • Costly if mass-produced for mail
  • Limited reach to some populations (those who do not have access to print media)
Social and digital media
  • Internet/websites
  • Social media
  • Mobile applications
  • Video/YouTube
  • Kiosks
  • Reach a large population rapidly
  • Combines audio and visual
  • Script or common material is used for consistent and controlled messaging
  • May be costly
  • Limited reach to some populations (those without internet access)
  • May require monitoring of comments
Outdoor media and public display
  • Billboard
  • Mass transit
  • Community
  • businesses
  • Broad audience reach
  • Message conveyed faster
  • Opportunity to reread message
  • Script is used for consistent and controlled messaging
  • May be costly
  • Limited reach for population that does not use the method of transport or visit the community business
Word of mouth
  • Personal communication
  • Telephone
  • Organizational meetings
  • Community presentations
  • Partnerships
  • Promotes discussion
  • More effective in promoting change
  • Effective in reaching intended audience
  • Messages can be tailored to individual or audience needs
  • Partnerships and other organizations provide support of the message
  • Time-consuming to coordinate communication and arrange presentations
  • May have limited audience
  • Message less controlled
Table 20.8 Advantages and Disadvantages of Communication Tools Used in Public Health Programs (See HHS, 2014.)

Communication Strategies

The program team develops and follows a systematic process to plan and implement communication strategies. Systematic processes ensure that communication is grounded in evidence, effective, efficient, and able to reach the intended target audience. HHS (2014) and the Center for Rural Health (2023) provide toolkits for health communication planning and implementation.

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).

The health communications program cycle is presented as four numbered circles connected by arrows in a larger circular shape. The steps are:  1 Planning and strategy development; 2 Developing and pretesting concepts, messages, and materials; 3 Implementing the program; 4 Assessing effectiveness and making refinements.
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.

Communication Considerations

The program team considers the needs of and barriers to communication with the intended target population. They integrate the target population’s health priorities, culture, language, and health literacy into messages and materials used in community health programs.

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.

Conversations About Culture

Stories from the Field: The White Earth Nation

The nurse and program team incorporate culturally and linguistically appropriate messaging and materials into health promotion programs. In this blog, the local public health department incorporated Anishinaabeg culture into messages encouraging COVID-19 prevention and vaccination.

Read the blog, and then respond to the following questions.

  1. How did the White Earth Public Health team incorporate cultural and linguistic needs into COVID-19 health communication?
  2. How did tailoring communication to the intended target population influence the health behaviors of the Anishinaabeg?

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.

Theory in Action

Demand to Understand: How Plain Language Makes Life Simpler

In this 19-minute TEDx Talk, Deborah Bosley discusses the importance of using plain language when communicating health information and suggests strategies to improve clarity of health communication.

Watch the video, and then respond to the following questions. If time does not allow full viewing, watch at 8:50 for the definition of plain language and then from 14:37 to the end for strategies.

  1. Why is it important to use plain language when developing messages and materials for community health programs?
  2. What strategies are recommended to ensure health communication is delivered using plain language?

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