**4. Strategic health communication design**

Health education messages must be carefully designed to be effective. The critical factor in strategic message design is adapting health education messages to meet the unique needs and communication orientations of specific audiences. This means that effective health communication efforts should adopt a consumer orientation to health education.35,36 Careful audience analysis is essential to identify the salient consumer characteristics that can be used for guiding message design.37,38

Good audience analysis research will help answer a variety of important questions for guiding cancer prevention and control efforts. These questions are likely to examine a number of relevant communication factors about members of targeted audiences. For example, what are the typical message exchange and information sharing processes employed by targeted groups of consumers? Who do these consumers typically talk to and acquire health related information from? Who do they trust? How do they receive and provide social support? What are their predispositions for interpreting cancer prevention and control messages? What are most influential factors for persuading members of targeted

Strategic Communication for Cancer Prevention

personal characteristics and interests.

sources.

and Control: Reaching and Influencing Vulnerable Audiences 381

background, beliefs, and orientations. Key bits of an individual's background information, such as the person's name, age, cultural memberships, or health status are gathered and included in the specific health messages sent to that person. For example, a tailored message might state, "Research has shown that mammograms should be scheduled every other year for a woman of your age, race, and family history with breast cancer Helen." By including specific key information about Helen's background in the message, the information becomes much more interesting and relevant for her. Typically, tailored communication systems employ interactive computer systems that can be used to gather relevant background information from consumers concerning key communication variables (age, race, gender, occupation, health history, etc.) through questions posed to these individuals, including questions eliciting information about individual demographics, psychographics, and health beliefs/behaviors. Once key background information is gathered from the individual, the information is used to select specific messages stored in a library of messages that match the unique background features of the individuals selected to receive health education messages. In this way, information about the individual health risks and orientations of a specific consumer, for example an elderly, African-American, male, with a history of prostate cancer and diabetes, will automatically be selected and used to provide contentappropriate health information to the individuals through a tailored health information communication system. As the consumer continues to interact with the tailored health information system, providing the system with additional background information, a tailored communication computer program can store and catalog this information to continually refine the content of message sent to this consumer to match his or her unique

In addition to developing strategic messages that match the cultural orientations of at-risk consumers, it is critically important to determine the most effective communication channels for reaching targeted populations of consumers. The best communication channels to utilize are those that are close, familiar, and easily accessible for targeted audience members.49 For example, it is important to employ communication channels that are easy for members of the intended audience to use. It would be a serious error to develop an online health education website for consumers who do not have access to computers or who are not sophisticated computer users. Communication channels that are dramatic and memorable can have strong influences on audience attention and interpretation of health messages.49 Health educators should consider using communication channels that can be accessed over time, channels that can retain important information for later review, and even interactive channels that can enable consumers to ask questions and receive clarifications about complex health information. The best strategic communication designs use interactive channels where consumers can provide feedback and ask questions to clarify the information provided. Multiple overlapping communication channels can present complementary messages that are reinforcing over time and delivered by multiple credible

It is important to decide what the best sources are for delivering key messages about cancer prevention and control strategies to different audiences.39 It is crucial to identify the most credible sources of health information for members of the intended audiences.49 Decisions need to be made about whether it is best to utilize familiar sources of information, expert sources, or perhaps peer communication as the most influential ways to provide cancer-

groups to attend to and respond positively to health messages? Which communication channels do members of these targeted groups prefer to use? What are the best ways to provide these consumers with feedback about their health behaviors that can promote and reinforce health behavior changes? What are the most influential communication strategies for developing cooperative and trusted relationships with members of targeted groups? The best health communication intervention programs will be designed to be responsive to audience communication patterns. They will be relevant to audience needs and interests. They will be easily accessible to targeted audience members. The messages will be culturally appropriate for key audience members. Messages and communication strategies will be adaptive to changing social situation. The messages provided will also be motivational and reinforcing, as well as engaging, interesting, and interactive.

Messages should be designed to appeal to key beliefs, attitudes, and values of targeted audience members, using familiar and accepted language, interesting images, and vivid examples to illustrate key points.29 It is wise to pre-test sample health education messages with representatives of targeted audiences to make sure the messages hit the intended mark with these audiences before implementing health communication intervention programs. Formative evaluation data gathered through message pre-testing is essential to refining health education messages.39 This is a form of user-centered design, where health education messages are shaped and refined by actively gathering feedback about campaign design from representatives of the actual audiences who are being targeted in health communication interventions.39 Pre-testing is also a strategy for helping to increase audience participation in health education efforts. This active participation can not only help to increase the cultural sensitivity of health communication efforts, but can also enhance audience members receptivity to and cooperation with health promotion efforts.39 Involving consumers, their family members, key members of their social networks, and community representatives can increase support and social encouragement for paying attention to, accepting, and utilizing health education messages.40,41,42

To be effective at presenting cancer prevention and control information it is wise to design multiple, reinforcing strategic messages that will be delivered at several points in time over different complementary channels of communication for reaching, influencing, and reinforcing vulnerable audiences with health education information. This multiple complementary message strategy builds from the communication principles of redundancy and reinforcement to enhance message exposure and impact.43 Multiple, reinforcing cancer prevention and control messages can help to capture audience attention by providing these consumers with relevant information at several points of time. This strategy helps to reinforce message content by repeating key ideas. This also helps to illustrate key health education concepts. The use of vivid imagery in health communication interventions through the use of powerful narrative and visual illustrations can also reinforce message content, especially for audiences with limited health literacy, as well as audience members who have problems with numeracy (understanding numerically presented information) that may make it difficult for them to comprehend statistics and numerical risk estimates.39,40,44,45,46,47

Tailored communication is a powerful approach for designing customized health messages to meet the unique needs and backgrounds of specific individuals.48 Tailored approaches provide specific customized messages to an individual that match the person's unique

groups to attend to and respond positively to health messages? Which communication channels do members of these targeted groups prefer to use? What are the best ways to provide these consumers with feedback about their health behaviors that can promote and reinforce health behavior changes? What are the most influential communication strategies for developing cooperative and trusted relationships with members of targeted groups? The best health communication intervention programs will be designed to be responsive to audience communication patterns. They will be relevant to audience needs and interests. They will be easily accessible to targeted audience members. The messages will be culturally appropriate for key audience members. Messages and communication strategies will be adaptive to changing social situation. The messages provided will also be motivational and

Messages should be designed to appeal to key beliefs, attitudes, and values of targeted audience members, using familiar and accepted language, interesting images, and vivid examples to illustrate key points.29 It is wise to pre-test sample health education messages with representatives of targeted audiences to make sure the messages hit the intended mark with these audiences before implementing health communication intervention programs. Formative evaluation data gathered through message pre-testing is essential to refining health education messages.39 This is a form of user-centered design, where health education messages are shaped and refined by actively gathering feedback about campaign design from representatives of the actual audiences who are being targeted in health communication interventions.39 Pre-testing is also a strategy for helping to increase audience participation in health education efforts. This active participation can not only help to increase the cultural sensitivity of health communication efforts, but can also enhance audience members receptivity to and cooperation with health promotion efforts.39 Involving consumers, their family members, key members of their social networks, and community representatives can increase support and social encouragement for paying attention to,

To be effective at presenting cancer prevention and control information it is wise to design multiple, reinforcing strategic messages that will be delivered at several points in time over different complementary channels of communication for reaching, influencing, and reinforcing vulnerable audiences with health education information. This multiple complementary message strategy builds from the communication principles of redundancy and reinforcement to enhance message exposure and impact.43 Multiple, reinforcing cancer prevention and control messages can help to capture audience attention by providing these consumers with relevant information at several points of time. This strategy helps to reinforce message content by repeating key ideas. This also helps to illustrate key health education concepts. The use of vivid imagery in health communication interventions through the use of powerful narrative and visual illustrations can also reinforce message content, especially for audiences with limited health literacy, as well as audience members who have problems with numeracy (understanding numerically presented information) that may make it difficult for them to comprehend statistics and numerical risk

Tailored communication is a powerful approach for designing customized health messages to meet the unique needs and backgrounds of specific individuals.48 Tailored approaches provide specific customized messages to an individual that match the person's unique

reinforcing, as well as engaging, interesting, and interactive.

accepting, and utilizing health education messages.40,41,42

estimates.39,40,44,45,46,47

background, beliefs, and orientations. Key bits of an individual's background information, such as the person's name, age, cultural memberships, or health status are gathered and included in the specific health messages sent to that person. For example, a tailored message might state, "Research has shown that mammograms should be scheduled every other year for a woman of your age, race, and family history with breast cancer Helen." By including specific key information about Helen's background in the message, the information becomes much more interesting and relevant for her. Typically, tailored communication systems employ interactive computer systems that can be used to gather relevant background information from consumers concerning key communication variables (age, race, gender, occupation, health history, etc.) through questions posed to these individuals, including questions eliciting information about individual demographics, psychographics, and health beliefs/behaviors. Once key background information is gathered from the individual, the information is used to select specific messages stored in a library of messages that match the unique background features of the individuals selected to receive health education messages. In this way, information about the individual health risks and orientations of a specific consumer, for example an elderly, African-American, male, with a history of prostate cancer and diabetes, will automatically be selected and used to provide contentappropriate health information to the individuals through a tailored health information communication system. As the consumer continues to interact with the tailored health information system, providing the system with additional background information, a tailored communication computer program can store and catalog this information to continually refine the content of message sent to this consumer to match his or her unique personal characteristics and interests.

In addition to developing strategic messages that match the cultural orientations of at-risk consumers, it is critically important to determine the most effective communication channels for reaching targeted populations of consumers. The best communication channels to utilize are those that are close, familiar, and easily accessible for targeted audience members.49 For example, it is important to employ communication channels that are easy for members of the intended audience to use. It would be a serious error to develop an online health education website for consumers who do not have access to computers or who are not sophisticated computer users. Communication channels that are dramatic and memorable can have strong influences on audience attention and interpretation of health messages.49 Health educators should consider using communication channels that can be accessed over time, channels that can retain important information for later review, and even interactive channels that can enable consumers to ask questions and receive clarifications about complex health information. The best strategic communication designs use interactive channels where consumers can provide feedback and ask questions to clarify the information provided. Multiple overlapping communication channels can present complementary messages that are reinforcing over time and delivered by multiple credible sources.

It is important to decide what the best sources are for delivering key messages about cancer prevention and control strategies to different audiences.39 It is crucial to identify the most credible sources of health information for members of the intended audiences.49 Decisions need to be made about whether it is best to utilize familiar sources of information, expert sources, or perhaps peer communication as the most influential ways to provide cancer-

Strategic Communication for Cancer Prevention

Formative Evaluation

Summative Evaluation

Research

Research

Interventions.

and Control: Reaching and Influencing Vulnerable Audiences 383

achieved for improving this situation? Audience Analysis Research Who are the key target audiences who are affected by this health

Message Testing Research What language level is most effectively understood by members of

Channel Testing Research Which channels of communication are most familiar to audience

Source Credibility Testing Which information sources will be deemed as trustworthy and

Usability Testing How easily can target audience members use the different media

needs or respond to changing conditions?

program cost-effective?

Fig. 1. The Functions of Evaluation Research for Informing Strategic Cancer Communication

and data. It is also critical for health educators to adopt culturally sensitive communication practices to reach and influence vulnerable populations. Community participative communication interventions are a valuable strategy for integrating consumers' perspectives into cancer education efforts and building community commitment to health communication interventions.41,42 It is a good idea to consider introduction of relevant communication technologies, such as tailored information systems, to support health

most persuasive?

needs to be addressed? What are the likely causes of the problem? What are the negative outcomes of the problem? What needs to be changed to address this problem? What are the ideal goals to be

problem? What are the target group members' unique beliefs, attitudes, values, and experiences related to this issue? What are their communication skill levels and orientations to this issue? Can these groups be segmented into homogenous sub-groups?

the target audience? What numerical examples will make sense to members of this audience? Which messages resonate with audience members, are interesting, memorable, and persuasive?

members? How easy are different communication channels for audience members to use? How likely is it for audience members to access and pay attention to different communication channels.

credible to target audience members? How attractive are different potential message sources for audience members? Which sources will audience members pay attention to? Which sources will be

selected for delivering health messages? Can they navigate through the different levels of information presented via these different media? Can they find the most relevant health information and the information they are most interested in?

How well are strategic communication strategies working with targeted audience members? How are the audience members reacting to key messages and communication strategies? Are there unintended reactions to the health education efforts? Is there a need to change communication strategies to better meet audience

How effective was the communication strategy for achieving established health goals? Did the communication effort influence health beliefs, values, attitudes, and behaviors? Did the effort influence cancer incidence, early detection, treatment, morbidity, quality of life, and survivorship? Was the communication

What narrative examples resonate with this audience?

Which channels are likely to work well together?

Needs Analysis Research What is the nature of the health issue, problem or disparity that

elated health information to different audiences. Just as with the use of strategic messages, it is a good idea to pre-test the use of different information sources and different communication channels with targeted audiences.39 Message testing research that examines the impact of different communication sources on targeted audience members can help strategic communicators make good decisions about the best representatives to employ to deliver health information to different audiences.
