**2. Vulnerable populations and health communication**

Communication is the central social process in health promotion and care for informing cancer prevention and control for vulnerable populations.1,2 The process of communication is the primary social mechanism used to both seek and deliver cancer care. Communication is the primary process for delivering cancer education and influencing cancer-related health behaviors. Communication is the coordinating process used to manage health care delivery systems. It is also the social process used to establish and reinforce health policies and practices. Health care consumers and providers depend upon communication to gather relevant health information for guiding evidence-based health decision making, encouraging participation in health care and health promotion activities, reducing uncertainty about cancers and increasing understanding about relevant health issues, as well as promoting needed cooperation and collaboration to achieve health goals.

Vulnerable populations are those groups of health care consumers who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the general population. 3 These vulnerable population members are typically the poorest, least well educated, and most disenfranchised members of modern society, including members of many immigrant and minority groups, the elderly, the socioeconomically deprived, the disabled, and people suffering from serious chronic diseases. 3 Many members of these vulnerable populations are likely to experience key health communication barriers such as health literacy challenges, limited access to and ability to use key channels of communication (such as new information technologies), as well as suffer from serious social and economic problems that can limit their ability to get needed care and to follow cancer prevention and control recommendations. 4,5 There are a broad range of significant health risks confronting members of vulnerable populations today, including risks from cancers, heart disease, diabetes, stroke, HIV/AIDS, and other serious health threats.6,7 Effective health communication is needed to help those members of the public who are at greatest risk (most vulnerable) for suffering from these health threats to recognize, minimize, and respond effectively to potential health problems.8,9

It is particularly important to effectively communicate clear, accurate, and persuasive information about cancer prevention and control to audiences who are at greatest risk for negative cancer outcomes, those who suffer from cancer health disparities.10,11,12,13 Unfortunately, current efforts to educate the most vulnerable segments of society about cancer prevention and control strategies have been insufficient to significantly reduce cancer incidence, morbidity, and mortality for members of these groups by helping them make informed decisions about their best health care and health promotion choices. 15,16,17,18 The

Strategic Communication for Cancer Prevention

illustrate key points.

about cancer prevention, screening, and treatment strategies.30,31

and Control: Reaching and Influencing Vulnerable Audiences 379

communication is essential to providing vulnerable consumers with relevant information

The best cancer communication education efforts begin with careful analysis of the critical cultural factors that influence the health beliefs and behaviors of targeted members of at-risk groups, since these cultural factors will also influence these consumers' reception and response to cancer prevention messages. It is important to identify the current levels of relevant cancer-related knowledge, strongly-held health beliefs, and primary health goals of key audience members before composing communication strategies. By determining what consumers know and don't know about cancer, health campaign strategist can guide the design of cancer-related health messages to help fill consumers' cancer information gaps and to correct any misconceptions these consumers may have concerning cancer prevention and control. Too often health communication efforts are based on very good intentions, but extremely limited audience data, so health promotion campaign do not hit the mark, failing to provide consumers with the information they most need. Without collecting good background information about audience members' cultural beliefs, attitudes, expectations, and behaviors, it is very difficult to develop health promotion messages that will be appropriate and influential for targeted audiences. The best health promotion messages are carefully designed to speak to audience members' unique cultural experiences. The messages employ familiar language and provide compelling culturally-rich examples to

It is also important to carefully assess the level of communication skills and the unique communication orientations of targeted audience members. By learning about the communication skills and orientations of key audiences, campaign planners can design messages that will be easily understood by member of these audiences. They can employ communication channels for delivering the messages that will be easy to use and comfortable for audience members to access. They can also identify and use appropriate information sources to deliver cancer prevention and control messages who are likely tol be

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

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

perceived as interesting and credible by members of key target audiences.

**4. Strategic health communication design** 

used for guiding message design.37,38

need for effective communication about cancer risks and responses is particularly acute, yet also tremendously challenging, for reaching vulnerable health care consumers.19,20 These vulnerable population members are heir to serious disparities in cancer-related health outcomes, resulting in alarming levels of cancer-related morbidity and mortality, especially in comparison to the rest of the public.19,21,22 The cultural barriers and health literacy challenges faced by many members of vulnerable populations, who are often immigrants, as well as non-native and substandard English speakers, readers, and writers, creates significant barriers to accessing and making sense of relevant cancer-related information.23,24,25 These consumers are often confused and misinformed about the causes, preventive strategies, early detection procedures, and the treatments for different forms of cancer, which serves to exacerbate their poor cancer-related health outcomes.25

Members of vulnerable populations who are likely to suffer from significant cancer-related health disparities are desperately in need of relevant, accurate, and timely health information about cancer prevention and control.26,27,28 Some vulnerable group members, such as elderly health care consumers, have elevated risks for contracting different forms of cancer, while other vulnerable group members, such as African American women, are more likely to die from breast cancer than other women.3,16,25,26 Many members of immigrant populations in the US are non-native English speakers and encounter serious language and health belief barriers that necessitate adaptive, culturally-sensitive communication strategies to provide them with needed cancer-related health information.27,28,29,30 Furthermore, consumers with serious and chronic medical conditions, as well as individuals who confront physical and mental disabilities, are often particularly vulnerable to health risks and have unique communication needs that must to be adequately addressed to provide them with the relevant health information they need to preserve their health.31 Strategic, adaptive, and culturally-sensitive health communication information dissemination programs are needed for reducing cancer-related health disparities by providing vulnerable consumers with relevant and persuasive health information to help them evaluate health risks, make informed health care decisions, and direct their health behaviors.

#### **3. Focus on cultural issues**

Vulnerable consumers' unique cultural backgrounds and orientations have powerful influences on their communication practices that must be carefully accounted for when designing and implementing strategic cancer communication efforts.32 It is critically important to identify and examine the relevant cultural issues that are likely to influence the ways consumers, particularly members of vulnerable populations, respond to communication about cancer prevention and control. 27,29,31 Several of the key cultural variables that influence cancer communication outcomes include the unique health beliefs, values, norms, and expectations that different consumers bring to health situations that influence their cancer-related health decisions and behaviors.26 It is also important to assess consumers' culturally-based language skills and orientations, their health literacy levels (both their levels of literacy for language and numbers), their motivations to seek health information, their unique media use patterns, and their social network memberships.33,34 Examination of these key cultural factors can provide relevant information for determining how to best design and deliver key messages for effectively communicating complex health information to diverse and vulnerable populations.27,20,31 Culturally-sensitive health

need for effective communication about cancer risks and responses is particularly acute, yet also tremendously challenging, for reaching vulnerable health care consumers.19,20 These vulnerable population members are heir to serious disparities in cancer-related health outcomes, resulting in alarming levels of cancer-related morbidity and mortality, especially in comparison to the rest of the public.19,21,22 The cultural barriers and health literacy challenges faced by many members of vulnerable populations, who are often immigrants, as well as non-native and substandard English speakers, readers, and writers, creates significant barriers to accessing and making sense of relevant cancer-related information.23,24,25 These consumers are often confused and misinformed about the causes, preventive strategies, early detection procedures, and the treatments for different forms of

Members of vulnerable populations who are likely to suffer from significant cancer-related health disparities are desperately in need of relevant, accurate, and timely health information about cancer prevention and control.26,27,28 Some vulnerable group members, such as elderly health care consumers, have elevated risks for contracting different forms of cancer, while other vulnerable group members, such as African American women, are more likely to die from breast cancer than other women.3,16,25,26 Many members of immigrant populations in the US are non-native English speakers and encounter serious language and health belief barriers that necessitate adaptive, culturally-sensitive communication strategies to provide them with needed cancer-related health information.27,28,29,30 Furthermore, consumers with serious and chronic medical conditions, as well as individuals who confront physical and mental disabilities, are often particularly vulnerable to health risks and have unique communication needs that must to be adequately addressed to provide them with the relevant health information they need to preserve their health.31 Strategic, adaptive, and culturally-sensitive health communication information dissemination programs are needed for reducing cancer-related health disparities by providing vulnerable consumers with relevant and persuasive health information to help them evaluate health risks, make

Vulnerable consumers' unique cultural backgrounds and orientations have powerful influences on their communication practices that must be carefully accounted for when designing and implementing strategic cancer communication efforts.32 It is critically important to identify and examine the relevant cultural issues that are likely to influence the ways consumers, particularly members of vulnerable populations, respond to communication about cancer prevention and control. 27,29,31 Several of the key cultural variables that influence cancer communication outcomes include the unique health beliefs, values, norms, and expectations that different consumers bring to health situations that influence their cancer-related health decisions and behaviors.26 It is also important to assess consumers' culturally-based language skills and orientations, their health literacy levels (both their levels of literacy for language and numbers), their motivations to seek health information, their unique media use patterns, and their social network memberships.33,34 Examination of these key cultural factors can provide relevant information for determining how to best design and deliver key messages for effectively communicating complex health information to diverse and vulnerable populations.27,20,31 Culturally-sensitive health

cancer, which serves to exacerbate their poor cancer-related health outcomes.25

informed health care decisions, and direct their health behaviors.

**3. Focus on cultural issues** 

communication is essential to providing vulnerable consumers with relevant information about cancer prevention, screening, and treatment strategies.30,31

The best cancer communication education efforts begin with careful analysis of the critical cultural factors that influence the health beliefs and behaviors of targeted members of at-risk groups, since these cultural factors will also influence these consumers' reception and response to cancer prevention messages. It is important to identify the current levels of relevant cancer-related knowledge, strongly-held health beliefs, and primary health goals of key audience members before composing communication strategies. By determining what consumers know and don't know about cancer, health campaign strategist can guide the design of cancer-related health messages to help fill consumers' cancer information gaps and to correct any misconceptions these consumers may have concerning cancer prevention and control. Too often health communication efforts are based on very good intentions, but extremely limited audience data, so health promotion campaign do not hit the mark, failing to provide consumers with the information they most need. Without collecting good background information about audience members' cultural beliefs, attitudes, expectations, and behaviors, it is very difficult to develop health promotion messages that will be appropriate and influential for targeted audiences. The best health promotion messages are carefully designed to speak to audience members' unique cultural experiences. The messages employ familiar language and provide compelling culturally-rich examples to illustrate key points.

It is also important to carefully assess the level of communication skills and the unique communication orientations of targeted audience members. By learning about the communication skills and orientations of key audiences, campaign planners can design messages that will be easily understood by member of these audiences. They can employ communication channels for delivering the messages that will be easy to use and comfortable for audience members to access. They can also identify and use appropriate information sources to deliver cancer prevention and control messages who are likely tol be perceived as interesting and credible by members of key target audiences.
