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DOI: 10.1111/j.1471-1842.2008.00783.x

Blackwell Publishing Ltd

Improving health communication

Supporting the practice of health communication

Giovanna F. Miranda*, Luisa Vercellesi†, Edoardo Pozzi‡ & Flavia Bruno†, *Research Centre Sanofi Midy, Sanofi-Aventis Spa, Milan, Italy, †Centre for Studies on Drug Communication, University of Milan, Italy, and ‡Research and Development, AstraZeneca Spa, Basiglio, Milan, Italy

Abstract

Background

: Health authorities, hospitals, commercial enterprises, and massmedia all deliver health and medical communication in different forms. Withsuch a vast amount of biomedical and clinical information available, any actionto ensure the spread of clinically relevant news items is welcome.

Objectives

: This paper tries to define a new role for health science librarians inimproving medical communication and reporting.

Methods

: Literature relating to the health and medical reporting is analysed toidentify major difficulties encountered by health communicators.

Results

: There are two areas where health science librarians can develop newroles in health communication: (i) supporting journalists and health communicatorsin selecting sources and understanding scientific papers, and (ii) directlytranslating scientific information into news items, supplying a list of productsin this direction (i.e. targeted newsletters, media releases, news items). Newskills and competencies needed to cope with the new roles are described indetail in a suggested academic curriculum for health communicators.

Conclusions

: A better understanding of the mass media’s needs can providemuch needed support in the field of health communication.

Introduction

The World Health Organization in promoting theethical value of health communication states that‘information is a basic right and health for all is apriority throughout the World’,

1

challenging anyobstacles to these rights is a primary goal.

2

Thecombination of the two elements ‘health’ and‘information’ from an ethical point of view is morethan the arithmetical sum of the two factors.

Difficulties in communications about health

3

arise not so much from research itself as from thegap existing between scientists and health commu-nicators,

4

and in how research tends to be interpreted

by the lay press, hence by the lay public.

5

Scientists‘lose control’ when their stories are exposed outsidethe scientific information circuit.

6,7

Consequently,information provided by the mass media cansometimes be disputed

4

and be responsible forproviding false hopes or unwarranted fears inrelation to medical and pharmacological researchfindings. In today’s world where drugs are a majortool for improving health, the clinical value of theinformation provided needs to be clearly defined.

Lay people and health information

Health topics commonly appear in all the media.Film stories and serials are often built around healthand medicine, adding to knowledge, understanding,and beliefs. In Europe (EU 27) within the media,31% of EU citizens are interested in scientific

Correspondence: Giovanna F. Miranda, Research Centre Sanofi Midy,Sanofi-Aventis Spa, Milan, Italy. E-mail: giovanna.miranda@sanofi-aventis.com

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research, 40% in sport, 35% in entertainment andcelebrities, 24% in politics, and 32% in arts andculture. It is worth mentioning that in a previousEU survey, more interest was expressed in newscientific discoveries than in politics or in sportsnews. It is possible that respondents might havefelt the expression ‘scientific discoveries’ to bemore related to their everyday life than ‘scientificresearch’, the term used in this survey. Within thetopic ‘scientific research’, medicine achieves thehighest interest of 62%.

8

Statistics on the use of the Web have clearlydefined the prominence of health information as atopic that lay people search for. Data publishedin 2005 by Health on the Net Foundation

9

showthat more than 35% European e-health surfers areseeking patient health information. The increasingnumber of lay people searching for health informationon the Web is worldwide. This phenomenon couldaffect the doctor–patient relationship, with the Webassuming the role of a virtual counselor.

10

In the USA in 2005, 42% of Web surfersresponding to a survey confirmed their interestin health information, considering the Web as themost reliable source; only 16% consideredinformation provided by traditional media asreliable.

11

The number of Web users is continually increasing,and nowadays in America about 113 million adults(80% of Internet users) use the Web to search forhealth information. The topics most commonlysearched for are information on specific diseases,medical or treatment problems, diet, and nutrition.

12

This shows an increase to 2000, when 52 millionadults in the USA (55% of those with Internetaccess), had used the Web to get health or medicalinformation.

13

According to the report OnlineSearch Health, 70% of surfers indicated that Webinformation influenced their decision about thetreatment of an illness, 50% asked the doctor newquestions as a result, and 28% said the Web affectedtheir decision about whether or not to visit a doctor.

13

Health communication

Hospitals, public health bodies, academic institutions,scientific associations, pharmaceutical industries,patients leagues and patients blogs, spas, and fitnesscentres provide health information (primarily for

education) to lay people through the mass media,booklets (delivered through physicians andpharmacists), websites, and health campaigns.

Information provided by public bodies generallycovers high-incidence diseases (such as asthma,hypertension, and diabetes), correct lifestyles (smok-ing, physical training, etc.), prevention issues(immunizations, periodical dental visits, monitoringof blood pressure, etc.), a correct approach to thehealth system, and new advances in medicine.Here, the topics selected have to balance betweenthe interest of the public, the requirements of thehealth system, and its budget restrictions. Privatelyowned blogs giving, in narrative form, a person’sown experiences and opinions are becoming morepopular.

14

In the commercial world, topics addressed aredirectly or indirectly related to the field of the activityof the organization, and communication is extensivelyconveyed through different channels and targets(Fig. 1).

Table 1 shows how commercial organizations, inour case pharmaceutical industries, can extensivelyprovide information and penetrate the communi-cation chain, using different channels and addressinga wide range of targets. In the case of the pharma-ceutical industry, the main topics are clearlydrugs, but the information and communicationalso involve prevention, diagnosis, treatment, andprognosis of all types of diseases.

Health science librarians can boost health communication

Health information and science have long beenrecognized as difficult subjects for the non-specialist,and the topic is no simpler for health communicators.

Figure 1 The communication quadrant in a commercial enterprise: the example of the pharmaceutical industry

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Some of the main obstacles are set out in Table 2,respectively, for health science librarians andhealth communicators.

Health science librarians using their traditionalskills (such as information retrieval, assessment,selection, processing, and storage) are an asset inhospitals, public health bodies, and pharmaceuticalcompanies. With the ever-increasing amount ofinformation on the Internet, librarians can nowfind new ways to increase their skills giving themnew roles as ‘coaches, consultants, advisors, andtrainers’, thus boosting their standing and useful-ness within the organization. It is common to findlibrarians working as part of health care teamsand serving as faculty members in evidence-basedmedicine courses.

15

Communication with users,

patients included, is a critical area, but emergingtechnologies (Web 2.0 and the 3-D virtual worldsoftware) offer new opportunities for betterservices.

16,17

Similar support would be useful for healthcommunicators such as medical journalists, pressagents, medical copywriters, and Web contentproviders who all contribute to selecting andtranslating scientific data into end-user informationfor the lay public through various forms of medicalnews reporting (newspapers, health magazines, radio,TV, and websites). In order for scientific informationto be useful to health communicators, the growingnumber of scientific publications and their quality,relevance, and usefulness of their contents have tobe continuously filtered and evaluated.

18

Librarians could help health communicators byfinding reliable sources and experts. Scientists andjournalists do not necessarily share the sameunderstanding of sources,

19

and reporters findscience journals hard to trust and not easy to verify.

20

Although the Web offers tremendous potentialof access to a range of sources, and interpersonalcommunication through blogs, wikis, communities,and such, the quality of the information still variesenormously, limiting its use as a reliable source.

21

Librarians could take a step-by-step approachto providing support for health communicators byidentifying and notifying them of services for the

Table 1 The complexity of communication in a commercial enterprise: the example of the pharmaceutical industry

Activities and items Target audience

Technical informationResearch streams Financial circles, investorsPatents Industrial circlesData sheets Health authorities, physicians, and pharmacistsLeaflets Health authorities, physicians and pharmacists, patients

Scientific informationCongress presentations Scientific communityBiomedical publications Scientific communityClinical publications Scientific community, physicians, pharmacists

DisseminationMedia releases Lay public and stakeholders through journalistsMedia conferences Lay public and stakeholders through journalists

EducationEducational workshops Journalists, health communicatorsEducational campaigns Lay publicContinuing medical education Physicians, pharmacists, other health professionals

PromotionCalls and give aways Physicians, pharmacists, other health professions

Table 2 Main difficulties in health and medical information for health science librarians and health communications

Health science librarians Health communicators

Information literacy Information literacyInformation overload Accessibility (costs)Few independent sources Growing numbers of scientific

publicationsSpecialized research and terminology

Quality of information

Target’s level of education Relevance of informationUsefulness of information

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media that indicate papers with newsworthycontent from publications, such as: (i) the BMJalerting service,

22

and (ii) websites collectingscientific and medical media releases.

23

They can also help by setting up local, tailoredalerting services;

24

indicating reliable sources forjournalists; explaining papers in the light of thescientific method and the differences betweenbiomedical and clinical papers, the importance ofbiometrics, conflicts of interest, and clinical trials;and indicating experts willing to speak to the media.

Health science librarians have their professionalskills including locating the best informationresources from library stock, searching databases,and navigating in the Web wilderness. They alsohave abilities in understanding, evaluating, select-ing, compiling, and processing information. Thecombinations of skills and abilities means they areobvious partners to help health communicatorsunderstand and master the material to hand. Thehealth science librarians’ skills and experience couldbe put to good use in improving communication.

Health science librarians’ skills and expertise

The librarian’s role is continually evolving. Seniorhealth science library positions already require amaster’s degree in information and librarianship,but this is not enough—they need a scientific andbiomedical background too. Specific skills in additionto the traditional ones are needed to face the challengeof this specialization (Table 3).

Supporting health care communication canbe seen as a two-stage process. The first stepinvolves health science librarians helping thecommunicators to work better. This can be done by:(i) providing targeted services, and (ii) suggestingnew types of resources and methods of accessinginformation providing a portfolio of experts will-ing to contribute promptly (Table 4).

At this stage, health librarians must learn thebasics of medical journalism. They must becomefamiliar with issues such as the different approachand weight assigned to sources;

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what makes afact newsworthy;

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how the health communicator

Table 3 Health science librarians’ skills and expertise

Librarian’s traditional skills Health science librarians’ skills

Retrieve, select, organize, and disseminate information Mastery of medical terminologyAssessment of information Study design, epidemiology, and biostatisticsManaging digital access and content Evaluation of scientific literatureLibrary planning, budget, and management of technologies Evaluation of advanced informationComputer skills Identification of clinical information and understanding

of evidence-based medicineGeneral communication skills Writing for empowering patients

Table 4 Health science librarians and the world of communication

Stage 1: Supporting health communicators and medical journalists Stage 2: Mastering the world of health communication

Different views of sources Basics of journalism (e.g. newsworthiness, five Ws, titles, and incipit); information in frame, graphics, info-graphics

Newsworthiness Verification and second opinionTime constraints Time and space constraintsPossible services, for example, identifying: Interviewing

• Portfolio of experts for prompt answers• Health news alert from scientific publishers• Suitable alerting services from literature database• Websites providing media releases on research

Editing/Writing clinical newsletters Patient’s agendaEditing/Writing media releases Editing/Writing news items

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adapts to time and space constraints; the need forverification and a second, critical, or possibly divergingopinion; and how to write a media release.

The second step (Table 4) involves taking a wholenew approach to the health librarian’s role by:• writing medical news items;• acquiring skills such as the concept of coordination

with the patient’s agenda;• assessing the minimum content of a journalistic

article, starting with the five Ws—who, what,where, why, when—which is often how a goodscientific article is built up;

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• assessing what basic information is needed for areliable medical news item, that is, which recom-mendations and guidelines should be followedin medical and drug reporting;

27

• using local professional codes and laws, how tobuild up a story, the importance of the

incipit

,and an appealing title; and

• using graphics, info-graphics, and corollaryinformation to frame the information.Support to health communicators in the future

may well become a question of health librariansbeing taken onto the staff of ‘health magazines’where they could be useful in at least three areas:gathering, production, packaging, and delivery ofnews items,

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in other words, becoming themselveshealth communicators.

Training health communicators

These are not the only changes in the librarian’srole needed to achieve reliable, useful medicalcommunication. The relationship between scientistsand the media is often uneasy on account of thecomplexity of the scientific method and its jargon.Scientists and doctors blame journalists for reportingmedical information wrongly or incompletely, butjournalists accuse the medical community of limitingaccess to information and erecting barriers to thedissemination of medical and pharmacologicalresearch to the public.

4

Lack of time, space, and knowledge; the speedof technology; and the information overload arejust some of the obstacles in the way of brief,simple news. The mass media do play a central rolein peoples’ lives, singling out the issues we shouldthink about. The need to bridge the gap betweenmedicine and the lay public is much felt, and is

shared by private and public participants in thesystem—academics, scientists, governments, healthcommunicators, lay people. All want a new way ofproviding information that avoids hype, noise, andsensationalism. Instead, there should be balanced,scientifically correct, and clinically relevant newsitems that would observe the rules of science,while at the same time fulfilling the basic needs ofjournalism and service to targets.

4

The ‘master course for health communicators’ runat the School of Pharmacy, University of Milan, inItaly is a unique decade’s example of a curriculumaddressing these issues.

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Similar European coursescan be found in the European Guide to ScienceJournalism training.

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Biomedical graduates learnhow to become familiar with the lay mass mediaand their ‘languages’. The programme focuses ondeveloping skills as a health communicatorcreating a bridge between science and the massmedia, with courses on selection, analysis, under-standing, mediating and disseminating scientificinformation, assessing its relevance for clinical use,and putting it in the right perspective.

Barriers to good scientific journalism such assensationalism, biases, conflicts of interest, lack offollow-up, involuntary distortion of information,news making (lack of time, space, knowledge),understanding when a story has a strong promotionalslant, and finding and using sources are analysed.This is where a close link with health sciencelibrarians can come in useful. Editorial needs arealso studied—publishing tight schedules, commercialneeds, competition for space, number of mediareleases received, etc.—and the lack of specializa-tion of most journalists.

Difficulties originating in the scientific milieuare examined. These include poor communicationsfrom scientists mainly because of their lack ofinterest in dissemination and disillusion/uneasyrelations with the media. Students read scientificarticles and analyse how to translate them into articlesfor the lay public, according to the ‘patient’s agenda’.

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Lessons on scientific issues include understandingthe scientific methods in general, reading randomizedclinical trial reports, and the meaning of evidence-based medicine. Also examined are questions suchas conflict of interest, ethical issues in research, theprinciple of precaution, risk assessment, and riskperception. The curriculum explores theoretical

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and practical aspects of methods and techniques,and scientific communication channels in the massmedia.

A first module of lessons deals with:• the theoretical basis of communication from a

transmitter to a receiver;• building up the ability to produce a good

message;• avoiding disturbances and mistakes;• trying to smooth out the asymmetry of commu-

nication; and• ethical, scientific, and journalistic principles and

editorial rules, models, and stereotypes ofscientific communication.The search and the assessment of health and

medical sources are part of the curriculum in thisarea with teaching provided by experienced healthscience librarians.

Teachers share their different skills—fromscientists to journalists—so as to lay solid founda-tions in both areas.

A number of workshops do team work on radioand television reporting, with role-playing andsimulated campaigns to the public. Lectures,seminars, and round-table gatherings offer a chancefor discussion and debate, similar to a press room.Considerable time is dedicated to practical work ina professional health communication environment,such as public relations offices, marketing agencies,museums and hospitals, newspapers, and broad-casting. This sort of ‘on-site’ study has alwaysprovided interesting and worthwhile experiencefor the science and media students and for theirhost institutions. A recent survey has shown thattwo out of three students could find a new jobor improve their role (data on file) in healthcommunication.

Conclusions

This paper suggests a new step forward from thelibrarian’s role as ‘information gatekeepers’ concernedwith controlling the flows in and out and back andforth of the library’s resources. Changing to the nextstage when librarians work as ‘informationintermediaries’, building up databases and decidinghow best to retrieve information. With today’sconstant developments in information technology,librarians are increasingly obliged to adopt what

are virtually ‘futuristic’ approaches, such as 3-Dvirtual world.

The new health librarians are trained to locatethe best information resources, in the library or inthe Web wilderness, and have skills in understanding,evaluating, cataloguing, and interpreting literature.This makes them ideal partners for helping thehealth communication professionals find, master,and translate the material at their disposal. Thisevolutionary change in role could lead to newinformation partnerships where the librarian’s skillsas an information assessor, tracker, and trainercomplement the reporter’s ability as an interpreter,explainer, and compelling writer. News reportingwill become more accurate and useful, offering aricher perspective, bringing in fresh voices andmore viewpoints than was possible in the past. Thelibrarian is responsible for discovering, nurturing,and cultivating information; for harvesting it; keepingit clean; storing, protecting, and sharing it; and, inthe future, for sharing communication responsibil-ities with health communicators.

Continuing education is essential for all librarypersonnel, professionals, or support staff, whetherthey intend to remain in their present position orare preparing to move to a higher one. Continuingeducation opportunities include formal and informallearning, and need not be limited to library sub-jects or the offerings of library schools and courses.Learning is a lifelong process, essential for profes-sional growth and instrumental for sustainingskills. Librarians have managed so far to cope withall the changes in the information process, andthey will surely continue to do so. Education, espe-cially continuing education, is cornerstone in theadvancement of their roles and part and parcel oftheir ‘adaptive’ nature.

There is consensus that health science librarianstoday need a professional qualification, and ideallythey should have a biomedical background ofsome sort, particularly if they approach the healthcommunication level. In this context, a medicalnews librarian will need further specialization inaddition to the general criteria for informationmanagement and assessment, with which weshould all be familiar. A medical news librarianneeds to acquire the basics of journalism in general,and specifically health communication, no matterhow these capacities are achieved. The second step

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involves taking a whole new approach to thehealth librarian’s role: writing medical news itemsthat require a greater understanding of channels,targets, and ‘languages’ suitable to differentmedia.

It is widely assumed that reading the profes-sional literature is one of the most effective ways ofkeeping up to date on the job, but there is little tobe found in the medical literature on this topic.The challenges to anyone wanting to become amedical journalist have been examined elsewhere.

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Curricula for medical journalists and health com-municators, like the academic postgraduatemaster course outlined here, could help satisfy thisneed for the continuing education of health librarians,and in this specific setting contribute to theempowerment of the lay public.

Acknowledgement

The authors thank Ms. Judy Baggott, TranslationUnit, Mario Negri Institute for PharmacologicalResearch, Milano Italy, for the revision of themanuscript.

Key Messages

Implications for Policy

•

Librarians could serve citizens by playing amore active role in becoming a bridge betweenmedical research and the mass media.

•

Health librarians could move from retrievalto assessment of papers for health communi-cation to lay people.

•

Health communicators and journalists as anew high-profile customer, requiring servicesand education.

Implications for Practice

•

New frontiers in the health science librarian’seducation need to be developed.

•

Librarians need to play a greater part inserving the community by providing healthcommunication.

•

Librarians should be more active in selectingmedical papers and translating evidence forlay people.

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Received 9 January 2008; Accepted 24 April 2008