Key Issues in Health Communication Research Within an Interdisciplinary ContextVictor J. Strecher, PhD, MPHProfessor and Director for Innovation and Social EntrepreneurshipUniversity of Michigan School of Public Healthstrecher@umich.edu

My purpose

Vic Strecher, PhD, MPHProfessor and Director for Innovation and Social EntrepreneurshipUniversity of Michigan School of Public Health

Founder, HealthMedia, Inc. (a Johnson & Johnson Company)

7392048

Shiv B and Fedorikhin A. 1999. Heart and mind in conflict: The interplay of affect and cognition in consumer decision making. Journal of Consumer Research. 26(3):278.

26

or

7392048 260%

10%

20%

30%

40%

50%

60%

High Cognitive Load Low Cognitive Load

59%

37%

Shiv B and Fedorikhin A. 1999. Heart and mind in conflict: The interplay of affect and cognition in consumer decision making. Journal of Consumer Research. 26(3):278.

Our work at the University of Michigan...

7

Our Research Network:

School of Public Health

School of Medicine

School of Information

School of Nursing

School of Dentistry

School of Social Work

School of Art

Department of Psychology

Department of Statistics

Institute for Social Research

Tailoring to specific needs and interests...

“By eliciting and reporting back information about

factors that influence patients’ health behaviors,

computer programs can achieve one of the strengths

of face-to-face patient counseling: the ability to

tailor the educational message for the individual

patient.”

1993

Engineering

Informatics

Psychology

Medicine

Nursing

CommunicationGraphic design

Screenwriting

Nutrition

Statistics

Demographics

Perceived Benefits

Perceived Barriers

Tailored MessageData

red

blue

aqua, gray

orange

Environment

Motivation

1994

Special dietary needs: diabetic, vegetarian, vegan, low fat, low cholesterol, low salt, weight reduction, lactose

Self-rating vs. scored items (grain, whole grain, fruit, vegetable, calcium, protein, fluid, drink, dessert servings; added fats, high-fat foods, breakfast).

Whole grain, grain, vegetable, fruit, calcium, dessert servings, high fat foods, added fats, breakfast, eating out.

Fats, fruits & vegetables, fibers

Fats, fruits & vegetables, fibers

Favorite foods: chocolate, seafood, ice cream, chicken, pizza, soups, steak, salads/ Chinese, Mexican, Italian cuisines

Pregnancy, disease history (HA, angina, CHD, CHF, OHD, breast, colorectal, prostate, stroke, diabetes, HBP, cholesterol, obesity, osteoarthritis) family history (HA, angina, CHD, CHF, OHD, breast, colorectal, prostate, stroke, diabetes, HBP, cholesterol, obestity, osteoarthritis).

Primary shopper? Eat out? (fast food/ full service)

Experimental design

Survey of patients in family practices

Tailoredmessage

Nomessage

Survey patients at homeUntailored

message

Percent of patients who remembered receiving dietary message (4 months) by receipt of tailored, untailored or no dietary message.

Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF and Sandler RS. The impact of message tailoring on dietary behavior change for disease prevention in primary care settings. American Journal of Public Health, 1994.

0%

20%

40%

60%

80%

Tailored Untailored No Message

15%

33%

73%

Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF and Sandler RS. The impact of message tailoring on dietary behavior change for disease prevention in primary care settings. American Journal of Public Health, 1994.

-10.0

-7.5

-5.0

-2.5

0

Tailored Untailored No Message

-1.0-4.0-10.0

Changes in grams of total fat per day (4 months) by receipt of tailored, untailored or no dietary message.

How much tailoring?

Demographics

Motives

Barriers

Coping strategies

Social Environment

Data

red, pink, greens

gray, maroon

pink, green, blue

red, gray, pink

blues, aqua, reds

High depthLow depth

Motives

Self-confidence

Success stories

Tailoring depth

+ + + +

Tailoring depth

6-m

o ce

ssat

ion

rate

Number high-depth tailored components

15%

20%

25%

30%

35%

40%

0 1 2 3

39%

34%

26%28%

Adjusted 6-month smoking cessation rates by cumulated number of high-depth intervention components received. Per Protocol analysis (n=944; OR=1.91; CI=1.18-3.11)

Relevance through images

Matched

Mismatched

Sunset

Tailored Pictures

Matched

Mismatched

Sunset

85 participants:

Most convincing testimonial

Most picture/text saccades

Smaller average pupil size

MORE RELEVANT MESSAGES

MORE ELABORATION AND MEMORY,

LESS WORK

MOREBEHAVIOR CHANGE

Understanding needs and

interests...

Gugulethu 2002

Psychology

Communication

AnthropologyJournalism

Getting the frog to jump...

Psychology

Philosophy Epidemiology

Health message AHA! Change

Motivational Interviewing

SO WHAT DO YOU THINK ABOUT THE RESULTS OF

YOUR HEALTH RISK ASSESSMENT?

OVERALL, I THINK I’M DOING REALLY WELL!

WELL... I GUESS I WOULDN’T SAY “HAPPY.”

YOUR NUTRITION SCORE IS A 2 OUT OF 10. WHAT DO

YOU MAKE OF THAT SCORE?

I GUESS IT’S NOT GREAT, BUT ONE THING I WON’T

DO IS GIVE UP MY DONUTS!

SO WE MAY HAVE TO FIND A WAY TO WORK IN THE OCCASIONAL DONUT.

WELL, THEY’RE NOT AS IMPORTANT AS MY HEALTH. I REALLY DO NEED TO WORK

ON MY DIET.

VIC, ON A SCALE OF 0-10, HOW MOTIVATED WOULD YOU SAY YOU

ARE TO EAT FEWER DONUTS.

I WOULD GIVE IT A

‘7’.

HMM... I’M WONDERING WHY YOU’RE NOT A ‘2’ OR A ‘3’. YOU SEEM REALLY COMMITTED TO

YOUR DONUTS.

TO BE HONEST, I’M A ‘7’ BECAUSE I JUST TURNED 50

AND I DON’T WANT TO GROW OLD AND FAT.

HERE’S A LIST OF THINGS PEOPLE VALUE. WHICH OF THESE VALUES ARE MOST IMPORTANT TO YOU?

I GUESS MOST OF ALL... I WANT TO BE IN CONTROL OF MY LIFE. I ALSO VALUE MY FAMILY

AND MY HEALTH.

SO VIC, YOU SAID THAT YOU VALUE BEING IN CONTROL, AND THAT YOU WANT TO BE THERE FOR YOUR FAMILY. HOW DOES

EATING TOO MANY DONUTS RELATE TO THESE VALUES?

Values

Behaviors

Values

Intrinsic motivation

Behaviors

“These studies, in concert with previous research, suggest that values affirmation reduces defensiveness via self-transcendence...”

COPD

CAD

CHF

Stroke

Cancer

Morbidity

DEATH

MortalityBehavior

Activity

Stress Mgt

Nutrition

Smoking

Sleep

Condition

Hypertension

Cholesterol

Pain

Depression

Back

Diabetes

Obesity

COPD

CAD

CHF

Stroke

Cancer

Morbidity

DEATH

MortalityBehavior

Activity

Stress Mgt

Nutrition

Smoking

Sleep

Condition

Hypertension

Cholesterol

Pain

Depression

Back

Diabetes

Obesity

PURPOSE

Life

Energy

Wellness

Getting bees to swarm...

Psychology

Biology Sociology

One queen bee

~ 10,000 worker bees

3-5% are active scout bees

A Swarm of Bees

Angle of waggle run indicates direction.

Coding location information in waggle dance

Duration of waggle run indicates distance.

One 16-hour “debate”: 11 sites, 149 scouts

Seeley& Buhrman (1999) Behav. Ecol. Sociobiol. 45:19-31.

The scout bees...

Starting things...

Engineering

Informatics

Psychology

Medicine

CommunicationGraphic design

ScreenwritingPoetry

Business

strecher@umich.edu

Research Real world

...with EMR

...with biometrics

...with coaches

Engineering

Informatics

Psychology

Medicine

Communication Graphic design

Screenwriting

Poetry

BusinessPhilosophy

SociologyMedicine Nursing

NutritionBiology

EpidemiologyJournalism

Screenwriting Anthropology

Statistics

The best way to predict the future is to

create it...

Thank you, Anne Moorhead!

Thank you!Victor J. Strecher, PhD, MPHProfessor and Director for Innovation and Social EntrepreneurshipUniversity of Michigan School of Public Healthstrecher@umich.edu