This presentation draws upon my book, Health Communication: From Theory to Practice, Second Edition, San Francisco: Jossey-Bass, an imprint of Wiley, 2013. It was given as part of a Sept. 10, 2014 Author's Night at the New York Academy of Medicine.

1. Copyrights © Renata Schiavo, 2013,
2014

2. Renata Schiavo/About Me
Founding President, Health Equity
Initiative
Senior Lecturer, Columbia University
Mailman School of Public Health
Editor-in-Chief, Journal of
Communication in Healthcare:
Strategies, Media and Engagement in
Global Health
Founder and Principal, Strategic
Communication ResourcesSM
Author, Health Communication: From
Theory to Practice
Proud NYAM Fellow 

3.  Making a difference in people’s health and lives
 Tackling health disparities/helping promote
health equity
 Fostering conversations and interventions that
help put the public back in public health
 Commitment to social innovation
 Developing global strategies that support local
solutions
 Encouraging participation and people’s
ownership of health and social issues/ solutions

4.  Health Communication: A Few
Definitions
 Ten Distinguishing Ideas for Health
Communication in the 21st Century
 Health Communication in the 21st
century: Why should you care?

5. “The art and technique of informing,
influencing, and motivating individual,
institutional, and public audiences about
important health issues. The scope of health
communication includes disease prevention,
health promotion, health care policy, and the
business of health care as well as
Enhancement of the quality of life and health
of individuals within the community”
– Healthy People, 2010 p. 11–20; Ratzan,1994

6. Health communication is the scientific
development, strategic dissemination, and
critical evaluation of relevant, accurate,
accessible, and understandable health
information communicated to and from
intended audiences to advance
the health of the public.
– J.M. Bernhardt , Journal of Public Health, 2004

7. “The process of understanding and sharing
[health related] meanings.”
– J. Pearson and P. Nelson (1991)
“Health communication and other disciplines
‘may have some differences, but they share
a common goal: creating social change by
changing people’s attitudes, external
structures, and/or modify or eliminate
certain behaviors’”
-- Centers for Disease Control and Prevention (2011)

8. “Health communication is a multifaceted and
multidisciplinary field of research, theory, and practice. It
is concerned with reaching different populations and
groups to exchange health-related information, ideas,
and methods in order to influence, engage, empower,
and support individuals, communities, health care
professionals, patients, policymakers, organizations,
special groups and the public, so that they will
champion, introduce, adopt, or sustain a health or social
behavior, practice, or policy that will ultimately improve
individual, community, and public health outcomes.”
– R.Schiavo (2013)

9.  Interpersonal Communication
› Provider–patient communication
› Personal selling and counseling
› Community dialogue (interpersonal communication at scale)
 Mass Media and New Media Communication, and
Public Relations
 Community Mobilization and Citizen Engagement
 Professional Medical Communications
 Constituency Relations which lead to Strategic
Partnerships in Health Communication
 Policy Communication and Public Advocacy
Schiavo, R. Health Communication: From Theory to Practice, San Francisco: Jossey-Bass, Second Edition, 2013. All rights reserved.

10. © Charlieaja | Dreamstime.com - Why? Photo

11.  Mirror how people talk about health and illness in
real life settings
 Resonance effect – “I heard it from many places”
 Multiple groups and stakeholders are engaged in
the same health issue = multiple group-specific
approaches to communication that may rely on
different areas/media
 Cost-effectiveness
 Increased reach among key groups and
stakeholders
 Increased ability to recruit and engage multiple
partners
 Only comprehensive programs can achieve
sustainable results

12. Communication operates in a complex environment, so
integration of multiple areas and media is key to effectiveness
Source: Schiavo, R. Health Communication from Theory to Practice. Second Edition. San Francisco: Jossey-Bass, 2013.
Figure 1.1. All rights reserved. Used by permission.

13. Multimedia communication (e.g., a combination of
interpersonal, community, new media, mass media,
professional clinical communication, etc) results in 35%
percent increase in attention and public engagement

14. Looking at key features that may help increase
communication effectiveness in the 21st century
© Boyande1971 | Dreamstime.com

15.  Beyond:
› Just participatory audience research, focus groups,
etc.
› Providing information
› Sender-receiver or top down approaches
 Effectively fostering ownership of health and social
issues among communities, key groups and
populations
 Participatory planning/community engagement in
all phases of health communication planning,
implementation and evaluation
 Key to sustainability of all interventions and related
behavioral, social and organizational results

16.  Communication for Development (C4D)
http://www.unicef.org/cbsc/
 Communication for Behavioral Impact (COMBI)
http://www.who.int/ihr/publications/combi_toolkit_outbrea
ks/en/
http://www.comminit.com/combi/category/sites/global/c
ombi/
 Other experiences and resources on The
Communication Initiative (CI) Network
http://www.comminit.com/global/search/apachesolr_sear
ch/community%20health%20workers?filters=tid:36

17.  Research and evaluation as an integral
process of the health communication cycle
› Focus on people, needs, situations, socio-
political environment
› In-depth understanding of key social
determinants of health
› In-depth situation and audience analysis
› Rigorous monitoring and evaluation process
› Participatory research methods
› Mixed methods (online/offline, quant/qual)

18. Source: Schiavo, R. 2013, Figure 14.3 - Flu Vaccine Campaign in Whyville
@ 2009 Numedeon, Inc. Used by permission.

19. Source: Schiavo, R. Health Communication: From Theory to Practice. Second
Edition. Figure 10.1. San Francisco, Jossey-Bass/Wiley. All rights reserved. Used by
permission.

20. Source: Schiavo, R. Health Communication from Theory to Practice. Second Edition. Figure 2.1. San Francisco:
Jossey-Bass, 2013. All rights reserved. Used by permission.

21.  Don’t produce any workshop, video,
brochure, or social media site before
establishing a sound communication
strategy
 Strategy = the “how” we achieve outcomes
and communication objectives
 Long-term process for partnership and
participation based on two-way dialogue
within all phases
 Beyond messages and media channels

22. “Communication goes beyond the delivery of a
simple message or slogan to encompass the full
range of ways in which people individually and
collectively convey meaning. Among the powerful
tools employed by SBCC [Social and Behavioral
Change Communication] programs are mass
media, community-level activities, interpersonal
communication, information and communication
technologies, and new media.”
~ Health Communication Capacity Collaborative (HC3), a USAID-funded project based
at the John Hopkins Bloomberg School of Public Health, Center for Communication
Programs
Schiavo, R. Health Communication: From Theory to Practice, San Francisco: Jossey-Bass, Second Edition, 2013. ©
Copyright, 2013. All rights reserved.

23. Photo Credits: Courtesy of Health Equity Initiative.
www.healthequityinitiative.org Used by permission.
Source: Schiavo, R. Health Communication from Theory to Practice. Second Edition.
San Francisco: Jossey-Bass, 2013. All rights reserved. Used by permission.

24.  A concept health communication borrows
from commercial and social marketing
 Inform policies/budget allocations for
health communication interventions
 Strongly connected to rigorous program
evaluation
 Need to strengthen cost-effectiveness
research
 Cost-benefit research can also support the
importance of communication interventions
 Capacity building key to all efforts

25.  The fun part!!!
 Creativity is great but needs to address
specific strategic needs
 Refrain from creating a mix of
communications vs. a communication
mix

26.  Moving away from the one-message = one
behavior approach to
Multiple audience- and media-specific
messages = multiple audience-specific
health and social behaviors
 Messages and activities tied together with
culturally-friendly channels with highest
reach

27. Mike Keefe, Intoon.com - Used by permission

28. People continue to talk about health and illness in a
variety of settings, venues, and across different media
Schiavo, R. Figure 14.2, 2013. All rights reserved. Used by permission

29. •“Showing instead of telling” is an old key mantra
of health communication
•Start your story thinking of “once upon a time…”
Make it personal and relevant to others!
Lynette Webb
© Ilianamihaleva | Dreamstime.com
© Deepta | Dreamstime.com

30. The human brain processes visual information
60,000 faster than other types of information
Ref: Parkinson, M. 2012

31.  Communication as a relationship business
 Good relationships = Shared meanings
 Strategies to develop and manage
successful multisectoral partnerships = an
essential communication competency
 Start early to involve potential
partners/key stakeholders/communities

32.  What do you want people to do?
 What happens between communication and health
or social behavior?
 e.g., awareness, attention, perceived risk/relevance, knowledge,
dealing with and addressing multiple obstacles/existing social
norms, behavior intention, perceived social support by multiple
groups /levels of society, behavior readiness and adoption,
behavior maintenance (in one’s lifestyle), wanting to become an
ambassador/engage others, etc. SUSTAINABLE
BEHAVIORAL AND SOCIAL RESULTS
 Many social, economic and environmental determinants
of health affect intermediate steps and behavior among
key groups and stakeholders
We are in the new era of BEHAVIORAL AND
SOCIAL IMPACT COMMUNICATION

33. Still don’t understand health
systems and its many
complementary elements and
participant groups?
 Watch what it takes to
make Maya cry in a World
Bank video, Health Systems
Creates Healthy Futures
 Systems are made of
people who can influence
social determinants of
health
https://www.youtube.com/watch?v
=PFVCNUOM5Us
Source: World Bank, Sept. 2011 and 2013

34.  Did these populations participate in the
health communication process?
 Did we engage them via community
dialogue, interpersonal communication,
participatory planning, interactive media,
or other community and social
engagement processes?
 Did the intervention had an impact among
vulnerable and underserved groups? Did it
help advance health equity?

35. Health communication theory and practice influences
and is influenced by the key issues of our times

36.  Health disparities
 Patient and community empowerment
 The rise of chronic diseases
 Limits of preventive medicine and behavior
 A mobile, on-demand, and audience-
driven communication environment
 Low health literacy
 Impact of managed care and other cost –
cutting interventions

37.  Reemergence of communicable
diseases
 Worldwide urbanization
 The threat of bioterrorism
 International access to essential drugs
 Global health workers brain drain and
other capacity-building needs in
developing countries

39.  Global demographic landscape reveals
myriad of cities and towns
 World urban population is expected nearly to
double by 2050
› 6.4 billion people expected to live in cities in 2050
 Long list of potential urban hazards
 Disproportionate inequalities among large
groups of city dwellers
› Within and between urban areas
› Significant numbers of early death and debilitating
diseases
› Health inequalities reflect larger social inequalities

40. Multisectoral partnerships and multidisciplinary health
communication teams are needed in order to address
urban health issues (and similar issues in other settings)
Schiavo, R., 2013. Figure 8.7. Health outcomes as a complex construct. All rights reserved. Used by permission.

41. Reference: Schiavo, R. In Okigbo, 2013. Table 1
Source: Unpublished table from Schiavo, R. and Ramesh, R. Strategic Communication in Urban Health Settings: Taking the
Pulse of Emerging Needs and Trends. Online report, May 4, 2010. Strategic Communication Resources, New York, NY. NY
http://www.renataschiavo.com/surveyresultsnew.html. All rights reserved. Copyrights  2010 by Renata Schiavo/Strategic
Communication Resources. Used by permission.

42. Ebola crisis and other outbreaks demonstrate that we need to
move from the disaster “rut” to a systematic approach to risk
communication in outbreak prevention and control settings
Schiavo, R. Figure 6.5., 2013. All rights reserved. Used by permission.

43.  Focus on:
› Prevention
› Community mobilization and community
health workers strategies
› Helping remove barriers to healthy behaviors
and access to services and information
› Being inclusive of vulnerable and
underserved populations – we cannot afford
otherwise
› Key role of constituency relations and multi-
sectoral partnerships

44.  Experiencing a recent “renaissance”
 Critical to:
› Promoting health equity/eliminating disparities
› Increasing access to health services
› Engaging and empowering communities and key groups to
address key social determinants of health
 Considered one of the most important disciplines in
public health and healthcare
› Anthrax crisis propelled communication to forefront of public
health
› Healthy People 2010 helped set guidance for increased
visibility/integration of health communication in public health
› Several international initiatives galvanizing field (e.g.,
communication for development, C4D, COMBI, HC3, centers of
excellence,, etc. )
Schiavo, R. Health Communication: From Theory to Practice, San Francisco: Jossey-Bass, Second Edition, 2013.
All rights reserved.

45.  Significant advances of health communication theory
and practice across different fields and sectors,
including public health, healthcare and community/social
development
 Health Communication Working Group (HCWG), part of
American Public Health Association (APHA) Public
Health Education and Health Promotion (PHEHP)
section, founded in1998
 Strong presence at APHA annual meetings
 Multiple sessions, annual film festival, business meetings
and social event
Schiavo, R. Health Communication: From Theory to Practice, San Francisco: Jossey-Bass, Second Edition, 2013. All rights
reserved.

46.  A main focus of Healthy People 2020 and several current
and upcoming international agendas, models, and
organizations
› UNICEF – Communication for Development
› WHO – Communication for Behavioral Impact
› CDC – CDCynergy – Health Communication and Public Health
Emergency Communication modules
› Dedicated health communication divisions of the National
Communication Association (NCA) and International Communication
Association (ICA)
 Several new positions started in past few years
› Includes academia, governments, non-profit organizations,
corporations, hospitals, foundations, etc.
› Increasingly the focus is on the complex and multifaceted
role of health communication
Schiavo, R. Health Communication: From Theory to Practice, San Francisco: Jossey-Bass, Second Edition, 2013. All rights
reserved.

47. To help
SAVE LIVES!
© Elya1000 | Dreamstime.com - People Having Fun Photo
© Xidong Luo | Dreamstime.com

48. Renata Schiavo, PhD, MA
www.renataschiavo.com
This presentation draws upon Schiavo, R. Health
Communication: From Theory to Practice, San
Francisco: Jossey-Bass, Second Edition, 2013. All rights
reserved.
http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118122194.html