CHAPTER 26 Public Health Practice in Communities 323 behaviors easy to do)is about making the"product"acces- behaviors. Public health managers need to be aware of how sible and convenient, delivering benefits in the right place at messages are produced and how they impact people In par- the right time. Promotion(delivering the message to the ticular, media can play a major role in how a problem is audience) is how the practitioner informs the target market framed. This framing influences how the public understands of the product, as well as its benefits, reasonable cost, and it, how much attention people will pay, and which actions convenience. Social marketing techniques have been used individuals or communities are likely to take. For example, uccessfully in many communities that seemed impervious the Harvard School of Public Health mounted a successful to traditional health promotion messages campaign to persuade television producers to include mes sages about designated drivers with their ads D. Communication Theory Knowledge and behavior change can each precede the other. In dissonance-attribution, behavior change comes mmunication theory describes the use of communication before attitude change and knowledge, whereas in the low ffect change at the community level and in society as well. involvement hierarchy, increased knowledge leads to behav- Communication influences community and societal change or change and finally attitude change. Early studies focused in areas such as building a community agenda of important on opinion or attitude change based on the credibility of the oublic health issues, changing public health policy, allocating information source, fear, organization of arguments, the role esources to make behavior change easier, and legitimizing of group membership in resisting or accepting communica new norms of health behavior tion,and personality differences. Since the 1960s, however, research has emphasized cognitive processing of information I. Delphi Technique leading to persuas ives key concepts and potential change Table 26-3 s The Delphi technique is a method for structuring a group strategies for communication. Table 26-4 outlines theori that it is effectiv a group of individuals, as a whole, to deal with a complex roblem. Furthermore, it is a method for the sy E. Environmental Infuences on Behavior tematic solicitation and collation of judgments on a par ticular health topic through a set of carefully designed Many health promotion campaigns seek to reduce high-risk sequential questionnaires, interspersed with summarized behaviors such as unhealthy eating, alcohol and drug abuse, information and feedback of opinions from earlier and smoking. Such programs should not ignore the material ponses. The Delphi technique is used most frequently to ocial, and psychological conditions in which the targeted integrate the judgments of a group of experts on guidelines behaviors occur. For example, a strong association exists there is insufficient evidence. It can also be among material hardship, low social status, stressful work or decision making in a disparate group such as a community life events, and smoking prevalence. Many strategies that coalition include modifications of the regulatory environment (e. g taxes on tobacco products)and"built"environment(e.g 2. Role of Media Communication impact of an environment that is conducive to exercise or obesity)seem to be at least as effective as those directly aime Media institutions play a crucial role in health behavior at behaviors. The structural as well as the political and socio- change because of their role in disseminating information. economic environment influences how people interact, As agents of socialization, media also have a powerful impact behave, ecover from noxious stimuli. This interaction in legitimizing behavioral norms. Popular and academic per ibed extensively by D. william Haddon for the spectives both hold that media communication plays a pow field of prevention(see Chapter 24). However, Had erful role in promoting, discouraging, or inhibiting healthy of countermeasures to injury is equally able 26-3 Concepts in Communication: Agenda Setting Definition tential Change Strategies Media agenda the media define, select, and emphasize (nghow Institutional factors and processes influenci Understand media professionals' needs and routines for Public agenda The link between issues covered in the media and ships to raise public Policy agend The link between issues covered in the media an the legislative priorities of policy makers licy makers about changes tuucate and tand Factors and process leading to identification of an definitio sue as a"problem"by social institution define an issue for the media and offer solutions. framing lecting and emphasizing certain aspects of a Advocacy groups"package" an important health issue story and excluding others rom Glanz K, Rimer BK, Viswanath K: Health behavior and health education: theory, research, and practice, Bethesda, Md, National Cancer Institute at National Institutes of Health,2008.http://www.cancer.gow/cancertopics/cancerlibrary/theorypdf
324 SECTION 4 Public Health Table 26-4 Overview of Community-Level Theories of Behavior Change The Key Fac Community organization Community-driven approaches to assessing and solving health and social problems Diffusion of innovations How new ideas, products, and practices spread Relative advantage thin a society or from one society to another Communication theory How different types of communication affect Media agenda sett health behavio Public oblem identification and definitio From Glanz K, Rimer BK, Viswanath K: Health behavior and health education: theor, research, and practice, Bethesda, Md, National Cancer Institute at National Institutes of Health2008.https://www.cancer-gow/cancertopics/cancerlibrary/theory.pdf Table 26-5 Application of Haddon Countermeasures to Gun Injury and Cancer Prevention Preventing Injury by Handguns Preventing Cancer Associated with Smoking 1. Prevent the creation of the hazard. Limit the number of handguns lume of tobacco production by changing lowed to be sold or purchased. 3. Prevent the release of the hazard nstall locks on handgun tobacco to certain age groups. 4. Modify the rate of release of the op cigarettes that bu 5. Separate the hazard from Store handguns only at gun clubs Establish shutoff times for vending machines and earlier to be protected by time eather than at closings of convenience stores and groceries. 6. Separate the hazard from th Keep guns in locked containers. Install filters on o be protected by a physical barrier 7. Modify relevant basic qualities of the onalize guns so they can be Reduce the nicotine content of cigarettes. Limit exposure to other potential sy 9, Begin to counter the Provide good access to emergency Set up screening to deter tal carcinogens)among smokers the early stages. pair, and rehabilitate the Provide high-quality trauma ca Provide good-quality health care for cancer patients. object of damage Modified from Runyan CW: Epidemio! Rev 25: 64/64, 2003 pplicable to harmful behaviors such as smoking( programs for poor women, and interventions to change 26-5). Structural interventions for patients with rmful sexual norms infection have been categorized into the following 3. Harm reduction or health-seeking behavior change. These approaches work to make harm reduction tech ologies available to those in need and to change rules, 1. Social change. These approaches focus on factors affe services,and attitudes about these technologies. Examples ing multiple groups(e. g, a region or country as a whole include efforts to provide safe housing for drug users and such as legal reform, stigma reduction, and efforts to cul . 00%condom use"campaigns tivate strong leadership on acquired immunodeficiency yndrome(AIDS) e interaction 2. Change within specific groups. These approaches address behavior and environment (such as those just social structures that create vulnerability among specific allows planners to think through the interaction of people, populations (e.g, men who have sex with men, mine harmful substances, and their environment. It opens up workers, disadvantaged women). Examples include efforts new ways of thinking about prevention in a more compre to organize and mobilize sex workers, microfinance hensive way