Enhancing the Role of Health Communication in the Prevention of Infectious Diseases

Abstract

Despite the recognized importance of health communication for disease prevention, a gap in knowledge was becoming apparent as regards the extent and nature of its use at the European level to support prevention and control of infectious diseases. To address this gap, the European Centre for Disease Prevention and Control (ECDC) commissioned in 2009 a consortium of universities to undertake a 3-year research project called “Translating Health Communications.” The outcomes of this project comprise 2 major areas: (a) primary information gathering to provide insights into how health communication activities are currently being used for communicable disease prevention in the European Union and European Economic Area and (b) synthesis of knowledge on the evidence of use and application of health communication approaches. The overview of main findings of the project presented in this article highlights the many challenges that remain and the various areas of opportunity in order to raise the profile of health communication in the prevention of infectious diseases in the European context.

In our daily work at the European Centre for Disease Prevention and Control (ECDC) in the fight against infectious diseases, we note numerous challenges that public health professionals face in their efforts to protect and improve people's health. Although implementing public health programs is a national competence, at the European Union (EU) level it is in the ECDC's mission to support the member states, the European Commission, and other EU agencies in improving prevention and control of communicable diseases. Because communicable diseases remain a significant public health threat, one of the numerous challenges that countries face is how to design and implement effective health promotion and health communication initiatives.

In this context, the ECDC has been looking at the status of health communication activities in Europe for communicable disease prevention and is providing evidence, guidance, and tools to support countries in developing effective communication interventions. Research has shown that properly designed communication activities can have a positive effect on health-related attitudes, beliefs, and behaviors, and thus can influence individual and community decisions to reduce risks to health.

The ECDC surveillance of infectious diseases clearly shows that traditional epidemiological and microbiological interventions are not enough to address key threats in contemporary infectious disease control in Europe, such as poor vaccine uptake, emergence and spread of antibiotic resistant microbes in health care settings and in the community, and transmission of HIV and STI in certain high-risk groups (ECDC, 2013a). The traditional interventions therefore need to be complemented with other preventive actions.

Behavioral change approaches and models have widely been used in the fields of noncommunicable disease, and with the notable exception of HIV/AIDS (ECDC, 2009), less so for developing communication interventions in the communicable disease sector. In this sector, academic research and evidence-based application of these theories and models in practice have a long tradition in the United States, but have for many years been considerably less applied to the specific European conditions.

A concrete example of the importance of effective health communication is seen in the challenges European countries currently face in order to address the reemergence of measles in the region. Countries have committed to eliminate endemic measles transmission within the World Health Organization European region by 2015, and for this, efforts to increase vaccination uptake for measles prevention are ongoing.

In the context of measles elimination efforts, alongside with strengthening the collection and sharing of data for action, as well as strengthening public health capacities and regional and international collaboration, further efforts are needed in the development of effective communication interventions. These entail, for example, behavior change communication to increase and sustain vaccine uptake at national and EU level; raising awareness among policymakers and other key audiences about the threat to public health from continued measles transmission; and advocacy for increased resources for achieving the elimination goal. To support country activities in these areas, the ECDC has developed a series of initiatives that include, among others, analyzing the barriers to reach underserved populations together with proposed solutions (ECDC, 2013b); discussing with experts from different fields, including from outside of the health sector, innovative ways to promote vaccine uptake; and providing practical tools for health care providers in order to enhance childhood vaccination uptake, as well as guides (ECDC, 2010, 2012) and reviews on evidence-based vaccination communication.

The Translating Health Communications Project

Despite the recognized importance of health communication, a gap in knowledge was becoming apparent as regards the extent and nature of its use at the European level to support prevention and control of communicable diseases. To address this gap, ECDC commissioned in 2009 a consortium of universities ¹ to undertake a 3-year research project entitled Translating Health Communications. The aim of this project was to assess the status of health communication activities in the EU, with a particular focus on the prevention and control of communicable diseases in EU and European Economic Area (EEA) countries.

The outcomes of the research project comprise two major areas: primary information gathering and synthesis of knowledge. The primary information gathering provided insights into how health communication activities are currently being used for communicable disease prevention in the region. This research served to assess which disease areas are most commonly the focus of interventions, which types of health communication are being predominantly used, and which are the gaps and opportunities for improvement in knowledge and praxis. The primary information gathering also served to identify the perceived priorities of national public health bodies involved in health communication activities. A report with the findings from this mapping exercise and needs assessment performed across 30 EU and EEA countries was published (Doyle et al., 2012), and the outcomes of this research are discussed in more detail in another article in this special issue of the journal.

The second area of work in the Translating Health Communications project was a synthesis of current knowledge in the area of health communication. A number of technical reports have been published by ECDC with the outcomes of this research, in the Insights Into Health Communication series. These summarize the evidence on the use and application of approaches such as social marketing, health advocacy, interventions to increase health literacy, trust and reputation management, risk communication, communication for behavioral change, and so forth. Various articles in this special section of the journal provide readers with an overview of this European evidence base for health communication in the prevention and control of communicable diseases and discuss the evidence of effective interventions and gaps in order to inform future research, policy, and practice.

The analysis and triangulation of the outcomes of the primary information gathering and the synthesis of available evidence allow for a comprehensive assessment of the challenges and opportunities for health communication in the prevention and control of communicable diseases in the EU and EEA countries. Some of the main findings, summarized in the subsequent list, pinpoint the areas where more work is needed in order to make health communication a truly integral part of the strategies to prevent and control communicable diseases in Europe:

	Enhancing collaborative working and strengthening partnerships and professional networks in the area of health communication is a major challenge within a complex and diverse EU environment but vital in order to promote the sharing of best practices and expertise. At the same time, the different EU country contexts create a unique opportunity for countries to share different ideas, resources, information, and examples, and to learn from each other.
	A significant amount of the available evidence and the research on effectiveness of health communication interventions, at least in the English language, comes from other regions, in particular from North America, and it often focuses on interventions for the prevention of noncommunicable diseases. The paucity of European research in this field highlights the importance of encouraging more studies that look into the experiences developed in the region.
	Further exploration is also needed on how the experiences gained in health communication for noncommunicable diseases can be translated into the area of communicable disease prevention, given that some participants during the primary information gathering process of the project felt that experience, information, and best practice is not necessarily shared across the two areas.
	During the primary information gathering, it was reported that across the EU health communication initiatives are most often used for the following communicable disease groups: influenza, HIV/AIDS, STI and blood-borne viruses, and vaccine-preventable diseases and invasive bacterial infections. Other disease areas mentioned, but with less frequency, were tuberculosis, antimicrobial resistance/health care–associated infections (with many participants stating that this has recently become a priority area), food- and waterborne diseases, and zoonosis. Health communication was said to be used the least frequently for emerging and vector-borne diseases. However, the level of activity varied considerably between disease groups and between countries.
	The research also looked into the areas of health communication used for prevention and control of communicable diseases. General health communication and crisis communication were reported to be more frequently used. Overall, the use of various other areas of health communication was reported, including health advocacy and health promotion, among others. Social marketing and health literacy were less frequently cited. However, a lack of conceptual clarity as regards to areas of health communication became apparent. Therefore, one of the outcomes of this research project is the proposal to establish a common, consistent, and shared glossary for relevant concepts and competencies in the area. Furthermore, it is also proposed to promote a more solid understanding of the application of different areas of health communication for communicable disease prevention in the European context.
	The research showed that not all current practices in health communication are supported with a strong evidence base, although the synthesis of knowledge highlights the relevance of using behavioral and social theories in the design, planning, and evaluation of effective behavior change interventions and programs. More knowledge is therefore needed on how to translate evidence into practice and on how to best harness the potential of different types of health communication, for example, of approaches such as social marketing, where a lack of conceptual clarity among interested practitioners in Europe on what it entails became apparent.
	It became apparent in the research that there is quite a different level of health communication capacity and expertise among member states, with some countries lacking necessary resources. Moreover, often people tasked with developing health communication initiatives were not academically or professionally trained in this field.
	The research showed that often health communication campaigns were implemented in a reactive manner and in response to crisis situations, such as a disease outbreak. In the area of risk communication on communicable diseases, for example, which is highlighted as an emerging area, a focus on emergency and outbreak situations rather than on strategic risk communication was identified. However, we should not forget that an increased emphasis on disease prevention is expanding the role of risk communication as a vital component of public health practice, and especially preparedness (Infanti et al., 2013). Moreover, changes in risk behavior are one of the major goals of disease prevention.
	The research found that more work on the systematic evaluation of health communication interventions is needed. The data collection showed a knowledge gap regarding evaluation: There is limited utilization of existing theories, principles, and frameworks for communication evaluation in the EU setting. This is worrying, because evaluation is a key to reinforce the evidential value of reported effects of communication interventions and to build a solid evidence base on what works in order to inform practice.
	The importance of dialogue with and participation of the intended audiences in the development of health communication activities was highlighted in the synthesis of knowledge because this enhances opportunities to reach behavioral change objectives. This confirms the relevance of formative research and of clearly defining and profiling audiences in order to tailor messages to the needs of the intended audiences.

The final output of the described Translating Health Communications project is to consider the implications of the research outcomes for the future development of health communication for communicable disease prevention and control in the EU. A report is being developed with proposals for future strategic directions, which will inform the ECDC's framework of actions in supporting countries' health communication capacities.

The research described earlier already reveals a number of areas of opportunity. Overall, the evidence base needs to be strengthened, in particular to study effectiveness of interventions, particularly in the European context and in the area of communicable disease prevention. The research community and academia can play a key role here, enhancing the development and support of the European health communication research capacity.

Education and training emerged as areas in which more work is needed; therefore, together with academia and professional associations in Europe, it needs to be assessed how to best enhance existing structures and foster new opportunities for capacity building and which core competencies are required. As the research showed, future training opportunities include, for example, the use of social media and new technologies, evaluation, public relations, and reputation management. The ECDC is keen to examine how the agency can contribute to strengthen expertise and skills in these fields for communicable diseases prevention.

To address the different levels of capacity among member states, the development of tools and guidance should be facilitated. This could offer support to health communication in a consistent way, such as on how to develop health communication strategies and plans. The ECDC's role could be to provide guidance for best practice in order to build the evidence base. To foster the much needed exchange of experiences and best practices in the area of health communication, the ECDC can also contribute by strengthening partnerships and facilitating professional networking.

As this overview of main findings of the project shows, many challenges remain in order to raise the profile of health communication in the European context. To address these challenges, the ECDC, together with other stakeholders in the EU and EEA region, can contribute to enhance the role of health communication for the prevention and control of communicable diseases, by encouraging further research, developing capacity building activities, and fostering collaboration and sharing of best practices.

Notes

¹Framework Partnership Agreement Grant/2009/007 “Establishing a programme for dissemination of evidence-based health communication activities and innovations on communicable diseases for country support in the EU and EEA/EFTA, 2009–12,” with a consortium of universities comprised of the Health Promotion Research Centre at the National University of Ireland Galway, as the lead coordinating centre, and the Institute for Social Marketing, University of Stirling, Scotland, and the University of Navarra Clinic, Pamplona, Spain.