Training the next generation of global health communication professionals: Opportunities and challenges

Health communication is an essential component of global health and international development practice. Over the last few decades, health communication has been institutionalized in a variety of global organizations across country settings and professional sectors. Defined as ‘an area of theory, research, and practice that relies on the integrated, strategic, and programmatic use of multiple communication areas and platforms¹ ’, strategic health communication for behavioral, social, and organizational change^1,2 – or more broadly social and behavioral change communication (SBCC)³ – has also been highlighted as a key discipline by national and global agendas, academic programs and their accrediting institutions, and recent meetings and conferences.

Recent epidemics, both within the realm of communicable and non-communicable diseases, have created the need for a diverse global workforce that should master and be able to implement key principles, strategies, and planning frameworks for health communication interventions. Many organizations have come or should have come to the realization that the development and production of unrelated ‘communications' outside of any strategic planning framework and concerted effort are not effective in achieving the kinds of behavioral, social and organizational results that may lead to improved health and social outcomes. There are a number of opportunities and challenges for pre- and post-graduate instruction and training on global health communication. While the list of opportunities and challenges is almost endless, I list below a few that appear to be prominent both from my own experience as a global health communication practitioner and researcher as well as from colleagues at international conferences, workshops and meetings.

1. Integrating the concepts of equity, social change, community engagement, systems-change, and social accountability within the theory and practice of global health communication is an opportunity for future professionals.

Health equity is a key issue of our times. Defined as ‘providing everyone with the same opportunity to stay healthy and/or cope with disease or crisis⁴' by removing the many barriers to a healthy life,^4,5 health equity is an important goal for the next generation of practitioners. In fact, it is only by creating an inclusive society where health and social improvements are within everyone's reach that we can make progress in our cities, neighborhoods and communities, and ultimately improve our ability to thrive and prosper. A systematic approach to health communication can help build bridges among different people and professions and create systems-change via multi-level interventions that look at policy, organizational, community, interpersonal, and individual behavior change. It is only by promoting systems change that we can create a favorable environment for individual behavioral change to occur.

As an example, Figure 1 illustrate the many intervention levels that should be considered to create the kind of social and policy-related support that is needed to motivate people to wash their hands with soap or alcohol-based hand rubs at critical times (e.g. before eating and after defecation, when in contact with patients or loved ones who are affected by any kind of illness). Many people may perceive handwashing as a very simple and effective hygiene measure, which among others is associated with preventing infectious diseases, diarrhea, and many other conditions.⁶ Yet many barriers still need to be addressed to enable several communities and people worldwide to adopt and sustain this behavior.⁶ These include social norms, lack of essential supplies (e.g. soap, water, etc.), conflicting priorities, low health literacy, limited cultural competence among healthcare providers, and/or low prioritization within local policies and interventions, which are all areas of intervention for global health communication.

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Of great importance in thinking about the many influencing factors, intersecting systems (e.g. healthcare, education, transportation, housing, parks and recreation, social welfare, etc.) and people who may help determine whether any person can adopt and sustain any health behavior, should be our commitment to community and civic engagement to create ownership of all solutions, and to encourage social accountability among ordinary citizens, civic society organizations, local business, corporations, government agencies and other stakeholders who are all essential members of and should all contribute to the health and well-being of our communities.⁵ There is an opportunity for global health communication programs (both in academia and within the realm of professional and community development) to prepare future practitioners and researchers to address the complexity of our increasingly interconnected world, and to promote equity and social justice by organizing and using evidence to work at the intersection of health and human rights, climate change, trade, community health and other key issues. Never as in our times has this been more important.

2. Arming new and future practitioners with practical tools and resources that would result in the sustainability of behavioral and social gains is a challenge that must be met by academic programs and capacity building interventions.

Moving past behavior change to behavioral and social change sustainability is always a challenge for most people and interventions. One of the issues is the limited number of generalizable, effective, and sustainable interventions and lessons learned that have been translated into standard practices, and therefore the resulting gap between research and practice.⁶ ‘In addition, there is inadequate documentation of the potential population or public health impact of behavioral change interventions⁷’. Finally, there are multiple definitions for the concept of sustainability. For global health communication, sustainability may refer to the effect of interventions that may result in (a) long-term behavioral gains at different levels of society; (b) a consistent and steady flow of goods and services that are essential for health system strengthening and functioning (e.g. in the above example, these may be water, soap, alcohol pads, capacity building and demonstration services for handwashing, and other related resources), and (c) the adoption and/or institutionalization of specific policies and social norms that may encourage specific health and social behaviors and/or contribute to community readiness to adopt and sustain a new health behavior.^2,8,9

While behavioral change has been linked to community and civic engagement^9,11,12; as well as the ability to connect to people's feelings and inner motivation (a concept that global health communication imports from commercial and social marketing practices)¹¹; and/or integrated and multisectoral approaches that combine different communication areas and media^2,10,12,13; and/or the process of achieving intermediate steps toward behavioral results (e.g. message recall, issue awareness, knowledge, behavioral intentions, behavior readiness, etc.)²; the future of global health communication research and practice is about ‘sustainability' and how we can all create the kind of system-level change that can support people and organizations in maintaining specific health or social behaviors in the long term.

3. Simplifying our language, finding common terminology, and focusing on best practices is a challenge for a well-intentioned but often fragmented community, as the many different communication models reflect organization-specific preferences, language and mission.

The tremendous growth that the field of global health communication has been experiencing in the last few decades has also resulted in a large number of models and planning frameworks that share many similarities, steps, and objectives (e.g. social and behavioral change/impact) but often reflects organizational preferences, missions, and favored terminology. While this is important within the context of specific organizations that are concerned with using the kind of language that may resonate best with their staff and volunteers, this may be confusing for people who are new to our discipline and/or work in limited resource settings under pressing conditions. A focus on best practices that can be extrapolated from different international models and planning frameworks (at least within the context of pre- and post-graduate instruction and training) may enable future professionals to focus on ‘what works' and help them implement key principles and strategies of global health communication for social and behavioral change no matter which model they may need to work with.

4. Sharpening our focus on evaluation is an opportunity for current and future practitioners to showcase the impact of our work, advocate for increased funding, and convince other professionals of the value of well-designed and well-executed global health communication interventions.

Building capacity for the evaluation of global health communication interventions is essential in the era of limited resources and organizational accountability. While no many studies seem to exist on the percentage of health communication programs that are ever evaluated toward behavioral and social results, ‘a study of 50 published nutrition and/or physical activity campaigns' showed that ‘fewer than 1/3 of the campaigns expressed goals in measurable terms¹⁴’. Our collective renewed emphasis on evidence building and evaluation should go behind ‘process indicators' (e.g. how many people we reach) and should increasingly include not only intermediate parameters such as awareness, knowledge, and skills (‘progress indicators') but also ‘outcome (behavioral, social and organizational)' and ‘impact indicators (impact on the rates, severity, and mortality of the health issue we seek to address)²’. For this to occur pre-graduate training and post-graduate/professional development programs need to equip practitioners on research methodologies that are of course inclusive of randomized control trials, the gold standard for any kind of evaluation, but also reflect local resources and infrastructures and include other kinds of surveys, qualitative methods, and case study analysis to support evidence on the path to behavioral change and most important behavioral sustainability.

5. Making sure that global health communication education and training is readily accessible to students and professionals in low-and-middle income countries and some developed countries is an opportunity for the entire academic and professional development community.

While several pre-graduate and post-graduate/professional development courses are already in existence, most of them take place in a handful of countries (e.g. the United States, Canada, the United Kingdom). Our community should find opportunities to expand the reach of such courses via the use of technology (e.g. via online programs and/or video conferencing) as well as to advocate in our workplaces and universities around the world, so that we can offer more convenient and accessible venues for this kind of global health communication education and training to professionals in different world regions. Moreover, empowering communities via human- and user-centered design methodologies to participate in the development of health communication interventions is another area of great importance and, hopefully, future growth.

6. Providing future and current practitioners with practical skills in health communication planning, media development, community and public engagement, cross-cultural communication, health equity communication, and much more is an opportunity and a strategic imperative for academic programs and professional development interventions.

Bridging theory with practice is always a challenge in a variety of disciplines. Yet ultimately market demands and professional priorities end up informing the kinds of skills future and current practitioners need to bring to their work. A pilot survey on the practice of health communication in urban settings showcased that very few of the participants had received any formal training on the full health communication planning cycle and actually the majority only had partial or no training at all on many aspects of communication.^1,15 Survey respondents indicated the need for further training on issues of diversity – and more specifically how to engage different groups and stakeholders on communication topics as well as tailor interventions to the needs and preferences of an increasingly diverse urban population; communication planning and evaluation – including communication planning, behavior change communication, message development, research methods for impact assessment or prior to the intervention; and health disparities – as related to the role of communication in addressing health disparities in urban settings, as well as improving knowledge on the nature, significance, and determining factors of such disparities.^1,15

Moreover, innovative methods are needed to bring to life the topics and skills that should be included in educational and training programs. Some of them include role playing; interdisciplinary courses and training modules that foster understanding about the ‘language' and priorities of multiple sectors on specific health and social topics; media and activity labs that are designed to enable participants to produce visual media, new media, theater performances, peer-to-peer training materials, events, presentations, community dialogue guides, and more; opportunities to practice participatory methodologies by actually (a) engaging youth and specific communities in the process of communication planning, implementation, and evaluation as well as in development and production of youth- and community-driven media, and/or (b) organizing and implementing community outreach or capacity building activities on specific health issues, just to name a few potential hands-on methodologies.

Finally, recognizing the transdisciplinary nature of population health issues and making sure that social and behavior change communication courses and training programs are offered across the fields of public health, medicine, healthcare, community development, international development, business, transportation, education, nutrition, housing, poverty alleviation and much more is an opportunity to expand the impact of the field and to strengthen understanding of the interconnection of the many of factors that determine health, economic, and social outcomes. With its people-centered mantras, transdisciplinary nature, unwavering commitment to human rights, intolerance for any forms of racism and social discrimination, the ‘know-how' that comes from being a key field of research and action within different sectors (corporate, nonprofit, community, academia, government, etc.), and its sharp focus on behavioral and social results, the field of global health communication has much to offer as part of the toolbox of future practitioners in a variety of fields.

In this issue…

This December issue reflects the increasing diversity of the kinds of global health communication perspectives our Journal brings to its readers. The articles included in this issue features research data, case studies, models, or perspectives from several countries including Hong Kong, Iran, Malawi, the United Kingdom, and the United States. Focusing on a variety of health areas (e.g. chronic diseases, mental health), media (e.g. radio, mass media, social media), communication areas (e.g. interpersonal communication and its link to verbal support), messaging and health literacy strategies, and/or communication strategies (e.g. focusing on the stories of ill celebrities), the articles in this issue touch upon many of the ‘hot' topics in global health communication. We hope you enjoy reading them and thank you for your support and readership this year. We also invite our authors and editorial board members to share these articles widely within their professional and media networks, so that we can all contribute to continuing to build community around our Journal. Happy Holidays to all and best wishes for 2017!