The Challenge with Centralized Health Messaging §
We needed local ways and forms of communication, the presidential address and radio announcements were not enough. Each community has their own way of accessing and spreading information.
55 year old respondent from KwaZulu-Natal, South Africa
Our research highlights a number of factors that make it challenging for distant authority figures to effectively communicate health messages.
These authority figures are at times not trusted by members of communities who may not believe that these authorities have the community’s best interests at heart. This is especially true for marginalized populations, such as transgender communities, who have faced stigma and discrimination.
At times, centralized forms of communication can appear insensitive to local contexts — with people being unable to contextualize these messages to fit into their lives; this makes it difficult for them to act on these messages.
Centralized communication tends to be one way and does not facilitate dialogue, which can be a crucial component of effective communication.
We get information through miking (public announcement). Announcements on sputum test (TB), eye treatment. This and that. Look, they give information through mike announcements and all. But if I don’t go to them, how will I understand the information?
An elderly TB patient in Dhaka, Bangladesh
Amplifying, yet Moderating Trusted and Familiar Sources §
Familiar and trusted sources, ranging from friends, family and neighbors to community leaders and health workers are effective channels of messaging as these sources are generally trusted, understand the local context and are available for dialogue.
In this hospital we have had field staff who have worked in the community. They can reach people door to door. They can tell pregnant women and others too about coronavirus.
Ward Nurse, Narayanganj, Bangladesh
However, these individuals may not be equipped with the right knowledge and in such cases may end up doing more harm than good. On the other hand, the lack of right knowledge does little in curtailing the ability and urge of these actors to engage in health related messaging and dialogue within their influence circles. During the COVID-19 pandemic, disinformation and conspiracy theories, often propagated within these familiar channels, led to confusion and mistrust. As such, public health cannot ignore these actors, especially those who have larger influence circles, and needs to engage, inform and moderate them.
Engaging trusted members of the community to inform design and delivery of digital health messages, from testing content, to recording audio or video clips, to championing a digital platform, can all ensure that messages are culturally relevant and increase trust and engagement.
A global study (Mason et al., 2022) conducted to assess factors of scalability of digital tools in LMICs during the COVID-19 pandemic identified 3 main lessons for launching and scaling digital interventions in health:
User-centered design is key to the widespread adoption of digital tools in health.
Strong, country-led partnerships between community based implementation organizations or other private stakeholders and the government ministries or public stakeholders are essential for scaling up digital tools successfully.
Using adaptable digital tools enables implementers to focus on the content rather than the technology.
While these levers can enable greater effectiveness and scale for digital health interventions especially for low-middle income countries, there remain challenges in sustainable financing, business models, or methods to evaluate impact rigorously, which should be considered for long-term sustainability1.
Online Communities and Role of Digital Tools §
Communities need not only be geographically localized and online communities are increasingly influencing health behaviors. These communities, which have lower thresholds for engagement when compared to physical ones, provide opportunities for cost-effective interventions from public health actors. Digital tools can effectively support health systems by facilitating immediate widespread distribution of information. In the near future, as internet access becomes more ubiquitous and as more and more individuals immerse themselves in online communities, it is quickly becoming imperative for public health systems to frame approaches to participate in these communities.
Findings from a systematic review of literature shows online communities supported patient empowerment by helping the patients become engaged and have the possibility of being equal contributors in the patient-provider relationship. The main findings indicated that online communities supported patient empowerment in the way of meeting emotional needs of handling conditions and the possibility of patients becoming equal contributors to the patient-provider relationship. Such communities provide patients and caregivers with new resources, offer new insights to non-patients, challenge traditional power dynamics between patients and clinicians, and form part of a growing trend in data collection.
When targeting a specific health seeker group, How Might We identify and tap into online communities that influence their health behaviors?
How Might We reach individuals and communities who are digitally disempowered and excluded?
How Might We create and incentivise a steady decentralized cohort of good faith influencers within communities and empower them with the right knowledge from a regulated source?
How Might We promote good faith influencers, while delegitimizing bad faith ones?