Journal of Health Care Communications Open Access

Keywords

Health industry; Stakeholder participation; Health communication; Health journalism

Abbreviations

CDC: Centers for Disease Control; KBBE: Knowledge-Based Bio- Economy; NCDs: Non-Communicable Chronic Diseases

Introduction

Public health is more than ever a concern for all governments of the world, both in developed and developing countries. In today’s world, nothing is more international than health; no other aspect of modern life is as profoundly impacted by globalization as public health. This fact is immediately recognizable by the growing homogeneity in disease pattern across different world regions. For instance, diseases such as diabetes and cancer used to be regarded as the diseases of affluence which are the characteristic of western societies. In only a matter of three decades the diseases of affluence have become the major cause of morbidity and mortality in the third world countries [1-3]. In the face of emerging global challenges including changing epidemiological pattern, increasing prevalence of chronic noncommunicable diseases (NCDs), shift in dietary pattern and its consequences on obesity and associated diseases, and the spread of HIV going unabatingly. Among the strategies to overcome these health issues, the media are widely used by government agencies and organizations, international agencies and nonprofit organizations to bring people together whether they are local, regional, national or international, to reach a state of complete physical, mental and social well-being. Though health communication for ameliorating population health is considered sufficient to meet the challenges of inadequate communication among different stakeholders, the limitations of this construct are becoming apparent which warrants for more cross-cutting intervention strategies [4]. There remains no doubt that effective communication is a powerful engine for health promotion [5], however it should be kept in mind that communications is not an end in itself. The purpose and utility of this construct can be fully exploited in a global context in which health is regarded as a prime concern for all development policies. Health communication is necessary but not enough to generate the impacts on associated societal and political elements which impact every aspect of human life and well-being [6,7]. The challenges encountered by healthcare institutions are multifaceted and extraordinarily complicated which necessitates an integrated public health by integrating cross-disciplinary expertise, coordination, and policymaking. To this end, national governments have to focus on developing policy capacity by incorporating health journalism and stakeholder communications across various sectors of health research [8].

Identifying the Key Stakeholders in Healthcare

Stakeholders of healthcare are diverse in nature and functionality and their connection and role in the industry. The different actors or stakeholders across the healthcare continuum hold a unique position forming a large set of network which interacts to keep the system functional and maintain a regulatory compliance with sectors of the economy. Though health sector is a traditionally a state driven force, with the expansion of capitalism and consequent engagement of non-traditional actors the complexity of the system grew more pronounced. In USA, for private regulators began to engage with healthcare sector in the early 20^th century [9]. The event is concomitant with the expansion of political and economic prominence of the country at the global stage which is felt till today. The efficiency of the sector remains subject to debate as it is underperforming comparing to most other developed nations who invest less on their health. Despite this fact, in terms of advancement in biomedical engineering and biotechnology industry [10], the country stands out as a global leader. Whether or not this achievement is credited to the inductive force of the nation’s economic prominence, the healthcare sector as a financial one has been noticeably successful especially in its contribution to the progress of the knowledge economy. Knowledge economy emphasizes on generating social and intellectual capital, which, unlike the traditional factors of production are not alienable, however essential to fostering innovation which is the key challenge of the knowledge-based economy [9,10]. In the USA, most public health programs, including sanitation, restaurant inspections, and investigations of epidemics, are the responsibility of state and local regulators, but the federal Centers for Disease Control and Prevention (CDC) serves as an essential resource for collaboration on a national level [9]. According to the European Commission- the Knowledge- Based Bio-Economy (KBBE) refers to the process of transforming life science knowledge into new, sustainable, eco-efficient and competitive products which is to emerge as a major contributor to the Bio-Economy through its essential role in underpinning economic growth, employment generation, and improving the standard of living [10-12]. The concept of Bio-Economy encompasses all industries and economic sectors that produce, manage and otherwise exploit biological resources and related services which over the last decades have led to significant innovations in many agricultural, industrial, medical sectors and societal activities [10, 12-14].

The Complexity of the Healthcare System

The healthcare system is by nature a complex one with numerous inherent perplexities that overwhelm the stakeholders engaged in the industry and in which almost every aspect is overseen by one regulatory body or another. Previous researches have revealed the historical roots of this complexity as interplay between intergenerational socio-political forces which continue to mark their effect in modern society. Health care professionals are said to feel that they spend more time complying with the intricacies of the system that direct their work than the work in its actual form [9]. Whether the complexity adds positive substance such as increased efficiency and better regulation of resources remains to be explored. However, the possibility of overcoming the complexity and the underlying shortcoming presents a more immediate imperative. Healthcare industry is unique in the sense that every attempt it takes must be made fruitful as nobody would like to see their health rights being compromised by any factor even if it is congenial to socioeconomic growth and might pay off in the long run. Issues related to health, therefore presents an immediate concern that needs to be dealt with immediacy and with due priority and making sure that the principles of health equality are respected as well [15]. Even if the health care succeeds in providing acceptable quality and access at an affordable cost, the healthcare culture would face disruptive, discontinuous change due to want of expert-based practice for which health professionals need to emphasize in their effort to preserve the best organizational culture [16,17]. Another crucial factor which makes healthcare an especially complex one is the apparent difficulty in its interoperability with other branches of science. The application of information technology (IS) on healthcare system, for instance is an arduous endeavor. Researchers in this sector have been appreciative of the individual roles and values and the context of the setting, and itemizing generalizability. Moreover, the entire theoretical base of the IS sector is based on organizational culture, their business processes and interaction with stakeholders [18]. Because generalizing healthcare in the context of IS research would require reflection on their suitability. For instance, hospitals, emergency rooms, and laboratorial environments are structurally different from business, and therefore successful implementation would require understanding the healthcare setting before they can be applied to IS theory [18]. The subject matter of organizational culture is rooted to the se of values shared by individuals within the organization such as, the established routines, traditions, ceremonies and reward systems, the manner in which people understand, describe and make sense of their working context which acts as a kind of social and normative glue [19,20]. Organizational culture accommodates the individual value setting in the professional sphere and the narratives that they take into account to make sense of their organizational behavior [20] (Table 1).

Table 1: Strategic stakeholder management in the healthcare systems.

Stakeholder Communication Management: Prospects and Challenges

As mentioned in the section above, health care is becoming more complex across all disciplines, at all levels [21]. These factors that drive this complexity include civil society, social justice, and the public sector and over the past decade in particular, these factors have been greatly affected by the hegemonic influences of growing knowledge-based economy and the philosophical assumptions and influences that are impacting directly on how the health system is evolving [22]. Successful stakeholder communication is contingent upon the proper selection of the target, the contents and the rationality of the message it conveys where mutual trust plays a seminal role [23]. As the number and complexity of stakeholders in healthcare sector has been increasing, it presents significant challenge and opportunity at the same time. The challenge of coordinating the complex set of functions at different levels can be overcome by a systematic approach and employing a solution oriented perspective. Health communication has always been facing countless challenges especially regarding designing and disseminating health messages. Although problems can be attributed to many a factors in this area, but the most critical issues usually evolve around the gap between health literacy and health communication, difficulties and inefficiency in communicating through the tools and channels of mass media, and the lack of well-trained professionals. Literacy-communication gap being one of the most pertinent challenges, health journalism – or ‘health communication’ to be specific, faces a general gap in people’s health literacy. Effective and appropriate use of health communication can efficiently ensure health literacy among a certain population. Another challenge for health communicators or journalists is to deal with unexplained medical jargons and poorly designed messages. Often the message designers are unaware of, or they fail to perceive, the general educational level of the target audience while preparing them. This leads to the educational gap that occurs while communicating health information among mass people. If people cannot understand the messages, they are never going to be aware of health issues – no matter how critically necessary.

Role of Health Communication, Research and Training in Promoting Health Messages

Health communication necessarily promotes health information usually through public health campaigns, health education. It includes the relationship between doctor and patient as well. Key purpose of communicating health information is to influence personal health choices. And the best way for health journalists to achieve this purpose is by improving health literacy.

It is expected that effective health communication be tailored for a specific audience within a given context. Besides one-toone, interpersonal and mass-level communication, extensive research into health communication is necessary to assess and reform health communication strategies. Research surrounding health communication can facilitate the development of preparing effective messages about health-related information through different media (print, electronic and new media). Media tools are very strong assistants here besides interpersonal relationships in health communities. As health communication research identifies and provides with better and more effective communication strategies, research in this field, thus, surely will improve the overall health of society by facilitating assessment and reformation of health policies of different countries of the world. The science of complex adaptive systems provides important concepts and tools for responding to the challenges of health care in the 21^st century [21]. Countries of the world contain diverse cultures that make up the groups of patients and/ or other stakeholders within the health care field. So, tailored and comprehensive communication among various cultures can be taught based on the findings of consecutive researches. Besides, extensive health care training programs will be also necessary to improve nonverbal and verbal communication between health care professionals and patients that can lead to improved patient outcomes. Health journalists can also promote training in health care facilities (i.e., hospitals), along with providing education materials to especially patients, and other stakeholders. While research can find and direct ways to achieving better communication strategies, training programs can help implement those strategies/policies by means of demonstrated skills achieved and even improved through performances in those training programs. Research and training projects also can find out whether a designed health communication campaign is working in desired pattern or not and thus can suggest corrective measures if necessary. So, these are effective tools to promote health information, and enabling persuasive behaviors across the globe – in appropriate manners. Designing a health message is considered as a key element of forming persuasive health communication strategy. Besides designing the message, understanding the audience’s perception of the communicated information is also a must to ensure effective delivery.

How Health Journalism Fits the Scenario

Health journalists can communicate to inform and educate people about ways to enhance healthy living in all sorts of countries – developed, developing or undeveloped; besides, they are powerful enough to encourage a people-friendly health policy and/or health communication strategy through many a measures such as: increase the level of knowledge and awareness of a health issue among a certain audience influence and/or change behaviors and attitudes towards a health issue educate healthy practices demonstrate the benefits of behavior changes to public health outcomes increase demand and support for health services help the concerned authorities understand the necessity of increased numbers of platforms (i.e., websites, software/ apps) to be initiated, and increase access to them increase ethical and responsible reporting on health-care issues widely covering issues regarding best and accurate use of medicines Keeping the society aware of issues regarding the broad context of medicine use, risks of medicine use, non-drug alternatives etc. [20]. Diminish misconceptions about different health issues, and above all advocate a position on a health issue or policy/strategy.

Communication Channels to be Used

Entertainment media

The entertainment industry has always been much utilized as a platform for advocating information across the world. Educating mass audience through messages designed and imparted in entertaining ways has become increasingly popular in all parts of the world. Entertainment makes learning fun which makes information easy to communicate. Animation series ‘Meena’ is a strong example of effective communication of messages carrying information of social values including education and health as well.

Social media marketing

Social media, now-a-days, has become one giant factor of advocacy regarding a variety of issues. Social network platforms, and even SMS services of mobile phones, have become widely used tools of mass communication. Particularly of social networking platforms, they are almost perfect tools to reach variety of audiences – even of specific choices, if necessary.

Interpersonal communication

It is often said that the best form of communication is done through interpersonal interactions; health communication, as well, can be made successful through strong interpersonal communications. And interpersonal communication is considered as the strongest method of effective communication because it can significantly influence decisions and behaviors of the audience than others do. Interpersonal communication allows intimate interactions between an individual (such as, a patient) and his/her health care providers like physician, therapist, pharmacist, and nurse.

Media-mix approach

A mixed-media approach is always a good thing applies; media-mix approach integrates a synergy effect which produces much more and better results than any single medium can. So, a combination of different forms of communication (e.g. interpersonal, group, organizational and mass) can be tried to reach different segments of a population.

Concluding remarks

Despite having made great leaps in science and technological terms, global healthcare industry of today is faced with host of policy infrastructure and management related conundrums. The persistent challenges in healthcare knowledge management stems from the oversight of the complexities system which necessitates contextualization of the underlying factors in a wider national development agenda. Healthcare is a continuum of structures and principles enshrined in a normative and operative framework aiming to interact in harmony, and attainment of which hinges on the mutual adaptation with other areas of the knowledge economy. Developing a knowledge-based economic system by leveraging social capital and underpinning research and organizational culture holds great promises to overcome the most pertinent organizational and communication issues global health. More in-depth engagement of cross-professional stakeholders is desirable to ensure best practice and harnessing the benefits of collective approach. Mutual collaboration for wealth and knowledge creation and management within the healthcare industry can be greatly facilitated by the active involvement of health journalism which is still a largely unexplored domain in the context of developing countries. In addition, health journalism has a lot to contribute in bridging the gap between global north and south in terms of cooperation in healthcare research and exchange of information and expertise which are fundamental to the advancement of knowledge economy.

References

1. Boutayeb A, Boutayeb S (2005) The burden of non-communicable diseases in developing countries.Int J Equity Health 4: 2.
2. Bishwajit G (2015) Nutrition transition in South Asia: The emergence of non-communicable chronic diseases. F1000Research 4: 8.
3. Bishwajit G, Ide S, Hossain MA, Safa MN (2014) Trade liberalization, urbanization and nutrition transition in Asian countries. J Nutrition Health Food Sci 1: 5.
4. Shariful SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, et al. (2014) Non-communicable diseases (NCDs) in developing countries: a symposium report. Global Health 10: 81.
5. Tang S, Dong D, Ji L, Fu H, Feng Z, et al. (2015) Whatcontributes to the activeness of ethnic minority patients with chronic illnesses seeking allied health services? a cross-sectional study in rural western china. Int J Environ Res Public Health 12: 11579-11593.
6. Freimuth VS, Quinn SC (2004) Thecontributions of health communication to eliminating health disparities. Am J Public Health 94: 2053–2055.
7. Batty GD, Deary IJ (2005) Health communication intelligence and health differentials. Am J Public Health 95: 1088.
8. Donald W Light (2005) Universal health care: lessons from the british experience. J Public Health 93: 25-30.
9. Robert I Field (2008) Why is health care regulation so complex? P T 33: 607–608.
10. Aguilar A, Bochereau L, Matthiessen L (2010) Biotechnology as the engine for the knowledge-based bio-economy. Biotechnol Genet Eng Rev 26: 371-388.
11. Aerni P (2007) Agricultural biotechnology and its contribution to the global knowledge economy. AdvBiochemEngBiotechnol 107: 69-96.
12. Madan ML (2005) Animal biotechnology: applications and economic implications in developing countries. Rev Sci Tech 1: 127-139.
13. Sara Harris (2002) Biotechnology: the next engine of growth for Taiwan’s economy? EMBO Rep 3: 598-600.
14. Enriquez J (2001) Green biotechnology and european competitiveness. Trends Biotechnol 19: 135-139.
15. Arras JD, Fenton EM (2009) Bioethics & human rights: access to health-related goods. Hastings Cent Rep 39: 27-38.
16. Grossmann C, Alexander GW, Olsen L, McGinnis JM, Rapporteurs (2011) Institute of medicine; national academy of engineering. Engineering a learning healthcare system: A look at the future: workshop summary.
17. Tim Scott, Mannion R, Davies H, Marshall M (2003)Thequantitative measurement of organizational culture in health care: a review of the available instruments. Health Serv Res 38: 923-945.
18. Alexander J, McLeod Jr (2009) Using stakeholder analysis to identify users in healthcare information systems research: who is the real user? International Journal of Healthcare Information Systems and Informatics. IJHISI 4: 3.
19. Davies HTO, Nutley SM, Mannion R (2000) Organisational culture and health care quality. Quality Health Care 9: 111-119.
20. Tang SH, Xin Wang, Huang R (2015) Analysis of high alert medication knowledge of medical staff in tianjin: A convenient sampling survey in china. J HuazhongUnivSciTechnolog Med Sci 35: 176-182.
21. Paul E Plsek, Greenhalgh T (2001) Complexity science. The challenge of complexity in health care. BMJ 323: 625–628.
22. Myrick F (2005) Educating nurses for the knowledge economy. Int J NursEducScholarsh 2: 20.
23. Culyer AJ (2005) Involving stakeholders in healthcare decisions--the experience of the national institute for health and clinical excellence (nice) in england and wales. Healthc Q 8: 56-60.
24. Bentur N, Resnitzky S, Sterne A (2010) Attitudes of stakeholders and policymakers in the healthcare system towards the provision of spiritual care in Israel. Health Policy 96: 13-19.
25. Harris KM, Edlund MJ, Larson LS (2006) Religious involvement and the use of mental health care. Health Serv Res 41: 395-410.
26. Knabe A, McCarthy M (2012) Civil society organisations and public health research--evidence from eight European union new member states. Cent Eur J Public Health 20: 287-293.
27. Sue Bowman (2013) Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health InfManag 10: 1c.
28. Leask J, Hooker C, King C (2010) Media coverage of health issues and how to work more effectively with journalists: a qualitative study. BMC Public Health 10: 535.