Are our messages landing? A behaviour change approach to communication – Shelley Enarson

Categories: Opinion.

 “The difference between mere management and true leadership is communication” – Sir Winston Churchill 

In considering how palliative care is communicated to a myriad of audiences, a few associations may come to mind: a presentation, a media article, a series of tweets, YouTube/ TikTok videos.

But if we dig a little deeper, these channels are simply gateway media to awareness raising; an important tenet in the implementation of the Public Health Strategy for Palliative Care.

The issue with raising awareness is that it is as broad a concept as symptom management. On a macro level, the communication “symptoms” we are seeking to address are widely varied.

To name a few:

  • misinformation around opioids for pain control at the end of life
  • preconceptions around the difference between hospice and palliative care
  • lack of awareness of palliative care benefits to patients and caregivers within health systems strengthening.

Leveraging creative communication tactics and pithy messaging certainly helps in gaining visibility on many of these (and other) palliative care issues.

But if the aim for communicating the importance of palliative care is to change attitudes, beliefs, and high level agenda setting priorities, leveraging behavior change theoretical frameworks can be of benefit.

These frameworks, or in some cases models, are deeply rooted in psychology in order to change a person’s thought patterns on a public health issue. Or for our purposes, to have their “awareness raised.”

The alternative is a one size fits all approach to public facing communication around palliative care as a priority, which may raise visibility and garner temporary momentum, but in the longer term is challenging to evaluate and replicate.

One of the key questions that guide behavior change theories, which is applicable to communicating palliative care is:

Which particular attitude or behavior are we seeking to change?

 The more streamlined an answer to this question can be integrated across an institution’s work objectives, the more each communication output will lead to strengthened outcomes, with the hopes of exponential impact.

Rooting health interventions in behavior change theory is not a panacea to addressing misconceptions.

During the apex of Covid-19, for example, even the CDC struggled with reaching audience segments to address pre-conceived myths and ideologies around mask wearing, vaccine uptake, social distancing and medical care avoidance.

However, the application of behavior change theories has been documented in relation to significant policy wins. Most notably, synchronized messaging campaigns in the 80s and 90s that tackled smoking cessation through behavior change models.

When public awareness campaigns began focusing less on the health dangers of smoking and more on revealing the deceptive practices of the tobacco industry – buy-in among stakeholders (both upstream and downstream) increased.

Behavior change models changed the message itself – not the medium nor the frequency. The outcome of smoking cessation nearly toppled the powerful tobacco industry in the United States and is considered promising practice among health communication experts.

In the modern palliative care movement, the stakes in communicating palliative care are high, with resources often low.

Adopting a behavior change framework is therefore important to ensuring our messages land.

In order to do so, practitioners can draw upon decades of heavy lifting around public health awareness campaign research and evaluation to advance a palliative care agenda, one that is communicated with resonance.

Shelley is a writer and health communication specialist based in Durham, North Carolina. She tweets at @shelleyenarson.

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