April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Strategies and Barriers Related to Communicating About Health and Racial Equity: Perspectives From Communicators in Practice
Inequalities in health are persistent and deeply unjust. The COVID-19 pandemic—which in the U.S. saw glaring disparities in morbidity and mortality, particularly for racial/ethnic minorities and those of lower socioeconomic position(1)—only heightened the urgent need to address these inequalities. There has been growing attention to how communication can be leveraged to promote health equity and, in particular, racial equity, yet evidence-based messaging strategies remain elusive(2). Moreover, the context in which communication would occur is challenging: While public health researchers recognize the importance of structural racism as a foundational determinant of health(3), U.S. public awareness of racial inequity remains stagnant(4), support for safety net policies that would advance it actually declined during the pandemic(5), and messaging aimed at increasing such support could encounter resistance.(6)
To inform future research on communicating about health and racial equity, it is critical to understand the barriers that the end-users of such research currently face in their communication practice and how they try to overcome those challenges. To this end, we conducted in-depth semi-structured interviews with communicators in practice drawn from four key groups: journalists, public health practitioners, equity organizers, and thought leaders (N=36). Participants were recruited through targeted concentric circles of contacts and snowball sampling. Interviews were held November 2022–June 2023; they were conducted via Zoom, ranged in length from 30 minutes to 1 hour, and were transcribed in real time using Otter AI. The transcripts were subsequently imported into Dedoose for qualitative coding by members of the study team, using a codebook developed based on the field notes taken following each interview. Each transcript was coded by a primary and secondary coder.
Participants reported using a range of strategies to communicate about health and racial equity, including stories, data on disparities, an emphasis on shared values (e.g., health equity affects “all of us”), and an emphasis on positivity and/or assets. Yet many also reported being unsure about whether these strategies were effective, and some reported ambivalence over the use of certain key terms in their communication efforts (e.g., equity, anti-racism). Participants recognized the need to think about their audience—for example, by identifying the right messenger, incorporating diverse sources, and centering the communities they are trying to serve. Myriad challenges to communication also were identified, such as concerns about audience alienation, the experience of audience pushback (e.g., minimizing importance of equity, denying racism exists), and institutional barriers (e.g., systemic racism of institutions, including newsrooms; resources or capacity limitations). Last, participants identified several resources that they used to support their communication, including formal and informal networks and coalitions, toolkits and messaging guides, and trainings and presentations from professional organizations (e.g., Public Health Communications Collaborative, Association of Health Care Journalists).
In sum, communicators in practice face many barriers to communicating about health equity and structural racism, and there is tremendous fragmentation in the strategies and resources available for supporting communication efforts. These findings from end-users should inform future communication research aimed at developing messaging strategies to advance health and racial equity.
To inform future research on communicating about health and racial equity, it is critical to understand the barriers that the end-users of such research currently face in their communication practice and how they try to overcome those challenges. To this end, we conducted in-depth semi-structured interviews with communicators in practice drawn from four key groups: journalists, public health practitioners, equity organizers, and thought leaders (N=36). Participants were recruited through targeted concentric circles of contacts and snowball sampling. Interviews were held November 2022–June 2023; they were conducted via Zoom, ranged in length from 30 minutes to 1 hour, and were transcribed in real time using Otter AI. The transcripts were subsequently imported into Dedoose for qualitative coding by members of the study team, using a codebook developed based on the field notes taken following each interview. Each transcript was coded by a primary and secondary coder.
Participants reported using a range of strategies to communicate about health and racial equity, including stories, data on disparities, an emphasis on shared values (e.g., health equity affects “all of us”), and an emphasis on positivity and/or assets. Yet many also reported being unsure about whether these strategies were effective, and some reported ambivalence over the use of certain key terms in their communication efforts (e.g., equity, anti-racism). Participants recognized the need to think about their audience—for example, by identifying the right messenger, incorporating diverse sources, and centering the communities they are trying to serve. Myriad challenges to communication also were identified, such as concerns about audience alienation, the experience of audience pushback (e.g., minimizing importance of equity, denying racism exists), and institutional barriers (e.g., systemic racism of institutions, including newsrooms; resources or capacity limitations). Last, participants identified several resources that they used to support their communication, including formal and informal networks and coalitions, toolkits and messaging guides, and trainings and presentations from professional organizations (e.g., Public Health Communications Collaborative, Association of Health Care Journalists).
In sum, communicators in practice face many barriers to communicating about health equity and structural racism, and there is tremendous fragmentation in the strategies and resources available for supporting communication efforts. These findings from end-users should inform future communication research aimed at developing messaging strategies to advance health and racial equity.