Vocabulary

Antenatal: Relating to the period before birth; pertaining to the care and medical attention given to pregnant women.

Abstinence: The act of refraining or abstaining from something, typically used to refer to avoiding certain behaviors, such as not engaging in sexual activity.

Condom: A sheath-like barrier device used during sexual activity to prevent pregnancy and reduce the risk of sexually transmitted infections (STIs).

Prenatal: Relating to the period before birth; activities, care, or development that occurs during pregnancy.

Postnatal: Relating to the period after birth; activities, care, or development that occurs after childbirth.

Breastfeeding: The practice of feeding a baby with breast milk, typically from the mother's breast.

Hormonal: Relating to hormones, which are chemical substances produced by the body that regulate various physiological functions.

Contraception: Methods or devices used to prevent pregnancy; birth control measures.

Immunization: The process of making a person immune or resistant to a particular infectious disease, usually through vaccination.

Dehydration: The condition that results from the loss of more fluids than the body takes in, leading to a lack of proper hydration and potential health problems.

Communication Objectives and Messages

Creating Objectives

(O’ Sullivan et al., 2003)

This chapter provides guidance on developing behavior change objectives for each audience segment for your health communication campaign. It discusses how to develop objectives that are congruent with the needs and characteristics of the intended audience, as determined by your analysis of the situation and audience segmentation. 

You will link the objectives to the outcome or evaluation measures developed for the communication program. To facilitate measuring the impact of the communication interventions, you will identify indicators that will help measure progress toward objectives. 

The use of clear objectives and indicators that track progress will benefit the strategic communication effort, while simultaneously demonstrating the program’s contribution to the overall health situation in a given community, region, or country. 

(Nagy & Fawcett, n.d.)

There are Three Basic Types of Objectives. They are:

• Process objectives. These are the objectives that provide the groundwork or implementation necessary to achieve your other objectives. For example, the group might adopt a comprehensive plan for improving neighborhood housing. In this case, adoption of the plan itself is the objective.

• Behavioral objectives. These objectives look at changing the behaviors of people (what they are doing and saying) and the products (or results) of their behaviors. For example, a neighborhood improvement group might develop an objective for having an increased amount of home repair taking place (the behavior) and fewer houses with broken or boarded-up windows (the result).

• Community-level outcome objectives. These are often the product or result of behavior change in many people. They are focused on change at the community level instead of an individual level. For example, the same neighborhood group might have an objective of increasing the percentage of people living in the community with adequate housing as a community-level outcome objective.

(O’ Sullivan et al., 2003)

The key to developing strategic behavior change objectives is keeping them SMART (Piotrow, Kincaid, Rimon, & Rinehart, 1997). A SMART objective is: 

Specific: The objective should say who or what is the focus of the effort and what type of change is intended. 

Example: Improve the knowledge of mothers of children up to five years of age in three rural provinces of Nicaragua about the benefits of hand washing (2001).

Measurable: The objective should include a verifiable amount or proportion of change expected. 

Example: Improve the knowledge of 80 percent of mothers of children up to five years of age in three rural provinces of Nicaragua so that hand washing increases from 10 percent of the time to 90 percent of the time.

Appropriate: The objective should be sensitive to audience needs and preferences as well as to societal norms and expectations.

Example: Improve the knowledge of 80 percent of mothers of children up to five years of age in three rural provinces of Nicaragua so that hand washing increases from 10 percent of the time to 90 percent of the time by explaining the link between lack of proper hand washing and diarrheal disease (research showed low levels of understanding among the audience concerning the link between proper hand washing and prevention of diarrheal disease).

Realistic: The objective should include a degree of change that can reasonably be achieved under the given conditions.

Example: Improve knowledge of 80 percent of mothers of children up to five years of age in three rural provinces of Nicaragua so that handwashing increases from 10 percent of the time to 90 percent of the time using a phased approach.

Time-bound: The objective should clearly state the time period for achieving these behavior changes.

Example: Improve knowledge of 80 percent of mothers of children up to five years of age in rural Nicaragua so that hand washing increases from 10 percent of the time to 90 percent of the time between January 2002 and January 2005.

(Nagy & Fawcett, n.d.)

Why Should You Create Objectives?

There are many good reasons to develop objectives for your initiative. They include:

• Having benchmarks to show progress. 

• Completed objectives can serve as a marker to show members of your organization, funders, and the greater community what your initiative has accomplished.

• Creating objectives helps your organization keep focused on initiatives most likely to have an impact.

• Keeping members of the organization working toward the same long-term goals.

(O’ Sullivan et al., 2003)

Step 1: Stating The Behavior Change That Will Meet The Audience’s Health Needs

Use the written description of the intended audience to ensure consistency throughout the development of the communication strategy. Each audience segment may require a different behavioral change objective. You and your team should be consistent in defining the objectives for each group or audience segment.

Name the behavior that will change as a result of the audience hearing, seeing, or participating in the strategic communication messages. Is the behavior change ultimately going to impact the audience’s health needs? For example, washing hands properly can reduce deaths due to diarrheal disease. At this point, you may need to clarify further the intended audience’s behavior. 

Step 2: Stating How Much the Behavior Will Change

By completing step 2 you will ensure that the behavior change objectives are measurable and realistic.

To make a reasonable estimate about the amount of behavior change that will occur (i.e. Improve knowledge of 80 percent of mothers of children up to 5 years of age about proper hand washing), given the overall context of the program and the resources available, consider the following:  

• Barriers to change.  

• Experiences of similar programs in the past.  

• Conditions under which the communication will occur.  

• How much behavior change is needed for the success of the program. 

Barriers

Keep in mind the barriers to change that affect the intended audience. How difficult will it be to get the attention of the audience? Are others actively trying to convince the intended audience to adopt behaviors different from those that this communication strategy will promote? Are there competing demands for the time and actions of the audience? In general, adopting a new behavior is easier for individuals than changing an existing behavior. 

For example, a woman may decide that it is more urgent for her to spend time at work than go to the clinic for an antenatal checkup. In this case, despite the best communication efforts, she may not go to the clinic. Similarly, a family may have limited financial resources available to treat health problems, and some other health issue may take precedence over the one that you are promoting. Keeping considerations such as these in mind will help ensure that expectations for behavior change are realistic. 

Prior Experiences 

Examine available research data and reports that describe prior health communication campaigns related to the issue at hand. How were the behavior change objectives stated? What changes were achieved? This information will help ensure that the objectives are realistic and feasible. 

Example 

In Zambia, the Helping Each Other to Act Responsibly Together (HEART) Campaign (Serlemitsos, 2001) used mass media to change norms related to risk reduction and safer sex among youth ages 15–19. The main objective was to promote healthy sexual behaviors among young people by reinforcing those behaviors that are safe while changing the unsafe ones. Specifically, increases were sought in the following ways:  

• The number of youth who believed that they could be at risk of HIV infection  

• The number of females who had never had sex and who continue to practice abstinence  

• The number of sexually active males who formerly were occasional condom users and who now will always use a condom 

Conditions Under Which the Communication Will Occur 

Review how conditions under which the communication will occur might affect results. Consider the portion of the analysis of the situation that examined in the following ways:  

• The “affordability” of behavior change.  

• The availability and accessibility of services and products needed to practice the desired behavior.  

• Social, economic, and political factors.

Amount of Behavior Change Needed 

Compare the amount of behavior change needed for the strategy to succeed and the amount of behavior change that is manageable within the strategy’s timeframe. Can the objectives be accomplished with available resources? Are there sufficient interpersonal, community-based, and mass media channels to reach the intended audience? Will more demand be created than the program can fulfill? Discuss proposed objectives with service delivery managers, and ensure that they will be able to provide enough supplies and services to meet the expected increase in requests.

Give a numerical or percentage change expected.

If it is not possible to measure behavior change in precise terms, try to establish a means of verifying that the audience’s behavior is at least following the general trend that would support the aim of the communication program.

Step 3: Deciding the Timeframe Within Which the Expected Change Will Occur

Identify the timeframe in which change will be achieved. Use timeframes that give people enough time to change. Strategic communication objectives may be stated in terms of months or years. Keep this long-term horizon in mind as you develop your behavior change objectives.

At this point, you should now have developed one or more behavior change objectives that are SMART.

Example: Developing Objectives Worksheet

You may wish to use the following example and worksheet to help you outline and create informed objectives for your health communication campaign.

Example: Bolivia—Las Manitos I (Valente et al., 1996) 

Project background: Bolivia’s National Reproductive Health Program was designed to address high rates of infant and maternal mortality and to satisfy an unmet demand for Family Planning (FP). The program also worked to improve the climate for FP and to broaden the range of services offered to include a variety of reproductive health services. A series of campaigns was designed and implemented over a number of years, the first of which was called Las Manitos I.

Creating A Message Brief

(O’ Sullivan et al., 2003)

A message brief is a document that the communication team develops and shares with experts at an advertising agency, PR agency, creative writers and designers, or any other organization or person involved in message development. The creative experts use the message brief as a springboard for developing creative concepts. 

Remember, it is the job of these experts to develop creative materials. The strategic health communication team outlines “what” the messages need to say. The creative experts determine the execution—”how” the messages will be designed. The more precise the message brief is, the more likely it is that the communication will be effective. A “tight” message brief leaves nothing to interpretation and is incapable of being misunderstood. A well-crafted message brief allows the creative experts to explore a variety of approaches, as opposed to a loosely worded brief that confuses the creative experts and leaves them wondering what the client really wants and needs. 

To communicate effectively with the intended audiences, the communication team needs to design messages that are (1) on strategy, (2) relevant, (3) attention getting, (4) memorable, and (5) motivational. 

The message brief in this chapter presents a way to summarize for the creative experts what we know about the health issue and the communication needs of the audience. The message brief also outlines the key fact that will lead to the desired behavior change and the promise or benefit for the intended audience that ideally will motivate it to adopt the change. Communication team members then define the support for the promise and develop a statement of the ultimate and lasting impression that the audience will take away from the message.

Message Design

(O’ Sullivan et al., 2003, p. 124)

Strategic health communicators craft key message points that are consistent and relevant for all channels and tools. This consistency and relevance contribute to the overall effectiveness of the communication strategy by ensuring that, for example, the service provider, the community mobilizer, and the actor featured in a radio announcement all reinforce the same key message points. This approach does not mean that planners create only one message for all these venues. It does mean that they identify the key points that are to be made in every message that is communicated to the audience, no matter which channel or tool is used.

Message Brief Outline

(O’ Sullivan et al., 2003)

The message brief is suggested as a useful means of gaining insight into the audience, which is one of the keys to designing messages that will resonate with audiences. Completing the message brief outline will provide you and your team with a simple document that describes what the message should say and do.

The message brief has two principal parts: a strategy component and a message development component. 

(O’ Sullivan et al., 2003, p. 127)

Step 1: Identifying the Key Fact

Strategic communicators look for the key factor or the single most important fact in a health problem or situation that, if addressed in the communication effort, will most likely lead to the desired behavior change. The key fact may be an obstacle or an opportunity. Selection of the single most important fact is key because a message is only effective if it addresses a single problem. The process of selecting the key fact forces the strategist to look for the relevance and importance that will make the message stand out.

From the information gathered in the analysis of the situation, you need to identify the key fact. It crystallizes what you know about the problem and the opportunities for solving the problem. As planning progresses, you can expect to observe a number of facts that might shape the creative work. The key fact can suggest the need to do the following:

• Eliminate a problem that the audience has with the product or idea.  

• Correct an erroneous or incomplete perception that the audience may have.  

• Reinforce or extend a benefit that the program delivers. 

•  Strengthen the reason for greater use of the product or an unexpected way to use the product or service.  

• Fill a void.

(O’ Sullivan et al., 2003)

Step 2: Identifying the Promise

Step 2 is to identify the promise or benefit to the members of the intended audience that will motivate them to change their behavior. The purpose of this step is to select a promise that is most persuasive to the primary audience. The promise is a clear benefit that the audience will understand after receiving the message. The promise should serve to differentiate the message from communication about other products, services, or behavior. 

It should convey a benefit like “happy, strong adolescents” or “your babies will live longer and healthier and will be stronger” and not a product attribute like “a modern, hormonal method of contraception.” An attribute should be used only when it communicates and supports the consumer benefit.

Put another way, the promise is the specific audience benefit that the health communicator wants the audience to associate most readily with the objective or proposed behavior change. For example, the promise of feeling secure and protected from contracting HIV or other STDs by using a condom is a clear benefit to the audience of adopting a particular behavior. The promise is a consumer-end benefit whose appeal is usually based on emotion and is consistent with the attributes of the product, service, and/or behavior. Although a product, service, or behavior may deliver more than one benefit, it is important to highlight a single benefit. Expecting the audience to associate the promise with more than one benefit may confuse the audience and may reduce the impact of the message.

Finding the promise that will resonate with the audience is one of the most challenging tasks in developing a communication strategy because it relies on having a clear understanding of the intended audience. 

Step 3: Defining the Support

Step 3 is to define the supporting statements that summarize why the audience should believe the promise. The support statements are based on research findings that have been analyzed to understand what will make the message credible to the audience. The reasons for the audience to believe the message may be factual or emotional. In the message brief, the support statements summarize why the promise is beneficial to the audience and why the promise outweighs any obstacles to using the product or service or any barriers to adopting the behavior.

Step 4: Describing the Competition for the Message

Even if the audience understands, relates to, and is motivated by the message, there may be other factors that limit the audience’s ability to adopt the proposed behavior. 

Competition for the message also exists in the more traditional sense, where a consumer has a choice of where to go to obtain health services or where to purchase health products. For organizations that are promoting their own clinics or brands of products, for example, the audience will evaluate the communication message in relation to other alternatives available to them. Often the challenge in analyzing the competition is to translate a relative advantage into an absolute advantage. 

This notion of competition links back to the positioning statement developed in the “Strategic Approach” section (see below). Remember that an effective position must differentiate itself from the competition. A positioning statement helps to communicate to the audience a unique appealing difference designed to give the product or service an edge over the competition. 

Positioning

Positioning Behavior change communicators use positioning to determine the best approach to motivate audiences to change or adopt a specific behavior. Once communicators have determined the objectives for an audience and have developed a long term identity, they need to think about how they are going to position the behavior to achieve the objectives and maintain the long-term identity. Closely intertwined with the long-term identity, positioning establishes in the minds of the audience an image of the desired behavior that helps the audience remember it, learn about it, act upon it, and advocate for it. If the long-term identity is everything an audience knows and feels about the product, service, or behavior, then positioning is the promotional image that is intentionally communicated to an audience. An effective position includes the following:

• Resonates with the audience.  

• Differentiates from the competition.  

• Stands out as better than the known alternatives.  

• Provides a benefit that is worth the cost or effort.

Steps to Developing a Position 

The first key step in developing a position is for you to know where the audience is currently going for its health products and services and how the audience is currently behaving.

The Strategic Approach section also notes that positioning creates the memorable cue for the audience to know why it should adopt a specific behavior. This idea is also contained in step 3 of “Define the Support.” Remember that the support statement should state why the message promise will benefit the audience and why it will outweigh obstacles to using the product or service or to adopting the behavior. 

You will encounter a number of places in the strategic design process where the concept of competition comes into play. You and your team need to be consistent in how you articulate what the competition is and why the audience should act on your message as compared to other messages.

The second key step is to determine what the positive behavior can realistically deliver that the audience will perceive as a benefit. This step may require additional audience research. Start by reviewing and following these basic steps:  

• Analyze the program’s capabilities, and identify differences from other programs (from “Analysis of the Situation”).  

• Analyze the audience’s perceptions of the product, service, or behavior (from “Analysis of the Situation” and “Audience Segmentation”).  

• List the audiences and their characteristics (from “Audience Segmentation”).  

• Match product, service, or behavior characteristics to audience needs and wants.  

• Explore positioning alternatives.  

• Develop a positioning statement.

Examples of Positioning 

1. By product difference: Is there a unique product feature? Injectables offer women 1 to 3 months of protection from unwanted pregnancy with just one injection.

2. By key attribute/benefit: What benefit can we offer that the audience will consider meaningful? Gold Star high-quality reproductive health services in Egypt.

3. By clients or users: Create an image for an audience that the service or product is only for them. Youth-friendly clinics geared to provide reproductive health services for adolescents.

4. By use: When and where is a service or product being used? National Immunization Days–specific dates when immunization are given.

5. Against a category: Position a product or service against the entire spectrum of products or services in that category. Ward and caring providers compared to all providers.

6. Against a specific competitor: Competitive brands. Brand A condom compared to Brand B.

7. By association: Associate the product or service with a lifestyle. Lux Soap: the soap of the start. If I use Lux Soap, I will be like a movie star.

8. By problem: How a product, service, or behavior will solve a problem. ORS to help reduce dehydration caused by diarrhea.

Checklist: Questions To Ask About the Position:

1. Does it resonate with the audience? 

2. Will it endure? 

3. Does it differentiate from the competition? Does it represent something better or different that is valued? 

4. Does it represent a feasible strategy? Can the program deliver the promise or benefit? 

5. Does it support the program view? 

6. Does it represent a clear vision? 

7. Can people in the involved organizations clearly articulate the position? 

8. Does it stimulate innovative communication activities?

Developing a Positioning Statement

A positioning statement describes how the behavior will be placed in the minds of the audience. It is not a catchy slogan. Positioning statements help writers develop catchy slogans, but they are not the slogans themselves. A positioning statement is not to be included in communication materials that go to audiences. It will, however, provide direction for the strategic approach and subsequent messages.

Develop one or two sentences describing as succinctly as possible the position for the product, service, or behavior. Make sure to include the name of the product, service, or behavior, the unique difference that sets it apart from the competition, and the benefit to the audience. Keep in mind that this is not a slogan. The positioning statement is the forerunner to a slogan—to be used to inform the creative team as they develop a slogan.

Step 5: Developing the Statement of the Ultimate and Lasting Impression That the Audience Will Have After Hearing or Seeing the Message

The ultimate and lasting impression of the message is what people retain after seeing it or hearing it, that is, the full range of thoughts, feelings, and attitudes about the product, service, or behavior proposed in the message. In other words, it is the “take-away” of the message, including its call to action. 

The overall impression is not a slogan but the belief and feeling that the audience should get from the communication. The take-away message may be explicit or implicit and may be communicated verbally or nonverbally. You should strive for a multifaceted but single-minded impression that will contribute to creating a powerful message brief. Such a message will communicate the identity of the strategy, paint a picture in the audience’s mind, and help to build a long-term identity for the product, service, or behavior.

Step 6: Describe the Desired User Profile

You and your team need to identify the important personality characteristics that the audience associates with the use of the product or service or with the change in behavior. Every message makes a statement about the kind of people that the audience perceives as using the product or service or performing the behavior. 

You, the strategist, must think like the audience and ask the following questions: 

• What is the profile of someone who would use the product or service or who would adopt the behavior?

• Do others want to emulate these users?

• What is it about the users that makes others aspire to be like them?

• Are these users perceived as smart, concerned for their families, modern, and responsible?

Step 7: Identifying the Key Message Points

Now you are ready, based on steps 1 through 6, to identify the key message points that will be included in all communication delivered by the partners who will implement the strategy. The key message points will be delivered in different ways based upon the work that the advertising agency or other communication experts develop. A message point can also be used specifically as an advertising slogan or as a counseling message or can be built into community-based activities.

(Centers for Disease Control and Prevention & Agency for Toxic Substances and Disease Registry, 2018)

A key message is like your elevator pitch. It’s a short, memorable sentence or two that conveys exactly what you want your target audience to know and understand. Every communication product needs at least one key message.

All messages, regardless of how they are delivered or by whom, should consistently contain the same core information. Medical staff in clinics, counselors, pharmacy staff, field workers, and any other partners in the communication effort should reinforce the key message points (O’ Sullivan et al., 2003).

(Centers for Disease Control and Prevention & Agency for Toxic Substances and Disease Registry, 2018)

What does a key message look like?

Key messages are the following: 

• Few in number: Limit your key messages to three. 

• Short and concise: Each key message should be no more than one or two sentences.

• Memorable: Messages should be both simple enough and original enough for the audience to remember.

• Focused on a specific topic: Avoid over explaining or including lots of background information.

• Consistent: Use repetition to make your key messages stick.

(O’ Sullivan et al., 2003)

Tip: Follow the seven C’s of effective communication (Williams, 1992) when developing messages:

1. Command attention

2. Cater to the heart and head.

3. Clarify the message.

4. Communicate a benefit.

5. Create trust.

6. Convey a consistent message.

7. Call for action.

Example: Summary Message Brief Worksheet

Example: Uganda

*Medical staff, counselors, pharmacy staff, community-based partners, advertising agency, and so on.

Next Steps

The message brief helps you and your team to develop messages that are on strategy, relevant, attention-getting, memorable, and motivational. The content of the message brief is consistent with the information gathered in the analysis of the situation, audience segmentation, behavior change objectives, and strategic approach phases of the strategy design process. If you find the process of developing the message brief confusing or problematic, your strategic approach may need to be revisited.

The key message points identified as a result of the message brief consist of the essential themes that should be included through all communication channels used by any of the strategy partners. 

(Centers for Disease Control and Prevention & Agency for Toxic Substances and Disease Registry, 2018)

Talking Points

What is a talking point? 

A talking point is a fact, figure, or story that supports a key message. 

When do I use a talking point? 

Talking points are developed as needed to help explain a complicated event or issue. 

What does a talking point look like? 

Talking points are: 

• Supported with research or data: Talking points offer numbers, facts, and figures.

• Limited in number: Keep talking points to five or fewer for each key message. 

• More specific than key messages: Talking points offer more insight. 

• Consistent with the key message: Talking points prove the key message to be true.

• Easy to understand: The tone is conversational and jargon-free.

Talking Point Example

The following example lists talking points to support the key messages related to NCEH or ATSDR’s PV investigation in Eastern Pennsylvania.

1. Key message: Protecting public health is ATSDR’s top priority. 

Talking points: 

• ATSDR has been investigating PV in Eastern Pennsylvania since 2006. 

• ATSDR responded immediately when the Pennsylvania Department of Health asked us to investigate PV in Eastern Pennsylvania. 

• ATSDR has secured grants and worked with experts to carry out the investigation.

2. Key message: ATSDR identified a cluster of PV cases in Eastern Pennsylvania.

Talking points:

• ATSDR is now conducting 14 research projects and four non-research projects.

• The projects are based on the recommendations of an expert panel that identified four areas for investigation: epidemiology, genetics, toxicology, and environmental analysis.

3. Key message: ATSDR is still investigating the cases.

Talking points:

• We expect fieldwork for the projects will be completed in Fall 2012. 

• We’ll present research findings and reports at future public meetings as the projects are completed.

References

Centers for Disease Control and Prevention & Agency for Toxic Substances and Disease Registry. (2018). Health Communication Playbook: Resources to Help You Create Effective Materials. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/nceh/clearwriting/docs/health-comm-playbook-508.pdf

Nagy, J., & Fawcett. (n.d.). Chapter 8. Developing a Strategic Plan | Section 3. Creating Objectives | Main Section | Community Tool Box. Community Tool Box. Retrieved September 27, 2023, from https://ctb.ku.edu/en/table-of-contents/structure/strategic-planning/create-objectives/main

O’ Sullivan, G. A., Yonkler, J. A., Morgan, W., & Merritt, A. P. (2003). A Field Guide to Designing A Health Communication Strategy. John Hopkins Bloomberg School of Public Health/Center for Communication Programs. http://ccp.jhu.edu/documents/A%20Field%20Guide%20to%20Designing%20Health%20Comm%20Strategy.pdf