There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) ...to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice-health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity.
We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts.
Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we "leave no one behind" and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.
There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, ...are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health.
Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising ...set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical explanations of narrative effects and research comparing narrative and nonnarrative approaches to persuasion, and makes recommendations for future research needs in narrative health communication.
The rapidly growing and evolving literature on the social environment and its influence on health outcomes currently lacks a clear taxonomy of dimensions of the social environment and the differing ...mechanisms through which each influences health-related behavior. This paper identifies five dimensions of the social environment—social support and social networks, socioeconomic position and income inequality, racial discrimination, social cohesion and social capital, and neighborhood factors—and considers each in the context of physical activity to illustrate important differences between them. Increasing the specificity of terminology and methods in social environmental research on health will enable more systematic inquiry and accelerate the rate of scientific discovery in this important area.
Objective: Examine the longitudinal effects of personal narratives about mammography and breast cancer compared with a traditional informational approach. Methods: African American women (n = 489) ...ages 40 and older were recruited from low-income neighborhoods in St. Louis, Missouri, and randomized to watch a narrative video comprised of stories from African American breast cancer survivors or a content-equivalent informational video. Effects were measured immediately postexposure (T2) and at 3- (T3) and 6-month (T4) follow-up. T2 measures of initial reaction included positive and negative affect, trust, identification, and engagement. T3 message-processing variables included arguing against the messages (counterarguing) and talking to family members about the information (cognitive rehearsal). T4 behavioral correlates included perceived breast cancer risk, cancer fear, cancer fatalism, perceived barriers to mammography, and recall of core messages. Structural equation modeling examined interrelations among constructs. Results: Women who watched the narrative video (n = 244) compared to the informational video (n = 245) experienced more positive and negative affect, identified more with the message source, and were more engaged with the video. Narratives, negative affect, identification, and engagement influenced counterarguing, which, in turn, influenced perceived barriers and cancer fatalism. More engaged women talked with family members more, which increased message recall. Narratives also increased risk perceptions and fear via increased negative affect. Conclusions: Narratives produced stronger cognitive and affective responses immediately, which, in turn, influenced message processing and behavioral correlates. Narratives reduced counterarguing and increased cognitive rehearsal, which may increase acceptance and motivation to act on health information in populations most adversely affected by cancer disparities.
Tailored health communication (THC) is any combination of information and behavior change strategies intended to reach one specific person based on information unique to that person, related to the ...outcome of interest, and derived from an individual assessment. THCs have been studied as a means to facilitate behavior change by influencing some key intermediate steps that precede the behavioral outcome. These include the extent to which people attend to communications, think about them, find them relevant and salient, and intend to take action. Evidence shows that THCs have achieved modest success in changing a number of cancer‐related behaviors, including smoking, diet, exercise, and cancer screening. However, it is likely that THCs could be more effective if they were developed with a greater understanding of message effects and what we refer to as the behavioral pathway. Instead of using unidimensional approaches to influence behavior change, a message effects approach would help researchers identify key leverage points for impact on such intermediate outcomes as persuasion and yielding. Such a strategy also might be used to determine when THCs are the preferred approach and when generic, targeted, or combinations of THCs and targeted communications might be appropriate. Viewing THCs from the perspective of the behavioral pathway might indicate use of different messages, sources, and formats to influence different people at different points on the pathway. We provide a brief history of THCs and suggest how integrating a broader perspective of health behavior and health communication theories could enrich THCs.
Abstract Objective: Compare effects of narrative and informational videos on use of mammography, cancer-related beliefs, recall of core content and a range of reactions to the videos. Method: African ...American women ( n = 489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, MO and randomly assigned to watch a narrative video comprised of stories from African American breast cancer survivors ( Living Proof ) or a content-equivalent informational video using a more expository and didactic approach ( Facts for Life ). Effects were measured immediately post-exposure and at 3- and 6-month follow-up. Results: The narrative video was better liked, enhanced recall, reduced counterarguing, increased breast cancer discussions with family members and was perceived as more novel. Women who watched the narrative video also reported fewer barriers to mammography, more confidence that mammograms work, and were more likely to perceive cancer as an important problem affecting African Americans. Use of mammography at 6-month follow-up did not differ for the narrative vs. informational groups overall (49% vs. 40%, p = .20), but did among women with less than a high school education (65% vs. 32%, p < .01), and trended in the same direction for those who had no close friends or family with breast cancer (49% vs. 31%, p = .06) and those who were less trusting of traditional cancer information sources (48% vs. 30%, p = .06). Conclusions: Narrative forms of communication may increase the effectiveness of interventions to reduce cancer health disparities. Practice implications: Narratives appear to have particular value in certain population sub-groups; identifying these groups and matching them to specific communication approaches may increase effectiveness.
Abstract Objective The best innovations in cancer communication do not necessarily achieve uptake by researchers, public health and clinical practitioners, and policy makers. This paper describes ...design activities that can be applied and combined for the purpose of spreading effective cancer communication innovations. Methods A previously developed Push–Pull-Infrastructure Model is used to organize and highlight the types of activities that can be deployed during the design phase of innovations. Scientific literature about the diffusion of innovations, knowledge utilization, marketing, public health, and our experiences in working to spread effective practices, programs, and policies are used for this purpose. Results Attempts to broaden the reach, quicken the uptake, and facilitate the use of cancer communication innovations can apply design activities to increase the likelihood of diffusion. Some simple design activities hold considerable promise for improving dissemination and subsequent diffusion. Conclusion Augmenting current dissemination practices with evidence-based concepts from diffusion science, marketing science, and knowledge utilization hold promise for improving results by eliciting greater market pull. Practice implications Inventors and change agencies seeking to spread cancer communication innovations can experience more success by explicit consideration of design activities that reflect an expanded version of the Push–Pull-Infrastructure Model.
The 2-1-1 system is a three-digit telephone information and referral service that connects people to health and social services available in their community. The attraction of 2-1-1's reach lies in ...its unique mix of numbers (16-17 million interactions per year); places (available in 50 states); and people (callers are disproportionately low-income, low-education, unemployed, uninsured). While many researchers, healthcare providers, and prevention specialists grouse about the difficulty of reaching and engaging the most vulnerable patients and populations in our communities, 2-1-1 specialists are busy listening to, talking with, and helping them. Not just a few, but by the millions, and in interactions that are initiated by those affected, not solicited by outreach specialists. These are literally calls for help, rising from the community. Copyright American Journal of Preventive Medicine; published by Elsevier Inc.
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