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Role for risk communication in closing military waste sites.

Lessons learned from environmental and occupational hazard risk management practices over the past 30 years have led the Department of Defense to explore alternative risk management approaches. Policies for cleanup of environmentally hazardous waste sites are undergoing examination and are being reframed. A Demonstration Risk Communication Program is described which incorporates principles that integrate risk-based scientific information as well as community values, perceptions, and needs in a democratic process that includes the public as an active participant from the earliest stages. A strong scientific foundation for assessment and characterization of risk is viewed as necessary but not sufficient; the public's values must be actively integrated into the negotiated criteria. The Demonstration Program uses a model to prepare the participants and to guide them through the process. A five-step process is presented: (1) create risk communications process action team including at least one member of the specific site audience; (2) professionally train participants on team dynamics including interpersonal communication skills; (3) train risk communicators to deliver a cogent presentation of the message to secure a decision acceptable to both the government and the public; (4) identify existing biases, perceptions, and values held by all participants; and (5) develop risk message incorporating science and values. The process action team approach assumes the participants enter into the effort with the goal of improved environment and safeguarded public health. The team approach avoids confrontational or adversarial interactions and focuses on a dialogue from which a negotiated team response develops. Central to the program is the recognition that communication is only effective when the dialogue is two-way.

Communication↗

Communications satellites in health education and health care provision. The WAMI experience.

Since 1971, the University of Washington School of Medicine, Seattle, has operated a four-state, medical education program covering Washington, Alaska, Montana, and Idaho. This WAMI Program involves four universities without medical schools and 15 communities. To maintain this program, communication between the sites is imperative and mandates travel. The experiments described in this article were undertaken to determine whether full-duplex audio and color-video interactions via communications satellites could replace the travel requirements of the WAMI Program. Experiments involving the administration of the program, the presentation of the undergraduate medical education curriculum, the provision of health services, and the formation of public policies were conducted. The results suggest that satellite communication has broad applicability in medical education and health care provision.

Alaska↗

Some workable community, employee and patient programs.

In the past few years, a number of hospitals and nursing homes have come up with communication programs that have been effective in reducing loses as well as improving relations with employees, patients, visitors, and residents. This article describes a number of these programs.

Facility Design and Construction↗

A critical assessment of theories/models used in health communication for HIV/AIDS.

Most theories and models used to develop human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) communication are based on social psychology that emphasizes individualism. Researchers including communication and health scholars are now questioning the presumed global relevance of these models and thus the need to develop innovative theories and models that take into account regional contexts. In this paper, we discuss the commonly used theories and models in HIV/AIDS communication. Furthermore, we argue that the flaws in the application of the commonly used "classical" models in health communication are because of contextual differences in locations where these models are applied. That is to say that these theories and models are being applied in contexts for which they were not designed. For example, the differences in health behaviors are often the function of culture. Therefore, culture should be viewed for its strength and not always as a barrier. The metaphorical coupling of "culture" and "barrier" needs to be exposed, deconstructed, and reconstructed so that new, positive, cultural linkages can be forged. The HIV/AIDS pandemic has served as a flashpoint to either highlight the importance or deny the relevance of theories and models while at the same time addressing the importance of culture in the development and implementation of communication programs.

Attitude to Health↗

A national survey of hypnosis training--its status in psychiatric residency programs: a brief communication.

Hypnosis training in psychiatric residency programs has not previously been well documented in the literature. This article examines the extent of such training in residency programs and the attitudes of residency directors to training and the use of hypnosis. A brief survey requesting information on hypnosis training was sent to all psychiatric residency directors in the United States. Sixty-three percent of responding program directors (n = 154) report offering either required or elective coursework in hypnosis. Of programs offering hypnosis training, the mean number of hours was 8, suggesting that many psychiatrists have only limited exposure to hypnosis during residency. The authors conclude that hypnosis training is widely variable within psychiatric residency programs and is dependent on the faculty and training director interests within individual programs.

Attitude of Health Personnel↗

In-home generalization of social interactions in families of adolescents with behavior problems.

The effects of a three-phase family communication program were evaluated. In the skill-teaching phase, family members were taught reciprocal social communication skills in a clinic setting. During the skill-review phase, each family member practiced the skills in their homes with the teacher. During the home-based family conference phase, each family was taught to use a structured format to resolve current family issues using their newly acquired skills. In-home parent-youth interactions were observed during a series of 1-hr sessions that involved directed and nondirected situations. Evaluation included a multiple baseline design across skills during the skill-teaching phase and a multiple baseline design across families for the family conference phase. Although the procedures of the skill-teaching phase resulted in parent-adolescent dyads learning to use the skills in the teaching setting, competent use of the skills in the home was not observed until the family conference phase was implemented. These results suggest the importance of home-based intervention if changes are to be obtained at home.

Adolescent↗

United Hospitals makes flex fly.

How can an employer convince an employee who may have to spend $20-120 a month for benefits (previously paid by the employer) that the expenditure makes sense? United Hospitals confronted the issue head-on when it began its flex benefits program. The company made flex work by involving managers in planning and developing an extensive communication program.

Community Participation↗

Using sign language with tracheotomized infants and children.

Children's ability to communicate with others is important for cognitive development. However, the number of infants and young children deprived of vocalization (aphonia) is increasing in the pediatric patient population due to tracheotomy. The Communication Program for Infants and Parents (CPIP) uses sign language as an alternative system to verbal communication.

Aphonia↗

Communication of adults with learning disabilities: self and others' perceptions.

This study investigated perceptions of the communication performance of 31 young adults with severe learning disabilities enrolled in a vocational-education program. Communication assessment questionnaires, designed to rate communication skills of these students, were completed by the students themselves and vocational educators. These questionnaires included items in the areas of comprehension, verbal expression, social communication, and problem solving. Overall, the students' perceptions of their own communication performance were remarkably similar to those of the vocational educators. However, students perceived their communicative performance as less problematic than did others. Of the four areas pertinent to communication, students and vocational educators perceived problem solving as most difficult. Implications of these findings are discussed with reference to the development of assessment procedures for adults with learning disabilities.

Adolescent↗

Creating a message for profit.

Advertising and marketing a medical group pose many problems and require detailed planning--but are well worth it. A medical group and an advertising agency chronicle their experience in forming a broad print communications program for the group, including the importance of knowing the target, setting a budget, and following up the program with market research.

Advertising↗

Word-of-mouth communications in health care marketing.

Word-of-mouth (WOM) advertising can be an important communications tool, since it addresses the right target--the decision maker, contains the needed information, and occurs at the right time. An effective WOM communications program will use a marketing survey to identify decision makers and measure their degree of preference for the provider to determine which decision makers can be influenced. A survey also should be used to discover the most significant information sources. To involve those sources in a WOM communications effort requires that they be satisfied with their provider and that they be convinced the provider is the best choice for the person who has requested the recommendation. To increase the likelihood that sources will be informed about a specific provider, pamphlets or other materials can be distributed to assist them. Other forms of encouragement include patient surveys and employee bonuses. An institution's WOM program should also be consistent with its other communications efforts. Messages must be compatible with the themes of advertising and publicity campaigns.

Advertising↗

Acquiring language through total communication.

Total communication provides an opportunity for very young children to receive training through both visual and auditory systems. Most children with severe hearing loss have auditory discrimination/perceptual problems in addition to a loss of hearing sensitivity. Because sophisticated assessment of auditory perceptual problems is not yet possible in hearing impaired infants, total communication provides immediate and consistent language input regardless of eventual determination of auditory perceptual skills. An illustration of a total communication program is provided.

Auditory Perception↗

Office ergonomics programs. A case study of North American corporations.

Subject matter experts from 13 North American corporations provided detailed descriptions of the historical development and the current components and operations of their office ergonomics programs. Results were summarized across corporations and presented for the following programmatic topics: backgrounds of key people, initial awareness and preliminary needs assessment, program development, program implementation, program monitoring and evaluation, program components, education and training, workstation and job analysis, early identification of cases, case management, and alternate office environments. The subject matter experts also provided comments about the strengths of their programs, their advice to others, and lessons they learned. These observations suggested the need for an office ergonomics program, and possibly other occupational health programs, to fit into a corporation's culture and capitalize on its infrastructure. Most corporations used multidisciplinary task forces or teams to develop their programs. Communication, which included training, awareness, advertising, and feedback, was also an important issue. Flexibility and simplicity were important attributes of these programs. It is hoped that this descriptive information will be helpful to some occupational health managers interested in or concerned about managerial perspectives and skills related to the development and implementation of programs within their own corporations.

Ergonomics↗

Putting the first audience first: conducting useful evaluation for a risk-related government agency.

The risk communication practitioner in a government agency has two essential, interdependent tasks. One is to help develop and monitor effective communication programs with various external public audiences. The other task is to do the same thing for the senior government managers whose support is a prerequisite to addressing the first audience. Hence, the second audience--the manager--is really the first. This paper addresses ways in which communication practitioners can satisfy this crucial audience. A profile of these managers suggests that they would find it highly beneficial to have more control over the public problems they encounter, especially in view of the growing pressures to do more with less and demonstrate "customer satisfaction." They would rather avoid crises than manage them. And they would rather have their bosses praise their successes than challenge their budgets or punish their perceived difficulties or failures. Communication practitioners who can help them attain such benefits will find their efforts in great demand. They would be helpful team members who provide timely insights that can make and show agency success. We offer ten ways for communication practitioners to be more useful which focus their current strengths on satisfying senior managers' needs by becoming more valuable members of the program team. By becoming more useful to the senior manager they serve both the agency and its publics.

Administrative Personnel↗

Successful internal program builds employee morale; reduces turnover. Washington Hospital Center, Washington, DC.

The Washington Hospital Center in Washington, D.C. is an example of what good can happen when a health care institution commits to developing a first-class internal communications program. The hospital center created a program that includes one-on-one dialogue between supervisors and staff, "town hall meetings, newsletters, memos, intranet, employee recognition and special events." The program builds employee morale and reduces turnover. It also has increased the quality of care and attention that patients receive.

District of Columbia↗

A program for enhancing medical interviewing using video-tape feedback in the family practice residency.

In an effort to enhance the medical interviewing skills of family practice residents in the clinical setting, the Minnesota Communication Program was developed. The Program, which uses video-tape feedback as the primary teaching method, stresses the integration of biological and psychosocial data as well as the establishment of a therapeutic relationship. A description of the Program including goals, teaching strategies, and guidelines for implementing video-tape feedback is presented. The Medical Interview Skills Checklist (MISC) and its use as an assessment tool are described. Results of a survey eliciting residents' responses to the Program and the implications of video-tape feedback for medical education are also discussed.

Educational Measurement↗

The ethics of health education as public health policy.

The concept of voluntariness is central to an understanding of ethical considerations in two aspects of public health education practice: (1) the selection of appropriate interventions, and (2) the selection of appropriate targets for such interventions. The position is taken that most mass communications programs in public health education are persuasive as well as informative in intent. It is argued that the impact of such programs on voluntariness can be analyzed with regard to the rationality and resistibility of the persuasive appeals involved. Considerations of justice, as well as voluntariness and liberty, are reviewed in the discussion of appropriate targets for intervention. The issue of victim-blaming in public health education is explored, and conditions under which behavioral public health programs may be morally justifiable are suggested.

Choice Behavior↗

Community Participation in Nutrition Communication: Models and Linkage Systems for Management.

New models of community participation, nutrition communication, and management linkages have been proposed. Changes in the health care sector have forced a major restructuring of facilities and a shifting of focus from traditional institution-based health care to a more community-based delivery of services, and from treatment to health promotion and disease prevention. These changes have also led to a redefinition of community clients and a review of the social processes whereby community members can participate actively in their health care. Challenges for health and nutrition professionals are to create manageable environments for meaningful dialogues, and to communicate action-oriented nutrition messages that reflect the community's values and realities. Some theories on learning and behaviour change can be applied to and aid in nutrition communication. At the same time, facilitators of and barriers to community participation in nutrition communication programs must be identified and addressed. In addition, during this time of health care transition, dietitians and nutritionists must position themselves as leaders in health and nutrition communication so that the community will act on their messages. Partnerships or linkages between organizations at the local, national, and international levels can assist in the effective delivery of nutrition information.

Journal Article↗