Through a Lens of Scarcity: Health Communication in a Low-Income Context (Gesundheit und Gesellschaft)

The conditions for strategic health communication campaigns as a public health tool are examined for low-income contexts. The theoretical framework drafts a socioecological model with an extension of poverty influences to bring into focus the dynamics of a resource-poor environment and its impact on health-related behaviours and health campaigns. The research design includes two studies conducted in Sierra Leone. Study 1 triangulated three qualitative methods to explore past and current health communication practice in Sierra Leone. Study 2 is a mixed-methods field experiment on handwashing which explored the effects of different campaign strategies. Results show that a community-based participatory approach with the inclusion of local leaders as health messengers was associated with higher chances of behaviour change than a non-treated setting. Further pathways for context-sensitive approaches for deprived audiences are suggested. About the author Hanna Luetke Lanfer holds an MA in Journalism (University of Groningen, Netherlands) and a Ph.D. in Health Communication from Erfurt University (Germany) with field studies conducted in Sierra Leone. Foreword Abstract Contents Abbreviations List of Figures List of Tables 1 Introduction 1.1 Background 1.2 Rationale for the Topic of This Research 1.3 Objectives 1.4 Outline 2 Strategic Communication 2.1 Communication 2.2 Strategic Communication 2.3 Health Communication 2.4 Overview of Communication Campaign Development 2.5 A Critical Perspective 3 Scarcity 3.1 Culture 3.2 Poverty 3.2.1 Economic views of poverty 3.2.2 Social and psychological poverty views 3.2.3 Multidimensional measurements of poverty 3.2.4 Poverty from the perspective of the poor 3.3 Summary 4 Integrating poverty influences into communication campaign development 4.1 Behavioural insights 4.1.1 Classic theories and models of behaviour 4.1.2 Socio-ecological models 4.1.3 Summary 4.2 Message design 4.2.1 Overview over existing message strategies 4.2.2 Influences of poverty on message design 4.2.3 Summary 4.3 Channels, formats and messengers 4.3.1 Overview over existing dissemination strategies 4.3.2 Influences of poverty on dissemination strategies 4.3.3 Summary 4.4 Ethical considerations of communication campaigns 4.5 Relevance of a lens of scarcity 5 Sierra Leone 5.1 Overview 5.2 Contextual characteristics 5.2.1 Political and institutional factors 5.2.2 Infrastructure and services 5.2.3 Natural environment 5.2.4 Media and communication environment 5.3 The West African Ebola epidemic 5.4 Summary 6 A Qualitative Study on Health Communication in a Low-income Context 6.1 Research Questions 6.2 Rationale for Using Triangulation in Qualitative Research 6.3 Procedures of the Three Methods 6.3.1 Interviews with Key Informants 6.3.2 Content Analysis of Ebola Communication Materials 6.3.3 Focus Group Discussions 6.4 Results of the Triangulation 6.5 Discussion 7 Field Experiment of a Communication Campaign on Hand Hygiene 7.1 Rationale for This Study 7.2 Formative Research 7.2.1 Relevance of the Behaviour of Interest 7.2.2 Research Questions 7.2.3 Sampling, Data Collection Procedures and Analysis 7.2.4 Results 7.2.5 Discussion 7.3 Audience Segmentation 7.4 Specification of Goals 7.5 Hypotheses and Research Questions 7.6 Material and Methodology 7.6.1 Experimental Design 7.6.2 Stimulus Material 7.6.3 Procedures 7.6.4 Measurement 7.6.5 Setting and Participants 7.6.6 Analytical Approach 7.7 Results 7.7.1 Observation 7.7.2 Survey 7.7.3 Summary of Hypothesis Testing 7.7.4 Post-Intervention Focus Groups and Research Diary 7.8 Discussion 8 Conclusion 8.1 Recapitulation of the Objectives and Key Findings 8.2 Relevance of this Research 8.2.1 Implications for Theory 8.2.2 Implications for Practice 8.3 Statement of Reflexivity and Ethics 8.4 Limitations 8.5 Recommendations for Future Research 8.6 Summary References The conditions for strategic health communication campaigns as a public health tool are examined for low-income contexts. The theoretical framework drafts a socioecological model with an extension of poverty influences to bring into focus the dynamics of a resource-poor environment and its impact on health-related behaviours and health campaigns. The research design includes two studies conducted in Sierra Leone. Study 1 triangulated three qualitative methods to explore past and current health communication practice in Sierra Leone. Study 2 is a mixed-methods field experiment on handwashing which explored the effects of different campaign strategies. Results show that a community-based participatory approach with the inclusion of local leaders as health messengers was associated with higher chances of behaviour change than a non-treated setting. Further pathways for context-sensitive approaches for deprived audiences are suggested. About the author Hanna Luetke Lanfer holds an MA in Journalism (University of Groningen, Netherlands) and a Ph. D. in Health Communication from Erfurt University (Germany) with field studies conducted in Sierra Leone "The conditions for strategic health communication campaigns as a public health tool are examined for low-income contexts. The theoretical framework drafts a socioecological model with an extension of poverty influences to bring into focus the dynamics of a resource-poor environment and its impact on health-related behaviours and health campaigns. The research design includes two studies conducted in Sierra Leone. Study 1 triangulated three qualitative methods to explore past and current health communication practice in Sierra Leone. Study 2 is a mixed-methods field experiment on handwashing which explored the effects of different campaign strategies. Results show that a community-based participatory approach with the inclusion of local leaders as health messengers was associated with higher chances of behaviour change than a non-treated setting. Further pathways for context-sensitive approaches for deprived audiences are suggested."--Page [4] of cover