Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
Leveraging the power of health communication: messaging matters not only in clinical practice but also in public health
Harry HX Wang, PhD1,2,3 #; YT Li, MPH4 #; Martin CS Wong, MD, MPH5,6
1 School of Public Health, Sun Yat-Sen University, Guangzhou, China
2 Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, China
3 Usher Institute, Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Scotland, United Kingdom
4 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
5 JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
6 Editor-in-Chief, Hong Kong Medical Journal
# Equal contribution
Corresponding author: Prof Martin CS Wong (wong_martin@cuhk.edu.hk)
 Full paper in PDF
In routine clinical practice, communicating with patients in a clear and persuasive manner during patient-provider encounters is increasingly important for effective healthcare. This greatly helps in improving access to care and diagnostic safety, fostering continuous healing relationships, reducing medical errors, strengthening family and social support, enhancing care adherence, increasing patient satisfaction, and avoiding malpractice claims.1 2 3 Moreover, effective communication is a pivotal ingredient in patient engagement and shared decision-making across the care continuum from screening and diagnosis through palliative care built on the patient’s greater knowledge of health problems and the clinician’s better ability to recognise individual patient beliefs, values, needs, and preferences.4 This, in turn, enables the development and dissemination of evidence-based, personalised messages from clinicians to inform diagnosis, treatment options, prognosis, and the likelihood of severe adverse effects for achieving optimal care for patients.5
The benefits of effective health communications in improving patient health outcomes and well-being also extend beyond clinical care. Whether to inform people about their health facts or to exert a long-lasting influence on their behaviour for living a healthier life, the use of different strategies is crucial in public health campaigns spanning a variety of areas, including the ongoing coronavirus disease 2019 (COVID-19) pandemic.6 7 Of equal importance is the integration of health communication in public advocacy and outbreak responses, which necessitate appropriate, practical, and straightforward messages that fill knowledge gaps for the target audience.
From a public health perspective, eye health is a global imperative for achieving universal health coverage and many of the Sustainable Development Goals. Improving eye health contributes substantially to maintaining independence and daily life activities, improving quality of life and well-being, ensuring educational attainment and workplace productivity, and reducing poverty and inequalities.8 Similar to the prevention and management of most chronic diseases, promoting and improving eye health also require a life course approach that aims to minimise risk factors through evidence-based interventions at important life stages from as early as the perinatal period through early childhood to adolescence, and into older age. Therefore, school-based public health efforts that incorporate expertise of education and communication of health messages to facilitate long-term behaviour changes in children and adolescents would have the most impact on reducing disease risk factors and disease onset in later-life.9 Engagement in collaborative endeavours from both teachers and parents has been proven effective in the problem-solving process to support school-age children with developmental disorders and impairments in social interaction.10 Whether the school-family partnership underpinned by teacher-parent communication could be linked with improved behaviour changes, eg, vision screening attendance, in other specific disease contexts such as vision impairment warrants further investigation.
Uncorrected refractive error, including myopia, hyperopia, astigmatism, and anisometropia, serve as the major and most easily avoidable cause of vision impairment among school-age children who are at risk of poor educational performance and social malfunctioning. In this issue of the Hong Kong Medical Journal, Du et al11 explore the association between teacher-parent communication and eye-health seeking behaviours of primary school students in a cross-sectional study conducted in rural China. The authors found that the delivery of a single clear message to parents from the teacher on the student’s inability to see the blackboard clearly could substantially improve the refractive examination attendance and spectacles wearing among students. It adds evidence to extend the benefits of teacher-parent communication beyond better educational experiences, coordinated learning environments, improved academic achievements, and enhanced habits development in daily life. The findings also provide impetus for further in-depth research to advance our understanding of the extent to which different modalities of teacher-parent interactions could inform, educate and empower parents about their child’s eye health issues. This may help in generating evidence for developing well-integrated, innovative strategies to plan and implement school-based eye health initiatives featured by strengthened partnership with teachers, parents, students, and the wider community to address undiagnosed or untreated refractive error and other vision impairment.
At the global level, an earlier report from the World Health Organization in 2019 highlighted the considerable challenges of a continuum of eye care throughout people’s lives: over 2 billion people worldwide are visually impaired or blind, and nearly half of vision impairments could have been prevented or have yet to be addressed through cost-effective and feasible health interventions.12 The subsequent 74th World Health Assembly organised in April 2021 has endorsed the global targets for effective coverage of refractive errors and cataract surgery—the two leading causes of vision impairment and blindness. A 40% point increase in effective coverage of refractive error and a 30% point increase in effective coverage of cataract surgery is envisaged by 2030. Apart from refractive errors and cataract, there are a range of other common ophthalmic conditions that pose enormous threats to healthcare such as glaucoma and diabetic retinopathy, which can lead to eye vision loss if not detected and treated early. Most recently, the Resolution entitled ‘Vision for Everyone; accelerating action to achieve the Sustainable Development Goals’ has been adopted by the United Nations General Assembly in July 2021 to urge the implementation of integrated people-centred eye care in health systems across the wide spectrum of promotive, preventive, curative and rehabilitative services by 2030. The United Nations vision underscores the significance of raising awareness and engaging and empowering people and communities pertaining to eye care needs and the importance of vision for all. To achieve this goal, eye health education and promotion within the wider community needs to reduce barriers that impede the affective dimensions of message dissemination and to optimise knowledge communication and service uptake.
However, achieving effective communication of health messages is never an easy task. Previous studies highlighted the increasing need for strengthening health communication and promotion in socially disadvantaged groups,13 or those living in deprived areas,14 and for care empowerment in managing underdiagnosed long-term conditions that require better professional education and tailored messages in primary care.15 16 The need for health communication efforts and mass media messages promoting infection control measures and use of guidelines in public education is also highlighted in risk communications and community engagement against the COVID-19 outbreak.17
A growing body of evidence indicates that digital communication, eg, mobile messaging for telecommunications or social media platform characterised by multi-channel communications, may offer innovative means for sharing, disseminating and amplifying health messages across all aspects of the communication spectrum to target audience and communities with unique merits such as enhanced audio-visual capabilities, improved attendance at healthcare appointments, and increased uptake of comprehensive eye examinations.18 19
The World Health Organization has also proposed a strategic framework that highlights the principles of accessible, relevant, actionable, timely, credible and trusted, and understandable communication.20 The framework could be used a basis for operationalising effective, integrated and coordinated communication across a broad range of health issues from chronic conditions (eg, vision impairment) to emerging risks (eg, COVID-19), and for measuring the impact of tailored communication efforts on health and well-being over time. A further step towards empirical evidence from well-designed studies on the impact of enhanced health communication with individuals and their families on disease prevention, health promotion, and quality of life through public health measures and its enablers would pave the way for achieving universal health coverage for individuals, communities, and society at large.
Author contributions
All authors contributed to the concept or design; acquisition of data; analysis or interpretation of data; drafting of the article; and critical revision for important intellectual content. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.
Conflicts of interest
The authors have declared no conflict of interest.
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