Managing Director and Founder of World Health Communication Associates. WHCA focusses on enhancing public health communication capacities to support health literacy, counter hazard merchants and advocate for healthier, safer, fairer and greener policies. Former head of Health Communications WHO EUROPE, Primary Care Fellow King's Fund, Regional Director Project HOPE in Central and Eastern Europe, GP and Mendocino Community Hospital Chief of Staff Ukiah California and Director People Detoxification Programme Lincoln Hospital Bronx , New York.
Risk communication has been identified as a core competence for guiding public health responses t... more Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new ap...
World hospitals and health services : the official journal of the International Hospital Federation, 2011
Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and... more Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and use information to prevent, treat and manage chronic illness. Poor health literacy is shown to be associated with riskier behaviour, poor health choices and poorer health. Hospitals can play an important role in enhancing people's NCD health literacy all the way along a patient's "NCD journey" from prevention to management by aligning their communications to the health literacy capacities of their users. The authors suggest training providers to communicate more effectively with patients, making their systems easier to navigate, simplifying written materials, incorporating the use of technology and mobile-health, and using individual and system level scorecards and checklists.
Lowell Levin, professor emeritus of the Yale School of Public Health, was an inspirational source... more Lowell Levin, professor emeritus of the Yale School of Public Health, was an inspirational source and mentor for many public health students, practitioners, managers, and leaders in the World Health Organisation, academia, and communities around the world. Lowell focused much of his research, consulting, and teaching on promoting the importance of citizen participation in healthcare, health promotion, self care, and the control of iatrogenic complications in medical care. > “Listen to the community: it’s defining its own problems, and may well know what to do about them.” 1 > > “There is a hidden healthcare system with clear definitions and roles. Eighty five per cent of healthcare takes place in a big pool without the ‘benefit’ of ‘medical clergy.’” 2 His research and work as a consultant throughout the world have often challenged established public health beliefs and practices. Committed to health promotion, in the 1960s he pioneered the citizen participation movement, fo...
Evidence-based behavior change interventions addressing health systems must be identified and dis... more Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, econo...
determinants. This means articulating the powerful social forces without falling back on reductio... more determinants. This means articulating the powerful social forces without falling back on reductionist, individualistic biomedical associations to describe social causes. Most importantly it means going beyond thinking of population patterning of health as only an aggregate of individual health outcomes. Instead the patterns must be conceptualized as things in themselves – as social facts – requiring explanation in their own terms, not in terms of something else – i.e. individual health outcomes. The social sciences that might help to provide the answers to these questions have been surprisingly reticent in their willingness to engage in a dialogue with public health about the nature of society. The descriptions of the lifeworlds of people and the ways in which living, working and coping in these lifeworlds constitute the basis of the dynamics of the production of health have been negligible in their influence and the theoretical possibilities of the dynamics of the interaction of the lifeworld and lifecourse has been largely overlooked. It is not that the ideas and concepts do not exist, they just have not migrated into public health. So although the potential for unravelling the concepts and principles involved and the potential to build models that would assist in this endeavour are readily to hand within the social and public health sciences, the next steps – to turn the existing knowledge into usable tools for the cross-disciplinary research that is required and the practical applications to make a difference on the ground – have not been taken. Perhaps the recent Commission on the Social Determinants of Health will provide the catalyst. But we must also fear that the traditional paradigms will hold sway and the potential for making the breakthroughs scientifically, practically and politically will remain out of reach.
... Search this site. Advanced search. Institution: Google Indexer; Sign in. Home; Research: Meth... more ... Search this site. Advanced search. Institution: Google Indexer; Sign in. Home; Research: Methods and Reporting. Education: Clinical review; Practice; Shortcuts; Endgames; CME. News; ... Jo Eirik Asvall. Franklin Apfel. Refocused the World Health Organization in Europe on public ...
Current risk assessment and risk communication of biosafety and biosecurity concerns lack a conve... more Current risk assessment and risk communication of biosafety and biosecurity concerns lack a convenient metric and conceptual framework. The absence of such a systematic tool makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new 7-category scoring scale is proposed for incidents and situations in laboratories related to the handling of human and animal pathogens. The scale aims to help clarify risk categories, facilitate coordination and communication, and improve public understanding of risk related to biosafety and biosecurity.
World hospitals and health services : the official journal of the International Hospital Federation, 2011
Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and... more Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and use information to prevent, treat and manage chronic illness. Poor health literacy is shown to be associated with riskier behaviour, poor health choices and poorer health. Hospitals can play an important role in enhancing people's NCD health literacy all the way along a patient's "NCD journey" from prevention to management by aligning their communications to the health literacy capacities of their users. The authors suggest training providers to communicate more effectively with patients, making their systems easier to navigate, simplifying written materials, incorporating the use of technology and mobile-health, and using individual and system level scorecards and checklists.
Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related inf... more Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Conce...
ABSTRACT Current risk assessment and risk communication of biosafety and biosecurity lacks a conv... more ABSTRACT Current risk assessment and risk communication of biosafety and biosecurity lacks a convenient metric and conceptual framework. The absence of such a systematic tool, the authors argue, makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new seven category scoring scale for the handling of human and animal pathogen related to incidents and situations in laboratories is proposed. The scale aims to help clarify risk categories, facilitate coordination and communication and improve public understanding of risk related to biosafety and biosecurity.
Risk communication has been identified as a core competence for guiding public health responses t... more Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new ap...
World hospitals and health services : the official journal of the International Hospital Federation, 2011
Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and... more Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and use information to prevent, treat and manage chronic illness. Poor health literacy is shown to be associated with riskier behaviour, poor health choices and poorer health. Hospitals can play an important role in enhancing people's NCD health literacy all the way along a patient's "NCD journey" from prevention to management by aligning their communications to the health literacy capacities of their users. The authors suggest training providers to communicate more effectively with patients, making their systems easier to navigate, simplifying written materials, incorporating the use of technology and mobile-health, and using individual and system level scorecards and checklists.
Lowell Levin, professor emeritus of the Yale School of Public Health, was an inspirational source... more Lowell Levin, professor emeritus of the Yale School of Public Health, was an inspirational source and mentor for many public health students, practitioners, managers, and leaders in the World Health Organisation, academia, and communities around the world. Lowell focused much of his research, consulting, and teaching on promoting the importance of citizen participation in healthcare, health promotion, self care, and the control of iatrogenic complications in medical care. > “Listen to the community: it’s defining its own problems, and may well know what to do about them.” 1 > > “There is a hidden healthcare system with clear definitions and roles. Eighty five per cent of healthcare takes place in a big pool without the ‘benefit’ of ‘medical clergy.’” 2 His research and work as a consultant throughout the world have often challenged established public health beliefs and practices. Committed to health promotion, in the 1960s he pioneered the citizen participation movement, fo...
Evidence-based behavior change interventions addressing health systems must be identified and dis... more Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, econo...
determinants. This means articulating the powerful social forces without falling back on reductio... more determinants. This means articulating the powerful social forces without falling back on reductionist, individualistic biomedical associations to describe social causes. Most importantly it means going beyond thinking of population patterning of health as only an aggregate of individual health outcomes. Instead the patterns must be conceptualized as things in themselves – as social facts – requiring explanation in their own terms, not in terms of something else – i.e. individual health outcomes. The social sciences that might help to provide the answers to these questions have been surprisingly reticent in their willingness to engage in a dialogue with public health about the nature of society. The descriptions of the lifeworlds of people and the ways in which living, working and coping in these lifeworlds constitute the basis of the dynamics of the production of health have been negligible in their influence and the theoretical possibilities of the dynamics of the interaction of the lifeworld and lifecourse has been largely overlooked. It is not that the ideas and concepts do not exist, they just have not migrated into public health. So although the potential for unravelling the concepts and principles involved and the potential to build models that would assist in this endeavour are readily to hand within the social and public health sciences, the next steps – to turn the existing knowledge into usable tools for the cross-disciplinary research that is required and the practical applications to make a difference on the ground – have not been taken. Perhaps the recent Commission on the Social Determinants of Health will provide the catalyst. But we must also fear that the traditional paradigms will hold sway and the potential for making the breakthroughs scientifically, practically and politically will remain out of reach.
... Search this site. Advanced search. Institution: Google Indexer; Sign in. Home; Research: Meth... more ... Search this site. Advanced search. Institution: Google Indexer; Sign in. Home; Research: Methods and Reporting. Education: Clinical review; Practice; Shortcuts; Endgames; CME. News; ... Jo Eirik Asvall. Franklin Apfel. Refocused the World Health Organization in Europe on public ...
Current risk assessment and risk communication of biosafety and biosecurity concerns lack a conve... more Current risk assessment and risk communication of biosafety and biosecurity concerns lack a convenient metric and conceptual framework. The absence of such a systematic tool makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new 7-category scoring scale is proposed for incidents and situations in laboratories related to the handling of human and animal pathogens. The scale aims to help clarify risk categories, facilitate coordination and communication, and improve public understanding of risk related to biosafety and biosecurity.
World hospitals and health services : the official journal of the International Hospital Federation, 2011
Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and... more Noncommunicable disease (NCD) health literacy is a person's ability to access, understand and use information to prevent, treat and manage chronic illness. Poor health literacy is shown to be associated with riskier behaviour, poor health choices and poorer health. Hospitals can play an important role in enhancing people's NCD health literacy all the way along a patient's "NCD journey" from prevention to management by aligning their communications to the health literacy capacities of their users. The authors suggest training providers to communicate more effectively with patients, making their systems easier to navigate, simplifying written materials, incorporating the use of technology and mobile-health, and using individual and system level scorecards and checklists.
Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related inf... more Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Conce...
ABSTRACT Current risk assessment and risk communication of biosafety and biosecurity lacks a conv... more ABSTRACT Current risk assessment and risk communication of biosafety and biosecurity lacks a convenient metric and conceptual framework. The absence of such a systematic tool, the authors argue, makes communication more difficult and can lead to ambiguous public perception of and response to laboratory biosafety incidents and biosecurity threats. A new seven category scoring scale for the handling of human and animal pathogen related to incidents and situations in laboratories is proposed. The scale aims to help clarify risk categories, facilitate coordination and communication and improve public understanding of risk related to biosafety and biosecurity.
Translation of health-related information material is an essential action that public health age... more Translation of health-related information material is an essential action that public health agencies on all levels need to take to support health knowledge, attitude and behavioral communication with different language speaking populations. Most translation projects, however, devote little time and resources to assessing and addressing the cultural and contextual factors which shape the health behaviours of different language speaking populations. Materials and interventions aimed at enhancing health knowledge and literacy seldom incorporate a systematic approach to cultural/contextual adaptation. Valuable evidence-based public health materials that have been shown to enhance healthier behaviours are often lost in translation. While a variety of cultural/contextual adaptation approaches have been reported, no internationally acknowledged adaptation standards have been agreed to date.
The cultural/contextual adaptation of public health materials and interventions is associated with higher vaccination uptake, better compliance with risk and outbreak communication and, faster responses to emergencies, especially related to vulnerable populations. Recent failures in the international Ebola response, for example, have been attributed in large part to culturally insensitive messaging and inadequate social mobilization.
Building on health promotion, health literacy, social marketing, cultural adaptation, behavioral communication and implementation science research, this article describes a new five-step stakeholder-based approach to the cultural/contextual adaptation of public health communication materials. This approach was developed for the European Centre for Disease Prevention and Control (ECDC) and refined through the practical adaptation of ECDC’s "Let’s talk about protection. Enhancing childhood vaccination uptake- Communication action guide for health care providers" in six European countries. An integrated top down/bottom up approach was refined through these country experiences and five key action steps were identified:
• Careful selection of materials and process coordinators • Early review by content and linguistic experts • Translation and quality check • Comprehension testing • Strategic dissemination – Proofreading, customized design, networking and evaluation.
These adaptation steps are described and analysed. Challenges and lessons learned are identified. Evidence of effectiveness is presented and questions are posed related to needed research follow-up.
From 1997- 2002, the World Health Organization developed the World Health Communication Network ... more From 1997- 2002, the World Health Organization developed the World Health Communication Network (WHCN) as a way of identifying and implementing mechanisms and strategies for communication with the public that effectively promote informed and ethical debate. Piloted in the WHO European Region, the WHCN brought together key players involved in communicating health messages to the public; including journalists, government spokespeople, intergovernmental and nongovernmental organizations (NGOs), advertisers, educators, researchers and health and environment practitioners. The network provided a platform for exchange of ideas, products and experience, supported skills development, highlighted good practice in the field of health and environment communication and established professional guidelines. Health communicators interested in enhancing health literacy and communication as a determinant of health and healthier choices will benfit form the wisdom expressed in this symposium's papers.
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Papers by Franklin J Apfel
Valuable evidence-based public health materials that have been shown to enhance healthier behaviours are often lost in translation. While a variety of cultural/contextual adaptation approaches have been reported, no internationally acknowledged adaptation standards have been agreed to date.
The cultural/contextual adaptation of public health materials and interventions is associated with higher vaccination uptake, better compliance with risk and outbreak communication and, faster responses to emergencies, especially related to vulnerable populations. Recent failures in the international Ebola response, for example, have been attributed in large part to culturally insensitive messaging and inadequate social mobilization.
Building on health promotion, health literacy, social marketing, cultural adaptation, behavioral communication and implementation science research, this article describes a new five-step stakeholder-based approach to the cultural/contextual adaptation of public health communication materials. This approach was developed for the European Centre for Disease Prevention and Control (ECDC) and refined through the practical adaptation of ECDC’s "Let’s talk about protection. Enhancing childhood vaccination uptake- Communication action guide for health care providers" in six European countries. An integrated top down/bottom up approach was refined through these country experiences and five key action steps were identified:
• Careful selection of materials and process coordinators
• Early review by content and linguistic experts
• Translation and quality check
• Comprehension testing
• Strategic dissemination – Proofreading, customized design, networking and evaluation.
These adaptation steps are described and analysed. Challenges and lessons learned are identified. Evidence of effectiveness is presented and questions are posed related to needed research follow-up.
identifying and implementing mechanisms and strategies for communication with the public that effectively promote informed and ethical debate. Piloted in the WHO European Region, the WHCN brought together key players involved in communicating health
messages to the public; including journalists, government spokespeople, intergovernmental and nongovernmental organizations (NGOs), advertisers, educators, researchers and health and environment practitioners. The network provided a platform for exchange of ideas, products and experience, supported skills development, highlighted
good practice in the field of health and environment communication and established professional guidelines. Health communicators interested in enhancing health literacy and communication as a determinant of health and healthier choices will benfit form the wisdom expressed in this symposium's papers.