Games for Health and Healthcare

As I've gotten older I've lost a lot of the interest I once had in playing games, but I'm still quite intrigued by the potential for games to provide health information to players and promote behavior change.

One of the first examples I personally experienced with this was the Fantastic Food Challenge, a project of MSU's Games for Entertainment and Learning Lab. There are a number of different games to play on the website that can provide a lot of useful information about eating well. If you've never kicked around the concept of games for learning and promoting health, this is certainly a good place to start.

For those that are already in this area, you might want to check out RWJ's new competition - Why Games Matter: A Prescription for Improving Health and Health Care. The application deadline is September 26, 2007, and you can get more information about the project and competition in their newsroom.

I don't know that I'll ever have a reason to really dig into this area, but it certainly gets me thinking a bit about how I could incorporate games into some of the interventions I'm kicking around in my head... Anyway, there's a lot of potential there, and I imagine researchers will pretty consistently be discovering new and better ways of using the power of gaming to provide health education.

Scientific Literacy and Understanding Research

For those who missed it, a new article in the New England Journal of Medicine has reported findings that gaining and losing weight can be influenced by social networks. One article, at U.S. News and World Report reports on the article, or you can go read the full article over on the NEJM website.

I'll say right off that I haven't read the actual article yet, I suspect I'll get to that tomorrow. But as the news about the article broke, I was surprised how many people were skeptical of the results. To me, it makes plenty of sense, for a variety of reasons. I had a number of conversations about this, and one of the things that kept popping up (over and over and over...) was something along the lines of "this was a correlational study, and correlation does not equal causation."

As I said, I haven't read the article yet, but that doesn't even matter. Some people seem to have a rote "correlation does not equal causation" response to any article that argues that X causes Y, when the main evidence is a correlation between X and Y.

On the one hand, it's good to know that the message that correlation does not necessarily prove causation has sunk in with a lot of people. And there are certainly plenty of other things that could be causing some of these findings. But apparently people have also seemed to miss the fact that correlation can provide evidence in favor of causation.

In any event, the discussions I had (with a lot of college-educated people) about the news coverage of that study was just an interesting example of how scientific literacy can play a big part in understanding health information. These were people who, at least in theory, have a pretty good understanding of basic science - but some were doubting the results of this study mainly because of a misunderstanding of the correlation-causation relationship. Scientific literacy certainly plays a major role in how well people can understand health-oriented news, and I think that's an aspect of health communication (from public health messages to marketing information) that is easy to overlook.

The Freedom of Academia

I'm still in the middle of my Ogilvy Healthworld visit, and to this point it's been an extremely informative trip. I've spent time talking with market researchers, account planners, account service people, medical experts, creatives, etc. I wish I could write more about specifics of the visit, but I had to sign paperwork that I wouldn't share proprietary information... Such is life.

But even without discussing specifics (and moving beyond Ogilvy to advertising agencies in general), I'll say that I have a newfound appreciation of working in academia. Working for pharmaceutical companies that have vast sums of money to lose, advertising agencies can find themselves working with conservative clients that might not be open to certain kinds of messages; to be fair, some of those conservative tendencies are the result of plenty of FDA regulations and concerns about lawsuits.

A lot of the people I've talked to up to this point at Ogilvy have a very positive view of what they're doing, and one can certainly make the case that DTCs (and other pharma ads) do a lot of good things to create awareness of conditions, remove stigma of certain diseases, etc. But I think that I'd have a hard time restricting the solutions I could explore due to what a client might agree with. Advertising agencies are filled with lots of very creative and talented people, and working on pharma ads must feel like they're working with one arm tied behind their backs.

This program is a great opportunity for academics and professionals to sit down and discuss a lot of issues central to health communication and promotion. I've learned a great deal about how such messages are created, and some of the rules that are in place to make sure everyone involved acts responsibly. I also think (or at least hope) that some of the things I'm working on can inform what those in the agency are thinking about different issues; even if they can't do exactly what I'm doing (for so many reasons), perhaps some of what is going on in academia can help improve how these professionals are going about their own work.

NYC and Asbestos

I'm currently in NYC as part of the Advertising Educational Foundation's Visiting Professor Program. This is a great program that places professors with advertising agencies to let them interact with industry professionals. I'm spending time at Ogilvy Healthworld, learning more about how they create communication campaigns for medical professionals and consumers, recruit people into clinical trials, etc. They do a lot of very interesting things, and it's been a great experience so far.

Yesterday, of course, a steam pipe exploded, causing all sorts of mayhem in Manhattan. This made life quite interesting last night and this morning. I walked the 1.5 miles to Ogilvy this morning and saw some workers (NYPD, FDNY, etc.) wearing masks over their faces. There were plenty that weren't, though - the majority fell into that category. Everything on the news since last night has indicated that continuous tests have showed that the air is free of asbestos, it was just the initial debris that seems to have had traces of asbestos.

The overriding message (from city officials and news media) that I've experienced comes down to - "It's safe to breathe the air."

At the same time, I've received calls from several people today that have revolved around the fact that the news has pictures of rescue workers wearing masks over their faces, so I might want to be careful about going outside and breathing the air if I'm not wearing the masks. I know that there's now way the city could/would force these works to not wear masks. But it's increasingly clear to me (just from my own personal experience) that there are two very clear messages being received by news audiences, and one of those messages is being sent by the workers that are shown wearing the face masks. That also seems to be the message that is having a stronger impact.

This just struck me as an intriguing case of competing and contradictory messages, personalized by the fact I'm getting more concerned phone calls than I think the situation really merits. Life in NYC seems to have largely returned to normal, however, and I'm sure more details about the explosion will be coming out in the coming days and weeks.

Social Norms at the Gym

It's not something I've ever studied, or had a need to research, but I'm constantly fascinated by the power (or lack thereof, at times) of social norms at gyms.

The Theory of Planned Behavior (TPB) and other related theories consider the importance of social norms on individuals' health behaviors. There are two cases that I've always found to be particularly interesting...

First, there are the social norms that result in almost everyone at the gym doing the same thing. This sort of social norm is at its most interesting when it results in everyone doing the same thing that isn't a particularly productive behavior. As an example, I've frequently found myself standing in an area with 8-10 guys, all of whom are doing nothing but bicep curls. I've had conversations with trainers, where they laugh about the same sort of situation - which apparently happens quite a bit. If those guys spent the same amount of time working out more efficiently, they could make much greater progress... My initial suspicion is that this is due at least in part to stories in the fitness mass media that stress bigger arms as the key to all that is good with the world. One good example is Men's Fitness actually editing Andy Roddick's arms for their June/July cover.

What I find even more intriguing, though, are the moments when someone goes against social norms in an extreme way. In an example from personal experience, I remember seeing a guy "squat" 600+ pounds; what he was doing was essentially picking up the weight, moving up and down an inch or two, and then throwing it back on the squat rack. It was so odd that when he would leave the room, everyone else (none of whom really knew each other) would discuss his odd behavior. Again, talking to trainers, they comment that those sorts of things happen from time to time. A friend who did some personal training once said to a client (who was a bit surprised at some of the things he was being asked to do, all of which were correct), "Have you ever seen ANYONE do the things that you've been doing at the gym?" What I'm wondering is if (1) these people think they're actually doing the same things as everyone else, (2) they're completely oblivious to what everyone else is doing, (3) they think they're smarter than everyone else, or (4) something else I haven't thought of yet.

Anyway, social norms play a key role in health communication and behavior, and there are few places that I find the power of social norms more interesting than the gym. I'm sure at some point my academic ADD will lead me to study this formally, but until then I think I'll have to content myself with observing these moments and keep an eye open for research that others are working on in this area.

Surgeon General in the News

I saw this in The New York Times this morning, but didn't really have a chance to read through the article until this evening. The article, Surgeon General Sees 4-Year Term as Compromised, discusses, in a nutshell:

Former Surgeon General Richard H. Carmona told a Congressional panel Tuesday that top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations.

One of the best discussions I've read regarding this article is over at Slashdot. (For those unfamiliar with Slashdot, it's a tech-oriented news site.)

Some of the things Carmona mentions in the article are quite remarkable, particularly a claim that he was instructed to mention Bush's name three times in every page of his speeches. It's worth noting that previous Surgeon Generals have discussed political problems with the Clinton and Reagan administrations, so this isn't just an anti-Bush article or discussion. This speaks to the role that politics can have at the national level in terms of health policy and research, of course, and the system that makes this possible.

I don't know that I have anything particularly profound to say on this... I guess it just makes me value the blind review process more than I otherwise would, because it gives me hope that the things that make it into research journals and receive grant funding are indeed the best research and ideas. I know I've already passed along word about this to several people, and hopefully plenty of others with an interest in health communication and healthcare policy will do the same. If the public becomes aware of this and believe it is an issue that needs to be addressed, perhaps someday we'll get to a place where the Surgeon General really can make decisions based purely on scientific evidence.

Nurses to Address Low Health Literacy?

Researchers have all sorts of ideas on how to address health literacy-oriented problems, myself included. RWJ's nursing newsletter pointed me to a nice summary of this full article, discussing how nurses could be one key to making sure patients understand the health information they receive.

Some of the strategies they discuss include using teach-back strategies (that require patients to re-explain what they were just told) and more use of visual aids when explaining health concepts. There are lots of good ideas in the article, no doubt. But this quote at the end of the RWJ summary caught my eye:

Noting that these communication strategies may require a significant time investment, experts say health literacy efforts are particularly well suited to nurses, who serve as patients' main point of contact in most health care settings.

While I agree that nurses will and should play a role in helping provide information to patients with low health literacy, it's hard to imagine nurses as "particularly well suited" to any work that requires a "significant time investment." Anyone who has spent much time talking to nurses (particularly nurses working on the floor of a hospital) knows that they don't have a lot of spare time on their hands.

Nurses' lack of time already seems to be a major problem when you talk to them about their jobs. I interviewed nurses at a nursing home as part of the evaluation for a telemedicine project, and one of the things almost every nurse mentioned as a problem in their jobs was not having enough time to spend with their patients. So while I agree that nurses can play a big role in helping educate patients of all kinds, somehow it just strikes me as unlikely that they have enough time on their hands to be the major driving force behind such an effort... Or perhaps as the nursing shortage is addressed, nurses will take on this role as a champion for patients with low health literacy...

In any case, health literacy is a complex problem, and I think the more people that are trying to tackle it, the better.

Advertising Cochlear Implants

This morning I went in to guest lecture in a Communication Sciences & Disorders class, to discuss the advertising of cochlear implants. For those who don't know what they are, from Wikipedia:

A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. The cochlear implant is often referred to as a bionic ear. Unlike hearing aids, the cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the cochlea with electrical impulses. External components of the cochlear implant include a microphone, speech processor and transmitter.

I was invited to the class to speak specifically about the marketing of these devices. Yesterday I was given some marketing materials from Advanced Bionics and Cochlear (and one or two other companies I don't remember off the top of my head), so I looked through the things I was given, the company websites, etc. This was an interesting experience for me, since (1) I was talking about advertising to non-advertising students and (2) I didn't know much about CIs before I started looking through all this material. I still don't know all that much, but certainly more than I did a couple days ago...

The first thing I'll say is that a lot of this stuff was very good advertising. Apparently all of these devices have managed to achieve a certain level of quality for helping people understand speech. Recognizing this, they've moved on to the ability to help people process music as a point of differentiation; the number of pictures featuring people playing musical instruments highlights the importance of music as the new frontier where CIs are competing with each other. I thought Advanced Bionics in particular did a great job of providing a LOT of information, tailored for adults learning about this for themselves and parents figuring this all out for a child. I haven't had time yet to go through some of what I was given, and it's something I want to do soon - the students in the class were particularly impressed with the video components of the patient materials.

The quality of the advertising itself aside, I was struck by some of the comments the students made about these marketing efforts. The general debate in the class was similar to what I've read about direct to consumer (DTC) pharmaceutical advertising - there are some definite benefits (patient education, etc.) and downsides (e.g., are companies really providing appropriate and sufficient information about the negatives?). But CIs present an interesting twist on the issue, since these are surgically implanted devices. That makes this a slightly different conversation, as prescription drugs can be tossed in the garbage - changing one's decision on a CI device isn't quite that simple.

In any event, it was an interesting visit to the class this morning, and I'm inclined to look into some of these issues a little more deeply. The advertising of CIs and implants in general would appear to be in its infancy (at least when compared to DTC pharmaceutical marketing efforts), so it will be interesting to see how it evolves over the coming years.