A Protocol for Exploring Health Coverage in News; Implementing and Evaluating a Health Promotion Intervention

Document Type : Original Research

Authors
S. Mohammadi 1
N. Keshavarz Mohammadi 1
ََA. Nasrollahi 2
A. Montazeri 3
A. Ramezankhani 1
1 School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Central Tehran Branch, Islamic Azad University (IAU), Tehran, Iran
3 Health Metrics Research Center, Iranian Institute for Health Sciences Research (ACECR), Tehran, Iran
Abstract
Aims: Mass media are among the most important tools for enhancing health information and health promotion in any country. Among the different types of mass media, news agencies are the primary source of health information. The present study examines health coverage in news agencies and implements and evaluates an intervention to improve health promotion news coverage.

Methods: The explanatory sequential mixed-method study includes five phases, including quantitative content analysis of news agencies, semi-structured interviews, intervention, and evaluation of the intervention, and synthesis of the recommendations. Four news agencies utilizing the purposeful sampling method would be selected and divided into two cases and two control groups. Primary outcomes: awareness-raising and enhancing the knowledge, attitude, and performance of health journalists and improving the communication between the media and the health sectors. Secondary outcomes: increasing the quality and quantity of public health (health protection, prevention, education, and promotion) related news agencies coverage. In the Fifth phase, utilizing the results of the four phases, a practical recommendation will be proposed for creating health-promoting media.

Perspective: This result would provide a more holistic approach to understanding the current situation, generating more effective and comprehensive strategies to utilize the potential of news agencies for health promotion and creating health-promoting news agencies.

Keywords

Subjects

Introduction
The mass media are key sources of health-related information and a reliable source for disseminating health-related information [1, 2]. Thus, they can play an important and positive educational role in helping people to adopt a healthier lifestyle [3]. Also, the media has the power to attract public and authorities' attention towards some specific topics or take their attention away from other topics [4]. Hence, the use of the media for health promotion has been highlighted in different international [5-7] and national [8] documents and declarations.
 Mass media are cost-effective tools for public health education as they can transfer information to a massive audience very fast [9]. Mass media, such as news agencies, are the primary sources of health information, especially in low-income and middle-income countries [10]. Moreover, it plays a determining role in educating and shaping public opinion and behaviors regarding health-related issues [11, 12].
Despite many news agencies with national coverage in Iran, health is rarely allocated a specific service in these agencies. Often, health is a sub-category of the social service; hence, many health-related contents are produced by journalists who are not health experts. The limited number of relevant studies on other types of mass media in Iran [13-15] that have examined health news coverage in some magazines, newspapers, and television programs demonstrate the low quantity or inappropriate coverage of health-related topics. Based on observations and also limited existing research, it seems that treatment-related aspect of medical-related topics (disease and their symptoms and epidemiology, treatment, and medicines) are covered more, compared to public health (health protection, prevention, education, and promotion) [4, 16-19]. For example, the results of a study by Keshavarz et al. showed that 22.1% of the articles published in magazines dealt with the physical dimension of health, of which only 2.9% of those articles were dedicated to the prevention and public health [13].
 As many current media are promoting medical services and technologies, it can be argued that they promote "diseases" rather than "public health". To our best knowledge, no study has examined the health coverage of Iranian news agencies. Understanding how media works and the factors shaping the news coverage is a key step towards developing and implementing interventions to create health-promoting media. However, few studies and so few tools help explore the depth, scope, and roots of this issue.
 
Methods
This study is designed as an explanatory sequential mixed-method study. The study has five phases, quantitative content analysis of News agencies, semi-structured interviews, intervention, and evaluation of the intervention, and synthesis of the recommendations. Each phase includes few steps as follows.
Phase 1: Quantitative Phase (pretest)
Aim:
  1. Identification of quantity of health-related published news
  2. Identification of share of public health news (protection, prevention, education, and promotion) in published health-related news
  3. Identification of the news agencies quality of health promotion published news
In this phase, all published content of 4 news agencies during 3 months would be examined. All news agencies registered with the Ministry of Culture and Islamic Guidance in Iran (42 news agencies) are listed to choose target news agencies. Two news agencies are selected purposefully based on their high visibility, willingness to collaborate, and different political orientation. Then for each case news agency, one similar news agency will be allocated as a control agency.
Inclusion and exclusion criteria:
Inclusion criteria register news agencies with the Ministry of Culture in Iran and have some sort of health news department. The exclusion criteria are unwillingness to participate in the study. Only health-related news would be examined.
Data collection:
For data collection, the Health Coverage in News agencies (HCIN) checklist is developed and validated. The checklist has two sections:
1) the First section includes questions about the media-related properties of each news, such as the year, source, and location of the publication, and the type of highlighted news value.
2) the Second section includes questions about the domain and the topic of public health news (such as physical, social, mental and spiritual, environmental, health economics, health policy, and others), Function of the content (informational /descriptive, educational or both of them), target groups and settings. Data collection lasts for 3 months.
Data Analyses:
Descriptive and analytical statistics will be conducted to analyze the data utilizing SPSS16 software. For quantitative variables, normality assumption will be investigated using the Kolmogorov-Smirnov test, and if so, a T-test and independent t-test will be conducted; otherwise, equivalent nonparametric tests will be conducted. In this study, the chi-square test is used for qualitative variables. A significance level less than 0.05 will be considered for all tests.
Phase 2: Qualitative Phases
Aim:
This phase aims to explore diverse key stakeholders in both media and health sectors about the current status of coverage of health-related topics in news agencies of Iran, its determinants, and recommendations for future improvement and developing health-promoting media.
Participants:
Participants include health and medical journalists, health professionals with experience working with media and public relations staff, and managers working in the health sector.
Inclusion and exclusion criteria:
Having a minimum of one year of relevant work experience in the media or health sector is required to enter the study. Exclusion criteria include not having any interest in participating in the study.
Data Collection:
In-depth semi-structured interviews using an interview guide will be held. The data will be recorded based on participants' consent and would be transcribed immediately after interviews. Interviews will be continued until data saturation.
Data Analysis:
Transcribed interviews would be analyzed by conducting conventional content analysis techniques. Codes will be generated and grouped based on their similarity into categories to identify the determinant factors shaping the current situation and recommendations to improve the media coverage of public health news. Peer and member checks will be performed to assess the trustworthiness of the data. Qualitative data will be managed by using MAXQDA software.
Phase 3: Intervention
Based on the results of the previous two phases of the study, three educational and information-communicational interventions would be developed in this phase. The intervention will be implemented only in two intervention news agencies (case news agencies) for one month. The other two control news agencies will receive no interventions.
The intervention will include the following components:
  • A briefing meeting with acting health journalists.
  • An educational workshop on health promotion, the importance of its news coverage, and how the health system in Iran works.
  • Provision of valid health education content (at least 20 topics) and sending them on every other day to the intervention group of news agencies' health service.
  • Provision of contact information of public health professionals, including telephone numbers and email addresses of public health experts and researchers, including faculty members of the school of public health in Shahid Beheshti University of Medical Sciences (SBMU) for easy communication between the health journalists and the public health experts and researchers
Primary outcomes:
Improving awareness, knowledge, and attitude, and practice of health journalists, improving communication quantity and quality between health professionals and acting health journalists and developing mutual understanding between health professionals and journalists about their different organizations and the way they operate.
Secondary outcomes:
Increasing the coverage of public health content and their news agencies' quality, promoting health literacy, and contributing to the development of health-promoting media.
Phase 4: Evaluation (posttest)
This phase includes evaluating the effectiveness of the implemented intervention on improving the quantity of public health news coverage and their news agencies' quality.
All published content of 4 news agencies during 3 months (from the beginning of the month of intervention up to two months after completion of the intervention) will be examined using the HCIN checklist. To measure the effectiveness of the intervention, the quantity of public health news and their news agencies quality would be compared between case and control news agencies. After the evaluation of the intervention, if the news agencies of the control group were interested, the intervention will be implemented for them as well.
Data Analysis:
Data are analyzed using descriptive and analytical statistics. For quantitative variables, normality assumption will be investigated using the Kolmogorov-Smirnov test, and if so, a T-test and independent t-test will be used; otherwise, equivalent nonparametric tests will be used. In this study, the chi-square test is used for qualitative variables. Data analysis is performed using SPSS 16 software.
Phase 5: Recommending practical solutions
Using the results of the all above phases of the study, a range of recommendations would be extracted for improving news agencies' coverage of public health news.
 
Perspectives
This study will develop innovative tools and methods and pilot some potential effective interventions. The results of this study are expected to contribute to strengthening health and media sector collaboration which is key for developing health-promoting news agencies.
 
Acknowledgments: The authors thank all the news agencies and participants for will spend their valuable time on this project. Finally, we wish to thank the health and safety school for their support for this research.
Ethical Permissions: The protocol for this study was approved by the Shahid Beheshti University of Medical Sciences ethical committee. The various sections of this paper are published in the form of papers and are available to other researchers.
Conflict of Interests: This study was a part of the first author's Ph.D. thesis in Health Education and Promotion at School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Authors’ Contributions: Mohammadi S. (First author), Introduction author/Methodologist/Original researcher/
Discussion author (19%); Keshavarz Mohammadi N. (Second author), Introduction author/Methodologist/
Original researcher /Discussion author (30%); Nasrollahi A. (Third author), Methodologist/Assistant/Discussion author (17%); Montazeri A. (Forth author), Methodologist, Assistant/Discussion author (17%); Ramezankhani A. (Fifth author), Methodologist/Assistant/Discussion author (17%).
Funding/Sources: Not Declared.
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Health Education and Health Promotion
Volume 9, Issue 1
Winter 2021
Pages 79-82