Are all Equity Messages Created Equal? How to Frame Messages about Health Equity for Your Audiences

Theoretical Background and research questions/hypothesis:

CDC’s Office of Health Equity (OHE) commits to using a communication and behavioral science-based approach to ensure messages about health equity are effective and properly framed Conducting formative research can improve the efficacy and quality of communication products. OHE conducted formative research using multiple approaches, including qualitative message testing of health equity messaging and imagery, to gather information about what people think, understand, and feel about health equity, how existing messages and definitions about health equity and social determinants of health are received by audiences, and gain insights about effective message framing to help meet audiences where they are.

Methods:

We utilized a tiered formative research approach to collect information to inform OHE’s communication efforts. First, we conducted a literature review and environmental scan to identify best practices for communicating about health equity and existing definitions and visuals that seek to explain health equity and related concepts, including social determinants of health. We then conducted purposive sampling to identify public health and healthcare professionals, health equity decision‐makers, and health equity community and thought leaders for key informant interviews to complement the literature review and environmental scan and identify additional definitions and images to test. Finally, we conducted message and image testing via eight focus groups representing a purposive sample of members of the general public from diverse audiences and in‐depth interviews with additional public health and health care professionals, health equity decision makers, and health equity community and thought leaders. We analyzed transcripts to identify themes and recommendations about how to effectively communicate about health equity.

Results:

Audience testing revealed that general audiences tend to prefer messages and images that describe equity concepts as they relate to individuals as opposed to displaying structural determinants that impact equity. However, showing how structural determinants impact equity was preferred by professional audiences. Participants preferred realistic images of people and inclusive, diverse representation. Definitions and explanations of equity and social determinants of health that used technical terminology or jargon were less successful at conveying the intended messages than those that used plain language. Additionally, the concept of equity, especially health equity, was new and unfamiliar to participants who were not health professionals. While these themes were consistent across focus groups, differences in messaging preferences were found between demographically distinct groups, suggesting the need to choose health equity message frames based on the intended audience.

Conclusions: While our message testing efforts are not expected to be generalizable to an overall population, our approach provides insight to improve the quality and appropriateness of our communication efforts. Messages and images explaining health equity and related concepts should be simple to understand, use layperson terms, and be relevant to the intended audience’s community and background.

Implications for research and/or practice:

OHE’s formative research findings enhance the knowledge base about how to effectively communicate about health equity. This work will advance attendees’ ability to communicate about health equity and integrate health equity into their health messaging.