A Framework for Equity-Centered Health Communication: Implications for Communication Design and Delivery

Stacy Robison, MPH, MCHES, CommunicateHealth, Inc., Rockville, MD

Theoretical Background and research questions/hypothesis:

As public health professionals, we know that our audiences face many barriers to accessing health information and services. Many of these barriers are systemic, rooted in racism, ableism, and other forms of discrimination. As a result, people of color, LGBTQ+ people, and people with disabilities face additional barriers to health and well-being. The COVID-19 pandemic and recent movements like Black Lives Matter, have highlighted these longstanding health inequities. In a politically polarized, rapidly evolving information environment, COVID communication missteps have eroded trust in public health authorities. Meanwhile, those at highest risk have felt unheard when public health institutions failed to address their needs.

Our audiences have tuned out at a time when we desperately need them to tune in — which was the impetus for expanding and evolving our understanding of the principles and techniques that underly successful health communication programs. CommunicateHealth’s Framework for Equity-Centered Health Communication (ECHC), represents a process, a mindset, and intended outcomes for equitable health communication practice. It requires us to empathize with the people we want to reach, learn from our audiences, and unlearn old methods and ways of thinking — not just at the beginning or the end of a project, but throughout the project lifecycle.

Methods and Results (informing the conceptual analysis):

Conceptualization of the ECHC framework began with building on the “Plan, Implement, and Evaluate” program model outlined in the National Cancer Institute’s Pink Book and modified to create more opportunity to include diverse voices and experiences. The ECHC incorporates key principles of human-centered design methodology, adult learning theory, and health literacy. Similar to the Pink Book model, the ECHC has 3 primary phases — understand, co-create, and implement — with 3 transition phases between them. Each primary phase includes an iterative cycle to intentionally create opportunity for more audience touchpoints and refinement of communication based on the unique needs of each audience segment. The level of audience involvement is not only a driver of data and insights, but also a means to demonstrating transparency and building trust with communities. In other words, the ECHC creates opportunity to define and design with affected community members rather than for them.

Conclusions: n/a

Implications for research and/or practice:

The ECHC offers a roadmap for the present moment, addressing past and current injustices and providing ways to make communications clear, relevant, empowering, and inclusive. Making equity an intentional foundation for health communication practice shows promise for navigating past and current injustices and driving a cascade of shifts in how we design campaigns and materials, how we conduct audience research, how we build materials and tools, and disseminate health information. As the framework is consistently applied in research and practice, it will continue to evolve, but the purpose will remain constant: to create an approach in which historically marginalized voices lead the conversation to drive more equitable outcomes. By giving people information they can understand and use to make informed decisions about their health, we help dismantle health disparities and advance health equity.