the problem setting communication objectives and proposing a plan to meet the wanted outcome analyze the target audience by determining interests, attitudes, behaviors, benefits, and barriers select channels and materials for communication in relation to what will most effectively reach audiences develop and pretest message concepts to determine understanding, acceptance, and reaction to the message implement communication with selected audience and monitor exposures and reactions to the message ensure information is available in the language of intended audiences assess the outcome and evaluate the effectiveness and impact of the campaign, noting if changes need to be made historical campaigns 2014 african ebola outbreak in 2018, four years after the first major outbreak of ebola in western africa, the democratic republic of congo and unicef partnered together to raise awareness about the deadly virus in a multi-national effort reaching around 800,000 people in affected areas. communication efforts about preventive measures and safe practices regarding the virus included home visits by nurses, campaigns in major cities and markets, and broadcasting through mass media. china's 2019 "zero-covid" policy following the global outbreak of the covid-19 pandemic in 2019, the chinese government under xi jinping issued a major health communication campaign titled the "zero-covid" policy. this new set of restrictions included lockdowns, stricter contact-tracing mechanisms, and increased testing to chinese citizens was aimed at attempting to stop the spread of covid-19. the policy was relatively successful at slowing the spread of the virus, however, it did cause major food shortages and other problems. world health organization's (who) heatwave initiative the who's "heatwave and health" initiative was launched in 2021 in co-partnership with the pan american health organization aimed at educating the public in south and central-american countries about the hazards present from heatwaves. awareness including what to do before and during a heatwave was communicated in the form of webinars, information youtube videos, and website articles. the campaign additionally focused on developing and/or strengthening local governments knowledge on the matter and establishing public safety plans when heatwaves are imminent. american smallpox epidemic in 1721, health communication was used to mitigate the smallpox epidemic in boston. cotton mather, a political leader, used pamphlets and speeches to promote inoculation of smallpox. alcohol abuse has been a problem within society for about as long as alcohol has been around. in the 19th century, the women's christian temperance union led a movement against alcohol abuse. they utilized mass communication to communicate the desired message. news papers and magazines allowed for the promotion of the anti-alcohol movement. cardiovascular disease three-community study and the five-city project were experimental campaigns to inform middle-aged men about the causes of cardiovascular disease. health messages were communicated via television, radio, newspaper, cookbooks, booklets, and bus cards. the three "communities" comprised three experimental communication strategies: a media-only campaign, a media campaign supplemented with face-to-face communication, and a no-intervention control group. the experimented revealed that after one year, the most informed at-risk men were those in the second experimental group: they men consumed the media campaign and were attended by a health care provider. entertainment media using the entertainment industry as a platform for advocating health information and education is a communication strategy that has become increasingly popular. the most utilized strategy is for health communication professionals to create partnerships with storyline creators so that public health information can be incorporated into within the plot of a television show. the centers for disease control and prevention has formed a strong partnership with hollywood, health, and society, at the university of southern california norman lear center to continue to produce new storylines on television and in film studios that will help to promote public health information. some of the resources provided with this partnership include comprehensive "tip sheets" to provide writers with easy to access and trustworthy information on health issues, and meetings and panels to discuss new information and resources. some of the most notable examples of this method of communication in recent years have been with the films contagion and i am legend in understanding the spread of disease, nbc's series parenthood in asperger's syndrome, and with the cw's series 90210 and spreading cancer awareness. more recently, film festivals and competitions focused specifically on health films have been organised by the american public health association, the international health film festival, the global health film initiative of the royal society of medicine and the public health film society. writers and storyline developers have an increased motivation to continue to incorporate public health information into their scripts with the creation of the sentinel for health awards in 2000, which honors storylines that effectively promote health topics and audience awareness of public health issues. surveys conducted by porter novelli in 2001 reported many interesting statistics on the effectiveness of this strategy, such as that over half of regular prime time and daytime drama viewers have reported that they have learned something about health promotion or disease prevention from a tv show. amongst this data, minority groups are significantly represented with well over half of african american and hispanic viewers stating that they had either taken some form of preventative action after hearing about a health issue on tv, or that a tv storyline helped them to provide vital health information to a friend or family member. direct marketing main article: social marketing some health organizations manage text messaging services to help people avoid smoking media advocacy use strategic mass media tools combined with widespread organization in order to advocate for healthy public policies or lifestyles. this can include the use of text messaging and email to spread messages from person to person, and using social networking venues to promote health information to a wide-ranging audience. as technologies expand, the platforms for health communication through media advocacy will undoubtedly expand as well. interpersonal communication health communication relies on strong interpersonal communication in order to influence health decisions and behaviours. the most important of these relationships are the connection and interaction between an individual and their health care provider (e.g., physician, therapist, pharmacist) and an individual's social support system (family, friends, community). these connections can positively influence the individual's decision to make healthy choices. patients are more prone to listen when they feel invested emotionally into the situation. if they feel as if they understand what is being said, they are more prone to make objective decisions based on the information heard. two of the most prominent areas of study in interpersonal health communication are the patient-centered and the relationship centered models of care. applications health communication has become essential in promoting the general public health in myriad situations. one of health communication's most important applications has been throughout major environmental events (e.g. hurricanes, flooding, tornados) and addressing the affected audience's questions and needs quickly and efficiently, keeping the protection of public health and the forefront of their message. health communication professionals are constantly working to improve this type of risk communication in order to be prepared in the case of an emergency. another increasingly important application of health communication has been in reaching students in the college community. the national college health assessment has measured that 92.5% of college students reported being in "good, very good, or excellent health", however college students seem to battle serious problems with stress, depression, substance abuse, and a general lack of nutrition in comparison to other age groups and audiences. professionals in health communication are actively striving for new ways to reach this at-risk audience in order to raise standards of public health in the college setting and to promote a healthier life style amongst students. challenges there are many challenges in communicating information about health to individuals. some of the most essential issues have to do with the gap between individual health literacy and healthcare workers and institutions, as well as flaws in communicating health information through mass media. health communication is additionally influenced by cultural values which in some cases can create a barrier in effective health communication. when the sender and receiver are from contrasting socioeconomic backgrounds, of a different race, or even vastly different ages, effective health communication declines. this is a result of the fact that people tend to trust and be more open to ideas coming from someone similar to themselves. literacy-communication gap further information: health literacy one problem that health communication seeks to address is the gap that has formed between health literacy and the use of health communication. while the goal is that health communication will effectively lead to health literacy, issues such as the use of unexplained medical jargon, ill-formed messages, and often a general educational gap have created barriers to patient healthcare literacy. specifically, studies have been done amongst elderly populations in america to illustrate a common audience who is left at a disadvantage due to this issue. the older adults comprise an age group that generally has the most chronic health conditions in comparison to other age groups, however studies have shown that this group has difficulty understanding written health materials, understanding health care and policies, and generally do not comprehend medical jargon. such shortcomings of health communication may lead to increased hospitalizations, the inability to respond to and manage a disease or medical condition, and a generally declining health status. to redress these problems, health communication professionals have recommended programs for improving physician communication with patients. one recommendation is to improve medical student training by adding lectures, workshops, and supervised encounters with patients to teach interpersonal and communication skills as a core competency. it is also recommended that practicing physicians improve their communication skills by attending webinars and on-site customized training programs. if physicians can improve their communication skills, they can ameliorate the problem of patient healthcare illiteracy and contribute to better patient adherence to medical advice. in some populations, health-related websites (e.g., webmd) and online support groups (e.g., association for cancer online resources) have increased access to health information. the role of language in communication, especially related to the patients' preferred language physicians use to communicate with them in, also plays a role. results of a 2019 systematic review found that limited english proficient (lep) patients have improved health outcomes when they receive care from physicians fluent in the patients' own preferred language. the national institute for health and care research (nihr) has published review of research for providers of health information, on what happens when health information is not clear, how to help people understand health information, and which groups of the population may need extra support understanding health content. it covers research on using simple, balanced language, finding the correct focus, alternative formats (e.g. videos, visuals), and online information. mass media mass communication is used to promote beneficial changes in behavior among members of populations. a major criticism of the use of mass media as a method of health communication is the unfortunate ability for false and misinformed messages to spread quickly through the mass media, before they have the chance to be disputed by professionals. this issue may generate unwarranted panic amongst those who receive the messages and be an issue as technology continues to advance. an example of this may be observed in the ongoing distrust of vaccinations due to the publication of numerous messages that wrongly link the childhood measles-mumps-rubella (mmr) vaccination with the development and onset of autism. the speed with which this message spread due to new social networking technologies caused many parents to distrust vaccinations and therefore forgo having their children receive the vaccine. although this panic is based on false information, many still harbor a lingering suspicion towards vaccinations and refuse them, which has caused a public health concern. historical timeline the following are some key events in the development of health communication as a formal discipline since the 1970s. international communication association establishes the therapeutic communication interest group (which later became the "health communication" division)the american academy on physician and patient (later renamed the american academy on communication in healthcare) was established to promote research, education, and professional standards in patient-clinician communication.health communication textbooks begin appearing: kreps & thornton (1984), sharf (1984), and northhouse & northhouse (1985)national communication association forms the commission for health communication, which later became the health communication divisionfirst peer reviewed journal devoted to health communication, health communication. followed in 1996 by the journal of