Popular Culture and Public Health

Transdisciplinary Approach

Transdisciplinary approaches to public health practice and research have been recommended to make a significant difference in meeting the health needs of Americans (Lawlor et al., 2015; Reme, Caban-Martinez, Young, Arlinghaus, & Gray, 2015). Lawlor et al. (2015) describe transdisciplinary approaches as those that develop new frameworks that integrate and expound on key concepts and methods across various disciplines. According to their TPS pedagogy, specific public health problems are identified and students are coached to define the problem and find solutions to problem using a transdisciplinary lens. Although the transdisciplinary approach is widely accepted, it is critical to think beyond the public health and medical professions, incorporating concepts and tools from the humanities, such as film studies and marketing, if we are to be successful in crafting communication to appeal to the broader public. This course incorporated transdisciplinary contributions, including health behavior and education, health communication, health policy, epidemiology, psychology, film and television, journalism, medicine, business, American cultural studies, literature, visual design, and engineering. Guest lecturers have included a former Google engineer, an epidemiologic intelligence officer, a documentary filmmaker, several public relations specialists, graphic designers, and journalists.

Evidence-Based Approach

One of the core competencies of the course is identification of sources of evidence-based information related to public health research, policy, and practice. Students are exposed to a broad array of scientific literature from multiple fields, and evidence from state-of-the-art studies is thoroughly covered in each class during discussion periods. For instance, students learn aspects of effective elements of mass communication for health behavior change (Reme et al., 2015). A number of successful public health campaigns, such as the Truth Campaign and CDC’s Verb Campaign, have been covered in detail (Farrelly, Davis, Haviland, Messeri, & Healton, 2005; Huhman et al., 2010). Students learn about audience segmentation, research, strategies to develop these successful campaigns, and evaluation plans that provided evidence to determine whether these campaigns were successful. We highlight articles that demonstrate application of health behavior change theories to real-world interventions, specifying multiple targets and levels of intervention for social and behavioral science programs and/or policies.

We also examine the use of narrative in health communication, considering that many Americans consume health education through television programming; additionally, we explore successful examples of entertainment education (Cram et al., 2003; Hinyard & Kreuter, 2007; Marcus, Huang, Beck, & Miller, 2010). For example, we evaluate health-related storylines that have been embedded into news programming (e.g., NBC’s The Today Show) and the plot lines of popular network television shows such as Desperate Housewives (Cram et al., 2003; Marcus et al., 2010). Similarly, as public health professionals attempt to harness the power of social media, best practices and advancements from emergent technology, such as phone applications, and social media, are covered in class (Harris, Mueller, & Snider, 2013; Lefebvre, 2009).

Problem-Solving Approach

We designed this course to explore real-world and timely public health problems through the lens of popular culture, using a problem-solution framework to engage students in addressing the problem of effective design of health behavior interventions and delivery of health information to an increasingly diverse, distracted, and media-savvy population (and subpopulations) in an already crowded information environment. For their final group project, students partner with a local community agency, institute, or department of public health. Past partners have included Beyond Housing, a community development organization located in St. Louis; The SPOT—Supporting Positive Opportunities With Teens—a community-based organization that provides access to medical and social services; The Center for Community Health Partnerships and Research within the Institute for Public Health, which has a mission to “enable beneficial community-academic partnerships that will effectively address the health needs of the St. Louis community”; and the St. Louis County Health Department.

Students complete an audience analysis for their partner organization, which consists of an assessment of the composition and characteristics of the specific target audience. This includes demographics, but as Grier and Bryant (2005) states, it is important for professionals to consider other factors in addition to stages of change and demographics. For instance, students are asked to describe how their target audiences gather their information (e.g., television, radio, social media, Internet, and word of mouth). We discuss application of aspects of social marketing to audience analysis and the development of the communication strategy. Students use the well-recognized components of marketing: “4P’s” (product, price, promotion, and place) in the development of communication strategies and create documents that include demographic information such as racial/ethnic composition, average age, average level of education, and income, which can be obtained from sources such as the Census or the Department of Labor (Daniel et al., 2009; Grier & Bryant, 2005). Where available, students also use data provided directly from partner organizations.

Modeled after AMC’s The Pitch (Holzman, Lambert, Lott, & Meagher, 2012), teams of four or five students create a communication strategy (a Pitch) for the target audiences of their partner organizations, applying knowledge and skills gained from course content and from previous course work. For their Pitch, students are allotted 10 to 15 minutes to present a salient communication strategy to representatives of the partner organization, based upon the organization’s needs and the student’s research. Student groups learn about the background and capacity of their organizations and develop an understanding of their communication needs. They conduct audience analysis, provide a specific product or communication goal, outline potential barriers that organizations and their target audience may face (e.g., social norms, mistrust, access, history, built environment), and develop an evaluation plan so the organizations can determine indicators of success. Representatives of the partner organizations have the opportunity to ask questions and provide feedback directly to student groups.

We use team-based learning, requiring teams of students, typically four or five students per team, to produce the audience analysis and Pitch for the community partners. Teams are also required to designate specific roles within each team to facilitate communication. In addition to a liaison, there is a designated note taker and discussion facilitator, to advance discussion and mind the time.

Course Evaluations

This course has now been offered four times, and over 100 students have taken the course. All courses at this particular university are evaluated at the end of the semester using an online course evaluation system. The evaluation comprises 12 questions using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This course has received very favorable reviews since it was first offered in spring 2013. Overall, the course has averaged 4.5 out of 5 for overall quality of instruction over three semesters (n = 26). The most recent iteration of the course received a 4.75 out of 5 for overall quality of instruction (n = 4). The lowest rating was instructors’ availability outside of class (4.5 out of 5). Students rated several aspects of the class very highly: encouragement of classroom participation, clarity of assignments, feedback on assignments, instructor’s enthusiasm for course material, and conveyance of high expectations for the course.

In addition to the online evaluations, students were asked to provide feedback during the final class of the semester. The instructor noted the strengths and weaknesses of the course and made adjustments to the course as necessary with each iteration. For instance, during the first semester the course was offered, a Photovoice assignment, a process in which people use photos to identify community strengths and challenges, was given to students to be included in their audience research (Wang & Burris, 1997). However, students stated they were uncomfortable going into communities in which they did not reside to take photographs. The Photovoice assignment was removed, and students are now asked to liaise with the representative of the partner organizations regularly and use organizational data, where available, to enhance their audience analysis. Students also expressed a desire to work on their final group projects (the Pitch) throughout the semester and designate class time for the instructor to help them troubleshoot or provide guidance on the project. There is now designated time allotted throughout the semester so that students can discuss the Pitch and their plans for audience analysis. Additionally, each team is asked to designate a liaison responsible for corresponding with representatives from partner organizations throughout the semester. Positive feedback garnered during debriefing sessions included learning from a diverse group of transdisciplinary experts; engaging in real-world, problem-solving assignments with community partners; reading literature from multiple fields; and incorporating media into the classroom. Students also remarked that the class was “fun” and “refreshing.”

Discussion

Strengths of this course include the use of transdisciplinary guest lecturers, and the use of varied media, ranging from music, to film, to commercials, and news clips. There are also a number of limitations to consider when developing a course such as Popular Culture and Public Health in other settings. While one of the assets of the course is the incorporation of transdisciplinary experts, it was sometimes challenging to bring guests into class, especially experts outside of the university. For instance, even with substantive, detailed preparation, it has been difficult to anticipate and integrate all aspects of guest lectures into the class. Additionally, approvals must be granted well in advance for guest speakers who were federal employees to visit class. Arranging guest speakers involves a substantial amount of planning time by the instructor to ensure proper approvals. While advance planning is critical, the instructor and students still needed to be flexible, as last-minute modifications to the schedule due to changes in schedules, inclement weather, and even illness have required changing the order of class sessions so that guests can speak. Because the course incorporates popular culture, it is a challenge for the instructor to keep abreast of current events, and these dynamic changes require continuous updating of course materials. Students have helped address this challenge by searching for media, such as commercials, recent news, and occurrences from social media, to be incorporated into the class. As this course is primarily focused on targeting individual behavior change, to facilitate and support individual behavior change and make healthy choices easy choices, the instructor must do a better job of developing communication strategies across multiple audiences, such as policy makers and leaders in the business sector.

Many of the leading causes of death in the United States are conditions that are related to individual health behavior; thus, one key to longer, healthier lives heavily relies on individuals’ ability to maintain healthy lifestyles and make health behavior changes. There are numerous challenges that public health professionals face in developing effective communications strategies for the general public and subpopulations. Savvy commercial marketing from companies, such as soft drink manufacturers and fast-food restaurants, flood the airwaves with images of delicious but high-fat, high-calorie foods. Commercial marketers can afford to develop commercials that use humor, fun, and sex to captivate audiences and encourage them to purchase their products. Conversely, public health professionals must be very careful in how they position behaviors and must be very clear in the specific health behaviors they are looking to change, often finding greatest success in targeting one particular behavior (Grier & Bryant, 2005; Wakefield et al., 2010).

Additionally, for public health professionals to be successful and effectively communicate with target audiences, they must penetrate the noise of competing demands, such as work obligations and family responsibilities. The explosion of the obesity epidemic as well as a rapidly aging population will only contribute to the burden of disease at the individual level and further stress an our public health infrastructure (Mokdad, Marks, Stroup, & Gerberding, 2004; Powell, Slater, Mirtcheva, Bao, & Chaloupka, 2007). Those teaching public health education specialists must do a better job of preparing future public health professionals to address the health challenges of Americans and develop more effective communication strategies. This course, Popular Culture and Public Health, may represent a modest step toward meeting these myriad challenges and improving the training of public health students.