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Infectious Diseases
July 14, 2021

Physician-Delivered Messaging as a Tool to Increase COVID-19 Knowledge and Preventive Behaviors—Implications Beyond a Pandemic

Author Affiliations
  • 1Department of Population Health, NYU Langone Health, New York, New York
JAMA Netw Open. 2021;4(7):e2118297. doi:10.1001/jamanetworkopen.2021.18297

The COVID-19 pandemic shined a bright light on the importance of health communication, defined as “the study and use of communication strategies to inform and influence individual and community decisions that enhance health.”1 Basic elements of communication include the source and channel (who sends the message and how), message (content and presentation), and audience (eg, Black adults aged 18-64 years).1 Although health communication alone cannot eliminate health disparities, it can increase knowledge about a health issue, influence social norms, and prompt action.1 In their recent study, Torres and colleagues2 evaluated the effect of physician-delivered messages on COVID-19 knowledge and preventive behaviors in 18 223 US adults (9168 Black and 9055 White) without a college degree. They also assessed whether messages tailored to the Black community would have differential effects on 4 main outcomes: COVID-19 knowledge gap, information-seeking behaviors, willingness to pay for masks, and self-reported safety behaviors (ie, mask wearing, hand washing, and social distancing). Participants were recruited online between August 7 and September 6, 2020, and randomized to receive 3 physician-delivered video messages about COVID-19 (intervention group) or 3 physician-delivered videos about general health topics, including fitness, sugar intake, and sleep (control group). Within the intervention group, the second COVID-19 video had 2 additional groups: participants either received information about the unequal burden of COVID-19 by race or did not.

Baseline characteristics were balanced across the intervention and control groups. The pooled intervention demonstrated statistically significant decreases in COVID-19 knowledge gaps. Additionally, statistically significant increases in information-seeking behaviors (ie, demand for more COVID-19 information) and willingness to pay for masks were observed. Safety behaviors were not statistically significant but did improve. Notably, the effects of physician-delivered messages on knowledge and behavior did not differ by race or subgroups within the intervention group (ie, those who received the message that “controlling for age, Black individuals were 3 times as likely to become infected as White individuals and 4 times as likely to die from it” vs those who did not receive the message). Prior research has shown that physicians are a trusted source of health information3 and that video-based interventions can support disease education, risk reduction, and control.4 Prior research has also shown that highlighting race and health disparities may not be needed to increase interest in certain health topics among African American individuals5 and, in some cases, may have unintended effects.6 The results of this study build on that prior work and provide further evidence that physician-delivered messages can be helpful across racially diverse groups of people.

Information seeking was a behavioral outcome measured by clicking on as many as 5 additional COVID-19 information resource links provided in the online survey. Zero clicks represented the lowest level of information-seeking demand whereas 5 represented the highest information-seeking demand. It is unclear whether participants clicked on the links because: (1) they had an unmet informational need that was not addressed by the physician-delivered COVID-19 video messages, (2) the links were available, or (3) they thought they should to be good study participants (ie, social desirability). It is also unclear how the additional information resources were chosen by the study team and why 5 were selected. This raises important questions regarding the ideal number of health resources to provide to patients and the general public. On the one hand, a single source of health information such as MedlinePlus or the US Centers for Disease Control and Prevention (CDC) may reduce the burden of information seeking for some people. On the other hand, people have different needs for cognition (ie, the extent to which people enjoy effortful cognitive activities or thinking) and information-seeking preferences.3 Accordingly, providing a broader set of reputable health information resources for people to explore and decide for themselves what best addresses their informational needs may be helpful.

Regarding reactions to the COVID-19 videos, study participants were asked whether the content was useful and trustworthy. However, those results were not reported. Future research should evaluate which aspects of physician-delivered messages were deemed most useful (eg, explanations of disease, recommendations for next steps) and how people determine trustworthiness of information in video-based formats (eg, body language, perceived concordance of important identities or values). Future work should also evaluate the grade level of the language used in physician-delivered and other health education videos, which can be done by putting a transcript of the video through a readability calculator. Some health organizations suggest that patient education materials not exceed a sixth-grade reading level. Similarly, the grade level readability of online health resources can be evaluated.

The COVID-19 pandemic magnified the importance of effective health communication. Health professionals were tasked with managing fear and uncertainty against the backdrop of what has been called an infodemic (ie, too much information), which included COVID-19 misinformation. One strategy to combat misinformation is to partner with trusted messengers, such as physicians, who can provide accurate information in ways that lay people can understand the first time they hear or read it, also referred to as plain language. Another strategy to combat misinformation is to help build a person’s health literacy skills. Health literacy affects health behaviors, outcomes, information seeking, and decision-making preferences.7 Healthy People 2030 defines personal health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”8 A limitation of the study by Torres et al2 is the lack of a health literacy measurement, although the use of video-based messaging is one way to make health information more accessible to people who have difficulty reading. Additionally, although intervention participants were asked whether they intended to shared information from the COVID-19 videos with others, those results were not reported.

This well-designed and novel study enriches the health communication literature. Torres and colleagues2 further validated the critical role of physician-delivered messages for supporting COVID-19 knowledge and risk reduction behaviors during a rapidly evolving pandemic. At the time this study was done, the emphasis was on risk reduction behaviors, including mask wearing, social distancing, and hand washing, because COVID-19 vaccines were not yet available. Now that COVID-19 vaccines are available to the general public and the CDC has relaxed mask wearing guidelines for people who are fully vaccinated (as of May 13, 2021), health professionals face new communication challenges. In the days ahead, health professionals will need to build vaccine confidence, clearly communicate updates to the COVID-19 science, and support new social norms.9 The study by Torres et al2 answered several important questions, but it also raised new ones. Future research should explore whether the type of physician delivering the message (eg, primary care physician vs specialist) affects message effectiveness and whether health messages delivered by other trusted messengers (eg, community health workers, nurses, and pharmacists) will achieve similar effects. Research is also needed to determine when general and/or mass messages (ie, 1 message for everyone), group-targeted messages (eg, for parents of children aged 12-15 years), and individually tailored messages based on personal characteristics are best used to enhance health knowledge and risk reduction behaviors for COVID-19 and other health conditions.

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Article Information

Published: July 14, 2021. doi:10.1001/jamanetworkopen.2021.18297

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Langford AT. JAMA Network Open.

Corresponding Author: Aisha T. Langford, PhD, MPH, Department of Population Health, NYU Langone Health, 227 E 30th St, New York, NY 10016 (Aisha.Langford@nyulangone.org).

Conflict of Interest Disclosures: None reported.

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