Mass Media and Medicine: When the Most Trusted Media Mislead

In the current issue of Mayo Clinic Proceedings, Caspermeyer et al address the importance of studying mass Mass Media and Medicine: When the Most Trusted Media Mislead.

Abstract

The mass media are a pervasive, institutional structure in all modern societies and can profoundly influence health-related beliefs and behaviors. Indeed, several studies have shown that adults obtain much of their health information from mass media. Moreover, classic health communication research demonstrates that mass media may be even more important than interpersonal communication in increasing awareness and knowledge of health issues.1Rogers EM Communication Strategies for Family Planning. Free Press, New York, NY1973Google Scholar, 2Schramm W Communication in family planning.Rep Popul Fam Plann. 1971; 7: 1-43PubMed Google Scholar Mass media can influence health behaviors and can promote health behavior change. Both the amount and the type of information presented in the media can shape our beliefs, attitudes, and perceived norms, which, in turn, influence behaviors. In addition, the media can influence beliefs indirectly. That is, people also discuss what they read, see, or hear with others and use such interactions to validate their own experiences and expectations. Taken together, these mechanisms lead to significant effects of the media on health care behavior. Given these effects, it is important to know what messages contemporary media are sending about particular health issues. How do the media portray persons with a particular illness? How do the media portray practitioners of relevant health services and medical treatment systems? Is the portrayal more negative or more positive than what scientific studies document? Is a particular illness portrayed in the media as being more or less common than in the real world? Are the severity and types of illness portrayed similar to what is seen in the real world? What is the cognitive, emotional, physiological, and attitudinal impact of these media messages? In the current issue of Mayo Clinic Proceedings, Caspermeyer et al3Caspermeyer JJ Sylvester EJ Drazkowski JF Watson GL Sirven JI Evaluation of stigmatizing language and medical errors in neurology coverage by 9 US newspapers.Mayo Clin Proc. 2006; 81: 300-306Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar address the importance of studying mass media coverage of health issues by examining news coverage of neurologic illness. They investigate 9 large US newspapers (with circulation >200,000) to determine how often the coverage of neurologic illness contains stigmatizing language and medical errors. The authors use content analysis methodology, an established and widely used research study design in the social sciences for systematically, quantitatively, and objectively comparing content of interest. Caspermeyer et al found that the newspaper coverage of specific neurologic conditions did not reflect the actual prevalence of these conditions. Medical errors or exaggerations were present in 20% of the sample. In addition, stigmatizing language was found in 21% of articles, and articles reporting on certain conditions (such as epilepsy and migraines) were more likely than others to contain this language. Based on these data, the authors stress the importance of bringing more accurate and responsible medical news coverage to the public. The findings from this study are both important and concerning. According to several surveys, newspapers are a widely used and highly trusted source of health information. For instance, the Gallup Organization reports that the sorts of print media that Caspermeyer et al studied are more likely to be trusted than television or online media.4Lantz J Lanier W Observations from the Mayo Clinic National Conference on Medicine and the Media.Mayo Clin Proc. 2002; 77: 1306-1311Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Similarly, a Centers for Disease Control and Prevention survey found that respondents report using newspapers and magazines as health sources more often than they do other media sources or family, friends, physicians, and nurses combined (78% vs 71%).51999 Porter Novelli HealthStyles Survey: soap opera viewers and health information: APHA executive summary, November 15, 2000.Available at: www.cdc.gov/communication/surveys/surv1999.htmGoogle Scholar Therefore, health information obtained through newspapers may have a disproportionate influence on individuals who place high trust in this source of information compared to other sources. An underlying assumption of the research conducted by Caspermeyer et al is that this coverage may misinform the public and reinforce negative perceptions of those who have neurologic illness. Indeed, people's view of the world is, to some extent, a mental and social construct influenced by media messages.6Gerbner G Gross L Signorielli N Morgan M Jackson-Beeck M The demonstration of power: violence profile No. 10.J Commun. Summer 1979; 29: 177-196Crossref PubMed Scopus (226) Google Scholar, 7Hawkins R Pingree S Television's influence on social reality.in: Pearl D Bouthilet L Lazar J Television and Behavior: Ten Years of Scientific Progress and Implications for the Eighties. 2. US Government Printing Office, Washington, DC1982: 224-247Google Scholar, 8Potter W Examining cultivation from a psychological perspective: component subprocesses.Commun Res. 1991; 18: 77-102Crossref Scopus (55) Google Scholar, 9Shapiro MA Lang A Making television reality: unconscious processes in the construction of social reality.Commun Res. 1991; 18: 685-705Crossref Scopus (85) Google Scholar, 10Shrum LJ Assessing the social influence of television: a social cognition perspective on cultivation effects.Commun Res. 1995; 22: 402-429Crossref Scopus (135) Google Scholar Research on the construction of social reality7Hawkins R Pingree S Television's influence on social reality.in: Pearl D Bouthilet L Lazar J Television and Behavior: Ten Years of Scientific Progress and Implications for the Eighties. 2. US Government Printing Office, Washington, DC1982: 224-247Google Scholar and on cultivation theory6Gerbner G Gross L Signorielli N Morgan M Jackson-Beeck M The demonstration of power: violence profile No. 10.J Commun. Summer 1979; 29: 177-196Crossref PubMed Scopus (226) Google Scholar shows that heavy television viewers' social realities more closely resemble the television world than those of light viewers'. Furthermore, this effect occurs over a range of content and behavior. For instance, heavy viewers of violent programming are more fearful of becoming victims of crime,6Gerbner G Gross L Signorielli N Morgan M Jackson-Beeck M The demonstration of power: violence profile No. 10.J Commun. Summer 1979; 29: 177-196Crossref PubMed Scopus (226) Google Scholar, 11Gonzalez MA Television and people's images of old age: testing a theory of susceptibility to mass media effects. Annenberg School of Communications, University of Pennsylvania, Philadelphia, Pa1979Google Scholar have more negative attitudes toward less powerful social groups,6Gerbner G Gross L Signorielli N Morgan M Jackson-Beeck M The demonstration of power: violence profile No. 10.J Commun. Summer 1979; 29: 177-196Crossref PubMed Scopus (226) Google Scholar, 11Gonzalez MA Television and people's images of old age: testing a theory of susceptibility to mass media effects. Annenberg School of Communications, University of Pennsylvania, Philadelphia, Pa1979Google Scholar, 12Gerbner G Gross L Morgan M Signorielli N Violence profile No. 11: trends in network television trauma and viewer conceptions of social reality, 1967-1979. Annenberg School of Communications, University of Pennsylvania, Philadelphia, Pa1980Google Scholar, 13Morgan M Longitudinal patterns of television viewing and adolescent role socialization. Annenberg School of Communications, University of Pennsylvania, Philadelphia, Pa1980Google Scholar and have more positive attitudes toward powerful groups.14Volgy T Schwartz J Television entertainment programming and the sociopolitical attitudes of the audience.Journal Q. Fall 1980; 57: 150-155Crossref Scopus (47) Google Scholar The degree to which the media alter people's perceptions of the world, however, is mediated by a variety of factors and individual differences. For instance, relevant social network contact can influence the role the media play. In this case, whether or not an individual knows someone with a particular neurologic disease can decrease the impact of stigmatizing portrayals. People with little or no direct experience with a topic are more likely to be influenced by the media. On the other hand, even a small amount of experience congruent with the media message may substantially increase a message's effectiveness.7Hawkins R Pingree S Television's influence on social reality.in: Pearl D Bouthilet L Lazar J Television and Behavior: Ten Years of Scientific Progress and Implications for the Eighties. 2. US Government Printing Office, Washington, DC1982: 224-247Google Scholar These findings have direct implications not only for understanding stigma but also for communicating risk. Caspermeyer et al documented that there was no correlation between disease prevalence and frequency of news coverage. In turn, it would be valuable to determine whether such discrepancies mislead individuals about relative risks of particular illnesses or shape public policy about where medical resources are most needed. Further research may suggest a direct relationship between this media coverage of risk and individual-level attitudes and behaviors. It may also suggest that the amount and type of news coverage is a key factor in setting the agenda for policy changes. If underreporting of certain (neurologic or other) health risks and issues is associated with relative lack of awareness of those issues, we can provide an empirical basis for concerted media advocacy and public affairs efforts directed at changing such coverage. Previous research has shown that the salience of risk perceptions can be closely associated with the extent of news coverage of individuals representing those risks.15Combs B Slovic P Newspaper coverage of causes of death.Journal Q. 1979; 56: 837-843Crossref Google Scholar, 16Lichtenstein S Slovic P Fischhoff B Layman M Combs B Judged frequency of lethal events.J Exp Psychol. 1978; 4: 551-578Google Scholar Holding the belief that a given behavior poses nontrivial risks is a necessary (though not necessarily a sufficient) condition in the process of changing such behaviors.17Prochaska JO DiClemente CC Norcross JC In search of how people change: applications to addictive behaviors.Am Psychol. 1992; 47: 1102-1114Crossref PubMed Scopus (6463) Google Scholar For the public health community, it is important to raise awareness of actual risks and make them salient enough to potentially influence individual behavior and community policy decision making. Any subsequent research initiatives designed to address the critical issues that remain should be guided by social and behavioral theories of health behavior and health behavior change. Several existing theories help explain why and how media content affects behavior. For example, at its broadest level, social cognitive theory suggests that individuals learn from the media. According to the theories of reasoned action and planned behavior, the underlying beliefs that guide behavior are learned from direct experience or inference. Individuals without first-hand experience learn and make inferences from the media. According to these theories, the impact of media content depends on the message's ability to change (or reinforce) behavioral, normative, and control beliefs that underlie specific behaviors. These theories are well suited but have rarely been used to understand the correlates of public attitudes toward specific risk factors or stigmatized persons with specific illnesses or to build a foundation for effective public campaigns. To address this deficiency in the literature, we need to better understand which messages and images (regarding stigma and risk) are most "potent." These objectives require investigators to focus on refining and testing a theoretical framework for stigma or risks, charting the messages that the public receives through the mass media, documenting the impact of messages on individuals, and examining the potential for change on the individual and macro-level. The knowledge generated will help illuminate the mechanisms whereby media content is internalized or rejected. The findings of Caspermeyer et al thus highlight the need for further research that (1) explicates the mechanisms by which proximal social interactions influence health outcomes and (2) identifies the collective properties of social environments that influence health outcomes. This research path offers a multilevel, transdisciplinary, and multimethod approach to studying possibilities for changing both individual perceptions and public policy. The long-term goal of such research is to establish a scientific base for identifying targets of intervention to decrease specific forms of stigma and implications of risk and, by doing so, improve public health. Evaluation of Stigmatizing Language and Medical Errors in Neurology Coverage by US NewspapersMayo Clinic ProceedingsVol. 81Issue 3PreviewTo analyze US newspaper coverage of neurologic diseases to determine whether stigmatizing language is used in describing patients and examine its sources where found and to examine stories for medical errors. Full-Text PDF