How Your Audience Influences What You Say

To help determine what content to include in your report, think about who your intended audience is, who may influence this audience's decisions (i.e., the secondary audiences), what different subgroups or segments are represented, what these segments need to know, and what they want to know. Keep in mind that no group is monolithic; you should expect to see a lot of variety within any given segment of the population.

Specific factors to consider include the following:

• What age groups are in the audience?
• What cultures or ethnic groups are represented?
• How familiar are they with managed care practices?
• How easy is it for them to understand the information in a performance report?
• How comfortable are they with the idea of being assertive about their own health care?
• Do they perceive that they have a choice?
• How interested are they in health care issues?
• How open are they to making a change?

What age groups are in the audience?

Older audiences are more likely to be familiar with health care terminology and more motivated to use the information. In contrast to the working population, retirees also tend to have the time to read things carefully, so they may be more receptive to thorough explanations and detailed examples. At the same time, they have substantially lower skills, which should influence the way in which you present information.

For details on literacy issues, go to Saying It Clearly.

What cultures or ethnic groups are represented?

In addition to gathering basic information about which ethnic and racial groups are included in your intended audience, you need to become aware of and sensitive to the ways in which their responses to information may vary. For example, in American culture, the physician is increasingly viewed as a partner in a joint effort to maintain the patient's health. But for many ethnic groups in this country, physicians are authority figures whose opinions should not be questioned. While many people would consider a physician's communication skills to be an important aspect of quality, certain segments would not share that concern and therefore would not value the information.

Depending on the composition of your audience, you may want to make a special point of addressing quality concerns that are relevant to specific groups and explaining issues that may not seem pertinent to those with different values.

For details on developing culturally appropriate materials, go to Saying It Clearly.

How familiar are they with managed care practices?

Consumers who have been in managed care plans for many years will be more familiar with how the system works and what the challenges really are. Those new to or less familiar with managed care may be more influenced by misconceptions, myths, and "horror stories" in the media. For the latter group, sponsors may need to provide some background on how the local health care system works.

For details, go to What You Have to Explain.

How easy is it for them to understand the information in a performance report?

The ability to comprehend complicated information varies with education as well as factors like age and culture. For instance, because of the complexity of the cognitive task, older audiences may have a harder time keeping track of multiple pieces of data. Immigrants may struggle with the language as well as the graphic presentations. The answer to this question will influence what you can say about health care quality as well as the quantity of information you can include in your report and the ways in which you present the data.

How comfortable are they with the idea of being assertive about their own health care?

This issue is usually associated with age and culture, but may have more to do with the cohorts represented by your audience. A cohort is a group of people whose lives have been shaped by similar experiences, like the Great Depression. For example, the current cohort of seniors is not accustomed to making their own decisions about health care. The Baby Boom generation, on the other hand, is expected to be much more assertive about their care when they reach old age. This comfort level is also affected by feelings of vulnerability; whatever the age, people who are ill often want someone else, such as their physician, to make decisions for them. The need to be assertive makes them feel anxious, not empowered.

Your answer to this question will influence what you say about the purpose of health care quality information. For instance, an emphasis on using the information to take decisive action could be lost on a passive audience, who may even be put off by materials that seem inconsistent with their needs. But this same group may respond well to a message that focuses on being informed and validating choices.

Do they perceive that they have a choice?

Information on quality may seem irrelevant to consumers who cannot use the data because they have no choices to make. Many Americans are not offered a choice of health plans by their employer or purchaser (such as Medicaid). Others may have a choice, but don't perceive the choice as a real one. They may be financially constrained from choosing a different health plan, or may simply feel like their other options are too risky. If they are sick, for example, they may be afraid that switching plans would endanger their treatment course or their relationships with doctors. Also, some people come from cultures or socioeconomic groups that do not support the kind of active decision making inherent in the use of health care quality information.

How interested are they in health care issues?

Even within the same age groups, the level of interest will vary. Women of childbearing age, for example, tend to be more interested in health care information than men of the same age. Noting that people have different tendencies to seek information, one expert suggests that sponsors aim for the middle ground: those who are not highly motivated to seek out and use information on quality but might be receptive to the idea.

How open are they to making a change?

Many consumers avoid changes and have a tendency to focus on the potential for negative consequences. Before they would consider using information to make decisions, they may need more information about what to expect from different health care organizations. In addition, they may be overly sensitive to information that is framed in a negative way. To counteract this sensitivity, you may want to make a point of putting a positive spin on information; for instance, rather than listing potential problems that consumers should watch for, you could list positive characteristics that consumers should seek.

For details, go to What You Have to Explain.