Reaching People Where They Are

While a few consumers actively seek out information on health care quality, most do not—even though they may be receptive once they see it. Consequently, you may not want to wait for consumers to come to you. Instead, you can think strategically about ways to get the information in front of your audience.

To develop this strategy, consider the following three issues:

• The Setting. Where can you find your audience?
• The Channel. What are the best ways to reach your audience in these settings?
• The Medium. What methods can you use to deliver your message within these channels?

The Setting

But physical availability is not enough in itself. Have the following questions in mind as you consider each location:

• Where will they be receptive to your message? Where will they be most attentive?
• Where will they find the message to be credible? What settings might arouse skepticism?
• In what setting do you have potential partners that will help you deliver the material?
• Where can you reach the people who are influential in the community?

To reach low-income women and children, for example, you can focus on organizations like schools and day care centers, libraries, Head Start programs, free health clinics, and other public health programs. To reach Medicare beneficiaries, you might want to distribute your information through hospitals, home health agencies, senior centers, lunch programs for the elderly, people who visit the home-bound, and other community-based organizations that serve this population.

But every audience is different, so don't assume that what works in one community will work in another. If possible, test your assumptions about promising settings with a sample of your audience to ensure validity.

The Channel

Sponsors of quality information projects need to think broadly about potential distribution channels for their information. Typically, consumers receive performance reports through their workplace or in the mail at home. But other, more personal channels may be more suitable. For instance, when children qualify for Medicaid benefits, the parent is the decision maker, and thus the audience for any information on health care quality. Although direct mail is a common way to reach this audience, many government agencies have found that the response to mass mailings is poor, suggesting the need for a different approach.

In the absence of a direct connection to your audience, what else can you do? Select links below to learn how you can:

• Identify Distribution Brokers.
• Train Distribution Brokers.

Identify Distribution Brokers

One solution to this dilemma is to identify "distribution brokers" who can serve as middlemen between you and your audience. Because of their relationships and familiarity with your intended audience, these organizations or individuals can be effective channels.

Here are some criteria for identifying distribution brokers for your materials:

• They have access to your intended audience.
• Your audience considers them to be a trusted source of information (that will add to the credibility of the information you have developed).
• They have the resources available to help you (e.g., volunteers, funding, time).
• They have some expertise that you can use, whether familiarity with health care issues or with the needs of your intended audience.
• They can co-sponsor events that would help to reach your audience.

Ideally, distribution brokers provide more than just a setting for you to make your information available. In addition to helping to distribute your information, some may be well-suited to answering questions and providing support to consumers. For specifics, select Steps for Involving Intermediaries in Your Program.

Train Distribution Brokers

If you choose to work with a third party to distribute your information on health care quality, be sure to provide adequate training. It is not enough to have distribution brokers that your audience knows and trusts. These intermediaries must be able to answer questions, guide consumers through the material, and even help them use the information to make decisions.

For details, go to Prepare and Use Information Intermediaries.

For example, the Community Service Society of New York (CSS) found that people with follow-up questions contacted the site where they got the information, not the agency that developed it. They learned that they would have to train community volunteers and help them build the capacity to handle the demand for more information. Similarly, employers also have to prepare their human resources staff as well as any other employees (such as union leaders) who are likely to get questions about a report on health care quality.

Medicare Rights Center Training Initiatives (PDF file, 59 KB; HTML)
© Copyright 2000. Employer Health Care Alliance Cooperative. All Rights Reserved. Used with Permission.

The Medium

The Options

To date, sponsors have experimented with the following options:

• Stand-Alone Printed Documents.
• Information Incorporated into Printed Open Enrollment Materials.
• Electronic Information on the Internet or an Intranet.
• Information Incorporated into Web-based Open Enrollment Materials (on an Intranet or the Internet).
• Mass Media.

Stand-Alone Printed Documents

This is the most common method for sponsors today, although it can vary widely, from small brochures to thick, data-heavy reports.

The Alliance in Madison, Wisconsin, produced Quality Counts:  Medical Group Report (PDF file, 759 KB; HTML)
© Copyright 2000. Employer Health Care Alliance Cooperative. All Rights Reserved. Used with Permission.

Information Incorporated into Printed Open Enrollment Materials

Rather than distribute a separate report, many employers prefer to fit the material on quality into their open enrollment materials. On the positive side, this approach allows sponsors to offer all the pertinent information in one package and helps to show how the quality information fits into the bigger picture. It also may be helpful to lower-literacy audiences to have quality information integrated with other information they need.

However, this approach has two drawbacks. One is a lack of visibility; some employees may not see the information on quality if it isn't very obvious. The second is the limited space that sponsors usually have to present the data and any context that employees could use. In an open enrollment document that must present a great deal of information, only one or two pages may be allotted for the quality information.

Electronic Information on the Internet or an Intranet

An increasing number of sponsors, including the Centers for Medicare & Medicaid Services (CMS, formerly the Health Care Financing Administration), put information on quality on the Web, which allows them to present a large amount of data without overwhelming the user. The Web is also a great way to get information to a large number of people without incurring the costs of printing and distribution.

For more information on the pros and cons of using the Web, go to Choosing Media.

A Web site can be an alternative or an adjunct to a printed report. While the ideal approach is to design a report that takes advantage of the interactive capabilities of the Web, many sponsors simply reproduce their existing written materials. Also, despite ambitious plans to take advantage of this popular technology, sponsors often find themselves having to produce written materials to meet the needs of the many consumers without access to the Internet.

	Maryland Health Care Commission  offers its print report online  as well as an interactive version of the report.
	The Pacific Business Group on Health sponsors the HealthScope Web site where consumers can find information to help them select quality health plans, hospitals, and medical groups.
	The Employer Health Care Alliance Cooperative (The Alliance) in Madison, Wisconsin provides QualityCounts, a report on medical group quality on the Web as well as in print.
	Colorado Business Group on Health sponsors the Colorado Health Online Web site which offers multiple views of results from Health Matters, their health plan satisfaction survey.
	The National Committee for Quality Assurance (NCQA) offers its Health Plan Report Card as an interactive tool online.
	The Centers for Medicare & Medicaid Services (CMS, formerly Health Care Financing Administration) offer online information about Medicare Health Plans through a tool called Medicare Health Plan Compare.
	The Office of Personnel Management (OPM) offers plan information online, Compare Health Plans.
	The Buyers Health Care Action Group (BHCAG) offers an electronic version of its consumer survey results at the Web site for Choice Plus at http://www.choiceplus.com.

Information Incorporated into Web-based Open Enrollment Materials (on an Intranet or the Internet)

For the small but growing number of employers that handle enrollment online, the Web offers the capability of integrating information on quality with other information about employees' plan choices. However, unless all employees have access to the Web site, this is not a reliable way to disseminate information.

The Office of Personnel Management's Federal Employees Health Benefits (FEHB) Web site.

Mass Media

In the past few years, a number of sponsors have experimented with using the mass media, particularly magazines and newspapers, to deliver information on quality. To date, quality reports in a magazine format have been available in several general interest journals, including US News & World Report, Consumer Reports, and some regional magazines. Many organizations have also sponsored a community-based publication (now a Web site) called Health Pages that combines general information on health care with comparative data on local health care organizations (www.thehealthpages.com).

But while the written media appear to have a great deal of potential for conveying data effectively, sponsors are less sure about using visual or audio media for this purpose since they seem better suited for educational and promotional efforts. Also, many sponsors believe that, to be able to use the information in decision making, the consumer will have to have access to a piece of paper (or at least a computer screen) with the data on it.

Benefits of mass media

Some sponsors like the idea because of the wide reach of the mass media and their expertise at communicating with consumers. Others hope that by presenting the information in new ways, the mass media will be able to overcome the problem of people not understanding data. If you pay for an insert or ad space rather than trying to get press coverage, you can also avoid relying on a reporter to translate the material correctly. This may be a good approach if you want to be sure that your message is delivered unedited.

Disadvantages of mass media

One obvious problem is that the mass media are not targeted and can be costly to use if you are buying space. That said, the increasing ability to customize offers new ways to reach specific audiences; many newspapers, for example, can limit the delivery of inserts to specific geographical zones. Another common concern is that quality information doesn't fit with the mentality of the press, which has to compress information and look for "angles." You may worry about losing nuances in the data, and thus losing control over the story.

Finally, if the press focuses on identifying "winners" and "losers," this distribution strategy can create serious problems for sponsors and their partners, especially the health plans and providers. It is very important to prepare your partners for the attention they may get from the press. Make sure they are aware of the data and its implications and are ready to discuss (and possibly defend) their performance.

How to Decide

In a perfect world, you would choose a medium for delivering information based on research with your audience. For example, you could ask them how they get information now, and how they'd like to get it. Then you could pretest materials in the field to see what response you get.

Whether or not it is feasible for you to conduct this kind of testing, it can be helpful to think through these questions first:

• What can you afford?
• What is Available?
• What are the implications for the presentation of quality information? For details, go to Choosing Media.
• Which Media Are Most Accessible and Appropriate?
• Does your audience have any limitations or disabilities, such as vision loss or low literacy, that could affect their ability to use certain media?
• Do they find printed information to be credible?
• Is your audience familiar with computers? Do they prefer the flexibility of electronic media like the Internet?

What Is Available?

Given the media that are already available to you, consider how those options would affect your ability to convey your message and achieve your goals. For instance, if you have to fit the information into the format of existing open enrollment materials, you may not have the space to include all the content you would like. Space limitations is one of the reasons why the Medicare & You 2000 handbook presented only two measures, in contrast to the 11 measures listed on the Medicare.gov Web site.

Which Media Are Most Accessible and Appropriate?

To think about what is likely to be best for your audience, consider the following questions:

• Does your audience have any limitations or disabilities, such as vision loss or low literacy, that could affect their ability to use certain media?

  Some disabilities may limit the ability of people to handle large, detailed documents or to manipulate data provided on the Internet. Also, people who can speak English may not be able to read English, and some may not even be able to read their native language.

• Do they find printed information to be credible?

  Is it consistent with their cultural norms? Would they be more comfortable hearing about quality, either through a trusted intermediary or through news shows on the radio or television?

Some audiences are not accustomed to getting information through written documents. For example, according to a survey of the attitudes of different ethnic groups, Hispanics/Latinos are significantly less likely to get information about health care from literature in the mail.

This survey also found that, rather than refer to written materials, many people prefer to rely on the guidance of trusted communicators, such as family members, authority figures in faith communities, and physicians. African-Americans and Hispanics/Latinos, for example, tend to put much more trust in physicians than do Caucasians. Building on an oral tradition, they also tend to look to the radio and television for information.

This material is based on findings from New America Wellness/Morehouse College of Medicine, Multiethnic Healthcare Attitudinal Research, conducted by Erlich Transcultural Consultants, March 1999.

• Is your audience familiar with computers? Do they have access to them? Might they prefer the flexibility of electronic media like the Internet?

  While electronic media have great advantages over paper, you have to consider their suitability for your audience. In particular, access to computers and to the Internet varies widely across socioeconomic and age groups. Younger consumers, for instance, tend to be much more comfortable and skilled with computers than their elders are. While this is changing rapidly, be careful not to assume a facility with computers that may not be there. Another issue is that those people who do have computers do not necessarily have equipment that can handle sophisticated applications and features (such a streaming video).

Combining Approaches

Many sponsors struggle with the fact that they are trying to satisfy the needs of different audience segments at the same time, where these segments differ not only in what they want to know but also in the ways in which they want to receive information. Some people will be interested in and capable of processing a large amount of detail, while others will only want a "top-line" summary of the results.

For a discussion on how to address this dilemma, go to Offering Information in Layers.

Similarly, part of your audience may be comfortable with a high-tech approach to delivering information, while others need a more personal touch.

One possible solution is to indicate differences in information needs in the report itself. For example, you could specify that certain information is intended for a particular kind of reader, while other information is pertinent for everyone. But this approach can get complicated very quickly. It also doesn't solve the distribution problem.

An alternative is to tailor your report to the various segments in your audience. But if you do this, you must also tailor your distribution strategy. That is, you have to think through how you will overcome the logistical challenge of getting people the report that is right for them. While this isn't easy, the following advice may prove useful:

• Let consumers self-select by making the appropriate information available in a place they are likely to be, through a trusted channel, and in a medium with which they are comfortable.
• Use several different media to deliver the same information, since you can never be absolutely sure which ones your audience will embrace. Also, people are more likely to hear your message if it is repeated through a variety of media.