Making messages useful and inclusive: More than words

This article introduces the concepts of actionability and positionality for health communication. To practice health literacy is to make messages actionable. To make messages actionable is to create a more supportive environment. This includes direct service and advocacy. This article is part of the "Health Literacy at the Intersections" series, which highlights how health literacy intersects with other facets of equitable health communication.

What is actionability?

Good health communication isn't just clear and simple. It's also usable. Making your messages actionable is key to practicing health literacy. That's why the CDC Clear Communication Index and the Patient Education Materials Assessment Tool (PEMAT) prompt us to focus on actionability when we assess health messages.

Let's use the example of an N95 to understand what this could involve. Let's turn the CDC Index and PEMAT scoring guide into a usable set of tips:

1. Give a clear recommendation. Example: "Cover your nose and mouth with an 'N95 respirator' in public."
2. Break the action into clear steps. Example: CDC's 'How to Use Your N95 Respirator'
3. Provide a tool to help with the action. Example: CDC's Find Free High-Quality Masks page.
4. Provide visual aids and examples.

It's hard to make something actionable, simple, and concise. If we were to directly talk with someone about N95s, we could tailor our advice to their needs. We could explain the word "respirator" or find another word to help them. We could give them N95s directly. We could provide a list of products and where to find them locally. We could directly ask whether we've met their needs. Online or in print materials, that's much harder.

What's the problem with actionability?

Like other health literacy practices, "actionability" is easier said than done. Even if someone perfectly understands how to put on an N95, how do we know they can afford one? How do we know they can reach free ones?

Whether or not we realize it, our messages carry assumptions. Here, we assumed someone can access the kind of mask we focused on. This might not be true in a tough financial situation. Or in an area without pharmacies. Or in light of certain physical accessibility needs.

It's likely not possible to make a single message that works for everyone. But we still need messaging that can work for everyone.

What is positionality? And why does it matter?

"Positionality" describes our access to power and privilege. This access differs based on multiple factors at once, e.g. racism, ablism, and classism.

While "power" and "privilege" might be abstract, they have concrete impacts in people's lives. Structural racism shapes pharmacy deserts and thus people's access to health resources like N95s. Classism can lead us to wrongly assume that everyone can afford an N95. Ablism can lead us to focus on visual aids without considering other media formats.

We can address some of these issues through communication training. Example: we can learn to include descriptions of visual media. We can address others through direct service. Example: we can tailor our message to the free masks we distribute. Other issues, however, require us to think of health communication as much more than info.

Actionability requires more than info.

When we make a health message, we have to address different contexts. Maybe someone's work requires water breaks throughout the day. Maybe racism introduces physical safety risks while face coverings reduce their risk of illness. Working with diverse partners can help us understand how positionality limits the actionability of our message. Together, we might find ways to tailor our message and provide direct service to help meet people's needs.

But we know this isn't enough. Ideally, our health communication is part of advancing health equity. Thus we should also act on the political and social determinants of health. How do health risks relate to where someone lives, works, and plays? What power structures make some places safer than others? What power structures make spaces riskier for some people?

Health communication should prompt us to act on these structures. For example, corporate practices during the pandemic meant more unpaid labor and more COVID risks for essential workers. Short-term, we might help people learn to use masks to protect themselves. But ideally, we can help make working conditions safer long-term. Advocacy is just as important as direct service for health communication.

If we don't want to assume people have N95s, we can give them masks. If we don't want to assume people have the safest working conditions, we can help make them safer. We could use our public health expertise to advocate for things like paid sick leave and workers' rights.

Conclusion

This article introduced the concepts of actionability and positionality as they relate to health communication. "Actionability" describes how usable your message is. "Positionality" describes how social/political forces shape how someone might use your message. Beyond clear communication and direct service, this highlights the need to include political advocacy in the scope of health communication as a means of addressing the social determinants of health.

About the author

Sam is a PhD candidate in Population Health Sciences at the Harvard T.H. Chan School of Public Health. Their research combines media studies and computational social science to help expand the scope of health literacy research. Outside of research, their work focuses on supporting social media communication that can help advance health equity.