Communications Breakdown: What Works (and Doesn't) in Health and Science Communication

Attention First, Understanding Next: Overcoming the Illusion of Communication

• CIRTC • Episode 8

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"The great enemy of communication...is the illusion of it." In this episode, we pull apart why your message might not be landing with your intended audience—or reaching them at all. From System 1 vs System 2 to creative risk, trade‑offs, and trusted messengers, we cover:
 
 • getting your audience's attention in a crowded media climate
 • from the Health Podcast Summit: three reasons messages fail
 • health literacy beyond reading level: access, design, inclusion
 • empathy for trade‑offs and offering workable alternatives
 • new research on the "truth sandwich" and correcting misinformation

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Links from the episode:

Quote: https://quoteinvestigator.com/2014/08/31/illusion/

Thinking, Fast and Slow: https://en.wikipedia.org/wiki/Thinking,_Fast_and_Slow

CPSC links: https://www.instagram.com/uscpsc/; https://bsky.app/profile/cpsc.gov

Dumb Ways to Die:

Aaron Carroll, MD, MS: https://academyhealth.org/about/people/aaron-e-carroll-md-ms

Health Podcast Summit: https://summit.healthpodcast.co/

Some research on the backfire effect:

Truth sandwich: https://en.wikipedia.org/wiki/Truth_sandwich

“The truth sandwich format does not enhance the correction of misinformation” (Swire-Thompson et al) https://pubmed.ncbi.nlm.nih.gov/40860910/

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This podcast is a project of the Center for Injury Research Translation and Communication (CIRTC). Connect with CIRTC: www.cirtc.org

Find CIRTC on LinkedIn, Bluesky, and YouTube.

Note: all thoughts and opinions shared in this podcast are personal and not representative of any organization.

Tracy:

Welcome to Communications Breakdown, where we break down what works and doesn't in health and science communication. I'm Tracy Mehan

Katrina:

And I'm Katrina Boylan. In this episode, the theme we're going to focus on is overcoming barriers to communication. You know, just because we're putting out messages does not mean that people are picking them up. And so when we were laying out the flow of this episode, I thought of a quote, uh, which is the great enemy of communication, we find, is the illusion of it. And I went looking for this quote on the internet just to make sure I knew who said it. And according to Quote Investigator, it was said by a man named William Whyte, who is a journalist for Fortune magazine. And so it was about business. But I think the same actually applies for health and public health information, or really any type of communication.

Tracy:

Yeah, I agree with that. And we decided that that is really what we're going to focus on for this episode, breaking down what we think gives the illusion of communication, like the quote says. And right off the bat, one of the things we see a lot is that people assume that their audience is actually paying attention to the content or the message or whatever they want their audience to consume. But really, for people to actually hear the message and understand it, they have to see it first. And in today's soundbite-based world, we know how hard it can be to actually get people's attention.

Katrina:

Yeah, so I know that we've referenced system one thinking versus system two thinking before on this podcast. And so I just wanted to give a little bit more information about that because I think it really does help us understand this attention issue a little better. And this concept is uh based on a theory by Daniel Kahneman, uh, who wrote the book Thinking Fast and Slow. And the theory is that most of the time we're moving through the world in what he calls system one, which is fast thinking. And so it's it's very automatic, it's intuitive, it doesn't use a ton of information. And often this is where emotional decision making comes in as well. And so information that takes more processing, like data or something that's complex requires what's known as system two thinking, which is slower, it's more rational, and again, it's just more cognitively involved. And so it takes more effort. And so system two is not the default setting that most of us are moving through the world in. And, you know, especially with lower attention spans and, you know, kind of sensationalized content, it can be really tough to get people out of system one. And so we have to think about that as health communicators or sharing anything that's maybe a little bit more complex, is that we can't go and just immediately share that. We've got to get them out of that system one thinking first. And, you know, I do think we often see messaging that requires that system two to really engage with. But again, if you're not getting the attention of the audience it's it's trying to reach, if you're not reaching them in that system one state, they're never going to be able to engage with that system two information.

Tracy:

Yeah, I think this is a really important concept. And I don't think it is something that as health communicators, we always think about. And I think there's a couple of concepts that are important for us to think about here. When I am actively seeking information, if I'm looking for it, I might be a little bit more likely actually to be in system two because I'm wanting something and I'm ready to engage with content. Versus if I am just kind of out in the world there looking at news, looking at my social media feed, whatever it is, I'm in system one all the time, pretty much, right? Yep. And so we need to be thinking about where is it that we're putting our information out and then adapt how we're saying the information based on what system they are likely to be in when they consume it. True. Yep. So I think that's really important. And then kind of the other angle is this uh thinking about who our audience is and what our goals for them are, because I think that can really impact how we develop our information too. So for right, so for instance, we have one social media platform that is geared towards researchers. We talk in a certain way to researchers, even though it's on social media, we can't be too flashy, we can't, you know, make things uncomfortable for them.

Katrina:

Right. You have to have an you have to have a look and a feel that isn't, you know, out of their comfort zone. Right.

Tracy:

I I have to talk like I have a esteemed voice, and I have to use the words that we use in academia, and you know, I have to talk in a certain way. I have to even look in a certain way. I did a post recently for a professional organization where I had the logo spinning, and that was you know, that was I questioned, is that too

Katrina:

too jazzy, too jazzy for for it, yeah.

Tracy:

Right. But then on the other side, when we are talking to parent audience, for instance, and I'm you know, putting information out there where they're probably gonna get it in their feed as they're scrolling on other things. I do have to actually think about how am I gonna create materials that actually get them to stop. If I write it in the boring way that we write grants or write our academic papers, they're just gonna go right by it. Right. So we really have to stop and think about who our audience is for the message and what are our goals and what is going to get them to stop.

Katrina:

Yep, absolutely.

Tracy:

You know, there's another one that comes to mind for me is the Consumer Product Safety Commission's social media posts. If you aren't familiar with them, definitely go look them up. We'll put a link to them in the show notes. They had a guy who was a marketing guy who did not come from public health, who took over their accounts and started posting these like crazy things. There's toasters with wings, and there's dinosaurs, and there's just all this crazy stuff. And we heard a lot of feedback, and Katrina and I both had the same reaction at the beginning where we were like, what is this? They're making they're making fun of public health messaging, people aren't gonna take this seriously. I I can I don't understand this. But then we really started to engage with it because we wanted to see what what are they doing? And wow, look at these numbers they're getting, and they're getting so much more engagement than the posts that we're posting. Yeah. And when we started digging into the comments, we started seeing things like, "I've never paid attention to this kind of messaging before, but wow, this made me stop and look. And now I've changed my so smoke alarm batteries and I never knew I needed to do that before." Or, you know, "I've changed my behavior in this other way. I've reported a product that was unsafe." And when we stepped back, it makes me uncomfortable. I, you know, I don't know how I feel about it. But if the goal is to reach a new audience and get them to change a behavior, it's working. And ultimately that's what matters, right?

Katrina:

Right, right. And, you know, we're not necessarily the audience they're trying to reach. We're already on board with what CPSC is doing. So, right, in order to expand the field, it is it was fascinating to see them take that risk. But Tracy, when I first started with you years and years ago, I'm pretty sure this is one of the first things that you assigned me to watch. There is a video out there or a song, and it's called Dumb Ways to Die. And again, we'll link to this in the notes if you haven't seen this. And I'm pretty sure if I recall correctly, it was it was produced by like an Australian Train Safety Commission or something like that. And it we'll link to it. But it's a cute little animated video with this really kind of sing song-y, uh, song that's all of these dumb ways to die. And you know, it it just really kind of gets you thinking about it and it's fun and it's cute. And I will warn you if you watch it, it will be in your head for weeks. But it was a different way to approach the message of it was it was something about train safety, if I recall correctly, you know, stopping at uh the gates, you know, not going around the gates when when um they come down for a train crossing. But I have seen it in Instagram and TikTok videos, but I've seen it as both like a tongue-in-cheek use and as a real like, no, don't do this kind of thing. And so I just love again that this thing that you showed me years and years ago has taken on new life, but it's because it was fun. You know, people don't expect it. And so I think it really stands out because we don't see that so often in public health.

Tracy:

Yeah, I think you kind of hit the nail on the head there. It's when you don't expect it that makes you stop. Yeah. And say, wait, what is this? And it it was, I mean, it's goofy, but it gets the point across. And I think, you know, things like that can make people stop and make people listen. Not it's not for everybody, not everybody can do that, uh, especially, you know, if that's not your tone, that's not your voice, you can't do it. You can't try and force it. You can only do that if you have somebody who can authentically have that as their, you know, persona, but it can work. And it's okay for us in public health to do some of those things sometimes. I think sometimes we're afraid to have personality, and you know, I'm here to say it can work. It's okay for us to do that.

Katrina:

Yep, yep, absolutely. So we've kind of covered what we can do to get their attention, and so now let's move on into what else can create that illusion of communication. Let's say we've got their attention. Where else can we lose it? And so Tracy and I uh recently attended the health podcast summit, and the keynote speaker there was really great. His name was Dr. Aaron Carroll, president and CEO of Academy Health. And he was there to talk about why health communication messaging fails. And something he said has really stuck with me, and it was about a theory from change management research about why people don't do what you want them to do. And he said there were three reasons. He said, first, it's that they don't understand it. Second, they don't like it, or third, they don't like you. And so we're gonna get into these three buckets. And so again, that first reason is that people don't understand what you want them to do for some reason. And, you know, if that's the case, that's great. There is a lot that we can do about that to help people understand. And so it happens, uh, it is Health Literacy Month, and health literacy is all about helping people understand. For anybody who's unfamiliar with the concept of health literacy, it it really just means delivering health information in a way that the patient can access, understand, appraise, and use. And I think a lot of people are familiar with reading level as a health literacy concept, but you know, Tracy, we do tend to think a little bit broader than that.

Tracy:

Yeah, on our team, when we think about health literacy, we are much more comprehensive than that. We think about things like can people actually find the information that we're putting out there? And are we putting it in the places where they are, not just where it's easiest for us to put it? We also think about what do they do when they do find the information? Can they actually get to it? Or is it behind a paywall, or do they need a password and just give up because they can't remember their password or don't want to sign up, right? We also think about things like design. Can they actually see it? And as I have gotten older, this has become more and more relevant to me. You know, is the font big enough? It's not in many cases for me anymore. And that stops me from being able to access the information. You know, does it have things like alt text or is it something a screen reader can pick up? It's important for us to make sure all people can access our information. And then finally, does it feel like it's for them? Are we using language that resonates with them? Are the visuals something they feel like reflects their life? Even the messenger matters in terms of who your audience is you're trying to reach. Are they going to hear it from that messenger? All of those things can affect health literacy.

Katrina:

Yeah, for sure. All right. So going back then to the three reasons for our communication issues, uh, you know, I'm finding that a lot of the communication and messaging that we see out in the kind of public health and health space really only addresses that first prong of, do they understand it? And so, you know, we do tend to approach people as if it's a knowledge deficit, you know, that they simply don't understand. And then the response is just to provide more data, because, you know, I think that's how we tend to understand and engage with things. But as Dr. Carroll pointed out in this talk, there is some evidence, um, although it's conflicting, and and we'll provide some data again down in the notes. But Dr. Carroll cited some data that providing more information in these cases often backfires. Um, so if if somebody, if you assume somebody doesn't understand and that's not the case, and you just give them more information, they're gonna assume you don't understand them and then they're gonna turn off. And so we have to consider that your audience might be in the second or third groups that Dr. Carroll talked about, which are actually skeptics of your message, or they're skeptics of you yourself. And that skepticism is more about trade-offs and trust.

Tracy:

Yeah, I think a lot about that second group, especially these days. It seems like we're running into that a little bit more, or maybe people are being more vocal about it. But I think it is really important for us to think about that just because they have different values or they're in different situations that might make what you're suggesting unfavorable, doesn't mean they can't listen to you or they won't change behavior. It means we need to think about not just shoving more information at them, but what is it that they need to hear? And how do we need to talk to them in a way that makes them actually feel like we do actually hear them, that we're listening to them. And we have to acknowledge that their trade-offs for performing that behavior, the cost might be too high, right? So we have to think about what is it that we're asking them to do and what are they pushing back against? Is it something that's difficult or uncomfortable or might not even match what they grew up learning? These are all things we have to think about, right? And so, how do we think about that and then change our messaging? Some of that comes from listening and really hearing. Some of that comes from just showing empathy that we did hear their viewpoint, acknowledging that, maybe coming up with some other alternatives that might be acceptable steps they can take, or maybe even framing it differently. How can we frame it in terms of outcomes that they value that are important to them?

Katrina:

Right, right, right. No, I think these are it's an important thing to think about. You know, in our line of work, we are creating safety materials that we hope people are able to turn around and use in their own lives. And one of the things that I have run into a lot is trying to find answers for questions like, you know, if we're doing messaging on baby gates, for instance, and you've got stairs in your home, and best practice is to have a screwed-in gate at the top of your stairs. But let's say your lease comes with a fee or an eviction, um, you know, some type of penalty if you put holes in the wall. And maybe there's no other way to secure gates. You know, we we don't provide, as you said, alternatives sometimes that I think really would show that audience that we do understand the situations they're in; we do acknowledge the trade-offs that all of these actions come with. And so, you know, I don't have a good answer here for for this, but it is something I think a lot about as we try to put ourselves in their shoes and figure out what are the trade-offs, what are we asking them to do? What other values might be at work here that interrupt, you know, what we're asking them to do?

Tracy:

Yeah, and there's lots of groups who are starting to do more in-depth work with communities and and hearing their voices. If you can, if there's a way for you to talk to your audience and listen to what some of their struggles are and then think about how to work together with them for some messaging, I think that's really important. I think another thing you could do with that community kind of leads me to our next thing that we wanted to talk about here is that third point, uh that third bucket that you were talking about earlier. And that's when the listener or the audience doesn't like you, which can be really hard. But one of the things you could do when you're working with your community group is ask them is a message from me or my organization gonna be heard? And if not, who would you listen to and start to think about that? Because we're not always the right messengers. And as public health people, that can be really hard for us to hear sometimes. And in the past, we have been able to go to places that we can't send people to anymore. Some of our formerly trusted institutions are now not trusted by everybody. So, what does that look like? And how do we as a field have to shift how we're doing things? I, you know, we don't always know the right answer in as a field. We're trying to figure out what that looks like. But being intentional with our choice of messenger can be really important. We can't just assume that we're it anymore. So, what does that look like? Who can help us get the message out when we can't? Who knows the language, who knows the culture, who knows the struggles in ways that we don't. You know, it can be important for us to consider. Is it hard because they're not trained like we are, and they might not have all the exact information, but as a field, I think this is an area where we can grow and what worked five years ago for public health communication does not work at all today. So you have to continue to learn and grow and see what's happening now and what's effective now.

Katrina:

And actually, you know, that is a great segue into the last piece of this discussion, which is what we can do about these different barriers to communication. And, you know, we've talked about some of them. But I want to go back to that quote that I talked about at the start, because when I looked it up, that quote was actually part of a larger paragraph that I think actually gives us the answer to this question. And so here it is. "The great enemy of communication, we find, is the illusion of it. We have talked enough, but we have not listened. And by not listening, we have failed to concede the immense complexity of our society and thus the great gaps between ourselves and those with whom we seek understanding." And so I think that means listening to our audiences, as you've mentioned, it means meeting them where they are. And, you know, we really do want to be clear here. We do not mean that listening means telling people what they want to hear. Right.

Tracy:

As communicators, we can't, uh, just push more information and hope it sticks. We need to match our strategies to the reason people are resisting. So I want to go back again to that podcast summit. Dr. Carol had two quotes that really stuck with me that I also think helped with this point. He said, "listen as hard as you speak" and "engage with people as much as with information." And those I really they made me stop and really think. Because I don't think we always listen to hear we listen to hear what you didn't hear about what we said, so we can tell you more information.

Katrina:

Yeah, no, uh, that is: yes.

Tracy:

Right. And so I think where we are right now, it's gonna be really important for us to really listen. And that concept of engaging with people, it's hard right now in our society with people who have such differing viewpoints and different words will set people off in different directions. But if we think about the people behind it and listen to what is behind what they're saying, you know, we're lucky because in the field of child injury prevention, there's not one person out there who doesn't want to prevent injuries to children. So if we can get to that common ground and find a way to talk to them about what's important to them and use words that will help them hear us, I think that's how we're gonna have to do it.

Katrina:

Yeah, you know, I I agree with you that if we're hearing that people are asking for information in different ways or asking us to lead with different parts of ourselves so that they can connect with us first before we ask them to do something. Yeah, I think that that's absolutely, you know, the way forward.

Tracy:

And look, it's not easy. And if my son listens to this, he's gonna crack up because one of his favorite stories about me is how his high school football coach, he had to tell him, Look, when you tell my mom no, what she hears is she didn't explain it to you well enough yet.

Katrina:

Right. It can be hard for all of us, right? No, that's– a lot of these are, are, we talk about this because that's what we ourselves are are learning. You know, this is what we're working on in our our own practice. So right. Yeah. All right. Well, before we wrap up, we wanted to share a piece of research that came out at the end of August and was published in the Journal of Educational Psychology. And it shed some light on a technique that many of you might have heard of called a truth sandwich. Now, if you aren't familiar with the truth sandwich, it's a technique introduced by a man named uh Dr. Dr. George Lakoff, um, who's a professor of linguistics. And it's a recommendation for journalists to address misinformation and disinformation. And we'll put links about this in the show notes so you can check those out. But basically, the truth sandwich starts with the truth and then addresses the misinformation or disinformation and then says the truth again. And so, you know, it uses that, it uses primacy, which means we remember the first thing we hear. It uses recency, which you remember we remember the last thing we hear, and then it uses repetition, which we're more likely to remember something we've heard multiple times. And so you might have heard this before, um, used to take on, you know, maybe some vaccine misinformation. I've seen it used in safe sleep, but basically, this is a technique that we've seen in journalism and in other communication spaces to push back on misinformation and disinformation.

Katrina:

And so Tracy shared with me some research that she saw that took a look at whether or not this technique of the truth sandwich was more effective than other types of corrective information. And so, again, we'll put a link to this study down in the show notes. But what the study did was it looked at that truth sandwich formation, which they label as fact, misinformation, fact, and what they call a bottom-loaded refutation structure. And so the way they did that, it goes misinformation, fact, fact. And so if I'm reading this correctly, what they found was that both of the corrective measures, the truth sandwich and that bottom-loaded structure, were fairly effective in correcting the misinformation and disinformation. But what it didn't find was any advantage to either method, um, especially with that truth sandwich. It didn't find that there was any advantage to using the truth sandwich structure. And so the authors of the study, I think, seemed to draw the conclusion that the truth sandwich was a harder message to parse, to understand. And thus the bottom-loaded structure, again, misinformation, fact, fact, would be easier to understand. It's a simpler message. And again, we'll put a link to this paper in the notes. You know, this is just our our look at it. But I thought that that was a really interesting update on something I know we're all facing, which is how to counter misinformation and disinformation. All right. Tracy, any thoughts before we go?

Tracy:

Yeah, there is one thing more I wanted to say about misinformation. Misinformation thrives when we don't think about why they aren't following our messaging, and we assume it's because they just don't. Know enough. So the more we think about these issues and how to improve our communications with that in mind, the better we'll get at combating misinformation. And the other is I kind of wanted to end with a message that health literacy really has come a long way. What started with a focus on reading levels has really grown into a field that's about access and design and trust and helping people actually use information in their own lives. And the people like us who are in this space, we've seen the progress. We know how the field is growing, and I'm excited about all of the different things that are coming. But there are still a lot of people who don't even realize health literacy is a field at all. And so we have a huge opportunity to continue having the discussion about what health literacy is and why it's so important so that we can bring others into the field. And that's a huge opportunity.

Katrina:

Yep. Absolutely. All right. Well, that is it for this episode. Thank you so much for listening. If you want to get in touch with us, you can leave a comment. You can also use the link at the top of the show notes to send us a text. And you can find us on LinkedIn and Blue Sky as CIRTC, that's C-I-R-T C.

Tracy:

And please reach out to us. We really do love to hear from you. We want to hear how you're putting health literacy into practice because we are all learning and growing in this together. Thanks for listening. Until next time.

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Katrina Boylan

Host
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Tracy Mehan

Host