THE ROLE OF INFORMATION AND COMMUNICATIONS TECHNOLOGY IN CHANGING MESSAGING

Several speakers emphasized the observation that information and communications technology (ICT) is changing traditional violence prevention messaging, making it more accessible to wider audiences, filtering and targeting messages, and opening lines of multidirectional conversation.

Speaker Erik Hersman of Ushahidi said that Ushahidi was born out of the 2008 post-election violence in Kenya. He described the initial start-up as an ad hoc group of volunteers who came together over 3 days in response to an urgent need. Blogging and media played integral roles in accelerating the company's timeline. It is worth noting that Ushahidi is a broad-band platform that has since been used in many countries all over the world. It has been used for disaster response, such as in Haiti and Japan, for election monitoring, and for citizen journalism.

Speaker and Forum member Jim Mercy of the Centers for Disease Control and Prevention said that information and communications technologies disrupt hierarchies, change the flow of information, and allow failure to occur more quickly so that progress can take place more quickly. Other speakers added that these technologies contribute to the democratization of information, by allowing ordinary citizens to discover solutions to their own problems.

Speaker and planning committee member Jody Ranck of the Public Health Institute spoke about key developments in ICT and about their effects on the future of public health. These key developments include more pervasive computing power, the appearance of cultures of sharing and cooperation, open health, biocitizenship and technological citizenship, and the rise of the infosphere¹ and the information organism.² Noting that global mobile network coverage has reached 90 percent, Dr. Ranck commented that social media has engendered a culture of sharing, of collective selves, and of real-time informatics. Dr. Ranck also emphasized the paradigm shift that has occurred in rethinking health with respect to the impact of technology: Internet and communications technologies have the power to make the invisible visible and to increase public engagement with data. Several speakers cautioned that as this paradigm changes, there will be a strong need to evaluate these new, faster, and more streamlined approaches in rigorous and appropriate ways that adapt to the rapidly changing technologies. Dr. Ranck also discussed new approaches to utilizing data, include the mining of “big data,” or datasets too large to store in a traditional manner. Big data has the ability to provide more nuanced information regarding communications trends and cultural and social norms.

NEW LITERACIES OR COMPETENCIES

Harnessing the power of ICTs could require adaptation of traditional communications tools. Several new literacies or competencies are required for adapting and incorporating information and communications technologies into violence prevention work.

Mr. Hersman spoke about one of the first competencies required for Ushahidi: the understanding from organizations that they should share their data. Large nongovernmental organizations were not sharing information or verifying if an event occurred. This barrier led to the building of a platform that could bypass these inefficiencies. Along the Ushahidi development path, many lessons were learned that are important to lay the groundwork for others developing their own ICT programs. The required skills include the ability to discerningly examine data sources and data, to question assumptions, to embrace innovation, and to take risks boldly knowing that such risktaking allows one to fail and then subsequently adjust more quickly.

Mr. Hersman also discussed the skill of dealing with “white space,” where sometimes the most innovative ideas emerge. In Mr. Hersman's opinion, the best disruptive ideas come from the edge, and this is where the intersection of technology and violence prevention has the potential to push the boundaries of innovation. The last competency that Mr. Hersman emphasized was the importance of humility with respect to approach, implementation, and advancement technologies for preventing violence.

Dr. Mercy agreed that there is a need for literacy in these areas, and he raised more questions: “What do we need to do to help us and help our colleagues, help our own fields to get up to speed? And where do we need to get up to speed? Do we need to know the intricacies of the technology, or what are the areas that we need to learn in order that we can advance and apply these technologies in useful ways?”

Dr. Ranck added that the area of visual culture—which includes visual data representation such as mapping, infographics, new media, and art—is expanding and these tools are helping to reframe health. That is, instead of simply displaying statistics and other numbers by themselves, people are using pictures to demonstrate the statistics and to send messages across populations and audiences with a wide range of background, knowledge, and literacy levels. More and more often data are being displayed in visually appealing ways in order to create more effective and meaningful messages.

Dr. Ranck also listed a number of other new literacies that are important for public health, including service design and change management, technological literacy, new methods in health informatics, and management of public–private partnerships. Transparency is also increasingly important because there are more participatory media and more distributed knowledge. Public health, he said, should address these arenas and could be leveraged as a platform to offer services that catalyze change.

Speaker Devon Halley from Deloitte Research GovLab (XBC) discussed the potential of cross-boundary collaboration and creating public value through ICT. He discussed the power of global networks in helping to buttress the use of knowledge. Social media and social networks offer a tremendous opportunity to develop new ways of engaging people and allowing them to collaborate and innovate. Thus, he said, new competencies are needed to manage this power.

As an example, Mr. Halley offered the story of a physician's powerful use of Sermo, which is a collaboration platform for medical professionals. This physician, who was in the emergency department, had a patient who had a serrated saw blade completely through his thumb, and the physician was uncertain of which approach to removing the blade would result in the least collateral damage. In the past, Mr. Halley said, the doctor would have turned to a colleague he knew in his own hospital or perhaps in some other, and the solution could have taken a long time to present itself. In this case, however, he posed the question online using Sermo, and very quickly another doctor who had seen this type of injury before posted a solution: use a drinking straw split along the length as leverage. Thus the physician, who had the knowledge, ability, and access to use Sermo, was able to effectively tap into the knowledge base of the entire medical community accessed on this website, not just those doctors in his immediate social sphere. As well, the solution itself was relatively low-tech and easy to manage, but would not have so readily manifested without this innovative tool.

Speaker Vish Viswanath of Harvard University of Public Health spoke of teaching children “media literacy” and how to develop a curriculum to do so. “Since we teach people how to buy clothes, how to buy cars, how to go to the restaurant from Yelp,” he said, “how do we do this for the use of media? We should develop an evidence-based curriculum around these new kinds of media and literacy and how we teach our kids to consume it in a more informed way.”

Breakout leader Kim Scott from the Child Resiliency Programme in Jamaica brought up another important competency related to the breaking down of the silos within the violence prevention field. In Jamaica, she said, the violence prevention field is splintered into sectors as well as within silos of types of violence. As had many other speakers in this workshop, she emphasized the importance of learning to perform multidisciplinary collaborations because so much effort and time is spent by researchers in one silo going over ground that has already been covered by others in similar fields. Being able to work across sectors and share information would allow researchers to work from existing knowledge and would thus require fewer resources. Speaker and Forum member Mark Rosenberg of the Task Force for Global Health responded to Dr. Scott, saying that collaboration is not easy. “It is not easy to get the people who work in HIV to go over and talk to the people who work in violence prevention or go talk to the people who work in polio eradication to share the lessons that they have learned. It is not easy, but it is possible. If we work only in silos, we lose that ability to get the bigger picture. If we are going to make progress, it is going to be because we see the details and the bigger picture at the same time, but that is going to take getting us together in ways that are hard but possible.” Because social and new media encourage sharing and collaboration, this goal might be easier to achieve through the lens of communications technology.

Speaker Judith Carta of the University of Kansas also noted the challenge in designing, evaluating, and scaling programs in an environment that changes rapidly, sometimes to the point that a particular innovation is no longer needed by the time the evaluation is finished. Dr. Rosenberg responded that the program design and evaluation cycle is going to undergo changes because of our ability to use communications technology. Some applications will be put forth that become widespread before we understand why they work and before they are tested on the small scale. An important competency in building, Dr. Rosenberg said, is learning how to embrace this rapid change and incorporate what is learned from research to modify the process successfully.

Facilitator and planning committee member Lisa Witter of Fenton spoke about competencies that are needed in the workplace. She said that social media are changing people and changing what hierarchies look like. For instance, those who would be traditionally considered “experts” are changing as younger people often mentor their more experienced (and often older) counterparts in technology. In turn, this is affecting organizations with traditional workplace structures and offering a democratization of empowerment in workers. “There is power leverage along what was a ladder,” she said, “and is now a lattice.”

Speaker William Riley from the National Institutes of Health spoke about the need to improve evaluation competencies given the burdensome length of time required for a full randomized controlled trial to be carried out. A typical randomized trial, even one that does not require any revisions or other things that might extend the process, lasts at least 7 years. During this time the researcher could be left behind by evolving technology and end up with an intervention that is no longer relevant. On the other hand, speeding up the timeline could result in inadequate development, use, or evaluation of the technology. Although RCTs are considered to be the gold standard for evaluation, he said, there are a number of types of uncontrolled trials that could be useful as well, particularly because mobile technology can assist in the real-time capture of data, and so it is possible to embed evaluation into the intervention itself.

In the research world, a new measure must be both reliable and valid, but sensitivity to change should also be taken into account. “We have to actually be able to look at how we can truncate these things and have measures that are more responsive to these short periods of time we're trying to assess,” Dr. Riley said. “We have to get to the point in the behavioral sciences and the epidemiologic world where our scales stay standard. Our instrumentation can improve, our processes and methods can improve, we can become more precise as we go along, but everything stays standard in terms of the scale, so that we can always talk to each other: clinicians to researchers, researchers to researchers, and we're talking about the same scale.” Speaker Joe McCannon of the Centers for Medicare and Medicaid Services (CMS) noted that new evaluation methodologies are being developed, such as methodologies that integrate formative and summative evaluation.

Speaker Michael Feigelson of the Bernard van Leer Foundation offered a final important competency that the violence prevention community needs to keep in mind when educating its donors and its potential donors: while reasonable attempt at prediction should be made, it should be made clear that exploring new fields requires accepting some level of uncertainty. “The problem that I came up against, which is a similar one that you will come up against, is, I could not prove anything. I could not even tell that reasonable a story because when you are in ‘white space,’ where it's a little uncomfortable because the rules aren't clear, you don't know what's going on, you don't know what's going to happen. The white space should be made attractive and not a scary phenomenon.”

APPROPRIATE MESSAGING AROUND VIOLENCE PREVENTION

Several speakers said that it is essential to ensure that violence prevention messages delivered with new communications tools are still appropriate and relevant. Breakout session leader Scott Goodstein of Revolution Messaging illustrated the importance of understanding who the target audience is and how usable the tools will be to that audience. Speaker and Forum member Kristin Schubert of the Robert Wood Johnson Foundation commented on the power of going beyond the individual level and amplifying the experience so it can be shared by everyone, while still ensuring that the experience is relevant.

Breakout leader Daniel Reidenberg from SAVE said that it is important to talk about and better understand the differences between the risk of something occurring, and predicting that something will occur. He also noted that deciding where to intervene on the continuum (that is, low-to-high) of risk requires careful examination of expected consequences. Speaker John Gordon of Fenton said that it is important to meet individuals where they are currently, so they are most receptive to messages, and both he and Dr. Reidenberg agreed that it will be important to move the messages past traditional public health gatekeepers directly to the target audience.

Breakout leaders Dahna Goldstein of Philantech and Harriet MacMillan of McMaster University both commented about the need first to clearly define the problem and then to identify important tools versus the other way around. Dr. MacMillan also noted that it would be useful for violence prevention practitioners to learn to create short messages, especially as people are growing increasingly more accustomed to receiving news and information in a short-message format.

Breakout leader Constance DeCherney of iCrossing noted that the best approach is not to try to solve a problem with one technology or one person but rather to involve all of the audiences affected by the issue in a variety of platforms, including mass media. Breakout leader and Forum member XinQi Dong of Rush Institute for Healthy Aging said that there is great ignorance concerning how to frame research-advocacy messages in order to reach decision makers, while Dr. Viswanath noted that some of the evaluation research offers insight into this framing. Dr. MacMillan added to this by saying that it is important to bring the decision makers into the process from the beginning rather than planning to disseminate information to them after the process is done. Mr. Gordon posed one possibility of creating an ICT prototype, to brand something quickly and disseminate the message, before scaling up into a full program.

FRAMING ISSUES

Framing the issue is an essential part of building a message for violence prevention. Dr. Rosenberg spoke about challenges that come up in framing violence prevention issues. The challenges he listed included

• Fatalistic beliefs about violence
• The separation of different types of violence into silos
• Disproportionate effects on the most vulnerable with the least influence
• Issues of privacy
• Stigma and a fear of reporting

Speaker Eesha Pandit of Breakthrough spoke about the Bell Bajao! campaign. The message in this campaign is carefully framed to push the audience to make a conceptual shift from placing the responsibility for violence prevention on the government to putting that responsibility on individuals, because it allows people to engage with these issues from where they are.

She noted that another key component of the campaign is its effort to use culture to change culture. She said that media, arts, and technology can be used for more than just to improve productivity and disseminate information; they can also be vessels for communicating cultural values, such as human rights. She emphasized that their program “transforms the way people think about domestic violence by pervading the culture in that way.”

Third, she stated, “We really believe that everyone needs to be a part of the solution… . Having an intersectional approach to identity is really the core of this work. Asking men and boys to participate in ending violence against women is not only about stopping violence against women and empowering women but also about changing the way we think about community and accountability and identity. It moves us from this us-versus-them model of rights and rights violations.” Thus, this type of framing shifts the paradigm away from a victims-and-perpetrators model into a paradigm about collective and shared responsibility and reimagining a community.

Dr. Carta discussed the paradox that the highest-risk families have the greatest need for effective parenting intervention, but those parents are the ones who are the hardest to keep engaged in a series of home visiting interventions. Given this situation, Dr. Carta and her colleagues created a mobile phone component for their intervention that aimed to teach parents positive ways of interacting with their children in the hopes that the mobile component would increase the participation rate.

Ms. DeCherney discussed the need to frame the conversation around healthy relationships rather than only reacting to a victim or someone who is being victimized in a relationship. Breakout leader Eric Brown of Impact-Games discussed the importance of knowing the audience in order to help frame the conversation.

Mr. McCannon commented that it is important to understand that people are inundated with information, and that the creation of new information is incentivized. However, less effort is put toward translating the information into action or taking something to scale. This is changing, and technology can be part of creating new incentives because of the ability to use more existing information. Mr. McCannon also noted that when framing messages, people need to consider how assumptions can change. For example, assumptions about how long something can take to develop can be challenged in situations where an urgent need drives the creation of a disruptive innovation, so assuming that everything takes time can limit possibilities. On the other hand, rushing to push new products or interventions can backfire when quality improvement, monitoring and evaluation, and adaptation are not included in the design.

BOX 5-1

Key Messages Raised by Individual Speakers. It is important first to have a deep understanding of the audience and the desired outcome and then to approach the solution technologically, if there is a technological solution. Existing self-organized and (more...)

Footnotes

1

The infosphere is the informational environment in which entities, processes, and interactions related to information exist.

2

An information organism is an entity interconnected with other information organisms that operates through the use and sharing of information.