Demand promotion, trust and the trouble with information environment
A part of the talk I gave today at the infodemic management masterclass organized by CAPHIA focused on what demand promotion means in health, how it intersects with trust and how the information environment makes everything more complicated for health authorities.
I often say that promoting an health product of health service is not analogous to commercial products or services.
Demand promotion of a health service or product is probably the most defined in vaccine demand promotion, where there’s been an increased recognition that successful immunization programs line up vaccine supply, access, and vaccine demand. Immunization professionals have recenlty been broadening the focus from vaccine hesitancy to look at more factors influencing vaccine confidence and uptake as part of vaccine demand promotion.
But in other health programmes, the formulation of demand has not yet been as advanced. But it’s useful to look at demand promotion in health context.
Demand in health consists of three components
When promoting demand in health we are trying to remove asymmetries in
- adherence to health guidance
- demand for health services and products, and
- demand for health information
The first one is a “push” factor, where the health system is asking people to do something. The last two are “pull” factors where the people are expecting something from the health system.
The goal of demand promotion is to achieve better alignment, so that the health system satisfies the pull from demand for products, services, and information and aligns it with pushing health-protective actions through guidance.
This dynamic of push and pull components in demand is important to understand.
Demand promotion hinges on trust
Trust is an exchange, and we need to reinforce that cycle of exchange.
For example, we pay taxes so that we have a functioning public health system. In turn, the health system is trying to protect us and if we trust it, we can make decisions that do not just protect our own health but also the health of other people in the community.
Every interaction we have with people and organizations around us can reinforce or erode trust.
Another way to look at it is that mistrust is the outgrowth of the perception that promises were broken and values were violated. If the health system doesn’t offer services that people want or demand, it is not fulfilling its promise and not offering services that are aligned with people’s values.
This is also true for health guidance. People will be more likely to follow health guidance if it is done to maintain a promise – protect people’s health from hazards they can’t control, especially if the guidance can be followed and it is aligned with people’s values.
But health guidance is often confusing or unclear to people in specific communities. An example of such a situation is COVID-19 guidance, which was expecting people to isolate at home without recognizing that in an urban slum, running water might not be available and that people live in multigenerational households – so isolation at home just was not realistic there. Guidance should have addressed that.
Trust has directionality and is not built in isolation from environmental influence
There are any dimensions of trust (who or what to trust) and it can be influenced by, for example, a person’s ideology, culture, experience with the health system, access to health services and products, and literacies (digital literacy, media literacy, information literacy, science literacy, health literacy)
Trust is a process, not an end state that we strive for – and it can be influenced by external factors
For example, the trust that is built can be hijacked.
Think about that example of TokTokers impersonating healthcare workers online to peddle scams for non-evidence based cures and products. They are misusing the trust healthcare workers enjoy form patients to scam people.
On the other hand, where there is mistrust, this can direct people into beliefs and behaviors that can reinforce this distrust. It makes it mush harder for health authorities to rebuild the trust.
An example here can be low vaccination acceptance among some groups of people. This belief contributes to lower vaccination rates in some areas and leads to outbreaks of diseases that were previously under control, like measles.
For those already skeptical of the health system’s motives or competence, an outbreak can be seen as validation of their fears. When health authorities manage outbreaks through measures like mandatory vaccinations or restrictions on unvaccinated individuals, this can lead to backlash from those who view such measures as coercive or infringing on personal freedoms. So this push and pull could confirm the skeptics’ fears and justify their resistance, creating a self-reinforcing loop of skepticism and mistrust.
Demand, trust and the information environment
How might the online information environment affect conversations and information seeking and misinformation about these topics?
Well, how people talk about a topic can change adherence to health guidance, demand for health services and products and demand for health information.
This makes it even more important to understand people’s concerns, questions, and information needs so that our efforts to align the demand components aren’t derailed by the conversations and dynamics of the information ecosystem.