The First Step

If I were to say `God why me?` about the bad things, then I should have said, `God why me?` about the good things that happened in my life. - Arthur Ashe.

Medical practice is inundated with the breaking of bad news to people. Right from the beginning of training, this act of empathy is imbibed into healthcare professionals, which eventually develops into an art. The reaction of patients and their families are varied, which never follows a pattern. The apparently stoic person may break down a few days later, some react with shock, despair, disbelief, denial and helplessness while others are positive , organising their lives with the available and seeking further resources. The diagnosis of a chronic disease is sometimes nothing short of a bereavement.

An often overlooked aspect is preparation and education of the individual. Though it is imperative that the population is aware of the disease process, it is more vital that actions are shown by results on the ground. Our experience over two decades shows that on average the person is aware of diseases, but is confused with multiple messages and information overload. Though we would expect the younger generation to be more suave in specific instances it has been proved otherwise. A 28 year old software engineer, a newly diagnosed diabetic with a foot ulcer believed that all he needed was healthy diet and exercise and he would be cured. A 45 year old gentleman diagnosed with diabetes was in complete denial because he had never taken any sugar with his drinks and believed that his diet was healthy. A 58 year old diabetic person wished to sue the car manufacturer following an accident because believed that the brakes were faulty. He had been a diabetic for 15 years and was on insulin. Three of our close friends and family have been found dead in their homes. They were all on insulin for diabetes of long duration. One of them was a widower and the other two had a tumultuous relationship with their wives over the past year and had been living separately. A 58 year old billionaire businessman was suddenly admitted for diabetic coma. He had not checked his sugars for the past 2 years and did not know his dose of insulin.

It is easy to fix blame on anybody, the person delivering the messages, education delivered, the person following the instructions or even the people aiding them, but the fact remains that in this conundrum, lives are being changed and lost. This means that this entire system needs to be looked at more closely and carefully and the process tailored in such a way that process is simplified keeping in mind individual perceptions and ability to take appropriate action.

The first step in this process is preparing the population to a likely eventuality of developing a chronic disease. In a departure from traditional measures is a newer method called social marketing, which applies commercial marketing strategies to promote public health. Social marketing is effective on a population level and healthcare providers can contribute to its effectiveness. Social marketers use a wide range of health communication strategies based on mass media; they also use mediated (for example, through a healthcare provider), interpersonal and other modes of communication and marketing methods such as message placement (for example, in clinics), promotion, dissemination and community level outreach. Multimodal communication channels including electronic and social media are very useful.

One of the key decisions in social marketing that guides the planning of most health communications is whether to deliver messages to a general audience or whether to `segment` into target audiences. Audience segmentation is usually based on sociodemographic, cultural and behavioural characteristics that maybe associated with the intended behaviour change. Social marketing is an effective way to change health behaviour in many areas of health risk. Doctors can enforce these messages during their direct and indirect contact with patients.

The goal of social marketing is not just to make the population aware, but inspire people to make appropriate changes to their behaviours for better health and in the event of a diagnosis prepare them to rapidly adjust to a lifestyle that is conducive to the problem.

This process is easier said than done. A prescriptive attitude maybe met with resistance and failures and such campaigns need to be pragmatic and iterative so that failures can be addressed with better strategy
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