Matthew Kreuter

Public Health Post: What is your research group’s approach to studying health communication?

Matthew Kreuter: We think about how communication and technology can help address inequalities. We have to first increase the reach of information to populations that are in traditionally information-poor environments. Secondly, we must make information more effective, and we do that by making it meaningful in the context of people’s lives. And third, we must think about how we can use communication technology to actually link people to needed services, whether those are health services or social services. Overwhelmingly, the work we do is community-based intervention.

What are people’s unmet social needs? How do these impact their access to health information?

Our research aims to improve the lives and health of low-income Americans. In many low-income populations, they are dealing with bigger problems than health. The most common one is housing. So, can people afford their rent? Do they have stable housing for the foreseeable future? Do they have enough space in the house? Is it quality housing? Other social needs would include food, transportation, and household needs. Or even having enough money for some unexpected expense.

The environments around people and the demands of daily life make it less likely that some people will encounter or even have the luxury of processing information about health. Because honestly, if you’re trying to feed your family, if you’re wondering where you’re going to stay next week because your housing situation is unstable, if you’re sending your kid off to school and you’re worried about whether they’ll make it there and back safely, getting a mammogram is just not that important.

Why might people with unmet social needs not act on certain health information or believe inaccurate information?

When we ask people about specific health information, there’s always a “Not sure” answer. It’s easier to move somebody from “I don’t know” to understanding what’s accurate than if they believe something that’s inaccurate. It’s harder to persuade someone if what they believe is counter to that to begin with, and even harder if their belief is based on experience.

There is also a history of some groups being misled by organizations that deliver health. So, trust has always been an issue in addressing health inequalities. And now, with all of the misinformation that is spreading through newer technologies, faster, and further, that mistrust becomes more problematic.

Why is tailoring necessary to communicate health information to those with unmet social needs?

When I was a doctoral student, we were experimenting with customized messages for individuals. We found that this worked better than giving people a one-size-fits-all approach.

Now, customized messaging is the basis for all of the algorithms that push messages to people in their online lives. It’s being used to sell products or ideas or misinformation. The lesson there is that customization matters, and knowing your audience matters.

When people perceive information to be relevant to them, their cognitive processing goes deeper. They tend to think about it more deeply, and remember it longer. If we’re talking to a particular population with a particular set of shared attributes or beliefs, we will make sure that content is familiar and aligned and resonates with them.

Will artificial intelligence (AI) be used to cater health messages to people?

It already is. When ChatGPT rolled out, one of the first things our research team did was have it generate responses to both accurate and inaccurate requests. I came away pretty impressed that what it generated was accurate.

But, accuracy is not the same as being compelling. There’s an art to communication about health. A colleague of mine in our English department says “AI can generate coherent sentences, but does it really have something to say?” You’re not likely to get compelling messages from current AI.

What are the next steps in ensuring equitable access to health information?

Public health currently lacks the systems to connect people in their daily lives with accurate and useful information. One of the ways we’re trying to do this is to set up community-level listening infrastructure to get an idea of what people are hearing in their daily lives, what they’re thinking about, what they understand and don’t understand. And then, in partnership with a whole bunch of community partners, we can push out accurate information that people want and need. If you know this, if you believe this, if you understand this, if you act on this, there will be benefits to you and your family. We need to get there, as a field.

Dr. Kreuter spoke more about his work at Boston University School of Public Health’s Public Health Conversation, Uncertainty, Trust, and the Future of Public Health Communication, on April 2. Revisit the conversation here.

This interview has been edited for length and clarity. Photo provided.