Role of Health Journalism in Promoting Communication among Stakeholders in Healthcare Sector

The concept of stakeholder participation has attracted considerable attention in recent years among health researchers especially in its perceived role in advancing knowledge economy which is fast becoming a key driving force in global healthcare sector and development. Knowledge dissemination among healthcare stakeholders has been greatly facilitated thanks to the remarkable progress of information and communication technology. However, there remains huge scope for improvement in terms of increasing South-South and North-South cooperation in healthcare communication. In order for healthcare service industry in emerging economies stay competitive in today’s complex and volatile economic environment, understanding the interest of different stakeholders, and how their influence shape various domains of social development is crucial. The magnitude of the task is overwhelming and success will depend on integrative approach by local and international actors in strategic decision making and translating to concrete policy framework which will provide the key for long term success for healthcare institutions. The present study draws on key messages regarding the necessity of cross-professional communication in health sector development by synthesizing insights from the existing literature. The authors underscore the role of health journalism as a potential instrument for strengthening health policy advocacy, developing international standards in communication and more effective knowledge management.


Introduction
Public health is more than ever a concern for all governments of the world, both in developed and developing countries. In today's world, nothing is more international than health; no other aspect of modern life is as profoundly impacted by globalization as public health. This fact is immediately recognizable by the growing homogeneity in disease pattern across different world regions. For instance, diseases such as diabetes and cancer used to be regarded as the diseases of affluence which are the characteristic of western societies. In only a matter of three decades the diseases of affluence have become the major cause of morbidity and mortality in the third world countries [1][2][3].
In the face of emerging global challenges including changing epidemiological pattern, increasing prevalence of chronic noncommunicable diseases (NCDs), shift in dietary pattern and its consequences on obesity and associated diseases, and the spread of HIV going unabatingly. Among the strategies to overcome

The Complexity of the Healthcare System
The healthcare system is by nature a complex one with numerous inherent perplexities that overwhelm the stakeholders engaged in the industry and in which almost every aspect is overseen by one regulatory body or another. Previous researches have revealed the historical roots of this complexity as interplay between intergenerational socio-political forces which continue to mark their effect in modern society. Health care professionals are said to feel that they spend more time complying with the intricacies of the system that direct their work than the work in its actual form [9]. Whether the complexity adds positive substance such as increased efficiency and better regulation of resources remains to be explored. However, the possibility of overcoming the complexity and the underlying shortcoming presents a more immediate imperative. Healthcare industry is unique in the sense that every attempt it takes must be made fruitful as nobody would like to see their health rights being compromised by any factor even if it is congenial to socioeconomic growth and might pay off in the long run. Issues related to health, therefore presents an immediate concern that needs to be dealt with immediacy and with due priority and making sure that the principles of health equality are respected as well [15]. Even if the health care succeeds in providing acceptable quality and access at an affordable cost, the healthcare culture would face disruptive, discontinuous change due to want of expert-based practice for which health professionals need to emphasize in their effort to preserve the best organizational culture [16,17]. Another crucial factor which makes healthcare an especially complex one is the apparent difficulty in its interoperability with other branches of science. The application of information technology (IS) on healthcare system, for instance is an arduous endeavor. Researchers in this sector have been appreciative of the individual roles and values and the context of the setting, and itemizing generalizability. Moreover, the entire theoretical base of the IS sector is based on organizational culture, their business processes and interaction with stakeholders [18]. Because generalizing healthcare in the context of IS research would require reflection on their suitability. For instance, hospitals, emergency rooms, and laboratorial environments are structurally different from business, and therefore successful implementation would require understanding the healthcare setting before they can be applied to IS theory [18]. The subject matter of organizational these health issues, the media are widely used by government agencies and organizations, international agencies and nonprofit organizations to bring people together whether they are local, regional, national or international, to reach a state of complete physical, mental and social well-being. Though health communication for ameliorating population health is considered sufficient to meet the challenges of inadequate communication among different stakeholders, the limitations of this construct are becoming apparent which warrants for more cross-cutting intervention strategies [4]. There remains no doubt that effective communication is a powerful engine for health promotion [5], however it should be kept in mind that communications is not an end in itself. The purpose and utility of this construct can be fully exploited in a global context in which health is regarded as a prime concern for all development policies. Health communication is necessary but not enough to generate the impacts on associated societal and political elements which impact every aspect of human life and well-being [6,7]. The challenges encountered by healthcare institutions are multifaceted and extraordinarily complicated which necessitates an integrated public health by integrating cross-disciplinary expertise, coordination, and policymaking. To this end, national governments have to focus on developing policy capacity by incorporating health journalism and stakeholder communications across various sectors of health research [8].

Identifying the Key Stakeholders in Healthcare
Stakeholders of healthcare are diverse in nature and functionality and their connection and role in the industry. The different actors or stakeholders across the healthcare continuum hold a unique position forming a large set of network which interacts to keep the system functional and maintain a regulatory compliance with sectors of the economy. Though health sector is a traditionally a state driven force, with the expansion of capitalism and consequent engagement of non-traditional actors the complexity of the system grew more pronounced. In USA, for private regulators began to engage with healthcare sector in the early 20 th century [9]. The event is concomitant with the expansion of political and economic prominence of the country at the global stage which is felt till today. The efficiency of the sector remains subject to debate as it is underperforming comparing to most other developed nations who invest less on their health. Despite this fact, in terms of advancement in biomedical engineering and biotechnology industry [10], the country stands out as a global leader. Whether or not this achievement is credited to the inductive force of the nation's economic prominence, the healthcare sector as a financial one has been noticeably successful especially in its contribution to the progress of the knowledge economy. Knowledge economy emphasizes on generating social and intellectual capital, which, unlike the traditional factors of production are not alienable, however essential to fostering innovation which is the key challenge of the knowledge-based economy [9,10]. In the USA, most public health programs, including sanitation, restaurant inspections, and investigations of epidemics, are the responsibility of state and local regulators, but the federal Centers for Disease Control and Prevention (CDC)

Journal of Healthcare Communications ISSN 2472-1654
culture is rooted to the se of values shared by individuals within the organization such as, the established routines, traditions, ceremonies and reward systems, the manner in which people understand, describe and make sense of their working context which acts as a kind of social and normative glue [19,20].
Organizational culture accommodates the individual value setting in the professional sphere and the narratives that they take into account to make sense of their organizational behavior [20] ( Table 1).

Stakeholder Communication Management: Prospects and Challenges
As mentioned in the section above, health care is becoming more complex across all disciplines, at all levels [21]. These factors that drive this complexity include civil society, social justice, and the public sector and over the past decade in particular, these factors have been greatly affected by the hegemonic influences of growing knowledge-based economy and the philosophical assumptions and influences that are impacting directly on how the health system is evolving [22]. Successful stakeholder communication is contingent upon the proper selection of the target, the contents and the rationality of the message it conveys where mutual trust plays a seminal role [23]. As the number and complexity of stakeholders in healthcare sector has been increasing, it presents significant challenge and opportunity at the same time. The challenge of coordinating the complex set of functions at different levels can be overcome by a systematic approach and employing a solution oriented perspective. Health communication has always been facing countless challenges especially regarding designing and disseminating health messages. Although problems can be attributed to many a factors in this area, but the most critical issues usually evolve around the gap between health literacy and health communication, difficulties and inefficiency in communicating through the tools and channels of mass media, and the lack of well-trained professionals. Literacy-communication gap being one of the most pertinent challenges, health journalism -or 'health communication' to be specific, faces a general gap in people's health literacy. Effective and appropriate use of health communication can efficiently ensure health literacy among a certain population. Another challenge for health communicators or journalists is to deal with unexplained medical jargons and poorly designed messages. Often the message designers are unaware of, or they fail to perceive, the general educational level of the target audience while preparing them. This leads to the educational gap that occurs while communicating health information among mass people. If people cannot understand the messages, they are never going to be aware of health issues -no matter how critically necessary.

Role of Health Communication, Research and Training in Promoting Health Messages
Health communication necessarily promotes health information usually through public health campaigns, health education. It includes the relationship between doctor and patient as well.
Key purpose of communicating health information is to influence personal health choices. And the best way for health journalists to achieve this purpose is by improving health literacy.
It is expected that effective health communication be tailored for a specific audience within a given context.

Area of focus Function
Community health workers (CHWs) [24] Multidisciplinary care teams in primary care settings Improved patient support at grass-root level, managing risk factors, help addressing the sociocultural determinants of health and illness, connecting community members with top-tier health care providers Chaplain/religious workers [25] Psychological betterment, professional / nonprofessional settings including home and religious establishments Spiritual and emotional support, mental backup in severe illness conditions, raising awareness against health and food related superstitions, stigma around certain types of diseases

Healthcare information system developers [26]
Information management, data integrity, patient confidentiality, patient-centered health care.
e-health and m-health, Cloud Computing in Healthcare, facilitating the distribution of health and diseases related information, special care and knowledge dissemination for rare and emerging diseases. Civil society organization (CSOs) [27] Meeting community/ environment specific healthcare needs Addressing the healthcare challenges for the disadvantaged neighborhoods, developing human rights based approach to healthcare, highlighting the special need for conflict and disaster prone areas.

Health journalists [28]
Mass media, healthcare communication, health education Scaling up interaction and communication across the continuum of healthcare stakeholders, bridging the gap between healthcare systems and policy makers, highlighting human rights, gender and health inequality related issues, maintaining effective commination between development actors at national and international levels. practices demonstrate the benefits of behavior changes to public health outcomes increase demand and support for health services help the concerned authorities understand the necessity of increased numbers of platforms (i.e., websites, software/ apps) to be initiated, and increase access to them increase ethical and responsible reporting on health-care issues widely covering issues regarding best and accurate use of medicines Keeping the society aware of issues regarding the broad context of medicine use, risks of medicine use, non-drug alternatives etc. [20]. Diminish misconceptions about different health issues, and above all advocate a position on a health issue or policy/strategy.

Entertainment media
The entertainment industry has always been much utilized as a platform for advocating information across the world. Educating mass audience through messages designed and imparted in entertaining ways has become increasingly popular in all parts of the world. Entertainment makes learning fun which makes information easy to communicate. Animation series 'Meena' is a strong example of effective communication of messages carrying information of social values including education and health as well.

Social media marketing
Social media, now-a-days, has become one giant factor of advocacy regarding a variety of issues. Social network platforms, and even SMS services of mobile phones, have become widely used tools of mass communication. Particularly of social networking platforms, they are almost perfect tools to reach variety of audiences -even of specific choices, if necessary.

Interpersonal communication
It is often said that the best form of communication is done through interpersonal interactions; health communication, as well, can be made successful through strong interpersonal communications. And interpersonal communication is considered as the strongest method of effective communication because it can significantly influence decisions and behaviors of the audience than others do. Interpersonal communication allows intimate interactions between an individual (such as, a patient) and his/her health care providers like physician, therapist, pharmacist, and nurse.

Media-mix approach
A mixed-media approach is always a good thing applies; media-mix approach integrates a synergy effect which produces much more and better results than any single medium can. So, a combination of different forms of communication (e.g. interpersonal, group, organizational and mass) can be tried to reach different segments of a population.

Concluding remarks
Despite having made great leaps in science and technological terms, global healthcare industry of today is faced with host of policy infrastructure and management related conundrums. The persistent challenges in healthcare knowledge management stems from the oversight of the complexities system which necessitates contextualization of the underlying factors in a wider national development agenda. Healthcare is a continuum of structures and principles enshrined in a normative and operative framework aiming to interact in harmony, and attainment of which hinges on the mutual adaptation with other areas of the knowledge economy. Developing a knowledge-based economic system by leveraging social capital and underpinning research and organizational culture holds great promises to overcome the most pertinent organizational and communication issues global health. More in-depth engagement of cross-professional stakeholders is desirable to ensure best practice and harnessing the benefits of collective approach. Mutual collaboration for wealth and knowledge creation and management within the healthcare industry can be greatly facilitated by the active involvement of health journalism which is still a largely unexplored domain in the context of developing countries. In addition, health journalism has a lot to contribute in bridging the gap between global north and south in terms of cooperation in healthcare research and exchange of information and expertise which are fundamental to the advancement of knowledge economy.