Settings: Finding the Audience for a Health Care Quality Report

Reconfirming Who Your Audience Is

Before you can identify appropriate settings, you need to have a clear and shared sense of the audience you are trying to reach. Assuming your resources are limited, you’ll probably need to set priorities within what could be a very broad audience.

Here are some examples of segments you may want to focus on:^[1]

• People who are not seriously ill, but who know they will be using health care in the next few months or year. Examples include:
  • Women who are pregnant or planning to become pregnant very soon.
  • People who are planning to have an elective surgery, such as a joint replacement.
  • People who recently moved to a community and need to find a primary care provider.
  You may need to extend the audience to include family members and close friends who can help fragile consumers deal with their health problems.
• People whose health problems are most pressing and serious. These people have the greatest need for comparative quality information, which is likely to be of high interest and significant value for them. Also, they use a disproportionate amount of health care services, so influencing them has a high potential impact.
• People with chronic conditions. People with well-managed chronic conditions may be both highly motivated and quite able to use quality information. However, some people in this segment can be difficult to reach, largely because people who are extremely ill may not have the energy and ability to focus on comparative quality data, even if the data are specific to their condition. You may need to target a secondary audience of people who help those who are very ill, frail, cognitively impaired, or otherwise unable to use your report.

Identifying Settings for the Chosen Audience

Start by answering these basic questions:

• Where you are likely to find the audience you are focusing on?
• Where can you reach them with your communications?

Your initial audience research should have identified all the places people go for health information, what kind of site or location they will most likely access, and which they are most likely to trust. In addition to the home—which increases the chances that multiple family members will see the material—other potential sites include clinics, physician offices, workplaces, educational institutions, and public libraries.^[2]

A setting does not have to be an actual place. Web sites that your audience tends to visit, for example, are valid settings for this purpose.

Assess the Merits of Each Setting

The presence of your audience in a given setting is not enough in itself. Distributing reports in the workplace and the home, for example, is not always effective. For instance, when children qualify for Medicaid benefits, the parent is the decisionmaker and thus the audience for any information on health care quality. Direct mail to the home is a common distribution method, but many government agencies have found that the response to mass mailings is poor, suggesting the need for a different approach.

Have the following questions in mind as you consider each location:

• Where will they expect to find this kind of information?
• Where will your audience be receptive to your message? Where will they be most attentive?
• Where will they find the message to be credible? What settings might arouse skepticism?
• In what setting do you have potential partners who will help you deliver the material? What will they need in order to help you?
• Where can you reach the people who are influential in the community?

To reach low-income women and children, for example, you can focus on organizations like schools and day care centers, libraries, Head Start program offices, community health clinics, and other public health programs. To reach Medicare beneficiaries, you might want to distribute your information through hospitals, home health agencies, senior centers, lunch programs for the elderly, people who visit the home-bound, and other community-based organizations that serve this population.

Every audience is different, so don't assume that what works in one community will work in another. If possible, test your assumptions about promising settings with a sample of your audience to ensure validity.

Example: Finding Medicaid Beneficiaries Where They Already Are

The Community Service Society of New York reached out to Medicaid beneficiaries by engaging community-based organizations (e.g., adult learning centers, social service providers, public health facilities) to host free workshops to educate people about managed care. To select organizations that could offer access to its target audience, CSS looked for ones that served its client population and provided educational programs, information, and resources, but not clinical services. They found that the programs were most successful when conducted either before or after some other event that people were already attending (e.g., before a literacy class).

^[1] The guidance on this page draws from Sofaer S, Hibbard J. Best Practices in Public Reporting No. 3: How to Maximize Public Awareness and Use of Comparative Quality Reports Through Effective Promotion and Dissemination Strategies. Rockville, MD: Agency for Healthcare Research and Quality, June 2009.
^[2] Several report sponsors—including the California HealthCare Foundation, Puget Sound Health Alliance, and Pittsburgh Regional Health Initiative—have used libraries as a way to reach their audiences. While the use of public libraries as a setting for quality reports has not been formally evaluated, their accessibility and mission to support public access to both print and Web-based information make them well suited for this purpose.