“Public health without effective health communication is really nothing”: Key informant interviews and thematic analysis as part of a multi-step research process to develop modernized public health communication competencies

Abstract

Background:

Communication is central to effective public health practice, with all roles and functions requiring proficiency in communication. A competency-based approach to public health enhances workforce development and helps ensure adaptability and collaboration by equipping professionals with the practical skills needed to address complex and evolving public health challenges, including through communication.

Methods:

Semi-structured interviews and reflexive thematic analysis were conducted to explore the perspectives of public health communication experts (researchers and practitioners) regarding the importance of public health communication, the challenges and opportunities faced by the field of practice, and the specialized competencies required for strengthened communication in modernized public health practice.

Results:

Twelve key informants were interviewed, and seven interrelated themes were generated from the data. The themes were organized in three main areas: the importance of public health communication, the various levels of influence on effective communication, and the support needed for strengthened communication capacity. Participants stressed the importance of partnerships and collaboration, dedicated resources, ongoing professional development, and tools to facilitate the implementation of the specialized competencies.

Conclusions:

A competency-based approach, including specialized roles and education and training programs aligned with updated communication competencies, will empower public health to tackle modern challenges. This research contributes to a multi-step research project to develop a Canadian public health communication competency framework and supports ongoing efforts to strengthen the public health workforce in Canada.

Keywords

public health health communication public health communication competency-based approach public health competencies

Introduction

Effective public health communication, grounded in a robust competency framework, is critical for addressing complex public health challenges by fostering participatory, equitable, and proactive actions. It is both the science and art of creating, disseminating, and evaluating health information for diverse audiences to advance health.¹ It involves an exchange of information and uses communication strategies to promote health-protective behaviors.² Public health refers to the collective of organizations and professionals that work to keep people healthy and prevent illness, disease, and premature death.³ (Re)Building trust in public health through communication requires tailored and collaborative approaches to engage diverse communities.⁴ By tailoring communication to the values and needs of communities, public health can better address health inequities, making a participatory approach increasingly essential.⁵

A competency-based approach in public health is outcomes-based and population-centered and tailors education and training to meet the demands of complex challenges.^6–8 Competency frameworks provide guidelines that facilitate the application of competencies in practice,⁸ from local to global organizations, as well as specific public health disciplines such as health promotion and environmental health.^9–13 Competencies are the values, knowledge, skills, and behaviors required to perform effectively.^8,14–16

In Canada, the Core Competencies for Public Health were released in 2008 and provide the building blocks for effective practice across all public health roles and core functions.¹⁵ There have been many calls for modernized and strengthened competencies for Canadian public health,^17–19 including within the communication domain.¹⁹ The public health response to COVID-19 brought to light some key communication challenges, including mis/disinformation, malinformation, large numbers of messengers and channels, and the speed of information creation and dissemination.²⁰

Both core competencies and specialty competencies are necessary to effectively perform across the range of functions and positions in public health practice and to guide training and education. Specialty competencies include specific knowledge related to professional activity,¹⁴ such as leadership, epidemiology, and public health communication. They allow public health practitioners to build upon core competencies for additional mastery.²¹ A public health communication competency framework would guide curriculum and professional development in this essential domain.

Despite the importance of public health communication, at the time of writing no specialized competency framework exists in Canada on the subject, and to our knowledge, only one other has been created, although it focused on the US and was conducted prior to many lessons learned during the COVID-19 pandemic.²² The current qualitative research is part of a larger body of research building toward Canadian public health communication competencies, which has also included gathering perspectives on communication competencies from the Canadian public health workforce.²³ This work explores expert perspectives regarding effective public health communication and the associated competencies required by the public health workforce. The objectives include:

Understand the importance of public health communication in practice;

Identify current strengths and weaknesses and future opportunities and challenges for improved public health communication practice;

Explore the competencies necessary for modern and effective public health communication practice; and

Explore the supports needed for effective implementation of a modernized public health communication framework.

Methods

This research used semi-structured interviews with key informants who have considerable expertise in public health communication research and/or practice. Reflexive thematic analysis^24–26 was conducted on interview transcripts to examine the current context related to public health communication and what is needed for more effective and modernized practice. The research is described according to the Consolidated Criteria for Reporting Qualitative Research (Supplemental 1: COREQ Checklist).²⁷

The research team is located in Ontario, Canada, and is composed of individuals who identify as both women and men and have expertise in public health and health communication. Collectively, the team brings interdisciplinary experience spanning qualitative and mixed methods research, public health education, risk and crisis communication, health equity, and public health practice. Team members hold academic and practice-based roles, with prior experience working in local and provincial public health agencies, non-governmental organizations, and policy advisory settings. A1 and 3–5 hold PhDs in public health and epidemiology. A1 and A2 hold Master of Public Health degrees. These positionalities may have shaped our assumptions about the importance of communication in public health systems and our attentiveness to themes related to credibility, community engagement, and systems-level change.

The key informant interviews are part of a multi-step project to build consensus for a modernized and strengthened public health communication competency framework. The subsequent and final step of this research was to revise and finalize the competency statements in light of the interview data presented here and the results from a modified Delphi technique.²⁸

Ethics

Ethical approval was obtained from the University of Guelph’s Research Ethics Board (#23-06-004). All participants provided written informed consent, in addition to interviewers summarizing the informed consent information before each interview began, allowing for questions from participants and allowing for withdrawal up to when interview data analysis began.

Participants

Potential participants were eligible if they were considered to have considerable expertise in public health communication research and/or practice with relevance to Canadian public health, as demonstrated by publication of scholarly and/or gray literature on the topic or demonstrable experience working in public health communication directly. Purposive sampling was used to recruit individuals known to the research team from previous environmental scans of scholarly literature and gray literature on public health communication within this multi-step research. Snowball sampling was used with identified participants who recommended others with related expertise. Direct emails inviting participants were sent from the Principal Investigator, A5, with informed consent materials attached. Up to three email reminders were sent to participants, inviting them to participate. Participants had to be 18 years or older, either working in public health in Canada or possessing expertise in public health communication in North America, and proficient in English. Participants from outside of Canada were eligible due to the international partnership and collaboration that is common in public health, the more recent renewal of U.S. public health competency framework,²⁹ and the use of American public health education accreditation in Canada.³⁰ No participants had a personal or close working relationship with the research team. All participants provided signed consent prior to the interviews being conducted and consented to the audio recording of their interviews.

Interviews were conducted virtually by A5 and A1 on Microsoft Teams³¹ from their home offices with no one else present, enabling key informants from across North America to participate. No repeat interview were conducted. Participants were offered a $100 gift card to an online retailer, and participation and receipt of the gift card were voluntary.

Interview process

The interview guide was developed by A1, A2, and A5, with feedback from additional research team members (Supplemental Appendix 2). It contained questions related to the following: demographics, strengths and weaknesses and challenges and opportunities of public health communication in Canada, the importance of public health communication, competencies needed for modern and effective public health communication practice, and design and delivery considerations for the public health communication competency framework. Interviews took place from September to October 2023 virtually via Microsoft Teams (selected by the participants) on a mutually decided date and time. Clarifying questions were asked by the interviewers and field notes were taken during each interview. The number of participants was shaped by the “adequacy of the data for addressing the research question” as is congruent with reflexive thematic analysis.³²

Data analysis

All interviews were recorded and transcribed verbatim using Microsoft Teams, with participants assigned random identifiers (e.g., Participant 1) by A1. Reflexive thematic analysis of the interviews was conducted using the approach described by Braun and Clarke,^24–26 which recognizes the active role of the researchers in interpreting the data. A1, who has a background in public health policy and communication, led the initial analysis. They began by reading and re-reading the interview transcripts and field notes, making reflective notes on their own assumptions and initial impressions.

An inductive approach to coding the transcripts line by line was then taken by A1 using NVivo 14.³³ The final coding frame was iteratively developed in consultation with A2 and A5, who brought complementary disciplinary perspectives. Throughout this process, the team discussed the analysis and reflected on their interpretation of the participant’s accounts.

Initial themes were generated by A1 and refined through repeated engagement with the data and in light of the research question and study objectives. Themes were then organized into three thematic areas and mapped to relevant system levels to support interpretability. These potential themes were reviewed collaboratively by the full research team (A1–A5), who critically reflected on divergent interpretations and ensured that the themes resonated with the data while remaining sensitive to the broader social and political context. The thematic framework was finalized with input from the team and informed subsequent modified-Delphi surveys and virtual meetings to build consensus on a public health communication competency framework for Canada.²⁸

Results

We conducted 12 interviews averaging 47 min in length. No participants withdrew or did not participate in the full interview. Six participants worked in academia, four in public health organizations, one at an international intergovernmental public health organization (which operates in various countries including Canada), and one in a health communication agency. Six participants work in Canada, five in the United States, and one internationally/globally. Job titles ranged from Professor, Dean, Manager, Social Media Lead, Communications Specialist, and Vice President. The average time the participants had spent in their role was 15 years. Participants had a range of formal training in public health communication, including graduate education, certificates related to health communication and information design, and expertise from on-the-job training and learning.

Seven themes were generated from the analysis, which we organized into three main areas: (1) the importance of public health communication, (2) the individual, organizational, and structural factors that impact effective public health communication, and (3) supports for strengthened capacity for public health communication. Themes were categorized based on the primary locus of change or influence described by participants. For example, discussions of communication skill development and practitioner roles were categorized as individual, whereas themes related to internal supports, tools, and institutional collaboration were coded as organizational. Themes that addressed systemic constraints, political influence, and the need for coordinated infrastructure were grouped at the structural level. Table 1 summarizes the theme area, theme, an illustrative quote, and the system level to which the theme applies.

Table 1.

Summary of theme area, theme, illustrative quote, and applicable system level.

Area	Theme	Quote	Level (individual, organizational, structural)
Importance of Public Health Communication: refers to the competencies, values, and practices of individual public health practitioners, particularly those related to communication skillsets, attitudes, and ethical commitments.	1.1. Public health communication is essential for all functions and roles in public health and the credibility and success of public health efforts	“Health communication is a core strategy across public health and government and the most important asset because it impacts credibility and the impact of their work . . . the one truly renewable and impeccable resource that they do have is their credibility.” – Participant 6.	All
Individual, Organizational, and Structural Factors that Impact Effective Public Health Communication: includes the structures, processes, and cultures within public health institutions (e.g., health units, regional agencies) that enable or constrain communication capacity and collaboration	2.1. Practitioners in public health roles need to possess communication competencies to engage with communities and partners effectively	“It [participatory approaches] is the next revolution in public health. It’s [participatory approaches] a foundational value or an approach in everything that we try to do, whether it’s with the community or whether it’s, you know, with people across your agency.” – Participant 11	Individual
	2.2. Community engagement, equity, and participatory approaches to public health communication are critical to enhancing public health impact	“[Public health’s role is to] be more in tune with the audience and what their real true needs are and how we can support them . . .” – Participant 12	Individual, Organizational
	2.3. Sustained and well-resourced collaborations and partnerships are necessary for tailored, consistent, and effective public health communication	“There is an absolutely essential obligation to build and sustain good, trusting and valuable partnerships with local health providers, local communities, local influencers and opinion leaders and so on. But often what happens is those partnerships are established too late and they’re not nurtured. They’re underfunded, under resourced and undervalued” – Participant 1	Organizational, Structural
	2.4. Constraints from a lack of resources and political influence contribute to ineffective public health communication	“Public health agencies, both federal, state, and local, are expected to do much more with many fewer dollars, and so that just puts a chokehold on everything, including communication.” – Participant 6	Structural
Supports for Strengthened Capacity for Public Health Communication: refers to the broader system condition, such as policy, governance, funding, and cross-sector partnerships, that shape the environment in which public health communication occurs	3.1. Trustworthy public health communication requires an understanding of the information ecosystem, cultural safety, and transparency	“Any whiff that the public or that a stakeholder has that public health officials are withholding or shading information . . . is going to destroy and damage trust.” – Participant 1	Individual, Organizational, Structural
	3.2. Implementation of a public health communication competency framework will require tools and dedicated training	“. . . focusing on prioritization and efficiency-focused communication tools that are quick and easy” – Participant 12	Structural
	3.3. Specialized public health communication education and training are needed to build the required competencies across the workforce	“I’ve noticed people that have been trained in communications, there’s a lot of people that work in public health that came in from communications training, not health communication training, but just general communications that aren’t familiar with the public health approaches.” – Participant 11	Structural

Area 1: Importance of public health communication

Theme 1.1: Public health communication is essential for all functions and roles in public health and the credibility and success of public health efforts

This theme emphasizes that public health communication is both a science and an art that advances population health and well-being and is foundational to the success of public health initiatives. Participant 10 emphasized that “public health without effective health communication is really nothing,” highlighting its centrality and necessity. Effective communication supports individuals and communities in adopting safer, healthier, and more protective behaviors, underscoring its role in public health efforts.

Health communication is a core strategy across public health and government and the most important asset because it impacts credibility and the impact of their work . . . the one truly renewable and impeccable resource that they do have is their credibility. – Participant 6

The process of effective public health communication involves meaning-making between public health organizations and practitioners and communities. It must go beyond mere information transmission by being responsive to community needs. Participant 8 emphasized the responsibility of public health practitioners and organizations “to participate in those public health communication practices [participatory practices] and give rise to this meaning.” The focus on the needs of the communities is not only essential for credibility and trust, but it also directly impacts behavior uptake and the success of initiatives. “Effective communication underpins the work of public health in supporting individuals and communities to engage in safer and more protective behaviours” – Participant 4. These comments emphasize that communication should be understood as a shared process of meaning-making that focuses on the values and needs of communities and thereby increases the credibility of public health and the success of public health initiatives.

Area 2: Individual, organizational, and structural factors that impact effective public health communication

Theme 2.1: Practitioners in public health roles need to possess communication competencies to engage with communities and partners effectively

This theme highlights the need for public health practitioners to possess specific communication competencies that enable them to engage communities meaningfully, advocate effectively, and build credibility. These competencies form the foundation upon which organizational communication capacity and system-wide partnerships must be built. Participants described gaps in specialized health communication competencies that significantly contribute to ineffective communication practices in public health contexts and, in turn, waning public trust. They noted that the communication-focused roles within public health often emphasize public relations and organizational communication rather than public health communication. Public health communication is a unique and multidisciplinary field that aims to influence and empower individuals, communities, and populations to improve health. Participants emphasized that public health communication needs to include a focus on participatory action that involves diverse communities and partners.

It [participatory approaches] is the next revolution in public health. It’s a foundational value or an approach in everything that we try to do, whether it’s with the community or whether it’s, you know, with people across your agency. – Participant 11

The skills required to lead participatory and deliberative processes are complex, communication-focused, and challenging to acquire on the job:

Well-intentioned people, they’re trying really hard. Some of them stumble upon how to do that [engage with multiple stakeholders in meaning-making]. Some of them don’t, and I think there’s a real kind of haphazardness to the way those kind of consultative processes are managed. – Participant 8

Participants conveyed the need for an increased focus on using effective communication to advocate for the value and role of public health to government, politicians, decision-makers, and the community. As Participant 6 observed, “It’s advocacy, it’s policymaker oriented, but it’s very rarely thought of and very rarely practiced.” During the COVID-19 pandemic, public health had an influx of resources and a heightened profile, much of which was directed to communication initiatives. Participants observed that more recently, public health systems have transitioned to recovery and other priorities, such as the health impacts of climate change. They noted that public health has receded to the background within the larger context of government activities and is not as visible:

It’s kind of like being pushed to the side and now there’s other sectors of government that are getting more attention and a lot of this also has to do with, you know, the fact that we’re not that great, actually communicating what we know and what solutions we might have and the perspective that we might have at the table. – Participant 11

It is crucial to communicate the value of public health initiatives and advocate for resources and continued involvement in pressing issues like climate change and housing.

Theme 2.2: Community engagement and a focus on equity in public health communication are critical to public health impact

Public health has a strong community- and equity-focused orientation. Participant 8 noted, “Community-based . . . that’s . . . the strength I’ve always seen more so than in other countries and other models that I’m aware of.” Participants explained that program and local/regional level public health form collaborative relationships with community-based organizations to develop successful programs:

I think that there’s a lot of great collaboration that happens across different types of sectors and organizations . . . things that . . . done really well, are almost like at the program level or maybe even done like regionally you’ll see like a really cool campaign or a really effective rollout of [a campaign]. – Participant 10

A focus on equity, rather than solely on vulnerable and priority populations, has enhanced our ability to understand audience needs and values, ensuring that the appropriate information reaches the right audiences. Participant 12 emphasized that public health’s role is to:

. . . be more in tune with the audience and what their real true needs are and how we can support them . . . because a massive amount of our role in public health is communications and sharing the right information at the right time to the right people.

This equity-focused approach promotes inclusivity and improves the effectiveness of public health initiatives by ensuring responsive and relevant communication. Such collaborative and equitable communication efforts are crucial for public health success, fostering trust and engagement across diverse communities.

Theme 2.3: Sustained and well-resourced collaborations and partnerships are necessary for tailored, consistent, and effective public health communication

This theme explores collaboration as a structural strategy for improving the design, delivery, and consistency of public health communication across jurisdictions and organizations. While trust and community engagement are important outcomes of collaboration and partnerships, the focus here is on the enabling conditions, such as sustained investment and strategic partnerships, that support communication systems. Choosing the right partners and nurturing the relationships are critical to improving communication between jurisdictions, silos, and organizations to meet the information needs of diverse communities. “Collaboration is crucial for communication to ensure consistent and effective messaging across the health unit into the community and across the province” – Participant 12. A consistent and clear approach to public health communication across organizations, sectors, and geographic regions relies on collaboration and partnerships.

Collaboration and partnerships are also essential for understanding the diverse needs and wants of communities, a significant aspect of effective public health communication. However, these partnerships are often reactive and not sustained, limiting their ability to engage communities meaningfully and tailor public health messages to resonate with diverse populations.

Building capacity [through partnerships and collaboration] in community organizations helps public health deliver programming while also developing skills within the organizations. There is an absolutely essential obligation to build and sustain good, trusting and valuable partnerships with local health providers, local communities, local influencers and opinion leaders and so on. But often what happens is those partnerships are established too late and they’re not nurtured. They’re underfunded, under-resourced and undervalued – Participant 1

Participants explained that this leads to the need to rebuild these connections every time a public health action, such as a crisis, arises. Maintaining these partnerships is further complicated by the constant flux within public health and partner workforces; as individuals move to different positions and sectors or leave the workforce, the competencies and relationships also dissipate and must be rebuilt. A strategic approach is necessary:

There needs to be a clear, Pan Canadian strategy about how do we do that, how do we support community organizations both to help deliver the things that we need to deliver, but then also to develop the skill set so that when some when something comes at us by surprise, we’re not then reskilling and continually playing catch up, but that they’re ready to go. – Participant 1

Attention needs to be paid to power dynamics and what is prioritized within the partnership:

We need representation of choosing whose knowledge and whose priorities are most important when working with partners and collaborators. If groups have differing opinions, how do you choose where to head? – Participant 5.

Additionally, fostering partnerships between public health organizations and researchers can support more effective public health action. Participant 1 noted, “I think we are missing really, really valuable opportunities to strengthen system capacity by looking outside of our organizations as opposed to just looking internally.”

Theme 2.4: Constraints from a lack of resources and political influence contribute to ineffective public health communication

This theme includes constraints caused by communication being an afterthought rather than a central component of the larger public health strategy.

I think too often questions around communication come at the end and that leads to a lot of the problems we see with everything from uptake for vaccination to difficulties in other kinds of public health areas. – Participant 1

Participants observed that although the importance of communication for the success or failure of public health initiatives has been clearly demonstrated, there is significant duplication of communication efforts across public health organizations with little coordination at the provincial or federal level. This lack of coordination leads to inefficient communication practices, such as focusing on providing information rather than also engaging directly with communities to understand their beliefs, wants, and needs:

I think during the pandemic, the government made no attempt to construct people’s beliefs about what masks were, why they were good, why they were helpful, and subsequently I think there was not a lot of belief or behaviour change resulted from official public health communication related to mask-wearing. – Participant 8

Participants expressed frustration having to do more with fewer resources, which constrains their ability to communicate and engage with the community effectively. Participant 6 pointed out, “Public health agencies, both federal, state, and local, are expected to do much more with many fewer dollars, and so that just puts a chokehold on everything, including communication.” Although coproduction and codesign are critical aspects of public health practice, the lack of time and resources often makes direct community engagement unfeasible. Participant 2 outlines this issue, “codesign, which I agree is a super important part of our practice, but it’s not always feasible based on timelines, especially if we’re in an emergency.”

Participants explained that political influence on public health further complicates transparent communication: “We’d like to be able to say this, but we can’t for XYZ reason, and those XYZ reasons had more to do with political pressures than with a lack of information” – Participant 1. Participant 3 echoed this sentiment, stating, “So there’s that balance of like we can do the advocacy and we can inform policy and practice, but only to the extent that we are politically allowed to do.”

Area 3: Supports for strengthened capacity for public health communication

Theme 3.1: Trustworthy public health communication requires an understanding of the information ecosystem, cultural safety, and transparency

This theme focuses on trust and transparency as core conditions for effective public health communication. While trust is shaped by communication capacity and built through long-term collaborations, here we explore how trust is actively maintained through culturally safe, audience-centered strategies and transparent communication within complex information ecosystems. Audience-centered approaches are necessary to move beyond just transmitting information to using “broader social behavior change approaches to generate demand for the services and the program” – Participant 11. Participants noted that public health operates within a complex communication ecosystem, requiring an omni-channel approach to effectively reach and understand diverse communities.

I feel like everybody knows that right now it’s doing that [public health communication] in a transparent, trustworthy, tailored, informative and persuasive and impactful way in a variety of channels and recognizing that the things that constitute persuasive, impactful, transparent, trustworthy aren’t exactly the same from channel to channel. – Participant 8

As stated by participants, trust (or credibility) is the most important asset in public health and transparent communication plays a key role in trustworthy communication. Participant 1 noted, “Any whiff that the public or that a stakeholder has that public health officials are withholding or shading information . . . is going to destroy and damage trust.” Practitioners need values like empathy, compassion, reciprocity, and reflexivity to be culturally safe and responsive. Positionality is important for transparency “so that it is transparent where the public health practitioner is coming from and the privileges they hold” – Participant 5.

Public health practitioners also need to stay abreast of the constantly changing environment and counteract misinformation. Participant 9 noted, “They have to consider what other competing messages they’re exposed to and all different channels that they are receiving with different weights.” Further, Participant 10 emphasized the importance of understanding how people use technology and consume information and how this impacts culture, behavior, and health.

Theme 3.2: Implementation of a public health communication competency framework will require tools and dedicated training

Supporting the effective implementation of public health communication competencies in practice will require a variety of tools and multiple levels of integration.

So that’s again like focusing on prioritization and efficiency-focused communication tools that are quick and easy. I don’t want to sound cheap about that, but it’s just that’s for public health units that’s helpful because there’s just so much to do that it’s almost overwhelming. – Participant 12

The tools participants suggested include competency self-assessment tools, guidance on integrating competencies into performance indicators, evaluation, and professional development, examples of competencies in practice contexts, a community of practice for understanding implementation of the framework, and resources for mapping competencies to public health curricula. Moreover, the importance of resource accessibility was emphasized: “So if there is a way to give leaders in public health the tools to take this information and apply it to their teams, I think that would be super helpful” – Participant 2.

Additionally, participants suggested cost-effective training resources such as webinars, factsheets, communities of practice, or social media videos that could help practitioners comprehend and implement the competencies. Prioritization of the competencies with what is needed to address current public health issues to upskill the workforce may also help practitioners focus their limited resources effectively.

Theme 3.3: Specialized public health communication education and training are needed to build the required competencies across the workforce

This theme emphasizes the need for specialized education and training in public health communication to ensure consistent competency across the workforce. Public health communication cuts across all roles and functions, requiring a shared foundational skillset that integrates theory, data, equity, and practical application: “it touches all aspects of public health and every single job in public health” – Participant 7.

. . . when I actually think about the public health professional, we can have very, very different roles and this [public health communication competencies] is in my opinion, such a fundamental skill set. – Participant 11

Specific health communication education and training are crucial:

I’ve noticed people that have been trained in communications, there’s a lot of people that work in public health that came in from communications training, not health communication training, but just general communications that aren’t familiar with the public health approaches. – Participant 11

Public health approaches focus on the population level to address underlying social determinants of health and health inequities.

Education and practice in applying theory, data, research, and lived experience to public health initiatives are crucial for connecting evidence to action. Participants 4 and 6 stressed the importance of building competencies in the practical application of theory, data, and research to practice. “They [public health students] don’t make the connection between the two [theory and practical skills] and I think this is a really important missing part of most people’s training” – Participant 6.

Participants described significant variability in training backgrounds – many professionals enter the field with general communication experience but lack grounding in public health theory and population health approaches. Participant 1 critiqued current approaches:

So what ends up happening is many public health organizations will take somebody whose background is in something else and try and teach them about communication. And my own narrow view is a lot of the time they get it wrong because they aren’t themselves communication experts.

A peer-to-peer training model may be beneficial for upskilling the workforce, where those with particular expertise in public health communication conduct training or mentorship:

because we are actually doing the job, we . . . have a particular expertise around training professionals and helping professionals learn skills that really benefit them in their work because we’re also doing it. – Participant 4

This approach facilitates bringing together diverse expertise, as health communicators are often adept at finding common ground and facilitating discussions.

I think people who are good at that, who are good at health [communication] often can be the ones kind of doing that facilitation, finding common ground because it’s something they are often very good at. – Participant 4

Peer-to-peer training also allows for realistic expectation setting for what can and cannot be accomplished through public health communication in practice.

We need to be aware of the limitations of health communication initiatives- as in they are not the be all end all and can’t do everything. This is similar to the competency about attending to the barriers and unintended consequences of initiatives but more focused on the actual limitations of a campaign, program, etc. and what it can achieve. – Participant 5

Partnerships between academia and public health organizations can also support capacity building in communication across the workforce:

more collaboration, certainly between departments of public health or public health organizations with the universities and university-based experts to support the kinds of things [upskilling, capacity development, surge capacity] that we’ve been discussing. – Participant 1

Participant 1 suggested these partnerships may also help support our ability to connect with communities and the community-based organizations that serve them, in turn supporting more effective public health communication.

Discussion

The current study explored expert perspectives on the importance of public health communication, its strengths and weaknesses, and the competencies needed for improved and modernized practice. Seven interrelated themes were generated, highlighting how communication is embedded in all aspects of public health and is foundational to trust, credibility, and equity. These themes were organized into three domains, including importance, influencing factors, and supports, and reflect a systems-level approach to understanding communication in practice. Our findings emphasize that public health communication is not a standalone function but a cross-cutting discipline that should be integrated across roles and levels of the public health system. This has important implications for how communication competencies are defined, taught, and applied in diverse settings. While this study focused on expert perspectives, participants represented a range of roles across research, policy, education, and practice. Their views reflected both shared priorities and differences shaped by their specific contexts. The results suggest that while a core set of communication competencies can provide a shared foundation, some competencies may require adaptation or prioritization depending on practitioners’ sector, setting, and role.

Public health communication plays a central role in influencing behavior, fostering engagement, and improving population health. Trust is an important outcome of effective communication by public health^34–36 and participants identified trust as the most important asset public health has. Communication directly influences trust and the adoption of health behaviors.^37,38 Trust also creates the conditions by which public health can support equity and develop and maintain mutually-beneficial relationships.^39,40

Participants also discussed the need for public health to be apolitical and the implications of politicization on public trust. While broad social and political reform is beyond the scope of recommendations of this research, the findings suggest that there are practical implications for public health communication. Trustworthiness can be demonstrated through compassionate, timely, accurate, and transparent communication, including how decisions are made and what information and evidence are included in decisions.⁴¹ A renewed focus on public health communication across systems is necessary to rebuild trust and better meet communities’ needs, although, improving trustworthy communication will face barriers such as resource limitations and political resistance.

Transparent communication was discussed by participants as critical to effective public health action. Transparency provides an understanding of how decisions are made, what information was used to make decisions, and why action was or was not taken, strengthening the relational aspect of trust.³⁹ Participants identified values including empathy, compassion, reciprocity, reflexivity, and an understanding of practitioner positionality to enable transparent communication. These values influence the work we do in public health and contribute to ethical practice.³⁹

These findings have implications for how communication competencies can be applied across the public health system. A competency-based approach requires practitioner-level, organizational, and structural strategies to be effective.⁸ At the local and regional levels, public health units can integrate communication competencies into core training and performance expectations across all roles, not only those in designated communication positions. Frontline staff, health promoters, and service providers all contribute to meaning-making with communities and require competencies in audience engagement, cultural safety, and participatory communication. At the organizational level, leadership teams can embed the framework into professional development strategies, hiring practices, and evaluation tools. Participants noted that traditional roles often prioritize media relations or internal messaging, which do not sufficiently support public health communication in its fullest form. These gaps can be addressed by intentionally mapping competencies across roles and disciplines. Finally, at the systems level, national and provincial agencies can invest in coordinated infrastructure to support communication across jurisdictions, reduce duplication, and promote shared language and learning. There have been widespread calls for renewed competencies and a focus on improving communication in Canada.^17–19 There has also been a decline in resources and attention allocated to public health over the years.⁴² While lessons learned from the COVID-19 pandemic and past pandemics emphasize the necessity of effective communication, sustained changes have not followed. Public health faces chronic underfunding and a lack of recognition across government and other silos.¹⁷ Many participants discussed the need for public health practitioners to better advocate for a seat at various tables working on complex issues, such as climate change, and communicate the value and impact of the work of public health.

Participants emphasized that governance and resource allocation must enable participatory and equity-oriented communication. Dedicated resources, upskilling the workforce, and increased capacity across the various levels of the public health system are important features of effective governance.⁴³ Governance should support the ongoing renewal of competencies so that the workforce reflects the competencies necessary to address changing contexts and current public health issues.^43,44 A key aspect of effective governance is also the development of a training platform to support upskilling and ongoing professional development matched to current competencies.⁴³

To address this, participants called for stronger partnerships across community organizations and academic institutions. Partnerships between public health and community organizations can also better address inequities and adapt communication to the contexts and needs of diverse communities.⁴⁵ Strengthening ties between academia and public health organizations was also discussed as a way to strengthen the workforce and the impact of public health. There are many factors that impact strong partnerships, including shared power and resources, clear decision-making and accountability structures, and frequent and open communication between partners.⁴⁶ These factors also extend to building partnerships with academia, where the focus should be on community needs, support for obtaining funding, and shared governance.⁴⁷

Further, engagement with communities using two-way communication and participatory approaches is necessary for effective public health action.⁴⁸ Public health is viewed as having a strong community and equity-focused orientation. Despite this orientation, inequities are widespread in Canada and were exacerbated by COVID-19.^17,19 Racism, colonialism, and inequities related to the social determinants of health are key equity issues in Canada.^19,49 Strategies and approaches to develop audience-centered, trustworthy, and tailored communication are complex and require a range of competencies and supportive environments.⁴⁸

Partnerships between public health and community-based organizations were another key area identified by participants as needing attention. Developing a specialized public health communication workforce will require investment in both education and implementation tools. Competency-based education and training should focus on learning in workplace-like conditions, connecting theory to action, and preparing practitioners to communicate effectively in complex, high-pressure environments.^8,14,50 Participants also highlighted the need for dedicated scholars and programs that focus specifically on public health communication, to support long-term capacity-building and specialization in this field.

Matching curriculum to competencies is an effective practice for developing competencies in public health students and practitioners.^51–53 Curriculum in public health education and professional development must align with the renewed Core Competencies for Public Health in Canada, Release 2.0 and the specialty framework that will ultimately be developed as a result of the larger project this research is part of. Participants also recommended tools for effectively implementing the framework, including training resources and resources for implementation into practice.

These tools must be clearly written and designed for practical use – supporting self-reflection, planning, and ongoing evaluation.^8,14 A competency-based approach requires mapping updated competencies and specialty competencies to roles across public health and enabling performance evaluation.⁵⁰ This approach allows public health to be agile and responsive to current demands.⁸

Limitations and future research

This research used purposive and snowball sampling which may result in a narrow group of participants. Limitations related to participant diversity are mitigated by complementary stages of research including a workforce survey and a modified-Delphi technique which will add depth to the data informing competency framework development. This research included a sufficient number of participants to reach thematic saturation according to Braun and Clarke’s Reflexive Thematic Analysis.³² We did not seek or claim to achieve thematic saturation. Instead, we considered whether the dataset provided sufficient richness and diversity to develop meaningful, well-supported themes. Based on the range of professional roles, organizational contexts, and communication experiences reflected in the interviews, we judged the dataset sufficient for generating a nuanced thematic account aligned with the study’s aims.

Participants were selected for their expertise in public health communication across research, education, and practice. As a result, the findings primarily reflect the perspectives of experienced professionals with deep familiarity with the field. While this offers insight into systemic issues and historical trends, it may limit transferability to early-career practitioners, students, or those in frontline roles. Limited demographic data were collected, and the sample is not necessarily representative of the broader Canadian public health workforce. However, efforts were made to recruit participants with diverse gender identities, educational backgrounds, and geographic representation. The larger research program intentionally sought broader demographic and professional diversity, including varied social locations, sectors, and levels of experience.

Interviews were conducted virtually, which may have affected rapport or the depth of discussion compared to in-person interviews. While virtual interviews increased accessibility across geographic regions, they may have limited opportunities for informal conversation, nonverbal cues, or spontaneous elaboration. Additionally, due to time constraints, interview transcripts and results were not returned to participants for comment or member checking, which may have limited opportunities to confirm or clarify interpretations. Future research should focus on building consensus on and implementing the public health communication competency framework. Research could develop tools for mapping curriculum to competencies, self-assessment of competencies, and performance evaluation. Research to examine how the competency framework is received and implemented into education, training, and practice will further help clarify the next steps required.

Significance for public health

Public health communication is essential for ensuring the credibility and success of public health initiatives. It is both a science and an art that facilitates behavior change and strengthens public trust. To be effective, public health communication must be transparent, culturally responsive, and audience-centered. It must address diverse community needs, emphasizing participatory approaches to co-create meaning. Public health communication should also prioritize advocacy to remain visible in addressing urgent and interdisciplinary issues like climate change. Unfortunately, public health agencies are expected to do more with fewer resources, constraining their ability to communicate and engage with communities effectively. Although collaborative partnerships with community organizations are essential for tailored communication, these relationships are often underfunded and reactive.

Implementing a competency framework, alongside specialized training in health communication, is needed to build the necessary workforce competencies to address modern and complex public health challenges. This study forms a foundation of public health communication competency areas and highlights their critical role in delivering effective public health practice. These findings could inform public health leaders, educators, and policymakers to inform curriculum development, professional development policies, and workforce upskilling.

Conclusion

This research examined the perspectives of public health communication experts, including both researchers and practitioners, regarding the critical role of public health communication, its strengths and weaknesses, and the necessary competencies for improved and modernized public health communication practice. Seven interconnected themes were generated, demonstrating the central role of public health communication in influencing health behavior, fostering engagement and trust, and improving population health. Effective public health communication must be transparent, participatory, and equity-oriented, with an emphasis on audience-centered strategies and partnerships with communities and academic institutions. As the public health system navigates increasingly complex challenges, from climate change to the infodemic, there is an urgent need to move beyond ad hoc communication toward a more strategic, coordinated, and competency-informed approach. Public health leaders should prioritize the integration of communication competencies across the workforce, supported by dedicated training, sustainable infrastructure, and governance that values communication as a core and cross-cutting function.

Supplemental Material

sj-pdf-1-phj-10.1177_22799036251390964 – Supplemental material for “Public health without effective health communication is really nothing”: Key informant interviews and thematic analysis as part of a multi-step research process to develop modernized public health communication competencies

Supplemental material, sj-pdf-1-phj-10.1177_22799036251390964 for “Public health without effective health communication is really nothing”: Key informant interviews and thematic analysis as part of a multi-step research process to develop modernized public health communication competencies by Melissa MacKay, Devon McAlpine, Lauren E. Grant, Andrew Papadopoulos and Jennifer E. McWhirter in Journal of Public Health Research

Supplemental Material

sj-pdf-2-phj-10.1177_22799036251390964 – Supplemental material for “Public health without effective health communication is really nothing”: Key informant interviews and thematic analysis as part of a multi-step research process to develop modernized public health communication competencies

Supplemental material, sj-pdf-2-phj-10.1177_22799036251390964 for “Public health without effective health communication is really nothing”: Key informant interviews and thematic analysis as part of a multi-step research process to develop modernized public health communication competencies by Melissa MacKay, Devon McAlpine, Lauren E. Grant, Andrew Papadopoulos and Jennifer E. McWhirter in Journal of Public Health Research

Footnotes

ORCID iD

Melissa MacKay

Ethical considerations

Ethical approval was obtained from the University of Guelph’s Research Ethics Board (#23-06-004).

Consent to participate

The participants of this study provided written consent for aggregate data only to be shared. As a result, individual data is not available to be shared publicly.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Canadian Institutes of Health Research (CIHR) through a CIHR Catalyst Grant (FRN 184647).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

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