As the midterms approach, communicators must increasingly look beyond broad labels like “Republican,” “Democratic” or “swing” to the values and belief systems that shape how audiences think about health care.

Using PRISM, Reservoir’s audience intelligence platform, we mapped all 435 congressional districts across 16 behavioral and ideological audience segments.

What we found: Audiences in districts with similar voting patterns can have very different views on health care – requiring different engagement strategies. For example:

• Two Republican districts: Lubbock, Texas (TX-19) and Greenville-Spartanburg, South Carolina (SC-04) are both consistently Republican but respond to different messages.
• • Lubbock has nearly four times the national concentration of “Consumer Empowerment Champions” – one of PRISM’s 10 Republican audience segments. They believe health care should operate more like a consumer marketplace and prioritize patient choice, transparency and control. They are especially receptive to messages about empowering patient decision-making.
  • Greenville-Spartanburg, by contrast, has emerged as one of the Southeast’s fastest-growing manufacturing and life sciences corridors. Key audiences here, like those we’ve identified as “Trust-the-Science Pragmatists,” are likely to find science, evidence-based innovation and access to rural health care most compelling.
• Two Democratic districts: Seattle, Washington (WA-07) and Jackson, Mississippi (MS-02) both consistently elect Democrats but represent different health care coalitions.
  • Seattle has long been a bastion of progressive politics – a trend reflected in its exceptionally high concentration of “Universal Care Progressives” – one of PRISM’s 6 Democratic audience segments. They strongly support universal, single-payer health care and respond best to messages about expanding access and systemic reform.
  • By contrast, Jackson and the surrounding Mississippi Delta reflect a different Democratic coalition. This district has nearly five times the national concentration of “Faith & Justice Progressives.” Their views are shaped by faith communities and lived health disparities, and they are especially persuaded by fairness, equity and affordability.
• Two swing districts: Scottsdale, Arizona (AZ-01) and southwestern Washington (WA-03) are both closely contested. But they aren’t simply “moderate” districts. Looking closer reveals that they have different fault lines and sources of common ground.
  • Scottsdale has roughly twice the national concentration of both Democratic “Health Care Incrementalists” and Republican “Health Futurists” – a distinctly suburban mix of audiences that share a desire for progress but differ over how fast it should happen. Messages that balance progress with practicality and proven benefits to patients are most likely to resonate with these voters.
  • Southwestern Washington is home to a high concentration of Democratic “Universal Care Progressives” alongside Republican “Wellness Evangelists” – an audience focused on prevention, healthy lifestyles and personal responsibility. Both share a commitment to healthier communities, but “Universal Care Progressives” look to public institutions and policy to drive progress, while “Wellness Evangelists” place that responsibility with individuals and families.

The key takeaway: How a district votes doesn’t paint the full picture. Effective audience engagement starts with understanding the values and belief systems that drive the audiences within a district.

Turning insights into action: PRISM turns district-level audience intelligence into actionable strategy and direct activation. These insights can help organizations:

• Prioritize districts: Identify the audiences most likely to be mobilized on your issue and where those key audiences are most concentrated.
• Tailor communications: Align messages with the values and belief systems most likely to resonate among priority audiences.
• Activate key audiences: Reach priority audiences directly through precision targeting, delivering tailored messages to the voters and influencers most likely to engage.

Go deeper: Click here to explore the PRISM district map, including the audience segments shaping health care opinions in these congressional districts.