When the facts are just not enough: credibly communicating about risk is riskier when emotions run high and time is short

Total Excess Mortality Surveillance for Real-Time Decision-Making in Disasters and Crises

Crises such as Hurricane Maria and the coronavirus disease 2019 (COVID-19) pandemic have revealed that untimely reporting of the death toll results in inadequate interventions, impacts communication, and fuels distrust on response agencies. Delays in establishing mortality are due to the contested definition of deaths attributable to a disaster and lack of rapid collection of vital statistics data from inadequate health system infrastructure. Readily available death counts, combined with geographic, demographic, and socioeconomic data, can serve as a baseline to build a continuous mortality surveillance system. In an emergency setting, real-time Total, All-cause, Excess Mortality (TEM) can be a critical tool, granting authorities timely information ensuring a targeted response and reduce disaster impact. TEM measurement can identify spikes in mortality, including geographic disparities and disproportionate deaths in vulnerable populations. This study recommends that measuring total, all-cause, excess mortality as a first line of response should become the global standard for measuring disaster impact.

Effects of Narrative Messages on Key COVID-19 Protective Responses: Findings From a Randomized Online Experiment

PURPOSE

We investigated the effectiveness of narrative vs non-narrative messages in changing COVID-19-related perceptions and intentions.

DESIGN/SETTING

The study employed a between-subjects two-group (narratives vs non-narratives) experimental design and was administered online.

SUBJECTS/INTERVENTION

1804 U.S. adults recruited via Amazon MTurk in September 2020 were randomly assigned to one of two experimental conditions and read either three narrative or three non-narrative messages about social distancing, vaccination, and unproven treatments.

MEASURES

Perceptions and intentions were assessed before and after message exposure (7-point scales).

ANALYSIS

Using multivariable regression, we assessed main effects of the experimental condition (controlling for baseline measures) and interactions between the condition and pre-exposure perceptions/intentions in predicting post-exposure outcomes.

RESULTS

Compared to non-narratives, narratives led to (1) less positive perceptions about the benefits of unproven treatments (Mnarrative = 3.60, Mnon-narrative = 3.77, P = .007); and (2) less willingness to receive an unproven drug (Mnarrative = 3.46, Mnon-narrative = 3.77, P < .001); this effect was stronger among individuals with higher baseline willingness to receive unproven drugs (baseline willingness = 2.09: b = -.06, P = .461; baseline willingness = 3.90: b = -.30, P < .001; baseline willingness = 5.71: b = -.55, P < .001). Narratives also led to more positive perceptions of vaccine safety/effectiveness, but only among individuals with lower baseline vaccine perceptions (baseline perceptions = 4.51: b = .10, P = .008; baseline perceptions = 5.89: b = .04, P = .167; baseline perceptions = 7: b = -.01, P = .688).

CONCLUSION

Narratives are a promising communication strategy, particularly for topics where views are not entrenched and among individuals who are more resistant to recommendations.

Boil Water Advisories as Risk Communication: Consistency between CDC Guidelines and Local News Media Articles

The Safe Drinking Water Act Public Notification Rule requires that customers of public water systems (PWS) be informed of problems that may pose a risk to public health. Boil water advisories (BWA) are a form of communication intended to mitigate potential health risks. The Centers for Disease Control and Prevention (CDC) developed guidance for BWAs. We examined how local US news media incorporate the CDC's guidelines when reporting on BWAs. A content analysis of 1040 local news media articles shows these reports did not consistently incorporate CDC guidelines. Overall, 89% of the articles communicated enough information for readers to determine if they were included in the impacted area. Articles that included at least some of the CDC's instructions for boiling water were likely (p < .001) to include other risk information, such as the functions for which water should be boiled (e.g., drinking, brushing teeth) and that bottled water could be used as an alternative source. However, this information was included in only 47% of the articles evaluated. Results suggest public notifications often do not serve the public need for clear risk communication.

[Risk communication in the containment of the COVID-19 pandemic: challenges and promising approaches]

Risikokommunikation spielt eine zentrale Rolle in Public-Health-Notlagen: Sie muss informierte Entscheidungen ermöglichen, schützendes bzw. lebenserhaltendes Verhalten fördern und das Vertrauen in öffentliche Institutionen bewahren. Zudem müssen Unsicherheiten über wissenschaftliche Erkenntnisse transparent benannt werden, irrationale Ängste und Gerüchte entkräftet werden. Risikokommunikation sollte die Bevölkerung partizipativ einbeziehen. Ihre Risikowahrnehmung und -kompetenz müssen kontinuierlich erfasst werden. In der aktuellen Pandemie der Coronavirus-Krankheit 2019 (COVID-19) ergeben sich spezifische Herausforderungen für die Risikokommunikation.

Der Wissensstand zu vielen wichtigen Aspekten, die COVID-19 betreffen, war und ist oftmals unsicher oder vorläufig, z. B. zu Übertragung, Symptomen, Langzeitfolgen und Immunität. Die Kommunikation ist durch wissenschaftliche Sprache sowie eine Vielzahl von Kennzahlen und Statistiken geprägt, was die Verständlichkeit erschweren kann. Neben offiziellen Mitteilungen und Einschätzungen von Expertinnen und Experten wird über COVID-19 in großem Umfang in sozialen Medien kommuniziert, dabei werden auch Fehlinformationen und Spekulationen verbreitet; diese „Infodemie“ erschwert die Risikokommunikation.

Nationale wie internationale Forschungsprojekte sollen helfen, die Risikokommunikation zu COVID-19 zielgruppenspezifischer und effektiver zu machen. Dazu gehören u. a. explorative Studien zum Umgang mit COVID-19-bezogenen Informationen, das COVID-19 Snapshot Monitoring (COSMO), ein regelmäßig durchgeführtes Onlinesurvey zu Risikowahrnehmung und Schutzverhalten sowie eine interdisziplinäre qualitative Studie, die die Konzeption, Umsetzung und Wirksamkeit von Risikokommunikationsstrategien vergleichend in 4 Ländern untersucht.

Strategic health communication on social media: Insights from a Danish social media campaign to address HPV vaccination hesitancy

OBJECTIVE

To evaluate whether the social media strategy developed for the campaign Stop HPV - stop cervical cancer was successful at engaging target groups in communication regarding HPV vaccination.

INTRODUCTION

In 2009, the Human Papillomavirus (HPV) vaccine became part of the Danish childhood vaccination program to protect Danish girls from cervical cancer. In 2015, after a period of massive media coverage questioning the safety of the HPV vaccination, a rapid decline in HPV vaccination coverage was observed. An information campaign was therefore launched in May 2017 to address HPV vaccination hesitancy. THE SOCIAL MEDIA STRATEGY: 'Heart-brain communication' combined facts and emotions through varied content. Community management guidelines were worked out to ensure that there was positive dialogue. Key Point Indicators (KPI) for Engagement Rate (ER) and Click Through Rate (CTR) were chosen to uphold engagement and traffic from Facebook to the website. The KPIs were used to measure effectiveness.

RESULTS

In January 2019, the social media campaign had reached 8,020,000 people with an average of 127 comments per post. The average ER from May 2017 to halfway through 2018 was 6.07% and the CTR was 2.09%. The content subgroup personal stories was the most effective in creating positive dialogue. One year after the launch of the campaign, the number of positive comments had increased from less than 50% to approximately 75%.

CONCLUSION

A comprehensive social media strategy using 'heart-brain communication' proved useful in a campaign for HPV vaccination. The success of the social media strategy was due to meticulous planning prior to launching the campaign, the use of content subgroups, the allocation of adequate resources for community management, the empirical analysis of content, and the use of evaluation results as guidance for the production of new content.

Impact of Communication Measures Implemented During a School Tuberculosis Outbreak on Risk Perception among Parents and School Staff, Italy, 2019

Risk perception has a significant impact on decisions people make when facing a threat: a mismatch between actual hazard and perceived risk can lead to inappropriate behaviours and suboptimal compliance to recommended public health measures. The present study was conducted in the aftermath of a tuberculosis (TB) outbreak that occurred in 2019 in a primary school in Italy. The aim was to evaluate the impact of communication measures implemented by local health authorities (including face-to-face meetings between LHAs and the local population, weekly press announcements, implementation of a telephone hotline and of an information desk, and social media communication), on risk perception among parents of schoolchildren and school staff, and to identify factors related to a change in risk perception before and after the said activities. An anonymous questionnaire was administered to parents of schoolchildren (n = 846) and to school staff (n = 70). Participants were asked about the level of risk they had perceived at two distinct times: when they first became aware of the outbreak and following implementation of communication activities. A significant reduction of perceived risk was found in both groups (p < 0.001) following the communication activities. The largest reduction was found among participants who reported having appreciated the meetings with the LHA healthcare staff. Our findings suggest that keeping an open approach, explaining the actual threat to the population and adapting communication to different listening skills, are essential for health authorities to successfully manage a public health emergency.

To believe or not to believe? How voice and accent information in speech alter listener impressions of trust

Our decision to believe what another person says can be influenced by vocally expressed confidence in speech and by whether the speaker–listener are members of the same social group. The dynamic effects of these two information sources on neurocognitive processes that promote believability impressions from vocal cues are unclear. Here, English Canadian listeners were presented personal statements ( She has access to the building) produced in a confident or doubtful voice by speakers of their own dialect (in-group) or speakers from two different “out-groups” (regional or foreign-accented English). Participants rated how believable the speaker is for each statement and event-related potentials (ERPs) were analysed from utterance onset. Believability decisions were modulated by both the speaker’s vocal confidence level and their perceived in-group status. For in-group speakers, ERP effects revealed an early differentiation of vocally expressed confidence (i.e., N100, P200), highlighting the motivational significance of doubtful voices for drawing believability inferences. These early effects on vocal confidence perception were qualitatively different or absent when speakers had an accent; evaluating out-group voices was associated with increased demands on contextual integration and re-analysis of a non-native representation of believability (i.e., increased N400, late negativity response). Accent intelligibility and experience with particular out-group accents each influenced how vocal confidence was processed for out-group speakers. The N100 amplitude was sensitive to out-group attitudes and predicted actual believability decisions for certain out-group speakers. We propose a neurocognitive model in which vocal identity information (social categorization) dynamically influences how vocal expressions are decoded and used to derive social inferences during person perception.

Evidence synthesis - Evaluating risk communication during extreme weather and climate change: a scoping review

INTRODUCTION

Communicating risk to the public continues to be a challenge for public health practitioners working in the area of climate change. We conducted a scoping literature review on the evaluation of risk communication for extreme weather and climate change to inform local public health messaging, consistent with requirements under the Ontario Public Health Standards (OPHS), which were updated in 2018 to include effective communication regarding climate change and extreme weather.

METHODS

Search strategies were developed by library information specialists and used to retrieve peer-reviewed academic and grey literature from bibliographic databases (Medline, Embase, Scopus and CINAHL) and Google country specific searches, respectively. The search strategy was validated through a workshop with experts and community stakeholders, with expertise in environment, health, emergency management and risk communication.

RESULTS

A total of 43 articles were included. These articles addressed issues such as: climate change (n = 22), flooding (n = 12), hurricane events (n = 5), extreme heat (n = 2), and wild fires (n = 2). Studies were predominantly from the US (n = 14), Europe (n = 6) and Canada (n = 5).

CONCLUSION

To meet the OPHS 2018, public health practitioners need to engage in effective risk communication to motivate local actions that mitigate the effects of extreme weather and climate change. Based on the scoping review, risk communication efforts during short-term extreme weather events appear to be more effective than efforts to communicate risk around climate change. This distinction could highlight a unique opportunity for public health to adapt strategies commonly used for extreme weather to climate change.

A Conceptual Model for Evaluating Emergency Risk Communication in Public Health

Public health threats, such as emerging infectious diseases, terrorism, environmental catastrophes, and natural disasters, all require effective communication. Emergency risk communication is a critical component of public health emergency planning and response. It is a complex process involving a variety of constructs that interact in dynamic ways over time. While emergency risk communication is generally recognized as an important tool for risk management and emergency response, the specific elements, processes, and outcomes are not well described and have not been systematically assessed. In this article, we describe a conceptual model for public health developed in collaboration with the Centers for Disease Control and Prevention (CDC). We propose using this model to inform practice and to guide evaluations of emergency risk communication. The model was informed by an extensive review of the emergency risk communication literature, interviews with researchers, and discussions with CDC stakeholders. This model can be adapted for a wide range of emergency events and incorporates key constructs to assess internal processes, as well as outcomes of emergency risk communication on audiences. Evaluating internal processes can help identify and correct messaging deficiencies. Outcome constructs describe expected target audience responses to emergency risk communication, such as changes in knowledge, attitudes, beliefs, and behaviors that may occur over time. This can help public health communicators learn how their various activities contribute to emergency risk communication outcomes.

The Social Amplification of Haze-Related Risks on the Internet

This study explores the implications of the digital network society for public health communication and management through an empirical study on communication related to the transboundary haze crisis in Singapore. Using the Social Amplification of Risk Framework (SARF), the authors applied sentiment and thematic analysis on haze-related posts on an online discussion forum (HardwareZone) and a social networking site (Facebook), and to haze-related articles in The Straits Times (a newspaper). The study shows that the medium matters in social amplification of risk: Facebook had an effect on the amplification of emotions, while HardwareZone and The Straits Times did not. In addition, the results show that spikes in online risk amplification were strongly influenced by unprecedented events. They also suggest that anger expressed online may be linked to a sense of futility. Implications for practice and recommendations for future research are provided in the conclusion.

Patient preferences toward an interactive e-consent application for research using electronic health records

OBJECTIVE

The purpose of this study was to assess patient perceptions of using an interactive electronic consent (e-consent) application when deciding whether or not to grant broad consent for research use of their identifiable electronic health record (EHR) information.

MATERIALS AND METHODS

For this qualitative study, we conducted a series of 42 think-aloud interviews with 32 adults. Interview transcripts were coded and analyzed using a modified grounded theory approach.

RESULTS

We identified themes related to patient preferences, reservations, and mixed attitudes toward consenting electronically; low- and high-information-seeking behavior; and an emphasis on reassuring information, such as data protections and prohibitions against sharing data with pharmaceutical companies. Participants expressed interest in the types of information contained in their EHRs, safeguards protecting EHR data, and specifics on studies that might use their EHR data.

DISCUSSION

This study supports the potential value of interactive e-consent applications that allow patients to customize their consent experience. This study also highlights that some people have concerns about e-consent platforms and desire more detailed information about administrative processes and safeguards that protect EHR data used in research.

CONCLUSION

This study contributes new insights on how e-consent applications could be designed to ensure that patients' information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a "concise and focused" presentation of key information followed by more details.

Understanding risk perceptions and responses of the public and health care professionals toward Clostridium difficile: A qualitative interpretive description study

BACKGROUND

The occurrence of Clostridium difficile infection is a major health-related risk. How the public and health care professionals perceive and respond to a health-related risk is shaped by socially and contextually structured evaluations and interpretations. Risk perceptions and responses are context dependent and therefore need to be understood within the context in which they are perceived and experienced.

METHODS

This interpretive description study used 8 public focus groups (39 participants) and 7 health care professional focus groups (29 participants) in 2 geographic areas (an area that had experienced a C difficile outbreak and an area that had not).

RESULTS

Both the public and health care professionals expressed varying concerns about the perceived consequences of C difficile occurring and the potential influence on emotional and physical health and well-being. In doing so, they drew upon a range of direct and indirect experiences and accounts from the media. Conceptual factors found to be important in influencing risk perceptions and responses included feelings of vulnerability, attribution of responsibility, judgments about competence, and evaluations of risk communicators.

CONCLUSIONS

If risk management and communication strategies are to achieve desired responses toward C difficile and wider risks, those responsible for managing risk must consider already established risk perceptions in addition to factors that have influenced them.

Crisis and Emergency Risk Messaging in Mass Media News Stories: Is the Public Getting the Information They Need to Protect Their Health?

The mass media provide an important channel for delivering crisis and emergency risk information to the public. We conducted a content analysis of 369 newspaper and television broadcast stories covering natural disaster and foodborne outbreak events and coded for seven best practices in crisis and emergency risk messaging. On average, slightly less than two (1.86) of the seven best practices were included in each story. The proportion of stories including individual best practices ranged from 4.6% for "expressing empathy" to 83.7% for "explaining what is known" about the event's impact to human health. Each of the other five best practices appeared in less than 25% of stories. These results suggest much of the risk messaging the public receives via mass media does not follow best practices for effective crisis and emergency communication, potentially compromising public understanding and actions in response to events.

Potential of social media as a tool to combat foodborne illness

The use of social media platforms, such as Facebook and Twitter, has been increasing substantially in recent years and has affected the way that people access information online. Social media rely on high levels of interaction and user-generated context shared through established and evolving social networks. Health information providers must know how to successfully participate through social media in order to meet the needs of these online audiences. This article reviews the current research on the use of social media for public health communication and suggests potential frameworks for developing social media strategies. The extension to food safety risk communication is explored, considering the potential of social media as a tool to combat foodborne illness.

Recommendations for biomonitoring of emergency responders: focus on occupational health investigations and occupational health research

The disaster environment frequently presents rapidly evolving and unpredictable hazardous exposures to emergency responders. Improved estimates of exposure and effect from biomonitoring can be used to assess exposure-response relationships, potential health consequences, and effectiveness of control measures. Disaster settings, however, pose significant challenges for biomonitoring. A decision process for determining when to conduct biomonitoring during and following disasters was developed. Separate but overlapping decision processes were developed for biomonitoring performed as part of occupational health investigations that directly benefit emergency responders in the short term and for biomonitoring intended to support research studies. Two categories of factors critical to the decision process for biomonitoring were identified: Is biomonitoring appropriate for the intended purpose and is biomonitoring feasible under the circumstances of the emergency response? Factors within these categories include information needs, relevance, interpretability, ethics, methodology, and logistics. Biomonitoring of emergency responders can be a valuable tool for exposure and risk assessment. Information needs, relevance, and interpretability will largely determine if biomonitoring is appropriate; logistical factors will largely determine if biomonitoring is feasible. The decision process should be formalized and may benefit from advance planning.

Perception of spokespersons' performance and characteristics in crisis communication: experience of the 2003 severe acute respiratory syndrome outbreak in Taiwan

Background/Purpose

To explore perception of spokespersons' performance and characteristics in response to the 2003 severe acute respiratory syndrome (SARS) outbreak.

Methods

This study was conducted from March to July, 2005, using semi-structured in-depth interviews to collect data. All interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was employed to analyze the transcribed data. Interviewees included media reporters, media supervisors, health and medical institution executives or spokespersons, and social observers.

Results

Altogether, 35 interviewees were recruited for in-depth interviews, and the duration of the interview ranged from 1 hour to 2 hours. Results revealed that the most important characteristics of health/medical institutions spokespersons are professional competence and good interaction with the media. In contrast, the most important behaviors they should avoid are concealing the truth and misreporting the truth. Three major flaws of spokespersons' performance were identified: they included poor understanding of media needs and landscape; blaming the media to cover up a mistake they made in an announcement; and lack of sufficient participation in decision-making or of authorization from the head of organization.

Conclusion

Spokespersons of health and medical institutions play an important role in media relations during the crisis of a newly emerging infectious disease.

Predicting response to reassurances and uncertainties in bioterrorism communications for urban populations in New York and California

Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban areas acknowledge the formidable technical and social challenges of consequence management. Effective risk and crisis communication is one priority to strengthen the U.S.'s response and resilience. However, several notable risk events since September 11, 2001, have revealed vulnerabilities in risk/crisis communication strategies and infrastructure of agencies responsible for protecting civilian populations. During recovery from a significant biocontamination event, 2 goals are essential: (1) effective communication of changing risk circumstances and uncertainties related to cleanup, restoration, and reoccupancy; and (2) adequate responsiveness to emerging information needs and priorities of diverse populations in high-threat, vulnerable locations. This telephone survey study explored predictors of public reactions to uncertainty communications and reassurances from leaders related to the remediation stage of an urban-based bioterrorism incident. African American and Hispanic adults (N=320) were randomly sampled from 2 ethnically and socioeconomically diverse geographic areas in New York and California assessed as high threat, high vulnerability for terrorism and other public health emergencies. Results suggest that considerable heterogeneity exists in risk perspectives and information needs within certain sociodemographic groups; that success of risk/crisis communication during recovery is likely to be uneven; that common assumptions about public responsiveness to particular risk communications need further consideration; and that communication effectiveness depends partly on preexisting values and risk perceptions and prior trust in leaders. Needed improvements in communication strategies are possible with recognition of where individuals start as a reference point for reasoning about risk information, and comprehension of how this influences subsequent interpretation of agencies' actions and communications.