The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner?

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak

BACKGROUND

Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak.

METHODS

Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework.

RESULTS

Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities.

CONCLUSIONS

The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Vaccine communication strategies among healthcare workers as a reflection of the Israeli Ministry of Health's communication strategies before and after the COVID-19 pandemic

Background

Healthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers' hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic.

Objectives

(1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic.

Methods

A qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling.

Results

Despite healthcare workers' perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders.

Conclusion

Healthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community.

Mpox: An Overview of Pathogenesis, Diagnosis, and Public Health Implications

Mpox, caused by viruses of the genus Orthopoxvirus, is an emerging threat to human and animal health. With increasing urbanization and more frequent interaction between humans and wild animals, the risk of Mpox transmission to humans has increased significantly. This review aims to examine in depth the epidemiology, pathogenesis, and diagnosis of Mpox, with a special focus on recent discoveries and advances in understanding the disease. Molecular mechanisms involved in viral replication will be examined, as well as risk factors associated with interspecific transmission and spread of the disease in human populations. Currently available diagnostic methods will also be discussed, with a critical analysis of their limitations and possible future directions for improving the accuracy and timeliness of diagnosis. Finally, this review will explore the public health implications associated with Mpox, emphasizing the importance of epidemiological surveillance, vaccination, and emergency preparedness to prevent and manage possible outbreaks. Understanding the epidemiology and control strategies for Mpox is critical to protecting the health of human and animal communities and mitigating the risk of interspecific transmission and spread of the disease.

Coping with outbreaks: Toward an infectious disease threat (IDT) appraisal model for risk communication

Through an online, nationally representative survey (N = 1,164), this study examines how individuals perceive and cope with infectious disease outbreaks. Findings inform risk and crisis communication strategies for health organizations. This study explored how individuals' threat appraisals (perceived controllability, perceived predictability, and perceived responsibility) and their cognitive (i.e., information seeking) and conative coping (i.e., protective actions) differ by infectious disease threat (IDT) type (i.e. airborne, bloodborne, foodborne, sexually-transmitted, waterborne, or zoonotic/vectorborne) in epidemic situations. Findings revealed that IDT types varied significantly based on individuals' appraisals of predictability, controllability, and responsibility for different disease types. Across all disease types, predictability was the most impactful factor related to participants' information seeking and planned protective action taking.

Physicians' Perspective on Vaccine-Hesitancy at the Beginning of Israel's COVID-19 Vaccination Campaign and Public's Perceptions of Physicians' Knowledge When Recommending the Vaccine to Their Patients: A Cross-Sectional Study

Because public healthcare workers (HCWs) are at the forefront of the battle against COVID-19, they must be able to provide vaccination information to their patients and respond to their anxieties and concerns. This research objectives were to (1) examine physicians' perceptions of how they received information about the Pfizer COVID-19 vaccine, their attitudes toward hesitant colleagues, and their own knowledge and self-efficacy in communicating information to their patients, and (2) to examine the public's perceptions of physicians' knowledge when recommending the COVID-19 vaccine to their patients. At the beginning of the vaccination campaign, a survey examined the attitudes of physicians in the Israeli public healthcare system (n = 295) regarding the Pfizer vaccine. In addition, the attitudes of a representative sample (n = 500) of the Israeli adult population (age 18+) were examined through interviews. Most of the participating physicians (81%) reported they had already been vaccinated or intended to be vaccinated. When asked about their reasons for vaccine hesitancy, 27% cited concerns about long-term side effects and doubts about the vaccine's effectiveness in preventing contagion. They cited system pressure and departmental norms as explanations for their eventual compliance. Moreover, they saw the system as less tolerant of hesitant physicians, while they themselves tend to be more tolerant. The results of the survey of the public showed that mostly young people (under 44) who tend to be critical believe that physicians do not have sufficient knowledge to make recommendations about the COVID-19 vaccine. The findings indicate that the health system should employ complete transparency in conveying the advantages and disadvantages of the COVID-19 vaccine to physicians. The system should be more tolerant of physicians' worries and concerns and grant legitimacy to their reservations and misgivings. Moreover, medical studies should reinforce physicians' immunological knowledge regarding vaccinations so they can help their patients make informed decisions.

A Review and Analysis of the Literature on Public Health Emergency Communication Practices

A systematic review using structured and transparent methods was carried out to collect and review the qualitative literature investigating trust in crisis communication during emerging infectious diseases. Qualitative synthesis was conducted using a descriptive thematic analysis approach. The GRADE-CERQual assessment was used to determine the confidence in each thematic finding to support decisions when implementing review findings. Overall, 13 studies were included in the review, resulting in 10 thematic categories that describe characteristics associated with crisis communication information and sources of crisis communication that can enhance or maintain public trust. The results of this review suggest the public judges the trustworthiness of crisis communication based on the information characteristics, including consistency, repetition, and timeliness, and especially transparency and uncertainty. Public health is a trusted source of crisis communication when the presenting spokesperson is a health official, the information is not perceived as politicized, and is timely. Community leaders, such as family doctors, are also trusted sources of crisis communication, whereas media and government officials face distrust because of perceived sensationalized information, and defensiveness and unreliable information respectively. Qualitative data in this area is limited, especially involving the public and priority populations, and should be the focus of future research.

How to Make Health and Risk Communication on Social Media More "Social" During COVID-19

Social media have changed the way citizens participate in and express opinions about government policy. Social media serve organizations in achieving four main goals: interacting with citizens; fostering citizen participation; furthering open government; and analyzing/monitoring public opinion and activities. We contend that despite the importance of social media, international and local health organizations have been slow to adopt to them, primarily due to the discrepancy between intraorganizational discourse modes and the type of discourse suitable for dialogue with the public. In this perspective paper, we recommend strategies for such public dialogue based on understanding the challenges faced by organizations on the road to becoming more “social” in their social media presence and in their health and risk communication. Subsequently, we propose an integrative approach that combines three complementary paths: (1) putting the “social” back into health organizations’ culture by inserting more “social” content into the internal organizational discourse through consultation with experts from different fields, including those who diverge from the scientific consensus. (2) Using strategies to enable health organizations to respond to the public on social networks, based on health communications research and studies on emerging infectious disease (EID) communication. (3) Engaging the public on social media based on the participatory approach, which considers the public as a partner that understands science and can work with the organizations to develop an open and innovative pandemic realm by using crowdsourcing to solve complex global health problems. For each path, we define the current challenges, among which are (1) overcoming organizational groupthink and hidden profiles, (2) treating all unofficial information as misleading, and (3) insufficient public engagement in solving complex global problems. We then offer recommendations for dealing with each challenge.

Cancer Information-seeking in an Age of COVID-19: Findings from the National Cancer Institute's Cancer Information Service

Seeking cancer information is recognized as an important, life-saving behavior under normal circumstances. However, given the significant impact of COVID-19 on society, the healthcare system, and individuals and their families, it is important to understand how the pandemic has affected cancer information needs in a crisis context and, in turn, how public health agencies have responded to meeting the information needs of various audiences. Using data from the National Cancer Institute's Cancer Information Service (CIS) - a long-standing, multi-channel resource for trusted cancer information in English and Spanish - this descriptive analysis explored differences in cancer information-seeking among cancer survivors, caregivers, tobacco users, and members of the general public during the onset and continuation of the COVID-19 pandemic (February - September 2020), specifically comparing interactions that involved a discussion of COVID-19 to those that did not. During the study period, COVID-19 discussions were more likely to involve survivors or caregivers compared to tobacco users and the general public. Specific patterns emerged across the four user types and their respective discussions of COVID-19 related to language of service, point of CIS access, stage on the cancer continuum, subject of interaction, cancer site discussed, and referrals provided by the CIS. These results provide insights that may help public health agencies deliver, prioritize, and tailor their messaging and response to specific audiences based on heightened health information needs during a crisis.

The Structure of Tweets About Vaccine Safety Between Health Organizations, Experts, and the Public: Analyzing Risk Communication Conversations

Objective:

This article considers how health education organizations in the World Health Organization's 9 Vaccine Safety Network (VSN) use Twitter to communicate about vaccines with the public, and whether they answer questions and engage in conversations. Almost no research in public health, to our knowledge, has explored conversational structure on social media among posts sent by different accounts.

Methods:

Starting with 1,017,176 tweets by relevant users, we constructed 2 corpuses of multi-tweet conversations. The first was 1,814 conversations that included VSN members directly, whereas the second was 2,283 conversations mentioning vaccines or vaccine denialism. The tweets and user metadata were then analyzed using an adaptation of rhetorical structure theory.

Results:

In the studied data, VSN members tweeted 12,677 times within conversations, compared to their 37,587 lone tweets. Their conversations were shorter than those in the comparison corpus (P < 0.0001), and they were involved in fewer multilogues (P < 0.0001).

Conclusion:

While there is diversity among organizations, most were tied to the pre-social media broadcast model. In the future, they should try to converse more, rather than tweet more, and embrace best practices in risk communication.

A mixed-methods sequential explanatory design comparison between COVID-19 infection control guidelines' applicability and their protective value as perceived by Israeli healthcare workers, and healthcare executives' response

Background

Healthcare workers (HCWs) are on the front line of the COVID-19 outbreak, and their constant exposure to infected patients and contaminated surfaces puts them at risk of acquiring and transmitting the infection. Therefore, they must employ protective measures. In practice, HCWs in Israel were not fully prepared for this sudden COVID-19 outbreak. This research aimed to identify and compare: (1) Israeli HCWs’ perceptions regarding the official COVID-19 guidelines’ applicability and their protective value, and (2) HCWs executives’ response to HWCs’ concern regarding personal protective equipment (PPE) shortage.

Methods

A mixed-methods sequential explanatory design consists of: (1) An online survey of 242 HCWs about the application of the guidelines and PPE, and (2) Personal interviews of 15 HCWs executives regarding PPE shortage and the measures they are taking to address it.

Results

A significant difference between the perceived applicability and protective value was found for most of the guidelines. Some of the guidelines were perceived as more applicable than protective (hand hygiene, signage at entrance, alcohol rub sanitizers at entrance, and mask for contact with symptomatic patients). Other were perceived as less applicable than protective (prohibited gathering of over 10 people, maintaining a distance of 2 m’, and remote services).

Conclusions

HCWs need the support of the healthcare authorities not only to provide missing equipment, but also to communicate the risk to them. Conveying the information with full transparency, while addressing the uncertainty element and engaging the HCWs in evaluating the guidelines, are critical for establishing trust.

Analysis of Public Perception of the Israeli Government's Early Emergency Instructions Regarding COVID-19: Online Survey Study

Background

On March 11, 2020, the World Health Organization (WHO) officially declared coronavirus disease (COVID-19) to be a pandemic. This posed challenges to many countries, prominent among which is communication with the public to gain their cooperation. Israel faces different challenges from other countries in its management of the COVID-19 crisis because it is in the midst of a deep constitutional crisis.

Objective

The objective of this paper was to examine the response of the Israeli public to the government’s emergency instructions regarding the pandemic in terms of correlations between overall risk perception and crisis management; overall risk perception and economic threat perception; crisis management and compliance with behavioral guidelines; and crisis management and economic threat perception. We also made comparisons between crisis management and spokesperson credibility and between crisis management and the credibility of information sources.

Methods

The sample was established using an online survey that enabled rapid and effective distribution of an online questionnaire during the COVID-19 crisis. The self-selection online survey method of nonprobability sampling was used to recruit participants (N=1056) through social network posts asking the general public (aged ≥18 years) to answer the survey.

Results

Participants aged ≥65 years perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% CI 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P<.001), overall risk perception and economic threat perception (r=0.22, P<.001), attitudes toward crisis management and compliance with behavioral guidelines (r=0.15, P<.001), and attitudes toward crisis management and economic threat perception (r=–0.15, P<.001). Participants who perceived that the prime minister was the most credible spokesperson evaluated the crisis management significantly higher than all other groups. The crisis management was evaluated significantly lower by participants who stated that infectious disease specialists were the most credible spokespersons. Participants for whom the Ministry of Health website was the most credible source of information evaluated the crisis management higher than all other groups. Participants for whom scientific articles were the most credible source of information evaluated the crisis management lower than those who perceived that the WHO/Centers for Disease Control and Prevention websites or Ministry of Health/hospital websites and health care workers were the most credible.

Conclusions

The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines. It was also found that crisis management and information cannot be approached in the same way for the overall public. Furthermore, unlike other epidemics, the COVID-19 crisis has widespread economic and social consequences; therefore, it is impossible to focus only on health risks without communicating economic and social risks as well.

Experts' Views on the Gaps in Public Health Emergency Preparedness in Israel: A Qualitative Case Study

BACKGROUND

Despite the significant improvement in all components of preparedness in the past decade, there are still gaps between the guidelines and the reality on the ground. The purpose of this study is to explore how Israeli public health and emergency medicine experts perceive the demands for health organization emergency preparedness and the actual practice.

METHODS

Qualitative phenomenological research. We interviewed 22 Israeli public health and emergency medicine experts face-to-face and conducted a content analysis.

RESULTS

The findings revealed barriers in the following areas: preparation and readiness of hospitals, preparedness and readiness in the community, connection between the community and the hospital, inter-agency coordination and interface, interdisciplinary integration, preparedness resources, postcrisis evaluation, assimilating smart technologies, information accessibility, and communication.

CONCLUSIONS

To reduce the gap between theory and practice, retrospective research and evaluation must be included to learn in depth what strategies and resources should be used during a health crisis. Likewise, profiles should be constructed and the community should be segmented in order to design resilience programs and accommodate information to subpopulations.

Ebola-Related Health Information Wanted and Obtained by Nurses and Public Health Department Employees: Effects of Formal and Informal Communication Channels

OBJECTIVES

The aim of this study was to (1) understand types and amounts of Ebola-related information that health organization employees wanted and obtained through formal, informal, internal, and external organizational communication channels; (2) determine potential discrepancies between information wanted and obtained; and (3) investigate how organizational structure might affect information wanted and obtained through these communication channels.

METHODS

Primary data were collected from 526 health workers in 9 hospitals and 13 public health departments in Texas from June to November 2015. Survey data were collected for 7 types of Ebola-related information health organization employees wanted and obtained through various types of organizational communication channels. Descriptive statistical analyses, mixed design analysis of variance, regression analyses, and multilevel analyses were used to analyze the data.

RESULTS

Hospital employees (mostly nurses in our sample) received more self-care information than they wanted from every communication channel. However, they received less about all other types of information than they wanted from every communication channel separately and combined. Public health department employees wanted more information than they received from every communication channel separately and combined for all 7 types of information.

CONCLUSIONS

Discrepancies existed between the types of Ebola-related information wanted and obtained by employees of hospitals and public health departments.

Correcting misinformation by health organizations during measles outbreaks: A controlled experiment

BACKGROUND

During epidemic crises, some of the information the public receives on social media is misinformation. Health organizations are required to respond and correct the information to gain the public's trust and influence it to follow the recommended instructions.

OBJECTIVES

(1) To examine ways for health organizations to correct misinformation concerning the measles vaccination on social networks for two groups: pro-vaccination and hesitant; (2) To examine the types of reactions of two subgroups (pro-vaccination, hesitant) to misinformation correction; and (3) To examine the effect of misinformation correction on these two subgroups regarding reliability, satisfaction, self-efficacy and intentions.

METHODS

A controlled experiment with participants divided randomly into two conditions. In both experiment conditions a dilemma was presented as to sending a child to kindergarten, followed by an identical Facebook post voicing the children mothers' concerns. In the third stage the correction by the health organization is presented differently in two conditions: Condition 1 -common information correction, and Condition 2 -recommended (theory-based) information correction, mainly communicating information transparently and addressing the public's concerns. The study included (n = 243) graduate students from the Faculty of Social Welfare and Health Sciences at Haifa University.

RESULTS

A statistically significant difference was found in the reliability level attributed to information correction by the Health Ministry between the Control condition and Experimental condition (sig<0.001), with the average reliability level of the subjects in Condition 2 (M = 5.68) being considerably higher than the average reliability level of subjects in Condition 1 (4.64). A significant difference was found between Condition 1 and Condition 2 (sig<0.001), with the average satisfaction from the Health Ministry's response of Condition 2 subjects (M = 5.75) being significantly higher than the average satisfaction level of Condition 1 subjects (4.66). Similarly, when we tested the pro and hesitant groups separately, we found that both preferred the response presented in Condition 2.

CONCLUSION

It is very important for the organizations to correct misinformation transparently, and to address the emotional aspects for both the pro-vaccination and the hesitant groups. The pro-vaccination group is not a captive audience, and it too requires a full response that addresses the public's fears and concerns.

Identification of Keywords From Twitter and Web Blog Posts to Detect Influenza Epidemics in Korea

OBJECTIVE

Social media data are a highly contextual health information source. The objective of this study was to identify Korean keywords for detecting influenza epidemics from social media data.

METHODS

We included data from Twitter and online blog posts to obtain a sufficient number of candidate indicators and to represent a larger proportion of the Korean population. We performed the following steps: initial keyword selection; generation of a keyword time series using a preprocessing approach; optimal feature selection; model building and validation using least absolute shrinkage and selection operator, support vector machine (SVM), and random forest regression (RFR).

RESULTS

A total of 15 keywords optimally detected the influenza epidemic, evenly distributed across Twitter and blog data sources. Model estimates generated using our SVM model were highly correlated with recent influenza incidence data.

CONCLUSIONS

The basic principles underpinning our approach could be applied to other countries, languages, infectious diseases, and social media sources. Social media monitoring using our approach may support and extend the capacity of traditional surveillance systems for detecting emerging influenza. (Disaster Med Public Health Preparedness. 2018; 12: 352-359).

The "New Public" and the "Good Ol' Press": Evaluating Online News Sources During the 2013 Polio Outbreak in Israel

The current research focuses on the 2013 polio outbreak in Israel as a case study to analyze the sources of information used in new media platforms, examining whether the new media have changed the ways in which we communicate about health issues. Specifically, we tracked and coded polio-related references on Hebrew news websites, blogs, forums, and Facebook posts. Overall, 24,388 polio-related references constituted our sampling frame. The findings suggest that there is a moderate-level correlation between the platform and the type of sources chosen by users. Beyond the differences between various platforms, we found that online information platforms rely not only on popular or pseudoscientific sources, but also on high-quality information. In fact, the analysis indicates that online news websites, forums, blogs, and Facebook posts create a unique blend of information, including scientific literature, medical professionals, and government representatives, as well as pseudoscientific research. These findings suggest a more optimistic view of the Internet as a source for health-related information in times of crises. Although the fact that members of the public are exposed to scientific sources does not indicate to what degree this affects their actual decision making. Exposure to a wider variety of sources may enhance health literacy, resulting in a better understanding of information needed to make informed decisions.