Introduction of a guide to enhance risk communication among low-income and minority populations: a grassroots community engagement approach

Communications for US Populations With Limited English Proficiency During Infectious Disease Outbreaks: A Scoping Review

The COVID-19 pandemic has highlighted the need for research about communicating with populations who have limited English proficiency in the United States during infectious disease outbreaks. These populations have experienced significantly worse health outcomes during emergencies, including the COVID-19 pandemic, and evidence-based risk communications are critical to protecting their health. To support improved development of emergency communications for these communities, we conducted a scoping review that examined the extent of research available, with an intent to identify which communications topics are covered in the literature and where research gaps exist. Following the JBI framework, with reporting guided by the PRISMA extension for scoping reviews, 6 electronic databases were systematically searched in October 2022. The inclusion criteria for articles selected were: data collected between 2009 and 2022, published in English, and focused on communications pertaining to emergency infectious disease outbreaks (eg, H1N1 influenza, Zika virus, COVID-19) for populations with limited English proficiency. Of 2,049 articles identified through the search, 31 met the inclusion criteria and were selected for review. We identified major limitations in the evidence base: a majority of studies were conducted only among Spanish speakers or during the COVID-19 pandemic, and most used qualitative or nonrandom samples. Most studies documented basic language barriers in communications, but there was little exploration of more nuanced barriers, such as cultural relevance or social context. Ahead of future outbreaks, more research is urgently needed to examine the information landscapes of populations with limited English proficiency, to inform the development of more effective communications strategies from public health institutions and others.

Neighborhood Belonging and Thoughts of Death Among Hispanics in the United States

OBJECTIVE

Suicide rates among Hispanics in the United States have steadily risen over the last 2 decades, especially among youth and adults in midlife. Social disconnection (low belonging) is associated with suicidal ideation; however, little is known about the demographic and social factors that impact a sense of belonging among Hispanic adults in midlife. The current study sought to examine (a) the association between demographic and social factors (acculturative stress, community integration and engagement, religiosity, ethnic cohesion) and neighborhood belonging as well as (b) whether neighborhood belonging is associated with passive suicide ideation (thoughts of death) among a community sample of Hispanic adults.

METHOD

This study uses a sample of 968 Hispanic adults in midlife, from Puerto Rican, Mexican, and Dominican backgrounds, from the Midlife in the United Sates (MIDUS): Survey of Minority Groups.

RESULTS

Overall, community integration, religiosity, and community engagement were unique positive predictors of neighborhood belonging; lifetime number of discrete events of discrimination was the only unique negative predictor. Among foreign-born respondents, community integration, community engagement, and discrimination were associated with neighborhood belonging, whereas, among U.S.-born respondents, only religiosity and community were associated with belonging. Neighborhood belonging was the only variable negatively associated with thoughts of death among depressed participants.

CONCLUSION

Fostering a sense of neighborhood belonging among Hispanic adults-particularly via promoting community engagement-may help decrease suicide risk.HIGHLIGHTSIntegration, engagement, and religiosity positively predicted belonging in Hispanic adultsLifetime events of discrimination was the only negative predictor of neighborhood belongingLower neighborhood belonging was associated with thoughts of death among depressed participants.

Key Considerations for Successful Risk Communication and Community Engagement (RCCE) Programmes During COVID-19 Pandemic and Other Public Health Emergencies

Risk communication and community engagement (RCCE) is a key pillar in public health emergency response that ensures accurate health information sharing, adoption of protective behaviours by the affected people, and collaborative participation by all stakeholders, including of the local community structures. The success of RCCE programmes rely on strong partnerships and engagement among affiliated groups; clear programme plans and guidelines; establishment of well-laid down coordination structures; and clear measures for reporting and documentation of programme activities. RCCE activities during public health emergencies must put more emphasis on strengthening local structures and communities to ensure active participation of communities in interrupting disease transmission.

The Local Health Department Mandate and Capacity for Community Engagement in Emergency Preparedness: A National View Over Time

CONTEXT

Local health departments (LHDs) perform the highly valued, yet time- and staff-intensive work of community engagement in public health emergency preparedness (CE-PHEP) when the Great Recession has had lingering effects on their organizational capacity.

OBJECTIVE

Track the extent to which LHDs still embrace collaborative, whole community approaches to PHEP in a historically low resource environment.

DESIGN

National survey in 2015 of LHDs using a self-administered online questionnaire regarding LHD practices and resources for CE-PHEP first fielded in 2012 ("The Community Engagement for Public Health Emergency Preparedness Survey"). Differences in 2015 survey responses were reviewed, and comparisons made between 2012 and 2015 responses.

SETTING

Randomized sample of 811 LHDs drawn from 2565 LHDs that were invited to participate in the 2010 National Profile of LHDs and participated in the 2012 CE-PHEP survey. Sample selection was stratified by geographic location and size of population served.

PARTICIPANTS

Emergency preparedness coordinators reporting on the LHDs they serve.

MAIN OUTCOME MEASURE

Community engagement in public health emergency preparedness intensity as measured by a scoring system that valued specific practices on the basis of the community capacity and public participation they represented.

RESULTS

Survey response was 30%; 243 LHDs participated. The CE-PHEP activities and intensity scores remained unchanged from 2012 to 2015. Local health departments that reported having an explicit CE-PHEP policy and experienced CE-PHEP staff member--2 of the top 3 predictors of CE-PHEP intensity--have dropped between 2012 and 2015. The numbers of LHDs with a CE-PHEP budget, also an important predictor of intensity, have not increased in a statistically significant way during that same period.

CONCLUSIONS

Local health departments appear to be in a CE-PHEP holding pattern, presumably pushed forward by the doctrinal focus on partner-centered preparedness but held back by capacity issues, in particular, limited staff and partner support. Local health departments operating in low-resource environments are encouraged to formalize their CE-PHEP policy to advance performance in this arena.

The association between socioeconomic status and reactions to radiation exposure: a cross-sectional study after the Fukushima Daiichi nuclear power station accident

Risk perception and individual reactions to risk are not necessarily comparable, and socioeconomic status may affect individual reactions to risk. This study aimed to investigate the association between socioeconomic status and reactions to radiation exposure risk. This cross-sectional study, based on a self-reported online survey was conducted between 3 March and 21 March 2012, one year after the accident at Fukushima Daiichi nuclear power station. We used feelings of anxiety and risk-averse behavior concerning radiation exposure as dependent variables, and equivalent income and educational attainment as independent variables. Multiple logistic regression analysis was applied to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) with adjustment for possible confounders. Among 10 000 participants, 23.0% felt anxious and 12.0% engaged in risk-averse behavior for radiation exposure. Participants with a higher socioeconomic status tended not to feel anxious but undertook risk-averse behavior. Participants in the highest quartile income category did not report feeling anxious but showed prevalent undertaking of risk-averse behavior for radiation exposure compared to the lowest income category (for anxiety, aOR, 0.77; 95% CI, 0.64–0.93, for risk-averse behavior, aOR, 1.33; 95% CI, 1.04–1.69). University or graduate-school graduates were associated with greater risk-averse behavior compared to junior high school or high school graduates (aOR, 1.49; 95% CI, 1.29–1.73). Socioeconomic status may affect reactions to radiation exposure risk. Risk communication strategies should consider the socioeconomic status of those affected.

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

BACKGROUND

Health services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community-those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries.

METHODS

A scoping review methodology was applied to peer-reviewed articles to answer the question: "How do health services identify, recruit and use boundary spanners and what are the outcomes?" The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services.

FINDINGS

We identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs.

CONCLUSIONS

Community boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes. Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

A national survey on health department capacity for community engagement in emergency preparedness

CONTEXT

Limited systematic knowledge exists about how public health practitioners and policy makers can best strengthen community engagement in public health emergency preparedness ("CE-PHEP"), a top priority for US national health security.

OBJECTIVES

To investigate local health department (LHD) adoption of federally recommended participatory approaches to PHEP and to identify LHD organizational characteristics associated with more intense CE-PHEP.

DESIGN

National survey in 2012 of LHDs using a self-administered Web-based questionnaire regarding LHD practices and resources for CE-PHEP ("The Community Engagement for Public Health Emergency Preparedness Survey"). Differences in survey responses were examined, and a multivariate analysis was used to test whether LHD organizational characteristics were associated with differences in CE-PHEP intensity.

SETTING

A randomized sample of 754 LHDs drawn from the 2565 LHDs that had been invited to participate in the 2010 National Profile of LHDs. Sample selection was stratified by the size of population served and geographic location.

PARTICIPANTS

Emergency preparedness coordinators reporting on their respective LHDs.

MAIN OUTCOME MEASURE

CE-PHEP intensity as measured with a scoring system that rated specific CE-PHEP practices by LHD according to the relative degrees of public participation and community capacity they represented.

RESULTS

Survey response rate was 61%. The most common reported CE-PHEP activity was disseminating personal preparedness materials (90%); the least common was convening public forums on PHEP planning (22%). LHD characteristics most strongly associated with more intense CE-PHEP were having a formal CE-PHEP policy, allocating funds for CE-PHEP, having strong support from community-based organizations, and employing a coordinator with prior CE experience.

CONCLUSIONS

Promising ways to engage community partners more fully in the PHEP enterprise are institutionalizing CE-PHEP objectives, employing sufficient and skilled staff, leveraging current community-based organization support, and aligning budgets with the value of CE-PHEP to US national health security.

It's not only what you say, it's also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh

BACKGROUND

During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak.

METHODS

We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person.

RESULTS

The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients.

CONCLUSIONS

During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.

Evidence-based communications strategies: NWPERLC response to training on effectively reaching limited English-speaking (LEP) populations in emergencies

INTRODUCTION

Identifying and overcoming barriers to effective emergency preparedness and response is one of the objectives for the Centers for Disease Control and Prevention's network of 14 Preparedness and Emergency Response Learning Centers (PERLCs) and 9 Preparedness and Response Research Centers (PERRCs). This report describes how a PERLC and a PERRC colocated at the Northwest Center for Public Health Practice responded to Los Angeles County Department of Public Health's (DPH's) request to improve emergency communications with limited English-proficient (LEP) populations.

METHODS/ACTIVITY

Activities included an assessment of training needs of the DPH preparedness workforce, a training series on social media and community engagement, and a toolkit of evidence-based findings to improve LEP populations' emergency communications and community resilience.

RESULTS/OUTCOMES

Most respondents to the training needs assessment considered themselves essential personnel during an emergency and stated that they have received proper training. Respondents would like to receive further emergency preparedness training, including additional clarity on their role during an emergency. The majority of participants rated the training series as excellent/very good and agreed that they will be able to apply the course content to their work. The percentage of participants who reported confidence in their knowledge and skills related to each course learning objective increased from the precourse survey to the postcourse survey.

DISCUSSION

This article discusses how the colocation of PERRC and PERLC offers efficiencies and expertise to accomplish multicomponent evidence-based requests. The ability to translate research findings quickly into evidence-based training and best practice resources is a strategic benefit to public health practice agencies working on emergency preparedness.

LESSONS LEARNED/NEXT STEPS

LA County DPH was able to use knowledge and lessons learned gained from this work to design and prioritize education and training offerings to improve the capacity to effectively engage and communicate with LEP communities before and during public health emergencies.

Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment

PURPOSE

The objective of this study was to determine if complementary and alternative medicine therapies are associated with mental health in postdisaster environments.

DESIGN

Pregnant women (N = 402) were interviewed between 2010 and 2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care.

METHODS

Symptoms of depression (Edinburgh Postnatal Depression Screen), prenatal anxiety (Revised Prenatal Distress Questionnaire), posttraumatic stress (PCL-S), and perceived stress (PSS) were examined. Logistic regression was used to adjust for income, race, education, parity, and age. The most commonly reported therapies were prayer, music, multivitamins, massage, and aromatherapy.

FINDINGS

Mental illness symptoms were common (30.7% had likely depression, 17.4% had anxiety, and 9.0% had posttraumatic stress). Massage was protective for depression (Edinburgh Postnatal Depression Index [EDSI] >8; adjusted odds ratio [aOR] = 0.6, 95% confidence interval [CI] = 0.3-0.9), while use of aromatherapy (aOR = 1.9, 95% CI = 1.1-3.2) and keeping a journal (aOR = 1.9, 95% CI = 1.1-3.2) were associated with increased odds of depression. Aromatherapy was associated with symptoms of pregnancy-related anxiety (aOR = 2.0, 95% CI = 1.1-3.8).

CONCLUSIONS

Symptoms of mental illness persist after disaster, when untreated. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms.

A proposed disaster literacy model

Although numerous government, nonprofit, and relief organizations have endeavored to educate and prepare the American public for disasters, adults with physical, mental, and educational disabilities remain among the most vulnerable and least prepared subgroups of the population. The lack of alignment between the literacy demands of existing disaster preparedness and recovery materials and the literacy skills of many vulnerable subgroups limits their ability to understand and effectively use potentially life-saving information. We review the literature on literacy and vulnerable populations, propose a new model for disaster literacy, and describe opportunities for incorporating best practices into planning and preparedness activities. Disaster literacy is defined here as an individual's ability to read, understand, and use information to make informed decisions and follow instructions in the context of mitigating, preparing, responding, and recovering from a disaster. Recommendations are made for developing and evaluating disaster communication materials for vulnerable populations. To meet and improve the disaster literacy of vulnerable populations we suggest pilot-testing and evaluation be routinely used to inform selection of media type, message, and point of contact.