Canadian Pandemic Influenza Preparedness: Communications strategy

Overview of the Health Communication Curriculum in Canadian Master of Public Health Programs

CONTEXT

Competency-based public health education ensures practitioners are well equipped to positively influence the health of the public. The Public Health Agency of Canada's Core Competencies for Public Health has named communication as an essential competency area for practitioners. However, little is known about how Master of Public Health (MPH) programs in Canada support trainees in developing the recommended core competencies in communication.

OBJECTIVE

Our research aims to provide an overview of the extent to which communication is embedded in the curriculum of MPH programs in Canada.

DESIGN

We conducted an online scan of Canadian MPH course titles and descriptions to determine how many MPH programs offer communication-focused courses (ie, health communication), knowledge mobilization courses (eg, knowledge translation), and other courses that may support communication skills. Two researchers coded the data; discrepancies were resolved via discussion.

RESULTS

Of the 19 MPH programs in Canada, less than half (n = 9) offer courses specifically focused on communication (ie, health communication); these courses are mandatory in only 4 programs. Seven programs offer knowledge mobilization courses; none are mandatory. Sixteen MPH programs offer a total of 63 other public health courses that are not focused on communication but contain communication terms (eg, marketing, literacy) in their course descriptions. No Canadian MPH program has a communication-focused stream or option.

CONCLUSION

Canadian-trained MPH graduates may not be receiving sufficient communication training to equip them for effective and precise public health practice. This is particularly concerning, given that current events have underlined the importance of health, risk, and crisis communication.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care

BACKGROUND

Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk.

OBJECTIVE

To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care.

METHODS

Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives.

RESULTS

95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care.

CONCLUSIONS

We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.

Canadian COVID-19 Crisis Communication on Twitter: Mixed Methods Research Examining Tweets from Government, Politicians, and Public Health for Crisis Communication Guiding Principles and Tweet Engagement

To foster trust on social media during a crisis, messages should implement key guiding principles, including call to action, clarity, conversational tone, compassion and empathy, correction of misinformation, and transparency. This study describes how crisis actors used guiding principles in COVID-19 tweets, and how the use of these guiding principles relates to tweet engagement. Original, English language tweets from 10 federal level government, politician, and public health Twitter accounts were collected between 11 March 2020 and 25 January 2021 (n = 6053). A 60% random sample was taken (n = 3633), and the tweets were analyzed for guiding principles. A tweet engagement score was calculated for each tweet and logistic regression analyses were conducted to model the relationship between guiding principles and tweet engagement. Overall, the use of guiding principles was low and inconsistent. Tweets that were written with compassion and empathy, or conversational tone were associated with greater odds of having higher tweet engagement. Across all guiding principles, tweets from politicians and public health were associated with greater odds of having higher tweet engagement. Using a combination of guiding principles was associated with greater odds of having higher tweet engagement. Crisis actors should consistently use relevant guiding principles in crisis communication messages to improve message engagement.

A content analysis of Canadian influencer crisis messages on Instagram and the public’s response during COVID-19

Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations (n = 0 or 1 construct per post) of constructs in captions and images and very infrequently used captions that combined threat (severity and susceptibility) with cues to action and efficacy. Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.

Engagement Analysis of Canadian Public Health and News Media Facebook Posts and Sentiment Analysis of Corresponding Comments during COVID-19

During the COVID-19 pandemic, key stakeholders have used social media to rapidly disseminate essential information to the public to help them make informed health-related decisions. Our research examined how the public responded to official actors’ Facebook posts during COVID-19 and examined the comment sentiment and post engagement rates. CBC News and CTV News received a greater proportion of negative comments and a lower average post engagement rate compared with Healthy Canadians. Additionally, the proportion of negative and positive comments varied over time for all sources; however, over 30% of the comments for all three actors were consistently negative. Key stakeholders should monitor the public’s response to their social media posts and adapt their messages to increase the effectiveness of their crisis communication efforts to encourage the adoption of protective measures.

Assessment of biosafety implementation in clinical diagnostic laboratories in pakistan related to the COVID-19 pandemic

Laboratory diagnostic capacity is crucial for an optimal national response to a public health emergency such as the COVID-19 pandemic. Preventing laboratory-acquired infections and the loss of critical human resources, especially during a public health emergency, requires laboratories to have a good biorisk management system in place. In this study, we aimed to evaluate laboratory biosafety and biosecurity in Pakistan during the COVID-19 pandemic. In this cross-sectional study, a self-rated anonymous questionnaire was distributed to laboratory professionals (LPs) working in clinical diagnostic laboratories, including laboratories performing polymerase chain reaction (PCR)-based COVID-19 diagnostic testing in Punjab, Sindh, Khyber Pakhtunkhwa, and Gilgit-Baltistan provinces as well as Islamabad during March 2020 to April 2020. The questionnaire assessed knowledge and perceptions of LPs, resource availability, and commitment by top management in these laboratories. In total, 58.6% of LPs performing COVID-19 testing reported that their laboratory did not conduct a biorisk assessment before starting COVID-19 testing in their facility. Only 31% of LPs were aware that COVID-19 testing could be performed at a biosafety level 2 laboratory, as per the World Health Organization interim biosafety guidelines. A sufficiently high percentage of LPs did not feel confident in their ability to handle COVID-19 samples (32.8%), spills (43.1%), or other accidents (32.8%). These findings demonstrate the need for effective biosafety program implementation, proper training, and establishing competency assessment methods. These findings also suggested that identifying and addressing gaps in existing biorisk management systems through sustainable interventions and preparing LPs for surge capacity is crucial to better address public health emergencies.

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.

Examining Social Media Crisis Communication during Early COVID-19 from Public Health and News Media for Quality, Content, and Corresponding Public Sentiment

Rising COVID-19 cases in Canada in early 2021, coupled with pervasive mis- and disinformation, demonstrate the critical relationship between effective crisis communication, trust, and risk protective measure adherence by the public. Trust in crisis communication is affected by the communication's characteristics including transparency, timeliness, empathy, and clarity, as well as the source and communication channels used. Crisis communication occurs in a rhetorical arena where various actors, including public health, news media, and the public, are co-producing and responding to messages. Rhetorical arenas must be monitored to assess the acceptance of messaging. The quality and content of Canadian public health and news media crisis communication on Facebook were evaluated to understand the use of key guiding principles of effective crisis communication, the focus of the communication, and subsequent public emotional response to included posts. Four hundred and thirty-eight posts and 26,774 anonymized comments were collected and analyzed. Overall, the guiding principles for effective crisis communication were inconsistently applied and combined. A limited combination of guiding principles, especially those that demonstrate trustworthiness, was likely driving the negative sentiment uncovered in the comments. Public health and news media should use the guiding principles consistently to increase positive sentiment and build trust among followers.

Canadian pandemic influenza preparedness: Public health measures strategy

Public health measures, also known as non-pharmaceutical interventions, are basic actions aimed at slowing the community spread of a communicable disease outbreak. In the event of an influenza pandemic, public health measures and antiviral drugs are the only tools available to mitigate the effects of the pandemic during the months before a vaccine becomes available. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) outlines how federal, provincial and territorial governments will work together to ensure a coordinated and consistent health sector approach to pandemic influenza preparedness and response. This article summarizes Canada's pandemic public health measures strategy, as described in the recently updated CPIP Public Health Measures Annex. The strategy builds on lessons learned during the 2009 H1N1 pandemic. Key elements of the public health measures strategy include individual measures (e.g. hand hygiene, self-isolation when ill), community-based measures (e.g. school closures, cancellation of mass gatherings), management of cases and close contacts, travel and border-related actions and public education. Factors that influence the effectiveness of public health measures in a pandemic include the pandemic epidemiology, timing of implementation, how the measures are used (i.e. alone or in combination), the scalability and flexibility of public compliance. The CPIP is an evergreen guidance document and the Annex will be updated as new information warrants.

Canadian Pandemic Influenza Preparedness: Antiviral strategy

Antiviral medications are the only influenza-specific pharmaceutical intervention that can be used to mitigate the impact of a pandemic until a vaccine becomes available. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) outlines how federal, provincial and territorial governments will work together to ensure a coordinated and consistent health sector approach to pandemic influenza preparedness and response. This article summarizes Canada's pandemic influenza antiviral strategy as described in the recently updated CPIP Antiviral Annex. The antiviral strategy builds on lessons learned during the 2009 H1N1 pandemic. Key elements of the strategy include ensuring equitable, timely and coordinated access to antivirals through government stockpiles; having regulatory mechanisms in place that facilitate timely access to antivirals; providing timely and evidence-based clinical guidance; maintaining effective stockpile management practices; and monitoring antiviral utilization, effectiveness and safety. Since the CPIP is an evergreen document, this Annex will be updated as new information warrants.