Assessing clarity of message communication for mandated USEPA drinking water quality reports

Evaluating Multi-Jurisdictional Enteric Illness Outbreak Messaging in Canada: A Content Analysis of Public Health Notices

Effective risk communication during enteric illness outbreaks requires the provision of clear and consistent information to diverse audiences to reduce risk of exposure, inform behavior changes, and prevent illness. Most enteric illnesses are caused by pathogens transmitted through consumption of contaminated food or water, contact with animals, or person-to-person contact. When multi-jurisdictional outbreaks occur, the Public Health Agency of Canada posts web-based Public Health Notices (PHNs) to inform Canadians. This study evaluated the comprehensibility of PHNs to optimize federal risk communication approaches. Publicly available web-based PHNs (n = 42) from 2014-2022 were obtained. A codebook was developed using the Centers for Disease Control and Prevention's (CDC) Clear Communication Index (CCI) and Health Belief Model (HBM) and systematically applied. A SMOG readability calculator was used to determine reading grade level. Descriptive statistics were calculated to summarize coded data. The average reading grade level was above Grade 12 (13.9 ± 1.1). PHNs communicated the nature of the risk (100%) and behavioral recommendations (96.5%) clearly. An active voice was sometimes used (61.9%), but numerical information was less commonly presented using best practices (38.1%). The HBM was fully incorporated in seven PHNs, with most PHNs using five of six constructs (66.7%). PHNs shared similar information in a consistent order (75.0%). Aligning PHNs to best practices in risk communication is recommended, including writing content at a reading grade level that supports comprehension by diverse audiences, following the CCI to increase clarity, including all HBM constructs to promote behavior change, and maintaining message consistency.

Legal and regulatory instruments for NCD prevention: a scoping review and descriptive analysis of evaluations in OECD countries

CONTEXT

Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries.

METHODS

A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants.

FINDINGS

We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness.

CONCLUSIONS

Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

Internet of Things and citizen science as alternative water quality monitoring approaches and the importance of effective water quality communication

The increasing demand for water and worsening climate change place significant pressure on this vital resource, making its preservation a global priority. Water quality monitoring programs are essential for effectively managing this resource. Current programs rely on traditional monitoring approaches, leading to limitations such as low spatiotemporal resolution and high operational costs. Despite the adoption of novel monitoring approaches that enable better data resolution, the public's comprehension of water quality matters remains low, primarily due to communication process deficiencies. This study explores the advantages and challenges of using Internet of Things (IoT) and citizen science as alternative monitoring approaches, emphasizing the need for enhancing public communication of water quality data. Through a systematic review of studies implemented on-field, we identify and propose strategies to address five key challenges that IoT and citizen science monitoring approaches must overcome to mature into robust sources of water quality information. Additionally, we highlight three fundamental problems affecting the water quality communication process and outline strategies to convey this topic effectively to the public.

Evaluation of rapid drug safety communication materials for patients in Japan

Since 2011, pharmaceutical companies in Japan have been required to issue two types of documents regarding severe adverse drug reactions reported post-marketing, namely the Rapid Safety Communication Materials for Patients and the Related Materials. However, the adequacy of these documents has not yet been systematically assessed. The aim of this study was to evaluate the adequacy of these two types of materials. The Rapid Safety Communications for Patients were obtained from the Pharmaceuticals and Medical Devices Agency (PMDA) website. The Related Materials were obtained from pharmaceutical companies or the PMDA website. Three assessors independently scored the Rapid Safety Communication for Patients and the Related Materials using the Centers for Disease Control and Prevention Clear Communication Index (CCI). In addition, the contents and descriptions of the materials were analyzed. In total, 13 materials for seven drugs were assessed. Almost all materials contained the "main message" and "call to action". However, the average CCI scores for the Rapid Safety Communication for Patients and Related Materials for Patients were 68.8 and 74.3 (out of 100), respectively. Further, none of the evaluated materials were scored above the CCI threshold score (i.e., ≥ 90%). Descriptions regarding "language", "state of science", and "risk" were not adequate. In particular, the terminology used in materials seemed difficult for patients to understand. In conclusion, the Japanese Rapid Communication Materials for Patients require improvement. Furthermore, a system for evaluating these materials prior to publication should be established.

Drinking Water in the United States: Implications of Water Safety, Access, and Consumption

Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.

Designing Occupational Safety and Health Training Materials for Clear Communication

INTRODUCTION

Printed materials are an essential part of occupational safety and health programs. Public health professionals at the Centers for Disease Control and Prevention (CDC) have created a Clear Communication Index (CCI) to guide design of health education materials for the general public.

METHODS

We revised an existing handout on heat exposure hazards in construction using the CCI and tested the old and new versions of the handout with an audience of 425 construction apprentices and journey-level workers.

RESULTS

Some features recommended by the CCI-such as the use of subheadings, numbering, and other visual cues-strongly conditioned the readers' understanding of the main message.

CONCLUSIONS

Design and layout have a significant impact on the delivery of messages in written materials. A communications-based rubric such as the CCI can help writers preparing written occupational safety and health materials for workers and general audiences.

Using the Clear Communication Index to Improve Materials for a Behavioral Intervention

Ensuring that written materials used in behavioral interventions are clear is important to support behavior change. This study used the Clear Communication Index (CCI) to assess the original and revised versions of three types of written participant materials from the SIPsmartER intervention. Materials were revised based on original scoring. Scores for the entire index were significantly higher among revised versions than originals (57% versus 41%, p < 0.001); however, few revised materials (n = 2 of 53) achieved the benchmark of ≥90%. Handouts scored higher than worksheets and slide sets for both versions. The proportion of materials scored as having "a single main message" significantly increased between versions for worksheets (7% to 57%, p = 0.003) and slide sets (33% to 67%, p = 0.004). Across individual items, most significant improvements were in Core, with four-items related to the material having a single main message. Findings demonstrate that SIPsmartER's revised materials improved after CCI-informed edits. They advance the evidence and application of the CCI, suggesting it can be effectively used to support improvement in clarity of different types of written materials used in behavioral interventions. Implications for practical considerations of using the tool and suggestions for modifications for specific types of materials are presented.