Emergency Risk Communication Principles and Applied Practices

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Emergency Risk Communication Principles and
Applied Practices

• Melinda Frost, MA, MPH
• Health Communications Officer
• US Embassy, Beijing

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Presentation Outline

• Emergency and Risk Communication Definitions
• Emergency Risk Communication Principles
• Emergency Risk Communication in China
• Developing an Emergency Risk Communication Plan

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Definitions

• Risk Communication communication about potential
  (uncertain) health risks to support informed
  decisions
• Emergency a health threat in which urgent
  response is required

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Why? Emergency Risk Communication

• To provide accurate and timely information as
  well as essential coordination during an emergency

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Why? Emergency Risk Communication

• To inform the public of potential risks and steps
  being taken during an emergency

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Why? Emergency Risk Communication

• To aid individuals, stakeholders, or communities
  to accept the imperfect nature of choices and to
  make best possible decisions during an emergency

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Emergency Communication Challenges

• Uncertainty
• High potential for altered or conflicting
  recommendations
• People are looking at multiple channels to check
  on rumors

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THE CERTAINTIES OF COMMUNICATING UNCERTAINTY

• You will be tempted to suppress your uncertainty
  and sound confident its human nature
• Things will turn out better if you resist that
  temptation

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THE CERTAINTIES OF COMMUNICATING UNCERTAINTY

• Over-confidence rings false, undermining everyone
  elses confidence even if you turn out right
• Over-confidence provokes acrimony, especially
  among your critics
• Over-confidence devastates your credibility and
  your ability to lead if you turn out wrong

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• Emergency Risk Communication Principles

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WHO Outbreak Communication (Emergency Risk)
Principles

• Trust
• Announce early
• Transparency
• Listen to and involve the public
• Planning

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Accuracy of Information

Speed of Release

• Credibility
• Trust

Successful Communication

Empathy Openness
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Components of Trust

• The public perception of
• Motives
• Are responders acting to protect my health and
  the health of my family?
• Honesty
• Are the responders holding back information?
• Competence
• Are the responders capable of controlling the
  outbreak?
• Trust must come before the crisis

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Announce Early

• First Announcement
• The most critical of all outbreak communication
  messages
• Must be early
• Likely to be wrong

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Transparency

• Barriers to Transparency
• Real or perceived competing interest (economic
  vs. public health)
• Spokespersons uncomfortable with delivering bad
  news

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Transparency

• Barriers to Transparency
• Fear the media will misrepresent bad or uncertain
  news
• Concern the public cant tolerate uncertainty or
  will panic
• Official belief that if you say nothing, nothing
  will happen

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Listen to and involve the public

• State continued concern before stating updates
• Acknowledge uncertainty
• Emphasize a process in place
• Tell people what to expect
• Give people things to do
• Let people choose their own actions
• Ask more of people

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Listen to and involve the public

• Dont try to allay panic
• Acknowledge peoples fears
• In every message, try to use
• Empathy
• Action
• Respect

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Influenza A H1N1 Communication Response Announce
Early, Transparency Trust

• First cases laboratory confirmed 4/15 - 17
• 4/22 Activation of Emergency Operations Center
  (http//www.cdc.gov/h1n1flu/)
• 4/23 Daily press briefings (http//www.cdc.gov/h1n
  1flu/press/)

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Risk Communication Principles Project Background

• Public Health Emergency Risk Communication Draft
  Guidelines and Handbook

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Risk Communication Principles Project Background

March 09 Preliminary Handbook Table Top
Sept 10 Final Handbook Table Top
October 06
November 07 Draft Guidelines
Dalian Workshop
Nov 06-Jan 07
2007-08 Training of Draft Guidelines
Review of Risk Communication Principles
2009-10 Re-draft of Risk Communication Handbook
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Risk Communication Principles
Pilot Training and Testing
January 07 March 08
Fujian Province Guizhou Province Jiangsu Province
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China MoH US CDC Emergency Risk Communication
Activities, 2006 2008

• Pilot Training and Testing
• Provinces
• Fujian
• Guizhou
• Jiangsu
• Training completed in 2007
• Anhui
• Chongqing
• Guanxi
• Hubei
• Liaoning
• Shanghai
• Yunnan
• Training scheduled for 2010-11
• Beijing
• Hebei
• Heilongjiang,
• Zhejiang,
• Sichuan

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Testing and Training of Effective Risk
Communication Principles

• In Fujian Province (Jan 2007), Guizhou and
  Jiangsu (Mar 2008) activities in to test
• Was training on the risk communication principles
  effective?
• Are risk communication principles effective for
  Chinese public?

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Risk Communication Principles Project Protocol

• Step 1 Health officials wrote public health
  messages based on a hypothetical case study
  involving a 3-stage H5N1 scenario.
• Step 2 Trained on Risk Communication Principles
  and Practice
• Step 3 Message revision based on principles and
  training
• Step 4 Message testing with citizen groups

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The risk communication training was effective

• Post-training messages
• More risk communication principles
• More types of principles to address psychological
  functions of risk communication
• Decrease feelings of uncertainty and fear
• Increase feelings of control
• Increased trust in health authority
• Address publics cognitive needs

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Guizhou health care workers wrote messages that
included this many Risk Communication principles
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Jiangsu health care workers wrote messages that
included this many Risk Communication principles
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Combined provincial health care workers wrote
messages including this many Risk Communication
principles
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Risk Communication Principles Message Testing
Results
184 Citizens
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Risk Communication Principles Message Testing
Results
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What the Public Wants to Know

• Feedback from Fujian Province Audiences
• How can I prevent getting the disease?
• How is the disease transmitted?
• Is what Im hearing about the disease true?
• What is the disease? And how serious?
• What is the government doing to prevent the
  spread of disease?
• Where can we go for more information?
• Is there a vaccine available?

• Topics from US Audiences
• What is the health threat?
• How does it harm people?
• How will I know if Ive been exposed?
• Signs and symptoms (long/short term)
• How can I protect myself/my family
• How is it treated?
• Where can I get more information?

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Where are People Going for Information?

• Television news
• CCTV
• Newspapers
• Website
• Health bureau, News Website, Sina.com,
  Xinhua.com, MSNBC.com, Baidu search engine
• Local health bureau
• Community residents committee
• Telephone line for public inquiries (hotline)
• Local health department, national hotline
• CDC
• Local hospital
• Emergency Center
• Neighbors

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Channels Used by The Public to Seek Emergency
Information

• Distant threat passive channels
• TV news, newspaper
• Threat is close by, but not in our community
  more active information seeking, but impersonal
  channels
• Internet, Website, Search engines
• Threat is here pro-active search through
  interpersonal channels
• Hotlines
• Visit local health bureau
• Call hospital
• Visit or call local community residents center
  and committee
• Call CDC

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Emergency Risk Communication Lifecycle
Pre-crisis
Initial
Maintenance
Resolution
Evaluation

• To facilitate and anticipate the needs of the
  public, the media, and partners at different
  stages
• Each stage has unique communications and
  information requirements

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Pre-Crisis Communication

• Be prepared
• Foster alliances
• Develop recommendations through consensus
• Test audience messages

Pre-crisis
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Planning

• Communicators
• Technical staff
• Policy makers

Communicators
Tech staff
Policy makers
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Nine Steps of Communication Response
4
3
5
2
6
1
7
8
9
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Public Information Release

• Select the appropriate channels of communication
  and apply them
• Simply
• Timely
• Accurately
• Repeatedly
• Credibly
• Consistently

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Trust Case Study

• Measles, Mumps Rubella Vaccine (MMR)
• United Kingdom, 2008

Raithatha N, Holland R, Gerrard S, Harvey I, A
qualitative investigation of vaccine risk
perception amongst parents who immunize their
children a matter of public health concern. J.
of Public Health Medicine. 25 (2) 2003
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MMR Vaccination in the UK What happened?

• In 1998, a researcher suggested that the MMR
  vaccine may cause autism
• In 2001, the same researcher developed another
  paper questioning the safety of MMR

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MMR Vaccination in the UK What happened?

• The media reported the paper out of proportion
• Subsequent papers and studies have disproved the
  link between MMR and autism

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Context in the United Kingdom in early 2000s

• Parents understood true benefits of vaccination
  but still felt dread at thoughts of long-term
  disability
• Lack of trust in recent government
• reaction to BSE crisis
• Slight lack of trust in motives, and knowledge
  base of doctors

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MMR Vaccination in the UKThe Results

• MMR Vaccination rates dropped from 91 to 80
  between 1998 and 2004
• 1,049 cases of measles between Jan Oct, 2008
  (the worst year since 1995)
• 55,000 cases of mumps between 2004-06

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Audience Perceptions and Rumors

• A rumor is a specific (or topical) proposition
  for belief, passed along from person to person,
  without secure standards or evidence being
  present.

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Rumor sources

• Blogosphere
• SMS text messaging
• Internet
• Word of mouth
• Where else?

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Audience Perceptions Sources of Insight

• Monitoring for rumors (listening to your
  audience)
• Social media websites,
• blogospheres
• Hotlines (12320, hospitals, etc.)
• Print/broadcast media

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Audience Perceptions Sources of Insight

• Listening to your audience
• Focus groups
• Intercept interviews
• What else?

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Rumor found to react or ignore?

• The two factors that influence a rumor are its
  importance to the listener and its ambiguity.
• Rumors travel when events have importance in the
  lives of individuals, and when the news received
  about them is either lacking or subjectivity
  ambiguous. The ambiguity may arise from the fact
  that the news is not clearly reported, or from
  the fact the conflicting versions of the news
  have reached the individual, or from his
  incapacity to comprehend the news he receives.

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How do we address misinformation?Risk
Communication Principles

• Rumors fly in the absence of news. Therefore, we
  must give the people the most accurate possible
  news, promptly and completely.
• Announce early
• Be transparent
• Listen to the public
• Show empathy

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How do we address a rumor?Messaging

• Simply denying a rumor does not eliminate
  ambiguity it may even increase it.
• No comment increases
• ambiguity.
• Silence REALLY increases ambiguity.

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Thank you!Questions?