Risk Communication Fundamentals

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Risk Communication Fundamentals

• For Public Health Professionals

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Good Risk Communication..

• seeks to
• translate the scientific findings and
  probabilistic risk assessment into understandable
  terms
• explain the uncertainty ranges, knowledge gaps
  and ongoing research programs
• address the issue of building credibility and
  trust
• understand the publics framing of the risk
  issues, especially the qualitative dimensions

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Good Risk Communication...

• seeks to
• acknowledge the specific questions that arise in
  this domain (publics perception)
• analyse the conditions needed for allowing the
  public to acquire needed information, skills and
  participatory opportunities

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Steps for Good Risk Communication

• acknowledge others arguments
• Ask permission
• Apologize
• Clean up
• Share (benefits or control)
• Give credit where it is due

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Risk Communication

• need to consider
• the message (information)
• the source (origination point of message)
• The communicator
• the channel (path)
• receiver (termination point)

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The Message

• Who is the target audience?
• How can they be reached?
• What level of education do they have?
• What do you need to tell them?

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The Source

• All sources are not equal (by decreasing
  trustworthiness)
• Family Doctor
• University researcher
• media
• Local government
• Federal government
• Industry

Mersereau Dugandzic, 1999
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The Communicator

• Needs to have
• Empathy
• Trustworthiness (must be earned)
• Showing emotion
• Good speaker
• Eye contact
• Identify with audience

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Channel or Medium

• Very important to choose the correct one for your
  target
• Entire messages can be missed if wrong medium is
  chosen
• Farmers and pesticide warnings on late night TV
• Complex written materials for Grade 6 education
• Written materials for evacuation notice due to
  fire
• Radio messages in English for French audience, etc

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Three Rules for Risk Communication

• tell people that you have determined they need to
  know
• tell them what they must know so that they can
  understand and feel that they understand the info
• add qualifiers to prepare them for what you are
  not telling them (until more info becomes
  available)

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EPA Risk Communication Guidelines

• Accept and involve public as a legitimate partner
• Plan carefully and evaluate performance
• listen to your audience
• be honest, frank and open
• coordinate and collaborate with other credible
  sources
• meet the needs of the media
• speak clearly and with compassion

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Powells Lessons in Risk Communication

• A risk information vacuum is a primary factor in
  the social amplification of risk
• ensure the vacuum either does not exist, or fill
  it with useful risk messages
• Regulators are responsible for effective risk
  communication
• Health Canada has an established practice of not
  announcing the issuance of a regulatory decision
• US FDA regularly makes brief statements in
  conjunction with regulatory actions

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Lessons (contd)

• Industry is responsible for effective risk
  communication
• primarily workplace hazards
• population health hazards (foodborne, etc)
• general environmental hazards (pesticides, etc)
• workplace and general env. hazards (metals, etc)
• incremental risks produced as a byproduct of
  beneficial industrial products (pharmaceuticals,
  modern transportation, etc)

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Lessons (contd)

• If you are responsible, act early and often
• some upcoming risks in the next decade are
• food safety
• endocrine disruptors
• greenhouse gases and global climate change
• biotechnology, especially agricultural
  applications
• health impacts of atmospheric pollutants
• There is always more to a risk issue than what
  science says
• what about emotion, moral issues, etc.

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Lessons (contd)

• Always put the science in a policy context
• whatever the risk controversy, the pubic will
  demand action by the politicians
• ban the substance, control the exposure, etc
• Educating the public about science is no
  substitute for good risk communication practice
• provide lots of information, how and why things
  are going to be done
• Banish no risk messages

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Lessons (contd)

• Risk messages should address directly the
  contest of opinion in society
• acknowledge the divergent opinions
• explain the range of risk estimates
• legitimate the people who disagree with your risk
  estimates
• Communicating well has benefits for good risk
  management

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How to Communicate Risk to Public?

• all we have to do is
• get the numbers right
• tell them the numbers
• explain what we mean by the numbers
• show them that they have accepted similar risks
  in the past
• show them that it is a good idea for them
• treat them nicely
• make them partners
• All of the above
• by Baruch Fischoff

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Avoid areas of confusion

• Zero risk
• Probability
• Significant
• Too careful estimates
• Negative vs. positive findings
• Population vs. individual risk
• Relative vs. absolute
• Association vs. causation

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Communication Problems

• occur when the message
• is not what the audience wants to hear
• is poorly presented
• is improper
• comes from the wrong source
• is sent via the wrong channel

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10 Deadly Sins of Presenting

• Appearing unprepared.
• Handling questions improperly.
• Apologizing for yourself or the organization.
• Not knowing knowable information.
• Unprofessional use of audiovisual aids.
• Seeming to be off schedule.
• Not involving participants.
• Not establishing rapport.
• Appearing disorganized.
• Providing the wrong content.

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Identifying Strategies

• look for use of confusing terms in your message
• either remove them or explain them
• step back and review wording
• listen to other non-scientific discussions to see
  use of words and their meaning
• adopt the popular usage of the word and its
  meaning

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ID Strategies (contd)

• Pre-test your message
• use friend or family member (non-scientific)
• ask them to identify words of concern or
  confusion
• Discuss your message with your mock audience
• may find out that your explanation is not good
  enough
• may determine where your communication went wrong

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Dealing with the Mixed Message

• substitute less confusing words
• if the word is still needed, clearly define it in
  the text
• give examples of intended meaning and some
  misuses of the term
• right in the text of the message
• use analogies, definitions, comparisons to help
  explain the term
• be consistent in the use of the term

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Designing your Risk Communication

• Choose your forum
• Choose your message
• Choose your source
• Know your audience!
• Focus group

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How People Learn
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How do people learn?

• Figure 1-1. Easiest Format to Learn From -
  Preferences by Age Group, From EPA, 2004,
  Evaluation of Mercury Risk Communication Messages.

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Exercise choose your medium

• Break into groups
• Choose your medium based on who the intended
  audience is (reading from EPA Graph on how people
  best integrate knowledge)
• How would you choose to tell
• 50 women the risks of hormone replacement
  therapy?
• Teenagers the risks of texting and driving?
• A small community of the acceptability of a new
  incinerator?

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Know your audience

• The likelihood of achieving a successful risk
  communication program increases with your
  knowledge of those with whom you are
  communicating.
• Early in the process, know who your publics are,
  what their concerns are, how they perceive risk,
  and whom they trust.

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Characteristics of your Publics

• Concerns
• Attitudes
• Levels of interest
• Levels of involvement
• Histories
• Levels of knowledge
• Opinions
• Reasons for interest
• Types of involvement

Are they potential supporters or potential
adversaries?
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Interacting with the Community(Chess et al. 1988)

• Citizen involvement is important because
• people are entitled to make decisions about
  issues that directly affect their lives
• input from the community can help the agency make
  better decisions
• involvement in the process leads to greater
  understanding of - and more appropriate reaction
  to - a particular risk
• those who are affected by a problem bring
  different variables to the problem-solving
  equation and
• cooperation increases credibility.

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Creating the Message

• What are the three most important things you
  would like your audience to know?
• What are the three most important things your
  audience would like to know?
• What are the three most important things your
  audience is most likely to get wrong unless they
  are emphasized? (Vincent Covello)

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Sound bite research

• Assumption national news, controversial topic 7
  to 9 seconds (21-27 words, 30 words max.)
• 3 messages 9 second knowledge/trust window
  (Vincent Covello)

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Risk Information Vacuum

• work of risk communication is to fill the gap
  between public knowledge and scientific
  assessment of risk
• gap will always exist
• how to fill it is the question
• risk information vacuum arises when
• over a long period of time, scientists make no
  special effort to communicate the results being
  obtained regularly and effectively to the public
• instead, partial scientific info dribbles out
  here and there, being interpreted in apparently
  conflicting ways and increases the publics fear

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Vacuum (contd)

• failure to implement good risk communication
  practices gives rise to a risk information vacuum
• this failure can have grave and expensive
  consequences for those regarded as being
  responsible for protecting the publics interest
• society abhors a vacuum, so it is filled from
  other sources

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Vacuum (contd)

• the vacuum gets filled
• events reported in the media will become the
  basis for the public framing of these risks
• an interest group takes up the challenge and
  fills the vacuum with its own information and
  perspectives
• the intuitively based fears and concerns of
  individuals grow spread until they become a
  substantial consensus in the arena of pubic
  opinion
• vacuum is filled by soothing sentiments of
  politicians
• there is no risk of danger from ......

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Examples of Vacuums

• dioxins
• outrageous media headlines
• scientific research
• no communications on the issue until too late
• Greenpeace filled the vacuum
• mad cow disease
• panic ensued when government did not provide
  details on the suspicions around the spread of
  BSE
• vacuum was filled by media and individual
  suspicions that become consensus

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Examples of Vacuums

• silicone breast implants
• manufacturers did not disclose their information
  in a timely manner
• failed to encourage a frank and open discussion
  of potential risks
• vacuum was created by the lack of this discussion
• panic and fear of autoimmune diseases filled the
  vacuum
• lawsuits began and are still costing billions of
  dollars
• no scientific information to support the claims

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Examples (contd)

• genetically altered/engineered crops
• people upset because the technology is unfamiliar
• government doesnt want to talk about the issues
  with the public
• vacuum will be filled, and it may be damaging to
  the industry

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Why Arent the Experts Trusted?

• expert group may have financial interest in
  proving the risk is small
• remediation technology spokesperson wanting to
  use the technology
• local mayor wanting to get re-elected
• company spokesperson not wanting plant shut down
• historical examples exist of where experts were
  wrong
• and handful of dissenters and activists were right

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Why arent the experts trusted? (contd)

• scientists tell us that risk assessment is a
  rough science and subject to error
• need to better explain how risk assessment is
  done
• need to better explain the use of safety factors
• some environmental risks are gradual, delayed,
  geometrical (made worse by other risks)
• better act now
• even though no evidence yet exists

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What will good risk communication do?

• over time good risk communication practices will
• nurture a facility for interpreting risk numbers
• including the meaning of risk estimates and the
  uncertainty associated with them
• help people to put the whole assortment of risks
  affecting them into a broad framework
• relative risk, comparative risk
• build institutional structures for arriving at a
  consensus on risk management options, and for
  allocating risk reduction resources effectively

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What is Risk?

• risk hazard outrage
• public cares too little about hazard
• expert cares too little about outrage
• experts need to realize
• outrage is as real as hazard
• outrage is as measurable as hazard
• outrage is as manageable as hazard
• outrage is as much a part of risk as hazard
• outrage is as much a part of your job as hazard

Peter Sandman
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Other Facts on Risk

• people overestimate hazard and are outraged
• which comes first?
• misunderstand hazard and get outraged?
• get outraged and misunderstand hazard?
• who is right?
• usually experts are right about hazard
• usually public is right about outrage

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How to Solve Risk Dilemma?

• solution
• experts must
• take public outrage seriously
• keep outrage separate from hazard
• respect peoples outrage

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Risk Communication Myths and Actions (Chess et
al. 1988)

• Belief in some common myths often interferes with
  development of an effective risk communication
  program. Consider the myths and actions you can
  take.
• Myth We don't have enough time and resources to
  have a risk communication program.
• Action Train all your staff to communicate more
  effectively. Plan projects to include time to
  involve the public.

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Myths 2

• Myth Telling the public about a risk is more
  likely to unduly alarm people than keeping quiet.
• Action Decrease potential for alarm by giving
  people a chance to express their concerns.
• Myth Communication is less important than
  education. If people knew the true risks, they
  would accept them.
• Action Pay as much attention to your process for
  dealing with people as you do to explaining the
  data.

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Myths 3

• Myth We shouldn't go to the public until we have
  solutions to environmental health problems.
• Action Release and discuss information about
  risk management options and involve communities
  in strategies in which they have a stake.

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Myths 4

• Myth These issues are too difficult for the
  public to understand.
• Action Separate public disagreement with your
  policies from misunderstanding of the highly
  technical issues.
• Myth Technical decisions should be left in the
  hands of technical people.
• Action Provide the public with information.
  Listen to community concerns. Involve staff with
  diverse backgrounds in developing policy.

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Myths 5

• Myth Risk communication is not my job.
• Action As a public servant, you have a
  responsibility to the public. Learn to integrate
  communication into your job and help others do
  the same.
• Myth If we give them an inch, they'll take a
  mile.
• Action If you listen to people when they are
  asking for inches, they are less likely to demand
  miles. Avoid the battleground. Involve people
  early and often.

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Myths 6

• Myth If we listen to the public, we will devote
  scarce resources to issues that are not a great
  threat to public health.
• Action Listen early to avoid controversy and the
  potential for disproportionate attention to
  lesser issues.

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Myths 7

• Myth Activist groups are responsible for
  stirring up unwarranted concerns.
• Action Activists help to focus public anger.
  Many environmental groups are reasonable and
  responsible. Work with groups rather than against
  them.

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High Hazard, low outrage

• Keep the risk message short.
• Make the risk message interesting.
• Stay on message.
• Test the risk messages.
• Plan and prepare for a long-term endeavour.
• Appeal to needs.
• Appeal to emotions, especially fear.
• http//www.psandman.com/handouts/sand59a.pdf)

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Contd

• See fear arousal as a competition
• Dont neglect other emotions. Identify and give
  people task that they can do.
• Give people a selection of tasks to choose from.
• Sequence recommended precautions.
• Think in stages.
• Focus resources on teachable moments.

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Contd

• Be alert for a short-term over-reaction.
• Be alert for signs of denial.
• Identify and address persuasion facilitators.
• Identify persuasion barriers and consider
  addressing them.
• Express empathy for apathy.
• Consider an alternative pre-crisis communication.

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What is a Focus Group?

• special kind of interview for the purpose of
  collective information about a specific subject
  or area of concern
• useful for gathering information on risk
  perceptions
• used to assess needs, preferences and attitudes
• information can then be used to
• formulate risk messages
• determine appropriate channel
• choose a communicator
• frame the risk information in an acceptable way

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Focus Group Design

• facilitator spends 2-8 hours with eight to twelve
  people
• job is to ensure all areas are explored
• usually has a helper to make group work better
• free flowing discussion
• group usually made up of individuals who have
  something in common
• age, activity, employed by same company, etc.
• record activities on flow chart or tape

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Why use a focus group?

• allows participants to discuss a subject openly
  and in great detail
• research can be conducted quickly
• organize, conduct and analyse research from
  several focus groups in as little as 2 weeks
• decisions can then be implemented almost
  immediately
• far less intimidating or frustrating than other
  forms of research
• anxiety of the individuals is lessened in the
  group context

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Goals for Collecting Information

• determine the interests, needs, attitudes of a
  sample of community members about a particular
  risk issue
• objectives
• determine attitudes and opinions already in
  existence
• determine knowledge level about this particular
  risk
• determine the resources necessary to better
  communicate risk
• obtain ideas on how to best communicate with this
  community

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Identifying Participants

• look carefully at the community
• demographics
• determine who may have most need for the risk
  information
• who is more interested?
• usually no more than 8 groups are necessary
• more important than numbers is how the groups are
  chosen

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How to Contact Participants?

• telephone
• letters
• meeting with people
• meeting with leaders of already established
  organizations
• how to introduce yourself
• why is issue important
• who you are
• what is the objective of the focus group
• why is the individual valuable

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Planning and Preparation

• place
• find a comfortable location, accessible to the
  majority
• make sure there are enough chairs and room for
  everyone
• time and date
• convenient to majority
• be there an hour before hand
• let everyone know how long it will be, and stick
  to it
• dont go longer than 2 hours

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Leading the Focus Group

• guidelines
• no right or wrong answers
• opinions are wanted
• we do not have to agree
• it is important for everyone to participate
• we will finish in two hours
• your names will be confidential
• all the information will be used in your community

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Focus Group Skills

• facilitator
• avoid a question and answer session
• let it be open
• set a cooperative tone
• be open and pleasant
• be prepared and organized
• establish and maintain an easy rapport
• be non-judgmental
• use probing techniques (to get further
  information)

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Closing the Focus Group

• summarize the session briefly
• thank them for their ideas
• ask if they want to know the results
• ask them if they want to keep in touch
• give them your name and number for future contact
• let them know when the information will be
  released to the community
• and when they will be able to give feedback

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Nelson Fok
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Case Studies

• Choose one of the 4 cases
• Who is your audience?
• What is your message?
• What three things do you want to communicate?
• What words will you use?
• Who is your communicator?
• What/who is your source?
• What will be your method/forum?

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Case 1

• E coli has been found in water supply for a small
  area of cottage country, rural Canada.

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Case 2

• Breast feeding rates are very low in your health
  region. You have been tasked with trying to
  improve the rate to national levels.

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Case 3

• A local industry wants to build an incinerator in
  your area. They have been a good corporate
  citizen in the past, and have good environmental
  history. Your department has approved the
  incinerator. The local people are upset and
  demanding answers. They are worried about cancer
  and emissions.

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Case 4

• A poor result from a food inspection has resulted
  in closing down a famous restaurant in the middle
  of tourist season. The owners, some public and
  the mayor are upset with your department.

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Present results of Case Study
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