Risk communication during an infectious disease event - pandemics and public health.
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Transcript of Risk communication during an infectious disease event - pandemics and public health.
SYDNEY MEDICAL SCHOOL
www.ncirs.usyd.edu.au
Effective communication strategies during an infectious disease event
Sheela Basrur Symposium, Toronto, 3 April 2013
A/Prof Julie Leask School of Public Health
[email protected] @JulieLeask
Dr Claire Hooker
Centre for Values, Ethics and the Law in Medicine
Acknowledgements
› Sheela Basrur
› Claire Hooker, Centre for Values, Ethics and the Law in Medicine, University of Sydney
› Catherine King, May Chiew, Alexis Pilsbury National Centre for Immunisation Research & Surveillance
› Peter Massey, Hunter New England Local Health District, NSW
H1N1
Source: www.crikey.com.au
Outline
› Understanding public responses
› Key challenges
› Working with the media
› Changing media landscape
› Practical risk communication suggestions
Understanding public responses to risk
“If we want to be prepared for a major flu epidemic we must understand not only the virus and how it spreads but also cities and how they function, organizations and how they
operate, communities and how they relate, and individuals and how they make choices.”
Kickbusch and Sakallarides 2006
THE RECIPIENT
› Availability heuristic
› Anticipatory regret
› Ambiguity aversion
Some particularly relevant cognitive heuristics and biases
Perception of the hazard
FRIGHT FACTORS › dreaded outcome › affects ‘vulnerable’ › identifiable victims › poorly understood by
science › contradictory
statements from sources
› involuntary
The goals in risk communication depend on the levels of outrage and hazard
From: Peter Sandman
Competence, objectivity, fairness, consistency, empathy
(Renn and Levine in Communicating Risks to the Public 1991)
What is the strongest form of communication?
The challenges
“One serious effect resulting from the restrictions above mentioned was that the general public was led to regard the disease as a very fearsome thing, and the application of regulations dealing with contacts strengthened their belief in the matter, with the result that so soon as the number of people fell ill they were in very many instances left to do the best they could for themselves because of the fear which the neighbours had of themselves contracting the disease. In some towns yellow flags and other symbols were displayed to warn the public from entering the invaded premises, and this was cruelly insisted on in some districts where, unfortunately, the local authorities had made no efforts to provide proper help for the stricken inhabitants.”
Report on the Influenza Epidemic in New South Wales in 1919;172
Uncertainty
› The public and the mass media have poor tolerance for uncertainty
› Uncertainty was communicated reasonably well during the H1N1 pandemic
Defining the risks
› Illness and death › Impacts of trade and travel restrictions
› Psychosocial impact of restrictions › Excessive healthcare usage › Stockpiling medicines › Reputation risks
Media Challenges
› Traditional mass media remains prime
› Limitations - Tendency to amplify high outrage
risks
- Tendency to reproduce error
- Lack of capacity to present complexity
- Potential for stigmatisation
Working with journalists
› Study: how journalists approached reporting avian influenza stories in 2007
Working within constraints
Tyranny of deadlines “On one axis you have maximum accuracy, integrity, detail - all of those
wonderful things. And then on the other one you've got time. Your job is to do the best you can within that parameter.”
(Newspaper medical reporter)
Need for images Human angle
Access to experts and transparency valued
Good ‘talent’ • Trusted • Knowledgeable • Communicate clearly and
compellingly • Accessible
“Just make sure your talent is always available – because nothing annoys media more than if they can't get someone, that is when things go pear shaped, because no-one is there to answer their questions”.
Newspaper reporter
Journalists balance ethical tensions
“We don't want to panic people, but at the same time we do want them to watch our news. There will be headlines, promos saying 'tonight Pandemic kills x many people' – but we just have to make sure we give an accurate report of what happens. But we always try to give advice. We want to reassure people what to do to protect themselves.”
(TV news producer)
Specialist Medical Reporters
› Better knowledge › Access to a wider range of sources › Gatekeepers and advocates › Cooperative but critical
“The media is not the public relations wing of the health department. We are not there simply to report what they want to tell the public - though we will usually do that also. But our role is to ask challenging, independent questions.”
(Newspaper medical reporter)
A changing media landscape
Slide courtesy of Carolyn Der Vartanian
Slide courtesy of Carolyn Der Vartanian
Social Media: A group of Internet-based applications that … allow the exchange of user-generated content. (Kaplan 2010)
The pitfalls….
… and the opportunities
Information: "Train services are resuming in parts of Brisbane. Stop walking on the tracks #TheBigWet #qldfloods" "No homes can be reconnected to electricity until they have been certified as safe by an electrician #qldfloods #TheBigWet“
Mythbusting Wivenhoe Dam is NOT about to collapse! #thebigwet #qldfloods"
There is currently NO fuel shortage in Brisbane. #qldfloods #thebigwet
The lighter side We're building an Ark Help! I've lost my Goldfish
Source: http://www.brightlabs.com.au
Signorini A, Segre AM, Polgreen PM (2011) The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. during the Influenza A H1N1 Pandemic. PLoS ONE 6(5): e19467. doi:10.1371/journal.pone.0019467 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019467
Estimate disease activity in real time
Consider this How could you and your organization use social media?
Effective communication during an infectious disease event
Being Prepared
› WHO do you need to communicate with?
› HOW are you going to communicate with them?
› WHAT do they need to know?
Source: http://www.sti.risk-technologies.com/AnnouncementPreview.aspx?eid=4845
Pre-event • Prepare
Event
• Media is ally • Be available • Work with specialist reporters • Appeal to ethical commitments to reduce stigmatization • Focus on action • Use social media
Post-event
• Media’s reflective and critical phase • Acknowledge shortcomings • Address non-medical costs • Evaluate
Preserve trust Working with the media
General advice
› Use trusted spokespersons › Be honest, frank and transparent › Err on the side of disclosure
Preserve trust
Not usually a helpful
concept
“Officials routinely expect the public to panic if told alarming things, and misdiagnose orderly efforts to prepare as panic.”
Peter Sandman Nature;2009
‘Panic’ is not usually a helpful concept in outbreaks
Talking about probability
› Define the risks › Qualitative & quantitative estimates
› Framing - Loss frame “If you don’t wear PPE…. - Gain frame “If you wear PPE….”
From http://www.chiin.ca/decisionaid.html
Communication tips
› Acknowledge uncertainty › Be dedicated to good technical
information › Explain rationale › Acknowledge emotional aspects › Communicate with all
stakeholders - Preparing channels before the
event - Have mechanisms for listening
› Prioritise special risk groups
Good communication requires supportive leadership
Prioritise special risk groups
› listen then share with communities the information needed
› localise, personalise and humourise › avoid paternalism, tokenism and ‘Aboriginalising’
An example… The pandemic project with Aboriginal and Torres Strait Islander communities
From: Massey PM et al Health Policy 2011;103:184-90 Australian Aboriginal and Torres Strait Islander communities and the development of pandemic influenza containment strategies: community voices and community control.
Social investment
Ministry of Health Report, October 1920
Retrospective assessment of what was needed in 1918-19
Conclusions
› Social and infrastructure investment › Action is a form of communication › Work with the traditional media › Evaluate efforts › Social media brings some risks but many opportunities
“The smart city builds these long before a crisis” Kickbusch and Sakallarides. Flu City—Smart City: applying health promotion
principles to a pandemic threat. Health Promotion International 2006
THANK YOU