Risk Communication

Risk Communication

in preparing and

responding to Health

Emergencies Emergencies

Messaging for special audiences : Decision Makers: Tourism Industry; Food Handlers, Households, Schools…

Objectives• To increase national

preparedness and response capacity for Health Emergencies with the focus on Cholera and other outbreaks of water and food borne diseases.

• To introduce and refresh

knowledge on risk

communication ….

• To outline the process for

developing a risk

communication strategy as

• To train key personnel in the main strategies of managing a Cholera outbreak

• To identify main areas for strengthening national response plans for health emergencies.

an essential component of

national preparedness and

response…

• To explore the dynamics of

developing key messages

for targeted audiences

Communication

•imparting or exchanging of information

• the successful conveying or sharing of ideas and feelings

Communication for Health (WHO)

• Communication is an important component in managing any infectious disease outbreak, and is essential in the event of an epidemic or pandemic.

• Accurate and timely information at all levels is criticalin order to:

▫ minimize unwanted and unforeseen social disruption and economic consequences, and to

▫ maximize the effective outcome of the response.

Effective Communication

1. Commands Attention

2. Communicates a benefit

3. Caters to the HEART, HEAD and POCKET 3. Caters to the HEART, HEAD and POCKET

4. Calls to Action

5. Clarify messages (information)

6. Is Consistent

7. Creates trust

What is Risk Communication?

Risk communication is an integral component of public health risk management. It is focused on dialogue with those affected and concerned and strives to ensure communication strategies are evidence based.

Under the IHR, risk communication for public health Under the IHR, risk communication for public health emergencies includes the range of communication capacities required through the preparedness, response and recovery phases of a serious public health event to encourage informed decision making, positive behaviour change and the maintenance of trust.

PAHO 2010

4 Kinds of Risk Communication Peter Sandman

1. Public Relations: High Hazard, Low Outrage

2. Stakeholder Relations: Moderate Hazard, Moderate OutrageOutrage

3. Outrage Management: Low Hazard, High Outrage

4. Crisis Communication: High Hazard, High Outrage

2

3 4

2

1

Public relations/ health education

• Audience: apathetic, aren’t interested, getting their attention is quite difficult

• Task: messages that reinforce appeals

1. High Hazard, Low Outrage

• Task: messages that reinforce appeals to move the audience towards your goals, provoke more outrage – action

• Medium:monologue via the mass media

• Barriers: audience inattention, size, media resistance

Stakeholder relations

• Audience: stakeholders – interested and attentive audience, neither too apathetic or too upset to listen

2. Moderate Hazard, Moderate Outrage

• Task: to discuss, explain, respond to the audience/ stakeholder

• Medium: dialogue, supplemented by specializes media

• Barriers: inefficiency of one on one dialogue

outrage management

• Audience: outraged – anger , largely at you, ‘fanatics’, (justified or not) you have

their attention

• Task: to reduce audience outrage –listening, acknowledging,

3. Low Hazard, High Outrage

listening, acknowledging, apologizing, sharing control and credit

• Medium: in person dialogue, audience does most of the talking

• Barriers: outrage

4. High Hazard, High Outrage

crisis communication – in a crisis there is no ‘PUBLIC’ everyone is a stakeholder

• Audience: very upset, outraged – more fear and misery than anger

• Task: to help the audience bear its fear and miseryand misery

• Medium: monologue via the mass media, dialogue – one on one where possible

• Barriers: stress of the crisis, missing the difference between crisis

communication and routine PR

‘Risk communication should be

incorporated into preparedness

Planning

Preparation Preparation Preparation

planning for major events and in all aspects

of an outbreak response.’

WHO

CRISIS

Preparation Start Control Recovery

PAHO Model 2010

What is the situation – diagnosis

Why communicate -objectives

To Whom - target audienceHow – channels, toolsWhen – time lineWho – responsible personsWith What - resources

How is it going –monitor

How effective was it –follow up evaluation

Activities:

• Form a cross-cutting communication team to

support the main goals of understanding, informing

and increasing awareness prior to and in the event of

an actual health event.

• Engage the business community in health emergency

preparedness planning and find ways in which they

can support the public health response:

• Develop a communication Strategy▫ Blueprint/Framework

▫ Doesn’t exist in isolation, furthers objectives and goals

▫ Interactive and flexible

▫ Addresses both internal and external communicationcommunication

▫ Ties in with National Emergency Plans

▫ Spells out key messages, target audiences and actions

SaysTo

In WHICH With WHAT WHO

Communicator

SaysWHAT

Message

To WHOM

Target Audience

In WHICH CHANNEL

Medium

With WHAT EFFECT

Effect

Communication Strategy for Cholera and Other

Water Borne Diseases

Goals

• Tie in with established protocols

• Identify regional and local objectives

InternationalInternational

WHO Cholera Guidelines

IHR2005

RegionalRegional

CAREC Cholera

Guidelines

National

National

Emergency

Plans

Communication Strategy

•Develop consistent messages:

▫ What is the risk… ▫ What is the risk…

▫ Effects of potential risk…

▫ How potential situation can

be prevented…

▫ How to respond in the event…

21

Communication Process

Signal

Source of

informationTransmitter Receptor Destiny

Message MessageInterferences

emitted received

Perception

23

Perception in Risk Communication

Signal

Real RiskPerceived

Risk

Source of

informationTransmitter Receptor Destiny

Message MessageInterferences

emitted receivedReal Risk

Risk

Risk Perception

• Risk is the probability of an

event occurring.

• Perceived risk from a • Perceived risk from a

particular threat and the

actual probability of that

threat occurring often bare

little relation to each other

Risk Perception

Based on:

1. Facts

Treat with:

1. Trust

2. Transparency

2. Feelings

3. Fear

2. Transparency

3. Early response

4. Listening

5. Planning

• Research what the target audience perceives and

believes. Awareness of Knowledge, Attitudes, Practices

and Beliefs will enable the communication team to tailor

messages and information.

• Create preparedness messages based on the research of

attitudes and knowledge. In all cases, messages must be attitudes and knowledge. In all cases, messages must be

clear, concise, consistent and call to action.

• Facilitate formal and informal dialogue with the

community to monitor what they need and want, and

inform: town hall meetings, panel discussions…

Role of Risk Communication in

Public Health Emergencies

• Help at risk populations make informed decisions

• Encourage protective behaviors

• Complement existing surveillance systems• Complement existing surveillance systems

• Coordinate health and non-health partners

• Minimize social and economic disruption

• Builds the trust required to prepare for, respond to and recover from serious public health threats

• key government officials • sectoral partners

▫ business leaders

• healthcare system and providers▫ cleaners

Define the audiences to be reached.

▫ cleaners

• media• special or vulnerable groups

▫ schools▫ food handlers

▫ hospitality/tourism industry...

Decide what communication

channels will be used:

• Print: posters, billboards, direct mail…

• Electronic: e-mail, web…

• Broadcast: radio, television…

Traditional: loud speakers…• Traditional: loud speakers…

• Novel: social media, theatre…

• Personal communication: community health

workers...

• Special events:

http://new.paho.org/blogs/haiti/?cat=5

Identify and train spokespersons and

other senior health and other sector

officials▫ Speak with one voice, even if there are several

people

▫ Ensure the spokespersons are trained in risk ▫ Ensure the spokespersons are trained in risk

communication

▫ Prepare taking points

Key Components:

•transparency

•acting quickly

•empathy

•trust

Information Management Flow Chart

Information Management Flow

Information Information Sources

Collection Analysis Products

•Health situation room•National EOC•PAHO Technicians•UN Agencies•NGOs

Conversion of data to information:

•Definition of analysis criteria•Cross reference of variables of analysis•information process•Graphic representations•Technical analysis of the results

Situation reports

ProtocolsIEC material

Other…

Evaluate the effectiveness

of your communication

• Throughout:

pre during post

• Adjust along the way• Adjust along the way

• Scale up what works as appropriate

• Identify lessons learned

• Refine communications plans for the future

Remember....�Reach out to partners, such as representatives from community groups,

youth groups, schools, mayors, unions, churches and associations. They can

assist later in keeping the public informed.

�Maximize Health Care opportunities - primary health care doctors and

community health promoters are key in supplying as well as transmitting community health promoters are key in supplying as well as transmitting

health information.

�Contact , collaborate with and incorporate leaders, gatekeepers and

celebrities, to communicate key messages.

�Stage simulations, discuss scenarios, what-ifs, so that contingencies can be

made to keep the public prepared, the government operating, and basic

services available.

Messaging• Message maps – developed to transmit

information simply

• Organize ideas

• Develop messages in response to anticipated

community concernscommunity concerns

• Link messages and actions to desired

behaviours

Problem:

Concern Evidence Audience Messages Channels Materials

• Risk communication planning and training is essential for a

comprehensive public health response

• Resources need to be allocated for risk communication activities

Decision Makers

• Surveillance and surveillance reports are a key internal

communication activity informing external communication

• Public health education on basic sanitation and hygiene is the

starting point

...households, schools, health

care workers, hospitality

sector...

• What is cholera and other water borne/diarrheal diseases

• How these diseases can be spread –• How these diseases can be spread –

• How these diseases can be prevented –

▫ Use safe water , How to make your water safe

▫ How and when to wash hands

▫ Safe personal sanitation (how to use toilets)

▫ Food safety – 5 keys to safer foods

• How these diseases may be treated at home

▫ Preparation of ORS

Health Care Providers

• Treatment and management protocols

▫ Cholera Guidelines

• Maintain surveillance systems and make reports • Maintain surveillance systems and make reports in a timely manner

• Cleaners:

▫ How to clean hospital facilities

▫ How to protect themselves when cleaning

Key Messages –

Food Handlers

Key Messages

School ChildrenSchool Children

Key Message

Households

• Video How to prevent diarrheal

diseases 60 secsHouseholds diseases 60 secs

Conclusions• The risk communication strategy and its components are

essential parts of national risk management plans.

• The most important aspects of the risk communication strategy are prepared in advance of a public health emergency. Beginning preparations at the time of an emergency is

tantamount to missing opportunities to control it. tantamount to missing opportunities to control it.

• During the preparation stage, it is vital to ensure fluid internal and inter-institutional coordination for the appropriate flow of information and communication.

• The risk communication strategy is not a poster, spot or campaign

Resources • PAHO - www.paho.org/riskcomm• WHO Food safety -

http://www.who.int/foodsafety/micro/riskcommunication/en/

• Peter Sandman - http://www.psandman.com/• US CDC - http://www.bt.cdc.gov/cerc/• US CDC - http://www.bt.cdc.gov/cerc/• Centre for risk communication -

http://www.centerforriskcommunication.com/• PAHO PED documents...

http://new.paho.org/disasters/index.php?option=com_content&task=view&id=997&Itemid=1&lang=en

• Witte, Meyer and Marell. Effective Health Risk Messages A step by step guide. London: Sage Publications 2001