Health and risk communication

Health communication is a field that has developed quickly over the last 50 years when health professionals began to understand the increasing need for effective communication with a public that began voicing its opinion, became more confident and aware of its rights, and critical of the way it was treated by the healthcare system.

According to Barry, health and risk communication is important because "in the next flu epidemic, whether it comes today or in the future, whether the virus is mild or severe, vaccination will be the most important weapon against the disease. The media will be the second most important weapon.”1 Today, in the age of the new media, mass communication is increasingly used to influence positions and leadership at the individual level as well as social norms, values, and policy at the societal level. The mass media is presently the most important source of information on health for the general public.2,3 Numerous surveys indicate that the public shows high interest in the media coverage of these subjects.4 Reliance on the media is high both among the healthy population, looking for information to help prevent diseases and improve health, and among patients, who turn to media channels to actively seek information relevant to their problem.5,6 This heavy reliance indicates the potential impact of the media on beliefs, attitudes and behaviors related to health.7 Credible and accurate reporting on health is extremely important. Realistic and credible coverage can help the public understand health information which is often complex and difficult to understand, and make the media into an effective change agent of personal behavior, to improve awareness of health risks,8 and to adopt preventive behavior patterns on important health issues.9 However, when reporting is not accurate and balanced, the public might receive the wrong impression, which could have problematic consequences for preventive health behavior.10 Likewise, such reporting can lead to cultivating unfounded hopes or fears11 and wrong choices by the public that could risk its health. The use of the media for the health education of patients as well as healthcare professionals enables them to provide better health services and achieve a higher level of satisfaction.

Risk communication is a relatively new and developing field amd is part of health and environmental communication, which has been gaining momentum in recent years. Risk communication enables us to relate to the circles of society, culture, health and communication in such a way that directly impacts public policy. Risk communication has many manifestations but can be divided into three types: Care communication – risk communication in which the risk and the way to manage it have already been determined by scientific research accepted by the majority of the target audience. Consensus communication – risk communication with the goal of informing and encouraging groups to work together in order to reach a decision how to manage (prevent or alleviate) the risk. Crisis communication – risk communication in extreme situations and immediate danger such as the outbreak of a lethal epidemic.12

Risk communication on health and environment combines fascinating issues concerning the relationships between government bodies, their use of the media, and the way they present risks to different target audiences. Some of the main questions that concern this field are: how to effectively inform the public about risk situations? What should be the relation between the public’s perceptions and the information it receives? How should messages be formulated for the public and customized for its perceptions and needs? How can trust relations be created between the communicating party and the recipients of the communication to foster cooperation?

The public’s response to natural disasters is influenced not only by its information about the risk13 but also by the way that risk is communicated. According to Rosa (2003), a risk is "a situation or event where something with human value (including human life) is at risk and in which the outcome is unknown.”14 According to Boholm (1998), risk perceptions and reactions to it are shaped by internalized social and cultural truths and values.15 Weinstein (1989) argues that risk perception is not only influenced by the the social structure of the individual but also by social and cultural construction that reflects values, symbols, history and ideology. This definition, which embodies the connection between risk perception and society, emphasizes the importance of the social component in risk communication, in theory and in practice.16

Israel, like other countries, is vulnerable to natural events and health risks (such as avian flu, swine flu and polio), environmental hazards caused by pollution and other technological disasters, as well as the ongoing threat of terrorism. While new tools and advanced technologies improve the predictability of many natural hazards, these events still cannot be predicted with certainty. Furthermore, readiness and response also require the understanding of human behavior, especially in states of emergency, an area that has become known as risk communication.

Governments and health organizations are frequently required to communicate risk to the public on health and environmental issues. For instance, when an epidemic crisis occurs (such as swine flu, Ebola); when a new vaccine is launched and its safety must be communicated; on issues of health promotion such as preventing driving under the influence of alcohol, smoking and eating unhealthy foods; and on health subjects related to the environment such as air pollution,  he risks caused by building gas-receiving terminals for the Tamar gas field and other reserves near inhabited areas; pesticides; climate change; genetically modified food; chemicals in consumer items; and water fluoridation.

Although organizations communicate with the public on a daily basis, they still lack the theoretical and professional knowledge of risk communication17 and their campaigns and programs often fail because of defective communication. Ineffective risk communication has existential consequences for public health. For instance, transmitting information about a new vaccine in an incomplete and nontransparent way could lead to the public's noncompliance with vaccination. In a study we conducted of the polio crisis in Israel following the detection of polio in the sewage in a number of places in Israel, the Health Ministry launched a widespread campaign calling on parents all over the country to vaccinate their children up to age nine with the weakened polio vaccine (OPV). The campaign, called “Two Drops,” was considered a resounding success by the Health Ministry , with a high rate of parents vaccinating their children. However, our study found that despite the high level of vaccination, for the first time, parents who are not vaccination resisters and who vaccinate their children according to the normal schedule of vaccination, were hesitant, and some even refused to vaccinate their children. The research was based on a survey of 200 parents as well as the analysis of 2,499 discussions between parents on blogs, forums, comments on news sites, and Facebook pages. The study found that one of the main causes of hesitation and refusal of parents to vaccinate, which arose from the responses of about one third of the parents who refused or hesitated (32%), was mistrust of the health system.18

Other examples of the possible consequences of the lack of effective communication by health organizations on health and environment occurred during natural disasters such as Hurricane Katrina, when the Bush administration did not respond and communicate the risk effectively,19 as well as the Ebola outbreak in a third world country, which exposed the gap between Western authorities and the population.20

The media functions as a mediator in the risk communication cycle. The public relies on multiple information sources about the risk, including television, radio, newspapers, friends and the internet, as well as text messages on mobile devices (which was a common means of communication during the recent tsunami disasters). Frequently the media operates on the sensation principle, with an interest in sifting contents or risks through the prisms of politics and human interest, sometimes omitting risk factors. Studies indicate that the media sometimes ignores its job as the public watchdog. See another example of a study we conducted on the way the media functioned during the Carmel fire.21

Risk Communication

The term “Risk communication” describes the dissemination of information and the public's reactions in conditions of uncertainty and threat. It is a relatively new field developing at an increasing pace in recent years. Risk communication focuses not only on the nature of the risk but also on the public's reaction to the risk messages, such as fear and resistance to the messages themselves as well as to the organizations and institutions that manage them. The decisions made in risk communication are to a certain extent byproducts of social, cultural and psychological effects.22,23 The success of risk communication depends on narrowing the gap between the experts’ and the public’s risk perceptions, to create mutual feedback between experts and the public.24

Risk communication includes numerous kinds of messages and processes. It involves a broad range of people such as parents, children, healthcare professionals, regulators, scientists, farmers, industrialists, workers and others. Risk communication is part of the discipline of risk assessment and risk management. According to the theory, the goal of risk communication is to maintain bidirectional communication, conducting a dialogue between the organization that manages the risk and the target audience, while making an effort to include the audience in the decision-making process. The audience responds in different ways to risks and its ability to deal with them. Sometimes the public does not regard the risks the same way the experts do. In other cases, the public is unaware of the risk or is even indifferent to it. Other times the organization that communicates the risk is not perceived as credible by part of the public, or the way that the risk is managed is not accepted by the public. If a dispute arises, the communicating organization must know how to deal with it.22

The risk communication process begins with an assessment of the risk as to who or which health systems will be hurt, how many of them will be hurt, how and to what extent, and how long the harm will last. The information obtained by the risk evaluation serves the risk managers to make decisions as to action related to the risk. Their decisions, and often the processes on which they based them, are communicated to the people who will be harmed or might be harmed by the risk, or those who have an interest in the risk for other reasons (such as ethical issues). At every stage of the process an assessment is made to establish the successes and failures of the risk communication. Risk communication has many aspects, one of which involves crisis situations, and is called “crisis communication."

Crisis communication is a special kind of communication distinct from routine communication for the following reasons:

  1. The risk is not always known to the public, and sometimes is not fully known to the scientific community. Therefore, there is sometimes a need to act before the full information is available to the decision-makers.
  2. The situation is in constant flux and requires improvisation and flexibility. The officials must be well trained and ready for different eventualities. Furthermore, since numerous organizations and agencies are involved in the process, impeccable coordination is needed to prevent redundancies, ineffectiveness and disputes between bodies, which can lead to public confusion and anxiety.25

Public behavior during crisis is sometimes motivated by conflicting factors: logic and emotion,26 the search for official sources of security versus the tendency to think independently. This hinders the ability of campaign designers to create an effective dialogue with the public.

Another area of risk communication is Emerging Infectuous Disease (EID) communication.27,28 There are only scant empirical studies in the literature about the role of risk communication during epidemic outbreaks.29-31 Moreover, much of the professional literature on epidemic outbreaks discusses the unilateral dissemination of information to the public by experts and mass media.29 This type of unilateral communication of risks to the public by governments during crisis contradicts the understanding of the nature of risk perception, which has psychological as well as scientific aspects. Furthermore, the pattern of unilateral communication is dated because it does not utilize the recent technological advances, primarily the social networks, which allow for bidirectional communication, and which have proven themselves as powerful tools of communication with the public. The organizations' understanding that the way to confront an epidemic crisis has led to changes in the media's role in crisis management. There has been significant progress since the principle of the “hypodermic needle" that "injects" the public with the message. For example, the Center for Disease Control’s Crisis & Emergency Risk Communication (CERC)32 model puts an emphasis on bidirectional communication between the organization and the public. Another noteworthy model is the four-channel model that focuses on mutual communication, places the public at the center, and views it as an active and not only receiving partner.33 This repositioning of the public as an active participant is facilitated by mobile technology, especially smartphones and internet-based tools. Even though there is a consensus that this perception is current and relevant, in practice the flow of information in many countries continues to be one-directional. The call for public involvement still reflects a perception of the public as an audience that should be involved, and does not take into account the public’s plurivocality and the reality of the public's opinions and knowledge “competing” with those of the health authorities. Furthermore, the understanding that in the 21st century the public is a full partner requires better understanding of the social and technological environment in which the public operates.

Developing risk communication programs

The outline for developing a risk communication plan includes:12

  • An introduction to program goals, program scope, background about the subject/the risk (what is the risk and who is affected by it), authority (under what authority – legal or organizational mandate) is the risk communicated, the purpose of the risk communication, and specific objectives
  • A profile of the public, including a description of the way the information about the public was collected and its key characteristics
  • Risk communication strategies
  • Evaluation strategies
  • Timetable and resources, including a detailed schedule identifying tasks and the people responsible for their completion, evaluation of budget and other resources (equipment, meeting rooms and so on)
  • Internal communication detailing how progress will be documented and what approvals are needed or have been obtained to execute the plan
  • A signup page with the names, job descriptions and signatures of the key members of the team who confirmed they read the program and agree with it

 

 References

  1. Barry JM. Pandemics: avoiding the mistakes of 1918. Nature.2009;459(7245):324-325.
  2. Bomlitz LJ, Brezis M. Misrepresentation of health risks by mass media. J Public Health (Oxf). 2008;30(2):202-204.
  3. Bubela TM, Caulfield TA. Do the print media "hype" genetic research? A comparison of newspaper stories and peer-reviewed research papers. CMAJ. 2004;170(9):1399-1407.
  4. Taylor H. "Cyberchondriacs" on the rise? Those who go online for healthcare information continues to increase. 2010; http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/448/ctl/ReadCustom%20Default/Default.aspx. Accessed 22.3.2015.
  5. Dutta-Bergman MJ. Developing a profile of consumer intention to seek out additional information beyond a doctor: the role of communicative and motivation variables. Health Commun. 2005;17(1):1-16.
  6. Hinks J, Gosmore J, Jenkins J, Corrigan E. Commentary: Is the internet replacing the local infertility support group. BioNews8.10.2004.
  7. Weimann G, Lev E. Mass-mediated medicine. Isr Med Assoc J. 2006;8(11):757-762.
  8. Schramm W. The nature of communication between humans. In: Schramm W, Roberts DF, eds. The Process and Effects of Mass Communication. Revised ed. ed. Urbana, IL: University of Illinois Press; 1971:3-53.
  9. Yanovitzky I, Blitz CL. Effect of media coverage and physician advice on utilization of breast cancer screening by women 40 years and older. J Health Commun. 2000;5(2):117-134.
  10. Hoffman-Goetz L, MacDonald M. Cancer coverage in mass-circulating Canadian women's magazines. Can J Public Health. 1999;90(1):55-59.
  11. Shuchman M, Wilkes MS. Medical scientists and health news reporting: a case of miscommunication. Ann Intern Med. 1997;126(12):976-982.
  12. Lundgren RE, McMakin AH. Risk Communication: A Handbook for Communicating Environmental, Safety, and Health Risks. Hoboken, NJ: John Wiley & Sons; 2013.
  13. JHSPH. Risk communication strategies for public health preparedness (Trainer: Edmunds, M.). 2011; http://www.jhsph.edu/preparedness/training/online/riskcomm.html. Accessed 8/12/2011, 2011.
  14. Rosa EA. The logical structure of the social amplification of risk framework (SARF): Metatheoretical foundation and policy implications. In: Pidgeon N, Kasperson RE, Slovic P, ds.
  15. The social amplification of risk.Cambridge: Cambridge University Press; 2003:47-49.
  16. Boholm A. Comparative studies of risk perception: a review of twenty years of research. Journal of Risk Research. 1998;1(2):135-163.
  17. Weinstein ND. Optimistic biases about personal risks. Science.1989;246(4935):1232-1233.
  18. Sandman PM. Crisis communication best practices: Some quibbles and additions. Journal of Applied Communication Research. 2006;34(3):257-262.
  19. Gesser-Edelsburg A,Shir-Raz Y, Green MS. Why do parents who usually vaccinate their children hesitate or refuse? General good vs. individual risk. Journal of Risk Research. 2014;Published online: 12 Dec 2014.
  20. Cole TW, Fellows KL.Risk communication failure: A case study of New Orleans and Hurricane Katrina. Southern Communication Journal. 2008;73(3):211-228.
  21. Ratzan SC, Moritsugu KP. Ebola crisis-communication chaos we can avoid. J Health Commun. 2014;19(11):1213-1215.
  22. Gesser-Edelsburg A, Zemach M. From a fiasco to the Supertanker grand finale: Israeli Prime Minister Netanyahu’s crisis communication during the Carmel disaster. Journal of Risk Research. 2012;15(8):967-989.
  23. Sandman P. Four kinds of risk communication. The Synergist (Journal of the American Industrial Hygiene Association). 2003;April: 26-27.
  24. Slovic P. Trust, emotion, sex, politics, and science: surveying the risk-assessment battlefield. Risk Anal. 1999;19(4):689-701.
  25. Fischoff B. A diagnostic for risk communication failers. In: Leiss W, Powell D, eds. Mad Cows and Mother's Milk: The Perils of Poor Risk Communication. 2 ed. Montreal & Kingston: McGill-Queen's University Press; 2004:26-40.
  26. Reynolds B. Crisis and emergency risk communication. Atlanta, GA: Centers for Disease Control and Prevention; 2002.
  27. Slovic P, Finucane M, Peters E, MacGregor D. Risk as analysis and risk as feelings: Some thoughts about affect, reason, risk and rationality. Risk Analysis. 2004;24(2):1-1.
  28. Freimuth V, Linnan H, Potter P. Communicating the threat of emerging infections to the public. Emerging Infectious Diseases. Emerging Infectious Diseases. 2000;6:337-347.
  29. Covello VT. Best Practices in Public Health Risk and Crisis Communication. Journal of Health Communication. 2003;8(sup1):5-8.
  30. Holmes BJ. Communicating about emerging infectious disease: The importance of research. Health, Risk & Society. 2008;10(4):349-360.
  31. Holmes BJ, Henrich N, Hancock S, Lestou V. Communicating with the public during health crises: experts' experiences and opinions. Journal of Risk Research. 2009;12(6):793-807.
  32. Rudd R, Comings J, Hyde J. Leave no one behind: Improving health and risk communication through attention to literacy. J Health Commun. 2003;8:104-115.
  33. Courtney J, Cole G, Reynolds B. How the CDC is meeting the training demands of emergency risk communication. Journal of Health Communication. 2003;8(sup1):128-129.