We also discuss implications for future PHEP. Washington, DC: National Academy Press. Anyone receiving disability-related state or federal funding can be easily identified, but there are large numbers of people who do qualify but who will not pursue government funding and, as such, are more difficult to locate. U.S. Department of Health and Human Services Similarly, population vulnerabilities can be mapped using Geographic Information Systems (GIS). Although other sites (Florida and DC) also involve at-risk populations in risk communication activities, the level of involvement in California was particularly noteworthy. Finally, the Oklahoma Department of Emergency Management and its McReady partners attend community safety fairs to present information about emergency preparedness. An American Red Cross coloring book (#62) includes pictures of what children should be doing during an emergency. The 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health recognizes the maturity and experience jurisdictional public health emergency preparedness and response programs have gained since 2011. Though a large body of research exists on public health emergency risk communication, only a small portion of that literature addresses vulnerable populations, and most citations are primarily descriptive in nature, leaving very few that offer empirical support for specific public health messaging strategies for use with vulnerable populations. For instance, during the SARS outbreak in China, a perceived lack of information transparency in the initial phase wrecked the effectiveness of risk communication and broadened the impact scope [6]. The Literature is Primarily Descriptive and Qualitative in Nature, Qualitative studies were most often represented in the literature on public health emergency risk communication with vulnerable populations,[21, 23, 29, 30, 31, 32, 33, 43, 44, 45, 61, 69, 70, 72] followed by literature reviews[24, 25, 35, 36, 37, 38, 46, 56, 65] and observational studies (survey-based). We scanned and reviewed websites for communication materials that were at the intersection of three domains: PHEP), at-risk populations, and risk communication. ), Social Theories of Risk. Before sharing sensitive information, make sure youre on a federal government site. Plan 9 distills these nine essential tips to keep in mind during an emergency, which CBO leaders can use with their constituents to prepare them for an emergency. Be honest, frank, and open. What is Risk Management. This approach makes the risk communication practices more actionable. It specifically asks states to coordinate activities within and across state and local jurisdictions, community organizations, health care providers and facilities, tribal organizations, etc. Unlike journalists, public health officials, and other gatekeepers of information, people on social media dont necessarily have to abide by strict standards of fact-finding. For example, all groups except those with visual impairments have the ability to interpret pictorial material, particularly if it is simple and does not require translation to multiple languages. Identification of all-stars, however, was a more subjective process--and one designed to identify exemplars, rather than to provide a detailed evaluation of each resource (although inter-rater agreement was high). Appropriate Governance Responses to Infectious Disease Threats: Developing Working Hypotheses. [(accessed on 10 February 2020)]; Special Report. Senior citizens, in turn, shared their experiences in disasters over their lifetime so that some intergenerational learning took place. American Journal of Public Health, 97 Supplement 1, S109-S115. Glik, D.C. (2007). Risk Communication and Public Health Messaging Needs for At-Risk Populations. Table 2 presents breakdowns of the 242 resources by key variables in the compendium. 2829). However, there is limited knowledge about how to best communicate with at-risk populations in emergencies. Risk Assessment and Risk Communication Strategies in Bioterrorism Preparedness Editors: Manfred S. Green, Jonathan Zenilman (Professor of Medicine), Dani Cohen, Itay Wiser, Ran D. Balicer Scarcity of relevant evidence-based resources Practical approach for coping with current bioterrorism threats Abstract 92340. Indeed, there are several challenges to the empirical study of public health preparedness given that full scale public health emergencies are (fortunately) rare events. (2007). The tip cards for early responders (#4), in one specific instance, point out that every person and disability is unique, as a means of motivating responders to ask a person before attempting to assist them. [24, 34, 47, 65], As our working definition of risk communication highlights the importance of actionable information, we examined citations for whether specific functional areas were addressed in the context of risk communication (i.e., did the communication provide actionable information or instruction related to specific functional areas). 109-59), DHS found clear deficiencies in communication and information-sharing strategies used by state and local emergency managers (DHS, 2006a, 2006b). (2000). Covello, V.T. In addition, we wish to thank Mary Vaiana, Nicole Lurie, and Sandra Quinn for their thoughtful reviews. Risk Communication in Public Health Emergencies. Including at-risk populations in drills can reveal risk communication problems: For example, one drill in Florida showed that police did not know how to communicate with deaf persons and, as a consequence, were perceived as threatening by deaf persons. Including children with disabilities in exercises and drills. Communicating public health guidance is key to mitigating risk during disasters and outbreaks, and ethical guidance on communication emphasizes being fully transparent. The research in this report was conducted by RAND Health and prepared for the United States Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. At-risk populations may lack trust in the emergency response community. Vulnerability assessments are key to developing successful risk communication strategies with vulnerable populations. State officials in public health and other agencies have made a number of advancements in risk communication, such as developing tool kits to guide local agencies and developing core messages for use with common types of disasters, particularly for natural disasters, as described in Section III (e.g., involving at-risk populations in the planning process and tailoring messages for Latinos). For example, GIS maps could be used to determine where vulnerable populations may cluster (e.g., locations of hospitals, nursing homes, low-income housing) and could use this information to target risk communication campaigns. Trust for Americas Health: Ready or Not? The site is secure. in the context of fda's responsibilities, risk communication activities fall into two broad categories: (1) interactively sharing risk and benefit information to enable people to make. Identifying in advance who is most in need of help can more precisely direct preparation and response efforts (Kasperson, 1986), including communication channels. Report on Special Needs Assessment for Katrina Evacuees (SNAKE) Project. Our compendium review identified relatively few risk communication materials intended for longer-term recovery. Last of Unaccompanied Children in Katrina Shelters Reunited with Families. Use strategies to identify and track at-risk populations. Once a DAF was complete for all identified documents, the data were entered into SPSS, Version 16.0 for analysis. For ease of comprehension, categories have been ordered in descending frequency, except for stage of preparedness, which has a natural ordering. CARF's CARF Guide to Accessibility: The CARF Guide to Accessibility[9] details the requirements that organizations must meet to successfully provide an environment that is accessible to individuals with disabilities. Furthermore, reviewers were informed that the aim was to capture approximately the best 10 percent. The OK-WARN program in Oklahoma may serve as a useful template for developing similar resources in other states. In our review of existing risk communication practices, we identified relatively few risk communication materials intended for the post-event response. The Crisis and Risk Communication Strategies in Tackling Issues of Disasters Abubakar Binji April 12, 2020 Healthcare Ethics, Healthcare Leadership, Healthcare Research, Social Change Throughout crises, information can be both vital and incomplete. Share lessons learned across organizations and geographic regions. Effective risk communicators must be trained to understand emergency risk communication, know their stakeholders, and be trusted in the community. Private whistleblowing: An ophthalmologist named Li Wenliang used social media to whistleblow that seven cases associated with SARS were identified and that detailed experimentation was ongoing. Nationwide Plan Review: Phase 1 Report. Below we describe several promising practices pertaining to involving key groups in emergency planning. Six propositions on public participation and their relevance for risk communication. Received 2020 Feb 27; Accepted 2020 Mar 18. There, informants conducted a small pilot evaluation focusing on health promotores and developed a curriculum to train health promoters based on their research. The 211 call center receives the same messages that are sent to the media in the event of an emergency. On the contrary, stalling or delaying reporting will undermine the trust in risk communication and governance [34] (pp. Risk communication: A handbook for communicating environmental, safety and health risks. Pictures and images can effectively communicate across the majority of at-risk populations; those with visual impairments will obviously require other communication modes. In Florida, PIOs use meetings to discuss important messaging issues and recent disasters. National Research Council. However, to enhance reach to at-risk populations, it will be important to broaden the number and types of professionals available and trained in risk communication beyond the health department PIO. Licensee MDPI, Basel, Switzerland. Even simple knowledge about how to exit the classroom must be clearly communicated. The construction of the compendium involved three progressive phases of review. Use of community forums and engagement of community partners in the evaluation will ultimately help to improve the capacity of agencies and their cultural competence with at-risk populations. All vulnerable populations included in the PAHPA definition are not included in Chapter 68 of Title 42. U.S. House of Representatives. These features include gender, education, age, and culture. Concepts in Disaster Medicine, 1(1), 57-62. (The literature review also identified the Internet as a successful delivery method for those who do have access.). Various agencies are involved in advertising the availability of 211 through TV spots, ads on buses, website announcements, etc. Psychological Bulletin, 133(4), 673-693. All but one study[36] addressed the issue of barriers; of the categories included on the DAF (Appendix A1), barriers related to trust were addressed most often,[7, 23, 24, 28, 29, 30, 31, 32, 37, 38, 39, 43, 56, 69, 70, 72] followed by inadequate resources to disseminate communication. For public health risk, specialists in life and social sciences, biomedicine, and public health must seek better answers from multiple disciplines. The theory of statistical decision. Informants said that the range of messages that need to be communicated to at-risk populations is broad because different at-risk populations may face different issues during emergencies. Eisenman, D.P., et al. The NIEHS Superfund Research Program (SRP) hosted a Risk e-Learning webinar series focused on strategies to communicate potential environmental health risks to reduce exposures and improve health. For example, those with limited space could identify an alternative location for storing necessities and suggest purchasing materials in bulk with a group to save money. The project team searched each of these organizations websites. Communication is a critical component of helping individuals prepare for, respond to, and recover from emergencies. Nelson, C., Lurie, N., & Wasserman, J. In addition, many aspects of communicating risks in the face of emergencies apply to all individuals, regardless of whether they are from an at-risk population. Background Risk communication is a key component of public health interventions during an outbreak. A good health risk communication strategy plays a comprehensive part to prevent or mitigate adverse human health outcomes related to hazardous substance exposure, environmental health. The sparseness of coverage for many vulnerable populations (noted above and in Table 2) is demonstrated here across different emergency types. Importantly, the HHS definition focuses on the ability to access or receive medical care. Public health disaster research: Surveying the field, defining its future. For the most part, functional areas were well distributed across types of vulnerable populations. At the beginning of the outbreak, the Wuhan government did not infuse a scientific risk communication into decision making and regarded the outbreak as a common public health issue instead of an emergency without a precise investigation and consensus about the epidemiological characteristics of COVID-19. Efforts must include repetition as well as precise and simple messages. Outlines 13 components of emergency planning for rural and suburban communities. People have widely varying capacities to process risk messages, including scientific and technical understandings of risk. In addition, there are also opportunities for mutual learning that would allow for formative research, improve health departments cultural competence, and enhance the capacity of organizations, including faith-based organizations, to serve their communities. We identified risk communication materials for at-risk populations by searching publicly available websites. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. That is, in keeping with previous definitions of risk communication (See [8]) this review addressed public health emergency communication for vulnerable populations that does not simply describe the nature or consequences of a risk, but rather that provides information on how to prepare for, protect against, or respond to the risk. Third, tailoring the format to the audience and situation can greatly impact clarity and understanding. As suggested by the PAHPA definition, many individuals will require messages specifically tailored to their functional needs. Gershon, R.R.M., et al. The literature review identified GIS as an innovative and promising tool in vulnerability assessments to effectively focus communication campaigns on areas in which at-risk populations are concentrated. Then, Dr. Zhang used quite straightforward language to explain how Shanghai is coping with the outbreak by integrating resources. The COVID-19 cases have covered all provinces in China and have also been reported in other countries, severe areas including Italy, Japan, Republic of Korea, and the US, and all of these cases were exported from Wuhan [16,17]. Continue with Facebook. Doxtator, L.A., Gardner, C.E., & Medves, J.M. The purpose of this study was to describe population knowledge and beliefs about COVID-19 and current social media coverage to address a gap in what is known about risk communication during health crises. Santa Monica, CA: RAND Corporation, 2009. https://www.rand.org/pubs/working_papers/WR598.html. CDC is working with state and local health officials to identify people who may have been in contact with individuals who have tested positive for monkeypox, so they can monitor their health. In accordance with the development of the COVID-19 outbreak, Table 2 illustrates the processes of internal and external communication with other events related to COVID-19 information. Ringel, J.S., Chandra, A., Leuschner, K.J., Lim, Y.W., Lurie, N., Ricci, K.A., et al. The Federal Response to Hurricane Katrina: Lessons Learned (retrieved from the White House website). Coordinating risk communication planning with state and local agencies and non-government partners. (2007). In addition to those individuals specifically recognized as at-risk in the PAHPA (i.e., children, senior citizens, and pregnant women) individuals who may need additional response assistance should include those who have disabilities; live in institutionalized settings; are from diverse cultures; have limited English proficiency or are non-English speaking; are transportation disadvantaged; have chronic medical disorders; and have pharmacological dependency. This research was funded by the National Social Science Fund Youth Program, grant number 18CZZ010. At-risk individuals have limited resources for emergency preparedness. The evaluation, which was performed at two sites, revealed that health promotores do affect recipients actions with regard to emergency planning. As shown in Appendix B2, 28 of these 73 organizations were within the Federal Government, 20 were associations (e.g., National Association of City and County Health Officials [NACCHO]), 15 were service organizations (e.g., the American Red Cross), four were research organizations (e.g., RAND), and four did not fit any of these classifications but were referenced sufficiently to warrant adding to our list of organizations. Statistic of Rumors Refuting. Like the vulnerability mapping tool that RAND is developing, it would be useful to use such a tool to import local Census data for identifying and locating at-risk populations. The model is presented in Figure 2 below. In New Orleans, 75 percent of all deaths were among senior citizens, yet only 15 percent of the citys total population is senior citizens (National Organization on Disability, 2006). Additionally, we searched all references dated 2000 or later in the National Cancer Institutes Risk Communication Bibliography2 and we reviewed publications posted on the Center for Risk Communication website (http://www.centerforriskcommunication.com/home.htm). The lack of translation to other languages was noted with regards to the risk communications in the compendium. Program and abstracts of the American Public Health Association 132nd Annual Meeting; November 6-10, 2004; Washington, DC. Literature review. COVID-19 originated in China and has spread across the world, but data are still being collected about cases in the United States. Prehospital and Disaster Medicine, 22(3), 165-173. [14], Community involvement may help emergency risk communications overcome common barriers to success related to trust and available resources for communication dissemination. This guidance is organized around six CDC preparedness goals: Prevent, Detect and Report, Investigate, Control, Recover, and Improve (CDC and HHS, 2006). Wooding, S., & Raphael, B. A key theme in our discussions with informants across states was the importance of using people first language that does not inappropriately attribute a disability to the audience but rather, emphasizes the importance of understanding what the various at-risk populations are able to do to prepare and respond to emergencies. A Fact Sheet for People who are Deaf or Hard of Hearing, Are You Ready? Are communication messages from government authorities involved in the disaster response received differently by non-dominant groups? Promising risk communication strategies, reflected in our all-star exemplars, cut across many superficial features such as length, medium, and production value. Weather reporters as spokespersons. Continuation Guidance, Budget Year Five, Attachment F, Focus Area F: Risk Communication and Health Information Dissemination (Public Information and Communication). The JCAHO Guide offers recommendations for emergency preparedness, response, and recovery for several vulnerable populations, including those who have disabilities, who live in institutional settings, who are elderly, who are from diverse cultures, who have limited English proficiency, who are children, who have chronic medical disorders, who have pharmacological dependency, and who are geographically isolated. That is, the information does not simply describe the nature or consequences of a risk, but rather provides information on how to prepare for, protect against, respond to, or recover from the risk. Academic Medicine, 82(9), 769-772. From the timeline of risk communication in Wuhan, we can generalize three aspects related to risk communication: governments decision making, governments information dissemination, and risk interpretation. For example, in California, the key events are earthquakes, heat, and fires, though guidance also covers terrorism and bioterrorism events. Eight resources were risk communications directed at the safety of responders themselves, rather than vulnerable populations. Given the wide-ranging set of possible sources, a snowball-sampling strategy was necessary. Journal of Health Care for the Poor and Underserved, 18(2), 299-314. The authors declare no conflicts of interest. (2007). Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China, Multidisciplinary Digital Publishing Institute (MDPI). What modes of communication are you using?). U.S. Department of Homeland Security. Frewer L. The public and effective risk communication. This includes older adults and people with disabilities. Information disclosure is a technical measure that needs to balance different factors such as public risk tolerance and possible subsequent outcomes. [7, 23, 40, 44, 56] Only a few citations (less than five) were identified that addressed those who live in institutional settings[36, 39, 58, 71] or individuals with pharmacological dependency. With respect to risk communication for public health emergencies, we reviewed the dynamic process of risk communication of the outbreak management of COVID-19 and used a message-centered approach to identify weaknesses in the risk communication process. A second theme was that understanding may be facilitated by simply defining terminology and spelling out assumptions. Besides, the way that the government handled the information of the outbreak made the information more ambiguous. Evaluation of risk communication strategies (e.g., Have you evaluated the impact of existing risk communication activities for at-risk populations? Helping pregnant women prepare. Educational settings are stressed as an important venue in public health preparedness: school nurses are identified as important partners for addressing the communication needs of children, and high school and college students are identified as potential participants in emergency planning and response. In the risk communication of COVID-19, some cases have shown that experts or the government failed to utilize understandable explanations about the epidemiological characteristics of the outbreak, the scientific principles in the prevention measures, and the curative effect of therapeutic activity. Supplementing imagery with audio messages is likely to address the needs of most at-risk populations. A strong focus of this guidance is on being more efficient and reducing the time to respond/act by improving coordination among different entities. Risk communication is a core capacity of the International Health Regulations (IHR) 2005 and one of 5 strategies within the Pandemic Influenza Preparedness (PIP) Framework. For the purposes of this project, we focus on risk communication that includes actionable information related to public health emergency preparedness (PHEP), response, and recovery for vulnerable populations. We made many attempts to garner such information through informal conversations with emergency preparedness experts, emergency preparedness conference attendees, and Internet searches. Effectiveness evaluation. Retrieved September 16, 2008, from http://psandman.com/col/4kind-1.htm. Dausey, D.J., Buehler, J.W., & Lurie, N. (2007). For this study, we framed our results in accordance with the five types of activities encouraged by the CDC guidance. Then, a simplified model of risk communication was employed to illustrate a collaborative network for effective risk communication. 109-417), signed by President George W. Bush in December 2006 created the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) and tasked it with new authorities for a number of efforts, including: Ensuring the integration of the needs of at-risk individuals (sometimes referred to as special populations, special needs populations, or vulnerable populations) on all levels of emergency planning. The previously mentioned SAMHSA guide on cultural competency (#113) explicitly emphasizes this point. Coordinate risk communication planning with state/local agencies and non-government partners. We identified a number of ongoing activities involving coordination of risk communication at our study sites. Fordis, M., Alexander, J.D., & McKellar, J. [5] In addition, less than 30 percent of a sheltered population had access to American Sign Language interpreters so that individuals with hearing impairment had no ability to receive information about risks and recovery. Web-based Training - Self-study. What does the public know about ebola? Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Risk communication efforts that include messages for these populations (e.g., how to access specialized resources, eligibility for specific social services) are critical. Introduction to the IRGC Risk Governance Framework, Revised Version. Effective risk communication is a dynamic, interactive, and adaptive process. Program/policy development or evaluation was an objective of several references[7, 21, 24, 25, 31, 36, 40, 46, 47, 58, 61, 62, 65, 67, 71, 72] with the remainder of studies being needs assessments,[24, 29, 30, 31, 32, 45, 70] hypothesis driven,[26, 27] or documentation of ways information is exchanged between countries.[66]. (Ed). (2004). [71] Several citations addressed an additional functional area, such as mental health[38, 46, 62, 65] or evacuation. (1989). Pregnant women may face physical limitations and communications would need to be sensitive to the needs of their children. Risk communication is a critical component of public health emergency preparedness (PHEP), response, and recovery efforts,[1] as it provides an all-important link for the public to make informed decisions about what actions to take. Community engagement would also be a significant step toward addressing the issues of mistrust. 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