Communicating to increase public uptake of pandemic flu vaccination in the UK: Which messages work?

BackgroundVaccination is considered the most effective preventive measure against influenza transmission, yet vaccination rates during the 2009/10 influenza A/H1N1 pandemic were low across the world, with the majority of people declining to receive the vaccine. Despite extensive research on the predictors of uptake of influenza vaccination, little research has focused on testing the effectiveness of evidence and theory-based messages.AimsTo examine the persuasiveness of messages promoting vaccination and antiviral use either as health-enhancing or as risk-reducing, as well as messages which conveyed evidence-based information about the costs and benefits of vaccination, or which applied anticipated regret as a motivator for vaccine uptake.MethodWe conducted 11 focus groups with forty-one members of the general population in England including young and older adults, those with lower education, parents, and those with elevated health risk. The data were analysed using thematic analysis.ResultsThe factual, evidence-based messages were well received with participants finding them the most convincing and useful, particularly where they gave cost–benefit comparisons. Health-enhancing messages were received with scepticism and concern that the messages were not honest about the potential lack of safety of vaccination. In contrast, risk-reduction messages were perceived as being more balanced and credible. Messages aiming to elicit feelings of anticipated regret for not getting vaccinated were generally perceived as patronising and unprofessional.ConclusionsVaccination messages should be kept brief, but convey balanced, evidence-based information, and be transparent in their communication of potential side-effects. The general public seem to prefer messages that are factual and emphasise the costs and benefits of vaccination, particularly with regards to vaccine safety.     

The Saudi Ministry of Health’s Twitter Communication Strategies and Public Engagement During the COVID-19 Pandemic: Content Analysis Study

BackgroundDuring a public health crisis such as the current COVID-19 pandemic, governments and health authorities need quick and accurate methods of communicating with the public. While social media can serve as a useful tool for effective communication during disease outbreaks, few studies have elucidated how these platforms are used by the Ministry of Health (MOH) during disease outbreaks in Saudi Arabia.ObjectiveGuided by the Crisis and Emergency Risk Communication model, this study aimed to explore the MOH’s use of Twitter and the public’s engagement during different stages of the COVID-19 pandemic in Saudi Arabia.MethodsTweets and corresponding likes and retweets were extracted from the official Twitter account of the MOH in Saudi Arabia for the period of January 1 through August 31, 2020. Tweets related to COVID-19 were identified; subsequently, content analysis was performed, in which tweets were coded for the following message types: risk messages, warnings, preparations, uncertainty reduction, efficacy, reassurance, and digital health responses. Public engagement was measured by examining the numbers of likes and retweets. The association between outbreak stages and types of messages was assessed, as well as the effect of these messages on public engagement.ResultsThe MOH posted a total of 1393 original tweets during the study period. Of the total tweets, 1293 (92.82%) were related to COVID-19, and 1217 were ultimately included in the analysis. The MOH posted the majority of its tweets (65.89%) during the initial stage of the outbreak. Accordingly, the public showed the highest level of engagement (as indicated by numbers of likes and retweets) during the initial stage. The types of messages sent by the MOH significantly differed across outbreak stages, with messages related to uncertainty reduction, reassurance, and efficacy being prevalent among all stages. Tweet content, media type, and crisis stage influenced the level of public engagement. Engagement was negatively associated with the inclusion of hyperlinks and multimedia files, while higher level of public engagement was associated with the use of hashtags. Tweets related to warnings, uncertainty reduction, and reassurance received high levels of public engagement.ConclusionsThis study provides insights into the Saudi MOH’s communication strategy during the COVID-19 pandemic. Our results have implications for researchers, governments, health organizations, and practitioners with regard to their communication practices during outbreaks. To increase public engagement, governments and health authorities should consider the public’s need for information. This, in turn, could raise public awareness regarding disease outbreaks.     

Health risk communication and amplification: learning from the MMR vaccination controversy

Immunisation is the cornerstone of childhood disease prevention. In this context the combined measles, mumps and rubella vaccination (MMR) has proved a world-wide success, although in the UK it has been at the centre of public controversy since 1998. Through the media, the public domain has witnessed contestation among expert views about the relative risks associated with the diseases vs. the potential side-effects of the vaccination. Attainment of health protection targets has been compromised. The UK Department of Health sought to redress this through a major communication exercise. This paper reports the findings of a study of information strategies that parents use to make sense of health risk issues, particularly MMR. The findings identify the importance of social networks in reinforcing parental understanding and beliefs. While the media are identified as important sources of information, there is no evidence to suggest that parents passively receive and act upon such risk messages. Official information has been able to capitalise on the strong social normalisation of vaccination, but has not responded fully to the evolving social interpretation of risks. The study reveals a preference for personal and face-to-face engagement with health professionals, stressing the importance of user-centred health risk communication.     

Where there’s smoke,there’s fire: focal points for risk communication

Large fires involving hazardous materials are often characterized by failing crisis communication. In this study, we compared opinions of experts regarding the risks of major fires to lay beliefs using a mental models approach. Amongst lay people this revealed relevant knowledge gaps and beliefs in opposition to those held by experts. While, experts considered the chance of getting cancer from inhaling smoke from a chemical fire extremely small, most lay people thought that even at a great distance, the chance of getting cancer to be large. To improve crisis communication about risk in a case of large chemical fires, and reduce the potential for messages to be misunderstood, distrusted or dismissed, we recommend a clarification of cancer risk in communications about public health emergencies such as chemical fires, for which lay people equate even small exposures to carcinogenic chemicals make one more likely to get cancer later in life.     

Competing perspectives on public involvement: Planning for risk characterization and risk communication about radiological contamination from a national laboratory

Public involvement is increasingly emphasized as part of government agencies' responses to environmental health hazards, including risk characterization and risk communication. For example, there is a growing body of literature on health and risk communication proposing best practices and evaluating processes, yet there has been little attention to the ways that preferences for process features and criteria for evaluating success may vary among stakeholders and between stakeholders and government agency staff. This paper reports on a study into how participants associated with an effort to address public health risks from the distribution of plutonium contaminated sewage sludge in Livermore, California, think about the most appropriate way to conduct a process integrating public involvement. Using Q method this paper identifies five perspectives about what constitutes a good collaborative process in this case. The lessons for organizers and participants of risk characterization and risk communication efforts when people subscribe to different (sometimes competing) perspectives about process are discussed.     

Traditional and Mobile Public Health Alert Communications with Health Care Providers

Objective

To systematically compare mobile (SMS) and traditional (email, FAX) communication strategies to identify which modality is most effective for communication of health alerts and advisories between public health agencies and health care providers in order to improve emergency preparedness and response.

Introduction

The effectiveness of emergency preparedness and response systems depends, in part, on the effectiveness of communication between agencies and individuals involved in emergency response, including health care providers who play a significant role in planning, event detection, response and communication with the public. Although much attention has been paid to the importance of communicating clinical data from health care providers to public health agencies for purposes of early event detection and situational awareness (e.g., BioSense) and to the need for alerting health care providers of public health events (e.g., Health Alert Networks), no studies to date have systematically identified the most effective methods of communication between public health agencies and community health care providers for purposes of public health emergency preparedness and response.The REACH (Rapid Emergency Alert Communication in Health) study is a 4-year randomized controlled trial to evaluate and compare the effectiveness of mobile (SMS) and traditional (email, FAX) communication strategies for sending public health messages to health care providers—physicians, pharmacists, nurse practitioners, physician’s assistants and veterinarians.

Methods

Providers were recruited from three sites (King County, WA; Spokane County, WA; and across the state of Montana; N=845) and randomized to receive time-sensitive public health messages via email, Fax, short message service (SMS) or to a control group that did not receive messages. For one year, alerts based on real events of public health interest were sent quarterly with follow-up telephone interviews conducted 5–10 days after the delivery date. Interviews consisted of approximately six questions that elicited information about message receipt, recall of its content and perceived credibility and trustworthiness of the message and source. In addition, provider access to online alert information and delivery success or failure was collected.

Results

Frequency of receipt, timeliness, content awareness, perceived credibility and perceived trustworthiness were measured and compared across communication delivery systems. On average 84.0% of participants were contacted in each follow-up survey following all alerts and across all three sites. Primary data analysis was designed to measure differences between the three communication groups using intent-to-treat methods. A set of secondary analyses examined the outcomes excluding providers who could not have received messages (due to incorrect contact information, known technical failures, or because providers could not receive messages by the assigned delivery message—for example, a provider without a Fax number randomized to the Fax group).We will discuss preliminary results of intent-to-treat analyses regarding rate of recall of study alert message content between traditional and mobile communications and perceived trustworthiness and credibility of message and message source by providers. In addition, we will report on frequency of accessing online alert information between traditional and mobile delivery groups.

Conclusions

There is currently no evidence-based research to guide or improve the practice of public health communication between public health agencies and health care providers before, during and after a public health emergency. Improving this communication via the use of effective media can enhance disease surveillance, which will aid in early detection and enhance case finding and situational awareness for public health emergencies. By systematically evaluating the relative effectiveness of mobile and traditional message delivery systems for emergency preparedness and response communications, the REACH study contributes to building the evidence base for novel and effective approaches to emergency communications.     

The Effect of a Wordless,Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial

BackgroundInnovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience.ObjectiveThe objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention.MethodsIn May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments.ResultsGlobally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors.ConclusionsDespite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises.Trial RegistrationGerman Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbnInternational Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04942-7     

Risk communication: identifying the importance of social context1

This editorial uses articles published in recent issues of Health, Risk and Society to critically review current approaches to risk communication. The effective communication of risk forms a key component of public health measures designed to improve the health of populations in countries such as the UK. These approaches assume that the recipients of the risk information are rational actors who will use the information to minimize their exposure to health hazards, and this will reduce the collective level of harm. However, a recent article in Health, Risk and Society indicated that individuals are not passive recipients of information and do not respond to risk information ‘rationally’. Individuals actively engage in looking for and using information but may also make conscious decisions to avoid certain forms of information. Their response to information is shaped by social context, their own needs for personal security and the extent to which they trust the source of specific items of information. As a result, there is little evidence that risk communication based on the rational actor model shapes an understanding or behaviour in ways in which health-policy makers and public health experts want.     

‘Am I normal?’ Teenagers,sexual health and the internet

The development of new communication technologies has created a wide variety of new fields in which human beings can construct identities. The past decade has seen a proliferation of opportunities to use the internet for health related advice and information and many new sites have been created where participants can construct identities, formulate problems and seek solutions concerning health related issues. This paper will report on a study of emails written in to a UK-based website concerned with health issues for young people. Our analysis was driven by corpus linguistics, a computational methodology for interrogating extensive datasets, and we have combined both quantitative and qualitative approaches to the study of language. We interrogated a 400,000 word dataset of messages and were able to identify terms whose usage was elevated compared to the English language as a whole. As well as personal pronouns, these included many terms related to sexual health and bodily development, as well as terms such as 'normal' and 'worried' which were identified for further exploration. Whereas previous research on sexual health has discovered the use of vague terms and euphemisms, here, young people described themselves, their anatomy and their identities in meticulous detail. This study enables us to define the role of health topics raised, the presentation of health concerns, and contributes towards the discovery of a distinctive 'genre' of health messages concerning sexual health which differs from that found by other researchers concentrating on face to face encounters. In conclusion we suggest that for researchers and practitioners working in health with young people in the medium of English there could be valuable lessons in communication to be learned from examination of corpora of the health care language concerned.     

Factors Influencing Trust in Agencies That Disseminate Tobacco Prevention Information

Several health-related agencies administer national and targeted public education campaigns to provide health information and change health-related behaviors. The trust the public has in these agencies as the source of the message impacts the effectiveness of their communication campaigns. In this study, we explore the perceived trust of agencies that communicate health messages in the tobacco control field. As part of a larger tobacco regulatory science study, we conducted six 90-min focus groups comprising 41 participants. Five main themes emerged pertinent to the agency: (1) its integrity, (2) its competence, (3) its motives, (4) how it is portrayed in the media, and (5) skepticism and mistrust about it. Given the significant resources spent on health messaging to the public and potential benefits offered by this communication, an understanding of public trust in the agencies as the source of health messages is important. Findings suggest health information may be ignored or discounted when there is mistrust in the agency sending those messages.     

Why the transformation of the risk message is a healthy sign: a model of the reception of warning messages

In this article, we examine the communication of health risks caused by technological and natural disasters to the public. Contrary to the commonly accepted view, we argue that in the context of the risk society, the transformation and multiplication of risk messages among the public is a healthy sign. We aim to show how the recipients of risk communication can overcome the confusion that emanates from the inevitable contradictions of warning messages. We used Luhmann’s communication theory to develop a model of the analysis of personal interpretations of warning messages and examined how this explained the variations in the personal sense of risk that shaped the reception of a warning message. Our model developed Luhmann’s concepts of first- and second-order observations: direct and reflective approaches to risk messages. Using data derived from seven focus groups conducted in four Estonian cities in 2009–2010, we examined how the choice between direct and reflective approaches to risk messages was dependent on recipient’s reflection of social relations in the messages and the channels of their delivery. We found that the first response to the warning message depended on whether the information could be dealt with by first-order observation. When members of the focus group realised they needed to use a second-order observation strategy, they tended to use emotions to respond to risk messages. Our data show that defining risks and legitimising solutions in a collective discussion tended to be more important for an individual than accessing the one-dimensional official constructions of risks.     

Why people remain inactive during a crisis: Interpreting and dealing with a crisis within a broader social context

Public inactivity has been addressed by scholars across different academic disciplines. Risk communication and behaviour change is difficult and costly due to limited attention to various messages in the public sphere. Crises pose particular challenges if organisations are to communicate effectively with the public to protect them from potential risks. The present study attempts to better understand what makes the public inactive when faced with a crisis. Specifically, I focus on how people perceive a crisis and the reasons they remain inactive during the crisis. Using 28 in-depth interviews with Korean citizens during two food-related crises, this study revealed that people interpreted the crisis within a broader social context, made underlying assumptions in understanding the crisis and believed what the media vividly showed. The findings also showed that people remained inactive because they avoided dealing with risks due to being distracted by their daily lives, they trusted social systems to manage the problem, and they felt they had high efficacy in resolving the crisis although they did not expect to make fundamental changes in the long-run.     

‘It's their blood not mine’: Who's responsible for (not) telling relatives about genetic risk?

With advances in the ‘new genetics’, an increasing number of people will have access to genetic information and predictive or susceptibility testing. Genetic knowledge has implications for individuals themselves, as well as other family members. In general, health professionals encourage people to pass on genetic risk information to their relatives. However, the disclosure of such information is not always straightforward and, consequently, some people may not be aware of their risk. If risk information is actively withheld, genetic counsellors may need to determine whether they have a duty to pass this on, particularly when preventive action can be taken. To date, little research has explored the barriers and facilitators in family communication about genetic risk. This paper draws on empirical data from a qualitative study exploring communication in families with late-onset familial disease. Interviews were conducted with participants who received genetic counselling for risk of Huntington's disease and hereditary breast or ovarian cancer. Participants' experiences of who was responsible for (not) telling relatives in their families is studied. A number of themes were identified. These were: (1) ‘whose place is it to tell’, (2) the gendering of disclosure, and (3) who is ‘family’. The implications of these findings are considered.     

‘A drop of water in the pool’: information and engagement of linguistic communities around a municipal pesticide bylaw to protect the public's health

The Multicultural Yard Health and Environment Project (MYHEP) used Toronto's Pesticide Bylaw roll-out process to examine how culturally specific perceptions and practices might influence the relevance of municipal public health information and community engagement strategies and the effectiveness of health protection initiatives. In Canada, and particularly in Toronto, such information is needed for governments to effectively engage with increasingly diverse populations. Focus groups and individual interviews were conducted with Spanish- and Cantonese-speaking participants to document opinions about pesticide use and regulation and views on municipal information and engagement strategies. MYHEP participants reported a need for more accessible environmental health messaging. There was confusion over the safety and legality of pesticide products available for sale in Toronto stores. Most participants indicated they were unwilling to make formal complaints about neighbours who were not complying with the bylaw (an important mechanism for enforcement). Results indicate that environmental health communication and engagement strategies need to be more carefully tailored to address local sociocultural and linguistic contexts in order to provide more equitable environmental health protection and promotion for all residents. These findings led Toronto Public Health to adapt its efforts so as to better engage communities regarding environmental health.     

What's in a message? Delivering sexual health promotion to young people in Australia via text messaging

Background  

Advances in communication technologies have dramatically changed how individuals access information and communicate. Recent studies have found that mobile phone text messages (SMS) can be used successfully for short-term behaviour change. However there is no published information examining the acceptability, utility and efficacy of different characteristics of health promotion SMS. This paper presents the results of evaluation focus groups among participants who received twelve sexual health related SMS as part of a study examining the impact of text messaging for sexual health promotion to on young people in Victoria, Australia.     

An evaluation of health communication materials for individuals with disabilities developed by three state disability and health programs

BackgroundHealth communication increasingly has been recognized as an important part of public health practice that can help raise awareness of potential health risks, influence attitudes and beliefs, and motivate individuals to change unhealthy behaviors. Yet, few health communication messages exist that target people with disabilities. An evaluation was conducted to assess the relevance and usefulness of health communication materials developed by or disseminated in, or both, three state disability and health programs.MethodsHealth care providers and people with a variety of physical and sensory disabilities participated in the evaluation. Qualitative and quantitative data were collected in each of the three states using key informant interviews, focus groups, and a Web-based provider survey.ResultsState program staff reported that health communication strategies and messages should be developed to improve access and remove barriers to health care, provide access to facilities, empower consumers, and educate health care providers about the needs of people with disabilities. Several of these needs are consistent with the needs identified by consumers in the focus groups. Consumers indicated that improvements to the overall content and design of the state-developed health communication materials are needed, yet health care and human service providers who participated in the Web-based survey were generally satisfied with the materials. Nearly all providers reported being aware of the materials; however, consumers were not familiar with the state-developed materials reviewed by the focus groups.ConclusionsImprovements in the content and dissemination of health promotion materials designed by states are indicated. Implications for public health practice, including recommendations for improving future health communication materials, are addressed in this article.     

Alcohol, drugs and Australian young people

Experimentation with alcohol and other drugs is often seen as a normal part of adolescent development. The harm associated with substance misuse in young people include injury, violent behaviour, sexual risk taking, drink-driving, overdose, toxicity and death (1-4). Australian young people are drinking alcohol and using illicit substances at an earlier age than previous cohorts (5). hey are more likely to binge drink, have poly-substance use and are at risk of co-morbid mental health problems (1-3). The reasons young people use drugs are complex and varied. An effective response to illicit drug use by young people has to be holistic, as complex and varied as the needs it addresses. It must seek to prevent minimize and manage harm caused by drug use and must be provided to and involve young people in the context of their family, peer group, school and community. Reaching out to young people with drug and alcohol problems is everyone's responsibility. Australia has developed specific prevention and early intervention programs for young people at risk of substance abuse however, further research and development is still needed for effective prevention, early intervention and treatment programs.     

News Reports and Their Role in Child Agricultural Injury Prevention

Objectives: The news media can be important sources of health information. News reports of child agricultural injuries were examined to assess what was reported and to evaluate potential implications for health communication and surveillance efforts. Methods: A content analysis was conducted of a convenience sample of 113 US news reports from 2012 to 2014 involving agricultural injuries to children less than 18 years of age. The data collection instrument included basic elements of injury surveillance, as well as variables related to injury causation and prevention. Results: Law enforcement personnel were the main source of information on the injury event (79%). Severity, age, sex, injury mechanism, and source were reported more than 90% of the time. However, few news reports mentioned use or lack of protective equipment (12%) or a prevention message (6%). Recommended prevention messages from the research team included keeping young children out of the farm worksite (38%) and following guidelines for age-appropriate work and recreational activities (31%). Conclusions: This study shows that news reports provide a valuable and relatively inexpensive addition to other childhood agricultural injury data sources. They highlight current serious events and have potential to be an effective communication tool with respect to education, prevention, and framing the public’s perception of injury risk. An important next step may be to partner with law enforcement to develop three to five prevention messages that can be shared with reporters to educate readers on risks and steps that can be taken to prevent similar injuries on farms and ranches.     

Communicating and enhancing teachers’ attitudes and understanding of influenza using refutational text

Influenza is an important public health issue and schools play an important part in preventing influenza outbreaks. However, little is known about teachers’ knowledge and attitudes toward influenza and vaccination. The purposes of this project were to assess preservice and early career teachers’ knowledge and attitudes of influenza, evaluate the effectiveness of a refutational text on increasing teachers’ attitudes towards and knowledge of influenza and vaccination, and evaluate the effects of participant epistemology, motivation, and cognitive engagement on influenza attitudes and knowledge. We implemented an experimental intervention with 64 pre-service and early career teachers on the effects of a refutational text in remedying influenza misconceptions. Teachers in this sample have vaccination rates (36% received five vaccines in a five-year period) consistent with other US adults. Pre-intervention knowledge scores were moderate and attitudes were slightly positive. Positive attitudes were correlated with increased vaccination. We found refutational texts are effective in eliciting more positive attitudes toward influenza vaccination. We found cognitive engagement was positively correlated to change in attitude. Refutational texts provide an effective mode of influenza and vaccination education.