Local stakeholders' perspectives on improving the urban environment to reduce child pedestrian injury: implementing effective public health interventions at the local level

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change.     

风险沟通和公共卫生

本文罗列了若干有关风险沟通及公共卫生的观点和看法,旨在通过解析风险、风险沟通的概念和相关理论,分析风险评估、风险管理和风险沟通之间的关联以及探寻风险沟通过程中的合作方的收益与阻碍、执行原则和有效风险沟通实践过程并列举风险沟通的实例例证,来说明风险沟通与公共卫生的关联,风险沟通如何提高处理突发公共卫生事件的实效性以及对如何应对突发公共卫生事件的长远潜在影响。     

Examining uncertainties in government risk communication: citizens' expectations

With the shift towards more participative approaches to risk communication and risk management, policymakers are expected to be more transparent with the public concerning existing uncertainties about health risks, such as lack of data or contradictory evidence. There is, however, a debate among researchers as to whether this transparency about uncertainties is indeed welcomed by the public and if it is effective in promoting trust in risk regulatory institutions. The qualitative study on which this article is based aimed to clarify citizens' perceptions of diverse sources of uncertainty in government risk communication and their expectations with respect to discussing uncertainties. Forty-seven adults from two major Canadian cities took part in focus groups or individual interviews in which they voiced their expectations about who should be involved in risk communication, why uncertainties should be communicated, what sources of uncertainties were preferred, as well as how and when these should be discussed. Their discussions showed that they expected the government to include citizens in evaluating and managing uncertainties pertaining to risks under individual control and directly informing consumer choices about health risks. In contrast, they questioned the relevance of systematically exposing uncertainties relating to risks perceived as outside individual control, and associated with very low probability scenarios of possible threats. Globally, they appraised the desirability of discussing uncertainties in risk communication in relation to the perceived utility of the information for decision-making. These findings indicate that risk communicators and managers need to consider ways in which discussions of uncertainties can empower citizens.     

A dialogic model of conversations about risk: Coordinating perceptions and achieving quality decisions in cancer care

We propose that academic scholarship and clinical practice should conceptualize communication about risk as a dialogic and relational process. This conceptual paper addresses how clinical decisions about cancer treatment are impacted by different risk perceptions. Patients and health care providers base their risk perceptions on analytic or experiential reasoning processes. However, most risk communication research in the clinical context only examines the transmissive and persuasive communication of these different risk perceptions. This transmissive communication results in a monologic model that limits the opportunities for patients and clinicians to incorporate their perspectives into a shared understanding. The dialogic model of risk communication contributes to a quality cancer care decision because it creates open space to find connections between patient values and clinical evidence while allowing the parties to have a satisfactory level of involvement. The final section of the paper describes theory behind a dialogic perspective and offers guidelines for how to implement it in risk communication to improve clinical decision making.     

Can the impact of public involvement on research be evaluated? A mixed methods study

Background Public involvement is central to health and social research policies, yet few systematic evaluations of its impact have been carried out, raising questions about the feasibility of evaluating the impact of public involvement. Objective To investigate whether it is feasible to evaluate the impact of public involvement on health and social research. Methods Mixed methods including a two‐round Delphi study with pre‐specified 80% consensus criterion, with follow‐up interviews. UK and international panellists came from different settings, including universities, health and social care institutions and charitable organizations. They comprised researchers, members of the public, research managers, commissioners and policy makers, self‐selected as having knowledge and/or experience of public involvement in health and/or social research; 124 completed both rounds of the Delphi process. A purposive sample of 14 panellists was interviewed. Results Consensus was reached that it is feasible to evaluate the impact of public involvement on 5 of 16 impact issues: identifying and prioritizing research topics, disseminating research findings and on key stakeholders. Qualitative analysis revealed the complexities of evaluating a process that is subjective and socially constructed. While many panellists believed that it is morally right to involve the public in research, they also considered that it is appropriate to evaluate the impact of public involvement. Conclusions This study found consensus among panellists that it is feasible to evaluate the impact of public involvement on some research processes, outcomes and on key stakeholders. The value of public involvement and the importance of evaluating its impact were endorsed.     

突发公共卫生事件风险沟通研究进展

风险沟通是处置突发公共卫生事件的重要环节.本文通过搜集国内外相关文献,对风险沟通的发展历史、沟通流程、理论模型等进行概述,重点关注风险沟通在突发公共卫生事件中的应用.理论研究和实践经验均表明,风险沟通应遵循特定的流程,根据事前、事中、事后的特点采取相应的沟通策略.2003年SARS疫情以后,我国的风险沟通机制不断完善,...     

Introduction of a guide to enhance risk communication among low-income and minority populations: a grassroots community engagement approach

Low-income populations, especially those belonging to minority groups, are among the most vulnerable groups before, during, and after a natural disaster. One of the factors that can be attributed to their vulnerability is the ineffectiveness of traditional risk communication systems in reaching this population. Many low-income populations are distrustful of government agencies and those who typically communicate risk messages. Consequently, traditional systems are not as effective in reaching these communities. Furthermore, traditional systems have been based on the social media that the general population uses and not based on social networks of disadvantaged populations which are more important than formal channels in these communities for dissemination of information. To bridge the gap, an approach is needed that relies on trusted agencies and leaders to educate and warn low-income communities about possible public health threats. A grassroots approach can enhance the capacity of the risk communication systems to more effectively reach vulnerable populations by engaging grassroots organizations in risk communication activities. The Guide to Enhance Grassroots Risk Communication Among Low-Income Populations provides strategies and guidance that can assist agencies in upgrading their systems for risk communication by building partnerships with local community stakeholders.     

健康传播视角下的突发公共卫生事件管理——基本理论、常用方法和效果评估

本文首先从新闻价值判断的角度分析了突发公共卫生事件为什么容易被媒体关注,强调了政府卫生部门在健康传播中的权威信源和传播主体的双重角色,并从议程设置理论、沉默的螺旋理论等传播学视角阐述了政府卫生部门在风险沟通中应重视媒体的作用。文章提出风险沟通的直接目标是降低危害,创造有利的舆论环境,根本目标是赢得社会公众的信任。文章列举了风险沟通的常用方法,如:舆情监测和预警、召开新闻发布会、善用新媒体、维护社会信任文化等。政府卫生部门作为健康传播的主体需要不断地接收传播效果的反馈,并进行科学的评估,根据传播效果调整传播的内容和形式。文章以受众问卷调查法为例,详细地描述了传播效果评估的过程。     

Communicating health risk.

Health risk communication is a two way interactive process that involves the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk. Although it has only recently become a topic for scientific research, much has been learned in relation to the strategies and the techniques that contribute to effective health risk communication. In parallel, there has probably never been a time of greater need for effective training in health risk communication. The media and the general public are now very hazard conscious, subsequent to apparently regular events in the areas of public health, safety and environmental issues. Public concern regarding such issues is sometimes much less than experts feel to be appropriate, whilst at other times concern has outstripped the concern of the experts involved. Health professionals trained in the techniques of health risk communication are a vital resource in ensuring that the workforce or the population is properly informed so as to exercise appropriate decisions and actions in relation to hazard and risk.     

Social agents and news media as risk amplifiers: a case study on the public debate about the E. coli outbreak in Germany 2011

The social amplification of risk framework highlights the role which the news media play in risk communication by interacting with other agents in amplifying risk. However, the precise ways in which the media and other social agents actually amplify risks in public debates are unclear. In this article we draw on insights from the sociology of news to examine whether and to what extent social agents and news media amplify an emerging health risk. We use the debate about the Escherichia coli outbreak in Germany in 2011 to examine three issues: the amount of risk reporting by news media and social agents in their function as news sources; their evaluation of risk; and how they contribute to the escalation of risk, also known as ripple effects. In this article we draw on data from a content analysis of press releases from public health authorities and affected stakeholders and of news items in leading German news media. We found that the affected stakeholders were amplifying the risk to the greatest extent. We also found that there was a shift over time in the use of dominant frames. At the start of the debate the risk was framed as a public health issue and linked to medical-scientific progress. As the debate developed, more attention was given to political and economic consequences of the outbreak and the original health risk event was layered by other risk-related events.     

Acceptability and Perceived Benefits and Risks of Public and Patient Involvement in Health Care Policy: A Delphi Survey in Belgian Stakeholders

BackgroundIn systems with public health insurance, coverage decisions should reflect social values. Deliberation among stakeholders could achieve this goal, but rarely involves patients and citizens directly.ObjectivesThis study aimed at evaluating the acceptability, and the perceived benefits and risks, of public and patient involvement (PPI) in coverage decision making to Belgian stakeholders.MethodsA two-round Delphi survey was conducted among all stakeholder groups. The survey was constructed on the basis of interviews with 10 key stakeholders and a review of the literature on participation models. Consensus was defined as 65% or more of the respondents agreeing with a statement and less than 15% disagreeing. Eighty stakeholders participated in both rounds. They were defined as the Delphi panel.ResultsBelgian stakeholders are open toward PPI in coverage decision processes. Benefits are expected to exceed risks. The preferred model for involvement is to consult citizens or patients, within the existing decision-making structures and at specific milestones in the process. Consulting citizens and patients is a higher level of involvement than merely informing them and a lower level than letting them participate actively. Consultation involves asking nonbinding advice on (parts of) the decision problem. According to the Delphi panel, the benefits of PPI could be increasing awareness among members of the general public and patients about the challenges and costs of health care, and enriched decision processes with expertise by experience from patients. Potential risks include subjectivity, insufficient resources to participate and weigh on the process, difficulties in finding effective ways to express a collective opinion, the risk of manipulation, and lobbying or power games of other stakeholders.ConclusionsPPI in coverage decision-making processes is acceptable to Belgian stakeholders, be it in different ways for different types of decisions. Benefits are expected to outweigh risks.     

Leave no one behind: improving health and risk communication through attention to literacy

Twice in recent times, the federal government mailed critical health-related information to every household in the United States. The mailings, the 1988 brochure Understanding AIDS and the 2001 postcard A Message to Americans, were designed to provide the general public with important information about needed action. This paper compares the development process undertaken for each mailing. The authors assess content and format in light of communication principles and the functional literacy skills of average adults. The authors, noting that the reading grade level of the postcard exceeds the reading ability of the average adult, recommend that plain language guidelines be combined with health and risk communication principles in all future efforts to alert the public.     

Brazilian cases and the debate about risk communication and governance in areas contaminated by lead

This investigation focused on lead contamination case studies in Brazil. The situations studied involve communities living in Santo Amaro da Purifica??o and Adrianópolis, in the north-east and south of Brazil, respectively. These communities have all had to live with environmental contamination and human exposure to lead as a consequence of industrial, mining and processing activities that were conducted by the same company for decades in a manner inconsistent with modern mining and industrial standards, with little control of environmental and human health impacts. The investigation sought to analyze the strategies of risk communication to local people, and to evaluate their engagement in risk management. The methodological approach included the analysis of newspaper articles, and interviews conducted with different stakeholders, such as residents, journalists, researchers and authorities. The results indicated the need to promote public involvement in the debate and in the decision-making process. The results also confirmed the hypothesis that associative models (represented by local neighborhood associations, for instance) are important for promoting and eliciting public participation in risk management.     

Evaluating the communication of environmental permitting decisions in diverse communities

Environmental communication plays a critical role in addressing the public's growing awareness and apprehension about environmental health risks. Although opportunities for public participation in environmental health assessments have greatly increased, environmental communication among key stakeholders is an evolving process. The authors evaluated the communication that occurred among a state environmental agency, six Title V operating facilities, and the public concerning environmental permitting decisions perceived to impact environmental and human health. The authors identify environmental concerns of diverse communities, analyze communication among key stakeholders regarding environmental permitting decisions, and propose recommendations for practitioners to improve environmental communication strategies among these key stakeholders in either urban or rural communities.     

Stakeholder engagement for improved school policy: development and implementation

The health and education departments of government share a responsibility for promoting the health of children through policies in the school setting. These policies can be enhanced through the involvement of such stakeholders as school personnel, students, parents or caregivers, health professionals, the non-profit sector and industry. Although there is little evidence-based literature on the roles of stakeholders in school policy development and implementation, stakeholder involvement appears to be critical throughout the policy process. This article discusses stakeholder involvement in the development and implementation of school policies that promote and support healthy eating and physical activity. Canadian examples illustrate stakeholder engagement in this context.     

Childhood Lead Poisoning in a Somali Refugee Resettlement Community in New Hampshire

Despite the gradual decrease in childhood lead poisoning in the United States, the risk for lead poisoning among African refugee children who resettle in the United States remains elevated. Communication methods implemented by resettlement agencies in the public health system for preventing childhood lead poisoning in this at-risk population warrant further investigation. We utilized structured interviews with key stakeholders (resettlement agencies, social service agencies developed by African refugees and resettled Somali refugees) involved in the refugee resettlement process to (1) describe the agency’s role in the refugee resettlement process; (2) examine communication methods utilized and barriers experienced by the public health system in reference to childhood lead poisoning; (3) describe the refugee population’s perception of childhood lead poisoning; (4) examine general challenges experienced by the public health system and the refugee population during the resettlement process; and (5) describe stakeholders’ recommendations to improve health communication efforts. Based on our findings, we propose that communities are important determinants in health-related problems for refugee populations. Each community has its own environment and public health system that interacts with each other to influence health risks and risk perceptions of its populations. We advocate that understanding a community’s ecology and implementing a culture-centered approach is essential for the public health system to help educate and prevent communication inequalities and health disparities among an at-risk African refugee population. This action can reduce a population’s resistance to communication and help build a community’s capacity to address a persistent public health problem, such as childhood lead poisoning.     

Health risk communication using comparative risk analyses

The ability to communicate effectively the degree or magnitude of public exposures or health risks is essential for risk assessors and risk managers. Various guidelines exist for communicating environmental and public health risks, including recommended approaches for putting risk data into proper context. Although it remains unclear as to which approach is the most useful or appropriate under different circumstances, risk comparisons are a popular choice for conveying the significance of or providing a better perspective on a particular chemical exposure or health risk. In this paper, several different types of risk comparisons are described that are frequently used in the private and public sectors, and these are illustrated using a variety of examples from the literature. These approaches include: (1) intrachemical comparisons, (2) interchemical comparisons, (3) comparisons to background levels of risk, (4) comparisons to theoretical risks or safety levels, and (5) comparisons to other actions or activities. The primary purpose of this paper is to summarize and briefly discuss the advantages and limitations of these risk communication approaches. The evolving field of risk communication is also discussed, including ongoing research on public risk perceptions and alternative methods for communicating risk magnitudes and data uncertainties.     

The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study

BACKGROUND: Anecdotally, communication between general practitioners (GPs) and occupational health professionals is poor and acts as a barrier to successful rehabilitation for work. It is not known how widely this view is held by the many stakeholders in rehabilitation for work, or how important the observation is in its effect. METHODS: A Delphi study was conducted by initial semi-structured telephone interview, followed by a three-round collation and feedback of opinion by e-mail. The 25 participants were identified by suggestion within the study process for their position as key informants within a wide range of stakeholders. RESULTS: The process generated a consensus statement which identifies the extremely important nature of rehabilitation for work, the crucial role by GPs, the central role of occupational health professionals in case management and the barrier represented by the often very poor communication between them. CONCLUSION: The way forward is to improve communication by mutual education and understanding and a team approach to rehabilitation strategy. This may be facilitated by the GPs who work in occupational health and disability assessment and the involvement of other health professionals to great benefit for all stakeholders.     

Participatory involvement of farming communities and public sectors in determining malaria control strategies in Mvomero District, Tanzania

Addressing the malaria-agriculture linkages requires a broad inter-disciplinary and integrated approach that involves farming communities and key public sectors. In this paper, we report results of participatory involvement of farming communities in determining malaria control strategies in Mvomero District, Tanzania. A seminar involving local government leaders, health and agricultural officials comprising of a total of 27 participants was held. Public meetings in villages of Komtonga, Mbogo, Mkindo, Dihombo and Luhindo followed this. Findings from a research on the impact of agricultural practices on malaria burden in the district were shared with local communities, public sector officials and other key stakeholders as a basis for a participatory discussion. The community and key stakeholders had an opportunity to critically examine the linkages between agricultural practices and malaria in their villages and to identify problems and propose practical solutions. Several factors were identified as bottlenecks in the implementation of malaria control in the area. Lack of community participation and decision making in malaria interventions was expressed as among the major constraints. This denied the community the opportunities of determining their health priorities and accessing knowledge needed to effectively implement malaria interventions. In conclusion, this paper emphasizes the importance of participatory approach that involves community and other key stakeholders in malaria control using an ecosystem approach. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in malaria control effort.     

Scientific trends in risk assessment research

The use of risk assessment approaches to evaluate the effects of toxic chemicals had its primary origin in 1976 when the U.S. Environmental Protection Agency (EPA) adopted the first federal guidelines to commit a major regulatory agency to risk assessment approaches for the evaluation of suspect carcinogens. The accompanying policy statement also adopted a risk management policy, which acknowledged that the agency would accept risk in making public health policy decisions; in essence, this represented a primary departure from the zero-risk goal that had dominated the first half of the environmental movement of the 70s. The approach adopted in 1976 was based on the experience of risk assessment approaches used for assessing low-dose-radiation effects on human health. To be certain that no public health risk be underestimated, particularly in light of the prior zero-risk goal, the practice of risk assessment for the first decade relied heavily on extremely protective assumptions in all aspects of the assessment process. For example, these assumptions included ranking the weight-of-evidence according to results in all related studies without regard for distinctions of tumor end point relevance to humans and the possibility that low-dose effects at environmental exposures might not be the same as high-dose effects. For low-dose-response characterization, the practice has been to characterize a plausible upper bound on risk by the use of a low-dose linear non-threshold dose-response curve. Exposure assessment likewise relied on maximum plausible assumptions to characterize exposure. More recently, more attention is being paid to developing accurate scientific databases that advance almost every aspect of the risk assessment process in the direction of more accurate risk characterization. This paper will discuss the recent trends in weight-of-evidence characterization, dose-response modeling, and exposure assessment and will compare the outcomes of these refined assessments to those evaluations that have relied on the earlier, conservative approaches. In essence, if the practices of the first decade for establishing plausible upper bounds on the risk were accurate, improved scientific data by and large should be expected to lower the overall theoretical risk. Indeed, this is the case when recent risk assessment research is applied but there are examples to the contrary. This paper represents a survey of recent trends and applications.