Leesa Lin

Communications in Public Health Emergency Preparedness: A Systematic Review of the Literature

During a public health crisis, public health agencies engage in a variety of public communication efforts to inform the population, encourage the adoption of preventive behaviors, and limit the impact of adverse events. Given the importance of communication to the public in public health emergency preparedness, it is critical to examine the extent to which this field of study has received attention from the scientific community. We conducted a systematic literature review to describe current research in the area of communication to the public in public health emergency preparedness, focusing on the association between sociodemographic and behavioral factors and communication as well as preparedness outcomes. Articles were searched in PubMed and Embase and reviewed by 2 independent reviewers. A total of 131 articles were included for final review. Fifty-three percent of the articles were empirical, of which 74% were population-based studies, and 26% used information environment analysis techniques. None had an experimental study design. Population-based studies were rarely supported by theoretical models and mostly relied on a cross-sectional study design. Consistent results were reported on the association between population socioeconomic factors and public health emergency preparedness communication and preparedness outcomes. Our findings show the need for empirical research to determine what type of communication messages can be effective in achieving preparedness outcomes across various population groups. They suggest that a real-time analysis of the information environment is valuable in knowing what is being communicated to the public and could be used for course correction of public health messages during a crisis.

Media Use and Communication Inequalities in a Public Health Emergency: A Case Study of 2009–2010 Pandemic Influenza A Virus Subtype H1N1

Objectives. Studies have shown that differences among individuals and social groups in accessing and using information on health and specific threats have an impact on their knowledge and behaviors. These differences, characterized as communication inequalities, may hamper the strength of a societys response to a public health emergency. Such inequalities not only make vulnerable populations subject to a disproportionate burden of adversity, but also compromise the public health systems efforts to prevent and respond to pandemic influenza outbreaks. We investigated the effect of socioeconomic status (SES) and health communication behaviors (including barriers) on peoples knowledge and misconceptions about pandemic influenza A(H1N1) (pH1N1) and adoption of prevention behaviors. Methods. The data for this study came from a survey of 1,569 respondents drawn from a nationally representative sample of American adults during pH1N1. We conducted logistic regression analyses when appropriate. Results. We found that (1) SES has a significant association with barriers to information access and processing, levels of pH1N1-related knowledge, and misconceptions; (2) levels of pH1N1-related knowledge are associated positively with the adoption of recommended prevention measures and negatively with the adoption of incorrect protective behaviors; and (3) people with higher SES, higher news exposure, and higher levels of pH1N1-related knowledge, as well as those who actively seek information, are less likely than their counterparts to adopt incorrect prevention behaviors. Conclusion. Strategic public health communication efforts in public health preparedness and during emergencies should take into account potential communication inequalities and develop campaigns that reach across different social groups.

What have we learned about communication inequalities during the H1N1 pandemic: a systematic review of the literature

BackgroundDuring public health emergencies, public officials are busy in developing communication strategies to protect the population from existing or potential threats. However, a population’s social and individual determinants (i.e. education, income, race/ethnicity) may lead to inequalities in individual or group-specific exposure to public health communication messages, and in the capacity to access, process, and act upon the information received by specific sub-groups- a concept defined as communication inequalities.The aims of this literature review are to: 1) characterize the scientific literature that examined issues related to communication to the public during the H1N1 pandemic, and 2) summarize the knowledge gained in our understanding of social determinants and their association with communication inequalities in the preparedness and response to an influenza pandemic.MethodsArticles were searched in eight major communication, social sciences, and health and medical databases of scientific literature and reviewed by two independent reviewers by following the PRISMA guidelines. The selected articles were classified and analyzed in accordance with the Structural Influence Model of Public Health Emergency Preparedness Communications.ResultsA total of 118 empirical studies were included for final review. Among them, 78% were population-based studies and 22% were articles that employed information environment analyses techniques. Consistent results were reported on the association between social determinants of communication inequalities and emergency preparedness outcomes. Trust in public officials and source of information, worry and levels of knowledge about the disease, and routine media exposure as well as information-seeking behaviors, were related to greater likelihood of adoption of recommended infection prevention practices. When addressed in communication interventions, these factors can increase the effectiveness of the response to pandemics.ConclusionsConsistently across studies, a number of potential predictors of behavioral compliance to preventive recommendations during a pandemic were identified. Our findings show the need to include such evidence found in the development of future communication campaigns to ensure the highest rates of compliance with recommended protection measures and reduce communication inequalities during future emergencies.

Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA

Abstract Background Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks. Methods In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between peoples awareness to prior pandemics and their awareness of and knowledge about MERS. Results Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified. Conclusions Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.

The public health system response to the 2008 Sichuan province earthquake: a literature review and interviews.

This paper describes and analyses the public health system response to the deadly earthquake in Sichuan province, China, in May 2008. Drawing on an experiential learning project consisting of a literature review and field research, including a series of interviews with medical and public health professionals, policy-makers and first responders, a conceptual framework was developed to describe the response. This approach emphasises the pre-existing preparedness level of the medical and public health systems, as well as social, economic and geo-political factors that had an impact on mitigation efforts. This framework was used to conduct post-disaster analyses addressing major response issues and examining methods employed during the public health response to the disaster. This framework could be used to describe and analyse the emergency response to other disasters.

Facing a Health Threat in a Complex Information Environment: A National Representative Survey Examining American Adults' Behavioral Responses to the 2009/2010 A(H1N1) Pandemic.

Background. Recent A(H1N1) studies suggest that intrapersonal and interpersonal factors may exert influence on people’s preventive behaviors for avoiding the flu during pandemics. Aims. Nonpharmaceutical interventions (NPIs) and vaccinations play key roles in containing disease transmission during a pandemic. We examined how intrapersonal and interpersonal factors influenced adoption of NPIs and vaccine uptake during the A(H1N1) pandemic of 2009. Method. The data come from a nationally representative sample survey of 1,569 American adults. Hierarchical multivariable logistic regression was conducted to investigate the association between socioeconomic position, concern and knowledge about the threat, social networks for health advice or health care seeking, health consultations with doctors, and NPIs (including individual’s social distancing behaviors and hygiene practices) and vaccine acceptance. Results. People with higher scores on health-related social networks, more knowledge or concern about A(H1N1), and those who have consulted their doctor were more likely than others to adopt NPIs. There was a significant association between being concerned about A(H1N1), having consulted a doctor, and seeking a vaccine. Conclusions. These findings suggest that interpersonal communication factors, such as health-related social networks and consultations with doctors, and intrapersonal factors, such as concern and knowledge, play a critical role in NPIs and vaccine uptake during pandemics and offer avenues for intervention.

Sources of Information During the 2014 West Virginia Water Crisis: A Cross-Sectional Survey.

OBJECTIVE On January 9, 2014, a faulty storage tank leaked 10,000 gallons of an industrial coal-processing liquid into the Elk River in West Virginia, contaminating the drinking water of 9 counties collectively known as the Kanawha Valley. In the context of this event, we explored the relationship between social determinants and (1) the timeliness with which residents learned about the crisis, (2) the source of information, (3) opinions on the source of information, (4) information-seeking behaviors, and (5) knowledge acquired. METHODS Between February 7 and 26, 2014, we conducted a survey of 690 adult residents of West Virginia. Descriptive statistics and multivariable statistical models were performed. RESULTS Information about water contamination spread quickly, with 88% of respondents from the affected counties hearing about the incident on the same day it occurred. Most people received the information from local television news (73%); social media users had 120% increased odds of knowing about the recommended behaviors. People who had a favorable opinion of the source of information demonstrated better knowledge of recommended behaviors. CONCLUSIONS The use of local television news during a crisis is important for timely dissemination of information. Information exposure across segments of the population differed on the basis of the populations background characteristics. (Disaster Med Public Health Preparedness. 2017;11:196-206).

Public Health System Research in Public Health Emergency Preparedness in the United States (2009–2015): Actionable Knowledge Base

Background In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. Objectives To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. Data Collection and Analysis We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Main Results Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. Conclusions In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.

Engaging the Diaspora in Response to the 2014 Fogo Volcano Eruption in Cape Verde.

On November 23, 2014, a volcanic eruption on the island of Fogo in Cape Verde, of the West Coast of Africa, affected approximately 200 households corresponding to a population of 1498. The eruption continued for 3 months and was the largest eruption, by volume and damage, on the archipelago in over 60 years. Most damage was caused by lava flows advancing into populated regions, destroying buildings, homes, and roads. As a result, 3 villages were abandoned and hundreds of residents evacuated to camps and schools in nearby areas. There were no injuries or deaths, but the evacuees lost homes and possessions.