Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project

Information scanning in the COVID-19 pandemic: a test and expansion of the channel complementarity theory using latent class analysis

BACKGROUND

During health crisis, individuals need information to comprehend their circumstances. Channel complementarity theory posits that in meeting their informational needs, people will use different sources in a complementary fashion. This paper puts to test the main tenet of channel complementarity theory by focusing on information scanning (i.e. routine health information exposure) in the context of the COVID-19 pandemic in Chile.

METHOD

A survey was conducted among a sample of Chilean adults (N = 2,805). The questionnaire addressed information scanning across six sources (television, radio, internet, social media, family, and friends or coworkers) and explores how socioeconomic and demographic variables, as well as COVID-19 perceived risk related to scanning. Latent class analysis was employed to identify patterns of complementarity across channels.

RESULTS

The analysis yielded a solution of five classes, namely 'high complementarity and high frequency' (21%), 'high complementarity and low frequency' (34%), 'high frequency on television and digital media' (19%), 'mass media predominant' (11%), and 'no scanning' (15%). Educational attainment, age, and COVID-19 perceived risk were associated with scanning.

CONCLUSIONS

Television was a central channel for information scanning during the pandemic in Chile and more than half of participants scanned COVID-19 information complementarily. Our findings expand channel complementarity theory to information scanning in a non-US context and provide guidelines for designing communication interventions aiming at informing individuals during a global health crisis.

Assessing Brigada Digital de Salud Audience Reach and Engagement: A Digital Community Health Worker Model to Address COVID-19 Misinformation in Spanish on Social Media

U.S. Spanish-speaking populations experienced gaps in timely COVID-19 information during the pandemic and disproportionate misinformation exposure. Brigada Digital de Salud was established to address these gaps with culturally tailored, Spanish-language COVID-19 information on social media. From 1 May 2021 to 30 April 2023, 495 Twitter, 275 Facebook, and 254 Instagram posts were published and amplified by 10 trained community health workers. A qualitative content analysis was performed to characterize the topics and formats of 251 posts. To assess reach and engagement, page analytics and advertising metrics for 287 posts were examined. Posts predominantly addressed vaccination (49.45%), infection risks (19.12%), and COVID-related scientific concepts (12.84%). Posts were educational (48.14%) and aimed to engage audiences (23.67%), promote resources (12.76%), and debunk misinformation (9.04%). Formats included images/text (55.40%), carousels (27.50%), and videos (17.10%). By 9 June 2023, 394 Facebook, 419 Instagram, and 228 Twitter followers included mainly women ages 24-54. Brigada Digital reached 386,910 people with 552,037 impressions and 96,868 engagements, including 11,292 likes, 15,240 comments/replies, 9718 shares/retweets, and 45,381 video play-throughs. The most engaging posts included videos with audio narration, healthcare providers, influencers, or music artists. This community-based model to engage Spanish-speaking audiences on social media with culturally aligned content to counter misinformation shows promise for addressing public health threats.

Coping with outbreaks: Toward an infectious disease threat (IDT) appraisal model for risk communication

Through an online, nationally representative survey (N = 1,164), this study examines how individuals perceive and cope with infectious disease outbreaks. Findings inform risk and crisis communication strategies for health organizations. This study explored how individuals' threat appraisals (perceived controllability, perceived predictability, and perceived responsibility) and their cognitive (i.e., information seeking) and conative coping (i.e., protective actions) differ by infectious disease threat (IDT) type (i.e. airborne, bloodborne, foodborne, sexually-transmitted, waterborne, or zoonotic/vectorborne) in epidemic situations. Findings revealed that IDT types varied significantly based on individuals' appraisals of predictability, controllability, and responsibility for different disease types. Across all disease types, predictability was the most impactful factor related to participants' information seeking and planned protective action taking.

Process and components of disaster risk communication in health systems: A thematic analysis

Risk communication (RC) is one of the necessary functions in disaster management. Establishing communication processes such as planning, transparency of policies and guidelines, RC expert training, providing communication infrastructure and evaluation in the shortest period reduces confusion and management inconsistency. One of the existing challenges is not knowing the exact dimensions of risk communication and its components in disasters. The aim was to identify the components of disaster risk communication in the health system. This research was conducted by systematic review and searching of the databases of PubMed, Scopus, Web of Science, ProQuest, Google Scholar and ScienceOpen 2000-2021 to identify the components of disaster risk communication in the health system. Thematic content analysis was used for data analysis. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 chart was used for systematic search, and a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality determination. Out of 12 342 articles extracted, 25 studies were included for analysis. The components of disaster risk communication were analysed in 6 categories and 19 subcategories. These categories include communication (communication processes, communication features and infrastructure), information (content production, content characteristics and publishing), risk communication management (risk perception assessment, planning, coordination and logistics), monitoring and control (monitoring and evaluation, accreditation, documentation), education and training (public and organisational) and ethics and values (culture and social beliefs, ethics and trust). According to this research, the establishment of communication infrastructure and advanced equipment such as various structured formats for communication and artificial intelligence; online and offline communication support systems; and timely and accurate notice can help achieve goals such as coordination and organisation in the health system and increase social participation.

Contribution

This study has clarified and explained all the main components and measures of risk communication that can be used for planning scientifically.

On the Influence of Message/Audience Specifics and Message Appeal Type on Message Empowerment: The Austrian Case of COVID-19 Health Risk Messages

A pandemic is a unique form of health crisis that requires intensive communicative efforts. In order to achieve positive health outcomes, messages need to be carefully designed. In this context, both message specifics and audience specifics receive consideration. This research tries to scrutinize (1) which message appeal (emotional vs. informative) is perceived more favorable by the Austrian public, (2) which message appeal (emotional vs. informative) leads to a higher degree of message empowerment, and (3) the degree to which message empowerment can be enhanced by (a) message specifics and (b) a combination of message and audience specifics. A quantitative survey with 337 Austrians revealed that the emotional appeal message led to a higher degree of message empowerment than the informative appeal message. Moreover, only message specifics were found to enhance message empowerment. Implications for message design are derived, before limitations and directions for future research are addressed.

Making It Work: The Experiences of Delivering a Community Mental Health Service during the COVID-19 Pandemic

The COVID-19 pandemic forced rapid innovative change to healthcare delivery. Understanding the unique challenges faced by staff may contribute to different approaches when managing future pandemics. Qualitative interviews were conducted with 21 staff from a Community Mental Health Team in the North West of England, UK, three months after the first wave of the pandemic. Thematic analysis was used to examine data reporting the challenges arising when working to deliver a service during the pandemic. Data is discussed under four headings; "senior trust managers trying to make it work", "individuals making it work", "making it work as a team", and "making it work through working at home". Clear communication was essential to ensure adherence to guidelines while providing safe care delivery. The initial response to the pandemic involved the imposition of boundaries on staff by senior leadership to ensure that vulnerable service users received a service while maintaining staff safety. The data raises questions about how boundaries were determined, the communication methods employed, and whether the same outcome could have been achieved through involving staff more in decision-making processes. Findings could be used to design interventions to support mental health staff working to deliver community services during future crises.

Visualizing the Knowledge Base and Research Hotspot of Public Health Emergency Management: A Science Mapping Analysis-Based Study

Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.

Lessons Learned From Dear Pandemic, a Social Media-Based Science Communication Project Targeting the COVID-19 Infodemic

The World Health Organization has identified excessive COVID-19 pandemic-related information as a public health crisis, calling it an "infodemic." Social media allows misinformation to spread quickly and outcompete scientifically grounded information delivered via other methods. Dear Pandemic is an innovative, multidisciplinary, social media-based science communication project whose mission is to educate and empower individuals to successfully navigate the overwhelming amount of information circulating during the pandemic. This mission has 2 primary objectives: (1) to disseminate trustworthy, comprehensive, and timely scientific content about the pandemic to lay audiences via social media and (2) to promote media literacy and information-hygiene practices, equipping readers to better manage the COVID-19 infodemic within their own networks. The volunteer team of scientists publishes 8-16 posts per week on pandemic-relevant topics. Nearly 2 years after it launched in March 2020, the project has a combined monthly reach of more than 4 million unique views across 4 social media channels, an email newsletter, and a website. We describe the project's guiding principles, lessons learned, challenges, and opportunities. Dear Pandemic has emerged as an example of a promising new paradigm for public health communication and intervention. The contributors deliver content in ways that are personal, practical, actionable, responsive, and native to social media platforms. The project's guiding principles are a model for public health communication targeting future infodemics and can bridge the chasm between the scientific community and the practical daily decision-making needs of the general public.

Testing the public's response to receiving severe flood warnings using simulated cell broadcast

European Governments must implement a public alerting system to reach mobile phone users affected by major emergencies and disasters by June 2022. Cell Broadcast is used to issue emergency alerts in several countries but has not yet been introduced in the UK. This paper presents the results of a joint research exercise that explored recipients' responses to cell broadcast messages that warned of floods of varying certainty, severity, and urgency. We adopted a mixed-methods approach employing semi-structured questions and focus groups to assess the perceptions of 80 workshop participants who received simulated emergency alerts on pre-prepared handsets. Our results suggest that although emergency alerting is welcomed, it is necessary to provide accurate and verifiable information, address accessibility challenges, and state location clearly and understandably. This life-saving technology, if used aptly by not over-alerting, specifying the specific urgency, certainty, severity and location of the flood risk, has the real potential of upgrading flood warnings in the UK.

The Relationships Between Socioeconomic Status, COVID-19 Risk Perceptions, and the Adoption of Protective Measures in a Mid-Western City in the United States

An individual's perception of risk plays an influential role in the behaviors they engage in, which could reduce or increase exposure or transmission of a certain disease. Since risk perceptions vary by social identities (e.g., gender, race/ethnicity, age) they are believed to influence the interpretation and likelihood of following guidance from risk-communication efforts. This study aims to understand how COVID-19 risk perceptions vary by social identity (with an emphasis upon socioeconomic factors), how such identities influence behavior adoption through risk-communication pathways, and how findings can be practically applied in messaging. Previous studies have investigated the role of social factors on risk perceptions, but SES has not been modeled as the main factor. Guided by the Health Belief Model and Social Determinant of Health Frameworks, findings from our 326 participants suggest those with high-risk COVID-19 perceptions identified as higher income and held more advanced educational degrees, suggesting a positive relationship between risk perceptions and SES. Individuals with high-risk perceptions more frequently reported practicing protective behaviors against COVID-19 and reported greater severity, susceptibility, barriers, benefits, trust, confidence, and health literacy in adopting behavior changes against the virus. When applying such findings to create a local risk-communication plan (logic model), it was found that messaging should be culturally relevant, in-plain language, and consistent to improve health literacy. In addition to using the most trusted and frequently used communication sources self-identified by residents, we recommend uniting trusted formal and informal community leaders to provide information in diverse pathways and formats.

Resilience and stress in frontline social workers during the COVID-19 pandemic in Singapore

As social work under normal circumstances is already a stress-laden helping profession, this study intended to examine the level of psychological distress among the frontline social workers during the COVID-19 pandemic and whether resilience and organizational support played a part in mitigating their psychological distress. Frontline social workers from various social service sectors across Singapore were surveyed using two standardized measurements to assess resilience (Connor-Davidson Resilience Scale 25) and psychological distress (Depression Anxiety and Stress Scale 21). A self-designed questionnaire comprising 10 items measured "personal" and "work-related" support at the organization. Sociodemographic data were captured using a structured questionnaire. The results showed that the frontline social workers, although resilient, were psychologically distressed in all the three areas of depression, anxiety and stress. The results indicated that those working in the Family Service Centers (FSC) were the most affected. Significant correlations were observed between psychological distress, resilience, and organizational support. Organizations must be mindful that support can help frontline staff who are usually younger and less experienced during challenging times such as the pandemic. Building the resilience of social workers will prepare them for their daily challenges and those that accompany unexpected situations.

Socioeconomic status, damage-related conditions, and PTSD following the Fukushima-daiichi nuclear power plant accident:The Fukushima Health Management Survey

The Great East Japan Earthquake severely damaged the Tohoku and Kanto districts, and Fukushima Prefecture faced a subsequent nuclear disaster. Few studies have reported the effects of socioeconomic stressors on individuals’ mental status following disasters. We analyzed the responses of 60,704 adult residents of a designated restricted area to the PTSD Checklist-Stressor-Specific Version (PCL-S). The relationships between the PCL-S scores and demographic, socioeconomic, and damage-related variables were analyzed using regression analysis to predict participants’ severity of PTSD symptoms. Approximately 14.1% of evacuees had severe PTSD symptoms (PCL-S ≥50) eighteen months post-earthquake. The PCL-S scores were higher among women, older adults, less educated people, those with a history of mental illness, and those living outside Fukushima Prefecture. The PCL-S scores increased with participants’ scores on the Kessler Psychological Distress Scale. The number of trauma-exposure stressors and socioeconomic stressors were associated with 1.52 and 3.77 increases in the PCL-S score, respectively. Furthermore, psychological distress, unemployment, decreased income, house damage, tsunami experience, nuclear power plant accident experience, and loss of someone close due to the disaster were associated with the prevalence of severe PTSD symptoms. The complex triple disaster of a major earthquake, tsunami, and nuclear accident created significant socioeconomic changes that may be important determinants of PTSD among residents of restricted access areas in Fukushima.

Emerging Adults' Adherence to Preventative Health Guidelines in Response to COVID-19

Objective

To examine rates of emerging adults’ (EA) adherence to preventative health behavior recommendations during early months of the COVID-19 pandemic and to investigate demographic (i.e., gender, years of education, socioeconomic status, school enrollment status, and living situation) and exposure and impact-related correlates of adherence.

Methods

Participants were 273 [M (SD) age = 22 (2.1) years, 55% female, 32% from minoritized groups] EA completed an online survey of adherence to 11 preventative health behaviors recommended by the Centers for Disease Control (CDC) during summer 2020. Participants rated adherence via a visual analog scale. Participants also reported demographic information and completed the COVID-19 Exposure and Family Impact Adolescent and Young Adult Version (CEFIS-AYA).

Results

Median levels of adherence to preventative recommendations ranged from 66% to 100%. Highest adherence levels (Mdn > 90%) were reported for quarantining if exposed to COVID-19; covering mouth when sneezing; avoiding the elderly/those at high risk; and avoiding large gatherings. Median adherence was <80% for mask wearing; maintaining a 6-foot distance; avoiding in-person visits with romantic partners or friends; and disinfecting surfaces. Female gender was the only variable significantly associated with overall adherence, and it explained 4% of the variance.

Conclusions

Following guidelines related to social distancing practices may be particularly challenging for EA, possibly because of unique developmental needs of this group, and males may be at greater risk for non-adherence to CDC recommendations. Therefore, public health messaging and adherence intervention development should be designed with males and social distancing practices in mind.

Perception survey of crisis and emergency risk communication in an acute hospital in the management of COVID-19 pandemic in Singapore

BACKGROUND

Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers.

METHODS

A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback.

RESULTS

Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital's response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff's primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important.

CONCLUSION

CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.

The impacts of knowledge, risk perception, emotion and information on citizens' protective behaviors during the outbreak of COVID-19: a cross-sectional study in China

BACKGROUND

Individual protective behaviors play an important role in the control of the spread of infectious diseases. This study aimed to investigate the adoption of protective behaviors by Chinese citizens amid the COVID-19 outbreak and its associated factors.

METHODS

An online cross-sectional survey was conducted from 22 January to 14 February 2020 through Wenjuanxing platform, measuring their knowledge, risk perception, negative emotion, response to official communication, and protective behaviors in relation to COVID-19. A total of 3008 people completed the questionnaire, of which 2845 were valid questionnaires.

RESULTS

On average, 71% of respondents embraced protective behaviors. Those who made no error in the knowledge test (AOR = 1.77, p < 0.001) perceived the high severity of the epidemic (AOR = 1.90, p < 0.001), had high negative emotion (AOR = 1.36, p = 0.005), reported good health (AOR = 1.94, p < 0.001), paid high attention to the governmental media (AOR = 4.16, p < 0.001) and trusted the governmental media (AOR = 1.97, p < 0.001) were more likely to embrace protective behaviors after adjustments for variations in potential confounding factors. Women and older people were also more likely to embrace protective behaviors. No regional or educational differences were found in the adoption of protective behaviors.

CONCLUSION

The majority of Chinese citizens embraced protective behaviors. Higher levels of protective behaviors are associated with higher knowledge, perceived severity, negative emotion, and attention to and trust in the official governmental media. Official governmental communication is the largest single predictor of protective behaviors.

Public Understanding, Perceptions, and Information Sources about Bioterrorism: Pilot Study from the Republic of Serbia

Bioterrorism presents a complex national, international, and human security threat, which requires a multidisciplinary approach to preparation and planning. Although the public plays an integral part of every aspect of bioterrorism, their understanding of and attitudes toward bioterrorism have not been extensively researched in the past, but are important for efficient knowledge communication. This study examines the baseline public comprehension and perceptions of bioterrorism, as well as the underpinning, trusted information sources in the Republic of Serbia. Results demonstrate overall poor understanding of bioterrorism and a notable lack of distinction between bioterrorism and infectious agents in general. These findings represent the first such body of knowledge in Europe and are in agreement with previous data from North America and Australia. Interestingly, the idea that bioterrorism agents are an intentional laboratory product of genetic engineering and synthetic biology approaches is significantly present among the surveyed population, but with contradicting views on whether such actions would be malicious or well-intended. These ideas, coupled with substantial mistrust in government institutions and news media, could inflict serious consequences and, therefore, should be taken into consideration when designing prevention and preparedness strategies, as well as interventions through knowledge communication.

The First 60 Days: American Public Health Agencies' Social Media Strategies in the Emerging COVID-19 Pandemic

In this paper, we capture, identify, and describe the patterns of longitudinal risk communication from public health communicating agencies on Twitter during the first 60 days of the response to the novel coronavirus disease 2019 (COVID-19) pandemic. We collected 138,546 tweets from 696 targeted accounts from February 1 to March 31, 2020, employing term frequency-inverse document frequency to identify keyword hashtags that were distinctive on each day. Our team conducted inductive content analysis to identify emergent themes that characterize shifts in public health risk communication efforts. As a result, we found 7 distinct periods of communication in the first 60 days of the pandemic, each characterized by a differing emphasis on communicating information, individual and collection action, sustaining motivation, and setting social norms. We found that longitudinal risk communication in response to the COVID-19 pandemic shifted as secondary threats arose, while continuing to promote pro-social activities to reduce impact on vulnerable populations. Identifying patterns of risk communication longitudinally allows public health communicators to observe changes in topics and priorities. Observations from the first 60 days of the COVID-19 pandemic prefigures ongoing messaging needs for this event and for future disease outbreaks.

Public perceptions, anxiety and the perceived efficacy of health-protective behaviours to mitigate the spread of the SARS-Cov-2/ COVID-19 pandemic

Objectives

Data relating to the novel coronavirus disease 2019 (COVID-19) in the Middle East remains sparse. This study examines the public's perceptions of the pandemic, assesses the extent to which participants have adhered to a range of recommended health-protective behaviours to prevent infection and evaluates whether anxiety about COVID-19 or perceptions related to the pandemic are associated with greater adherence to these behaviours.

Study design

A cross-sectional, survey-based design was used. Data were collected using an electronic survey distributed to students, staff and faculty at universities in the three major cities of the United Arab Emirates, Abu Dhabi, Al Ain and Dubai, between the 23rd and 31st of April 2020. A total of 634 participants were included in the analysis.

Methods

Participants reported whether they had adhered to health-protective behaviours such as spatial distancing, increased hygiene and disinfection and diminished time spent outside their homes. They also reported the perceived efficacy of a range of behaviours aimed at reducing risk for contracting COVID-19. Data relating to perception of risk, negative consequences of contracting the disease, perceived longevity of the illness and perceptions of the accuracy of the information read about COVID-19 were collected. Anxiety related to COVID-19 was also assessed, as well as a range of demographic variables. Binary logistic regressions were used to examine whether the demographic variables, perceived efficacy ratings and the perception variables were associated with overall adherence.

Results

A total of 44.8% of the sample reported adherence to all the examined behaviours. Participants who were employed, those with some or completed postsecondary education and those with a chronic illness diagnosis were more likely to adhere to the precautionary behaviours. The perception of personal risk of infection (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.71–0.98), perception of substantial life consequences of becoming infected (OR: 0.87, 95% CI: 0.75–0.10) and the perception that the public health information was clear (OR: 0.69, 95% CI: 0.57–0.83) were all positively related with behavioural adherence. The health-protective behaviours were all perceived as being highly efficacious in combating infection, and these efficacy ratings were also positively associated with greater behavioural adherence (OR: 0.41–0.77). Having read the official government public health information was related to greater behavioural adherence (OR: 0.37, 95% CI: 0.23–0.61).

Conclusions

Dissemination of reliable public health information during a public health crisis is essential. This study's results highlight the importance of providing the public with information that is clear and consistent and, moreover, emphasises the efficacy of the recommended behaviours as this is likely to improve adherence. When individuals perceive themselves to be at personal risk and are aware of the severity of the consequences posed by the illness, they are more likely to adopt caution. However, in this sample, the trustworthiness of the information portrayed in the media and the perceived duration of the pandemic – whether this would resolve soon or persist well into the future – did not impact adherence.

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There was widespread adherence to health-protective behaviours in response to COVID-19.

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If participants believed that a particular behaviour would be efficacious, they were more likely to employ it.

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Anxiety about COVID-19 was highly prevalent but unrelated to behavioural adherence.

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Participants who had read the government's public health information exhibited greater adherence.

Public Behavior Change, Perceptions, Depression, and Anxiety in Relation to the COVID-19 Outbreak

Background

COVID-19 has spread rapidly and internationally, which has elicited public panic and psychological problems. Public protective behaviors and perception play crucial roles in controlling the spread of illness and psychological status.

Methods

We conducted a cross-sectional online survey in the hardest-hit Hubei province and other areas in China affected by the COVID-19 outbreak. Questions about their basic information, the perception of the COVID-19 outbreak, recent preventive or avoidance behaviors, and self-reported mental health scales including the Patient Health Questionnaire and Self-Rating Anxiety Scale were included. Binary logistic regressions were used to investigate the association between personal variables/perceptions and psychological distress.

Results

A total of 6261 people were included in the analysis, with 3613 (57.7%) in Hubei province (1743 in Wuhan). The majority of people have adopted preventive and avoidance behaviors. People from Hubei, with contact history, and people who were infected or whose family members were infected had a much higher prevalence of depression and anxiety. Providing truthful and sufficient information, informing the public about the severity of the disease, and perceptions that the outbreak can be controlled by protective behaviors were associated with lower prevalence of depression and anxiety.

Conclusions

Assessing the public response, perception, and psychological burden during the outbreak may help improve public health recommendations and deliver timely psychological intervention. Further research may focus on the psychological status of a specialized group to identify methods of delivery of better support based on public response and psychological demand.

Psychological Effects and Associated Factors of COVID-19 in a Mexican Sample

OBJECTIVES

The coronavirus disease 2019 (COVID 19) is a new viral zoonosis of global concern that could cause psychological sequelae. We examined the levels of psychological distress, anxiety, depression, and stress during the COVID-19 outbreak in a Mexican sample.

METHODS

An online survey was applied that collected information on demographic and financial status data, physical status, contact history, knowledge, concerns, and precautionary measures concerning COVID-19. Impact of Event Scale-Revised and Depression, Anxiety, and Stress Scale were included.

RESULTS

A total of 50.3% of respondents rated psychological distress as moderate-severe; 15.7% reported moderate-severe depressive symptoms; 22.6% reported moderate-severe anxiety symptoms; and 19.8% reported moderate-severe stress levels. Female gender, older age, divorced status, lack of confidence related to security of the test, lower satisfaction of health information concerning COVID-19, history of direct or indirect contact with a COVID-19 confirmed case, live with just 1 other person, and spent >9 h/d at home were associated with greater psychological distress and/or higher levels of stress, anxiety, and depression. By contrast, precautionary measures, such as hand hygiene and wearing masks, were associated with lower levels of psychological distress, depression, anxiety, and stress.

CONCLUSIONS

COVID-19 outbreak results in considerable psychological effects among the Mexican sample.

Communicating with the Public About Marauding Terrorist Firearms Attacks: Results from a Survey Experiment on Factors Influencing Intention to "Run, Hide, Tell" in the United Kingdom and Denmark

Effective risk communication is an integral part of responding to terrorism, but until recently, there has been very little pre-event communication in a European context to provide advice to the public on how to protect themselves during an attack. Following terrorist attacks involving mass shootings in Paris, France, in November 2015, the U.K. National Police Chiefs' Council released a Stay Safe film and leaflet that advises the public to "run," "hide," and "tell" in the event of a firearms or weapons attack. However, other countries, including Denmark, do not provide preparedness information of this kind, in large part because of concern about scaring the public. In this survey experiment, 3,003 U.K. and Danish participants were randomly assigned to one of three conditions: no information, a leaflet intervention, and a film intervention to examine the impact of "Run, Hide, Tell" advice on perceptions about terrorism, the security services, and intended responses to a hypothetical terrorist firearms attack. Results demonstrate important benefits of pre-event communication in relation to enhancing trust, encouraging protective health behaviors, and discouraging potentially dangerous actions. However, these findings also suggest that future communications should address perceived response costs and target specific problem behaviors. Cross-national similarities in response suggest this advice is suitable for adaptation in other countries.

A Conceptual Model for Evaluating Emergency Risk Communication in Public Health

Public health threats, such as emerging infectious diseases, terrorism, environmental catastrophes, and natural disasters, all require effective communication. Emergency risk communication is a critical component of public health emergency planning and response. It is a complex process involving a variety of constructs that interact in dynamic ways over time. While emergency risk communication is generally recognized as an important tool for risk management and emergency response, the specific elements, processes, and outcomes are not well described and have not been systematically assessed. In this article, we describe a conceptual model for public health developed in collaboration with the Centers for Disease Control and Prevention (CDC). We propose using this model to inform practice and to guide evaluations of emergency risk communication. The model was informed by an extensive review of the emergency risk communication literature, interviews with researchers, and discussions with CDC stakeholders. This model can be adapted for a wide range of emergency events and incorporates key constructs to assess internal processes, as well as outcomes of emergency risk communication on audiences. Evaluating internal processes can help identify and correct messaging deficiencies. Outcome constructs describe expected target audience responses to emergency risk communication, such as changes in knowledge, attitudes, beliefs, and behaviors that may occur over time. This can help public health communicators learn how their various activities contribute to emergency risk communication outcomes.

Delivering risk information in a dynamic information environment: Framing and authoritative voice in Centers for Disease Control (CDC) and primetime broadcast news media communications during the 2014 Ebola outbreak

Objective

During a disease outbreak, media serve as primary transmitters of information from public health agencies to the public, and have been shown to influence both behavior and perception of risk. Differences in news frequency, framing and information source can impact the public's interpretation of risk messages and subsequent attitudes and behaviors about a particular threat. The media's framing of an outbreak is important, as it may affect both perception of risk and the ability to process important health information.

Methods

To understand how risk communication by the Centers for Disease Control and Prevention (CDC) during the 2014 Ebola outbreak was framed and delivered and to what extent primetime broadcast news media mirrored CDC's framing and authoritative voice, 209 CDC communications and primetime broadcast transcripts issued between July 24 and December 29, 2014 were analyzed and coded by thematic frame and authoritative voice. Dominant frame and voice were determined for each month and for overall period of analysis.

Results

Medical frame was dominant in CDC (60%), Anderson Cooper 360 (49%), The Rachel Maddow Show (47%) and All In with Chris Hayes (47%). The human interest frame was dominant in The Kelly File (45%), while The O'Reilly Factor coverage was equally split between sociopolitical and medical frames (28%, respectively). Primetime news media also changed dominant frames over time. Dominant authoritative voice in CDC communications was that of CDC officials, while primetime news dominantly featured local and federal (non-CDC) government officials and academic/medical experts.

Conclusion

Differences in framing and delivery could have led the public to interpret risk in a different way than intended by CDC. Overall, public health agencies should consider adapting risk communication strategies to account for a dynamic news environment and the media's agenda. Options include adapting communications to short-form styles and embracing the concept of storytelling.

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Analyzes frames in CDC's primetime news risk communications during Ebola outbreak.

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CDC consistently used medical frames and “CDC official” voices.

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Primetime news predominantly used human interest, sociopolitical, and medical frames.

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Primetime news dominantly used local/federal officials, academic/medical experts.

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Framing differences could impact risk perception, attitudes, and subsequent behaviors.

How Do Low-Literacy Populations Perceive "Dirty Bombs"? Implications for Preparedness Messages

Potential terror events such as "dirty bombs" could have significant public health effects, but little is known about how low-literacy populations perceive dirty bombs, their trust in public health or government officials to provide credible information, and their willingness to comply with recommended actions. We surveyed 50 low-literacy adults from a large urban center; they were mostly members of ethnic minority groups. We used unique social marketing methods-perceptual mapping and vector message modeling-to create 3-dimensional models that reflected respondents' knowledge of what a dirty bomb is, their intended behaviors should one occur, and their concerns about complying with "shelter in place" recommendations. To further understand individual variations in this at-risk group, a k-means cluster analysis was used to identify 3 distinct segments, differing on trust of local authorities and their emergency response, willingness to comply with emergency directives, and trust of information sources. Message strategies targeting each segment were developed to focus on concepts important to moving the groups toward a "shelter in place" behavior, revealing key differences in how best to communicate with risk communication. We discuss how these methods helped elucidate specific differences in each segment's understanding of and likely response during the event of a "dirty bomb" and how these techniques can be used to create more effective message strategies targeted to these groups.

Behavioral Recommendations in Health Research News as Cues to Action: Self-Relevancy and Self-Efficacy Processes

This study argues that behavioral recommendations in health news function as cues to action. A proposed self-oriented model seeks to explore the impacts of behavioral recommendations in health research news as cues to action through their influences on self-relevancy and self-efficacy. A content analysis (Study 1) first establishes that health research news commonly features behavioral recommendations. A message experiment (Study 2) then explores the utility of behavioral recommendations as cues to action by demonstrating a self-relevancy effect: Health research news with, as opposed to without, behavioral recommendations increases the self-relevancy of advocated health behaviors, which then improve people's attitudes toward and intentions to adopt those behaviors. A second message experiment (Study 3) tests whether varying presentations of behavioral recommendations alter their effectiveness as cues to action and thus people's behavioral intentions through a dual effect process. In addition to the previously demonstrated self-relevancy effect, this experiment shows that concrete, as opposed to abstract, behavioral recommendations trigger a self-efficacy effect, increasing perceived self-efficacy and further improving behavioral intentions.

Perceptions on the risk communication strategy during the 2013 avian influenza A/H7N9 outbreak in humans in China: a focus group study

Objective

To identify the general public’s perceptions of the overall risk communication strategy carried out by Chinese public health agencies during the first wave of avian influenza A(H7N9) outbreak in humans in 2013.

Methods

Participants were recruited from communities in Beijing, Lanzhou and Hangzhou, China in May and June 2013 by convenience sampling. Demographics and other relevant information were collected using a self-administered questionnaire. Focus group interviews were conducted using a set of nine pre-developed questions and a tested moderator guide. The interviews were audio recorded and were transcribed verbatim. The constant comparative method was used to identify trends and themes.

Results

A total of nine focus group interviews, with 94 participants recruited from nine communities, were conducted. Most participants received H7N9 information via television and the Internet. Most the participants appreciated the transparency and timeliness of the information released by the government. They expressed a sense of trust in the recommended public health advice and followed most of them. The participants suggested that the government release more information about clinical treatment outcomes, have more specific health recommendations that are practical to their settings and expand the use of new media channels for risk communication.

Conclusion

The public perceived the overall risk communication strategy by the Chinese public health agencies as effective, though the moderator had a governmental agency title that might have biased the results. There is a need to expand the use of social media for risk communication in the future.

Using eye tracking and gaze pattern analysis to test a "dirty bomb" decision aid in a pilot RCT in urban adults with limited literacy

Background

Eye tracking is commonly used in marketing to understand complex responses to materials, but has not been used to understand how low-literacy adults access health information or its relationship to decision making.

Methods

This study assessed how participants use a literacy appropriate “dirty bomb” decision aid. Participants were randomized to receive a CDC “factsheet” (n = 21) or literacy-appropriate aid (n = 29) shown on a computer screen. Using 7 content similar slides, gaze patterns, mean pupil fixation time and mean overall time reading and looking at slides were compared. Groups were also compared by literacy level and effect on 'confidence of knowledge' and intended behavior.

Results

Results revealed differing abilities to read densely written material. Intervention participants more precisely followed text on 4 of 7 content-similar slides compared to control participants whose gaze patterns indicated unread text, or repeated attempts at reading the same text, suggesting difficulty in understanding key preparedness messages. Controls had significantly longer pupil fixations on 5 of 7 slides and spent more overall time on every slide. In those with very low literacy, intervention participants were more likely than controls to say they understood what a “dirty bomb” is and how to respond if one should occur.

Conclusions

Results indicate limited- literacy adults, especially those with very low literacy, may not be able to understand how to respond during a “dirty bomb” using available materials, making them vulnerable to negative health events. This study provides insights into how individuals perceive and process risk communication messages, illustrating a rich and nuanced understanding of the qualitative experience of a limited literacy population with written materials. It also demonstrates the feasibility of using these methods on a wider scale to develop more effective health and risk communication messages designed to increase knowledge of and compliance with general health guidelines, and enhance decision making. This has application for those with learning disabilities, those with limited media-literacy skills, and those needing to access the diverse array of assistive technologies now available. Eye tracking is thus a practical approach to understanding these diverse needs to ensure the development of cogent and salient communication.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-016-0304-5) contains supplementary material, which is available to authorized users.

What do we know about health-related knowledge translation in the Circumpolar North? Results from a scoping review

BACKGROUND

Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations.

OBJECTIVES

To examine the extent, range and nature of literature about health-related KT in Inuit communities.

DESIGN

A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges.

RESULTS

From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action.

CONCLUSIONS

This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.

Perceptions and plans for prevention of Ebola: results from a national survey

Background

Literature suggests that Americans may have higher levels of perceived threat to Ebola than are warranted.

Methods

We surveyed 1018 U.S. adults from a nationally representative Internet panel about their knowledge, perceived threat, and behavioral intentions during the 2014 Ebola outbreak.

Results

Eighty-six percent of respondents knew that Ebola could be transmitted through blood and bodily fluids. However, a large percentage had some inaccurate knowledge and 19 % believed Ebola would spread to the U.S. Respondents favored mandatory quarantine (63 %) and travel bans (55 %). Confidence in the ability of the media and government to accurately report on or prevent a U.S. epidemic was low. Fifty-two percent intended to engage in behaviors such as avoiding public transportation.

Discussion

Despite low perceived susceptibility, half intended to engage in behaviors to prevent transmission and large numbers favored policies not currently recommended by health officials. The extreme nature of Ebola virus likely motivated people to engage in behaviors and favor policies that were not necessary given the low risk of transmission in the U.S.

Conclusions

Health officials should ensure the public has accurate information about Ebola and bolster confidence in the government’s ability to control infectious diseases in case of a future outbreak in the U.S.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2441-7) contains supplementary material, which is available to authorized users.

Who is sceptical about emerging public health threats? Results from 39 national surveys in the United Kingdom

Objectives

Members of the public are often sceptical about warnings of an impending public health crisis. Breaking through this scepticism is important if we are to convince people to take urgent protective action. In this paper we explored correlates of perceiving that ‘too much fuss’ was being made about the 2009/10 influenza A H1N1v (‘swine flu’) pandemic.

Study design

A secondary analysis of data from 39 nationally representative telephone surveys conducted in the UK during the pandemic.

Methods

Each cross-sectional survey (combined n = 42,420) collected data over a three day period and asked participants to state whether they agreed or disagreed that ‘too much fuss is being made about the risk of swine flu.’

Results

Overall, 55.1% of people agreed or strongly agreed with this sentiment. Perceiving that too much fuss was being made was associated with: being male, being white, being generally healthy, trusting most in a primary care physician to provide advice, not knowing someone who had contracted the illness, believing you know a lot about the outbreak, not wishing to receive additional information about the outbreak and possessing worse factual knowledge about the outbreak than other people.

Conclusions

In future disease outbreaks merely providing factual information is unlikely to engage people who are sceptical about the need to take action. Instead, messages which challenge their perceived knowledge and which present case studies of people who have been affected may prove more effective, especially when delivered through trusted channels.

•

Data from 39 UK telephone surveys conducted during the ‘swine flu’ pandemic were analysed (n = 42,420).

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Scepticism was assessed by asking whether participants agreed that ‘too much fuss is being made about the risk of swine flu.’

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Around half of respondents were sceptical about the risk of swine flu (55.1%).

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Scepticism was associated with being white, healthy and male, and having high subjective knowledge about the outbreak.

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Challenging perceived knowledge may improve communication with sceptical groups in future.

Middle East respiratory syndrome: knowledge to date

OBJECTIVE

To provide a conceptual and clinical review of Middle East respiratory syndrome.

DATA SOURCES

Peer-reviewed articles were identified through searches of PubMed using the terms "Middle East respiratory syndrome," "coronavirus respiratory illness in Saudi Arabia," and "novel (beta) coronavirus and human coronavirus Erasmus Medical Center". In addition, articles were searched on the websites of the World Health Organization and the U.S. Centers for Disease Control and Prevention using the terms "Middle East respiratory syndrome" and "novel coronavirus in Middle East." The reference lists of these articles and relevant review articles were also reviewed.

STUDY SELECTION AND DATA EXTRACTION

Final references were selected for inclusion in the review on the basis of their relevance.

DATA SYNTHESIS

The emerging Middle East respiratory syndrome coronavirus causes severe pulmonary disease with multiorgan involvement and a high fatality rate. Within months after its emergence, Middle East respiratory syndrome coronavirus was reported in several countries worldwide in people who had traveled from the Middle East. Middle East respiratory syndrome coronavirus is considered a zoonotic virus that has crossed the species barrier to humans, but the pathogenesis and the routes of transmission are not completely understood. There is currently no recommended treatment for Middle East respiratory syndrome coronavirus, although supportive treatment has played an important role.

CONCLUSIONS

This syndrome has raised global public health concerns about the dissemination of an emerging infectious disease and highlights the need for a coordinated global response to contain such a disease threat.

Attitudes and perceptions of urban African Americans of a "dirty bomb" radiological terror event: results of a qualitative study and implications for effective risk communication

OBJECTIVES

Radiological terror presents a real threat, but little is known about how low-income, urban African Americans may respond to such threats. The aim of this study was to understand the unique challenges of this group and to explore their knowledge of what a "dirty bomb" is, their intended behaviors should one occur, and their barriers to complying with "shelter in place" recommendations.

METHODS

Thirty-seven 18-65-year-olds who were users of community centers in disadvantaged areas participated in 3 focus groups in Philadelphia. Results were analyzed by using the Krueger method of analyzing narrative text.

RESULTS

The responses highlighted little knowledge or concern about a dirty bomb. Lack of trust in local authorities was expressed, with participants indicating that they did not feel their needs were addressed. While shelter in place was understood, most said they would still check on family or talk with others to get the "whole truth" because the most trusted information sources were neighbors and community leaders.

CONCLUSION

Our results indicate that a risk communication intervention for urban minorities may support desirable behaviors in the event of a dirty bomb, but successful communication will require establishing a local leader as a spokesperson to convince people of the importance of sheltering in place.

Reliability and validity of the Assessment for Disaster Engagement with Partners Tool (ADEPT) for local health departments

OBJECTIVE

This study presents reliability and validity findings for the Assessment for Disaster Engagement with Partners Tool (ADEPT), an instrument that can be used to monitor the frequency and nature of collaborative activities between local health departments (LHDs) and community-based organizations (CBOs) and faith-based organizations (FBOs) for disaster preparedness, response, and recovery.

METHODS

We used formative research to develop the instrument by ranking LHDs according to their disaster outreach and engagement activities. We validated the scale through a 2011 national survey of disaster preparedness coordinators (n=273) working in LHDs. We reduced the original measure of 25 items to a final measure comprising 15 items with four dimensions: (1) communication outreach and coordination, (2) resource mobilization, (3) organizational capacity building, and (4) partnership development and maintenance. We used internal consistency reliability m correlation and factor analysis to validate the measure.

RESULTS

Using internal consistency reliability, we found reasonable inter-item reliability for the four hypothesized dimensions (Cronbach's alpha: 0.71-0.88). These four dimensions were confirmed through correlation and factor analysis (Varimax rotation).

CONCLUSION

Higher scores on all four dimensions of ADEPT for organizational respondents suggest that more activities were conducted for inter-organizational preparedness in those organizations than in organizations whose respondents had lower scores. This finding implies that organizations with higher ADEPT scores have more active relationships with CBOs/FBOs in the realm of preparedness, a key element for creating community resilience for emergencies and disaster preparedness.

Communicating public health advice after a chemical spill: results from national surveys in the United Kingdom and Poland

OBJECTIVE

The aim of this study was to enhance public health preparedness for incidents that involve the large-scale release of a hazardous substance by examining factors likely to influence public responses to official guidance on how to limit their exposure.

METHODS

An online demographically representative survey was conducted in the United Kingdom (n = 601) and Poland (n = 602) to test the strength of association of trust in authorities, anxiety, threat, and coping appraisals with the intention to comply with advice to shelter in place following a hypothetical chemical spill. The impact of ease of compliance and style of message presentation were also examined.

RESULTS

Participants were more likely to comply if at home when the incident happened, but message presentation had little impact. Coping appraisals and trust were key predictors of compliance, but threat appraisals were associated with noncompliance. Anxiety was seen to promote behavioral change. UK participants were more likely to comply than Polish participants.

CONCLUSIONS

Successful crisis communications during an emergency should aim to influence perceptions regarding the efficacy of recommended behaviors, the difficulties people may have in following advice, and perceptions about the cost of following recommended behaviors. Generic principles of crisis communication may need adaptation for national contexts.

Twitter in the cross fire--the use of social media in the Westgate Mall terror attack in Kenya

On September 2013 an attack on the Westgate mall in Kenya led to a four day siege, resulting in 67 fatalities and 175 wounded. During the crisis, Twitter became a crucial channel of communication between the government, emergency responders and the public, facilitating the emergency management of the event. The objectives of this paper are to present the main activities, use patterns and lessons learned from the use of the social media in the crisis. Using TwitterMate, a system developed to collect, store and analyze tweets, the main hashtags generated by the crowd and specific Twitter accounts of individuals, emergency responders and NGOs, were followed throughout the four day siege. A total of 67,849 tweets were collected and analyzed. Four main categories of hashtags were identified: geographical locations, terror attack, social support and organizations. The abundance of Twitter accounts providing official information made it difficult to synchronize and follow the flow of information. Many organizations posted simultaneously, by their manager and by the organization itself. Creating situational awareness was facilitated by information tweeted by the public. Threat assessment was updated through the information posted on social media. Security breaches led to the relay of sensitive data. At times, misinformation was only corrected after two days. Social media offer an accessible, widely available means for a bi-directional flow of information between the public and the authorities. In the crisis, all emergency responders used and leveraged social media networks for communicating both with the public and among themselves. A standard operating procedure should be developed to enable multiple responders to monitor, synchronize and integrate their social media feeds during emergencies. This will lead to better utilization and optimization of social media resources during crises, providing clear guidelines for communications and a hierarchy for dispersing information to the public and among responding organizations.

The swine flu emergency department: the relationship between media attention for the swine flu and registrations in an emergency medicine unit

INTRODUCTION

When the world is faced with a new potential pandemic outbreak, the media report heavily about it. Media are an important disseminator of health threat information. This study examined potential media effects during the 2009 outbreak of A/H1N1 influenza.

HYPOTHESIS

To examine the relationship between media reports of the swine flu and self-registrations in an emergency department (ED) of a tertiary hospital in Flanders, Belgium.

METHODS

All articles concerning swine flu published in seven Flemish newspapers were selected during the biggest flu peak in Belgium. This number was compared with the number of patients who presented themselves with a self-diagnosis of swine flu symptoms during the same time frame. The Pearson's correlation coefficient was selected to determine the relationship. The cross-correlation function determined the direction of this relationship.

RESULTS

A strong correlation was found between the number of potential patients (n = 308) and the number of articles in the Flemish press (n = 1657). The number of patients was the leading indicator; increases in the volume of written press followed increases in the number of patients.

CONCLUSION

Media reporting is extensive when a new infectious disease breaks out and intensifies when it is feared that pandemic levels are reached. This was also the case with the swine flu outbreak in Flanders. These findings suggest that a rise in the number of media reports follows a rise in the number of cases, rather than the reverse.

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.

Intention to engage in preventive behaviors in response to the A/H1N1 pandemic among university entrants in four Chinese cities

This study examined the factors influencing the uptake of A/H1N1-related preventive behaviors among Chinese university students. During the 2009 A/H1N1 pandemic, a survey was administered to 2882 university students across 4 Chinese cities. We found greater self-efficacy and a stronger belief in the benefits of preventive behaviors to be associated with the intended adoption of preventive behaviors. However, knowledge about the transmission of A/H1N1 was not associated with the intent to engage in preventive behaviors. These results may be used to inform pandemic prevention campaigns for university students in the region.

Factors Associated With H1N1 Influenza Vaccine Receipt in a High-Risk Population During the 2009-2010 H1N1 Influenza Pandemic

BACKGROUND

Persons with spinal cord injuries and disorders (SCI/D) are at high risk for respiratory complications from influenza. During pandemic situations, where resources may be scarce, uncertainties may arise in veterans with SCI/D.

OBJECTIVE

To describe concerns, knowledge, and perceptions of information received during the 2009-2010 H1N1 influenza pandemic and to examine variables associated with H1N1 vaccine receipt.

METHODS

In August 2010, a cross-sectional survey was mailed to a national sample of veterans with traumatic and nontraumatic SCI/D.

RESULTS

During the pandemic, 58% of veterans with SCI/D received the H1N1 vaccine. Less than two-thirds of non-H1N1 vaccine recipients indicated intentions to get the next season's influenza vaccine. Being ≥50 years of age and depressed were significantly associated with higher odds of H1N1 vaccination. Being worried about vaccine side effects was associated with lower odds of H1N1 receipt. Compared to individuals who reported receiving an adequate amount of information about the pandemic, those who received too little information had significantly lower odds of receiving the H1N1 vaccine. Those who received accurate/clear information (vs confusing/conflicting) had 2 times greater odds of H1N1 vaccine receipt.

CONCLUSIONS

H1N1 influenza vaccination was low in veterans with SCI/D. Of H1N1 vaccine nonrecipients, only 63% intend to get a seasonal vaccine next season. Providing an adequate amount of accurate and clear information is vital during uncertain times, as was demonstrated by the positive associations with H1N1 vaccination. Information-sharing efforts are needed, so that carry-over effects from the pandemic do not avert future healthy infection prevention behaviors.

Individual and community influences on adherence to directives in the event of a plague attack: survey results

OBJECTIVES

  During a public health emergency, public health officials issue directives with actions people need to take to protect themselves. Past research has shown that adherence to these directives depends on individual beliefs and circumstances. This report presents new research about the effects of community factors on adherence.

METHODS

  A random digit-dial survey of 936 residents in the St Louis, Missouri, area was conducted in 2008 to assess barriers to and facilitators of adherence to directives issued in response to a hypothetical scenario involving the intentional release of the bacterium that causes plague. Community factors were assessed using characteristics of census tracts for individual respondents. Multilevel modeling was used to understand how individual and community factors contributed to the likelihood of adherence.

RESULTS

  The majority of participants indicated that they would adhere to 3 distinct directives. Community poverty and ethnic homogeneity as well as individual-level barriers were negatively associated with adherence to a 6-day quarantine. Having children younger than 18 years and being away from home when the directive was called were negatively associated with adherence to a 10-hour quarantine. Logistical concerns were negatively associated with visiting a point of dispensing for prophylactic antibiotics.

CONCLUSIONS

  Our findings establish an empirical basis for the influence of community factors on adherence to public health directives. The influence of community and individual factors on adherence varies across directives. Consequently, communication strategies to disseminate directives and organizational strategies to support them must vary according to the nature of the directives.

The impact of communication materials on public responses to a radiological dispersal device (RDD) attack

It is a common assumption that, in the event of a chemical, biological, radiological, or nuclear (CBRN) attack, a well-prepared and informed public is more likely to follow official recommendations regarding the appropriate safety measures to take. We present findings from a UK study investigating the ability of crisis communication to influence perceptions of risk and behavioral intentions in the general public in response to CBRN terrorism. We conducted a focus group study involving a scenario presented in mock news broadcasts to explore levels of public knowledge, information needs, and intended behavioral reactions to an attack involving an overt radiological dispersal device (RDD), or dirty bomb. We used the findings from these focus groups to design messages for the public that could be presented in a short leaflet. We then tested the effects of the leaflet on reactions to the same scenario in 8 further focus groups. The impact of the new messages on levels of knowledge, information needs, and intended compliance with official recommendations was assessed. The provision of information increased the perceived credibility of official messages and increased reported levels of intended compliance with advice to return to normal/stop sheltering, attend a facility for assessment and treatment, and return to a previously contaminated area after decontamination of the environment has taken place. Should a real attack with an RDD occur, having pretested messages available to address common concerns and information needs should facilitate the public health response to the attack.