Effective health risk communication about pandemic influenza for vulnerable populations

Defining vulnerabilities and enabling community engagement in epidemics preparedness: the CAVE model from Austria

During the COVID-19 outbreak the transdisciplinary research project CAVE (Community Engagement and Vulnerability Assessment in Epidemics) investigated perceptions and practicability of public health communication among stakeholders of care and social facilities in Austria. It aimed at finding accurate definitions of vulnerability in the context of epidemics and at developing operational models for engagement of vulnerable groups in co-creating epidemic response mechanisms. Transdisciplinary methods included semi-structured interviews, focus group discussions, and desk reviews as well as spatial analysis and composite indicator-based mapping methods. Informants and participants in the community engagement phase represented clients as well as middle and lower management levels of Austrian care and social facilities for older persons and persons with cognitive impairments, persons depending on mobile healthcare services, homeless people, and socially deprived communities. A narrow definition of vulnerability as well as missing strategies for participation and community engagement limited communication with stakeholders and the implementation of protective measures. An inclusive definition of vulnerability beyond medical and physical indicators should be employed to account for social, psychological, and emotional aspects contributing to a higher risk of being affected by epidemics. The CAVE model provides a multi-level definition of vulnerability that allows for participatory engagement in co-creating adapted crisis response measures. We suggest policymakers and health authorities to consider a broader definition of vulnerability and to commit to pro-active engagement with stakeholders representing these sectors. This requires the establishment and maintenance of communication structures as well as political recognition of civic participation in the creation and implementation of epidemic response measures.

Factors Impacting COVID-19 Vaccine Uptake and Confidence Among Immigrant and Refugee Populations in Canada

OBJECTIVE

This study examines the barriers and facilitators to COVID-19 vaccination among immigrant and refugee populations, with a focus on informing primary healthcare stakeholders on effective strategies to address the health needs of these groups. Although conducted in Canada, the findings are relevant to countries facing similar challenges in promoting vaccine uptake among migrant communities.

METHODS

As part of an evaluation of best practices in COVID-19 vaccination promotion and provision, data were collected using in-depth key informant interviews with a cross-section of primary care stakeholders (n = 11).

MAIN FINDINGS

Key barriers to vaccine promotion and provision included distrust of health and government services, misinformation, lack of vaccine confidence, and access or systems-level barriers. Effective facilitators were relationship-building and equity-driven approaches, such as community engagement and development, culturally and linguistically effective communication, one-on-one supports, and collaboration with community members as valued partners and staff. These strategies were identified as best practices that enhanced vaccine confidence and uptake.

CONCLUSION

The risk and impacts of COVID-19 are disproportionately distributed worldwide, affecting migrant populations in many countries. Primary healthcare stakeholders must understand the barriers and facilitators to vaccine promotion to effectively address health inequalities. Increasing vaccine uptake and confidence among immigrant and refugee populations requires targeted and tailored approaches that are culturally responsive and equity-informed. These findings provide valuable insights for health systems globally, supporting efforts to reduce health inequities by using inclusive vaccination strategies.

Diphtheria Outbreak among Persons Experiencing Homelessness, 2023, Linked to 2022 Diphtheria Outbreak, Frankfurt am Main, Germany

After 3 cases of Corynebacterium diphtheriae infection associated with intravenous drug use among persons experiencing homelessness (PEH) were reported to the Health Protection Authority in Frankfurt am Main, Germany, in 2023, we examined pathogen spread among PEH. Furthermore, we investigated a possible link with the 2022 outbreak of diphtheria in Europe. From swab samples collected during August-November 2023 from 36 PEH and cutaneous lesions, we detected 3 additional cases of cutaneous toxigenic C. diphtheriae. Sequence type 574 was identified in 5 case-isolates and is genetically associated with 1 of the predominant clusters in identified in the 2022 outbreak. Our findings demonstrate the need for increased detection and monitoring of cutaneous diphtheria and boosting immunity against diphtheria in groups with increased risk for infection. Genomic analyses are valuable for identifying genetic relationships between outbreaks, even when epidemiologic data are scarce.

The impact of health risk communication on self-perceived health and worry of targeted groups: Lessons from the Swedish COVID-19 response

BACKGROUND

The Swedish COVID-19 strategy aimed to protect vulnerable groups through targeted measures, categorizing individuals aged 70 and above as high-risk. This study examines the impact of such group-based risk assessments on subjective health and virus-related concerns among older adults.

METHODS

We analyzed survey data from the SOM Institute for 68- to 71-year-olds in 2019 (N = 684) and 2020 (N = 726). Using ordered logit regression, we compared perceived health and virus-related concerns between individuals just below (68-69 years) and just above (70-71 years) the high-risk age threshold, controlling for demographic factors.

RESULTS

In 2020, 70-year-olds reported significantly lower perceived health compared to their 69-year-old peers, a difference not observed in 2019. Furthermore, 70-year-olds exhibited significantly higher virus-related concerns than their slightly younger counterparts. These patterns persisted when expanding the analysis to include individuals aged 68 and 71.

CONCLUSION

Our findings suggest that the Swedish COVID-19 strategy, while aimed at protecting individuals aged 70 and over, may have inadvertently increased perceived vulnerability and health concerns within this group. Conversely, those just below the high-risk age threshold reported better health and lower virus-related concerns, highlighting potential unintended psychological consequences of age-based risk communication.

Psychological entitlement and conspiracy beliefs: evidence from the COVID-19 pandemic

Psychological entitlement describes the dispositional tendency to claim excessive and unearned rewards and resources, and to demand undeserved special treatment. In one experiment, one cross-sectional survey, and one time-separated survey (total n = 721), we show that psychological entitlement is associated with general conspiracy theory endorsement, COVID-19 specific conspiracy theory endorsement, and conspiracy theorizing as an overarching cognitive style. We find those high in entitlement are more likely to report having made discretionary visits to non-essential venues and services (e.g. buffets, spas, casinos) during the pandemic, and that these risky public health behaviors are mediated through beliefs in conspiracy theories. We identify consequences for public health behavior and conclude with a research agenda for better understanding the underlying mechanisms linking entitlement and conspiracy beliefs.

Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design

BACKGROUND

Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited.

OBJECTIVE

This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication.

METHODS

Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression.

RESULTS

Age had a negative effect on both perceived and objective comprehension-age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87).

CONCLUSIONS

The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed).

Beyond COVID: towards a transdisciplinary synthesis for understanding responses and developing pandemic preparedness in Alaska

Pandemics are regularly occurring events, and there are foundational principles of pandemic preparation upon which communities, regions, states, and nations may draw upon for elevated preparedness against an inevitable future infectious disease threat. Many disciplines within the social sciences can provide crucial insight and transdisciplinary thinking for the development of preparedness measures. In 2023, the National Science Foundation funded a conference of circumpolar researchers and Indigenous partners to reflect on COVID-19-related research. In this article, we synthesise our diverse social science perspectives to: (1) identify potential areas of future pandemic-related research in Alaska, and (2) pose new research questions that elevate the needs of Alaska and its people, pursuant of a specific body of pandemic knowledge that takes into account the ecological and sociocultural contexts of the region. In doing so, we highlight important domains of research in the social sciences from transdisciplinary perspectives, including the centering of Indigenous knowledges and needs, the contexts of risk perception and resilience, food and housing security, and more. We highlight the contributions of social sciences to pandemic knowledge and provide a foundation for future pandemic-related research in Alaska.

Risk perception and reappraisal during the COVID-19 pandemic in southeast Alaska: Self-identified determinants of risk and protective health behaviors

Social and cultural context shapes how communities perceive health, well-being, and risk. Risk reappraisal can occur over time as a product of new information and improved understanding. We investigate risk perception and protective behaviors in Lingít Aaní (Southeast Alaska) during the first year of the COVID-19 pandemic. Surveys were circulated at two time points: (1) April-June 2020, before COVID-19 reached epidemic levels in the region, and (2) November 2020-February 2021. Ordinary least squares (OLS) regression models were used to analyze how demographic characteristics of the respondent population were related to risk perception. OLS models were again used to predict how individuals engaged in protective behaviors while controlling for risk perceptions. Controlling for demographic characteristics, risk perception increased as age increased for perceived risk of getting sick and dying from COVID-19, males perceived lower risk in general for all tested variables, and Alaska Native respondents perceived higher risk than non-Alaska Native respondents. Controlling for risk perception, results for protective behaviors were mixed; however, the strongest association identified was that knowing someone with a positive COVID-19 diagnosis increased protective behaviors. Between the two time points, risk perceptions increased significantly for variables related to oneself, others, and community members becoming infected with COVID-19. Protective behaviors like traveling less than normal, buying more cleaning products, and engaging in more subsistence gathering significantly increased. Identifying patterns of risk perception and protective behaviors, and especially how they change over time, are critical to developing place-specific public health recommendations, action, and preparedness plans against future infectious threats.

College students in China during initial COVID-19 pandemic: Role of social media on attitudes toward preventive measures

Objective: To examine the direct and indirect associations (through risk perceptions) between college students' social media use and their perceived importance of COVID-19 preventive measures. Participants and Method: 1,353 undergraduate students in China completed an online survey in 2020 Spring. Results: Participants reported high reliance on social media for COVID-19 updates, which was positively associated with perceived importance of preventive measures. Information-oriented social media use was associated with higher perceived importance of preventive measures not only directly but also indirectly via increased cognitive and emotional risk perceptions. Social-oriented media use, on the other hand, had a negative direct association with perceived importance of preventive measure as well as a positive indirect association via emotional risk perception. Conclusions: This study shows that social media are important information sources for college students during the early stage of the pandemic and their response to the pandemic was related to social media use.

Inclusive Crisis Communication in a Pandemic Context: A Rapid Review

Background: Crisis communication might not reach non-native speakers or persons with low literacy levels, a low socio-economic status, and/or an auditory or visual impairments as easily as it would reach other citizens. The aim of this rapid review was to synthesize the evidence on strategies used to improve inclusive pandemic-related crisis communication in terms of form, channel, and outreach. Methods: After a comprehensive search and a rigorous screening and quality assessment exercise, twelve comparative studies were selected for inclusion in this review. Data were analyzed and represented by means of a structured reporting of available effects using narrative tables. Results: The findings indicate that a higher message frequency (on any channel) may lead to a lower recall rate, audio-visual productions and tailored messages prove to be valuable under certain conditions, and primary healthcare practitioners appear to be the most trusted source of information for most groups of citizens. Trust levels were higher for citizens who were notified in advance of potential exceptions to the rule in the effect of preventive and curative measures promoted. Conclusions: This review contributes to combatting information inequality by providing evidence on how to remove the sensorial, linguistic, cultural, and textual barriers experienced by minorities and other underserved target audiences in COVID-19-related governmental crisis communication in response to the societal, health-related costs of ineffective communication outreach.

Socioeconomic Impact and Response Strategies to the Multifaceted Respiratory Illness Outbreak in Northern China: Beyond Influenza A and Mycoplasma Pneumoniae

This study examines the socioeconomic and public health effects of a recent respiratory illness outbreak in northern China, focusing on Beijing following the lifting of coronavirus disease 2019 (COVID-19) restrictions. It analyzes the implications of increased influenza A (H3N2) and Mycoplasma pneumoniae cases on urban health systems and economic structures. This mixed-methods study integrated a review of academic and governmental literature, a quantitative analysis of public health data, and a qualitative assessment of response strategies. Findings indicate a significant increase in respiratory illnesses in late 2023, prompting a proactive response from health authorities that involved expanded hospital capacity and intensified surveillance. Challenges, including resource limitations and public health fatigue, persisted, affecting response efficacy. Effective outbreak management was achieved through immediate health responses, although the event highlighted the need for improved infrastructure, surveillance, and policy frameworks. Recommendations emphasize the importance of international collaboration and comprehensive preparedness plans to strengthen global health security for future epidemics.

Fighting Fire or Fighting War: Examining the Framing Effects of COVID-19 Metaphors

Metaphorical language describing the COVID-19 pandemic as a war has been pervasive in public discourse (e.g. "the pandemic is a war," "the virus is an enemy," and "the vaccine is a weapon"). This study employs an online survey experiment (N = 551 U.S. adults) to examine the impact of war metaphors compared to non-metaphorical literal frames and fire metaphors (e.g. "the pandemic is a wildfire"). War metaphors exhibited little advantage over literal frames across a variety of desirable outcomes (i.e. the adoption of pro-health behaviors against COVID-19, perceived solidarity and collective responsibility to curb the pandemic, and intentions to discuss and share the health news with others). However, this study revealed some benefits of war metaphors over fire metaphors. Compared with fire metaphors, health news featuring war metaphors increased both positive emotions and perceived threats of COVID-19, which in turn promoted pro-health behaviors against COVID-19 and perceived solidarity to cope with the public health crisis. Moreover, positive emotions in response to war metaphors also indirectly encouraged the retransmission of science-based COVID-19 health news. This study thus showcased the benefits and limitations of war metaphors and revealed the mediating roles of perceived threats and positive emotions in explaining war metaphorical framing effects. Implications of using war and fire metaphors for communicating about public health crises are also discussed.

Exploring the Singapore general population's trust in COVID-19 information from different sources and its association with perceived risk of infection during the pandemic

Background

The degree of public trust in the government's competence is crucial in preventing the spread of misinformation and reducing psychological distress during a pandemic. The study aimed to (i) explore the trust in COVID-19 information from different sources and trust in the ability of the World Health Organization (WHO), government departments and related institutions in handling the epidemic in Singapore and (ii) its association with perceived risk of infection among Singapore residents.

Methods

A total of 1,129 participants (aged 21 and above) were recruited from a cross-sectional study examining the well-being and resilience of Singapore's population between May 2020 to June 2021. Trust in COVID-19 information from different sources was measured on a 10-point scale and an ordinal 7-point scale was used for perceived risk of infection. Descriptive statistics and multivariate logistic regression model were conducted.

Results

85.5% reported high trust in COVID-19 information from the government and their ability in handling the pandemic. Participants also reported high trust in COVID-19 information from local public health or infectious disease experts (84.4%) and traditional media (77.2%). Low trust in the ability of government departments and related institutions was associated with higher future (1 month) perceived risk of infection (OR: 5.7, 95% CI 1.02-32.45) and low trust in social media was associated with higher current perceived risk of infection (OR: 2.4, 95% CI 1.09-5.24).

Discussion

The present study provided insight on the level of trust on COVID-19 information from different sources and its associated perceived risks of infection. Future qualitative studies are recommended to facilitate better understanding of public trust and identify strategies for how it can be effectively addressed to support future public health responses.

Are the 7C psychological antecedents associated with COVID-19 vaccine behaviours beyond intentions? A cross-sectional study on at-least-one-dose and up-to-date vaccination status, and uptake speed among adults in France

BACKGROUND

Widely documented psychological antecedents of vaccination are confidence in vaccines, complacency, convenience, calculation, collective responsibility (5C model) with the recent addition of confidence in the wider system and social conformism. While the capacity of these seven antecedents (7C) to explain variance in COVID-19 vaccine intentions has been previously documented, we study whether these factors also are associated with vaccine behaviours, beyond intentions.

METHODS

From February to June 2022, we recruited a sample of adults in France, including persons with notified recent SARS-CoV-2 infection, along with relatives and randomly selected non-infected persons. Participants completed self-administered questionnaires assessing COVID-19 vaccination history and the 7C antecedents. We defined vaccination behaviours as three outcomes: at-least-one-dose vaccine status by 2022 (N = 49,019), up-to-date vaccination status (N = 46,566), and uptake speed of first dose (N = 25,998). We conducted multivariable logistic regressions and Cox models.

RESULTS

Among the 49,019 participants, 95.0% reported receipt of at least one dose and 89.8% were up to date with recommendations. All 7C antecedents were significantly associated with the outcomes, although effects were weaker for up-to-date vaccination status and uptake speed. The strongest effects (most vs. least vaccine-favourable attitude level, at-least-one-dose vaccination status) were observed for collective responsibility (OR: 14.44; 95%CI: 10.72-19.45), calculation (OR: 10.29; 95%CI: 7.53-14.05), and confidence in the wider system (OR: 8.94; 95%CI: 6.51-12.27).

CONCLUSION

This study demonstrates that the 7C not only explain vaccine intention, but also vaccine behaviours, and underpins the importance of developing vaccine promotion strategies considering the 7C antecedents.

Trust as a catalyst: revealing the impact of government trust and professional trust on public health policy compliance during a pandemic

BACKGROUND

Existing research has extensively explored the relationship between government trust and compliance behaviour, but significant controversies exist. Some studies suggest a strong positive correlation between the two. Other studies have found that government trust hinders compliance behaviour. However, during the pandemic, the effectiveness of public health policies largely depends on the public's compliance with these policies. To examine the aforementioned controversies, this study utilizes survey data on the Chinese population during the COVID-19 period to explore the relationship between compliance with public health policies and government trust.

METHODS

The study conducted a questionnaire survey of 1,395 individuals from 25 provinces in China from mid-November to mid-December 2022. Firstly, we categorized the public's compliance behaviour with public health policies based on the results of factor analysis. Subsequently, we examined the impact of government trust and professional trust on compliance behaviour with public health policies by constructing a structural equation model.

RESULTS

Based on the results of factor analysis, we classified public adherence to public health policies into protective compliance and restrictive compliance. Results from the structural equation model show a positive correlation between the public's trust in the government and both protective and restrictive compliance, with a stronger influence on protective compliance. Government trust also exerts a positive impact on restrictive compliance behaviour through professional trust. Additionally, the study indicates a significant positive correlation between the public's professional trust and restrictive compliance, while it does not significantly affect protective compliance. Moreover, the public from rural areas demonstrates a greater willingness to adhere to both types of public health policies. Married individuals exhibit a stronger inclination toward protective compliance, while females show a stronger tendency toward restrictive compliance.

CONCLUSION

The study revealed a significant positive impact of government trust and professional trust on compliance behaviour with public health policies during the COVID-19 pandemic, refuting any negative correlation between government trust and compliance behaviour. Normative motivations for compliance behaviour had a substantial impact on adherence. These findings offer valuable insights for future public health crisis management and public policy formulation.

(Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden

BACKGROUND

The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers.

METHODS

In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis.

RESULTS

Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities' pandemic response.

CONCLUSION

This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

COVID-19 risk communication gaps, needs, and strategies related to pandemic preparedness plans among vulnerable, Black American subgroups: A qualitative study

OBJECTIVE

Improving current and future risk communication plans is critical to mitigate the COVID-19 pandemic and begin to prepare for future pandemics. Minority groups, particularly African Americans, have been limited in engagement to prepare these plans which has been demonstrated to be disadvantageous. We report findings from a qualitative study that describes gaps, needs, and strategies to improve communication among vulnerable, Black American subgroups during the COVID-19 pandemic.

METHODS

Sixty-two Black Americans in uniquely, vulnerable subgroups participated in qualitative, semi-structured interviews from May to September 2020. Thematic analyses were used to identify themes.

RESULTS

Participants were 16 essential workers, 16 parents, 15 young adults, and 15 individuals with underlying medical conditions. Emerging themes were: (1) Poor communication and miscommunication fueled fear and confusion; (2) Information sources and channels: How do I choose one?; (3) Communication needs were simple yet complex; (4) All information sources are not trusted information sources; (5) Preferred yet trusted channels and types of information; and (6) Dissemination of COVID Research: Why and How. Subgroups varied in information sources and processes for choosing the source, communication needs, and channels and types of information needed. They shared why they did and did not trust certain sources along with the importance of COVID research dissemination to promote informed decision-making throughout the pandemic.

DISCUSSION

This study found that Black American subgroups had diverse, yet trusted and non-trusted messages, messengers, and strategies for communication and wanted research results disseminated. We describe multi-level stakeholders and strategies to help improve risk communication for pandemics, and potentially preparedness and health outcomes.

Inequalities in Covid-19 Messaging: A Systematic Scoping Review

The impact of the Covid-19 pandemic has been widely documented. While deaths are now in the millions and many more have been impacted in other ways, the impact of Covid-19 has not been felt equally, with it exacerbating existing inequalities and disproportionately impacting a number of populations. With this Covid-19 has created unprecedented challenges in relation to health communication, with the need to reach disadvantaged populations. This systematic scoping review sought to 1) synthesize the existing research regarding communication inequalities in the response to the Covid-19 pandemic, and 2) analyze the recommendations that emerge from this body of evidence on how to best address these inequalities. This review includes 40 studies that fell into three broad groups (1) those revealing a disadvantage or inequality in studies of general population; (2) those focussing on communication with sub-groups disproportionately affected by the pandemic; and (3) those reporting and evaluating practical attempts to address inequalities. The results largely corroborate those found in past pandemics, highlighting the role of sociodemographic, cultural/religious, and economic factors in facilitating/jeopardizing the public's capacity to access and act upon public health messaging. In a number of studies it was encouraging to see recommendations from the literature - particularly, lessons learnt on the importance of community partnerships, trusted messengers and the co-creation of health and risk messages - being applied, however many challenges remain unmet. Covid-19 has also highlighted the need to actively tackle misinformation, something which was recognized, but largely unaddressed.

Pandemic threat and group cohesion: national identification in the wake of COVID-19 is associated with authoritarianism

Authoritarianism emerges in times of societal threat, in part driven by desires for group-based security. As such, we propose that the threat caused by the COVID-19 pandemic was associated with increased authoritarian tendencies and that this can be partially explained by increased national identification. We tested this hypothesis by collecting cross-sectional data from three different countries in April 2020. In Study 1, data from Ireland (N = 1276) showed that pandemic threat predicted increased national identification, which in turn predicted authoritarianism. In Study 2, we replicated this indirect effect in a representative UK sample (N = 506). In Study 3, we used an alternative measure of authoritarianism and conceptually replicated this effect among USA citizens (N = 429). In this US sample, the association between threat and authoritarian tendencies was stronger among progressives compared to conservatives. Findings are discussed and linked to group-based models of authoritarianism.

Communications for US Populations With Limited English Proficiency During Infectious Disease Outbreaks: A Scoping Review

The COVID-19 pandemic has highlighted the need for research about communicating with populations who have limited English proficiency in the United States during infectious disease outbreaks. These populations have experienced significantly worse health outcomes during emergencies, including the COVID-19 pandemic, and evidence-based risk communications are critical to protecting their health. To support improved development of emergency communications for these communities, we conducted a scoping review that examined the extent of research available, with an intent to identify which communications topics are covered in the literature and where research gaps exist. Following the JBI framework, with reporting guided by the PRISMA extension for scoping reviews, 6 electronic databases were systematically searched in October 2022. The inclusion criteria for articles selected were: data collected between 2009 and 2022, published in English, and focused on communications pertaining to emergency infectious disease outbreaks (eg, H1N1 influenza, Zika virus, COVID-19) for populations with limited English proficiency. Of 2,049 articles identified through the search, 31 met the inclusion criteria and were selected for review. We identified major limitations in the evidence base: a majority of studies were conducted only among Spanish speakers or during the COVID-19 pandemic, and most used qualitative or nonrandom samples. Most studies documented basic language barriers in communications, but there was little exploration of more nuanced barriers, such as cultural relevance or social context. Ahead of future outbreaks, more research is urgently needed to examine the information landscapes of populations with limited English proficiency, to inform the development of more effective communications strategies from public health institutions and others.

Effectiveness of communications in enhancing adherence to public health behavioural interventions: a COVID-19 evidence review

Health communication has relevance for virtually every aspect of health and well-being, including disease prevention. This review explored the effectiveness of communications in enhancing the adoption of or adherence to behavioural interventions (non-pharmaceutical interventions (NPIs)) related to COVID-19. The review takes the UK as a case study and focuses on self-reported behaviours (e.g. social distancing). It also reviews the psychosocial determinants of adherence. Searches were conducted using PubMed, Scopus, CINAL, ASSIA and iCite databases. Eleven thousand five hundred records were identified and 13 were included in the final sample. Included studies suggest that NPI adoption or adherence was generally high, and communication had significant impacts, with key themes including clarity and consistency, trust and control. Based on the evidence in this review, features of effective communication in the context of NPI adoption or adherence are (i) information should be conveyed clearly and conflicting (mixed) messages should be avoided; (ii) information should be conveyed by trusted sources (e.g. health authorities) and (iii) communication should strike a balance between being authoritative but avoiding language seen as controlling (e.g. 'you must'). Future research should prioritize quantitative, experimental and longitudinal study designs, that focus specifically on communication as an intervention, and which measure behaviour. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Spanish-Language Communication of COVID-19 Information Across US Local Health Department Websites

The COVID-19 pandemic has brought new urgency to a longstanding problem: the US health system is not well-equipped to accommodate the country's large limited English proficient (LEP) population in times of national emergency. We examined the landscape of Spanish-language COVID-19 website information compared to information in English provided by health departments of the top 10 cities by population in the USA. For each city, coders evaluated three score measures (amount of information, presentation quality, and ease of navigation) for six content types (general information, symptoms, testing, prevention, vaccines, and live statistics) across six delivery modes (print resources, website text, videos, external links, data visualization, and media toolkits). We then calculated a grand average, combining all cities' values per score measure for each content type-delivery mode combination, to understand the landscape of Spanish-language information across the country. Overall, we found that, for all cities combined, nearly all content types and delivery modes in Spanish were inferior or non-existent compared to English resources. Our findings also showed much variability and spread concerning content type and delivery mode of information. Finally, our findings uncovered three main clusters of content type and delivery mode combinations for Spanish-language information, ranging from similar to worse, compared to information in English. Our findings suggest that COVID-19 information was not equivalently provided in Spanish, despite federal guidance regarding language access during times of national emergency. These results can inform ongoing and future emergency communication plans for Spanish-preferring LEP and other LEP populations in the USA.

Acceptance of Public Health Measures During the COVID-19 Pandemic: A Cross-Sectional Study of the Swiss Population's Beliefs, Attitudes, Trust, and Information-Seeking Behavior

Objectives: This study aimed to advance the understanding of the factors associated with population acceptance of public health measures during the COVID-19 pandemic. Methods: In January 2022, we conducted a cross-sectional survey of the Swiss population (N = 2,587). Questionnaires were administered through computer-assisted web interviewing. Measures covered included information-seeking behavior, attitudes towards and beliefs about public health measures enacted, and trust in institutions. Results: Television and newspapers were the most used information sources. Those with higher education levels were more likely to use channels from public institutions, newspapers, and television. The most important criterion for reliable information was scientific evidence. Trust was highest for doctors, healthcare workers, universities, research institutes, and public health institutions. Acceptance of public health measures was high overall, and attitudes, beliefs, information-seeking behavior, and trust were positively related to acceptance. Trust in science remained stable, while trust in public health institutions decreased slightly. Conclusion: While nurturing a two-way dialogue with the population, institutions should target communication considering age and culture, improve risk communication, ground messages in scientific evidence, and ensure mass media presence.

World Health Organization myth busters and indigenous perceptions of COVID-19: Quechua and Shipibo communities

When the COVID (SARS-V2) pandemic swept across the world, it impacted Indigenous communities more than others. This is due to a variety of reasons: socioeconomic injustice and racialization, lack of access to equitable healthcare, and linguistic discrimination. As a result, several communities and community types demonstrated this effect when perceptions of inferences or other COVID-related information were measured. This paper reports on a participatory collaborative study with two Indigenous communities in rural Peru-ten Quechua-speaking communities in Southern Cuzco and three Shipibo-speaking communities in Ucayali regions. We investigate the communities' level of preparedness for the crisis by eliciting answers based on the World Health Organization COVID 'MythBusters' in a form of a semi-structured interview. Interviews were transcribed, translated, and analyzed in search of the effect of three variables: gender (male/female), language group (Shipibo/Quechua), and proficiency in the Indigenous language (from 0 to 4). Data reveal that all three variables have some effect on the target comprehension of COVID-related messages. Additionally, we explore other possible explanations.

Localizing COVID-19 Misinformation: A Case Study of Tracking Twitter Pandemic Narratives in Pennsylvania Using Computational Network Science

The recent COVID-19 outbreak has highlighted the importance of effective communication strategies to control the spread of the virus and debunk misinformation. By using accurate narratives, both online and offline, we can motivate communities to follow preventive measures and shape attitudes toward them. However, the abundance of misinformation stories can lead to vaccine hesitancy, obstructing the timely implementation of preventive measures, such as vaccination. Therefore, it is crucial to create appropriate and community-centered solutions based on regional data analysis to address mis/disinformation narratives and implement effective countermeasures specific to the particular geographic area.In this case study, we have attempted to create a research pipeline to analyze local narratives on social media, particularly Twitter, to identify misinformation spread locally, using the state of Pennsylvania as an example. Our proposed methodology pipeline identifies main communication trends and misinformation stories for the major cities and counties in southwestern PA, aiming to assist local health officials and public health specialists in instantly addressing pandemic communication issues, including misinformation narratives. Additionally, we investigated anti-vax actors' strategies in promoting harmful narratives. Our pipeline includes data collection, Twitter influencer analysis, Louvain clustering, BEND maneuver analysis, bot identification, and vaccine stance detection. Public health organizations and community-centered entities can implement this data-driven approach to health communication to inform their pandemic strategies.

The Need for Systems Approaches for Precision Communications in Public Health

A major challenge in communicating health-related information is the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. To date, public health communications approaches have often not adequately accounted for the complexities of these systems to the degree necessary to have maximum impact. The virality of COVID-19 misinformation and disinformation has brought to light the need to consider these system complexities more extensively. Unaided, it is difficult for humans to see and fully understand complex systems. Luckily, there are a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. Using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.

Social Distancing during the COVID-19 Pandemic in Switzerland: Health Protective Behavior in the Context of Communication and Perceptions of Efficacy, Norms, and Threat

The success of health protection measures depends on public compliance. This paper aims to understand the influence of three different types of communication (i.e., news media, social media, and interpersonal communication) on people's engagement in health protective behavior during a public health crisis. Our C-ENT model of health protective behavior proposes that communication raises perceptions of efficacy, norms, and threat, which in turn influence health protective behavior (communication → efficacy, norms, threat: C-ENT). We test the model for the case of social distancing during the COVID-19 pandemic, based on a representative online survey during the first week of the lockdown in Switzerland (N = 1005). The results support the C-ENT model and illustrate the important role of communication engagement during a public health crisis. News media use was associated with perceptions of behavior-related efficacy and norms and disease-related threat, and these perceptions were positively associated with compliance with social distancing. Social media use and interpersonal communication were related with perceived norms. Social media use was negatively and interpersonal communication positively associated with health behavior-supporting normative perceptions. Our findings suggest taking the distinct pattern among communication types (i.e., news media, social media, and interpersonal communication), perceptions, and behavior into account in order to understand existing dependencies and design respective communication strategies.

"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'.

Introduction

Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap.

Methods

This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods.

Results

Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic.

Conclusion

Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

How health organizations communicate about COVID-19 on social media: a comparative content analysis

BACKGROUND

This study examined how different health organizations (i.e., the Chinese CDC, the Korean CDC, the United States CDC, and WHO) communicated about the COVID-19 pandemic on social media, thus providing implications for organizations touse social media effectively in global health crises in the future.

METHODS

Three bilingual researchers conducted a content analysis ofsocial media posts (N = 1,343) of these health organizations on Twitter and Sina Weibo to explore the frames of the COVID-19 pandemic, the purposes, and the strategies to communicate about it.

RESULTS

Prevention was the dominant frame of the social media content of these four health organizations. Information update was the major communication purpose for WHO, the United States CDC, and the Korean CDC; however, guidance was the primary communication purpose for the Chinese CDC. The United States CDC, the Chinese CDC, and the Korean CDC heavily relied on multiple social media strategies (i.e., visual, hyperlink, and authority quotation) in their communication to the public about the COVID-19 pandemic, whereas WHO primarily employed quoting authorities. Significantdifferences were revealed across these health organizations in frames, communication purposes, and strategies. Theoretical and practical implications and limitations were discussed.

CONCLUSIONS

This study examined how different global health organizations communicate about the COVID-19 pandemic on social media. We discussed how and why these global health organizations communicate the COVID-19 pandemic, which would help health-related organizations design messages strategically on global public health issues in the future.

Art Advocacy: Applying a Public Memory Rhetorical Framework to Health Crisis Communication

Health campaigns and public health messaging strategies often rely on text-based efforts to communicate with audiences. As research grows in the areas of health and visual media, this essay puts a rhetorical framework of public memory in conversation with health campaign communication to show possibilities for audiences who are less likely to be moved by traditional institutional health narratives. The artifact for analysis is an art installation by Domenic Esposito, who in 2018 designed and placed a large scale "Opioid Spoon" at the headquarters of Purdue Pharma in Stamford, Connecticut. After situating public art as an effective way to advance health crisis messaging, we then preview the next phase of this research project that analyzes COVID-19 art as a counterpublic health narrative. We conclude by suggesting future health communication scholarship engage with the intersections of public health art, memory, and advocacy in order to reflect more accurately how communities experience health inequity.

Predicting Public Cooperation Toward Government Actions in the Early Stages of an Influenza Pandemic in the United States: The Role of Authentic Governmental Communication and Relational Quality

During a public health crisis, government sector is considered the natural leader for overall preparedness and management efforts. Integrating the literature from public relations and public health disciplines, this study proposes a theoretical model to predict individuals' perceptions, communicative action, as well as their behaviors to follow the governments' instructions in the early stages of the COVID-19 outbreak in the United States. Linking relationship management factors and the framework of the situational theory of problem-solving, the findings of this study demonstrate that authentic communication and relational quality can help increase positive perceptual, attitudinal, and behavioral outcomes desired by governments regarding pandemic management. However, our findings suggested that unproductive uses of authentic governmental communication may create adverse effects on publics' perceptions and interpretations and thus pose potential risks, particularly when a public health issue is significantly politicized. Specifically, this study found that, in the case of the COVID-19 pandemic in which the Trump administration was blamed for lack of planning and halting responses in the fight against the virus, conservatives who believe that the federal government is practicing authentic communication during the pandemic would consider the issue less important and irreverent; meanwhile, they would recognize more barriers to adopt preventive actions. Theoretical and practical implications are discussed.

Information Delayering Safety Management (IDSM): A New Method of System Safety in Urgent Situations Needs to Be Established

Organizational safety decisions rely heavily on safety information in today's data-driven era, but there is a significant danger of information distortion that can compromise system safety. To address the issue of information distortion and enhance system safety, a new approach called information delayering safety management (IDSM) has been developed and implemented. The IDSM method combines delayering management mode and graph theory to study the relationship between information distortion management and delayering management. By using the delayering mode as a theoretical foundation for safety information management, information distortion can be reduced. The implementation of this approach from a graph theory perspective has been tested using a case study and has been proven to effectively enhance the reliability of safety information and ensure system safety. The minimum control set of the directed graph algorithm can be used to realize the whole network management of safety information distortion. The amount of safety information and signal noise can be controlled by adjusting connectivity, and safety information distortion can be regulated through the adjustment of structural holes and flow direction. Overall, IDSM offers a new, effective method for accident analysis and safety management, allowing safety professionals to make informed decisions based on robust advanced evidence.

Psychological distress and anxiety in Arab refugees and migrants during the COVID-19 pandemic in Germany

The COVID-19 pandemic is associated with various psychological stressors due to health-related, social, economic, and individual consequences, especially for minority groups such as refugees and other migrants who live in unstable conditions and have lost their social support groups. The aim of this study was to explore the impacts of the COVID-19 pandemic on this specific population in Germany.This study used a mixed-method approach. A total of 85 migrants took part in an online survey in Germany from April to July 2020. The questionnaire included demographic information and measures of psychological distress, anxiety and depressive symptoms, as well as risk and protective factors for psychological health during the COVID-19 pandemic. Semi-structured interviews with 10 refugees were conducted between May and June 2020. In our sample, 54.5% expressed fear of being infected with COVID-19. Participants spent several hours per day thinking about COVID-19 (M  =  3.13 hours). Psychological and social determinants of mental health showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. Interviews showed that especially for refugees with limited information regarding access to medical treatment, the pandemic increased already-existing psychological symptoms and worries about their families back home and reminded them of their flight from their home country to Europe. The COVID-19 pandemic is associated with psychological distress, anxiety, and depression in refugees and migrants in Germany. Information on where to get medical treatment, if needed, is of utmost importance to this population group, in addition to other strategies such as maintaining a healthy lifestyle and social contacts, and acceptance of strategies to cope with anxiety and negative emotions.

Psychosocial Stressors and Coping Strategies Among African Americans During Early Stages of the COVID-19 Pandemic: a Qualitative Study

OBJECTIVES

The disproportionate impact of coronavirus (COVID-19) on African Americans along with associated inequities in social determinants of health (SDOH) and racism increase their vulnerability to the psychosocial impact of COVID-19. This qualitative study applied the socio-ecological model (SEM) to explore psychosocial stressors, coping styles, and needs to improve psychosocial health among unique subgroups of African Americans in early pandemic stages.

METHODS

Sixty-two African Americans (16 parents, 15 young adults, 16 essential workers, and 15 individuals with underlying medical conditions) participated in qualitative, semi-structured interviews between May and September 2020. Interview data were analyzed based on the SEM using thematic analysis.

RESULTS

The majority (84%) reported being stressed with parents having the highest level. Four themes emerged : (1) our COVID-19 pandemic state of mind, (2) top stressors in the early stages of the COVID-19 pandemic, (3) coping strategies during COVID-19, and (4) needs during the COVID-19 pandemic to reduce stress. While there were similarities, different stressors were experienced among subgroups, which yielded different coping styles and needs from stakeholders across multi-levels to improve their psychosocial health.

CONCLUSIONS

Findings suggest current and future pandemic response plans need targeted strategies across multiple levels of influence to address the psychosocial impact of the COVID-19 pandemic on African Americans.

Public engagement in government officials' posts on social media during coronavirus lockdown

BACKGROUND

Social media has been a common platform to disseminate health information by government officials during the COVID-19 pandemic. However, little is known about the determinants of public engagement in officials' posts on social media, especially during lockdown.

OBJECTIVES

This study aims to investigate how the public engages in officials' posts about COVID-19 on social media and to identify factors influencing the levels of engagement.

METHODS

A total of 511 adults aged 18 or over completed an online questionnaire during lockdown in Iraq. Levels of engagement in officials' posts on social media, trust in officials and compliance of government instructions were assessed.

RESULTS

Fear of COVID-19 and trust in officials were positively associated with compliance of government instructions. Trust in officials was also associated with active engagement in officials' posts on social media, including commenting, posting and sharing of the posts.

CONCLUSIONS

Trust in government has been established during the COVID-19 pandemic. Public engagement in officials' posts is crucial to reinforce health policies and disseminate health information.

Survey on public awareness, attitudes and self-protective behavior adoption in different periods of COVID-19

Introduction

The outbreak and spread of the pandemics have been an issue of critical concern globally, posing a significant threat to the health sector globally. This study aimed to examine the basic knowledge and attitudes toward the recommended protective measures at different times, respond to the COVID-19 pandemic, and provide recommendations for developing targeted strategies and measures for preventing and controlling public health emergencies.

Methods

The study used self-filled questionnaires to examine the public's knowledge, attitudes, and practices on COVID-19 at two different period, from 20 to 31 March 2020 (the beginning period) and 22-27 April 2022 (the regular epidemic prevention and control period). Descriptive and quantitative analyses were used for statistical analysis.

Results and discussion

The survey collected 2375 valid questionnaires. A comparison of the two periods reveals that as the epidemic continued over a long period, the level of knowledge, attitudes toward preventive measures, risk perceptions, and adoption behavior of the respondents at the beginning of the epidemic were significantly higher than during the regular epidemic prevention and control period. With the upsurge in the spread of the epidemic, the public needs a multi-channel, targeted, and all-round guidance and information on prevention and control of the COVID-19, and internalizes knowledge into individual's behavior of actively responding to diseases.When the epidemic lasts for a long time, the relevant agencies should strengthen their monitoring role to promote public compliance with the recommended measures.

Knowledge, perceived risk, and attitudes towards COVID-19 protective measures amongst ethnic minorities in the UK: A cross-sectional study

Background

Minority ethnic groups are at increased risk of COVID-19 related mortality or morbidity yet continue to have a disproportionally lower uptake of the vaccine. The importance of adherence to prevention and control measures to keep vulnerable populations and their families safe therefore remains crucial. This research sought to examine the knowledge, perceived risk, and attitudes toward COVID-19 among an ethnically diverse community.

Methods

A cross-sectional self-administered questionnaire was implemented to survey ethnic minority participants purposefully recruited from Luton, an ethnically diverse town in the southeast of England. The questionnaire was structured to assess participants knowledge, perceived risk, attitudes toward protective measures as well as the sources of information about COVID-19. The questionnaire was administered online via Qualtrics with the link shared through social media platforms such as Facebook, Twitter, and WhatsApp. Questionnaires were also printed into brochures and disseminated via community researchers and community links to individuals alongside religious, community and outreach organisations. Data were analysed using appropriate statistical techniques, with the significance threshold for all analyses assumed at p = 0.05.

Findings

1,058 participants (634; 60% females) with a median age of 38 (IQR, 22) completed the survey. National TV and social networks were the most frequently accessed sources of COVID-19 related information; however, healthcare professionals, whilst not widely accessed, were viewed as the most trusted. Knowledge of transmission routes and perceived susceptibility were significant predictors of attitudes toward health-protective practises.

Conclusion/recommendation

Improving the local information provision, including using tailored communication strategies that draw on trusted sources, including healthcare professionals, could facilitate understanding of risk and promote adherence to health-protective actions.

Risk communication and community engagement as an emerging pillar of health emergency management in Iran: Achievements and the way forward

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict. Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the "Shahid Qassem Soleimani" project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

The impact of epidemic information on the public's worries and attitude toward epidemic prevention measures during the COVID-19 outbreak

Since the outbreak of 2019 coronavirus disease (COVID-19) in December 2019, the Chinese government has implemented effective epidemic prevention measures. To provide useful information for governments to manage this public health crisis, we conducted an online survey among Chinese general population from February 24 to 28, 2020. In this study, we examined the impact of epidemic information and rumors on public's worries and attitude toward prevention measures during the outbreak of COVID-19. A total of 853 valid questionnaires (641 women, 75.1%) were collected from 24 provincial regions in China. Most respondents' ages ranged from 18 to 60 (833 participants, 97.66%). A mediation model was built to analyze the influence of epidemic information and rumors on worries and attitude. The results showed that the amount of epidemic information positively predicted public's worries, which in turn predicted a supportive attitude toward the prevention measures. Worries partially mediated the relationship between the amount of epidemic information and the supportive attitude. The amount of rumors negatively predicted the supportive attitude. The results of this study implied the importance of timely and credible information providing to evoke a certain level of worry and promote public cooperation, and the necessary attention to refute and resist rumors for effective risk communication in a public health crisis.

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.

The Relationship between COVID-19 Protection Behaviors and Pandemic-Related Knowledge, Perceptions, Worry Content, and Public Trust in a Turkish Sample

Background: This study aimed to explore the effect of knowledge, COVID-19-related perceptions, and public trust on protective behaviors in Turkish people. Methods: Data were collected from an online survey (Turkish COVID-19 Snapshot Monitoring) conducted between July 2020 and January 2021. The recommended protective behaviors (hand cleaning, wearing a face mask, and physical distancing) to prevent COVID-19 were examined. The impacts of the following variables on protective behaviors were investigated using logistic regression analysis: knowledge, cognitive and affective risk perception, pandemic-related worry content, public trust, conspiracy thinking, and COVID-19 vaccine willingness. Results: Out of a total of 4210 adult respondents, 13.8% reported nonadherence to protection behavior, and 86.2% reported full adherence. Males and young (aged 18−30 years) people tend to show less adherence. Perceived self-efficacy, susceptibility, and correct knowledge were positively related to more adherence to protective behavior. Perceptual and emotional factors explaining protective behavior were perceived proximity, stress level, and worrying about the relatives who depended on them. Trust in health professionals and vaccine willingness were positive predictors, while conspiracy thinking and acquiring less information (<2, daily) were negative predictors. Unexpectedly, trust in the Ministry of Health showed a weak but negative association with protection behavior. Conclusions: Perceived stress, altruistic worries, and public trust seem to shape protection behaviors in addition to individuals’ knowledge and cognitive risk perception in respondents. Males and young people may have a greater risk for nonadherence. Reliable, transparent, and culture-specific health communication that considers these issues is required.

Hesitant and anti-vaccination groups: A qualitative study on their perceptions and attitudes regarding vaccinations and their reluctance to participate in academic research- an example during a measles outbreak among a group of Jewish parents in Israel

Background

Vaccination is widespread in Western countries and, overall, there is a high vaccination rate. However, immunization is still an enduring challenge. In recent years, the number of parents who choose to delay or refuse vaccines has risen.

Objectives

(1) to identify the perceptions and attitudes of hesitant and anti-vaccination parents regarding vaccination in general, and vaccinating their children in particular and; (2) to describe the responses of potential participants to the request to participate in academic research regarding their perceptions and attitudes on the subject of vaccines.

Methods

The research employs the qualitative hermeneutic phenomenological method using two research tools: (1) in-depth interviews with 7 hesitant and 11 anti-vaccination Jewish parents in Israel; and (2) the researchers' field notes from this study process, which describe the responses of 32 potential participants to the request to participate in this academic research.

Results

The main findings indicate that while most of the interviewees admit to the efficacy of vaccines in preventing diseases, they oppose the way in which vaccines are promoted-based on providing partial information and disregarding parents' concerns and questions. Therefore, they demand transparency about the efficacy and safety of vaccines. The findings also point to a paradoxical finding. On the one hand, these groups claim that health organizations do not understand their position, referring to them as "science-deniers", even though they are not. On the other hand, these parents choose to refrain from participating in scientific studies and voicing their opinions, thereby perpetuating the situation of being misunderstood.

Conclusion

Hesitant and anti-vaccination groups express mistrust in academic institutions and health organizations. Therefore, an effective dialogue that would include hesitant and anti-vaccination groups, the academy, and health organizations may contribute to a better understanding of the barriers that prevent these groups from getting vaccinated or vaccinating their children and promote public health.

Effect of communicating community immunity on COVID-19 vaccine-hesitant people from ethnically diverse backgrounds: an experimental vignette study in the UK

OBJECTIVES

Achieving high vaccination coverage is vital to the efforts of curbing the impact of the COVID-19 pandemic on public health and society. This study tested whether communicating the social benefit through community protection for friends and family members versus overall society, affects vaccination intention and perception among a sample enriched with respondents from black and ethnic minority backgrounds.

DESIGN

A web-based experimental survey was conducted. Eligible participants were individually randomised, with equal probability, to one of the three experimental vignettes.

SETTING

England.

PARTICIPANTS

We recruited 512 (212 white, 300 ethnically diverse) vaccine-hesitant members from an online panel.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the intention to get vaccinated against COVID-19. The secondary outcome consisted of a behavioural measure in the form of active interest in reading more about the COVID-19 vaccine. Additional measures included the perceived importance and expected uptake in others, as well as the attitudes towards vaccination.

RESULTS

Logistic regression models did not show an effect of the messages on intentions for the overall sample (society: adjusted OR (aOR): 128, 95% CI 0.88 to 1.88 and friends and family: aOR 1.32, 95% CI 0.89 to 1.94). The role of vaccination in achieving community immunity yielded higher vaccination intentions among study participants with white ethnic background (society: aOR: 1.94, 95% CI 1.07 to 3.51 and friends and family: aOR 2.07, 95% CI 1.08 to 3.96), but not among respondents from ethnically diverse backgrounds (society: aOR: 0.95, 95% CI 0.58 to 1.58 and friends and family: aOR 1.06, 95% CI 0.64 to 1.73). The messages, however, did not affect the perceived importance of the vaccine, expected vaccination uptake and active interest in reading more about the vaccine.

CONCLUSIONS

Thus, although highlighting the social benefits of COVID-19 vaccinations can increase intentions among vaccine non-intenders, they are unlikely to address barriers among ethnically diverse communities.

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.

Psychometric properties of public trust in Covid-19 control and prevention policies questionnaire

Background

Public trust is a crucial concept in the COVID-19 pandemic, which determines public adherence with preventive rules as a success factor for disease management. This study aimed to develop and validate a tool to measure public trust in COVID-19 control and prevention policies (COV-Trust tool).

Methods

This is a psychometric study that was conducted in 2020 (March-August). A primary tool was developed through literature review, in-depth interviews with experts and expert panel meetings. Content and construct validity was evaluated using content validity index (CVI) and content validity ratio (CVR) indexes and exploratory and confirmatory factor analysis, respectively. Cronbach α coefficient was calculated to determine the internal consistency.

Results

A 28-item questionnaire with seven factors was developed. Factors included macro policy-making and management of pandemic, pandemic control policies implementing at all levels and their effectiveness, providing protective equipment and medicine for hospitals and public, prevention of negative socio-economic consequences of the pandemic, public participation, informing and public education and public behavior. The questionnaire reliability was calculated to be α = 0.959. Based on the experts’ opinion, tool content validity was estimated to be CVR = 0.73, CVI = 0.89. RMSEA = 0.07 revealed a good model fit as the confirmatory factor analysis results for the tool.

Conclusion

COV-Trust tool is a well-fit tool to be used during this pandemic for improving policies effectiveness and could be used in similar situations as it determines the success of public health interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14272-9.

Investigating public trust during the outbreak of Covid-19 is of utmost important for both research and policy making perspectives.

COV-Trust tool (Seven factors and 31 items) was developed and validated.

COV-Trust tool comprehensively assesses public trust in various aspects of policies and their determinants and can provide valuable information for promoting the effectiveness of policies.

The effect of vaccination beliefs regarding vaccination benefits and COVID-19 fear on the number of vaccination injections

The Coronavirus disease pandemic of 2019 is a vast worldwide public health hazard, impacting people of all ages and socioeconomic statuses. Vaccination is one of the most effective methods of controlling a pandemic like COVID-19. This study aims to investigate the relationship between the number of vaccination injections and fear of COVID-19 and test whether beliefs benefit from vaccination COVID-19 mediate the effect of fear of COVID-19 on the number of vaccination injections. A total of 649 Vietnamese adults were enrolled online to finish answering, including scales The Health Belief Model (HBM) and The Fear of COVID-19 (FCV-19S), consisting of 340 (52.4%) males and 309 (47.6%) females. The data were analyzed using variance, regression, and a simple mediation model. The total score of COVID-19 fear was M = 22.26, SD = 5.49. Vietnamese fear of COVID-19 was at a medium level. Our results suggest that 18- to 20-year-olds are more fearful of COVID-19 than others. People who received the first dosage exhibited a greater fear of COVID-19 than those who received the second dose and were not inoculated. Additionally, the beliefs benefit of vaccination COVID-19 has a role in the relationship between the number of vaccination injections and fear of COVID-19. During the pandemic, adults in Vietnam are more afraid of COVID-19 than during prior outbreaks. Besides, the Vietnamese populace demonstrated a considerable demand for and high acceptability of the COVID-19 vaccine. The current study indicates that psychological counselors and therapists should counsel clients on the value of vaccination and address the fear of COVID-19 as public understanding of the benefits of vaccines increases. To further clarify the effect of this issue on the correlation between fear of COVID-19 and the number of vaccinations, the results of this study indicate that the existing vaccine communication factor for COVID-19 vaccination should be modified to increase confidence in the benefits of immunization.

Information overload's double-edged sword effect on sense of safety: Examining the moderating role of hypervigilance

Since the COVID-19 pandemic outbreak, long-term overlooked motives concerning a sense of safety have become a primary concern. People's sense of safety largely depends on the information they receive. Indeed, a tsunami of information about the virus has been disseminated by all forms of media to people's electronic devices, thus permeating their lives. This study proposed that the over-abundance of information, known as information overload, could endanger individuals' sense of safety by increasing their rumination about COVID-19. However, it could also enhance their sense of safety by increasing their positive attitudes toward COVID-19 precautions. Furthermore, we proposed that individuals' hypervigilance could strengthen the relationship between information overload and rumination about COVID-19 and attitudes toward COVID-19 precautions. We tested these hypotheses using a cross-sectional survey study (N = 403) in February 2021 and a diary study (N = 98) in July 2021 in China. The results of both studies support the dual mediating paths of the relationship between information overload and sense of safety. We also found that hypervigilance moderated the relationship between information overload and rumination about COVID-19. Overall, our study offers insights into how social media may influence people's sense of safety and how individual differences in hypervigilance play a role in the process.

Topic Analysis of Traditional and Social Media News Coverage of the Early COVID-19 Pandemic and Implications for Public Health Communication

OBJECTIVE

To characterize and compare early coverage of coronavirus disease 2019 (COVID-19) in newspapers, television, and social media, and discuss implications for public health communication strategies that are relevant to an initial pandemic response.

METHODS

Latent Dirichlet allocation (LDA), an unsupervised topic modeling technique, analysis of 3271 newspaper articles, 40 cable news shows transcripts, 96,000 Twitter posts, and 1000 Reddit posts during March 4-12, 2020, a period chronologically early in the timeframe of the COVID-19 pandemic.

RESULTS

Coverage of COVID-19 clustered on topics such as epidemic, politics, and the economy, and these varied across media sources. Topics dominating news were not predominantly health-related, suggesting a limited presence of public health in news coverage in traditional and social media. Examples of misinformation were identified, particularly in social media.

CONCLUSIONS

Public health entities should use communication specialists to create engaging informational content to be shared on social media sites. Public health officials should be attuned to their target audience to anticipate and prevent spread of common myths likely to exist within a population. This may help control misinformation in early stages of pandemics.