Time matters in pandemic risk communication: A moderated effect of information timeliness on stakeholder perception in Singapore

The outbreak of the COVID-19 pandemic shows the increasing importance of determining the factors of the public perceptions of personal and societal risks. These perceptions can shape people's behaviors, which, in turn, alter the spread of a pandemic on the community level. However, previous research on risk communication was inconsistent, and little is known about the impact of timely warning messages on stakeholders' perceptions of public health emergencies. To address this theoretical gap, this study analyzes the survey data (N = 538) from Singapore to explore the main effect of information timeliness on the respondents' stakeholder perceptions. This effect is moderated by normative factors, including attention and threat perceptions. We find that the more timely the government updates the risk information, the more trustworthy the stakeholders appear in respondents' opinions. Such an effect is weakened when the pre-decision attention or the threat perception interacts with the predictor independently. However, this effect on stakeholder perceptions becomes stronger if both moderators interact with the information timeliness. That is, an appropriate combination of the information released by the government can effectively enhance the image of the stakeholders during the pandemic.

How to improve IARC's RF-EMF cancer hazard communication

A crucial aspect of IARC's evaluation of the relative carcinogenicity of agents is the communication of its conclusions. The present paper addressed the experimental risk perception literature pertaining to IARC's radiofrequency electromagnetic field evaluation communication, and derived specific recommendations for improving it.

The effect of likelihood and impact information on public response to severe weather warnings

Meteorological services are increasingly moving away from issuing weather warnings based on the exceedance of meteorological thresholds (e.g., windspeed), toward risk-based (or "impact-based") approaches. The UK Met Office's National Severe Weather Warning Service has been a pioneer of this approach, issuing yellow, amber, and red warnings based on an integrated evaluation of information about the likelihood of occurrence and potential impact severity. However, although this approach is inherently probabilistic, probabilistic information does not currently accompany public weather warning communications. In this study, we explored whether providing information about the likelihood and impact severity of forecast weather affected subjective judgments of likelihood, severity, concern, trust in forecast, and intention to take protective action. In a mixed-factorial online experiment, 550 UK residents from 2 regions with different weather profiles were randomly assigned to 1 of 3 Warning Format conditions (Color-only, Text, Risk Matrix) and presented with 3 warnings: high-probability/moderate-impact (amber HPMI); low-probability/high-impact (amber); high-probability/high-impact (red). Amongst those presented with information about probability and impact severity, red high-likelihood/high-impact warnings elicited the strongest ratings on all dependent variables, followed by amber HPMI warnings. Amber low-likelihood/high-impact warnings elicited the lowest perceived likelihood, severity, concern, trust, and intention to take protective responses. Taken together, this indicates that UK residents are sensitive to probabilistic information for amber warnings, and that communicating that severe events are unlikely to occur reduces perceived risk, trust in the warning, and behavioral intention, even though potential impacts could be severe. We discuss the practical implications of this for weather warning communication.

Communicating the Imperfect Diagnostic Accuracy of COVID-19 Rapid Antigen Self-Tests: An Online Randomized Experiment

OBJECTIVE

To investigate the potential impacts of optimizing coronavirus disease 2019 (COVID-19) rapid antigen test (RAT) self-testing diagnostic accuracy information.

DESIGN

Online randomized experiment using hypothetical scenarios: in scenarios 1 to 3 (RAT result positive), the posttest probability was considered to be very high (likely true positives), and in scenarios 4 and 5 (RAT result negative), the posttest probability was considered to be moderately high (likely false negatives).

SETTING

December 12 to 22, 2022, during the mixed-variant Omicron wave in Australia.

PARTICIPANTS

Australian adults. Intervention: diagnostic accuracy of a COVID-19 self-RAT presented in a health literacy-sensitive way; usual care: diagnostic accuracy information provided by the manufacturer; control: no diagnostic accuracy information.

MAIN OUTCOME MEASURE

Intention to self-isolate.

RESULTS

A total of 226 participants were randomized (control n = 75, usual care n = 76, intervention n = 75). More participants in the intervention group correctly interpreted the meaning of the diagnostic accuracy information (P = 0.08 for understanding sensitivity, P < 0.001 for understanding specificity). The proportion who would self-isolate was similar across scenarios 1 to 3 (likely true positives). The proportion was higher in the intervention group than in the control for scenarios 4 and 5 (likely false negatives). These differences were not statistically significant. The largest potential effect was seen in scenario 5 (dinner party with confirmed cases, the person has symptoms, negative self-RAT result), with 63% of the intervention group and 49% of the control group indicating they would self-isolate (absolute difference 13.3%, 95% confidence interval: -2% to 30%, P = 0.10).

CONCLUSION

Health literacy sensitive formatting supported participant understanding and recall of diagnostic accuracy information. This may increase community intentions to self-isolate when there is a likely false-negative self-RAT result. Trial registration: Australia New Zealand Clinical Trial Registry (ACTRN12622001517763).

HIGHLIGHTS

Community-based diagnostic accuracy studies of COVID-19 self-RATs indicate substantially lower sensitivity (and higher risk of false-negative results) than the manufacturer-supplied information on most government public Web sites.This online randomized study found that a health literacy-sensitive presentation of the imperfect diagnostic accuracy COVID-19 self-RATs supported participant understanding and recall of diagnostic accuracy information.Health literacy-sensitive presentation may increase community intentions to self-isolate after a negative test result where the posttest probability is still moderately high (i.e., likely false-negative result).To prevent the onward spread of infection, efforts to improve communication about the high risk of false-negative results from COVID-19 self-RATs are urgently needed.

Understanding the Risk of Social Vulnerability for the Chinese Diaspora during the COVID-19 Pandemic: A Model Driving Risk Perception and Threat Appraisal of Risk Communication-A Qualitative Study

During the first wave of the COVID-19 pandemic, immigrants were among the most socially vulnerable in Western countries. The Chinese diaspora in Canada were one such group due to the widespread cultural stigma surrounding their purported greater susceptibility to transmit and become infected by COVID-19. This paper aims to understand the social vulnerability of the Chinese diaspora in the Greater Toronto Area, Canada, during the first wave of COVID-19 from an explanation of their risk perception and threat appraisal of risk communication. We conducted secondary data analysis of 36 interviews using critical realism. The participants self-identified as being of Chinese descent. The results were used to develop a model of how social vulnerability occurred. In brief, cognitive dissonance was discovered to generate conflicts of one's cultural identity, shaped by social structures of (i) stigma of contagion, (ii) ethnic stigma, and (iii) public sentiment, and mediated by participants' threat appraisal and (iv) self-reliance. We assert that risk communicators need to consider their audiences' diverse socialization in crafting messages to modify behaviors, create a sense of responsibility, and mitigate public health threats. A lack of awareness of one's cognitive dissonance driven by cultural vulnerability may heighten their social vulnerability and prevent them from taking action to protect themself from high-risk events.

Evaluating layperson interpretation of actuarial sexual violence risk data: A multi-method comparison of risk communication with attention to gender bias

Forensic clinicians are often called upon to help courts determine the likelihood that someone will continue to commit sexually violent acts in the future. The utility of these evaluations depends largely on how effectively the results are communicated to and understood by the trier of fact. Actuarial results, such as those commonly reported in sexual offense risk assessments, appear particularly challenging for laypersons to understand. Using a representative sample of 206 U.S. adults, this study examines three methods of communicating actuarial risk via simulated expert testimony on participants' ratings of a hypothetical evaluee's risk of sexual re-offending. The results suggested that all participants, regardless of how results were communicated, over-estimated the examinee's risk level relative to the expert's probabilistic findings, but tended to agree with the expert's categorical predictions. Participants who were only shown actuarial data consistently rated the evaluee as more dangerous and likely to commit future sexually violent acts. Additionally, it was found that gender significantly impacted participants' perceptions, such that women found the evaluee more dangerousness and desired greater social distance from him. This study has implications for best practices regarding expert communication of actuarial results in cases involving sexual violence.

Utilisation and impact of predict prostate on decision-making among clinicians and patients in a specialist tertiary referral centre: A retrospective cohort study

Background

Patients with intermediate-risk prostate cancer are faced with the decision of whether to undergo radical treatment. Decision-making aids, such as Predict Prostate, can empower both clinicians and patients to make treatment decisions with personalised information, but their impact on multi-disciplinary team (MDT) decision-making and uptake of radical treatment remains unknown.

Objective

The objective of this study is to assess the utilisation and utility of Predict Prostate in informing treatment decisions for patients with intermediate-risk prostate cancer.

Patients and Methods

A retrospective cohort study was conducted in Cambridge University Hospitals (CUH) of patients referred to the prostate cancer specialist multi-disciplinary team (pcSMDT) and robotic prostatectomy clinic (ROPD) between September 2019 and August 2021 for consideration of radical prostatectomy (RARP). Data on patient characteristics, use of PredictProstate and management decisions were collected from the Epic electronic medical record (EMR) of 839 patients, of whom 386 had intermediate-risk prostate cancer.

Results

The use of Predict Prostate at the pcSMDT increased in the second half of the study period (34.5% vs. 23.8%, p < 0.001). The use of Predict Prostate was associated with an increased likelihood of attending ROPD for men with CPG2 prostate cancer (OR = 2.155, 95% CI = 1.158-4.013, p = 0.015) but a reduced likelihood of proceeding with RARP for men with CPG2 (OR = 0.397, 95% CI = 0.209-0.753, p = 0.005) and CPG3 (OR = 0.305, 95% CI = 0.108-0.861, p = 0.025) prostate cancer.

Conclusion

Our study showed that the use of Predict Prostate for patients with intermediate-risk prostate cancer is associated with increased attendance at specialist surgical clinic and a reduced chance of undergoing radical prostate surgery.

Use of Persuasive Language in Communication of Risk during Prostate Cancer Treatment Consultations

BACKGROUND

Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician's recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment.

METHODS

A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician's treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations.

RESULTS

A total of 496 quotes about cancer prognosis (n = 127), life expectancy (n = 51), and side effects (n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language (n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors (P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity.

CONCLUSIONS

Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate.

IMPLICATIONS

Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language.

HIGHLIGHTS

Physicians use persuasive language favoring their treatment recommendation when communicating risks of prostate cancer treatment, which may influence a patient's treatment choice.Coders predicted physician treatment recommendations based on isolated, randomized quotes about cancer prognosis, life expectancy, and side effects with 91% accuracy.Qualitative analysis revealed that when favoring nonaggressive treatment, physicians used persuasive language that amplified side effect risks and downplayed cancer risk. When favoring aggressive treatment, physicians did the opposite.Providers should be cognizant of using persuasive strategies and aim to provide quantified assessments of risk that are jointly interpreted with the patient so that patients can make evidence-based conclusions regarding risks without solely relying on persuasive language.

Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach

BACKGROUND

To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations.

METHODS

Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content.

RESULTS

The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate.

DISCUSSION

When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.

Effective sample size: A measure of individual uncertainty in predictions

Clinical prediction models are estimated using a sample of limited size from the target population, leading to uncertainty in predictions, even when the model is correctly specified. Generally, not all patient profiles are observed uniformly in model development. As a result, sampling uncertainty varies between individual patients' predictions. We aimed to develop an intuitive measure of individual prediction uncertainty. The variance of a patient's prediction can be equated to the variance of the sample mean outcome inn ∗ $$ {n}_{\ast } $$ hypothetical patients with the same predictor values. This hypothetical sample sizen ∗ $$ {n}_{\ast } $$ can be interpreted as the number of similar patientsn eff $$ {n}_{\mathrm{eff}} $$ that the prediction is effectively based on, given that the model is correct. For generalized linear models, we derived analytical expressions for the effective sample size. In addition, we illustrated the concept in patients with acute myocardial infarction. In model development,n eff $$ {n}_{\mathrm{eff}} $$ can be used to balance accuracy versus uncertainty of predictions. In a validation sample, the distribution ofn eff $$ {n}_{\mathrm{eff}} $$ indicates which patients were more and less represented in the development data, and whether predictions might be too uncertain for some to be practically meaningful. In a clinical setting, the effective sample size may facilitate communication of uncertainty about predictions. We propose the effective sample size as a clinically interpretable measure of uncertainty in individual predictions. Its implications should be explored further for the development, validation and clinical implementation of prediction models.

Assessing Regional Weather's Impact on Spinal Cord Injury Survivors, Caregivers, and General Public in Miami, Florida

(1) Background: Climate change is increasing the already frequent diverse extreme weather events (EWE) across geographic locations, directly and indirectly impacting human health. However, current ongoing research fails to address the magnitude of these indirect impacts, including healthcare access. Vulnerable populations such as persons with spinal cord injury (pSCI) face added physiologic burden such as thermoregulation or mobility challenges like closure of public transportation. Our exploratory research assessed commute and transport to healthcare facilities as well as the knowledge, attitudes and behaviors (KAB) of pSCI regarding EWE and climate change when compared to pSCI caregivers (CG) and the general public (GP). (2) Methods: A KAB survey was employed to conduct a cross-sectional assessment of pSCI, CG, and GP in Miami from October through November 2019 using snowball sampling. Descriptive and logistic regression statistical analyses were used. (3) Results: Of 65 eligible survey respondents, 27 (41.5%) were pSCI, 11 (17%) CG, and 27 (41.5%) GP. Overall, pSCI reported EWE, particularly flooding and heavy rain, affecting their daily activities including healthcare appointments, more frequently than CG or GP. The overall models for logistic regression looking at commute to and attendance of healthcare appointments were statistically significant. pSCI self-report being less vulnerable than others, and a large proportion of each group was not fully convinced climate change is happening. (4) Conclusions: This study provided insight to the KAB of 3 population subgroups in Miami, Florida. pSCI are significantly more vulnerable to the effects of regional weather events yet exhibit disproportionate self-perception of their vulnerability. Continued and more comprehensive research is needed to characterize the barriers that vulnerable populations face during weather events.

Rage against the machine? Framing societal threat and efficacy in YouTube videos about artificial intelligence

Artificial intelligence (AI) has become a part of the mainstream public discourse beyond expert communities about its risks, benefits, and need for regulation. In particular, since 2014, the news media have intensified their coverage of this emerging technology and its potential impact on most domains of society. Although many studies have analyzed traditional media coverage of AI, analyses of social media, especially video-sharing platforms, are rare. In addition, research from a risk communication perspective remains scarce, despite the widely recognized potential threats to society from many AI applications. This study aims to detect recurring patterns of societal threat/efficacy in YouTube videos, analyze their main sources, and compare detected frames in terms of reach and response. Using a theoretical framework combining framing and risk communication, the study analyzed the societal threat/efficacy attributed to AI in easily accessible YouTube videos published in a year when public attention to AI temporarily peaked (2018). Four dominant AI frames were identified: the balanced frame, the high-efficacy frame, the high-threat frame, and the no-threat frame. The balanced and no-threat frames were the most prevalent, with predominantly positive and neutral AI narratives that neither adequately address the risks nor the necessary societal response from a normative risk communication perspective. The results revealed the specific risks and benefits of AI that are most frequently addressed. Video views and user engagement with AI videos were analyzed. Recommendations for effective AI risk communication and implications for risk governance were derived from the results.

Perceived Challenges to Tribally Led Shellfish Toxin Testing in Southeast Alaska: Findings From Key Informant Interviews

Shellfish harvesting is central to coastal Alaska Native ways of life, and tribes in Southeast Alaska are committed to preserving sustainable and safe access to subsistence foods. However, consumption of non-commercially harvested shellfish puts Alaska Native communities at elevated risk of exposure to shellfish toxins. To address a lack of state or federal toxin testing for subsistence and recreational harvesting, tribes across Southeast Alaska have formed their own toxin testing and ocean monitoring program. In this study, we interviewed environmental managers responsible for tribes' testing and others with shellfish toxin expertise to report on perceptions of barriers to tribally led testing in Southeast Alaska. Tribal staff identified 40 prospective key informants to interview, including all environmental managers responsible for shellfish toxin testing at subsistence sites in Southeast Alaska. All 40 individuals were invited to participate in an interview and 27 individuals were interviewed. The most frequently discussed barriers to shellfish toxin testing in Southeast Alaska relate to logistical and staffing difficulties associated with communities' remote locations, inconsistent and inadequate funding and funding structures that increase staff burdens, risk communication challenges related to conveying exposure risks while supporting subsistence harvesting, and implications of climate change-related shifts in toxin exposures for risk perception and risk communication. Participants stressed the social origins of perceived barriers. Disinvestment may create and sustain barriers and be most severely felt in Native communities and remote places. Climate change impacts may interact with social and cultural factors to further complicate risk management.

Scenario-Based Messages on Social Media Motivate COVID-19 Information Seeking

Communicating information about health risks empowers individuals to make informed decisions. To identify effective communication strategies, we manipulated the specificity, self-relevance, and emotional framing of messages designed to motivate information seeking about COVID-19 exposure risk. In Study 1 (N=221,829), we conducted a large-scale social media field study. Using Facebook advertisements, we targeted users by age and political attitudes. Episodic specificity drove engagement: Advertisements that contextualized risk in specific scenarios produced the highest click-through rates, across all demographic groups. In Study 2, we replicated and extended our findings in an online experiment (N=4,233). Message specificity (but not self-relevance or emotional valence) drove interest in learning about COVID-19 risks. Across both studies, we found that older adults and liberals were more interested in learning about COVID-19 risks. However, message specificity increased engagement across demographic groups. Overall, evoking specific scenarios motivated information seeking about COVID-19, facilitating risk communication to a broad audience.

Media coverage of COVID-19 vaccines: sources of information, and verification practices of journalists in Ghana

BACKGROUND

Research on vaccines confirms the crucial role media play in framing discourses and mobilizing public support for successful immunization campaigns. What journalists cover on vaccination issues and their diligence in producing stories can influence attitudes to and uptake of vaccines. This paper contributes to emerging discussions on the role of the media in pandemics and in vaccination programs by interrogating the information seeking and verification practices of journalists reporting on COVID-19 vaccines in Ghana.

METHODS

A cross-sectional online survey was conducted among journalists from June to July 2021 through self-administered questionnaires by means of Google forms. The opinions of 300 respondents, randomly drawn from members of the Ghana Journalists' Association, were solicited and a response rate of 73% obtained.

RESULTS

Majority of journalists surveyed relied on official health sources for their information on COVID-19 vaccines (61.5%) and were confident the benefits of vaccines outweigh the risks (70%). While journalists relied on a variety of expert sources, social media platforms served as important sources of information also, with respondents stating a preference for Facebook (48.3%), and WhatsApp (44%). Journalists stated they were guided by sound practices such as source credibility and relevance, but betrayed weaknesses in their verification practices with a third of them admitting to sharing unsolicited information from social media.

CONCLUSIONS

Journalists in Ghana generally display a positive attitude towards COVID-19 vaccines and regularly search for information from official sources to inform their work, thus making them vital allies in overcoming vaccine hesitancy. Laxity in verification practices, however, makes them inadvertent agents of misinformation.

Examining Perceptions of Uncertain Language in Potential E-Cigarette Warning Labels: Results from 16 Focus Groups with Adult Tobacco Users and Youth

E-cigarette use among youth presents a public health risk. Yet, cigarette smokers who substantially reduce their smoking or switch completely from traditional combustible cigarettes could benefit. As science about e-cigarettes is continually emerging, any potential warnings are likely to contain uncertain language. Hedged verbiage may impact decision making. To assess reactions, we conducted 16 online focus groups; 8 with youth (n = 32, grouped by gender and by vaping experience) and 8 with adult tobacco users (n = 37, grouped by smokers, dual users of e-cigarettes and cigarettes, and former smokers who switched to e-cigarettes). Each focus group viewed and discussed 8 potential warnings messages. We conducted an inductive thematic analysis of the reactions to warning messages that contain uncertain language. Respondents' reactions were often negative, but varied based on specific usages of uncertainty, existing beliefs about uncertainty in law and science, and smoking/vaping use patterns that supported the use of uncertainty related to e-cigarettes. Many youth (and some adults) believed that uncertain language enabled audiences to minimize the likelihood of harm or interpreted it as meaning there are both healthy and unhealthy e-cigarettes. This qualitative study provides evidence that the use of types of uncertain language, the frequency of that use, and/or the selection of particular words in warnings, might not achieve the intended public health aims of increasing understanding of risk, deterring youth uptake, and/or facilitating a substantial switch from cigarettes. The use of certain types of uncertain language appears to have significant potential to bring unintended consequences. Suggestions for research and policy are included.

How to convince the vaccine-hesitant? An ease-of-access nudge, but not risk-related information increased Covid vaccination-related behaviors in the unvaccinated

In this study, we contrast how different benefit and harm information formats and the presence or absence of an ease-of-access nudge may facilitate COVID vaccination uptake for a sample of 620 unvaccinated Dutch adults at a timepoint when the vaccine had been widely available for more than a month. Using a 2 × 2 between-subjects factorial design, we varied the information format on mRNA COVID vaccination statistics (generic text vs. facts box) and an affirmative nudge emphasizing the ease of making a vaccination appointment (absent vs. present). We assessed the acceptance of the vaccination information provided, perceptions on the vaccination, and whether participants directly visited a COVID vaccination appointment website. Whereas the facts box did not significantly affect participants' information acceptance, vaccination attitudes, intentions, and link clicking, the affirmative nudge alongside an online link systematically increased the likelihood of clicking on the link to make a vaccination appointment. A verbal nudge emphasizing the ease of vaccine accessibility is more likely to increase vaccination uptake in an unvaccinated population than informational campaigns on vaccine effectiveness.

The 8 billion milestone: Risk perceptions of global population growth among UK and US residents

In November 2022, the global human population reached 8 billion and is projected to reach 10 billion by 2060. Theories, models, and evidence indicate that global population growth (GPG) increases the likelihood of many adverse outcomes, such as biodiversity loss, climate change, mass migrations, wars, and resource shortages. A small body of research indicates that many individuals are concerned about the effects of GPG, and these concerns are strongly related to the willingness to engage in mitigative and preventative actions. However, scientific understanding of the factors that influence GPG risk perceptions remains limited. To help address this research gap, we conducted a study of the perceived risk of GPG among UK and US residents (N = 1029) shortly after the "8 billion milestone." Our results confirmed that GPG is perceived as a moderate-to-high risk and these perceptions have a strong positive relationship with the willingness to engage in and support risk management actions. Our participants believed that the worst effects of GPG were yet to come but would largely be geographically and socially remote. Despite their willingness to engage in risk management actions, our participants reported low self-efficacy and that governments (cf. individuals and communities) have the greatest capacity to influence GPG. Risk perceptions were strongly predicted by worldviews and were higher among our UK (cf. US) participants. We also found that the perceived benefits of GPG were low and found no evidence to suggest that risk perceptions were affected by exposure to media coverage of the 8 billion milestone.

The impact of nontransparent health communication during the COVID-19 pandemic on vaccine-hesitant people's perception of vaccines

Background

Although transparency is crucial for building public trust, public health communication during the COVID-19 pandemic was often nontransparent.

Methods

In a cross-sectional online study with COVID-19 vaccine-hesitant German residents (N = 763), we explored the impact of COVID-19 public health communication on the attitudes of vaccine-hesitant individuals toward vaccines as well as their perceptions of incomprehensible and incomplete information. We also investigated whether specific formats of public health messaging were perceived as more trustworthy.

Results

Of the 763 participants, 90 (11.8%) said they had become more open-minded toward vaccines in general, 408 (53.5%) reported no change, and 265 (34.7%) said they had become more skeptical as a result of public health communication on COVID-19 vaccines. These subgroups differed in how incomprehensible they found public health communication and whether they thought information had been missing. Participants' ranking of trustworthy public health messaging did not provide clear-cut results: the fully transparent message, which reported the benefit and harms in terms of absolute risk, and the nontransparent message, which reported only the benefit in terms of relative risk were both considered equally trustworthy (p = 0.848).

Discussion

Increased skepticism about vaccines during the COVID-19 pandemic may have partly been fueled by subpar public health communication. Given the importance of public trust for coping with future health crises, public health communicators should ensure that their messaging is clear and transparent.

Risk communication and community engagement in the context of COVID-19 response in Bangladesh: a qualitative study

Background

The global COVID-19 pandemic profoundly impacted nations worldwide, and Bangladesh was no exception. In response, the government of Bangladesh implemented community awareness initiatives aimed at containing the spread of the virus, aligned with international guidelines and recommendations. Despite these efforts, a lack of comprehensive community awareness programs played an essential role during the pandemic, not the preventive measures. A qualitative study employing framing theory was conducted to gain a deeper insight into how the social context influenced risk communication and community response throughout the COVID-19 pandemic in Bangladesh.

Methods

The study was conducted in four selected districts of Bangladesh from February to May 2022 using complementary data collection methods, including key informant interviews, in-depth interviews, and focus group discussions with purposely selected participants. Data were analyzed thematically by following six steps of the thematic analysis process. Codes were developed based on the data and summarized into themes and sub-themes grounded on the codes.

Results

The findings indicate that the government of Bangladesh, along with development partners and non-government organizations, made a significant effort to raise awareness about COVID-19 in the community. However, there were certain limitations to this effort. These include a lack of social science and public health approaches to understanding the pandemic; inadequate coordination among the authorities for COVID-19 prevention and control; technological and geographical barriers for disseminating messages; the living conditions and lack of facilities; socio-cultural norms in understanding the COVID-19 health messages, and the gendered understanding of the messages. The findings also revealed that the awareness activities remained a one-way approach to inform the people and faced challenges to actively engage and create ownership of the community in the pandemic response.

Conclusion

The study identified gaps in implementing risk communication and community engagement strategies in Bangladesh during the COVID-19 pandemic. Increasing focus on public health and prioritizing community ownership is essential to designing a more effective community awareness campaign. This approach will help ensure that health messages are communicated effectively and tailored to different communities' needs.

College students' perceptions of COVID-19 conversations on social media

Objective: This project assessed college students' perceptions of social media conversations about COVID-19 in the United States. Participants: A total of 110 college students completed an online survey (N = 110) over two periods of time: April 2020 (n = 60) and September 2020 (n = 50). Method: Measurements included students' perceptions of sentiment, risk, blame, outrage, and opinion/behavioral intention. Results: Survey results showed that college students' attitudes and perceptions of these concepts on social media varied from April to September with negative sentiment, concern, uncertainty, and risk perception decreasing over time while blame and outrage increased over time. A sample of tweets was also examined for these constructs. Conclusions: This study provides important insight on college students' perceptions during a public health emergency and how they use social media as a tool for health information.

Risk communication in multistakeholder engagement: A novel spatial econometric model

Existing studies on the environmental Kuznets curve (EKC) neglect the inverse effect of pollution transfer from environmental regulation interactions on pollution reduction from a risk analysis perspective. Based on the regional differentiated attitudes on the environmental regulation reached in risk communication by the risk awareness biases of multiple interest groups, this article clarifies the causality between risk communication and risk transfer based on multistakeholder engagement processes; furthermore, the article incorporates the simultaneous action of the technological innovation effect and pollution risk transfer effect to construct a spatial environmental hyperbolic model with a bidirectional correlation between pollution emissions and economic growth in different regions. To verify our model, we select the pollution from agricultural watersheds in China as a sample to examine the two inverse effects. The results demonstrate that (1) agricultural watershed pollution and economic growth show an inverted U-shaped relation and a U-shaped relation in the local region and adjacent regions, respectively; (2) the pollution reduction assessment of the classical EKC model can be largely attributed to pollution risk transfer behavior; and (3) the turning point of the U-shaped curve appears earlier than that of the inverted U-shaped curve in the spatial hyperbola model. The findings suggest that stakeholders should consider the risk awareness bias caused by the imbalance of regional economic development and the scenarios that provide a "haven" for pollution risk transfer. Moreover, our study expands the theoretical connotation of the classical EKC hypothesis and is more suitable for pollution reduction scenarios in developing countries.

Field testing Australian bat lyssavirus risk communication resources

ISSUE ADDRESSED

Australian bat lyssavirus (ABLV) is a fatal zoonosis, which can be transmitted to humans through scratches or bites from infected bats. Currently, there is a lack of research evaluating risk communication resources about ABLV or the dangers from handling bats. The purpose of this study was to field test resources aimed at educating the public about risks to humans and bats from human-bat interaction, then update these resources based upon feedback to ensure they were relevant and appropriately targeted to the public.

METHODS

Thirteen semi-structured interviews with a purposive sample of participants chosen for maximum variation of age and sex were conducted. Two investigators analysed the data independently using a deductive approach and then came to consensus by discussion.

RESULTS

The main themes were a wide-ranging level of knowledge and opinions about bats, the resources having an effect on people, and messaging in relation to children and pets being particularly important.

CONCLUSION

This study highlighted the complexities of risk communication to a broad audience with varied experience and knowledge about bats, and the importance of evaluation prior to implementation to ensure risk communication is relevant and appealing to the intended audience. SO WHAT?: Field testing of health education material prior to implementation is an effective way to ensure key messages are understood, and is important when communicating about fatal but preventable zoonoses such as ABLV.

[Implementation and Evaluation of Risk Communication Regarding Residual Pesticides]

In this study, a public seminar on risk communication methods was conducted to raise awareness and disseminate accurate knowledge about residual pesticides to consumers. Additionally, surveys on consumer awareness were conducted on the attendees before and after the seminar to evaluate its effectiveness. Responses were obtained from 84 participants. The paired t-test was used to analyze the changes in awareness before and after the seminar. The results showed significant improvements in "trust in the government" and "understanding of residual pesticides." Furthermore, step-wise multiple regression analysis was performed to explore the factors influencing satisfaction with the risk communication seminar, and the item "understanding of the safety of residual pesticides in food" was extracted. Understanding food safety is a crucial concern in daily life for consumers. To enable consumers to have an accurate understanding of food risks and make appropriate judgments, it is essential to continue implementing risk communication and conveying information about food safety and security in the future.

A struggle for control beyond the facts: examining constructs of GM technology in Philippine opinion columns

GM technology has constantly faced opposition in the Philippines. The debate heightened in 2016, when the Supreme Court halted the field testing of Bt eggplant, which triggered a public debate. This ruling was overturned, but GM technology remained in the public consciousness because of the general visibility of science, health, and food security issues. The researcher analyzed opinion columns in major Philippine news outlets from 2016-present to examine candid framings of the GM debate. Through inductive analysis, the researcher found that the debate represents a struggle for control. The crops are not so much monsters as they are hyperbolic jokes that do not meet their promises; they too, represent a foreign industrial invader that can be countered only by contextualized and localized farming. These findings add nuance to our understanding of the GM debate in the Global South.

COVID-19 Risk Communication and Community Engagement (RCCE) in Malawi: Challenges and Response

The outbreak of COVID-19 created a global health crisis that has impacted our everyday lives. Risk communication and community engagement (RCCE) is one of the strategic pillars the World Health Organization (WHO) recommends when dealing with public health emergencies like COVID-19. In Malawi, the COVID-19 RCCE response was coordinated by the country's Ministry of Health and involved various organizations that distributed COVID-19 risk communication materials and engaged communities on important infection preventive practices. Furthermore, the Ministry of Information was involved in ensuring the messages were put across at national and subnational levels. Despite the efforts, most Malawians were reluctant to embrace set public health measures for COVID-19. Guided by a phenomenological approach, we used in-depth interviews with senior officials from 10 organizations, including the Ministry of Health, who were involved in RCCE response in Malawi, to understand the challenges that were faced in the implementation of RCCE activities in Malawi. We also reviewed project reports from three organizations, taken from the same implementing local organizations, to understand the experiences of implementing RCCE strategies in Malawi. We established that misconceptions, poor coordination, lack of political will, low-risk perceptions, and social norms undermined the response in Malawi. The results underscore the need for the authorities in Malawi to invest more in RCCE and strengthen the capacity to handle future epidemics. There is also a need to develop a national RCCE strategy with guidelines and protocols on methods of coordination, flow of communication, responsible ministry, tools for handling dis/misinformation and myths, and community engagement.

Nigeria Centre for Disease Control, awareness creation and risk communication of Covid-19 pandemic amongst non-literate population in South-West Nigeria: Lessons for future health campaign

Risk communication of Covid-19 pandemic in Nigeria appeared to be urban-centered with the dominant use of social media, print communication and other controlled media. In such times of public health emergencies, non-literate population could be vulnerable as a result of their limited understanding of the nature of such health risk. Therefore, the study seeks to investigate the extent to which Nigeria Centre for Disease Control (NCDC) communicated the risk of Covid-19 disease to non-literate population in its public health campaign during the pandemic in South-West Nigeria. The study adopts risk communication theory which advances the approach communication should take during public health emergencies. Using descriptive cross-sectional mixed methods research design, a sample of 420 respondents were purposively selected from 6 towns in the rural areas of Lagos, Oyo and Osun states to examine the level of awareness on Covid-19 pandemic among non-literates. In addition, NCDC risk communication on Covid-19 for non-literate population were analyzed from 3 Jingles in Yoruba language as well as 9 flyers designed for Covid-19 disease from NCDC websites. Results showed that NCDC awareness creation on Covid-19 disease for non-literates in Southwest achieved significant success as a result of the medium used in creating awareness. Specifically, radio was highly rated among majority of the respondents (60.4%) followed by health workers (19.8%) as channels that created understandable message on Covid-19 safety protocols. Further findings on Jingles content revealed that all Covid-19 safety protocols were communicated in Yoruba language for Southwest populace. However, NCDC fall short in communicating Covid-19 risk effectively for non-literates in Southwest as jingles only buttressed the Covid-19 safety protocols and symptoms as well as the need to comply, without educating the masses on the dreadful nature of the disease and its dynamics. Though flyers designed by the NCDC communicated risk to an extent, nevertheless, graphics and symbols on Covid-19 disease were complimented by words in English language only, which could be difficult for non-literates to decipher. Based on the findings, the study recommends that public health agencies need to educate non-literate population about the nature of a disease more than creating awareness about the outbreak of a disease, and such education should be strategic, context-specific, and evidence-based.

The Relationship Between Communicative Actions, Behavioral Intentions, and Corporate Reputation in the Framework of Situational Theory of Problem Solving in a Public Health Crisis

Objectives: This study aims to determine the individuals' communicative actions based on the basic assumptions of the situational theory of problem solving (STOPS) and the effect of these actions on people's willingness to follow WHO's instructions in the event of an epidemic. It also seeks to determine the impact of corporate reputation on people's communicative actions and intention to follow instructions. Methods: Data were collected digitally from 261 graduate students enrolled at a state university in the Eastern Anatolia Region of Turkey. A structural equation model (SEM) was employed for data analysis. Results: Perceptual antecedents affected situational motivation, and situational motivation affected communicative actions. Communicative actions were a determining factor in individuals' willingness to follow instructions. The perception of corporate reputation influenced both communicative actions and people's willingness to follow instructions. Conclusion: The study revealed that STOPS can provide an important theoretical framework for more effective risk communication practices in public health crises such as epidemics. It also displayed the relationship between the individuals' communicative actions and their willingness to follow instructions and the determining effect of corporate reputation on both of these factors.

A sentiment and content analysis of tweets on monkeypox stigma among the LGBTQ+ community: A cue to risk communication plan

Background

The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community.

Methods

The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study.

Findings

This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation.

Interpretation

This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing.

COVID-19 Vaccine Hesitancy among Unvaccinated Adults: A Cross-Sectional Exploratory Analysis of Vaccination Intentions in Italy Related to Fear of Infection

From the initial COVID-19 outbreak, Italy was the first Western country to be seriously affected by the pandemic. Understanding vaccine hesitancy can help efforts to achieve broad vaccination coverage. The objectives of this research were to determine the extent of vaccine hesitancy in Italy and to understand the characteristics of those segments of the population with some hesitancy. Between January and February 2021, 41,473 subjects answered the second questionnaire delivered in phase II of the web-based EPICOVID19 survey. Among the included adult volunteers living in Italy, 4653 (11.2%) reported having previously received at least one dose of the COVID-19 vaccine. In the sample of 36,820 respondents, all not vaccinated (age 51.1 ± 13.5; 59.7% female; 63.6% high level of education), the comparison between hesitant and inclined participants was accompanied by percentages and odds ratios. A total of 2449 individuals were hesitant (6.7% of the unvaccinated ones). Hesitancy was higher among women (OR = 1.48; 95%CI: 1.36-1.62); it was highest in the 50-59 and 40-49 age groups and among those with a lower educational level. A higher level of education was associated with a lower proportion of hesitancy (5.54%) compared with 9.44% among respondents with a low level of education (OR = 0.56; 95%CI: 0.46-0.68). Hesitancy was most common in subjects who did not report fear of infection (12.4%, OR = 4.0; 95%CI: 3.46-4.61). The results can guide the design of tailored information and communication campaigns through considering objective and subjective characteristics.

An Individualized Postoperative Pain Risk Communication Tool for Use in Pediatric Surgery: Co-Design and Usability Evaluation

BACKGROUND

Risk identification and communication tools have the potential to improve health care by supporting clinician-patient or family discussion of treatment risks and benefits and helping patients make more informed decisions; however, they have yet to be tailored to pediatric surgery. User-centered design principles can help to ensure the successful development and uptake of health care tools.

OBJECTIVE

We aimed to develop and evaluate the usability of an easy-to-use tool to communicate a child's risk of postoperative pain to improve informed and collaborative preoperative decision-making between clinicians and families.

METHODS

With research ethics board approval, we conducted web-based co-design sessions with clinicians and family participants (people with lived surgical experience and parents of children who had recently undergone a surgical or medical procedure) at a tertiary pediatric hospital. Qualitative data from these sessions were analyzed thematically using NVivo (Lumivero) to identify design requirements to inform the iterative redesign of an existing prototype. We then evaluated the usability of our final prototype in one-to-one sessions with a new group of participants, in which we measured mental workload with the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) and user satisfaction with the Post-Study System Usability Questionnaire (PSSUQ).

RESULTS

A total of 12 participants (8 clinicians and 4 family participants) attended 5 co-design sessions. The 5 requirements were identified: (A) present risk severity descriptively and visually; (B) ensure appearance and navigation are user-friendly; (C) frame risk identification and mitigation strategies in positive terms; (D) categorize and describe risks clearly; and (E) emphasize collaboration and effective communication. A total of 12 new participants (7 clinicians and 5 family participants) completed a usability evaluation. Tasks were completed quickly (range 5-17 s) and accurately (range 11/12, 92% to 12/12, 100%), needing only 2 requests for assistance. The median (IQR) NASA TLX performance score of 78 (66-89) indicated that participants felt able to perform the required tasks, and an overall PSSUQ score of 2.1 (IQR 1.5-2.7) suggested acceptable user satisfaction with the tool.

CONCLUSIONS

The key design requirements were identified, and that guided the prototype redesign, which was positively evaluated during usability testing. Implementing a personalized risk communication tool into pediatric surgery can enhance the care process and improve informed and collaborative presurgical preparation and decision-making between clinicians and families of pediatric patients.

Trust and trustworthy artificial intelligence: A research agenda for AI in the environmental sciences

Demands to manage the risks of artificial intelligence (AI) are growing. These demands and the government standards arising from them both call for trustworthy AI. In response, we adopt a convergent approach to review, evaluate, and synthesize research on the trust and trustworthiness of AI in the environmental sciences and propose a research agenda. Evidential and conceptual histories of research on trust and trustworthiness reveal persisting ambiguities and measurement shortcomings related to inconsistent attention to the contextual and social dependencies and dynamics of trust. Potentially underappreciated in the development of trustworthy AI for environmental sciences is the importance of engaging AI users and other stakeholders, which human-AI teaming perspectives on AI development similarly underscore. Co-development strategies may also help reconcile efforts to develop performance-based trustworthiness standards with dynamic and contextual notions of trust. We illustrate the importance of these themes with applied examples and show how insights from research on trust and the communication of risk and uncertainty can help advance the understanding of trust and trustworthiness of AI in the environmental sciences.

How do women at increased risk of breast cancer make sense of their risk? An interpretative phenomenological analysis

OBJECTIVES

Offering breast cancer risk prediction for all women of screening age is being considered globally. For women who have received a clinically derived estimate, risk appraisals are often inaccurate. This study aimed to gain an in-depth understanding of women's lived experiences of receiving an increased breast cancer risk.

DESIGN

One-to-one semi-structured telephone interviews.

METHODS

Eight women informed that they were at a 10-year above-average (moderate) or high risk in a breast cancer risk study (BC-Predict) were interviewed about their views on breast cancer, personal breast cancer risk and risk prevention. Interviews lasted between 40 and 70 min. Data were analysed using Interpretative Phenomenological Analysis.

RESULTS

Four themes were generated: (i) encounters with breast cancer and perceived personal significance, where the nature of women's lived experiences of others with breast cancer impacted their views on the significance of the disease, (ii) 'It's random really': difficulty in seeking causal attributions, where women encountered contradictions and confusion in attributing causes to breast cancer, (iii) believing versus identifying with a clinically-derived breast cancer risk, where personal risk appraisals and expectations influenced women's ability to internalize their clinically derived risk and pursue preventative action and (iv) perceived utility of breast cancer risk notification, where women reflected on the usefulness of knowing their risk.

CONCLUSIONS

Providing (numerical) risk estimates appear to have little impact on stable yet internally contradictory beliefs about breast cancer risk. Given this, discussions with healthcare professionals are needed to help women form more accurate appraisals and make informed decisions.

Communicating the risks of handling bats: analysing approaches used by Australian stakeholders in the context of Australian bat lyssavirus

Australian bat lyssavirus (ABLV) is a member of the Lyssavirus genus of the Rhabdoviridae family and is found in Australian bat species. It is of public health concern because of the rabies-like syndrome it causes in humans, resulting in government health and wildlife agencies using varied communication approaches to inform targeted audiences about zoonotic risks associated with handling bats. Despite these warnings, the number of reports of human-bat interactions remains high. This paper details a survey conducted to analyse the approaches utilised by a range of stakeholders to educate and communicate warnings to their target audiences. The survey focused on identifying the target audiences, communication methods used, along with the message frequency, content, and perceived effectiveness. Analysis of the top three messages delivered by stakeholders revealed that over half were information-focused messages and over a third, instruction-focused. Stakeholders identified the need to balance messaging about bat handling risks with information regarding the vulnerable status of bats and their environmental significance. Whilst the most common and (perceived) effective method of communication was one-on-one discussions, it was also identified to be ineffective for targeting mass audiences leading stakeholders to recognise the need to adapt to more efficient means of communication. The outcomes of this study may be useful to improve risk communication strategies regarding ABLV in Australia.

Framework for multirisk climate scenarios across system receptors with application to the Metropolitan City of Venice

Climate change influences the frequency of extreme events that affect both human and natural systems. It requires systemic climate change adaptation to address the complexity of risks across multiple domains and tackle the uncertainties of future scenarios. This paper introduces a multirisk analysis of climate hazard, exposure, vulnerability, and risk severity, specifically designed to hotspot geographic locations and prioritize system receptors that are affected by climate-related extremes. The analysis is demonstrated for the Metropolitan City of Venice. Representative scenarios (RCP4.5 and RCP8.5) of climate threats (i.e., storm surges, pluvial flood, heat waves, and drought) are selected and represented by projections of Regional Climate Models for a 30-year period (2021-2050). A sample of results is as follows. First, an increase in the risk is largely due to drought, pluvial flood, and storm surge, depending on the areas of interest, with the overall situation worsening under the RCP8.5 scenario. Second, particular locations have colocated vulnerable receptors at higher risk, concentrated in the urban centers (e.g., housing, railways, roads) and along the coast (e.g., beaches, wetlands, primary sector). Third, risk communication of potential environmental and socio-economic losses via the multirisk maps is useful to stakeholders and public administration. Fourth, the multirisk maps recommend priorities for future investigation and risk management, such as collection of sensor data, elaboration of mitigations, and adaptation plans at hotspot locations.

Development of a community-informed communication toolkit to prevent spread of viral illness in schools, including SARS-COV-2

Introduction

Schools were uniquely impacted during the COVID-19 (SARS-COV-2) pandemic. We sought to elucidate how parents/guardians of elementary and middle school students in Maryland navigated the return to in-person school following remote instruction. We also sought to understand how they perceived communication about school-based COVID-19 mitigation strategies and their preferences for the content and format of public health communication about COVID-19 mitigation in schools.

Methods

We engaged a community advisory board comprised of key partners and implemented a survey and focus groups.

Results

Results indicated that parents/guardians wanted clearer communication about COVID-19 mitigation policies in schools and were experiencing fatigue and confusion. These insights informed the development of a tailorable communication toolkit. The toolkit was designed to (1) inform parents/guardians about the importance and effectiveness of mitigation strategies for preventing viral spread to keep children in school, (2) promote a sense of community and support, and (3) help school communication teams effectively communicate information about mitigation strategies being implemented.

Discussion

We describe a process for leveraging schools as a trusted messenger, engaging school communities in the development of communication messages, and utilizing a tailorable communication toolkit in the context of shifting public health guidance and local needs. The toolkit development and dissemination process offers a model for targeting public health messaging to parents/guardians in school settings.

[Integrating Public Health Expertise in Research: a Series of Workshops about Vector-Borne and Other Zoonotic Diseases]

Research groups must understand the needs and requirements of the public health service to be able to develop tools and strategies for supporting it in risk assessment and risk communication. The zoonotic research consortia RoBoPub, Q-GAPS, TBENAGER and ZooBoCo used the format of workshops to include the expertise of the public health service system in their work. We present the results of three workshops that were held with representatives of the German public health service as part of the annual congress of the Federal Association of Physicians of German Public Health Departments in 2018, 2019 and 2022. Each workshop, held in a world-café format, lasted 90 minutes and had its own thematic focus. In the first workshop, information on the goals, problems, solutions and expectations of the public health service from the research consortia concerning exposure to rodent-borne infections during their occupational and leisure-time activities as well as the use of risk maps was collected. In the second and third workshops, participants developed risk communication strategies based on scenarios of outbreaks and identifications of new risk areas. Each workshop had more than 20 participants, of which at least half worked for local public health authorities. Foremost, participants expected practical, target group-specific material for risk communication from the research groups. According to the experience of most participants, direct contact with the affected groups was essential for risk communication. To raise awareness of the situation and establish contact with the relevant target groups, social media can complement traditional media, especially for hard-to-reach groups. However, their use should be considered and planned carefully. The workshop format was appropriate for integrating the public health expertise in the research activities. The expectations of the public health service on material for risk communication could be translated into a guideline, a risk management plan and pathogen descriptions by the research groups. When integrating the expertise of the public health authorities in their work, research groups should consider how to reach a suitable panel of representatives and how to keep the workload for those at an acceptably low level.

'Stay home and stay safe … but maybe you can have somebody over': public perceptions of official COVID-19 messages during the 2020 holiday season in Canada

BACKGROUND

The COVID-19 pandemic triggered extreme preventive measures, including economic and social lockdowns. Many experts and commentators, however, have argued in favor of a harm reduction approach, giving individuals the liberty to assess their risk and potentially engage in risky behavior more safely. Drawing on concepts from harm reduction literature we examine how Canadians interpreted messages intended to mitigate harm during the 2020 end-of-year holiday season.

METHODS

We conducted 12 focus groups in four Canadian cities to discuss public health guidance to reduce the spread of COVID-19, how these messages influenced their holiday celebration plans, and how they interpreted harm mitigation messages.

RESULTS

Focus group participants (n = 82) described COVID-19 public health guidance as confusing and difficult to follow. Participants considered that messages intended to mitigate harm from official sources would contribute to deepening confusion and uncertainty, allow for personal interpretation of guidelines, and discourage those who follow guidelines diligently.

CONCLUSION

Official public health messaging intended to mitigate harm in rapidly evolving crisis situations can be ineffective in reducing risky behaviors because it may instead encourage people to not abide the recommended guidelines. In these situations, harm reduction messaging should be limited to specific groups who cannot otherwise avoid risk exposure.

How Do People Process Different Representations of Statistical Information? Insights into Cognitive Effort, Representational Inconsistencies, and Individual Differences

BACKGROUND

Graphical representation formats (e.g., icon arrays) have been shown to lead to better understanding of the benefits and risks of treatments compared to numbers. We investigate the cognitive processes underlying the effects of format on understanding: how much cognitive effort is required to process numerical and graphical representations, how people process inconsistent representations, and how numeracy and graph literacy affect information processing.

METHODS

In a preregistered between-participants experiment, 665 participants answered questions about the relative frequencies of benefits and side effects of 6 medications. First, we manipulated whether the medical information was represented numerically, graphically (as icon arrays), or inconsistently (numerically for 3 medications and graphically for the other 3). Second, to examine cognitive effort, we manipulated whether there was time pressure or not. In an additional intervention condition, participants translated graphical information into numerical information before answering questions. We also assessed numeracy and graph literacy.

RESULTS

Processing icon arrays was more strongly affected by time pressure than processing numbers, suggesting that graphical formats required more cognitive effort. Understanding was lower when information was represented inconsistently (v. consistently) but not if there was a preceding intervention. Decisions based on inconsistent representations were biased toward graphically represented options. People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did. Graph literacy was not related to processing efficiency.

LIMITATIONS

Our study was conducted with a nonpatient sample, and the medical information was hypothetical.

CONCLUSIONS

Although graphical (v. numerical) formats have previously been found to lead to better understanding, they may require more cognitive effort. Therefore, the goal of risk communication may play an important role when choosing how to communicate medical information.

HIGHLIGHTS

This article investigates the cognitive processes underlying the effects of representation format on the understanding of statistical information and individual differences therein.Processing icon arrays required more cognitive effort than processing numbers did.When information was represented inconsistently (i.e., partly numerically and partly graphically), understanding was lower than with consistent representation, and decisions were biased toward the graphically represented options.People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did.

Confidence deficits and reducibility: Toward a coherent conceptualization of uncertainty level

Outside of the field of risk analysis, an important theoretical conversation on the slippery concept of uncertainty has unfolded over the last 40 years within the adjacent field of environmental risk. This literature has become increasingly standardized behind the tripartite distinction between uncertainty location, the nature of uncertainty, and uncertainty level, popularized by the "W&H framework." This article introduces risk theorists and practitioners to the conceptual literature on uncertainty with the goal of catalyzing further development and clarification of the uncertainty concept within the field of risk analysis. It presents two critiques of the W&H framework's dimension of uncertainty level-the dimension that attempts to define the characteristics separating greater uncertainties from lesser uncertainties. First, I argue the framework's conceptualization of uncertainty level lacks a clear and consistent epistemological position and fails to acknowledge or reconcile the tensions between Bayesian and frequentist perspectives present within the framework. This article reinterprets the dimension of uncertainty level from a Bayesian perspective, which understands uncertainty as a mental phenomenon arising from "confidence deficits" as opposed to the ill-defined notion of "knowledge deficits" present in the framework. And second, I elaborate the undertheorized concept of uncertainty "reducibility." These critiques inform a clarified conceptualization of uncertainty level that can be integrated with risk analysis concepts and usefully applied by modelers and decisionmakers engaged in model-based decision support.

Explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy: Based on action research

Background and Aims

Reluctance to childbearing and then the reduction of the total fertility rate are common experiences of developed countries and many developing countries, including Iran, therefore, the purpose of this study was explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy.

Methods

The study was conducted by action research and according to RCCE during 9 months in Ardabil city. The statistical population consisted of 41 married women aged 15-54 who were eligible for childbearing, these women were purposefully selected from among the people covered by Ardabil health centers and interviewed. Data were collected using open and in-depth interviews by the researcher and analyzed by content analysis.

Results

The results of data analysis led to the extraction of three main categories, personal, familial, and social barriers. The "personal barriers" category was classified into three subcategories, namely mental, belief, and awareness barriers, the "familial barriers" category was classified into two subcategories, namely social and financial barriers, and the "social barriers" category was classified into two subcategories, political and managerial barriers.

Conclusions

According to the results, a set of personal, familial, and social factors could affect childbearing among married women. Identification of these factors can play an effective role in designing educational and managerial programs.

Examining expertise: Synthetic biology experts' perceptions of risk, benefit, and the public for research and applications regulation

Scientific experts can play an important role in decision-making surrounding policy for technical and value-laden issues, often in contexts that directly affect lay publics. Yet little is known about what characterizes scientific experts who want lay public involvement in decision-making. In this study, we examine how synthetic biology experts' perceptions of risks, benefits, and ambivalence for synthetic biology relate to views of lay publics, deference to scientific authority, and regulations. We analyzed survey data of researchers in the United States, who published academic articles relating to synthetic biology from 2000 to 2015. Scientific experts who see less risk and are more deferent to scientific authority appear to favor a more closed system in which regulations are sufficient, citizens should not be involved, and scientists know best. Conversely, scientific experts who see more potential for risk and see the public as bringing a valuable perspective appear to favor a more open, inclusive system.

The Lure of Beauty: People Select Representations of Statistical Information Largely Based on Attractiveness, Not Comprehensibility

OBJECTIVE

People differ in whether they understand graphical or numerical representations of statistical information better. However, assessing these skills is often not feasible when deciding which representation to select or use. This study investigates whether people choose the representation they understand better, whether this choice can improve risk comprehension, and whether results are influenced by participants' skills (graph literacy and numeracy).

METHODS

In an experiment, 160 participants received information about the benefits and side effects of painkillers using either a numerical or a graphical representation. In the "no choice" condition, the representation was randomly assigned to each participant. In the "choice" condition, participants could select the representation they would like to receive. The study assessed gist and verbatim knowledge (immediate comprehension and recall), accessibility of the information, attractiveness of the representation, as well as graph literacy and numeracy.

RESULTS

In the "choice" condition, most (62.5%) chose the graphical format, yet there was no difference in graph literacy or numeracy (nor age or gender) between people who chose the graphical or the numerical format. Whereas choice slightly increased verbatim knowledge, it did not improve gist or overall knowledge compared with random assignment. However, participants who chose a representation rated the representation as more attractive, and those who chose graphs rated them as more accessible than those without a choice.

LIMITATIONS

The sample consisted of highly educated undergraduate students with higher graph literacy than the general population. The task was inconsequential for participants in terms of their health.

CONCLUSIONS

When people can choose between representations, they fail to identify what they comprehend better but largely base that choice on how attractive the representation is for them.

HIGHLIGHTS

People differ systematically in whether they understand graphical or numerical representations of statistical information better. However, assessing these underlying skills to get the right representation to the right people is not feasible in practice. A simple and efficient method to achieve this could be to let people choose among representations themselves.However, our study showed that allowing participants to choose a representation (numerical v. graphical) did not improve overall or gist knowledge compared with determining the representation randomly, even though it did slightly improve verbatim knowledge.Rather, participants largely chose the representation they found more attractive. Most preferred the graphical representation, including those with low graph literacy.It would therefore be important to develop graphical representations that are not only attractive but also comprehensible even for people with low graph literacy.

Do colored cells in risk matrices affect decision-making and risk perception? Insights from randomized controlled studies

Risk matrices communicate the likelihood and potential impact of risks and are often used to inform decision-making around risk mitigations. The merits and demerits of risk matrices in general have been discussed extensively, yet little attention has been paid to the potential influence of color in risk matrices on their users. We draw from fuzzy-trace theory and hypothesize that when color is present, individuals are likely to place greater value on reducing risks that cross color boundaries (i.e., the boundary-crossing effect), leading to sub-optimal decision making. In two randomized controlled studies, employing forced-choice and willingness-to-pay measures to investigate the boundary-crossing effect in two different color formats for risk matrices, we find preliminary evidence to support our hypotheses that color can influence decision making. The evidence also suggests that the boundary-crossing effect is only present in, or is stronger for, higher numeracy individuals. We therefore recommend that designers should consider avoiding color in risk matrices, particularly in situations where these are likely to be used by highly numerate individuals, if the communication goal is to inform in an unbiased way.

Same Score, Different Audience, Different Message: Perceptions of Sex Offense Risk Depend on Static-99R Risk Level and Personality Factors of the Recipient

There are multiple ways to report risk scale results. Varela et al. (2014) found that Static-99R results were interpreted differently by prospective jurors based on risk level (high vs low) and an interaction between risk level and risk communication format (categorical, absolute estimate, and risk ratio). We adapted and extended Varela et al.'s (2014) study using updated Static-99R norms, recruiting a population-wide sample (n = 166), and adding variables assessing the personality factors 'cognitive motivation' (i.e., need for cognition) and 'attitudinal affect' (i.e., attitudes toward sex offenders, authoritarianism). We found a main effect of risk level and no effect of either communication format or the interaction between the two. Adding the personality variables increased explained variance from 9% to 34%, suggesting risk perception may be more about the personality of the person receiving the information than the information itself. We also found an interaction between attitudes toward sex offenders and risk level. Our results suggest risk perception might be better understood if personality factors are considered, particularly attitudes toward sex offenders. Because biases/personality of the person receiving the information are unknown in real world settings we argue that sharing multiple methods for communicating risk might be best and more inclusive.

Anticipated Psychological or Behavioral Reactions to Learning Alzheimer Biomarker Results: Associations With Contextual Factors

BACKGROUND

As Alzheimer disease (AD) biomarker testing becomes more widely available, adults may opt to learn results. Considering potential reactions to learning biomarker results can guide prebiomarker and postbiomarker testing education and counseling programs.

METHODS

Cognitively healthy adults enrolled in observational Alzheimer research responded to a telephone survey about learning AD risk information (n=334; 44% Black or African American; mean age=64.9±7.0). Multiple linear regression models tested if contextual factors predicted anticipated psychological impact (distress, stigma, and cognitive symptoms) or behavior change (planning and risk-reduction). Secondary analyses tested for differences in relationships by racial identity.

RESULTS

Internal health locus of control, concern about AD, self-identified sex, education, family dementia history, and belief in AD modifiability predicted anticipated psychological impact. Concern about AD, age, racial identity, belief in AD modifiability, research attitudes, and exposure to brain health-related social norms predicted anticipated behavior change. For Black respondents, there were no sex differences in anticipated distress, whereas there were stronger relationships between health locus of control, brain health social norms, and education on outcomes compared with White respondents.

CONCLUSIONS

Results may inform personalized and culturally tailored biomarker testing education and counseling to minimize psychological impacts and increase behavior change related to learning AD risk information.

A structured literature review of the health infodemic on social media in Africa

Infodemics is a multi-faceted threat that needs to be dealt with by governments during public health emergencies. This strategic review described the role of social media platforms in creating and reinforcing an infodemic during health pandemics in Africa. The inclusion criteria for the review were African research on infodemics on social media during pandemics, epidemics or endemics in the past 10 years. A structured literature review, making use of the Sample, Phenomenon of Interest, Design, Evaluation, Research (SPIDER) scoping review methodology framework, identified scholarly publications from various academic databases. A total of 41 articles met the eligibility criteria. The six factors identified included stakeholders, socio-economic context, conspiracy theories, sources of information, government responses and verification mechanisms. The findings of this study indicate that governments needs to include infodemics in the risk communication strategy for public health emergencies. Verification of misinformation can mitigate the effects of conspiracy theories while the socio-economic context of the audience will influence planning strategies to mitigate infodemics on social media.

Contribution

This study contributes to the knowledge base of risk communication during pandemics in Africa by providing a review of how infodemics on social media have influenced the COVID-19 pandemic on the continent. The results also provide a foundation for the research agenda in this research field that will provide an evidence-based response to the pandemic in Africa.

A risk science perspective on vaccines

Vaccines can be seen as one of the greatest successes in modern medicine. Good examples are the vaccines against smallpox, polio, and measles. Unfortunately, vaccines can have side effects, but the risks are considered by the health authorities and experts to be small compared to their benefits. Nevertheless, there are many who are skeptical of vaccination, something which has been very clearly demonstrated in relation to the COVID-19 disease. Risk is the key concept when evaluating a vaccine, in relation to both its ability to protect against the disease and its side effects. However, risk is a challenging concept to measure, which makes communication about vaccines' performance and side effects difficult. The present article aims at providing new insights into vaccine risks-the understanding, perception, communication, and handling of them-by adopting what is here referred to as a contemporary risk science perspective. This perspective clarifies the relationships between the risk concept and terms like uncertainty, knowledge, and probability. The skepticism toward vaccines is multifaceted, and influenced by concerns that extend beyond the effectiveness and safety of the vaccines. However, by clarifying the relationships between key concepts of risk, particularly how uncertainty affects risk and its characterization, we can improve our understanding of this issue.