FOUNDATIONS OF RISK COMMUNICATION AND

COMMUNITY ENGAGEMENT (RCCE)

MODULE 1B

MANAGING UNCERTAINTY
ESTABLISHING AND MAINTAINING TRUST
LISTENING

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MANAGING UNCERTAINTY

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 What we know from the research
Uncertainty is always part of public health emergencies

Common areas of uncertainty:

• Causes
• Scope of harm
• At-risk groups
• Effective interventions
• Outcomes related to a health threat

3 kinds of uncertainty:
• In messages about “unknowns”
• Between conflicting messages
• Found in the context of multiple uncertainties (economic, social, etc.)
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 What causes the most confusion in your area?

q When the government communicates about what is still unknown

regarding COVID-19.

q When the government changes recommendations and guidance over

time.

q When various organizations provide conflicting information or

recommendations about COVID-19.

q When people hear different recommendations that apply

in different locations.

q Other?
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 After 10 months: COVID-19 Still Awash in Uncertainties

Bloomberg: Africa Lifts Curfew: https://www.bloomberg.com/news/articles/2020-10-31/nigeria-lifts-curfew-on-africa-s-biggest-city-after-protests

WA Post: https://www.washingtonpost.com/world/2020/10/28/melbourne-australia-coronavirus-lockdown-111-days/
The Guardian: On the brink of disaster: https://www.theguardian.com/world/2020/oct/16/on-the-brink-of-disaster-europes-covid-fight-takes-a-turn-for-the-worse
news.com.au: China comes out of COVID-19: https://www.news.com.au/world/coronavirus/china-comes-out-of-covid19-absolutely-laughing/news-story/e290b19533817fd277a16f8ad9be12fb
British government adviser: https://nypost.com/2020/10/17/uk-government-adviser-calls-for-lockdown-amid-covid-resurgence/

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 We still don’t know . . .
When will it be safe to embrace my friends? Which “wave” are we in now?
When will COVID-19 be over? How long can COVID-19 affect people?

If I was already infected and recovered, am I immune? For how long?

When will I be able to get the vaccine to prevent COVID-19?
When can my children go back to school?
How many people will ultimately die from COVID-19?
How can we balance needs of the economy with stopping COVID-19?
Will COVID-19 mutate?
How long before I can travel internationally?

Will the new strain of COVID-19 affect vaccine efficacy?

Where is it safe to travel now?
Is the virus that lands on surfaces enough to infect someone?
Is it safe to go back to work?

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 Transparency and Consistency:
Messaging to Manage Uncertainty
• Explicitly acknowledge uncertainties—it is associated with
trust
– Transparency is highly valued
– Say what is known with what is unknown
– Set expectations for change
• Information must be consistent
– Over time
– Between sources
• Discrepancies must be explained
• When you don’t have the answer, be transparent about how
decisions are being made.

Sopory, et al., 2019; WHO, 2017; Savoia, Viswanth K. 2015; HEALTH

Schoch-Spana et al, 2016; Pappenberger, 2018, Quinn, et al. 2008, EMERGENCIES
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Taylor-Clark 2007; Infanti, et al., 2013.
 Say how decisions are being made
in the context of uncertainty

28 May 2020—EURO’s COVID-19 Guidelines

for Prisons

“In this situation of uncertainty, we explored

all the ideas we had to tackle the potential
outbreak. We amended checklists almost
every day to find the right ways to
operate”, said Dr Giuliani. Dr Ruggero Giuliani,
who has been coordinating
http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid- COVID-19 control measures in the
19/news/news/2020/5/experience-of-health-professionals,-police-staff-and- San Vittore prison, located in
prisoners-in-italy-informs-who-covid-19-guidelines-for-prisons Italy’s Lombardy region.
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ESTABLISH AND MAINTAIN TRUST

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 The Messenger Matters: TRUST
The overriding goal for outbreak
communications is to communicate
with the public in ways that build
TRUST.
WHO Outbreak Communication Guidelines, 2005

Positive outcomes of strong trust include:

• Increased practice of protective behaviors
• Higher levels of message acceptance
• Participation in preparedness
• Increased vaccine acceptance

Besley et al., 2012; Bitsch, Koković & Rombach, 2014; Freimuth, et al 2014; Gilles, et al. 2011; Mei et al., 2013; Paton, 2008; Perko
et al., 2012; van der Weerd et al., 2011; Sopory et al., in press.

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 Trust is public perception of the messenger
●Are risk managers competent?
●Are they in agreement with other
Your skills
experts?
●Are risk managers part of your
“community”?
●Do they share your values?
Your Your
●Will they share in the burden relationships motives
and consequences of the ●Are they acting to
advice they give you? TRUST safeguard my health?

Your Your
integrity empathy
●Do they understand, respect, and
●Are risk managers telling the truth? care about me and my concerns?
●Are they reliable?
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Building a Foundation of Trust through Messaging

Dialogue

Multiple
Timely
channels

Easy-to- Avoid
Link to self-
understand rapid
efficacy
changes

Acknowledge Coordinated and

Link to accessible
consistent with other Transparency
services uncertainty responders

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WHO, 2017 EMERGENCIES
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ENGAGEMENT:
LISTENING/RESPONDING & COMMUNITY ENGAGEMENT

Photo credit: https://apps.who.int/iris/bitstream/handle/10665/259807/9789241550208- HEALTH

eng.pdf?sequence=2 EMERGENCIES
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No “best way,” but many good options for listening

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WHO 2008; WHO 2017

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 Adapting Listening Mechanisms Locally

West Africa Ebola 2014-2016

• Liberia
• Geopoll and Internews
• Monthly SMS surveys on concerns and information sources
• 200 citizens in each of five regions of the country

“When dealing with complex issues like Ebola, you have to start with
what information Is most critical to the local population, not with what
you want them to know . . .” Mark Frohardt, Internews

Multimedia monitoring Sierra Leone - W. Africa Ebola

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 The Ambulance Project:
Listening and Responding

Roving Ambulance exhibits by U.S. CDC, WHO, UNICEF, Village of Buya Romende, Sierra Leone . Sierra Leonean WHO
District Health Management Team, Port Loko Sierra Leone staff person provides an introduction to the Ambulance project,
Photo: Erin Burdette

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U.S. Centers for Disease Control, 2015 EMERGENCIES

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 What is Community Engagement?

• Facilitating decision-making at the local level

• Inclusion of communities early in preparedness and response activities
• Identifying and empowering sources in the community that are credible to
local audiences
• Working with community member to tailoring and localize health messages
and materials
• Empowering community members to tailor and mobilize community
interventions
• Encouraging community based participation in the development and
dissemination of messaging can help inform the types of strategies to be
used
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 Benefits of Community Engagement (CE)

The success of institutional emergency plans

depends on communities and institutions working
together.

Collaborative relationship generates more timely response.

Higher levels of public involvement/engagement

linked to improved community response.

Involvement of the community in the

development of interventions and messages
increases attention and “buy in.”
Bavel et al. 2020; CDC, 2009; CDC 2017; CDC, 2018; Shiavo et al. 2014; NCCAH 2016; PAHO HEALTH
2016; Ramsbottom et al.; 2017; WHO, 2017; Hsu et al. 2017
Photo credit: https://apps.who.int/iris/bitstream/handle/10665/259807/9789241550208-
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eng.pdf?sequence=2
 RCCE

Risk
Trust Uncertainty
Perception

Listening Dialogue Engagement

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THANK YOU

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