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BUILDING COMMUNICATION
CAPACITY TO COUNTER
INFECTIOUS DISEASE
THREATS
Proceedings of a Workshop
Additional copies of this publication are available for sale from the National
Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800)
624-6242 or (202) 334-3313; http://www.nap.edu.
Project Staff
CECI MUNDACA-SHAH, Director, Forum on Microbial Threats
V. AYANO OGAWA, Associate Program Officer
T. ANH TRAN, Senior Program Assistant
JULIE PAVLIN, Director, Board on Global Health
Consultant
JOE ALPER, Consulting Writer
__________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning
committees are solely responsible for organizing the workshop, identifying topics,
and choosing speakers. The responsibility for the published Proceedings of a
Workshop rests with the workshop rapporteurs and the institution.
FORUM ON MICROBIAL THREATS1
__________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and
roundtables do not issue, review, or approve individual documents. The
responsibility for the published Proceedings of a Workshop rests with the
workshop rapporteurs and the institution.
Reviewers
1 INTRODUCTION
Meeting Objectives
Organization of the Proceedings of a Workshop
REFERENCES
APPENDIXES
A STATEMENT OF TASK
B WORKSHOP AGENDA
C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND
MODERATORS
Boxes, Figures, and
Tables
BOXES
FIGURES
7-1 Responses to the question, “In one word, what do you think the
biggest challenge is with building communication capacity to
counter infectious disease threats?”
TABLES
MMR mumps-measles-rubella
Introduction1
MEETING OBJECTIVES
To learn about current national and international efforts to develop
the capacity to communicate effectively during times of infectious
disease outbreaks, and to explore gaps in the research agenda that
may help address communication needs to advance the field, the
Forum on Microbial Threats of the National Academies of Sciences,
Engineering, and Medicine convened a 1.5 day workshop on
December 13 and 14, 2016, in Washington, DC. This workshop
brought together stakeholders at different levels of outbreak
detection, preparedness, and response. They reviewed progress and
needs in strengthening communication capacity for dealing with
infectious disease threats for both outbreaks and routine challenges
in the United States and abroad. An ad hoc committee with
members Jeffrey S. Duchin (Chair), Baruch Fischhoff, Jennifer Gardy,
Rima F. Khabbaz, Rafael Obregon, Jennifer Olsen, J. Douglas Storey,
and Janet Tobias planned the workshop. The workshop featured
invited presentations and discussions that aimed to meet the
workshop’s objectives (see Box 1-1).4
In his welcome to the workshop attendees, David Relman, the
Thomas C. and Joan M. Merigan Professor at Stanford University,
noted that the forum members have been discussing the essential
role communication plays in the prevention, detection, and response
to microbial threats and have sought to organize a workshop to
discuss key problems and strategies around this important topic for
several years. “We view these topics as fundamental to the business
of translating theory and research and development into policy in the
realm of emerging infectious disease,” said Relman. Jeffrey Duchin,
health officer and chief of the Communicable Disease Epidemiology
and Immunization Section for Public Health in Seattle and King
County, Washington, added that the high-level goals of the
workshop were to highlight the benefit and importance of cross-
disciplinary contributions in this area and to examine opportunities
and challenges for building improved communication capacity and
capability.
BOX 1-1
Workshop Objectives
Examine the key elements of communication capacity
necessary to address infectious disease threats, including
scientific foundations for effective communication;
roles of scientists and health professionals, the community,
and media;
evidence-based methods for designing, pretesting, and
evaluating communication strategies; and
multisector support for investment in these capabilities.
Examine the current state of science regarding public
engagement and trust, the understanding of risk and health-
protective behaviors, and behavioral responses, including
the cognitive, affective, social, and economic factors
shaping health-related decision making;
the roles of persuasive versus nonpersuasive
communication;
the roles of traditional and digital media;
proactive and reactive management of misinformation and
rumors; and
bidirectional communication platforms, both to engage the
public and to generate data.
Assess the implications of the 2005 International Health
Regulations (IHR) and lessons learned from recent
outbreaks.
Discuss research needs, opportunities, and barriers for
collaboration among, across, and within the epidemiology,
biomedical, and social and behavioral science communities.
__________________
1 The planning committee’s role was limited to planning the workshop, and the
Proceedings of a Workshop has been prepared by the workshop rapporteurs as a
factual summary of what occurred at the workshop. Statements,
recommendations, and opinions expressed are those of individual presenters and
participants and are not necessarily endorsed or verified by the National
Academies of Sciences, Engineering, and Medicine, and they should not be
construed as reflecting any group consensus.
2 Available at www.who.int/topics/international_health_regulations/en (accessed
February 13, 2017).
3 See www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa (accessed February
23, 2017).
4 The full statement of task is available in Appendix A.
2
Perspectives on Building
Communication Capacity to
Counter Infectious Disease
Threats
FIGURE 2-1 As the delay between outbreak and risk communication widens,
the opportunity to control the outbreak diminishes.
SOURCE: Rainford presentation, December 13, 2016.
FDA has developed a strategic plan for risk communication (FDA Risk
Communication Advisory Committee, 2009) that attempts to balance
moving too early and raising a needless alarm and moving too late and
missing an opportunity to reduce mortality and morbidity. FDA, said
Fischhoff, has recognized that it does not know the public audience very
well. This type of document addresses building baseline capacity within an
organization, but a need also exists to prepare surge capacity that brings
in external resources, particularly people who are not on the front lines at
all times and who have time to think about these types of issues. As an
example of surge capacity, Fischhoff mentioned the Applied Psychology
Unit at the United Kingdom’s Medical Research Council, which was a
collection of external experts who conducted behavioral research and
stood ready to help British agencies and stakeholders.
Summarizing his presentation, Fischhoff said the science of
communicating well about infectious diseases exists and is often used
effectively. Communicating well about infectious diseases, he stated,
requires diverse forms of expertise and trusted relationships. He added
that providing the resources and organization needed to address routine
challenges and disease outbreaks requires strategic leadership.
When asked what he thought the biggest challenge to successful risk
communication was, Fischhoff replied that the biggest challenge was not
letting the problem get out of control. “Research suggests that you can
explain most things to most people if you have not lost control of the
problem,” he said. “But once the problem gets out of control, then you
have other people grabbing the microphone who have other agendas and
you have misinformation that gets out.” As examples of what can go
wrong, he said the climate change community and nuclear power industry
made the mistake of believing that their story would tell itself. Capacity
building that views communications as a two-way process and includes
trust-building activities can enable organizations to get out in front and
stay ahead of problems, Fischhoff added.
Fagerlin noted that, of the three choices, participants in the study liked
the heat map best, a key finding given that aesthetics can play a
significant role in getting people to pay attention in the first place. In the
social media age, when information sharing is important, people are more
likely to share something they find aesthetically pleasing, she said. “As
long as different approaches are equivalent in terms of knowledge, risk
perception, and behavioral intentions, I think it is important that we ask
people what they like and do not like so that we can communicate farther
and wider,” said Fagerlin.
Persuasion can be a critical risk communication tactic for influencing
behavior, but persuasion using social norms can be tricky, said Fagerlin. As
an example, she explained that telling people that almost half of all
American adults do not vote does not inspire people to vote. In fact, she
said, it has the opposite effect because it absolves them of the guilt of not
voting. The same is true for immunization: trying to inspire people by
using the concept of herd immunity to get them to contribute to that
common good has the opposite effect.
One promising risk communication tactic is to target messages and the
media for conveying those messages to reach specific groups of people.
“How we communicate should differ based on the audience that we are
trying to reach,” said Fagerlin. However, in this age of informatics and
social media, message targeting should be more sophisticated than basing
it on broad categories such as sex, race, or ethnicity, added Fagerlin.
Given that Google can pop up ads based on what someone searches for
on Amazon, Fagerlin wondered how the public health community could
make the same type of highly targeted connections.
Fagerlin briefly discussed message evaluation, and how many
investigators, including herself, use survey measures to assess knowledge,
risk perceptions, behavioral intentions, and satisfaction with messages.
However, she said, surveys may not be the best approach for evaluating
messages, and as an example she discussed the results of a study on the
effectiveness of various public service announcements intended to get
smokers to call a quit line (Falk et al., 2011). In this study, Falk and her
colleagues had participants watch several professionally created television
ads and asked them which would be more effective at getting people to
quit smoking. A second group of participants watched the same ads while
the researchers monitored the participants’ brain activity by using
functional magnetic resonance imaging (fMRI). When these ads ran on
California television stations, the fMRI results accurately predicted which
public service announcements would be the most effective; the survey
results had no predictive power. Although testing every message using
fMRI is not feasible, it points to the importance of using other
physiological and ecological measurements, such as how long people look
at messages and how often they share them, said Fagerlin.
She noted in closing that it is imperative to think about who the
audience is and to talk to that audience before launching a campaign.
Using new services such as Amazon Mechanical Turk, Knowledge
Networks, and Survey Sampling International, she suggested, is a
relatively simple and quick means to test various strategies with intended
audiences.
J. F. Granlund
J .F. Granlund
J. F. Granlund
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Wijooliani
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Pullot ja kannut
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Kolkutan vielä:
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Päähäni lakin
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Klingeli plingeli klingeli plang.
J .F. Granlund
J .F. Granlund
Kemell
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