Reasoning for Public Health Emergency Risk Communication

1. Characteristics of Naturalistic Characteristics of Naturalistic Characteristics of Risk Communication Characteristics of Risk Communication Decision Making (Klein, et al., 1993) Decision Making (Klein, et al., 1993) in PH Emergencies/Urgent, High in PH Emergencies/Urgent, High Concern Events Concern Events ill ill - - structured problems structured problems incomplete information, missing facts incomplete information, missing facts Concept Model Concept Model -- -- Public Health Public Health uncertain dynamic environment uncertain dynamic environment uncertain dynamic environment uncertain dynamic environment RISK RISK Risk Communication in Emergencies Risk Communication in Emergencies shifting ill shifting ill - - defined goals defined goals evolving nature of urgent events evolving nature of urgent events action feedback loops action feedback loops agency, public and partner feedback agency, public and partner feedback ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT CHARACTERIZATION CHARACTERIZATION CHARACTERIZATION COMMUNICATION COMMUNICATION COMMUNICATION time stress time stress need for immediate information need for immediate information high stakes high stakes high event visibility high event visibility Public Health Culture Public Health Culture High Concern Event High Concern Event multiple players multiple players multiple stakeholders & levels of multiple stakeholders & levels of MESSAGE DEVELOPMENT MESSAGE DEVELOPMENT • • Collaborative Collaborative • • Time Sensitive Time Sensitive government government • • Factual, Deliberate Factual, Deliberate • • Incomplete Knowledge Incomplete Knowledge organizational goals/norms organizational goals/norms consultative, collaborative PH model consultative, collaborative PH model • • Process Oriented Process Oriented • • Urgent need for info Urgent need for info • • Target Population Focus Target Population Focus • • Broad Population Focus Broad Population Focus MESSAGE DELIVERY MESSAGE DELIVERY Decision support Decision support Decision support Decision support Decision support Decision support needed here needed here needed here needed here needed here needed here Phases of emergency message development Phases of emergency message development Phase (Themes) Phase (Themes) Sub Sub - - themes themes Comments Comments 1. Info receiving 1. Info receiving Cyclical Cyclical Collaborative Collaborative -- -- other other counties, epi staff, SHD & counties, epi staff, SHD & CDC CDC 2. Info seeking 2. Info seeking Cyclical Cyclical State HD and CDC State HD and CDC 3. Meeting 3. Meeting Who is in charge Who is in charge Collaborative Collaborative What What ’ ’ s the message s the message Cyclical Cyclical Who speaks Who speaks 4. Message content 4. Message content What What ’ ’ s the message s the message Cyclical Cyclical Who speaks Who speaks Use heuristics Use heuristics Collaboration Collaboration 5. Standardize 5. Standardize What What ’ ’ s the message s the message Message template guides Message template guides communication communication Who speaks Who speaks 6. Give out info 6. Give out info Who Who ’ ’ s in charge s in charge Means of distribution: Means of distribution: Who speaks Who speaks website, radio, newspaper, website, radio, newspaper, etc. etc. Reasoning for Public Health Emergency Risk Communication Jacqueline Merrill, RN, MPH 1, Suzanne Bakken, DNSc1,2 ,Vimla Patel, PhD 2 1School of Nursing and 2Department of Biomedical Informatics, Columbia University, New York, NY SCOPE OF THE PROBLEM RESULTS DISCUSSION • Public health risk communication in emergencies and urgent events is often sub optimal because established risk communication theory and principles can be overlooked • The routine steps of public health risk message development are affected by the nature of emergencies and urgent events (illustrated in model below) • Informatics methods can supply decision support tools to aid development of effective theory-based public health emergency risk messages • A foundational step to developing such support is clear understanding of the message development process • PRELIMINARY ANALYSIS • Subjects demonstrated sound conceptual knowledge of risk communication principles and theory • Message development steps were applied in different order than recommended by experts, and steps skipped • Subjects used message templates and heuristics • Message development relied strongly on collaboration and conformed to model of group decision making under stress • Naturalistic Decision Making Model conflicts with deliberate, consultative style of non-emergency decision making typical used in US public health agencies. • Factors associated with sub optimal group decision making in the Naturalistic Model include self censorship and undermined confidence • Sub optimal decisions are likely to contribute to sub-optimal messages • Example: all subjects skipped the message evaluation step recommended by experts, a step intended to expose message weaknesses • Secondary analysis revealed a structured process with well defined goals that could be automated • Decision support needed, such as partially automated text authoring that will test message completeness and conformance to risk communication theory • Decision support for public health emergency risk message development must address institutional culture and process evaluation FUTURE STUDY • Use rapid ethnography to explore contribution of public health organizational culture to message development process during actual urgent event • Model the workflow of message authors to develop algorithms to guide semi-automation of authoring process • Discourse analysis of existing risk messages to identify typical message structures and components of effective messages • Incorporate health communication theory into stages of automated message construction • SECONDARY ANALYSIS • Analysis focused on sequence of activities and steps involved • Goals are not ill defined (although problem may be) • Process phases (or themes) and sub-themes were identified • Process phases were cyclical or collaborative, sometimes both • Points of redundancy were message heuristic, standardized template and a strong collaborative approach OBJECTIVES • Identify theory-based principles and expert recommendations for emergency public health risk communication • Identify features of emergency risk message development in high concern situations • Examine how practice compares with theory-based recommendations • Identify process steps in emergency message development REFERENCES [1] Association of State and Territorial health Officials. Communication in Risk Situations. Wash. DC: Author, 2002 [2] Reynolds, B. Crisis and Emergency Risk Communication. Atlanta: Centers for Disease Control and Prevention, 2002. [3] Klein, GA, Orasanu, J, Calderwood, R. and Zsambock, CD. Decision making in action: models and methods. Norwood, CT: Ablex, 1993. [4] Hinds, P.S., Vogel, R.J., Clarke-Steffen, L. The possibilities and pitfalls of doing a secondary analysis of a qualitative data set, Qualitative Health Research, 1997, vol. 7(3): 408-24. METHODS • Think aloud protocol conducted with 3 experienced public health information officers • Subjects asked to describe actions performed while preparing public health risk communication to address a paper based emergency scenario • Preliminary analysis coded responses to published recommendations of emergency risk communication experts • Secondary analysis used open and axial coding to reveal massage process steps ACKNOWLEDGMENTS This work was supported by a National Institute of Nursing Research Training Grant, T32 NR007969. The authors thank Susan Ledlie, RN, DNSc for consultation on secondary data analysis