COMMUNICATION IN RISK SITUATIONS

RESPONDING TO THE COMMUNICATION CHALLENGES POSED BY BIOTERRORISM AND EMERGING INFECTIOUS DISEASES

April 2002

COMMUNICATION IN RISK SITUATIONS

RESPONDING TO THE COMMUNICATION CHALLENGES POSED BY BIOTERRORISM AND EMERGING INFECTIOUS DISEASES

Acknowledgements		3
Introduction		4
Background: Communication Theory and Practice		5
	Risk Communication Rules	6
	Risk Communication Theories	7
Message Maps		9
	Smallpox Questions	9
	Draft Sample Message Maps	13
Working with the Media		16
	77 Questions Commonly Asked by Journalists	16
	Interview Tips	18
Involving the Community		20
	Public Meetings	21
	Factors that Influence Public Perception	22
	Methods of Communication	23
	Avoiding Pitfalls in Presentations & Interviews	24
	Presentation Aids	26
	Using Risk Comparisons	27
	Managing Hostile Situations	27
CDC Bioterrorism Guidance: Communication		29
Bibliography		31
Supplemental Reading		35

Copyright 2002 Association of State and Territorial Health Officials
Acknowledgements

Much of the material presented in this document has been sourced from workshops presented for ASTHO by Dr. Vincent T. Covello, Director of the Center for Risk Communication, New York, N.Y., and are used with his permission. Additional materials have been provided by the staff of the Center for Risk Communication and are used with permission.

Sincere appreciation and thanks are extended to Vincent T. Covello, PhD, for his invaluable contributions to the science of risk communication and to the development of this workbook, to Stacy Baker, Public Health Foundation, for her assistance and dedication, and to Cynthia Johansson for her insight and professionalism.

ASTHO would also like to thank the Centers for Disease Control and Prevention, The National Center of Environmental Health, and the National Center of Infectious Diseases for their support of this project.

ASTHO also acknowledges the guidance and support of ASTHO members and other public health officials who participated in the focus groups that helped determine the direction of this project.

This workbook was compiled and edited by Paula A. Steib, Director of Communications, Association of State and Territorial Health Officials.
Introduction

The purpose of this workbook is to provide a guideline for the communication of health risk information to diverse audiences in response to the risks posed by bioterrorism and emerging infectious diseases. It is intended for public information staff and state public health officials who must respond to media and public concerns about public health emergencies – natural or manmade.

It is critical to have a plan in place to deal with a crisis before it happens. This workbook and the accompanying webcasts are intended to help state health officials and public information officers work together to create crisis communication plans and messages.

The workbook includes specific suggestions for mapping our responses to anticipated questions, for presenting information, and for interacting effectively with the media and the public. A section is devoted specifically to communications guidelines for dealing with a smallpox incident.

Much of the material in this workbook deals with establishing trust and credibility – two of the cornerstones of effective risk communications. When an issue is of high concern, such as the 2001 anthrax incidents or the threat of a smallpox outbreak, trust and credibility on the part of communicators is essential. Without them your message will not be heard, people will not make informed decisions, and problems can escalate.

Communicating information about possible life threatening issues can be difficult, but if it is not done well, the communicator can put the public at greater risk by creating misunderstanding or possibly inciting panic. Professional communicators owe it to the people and agencies they represent, as well as to the public, to be prepared to deal with a crisis – natural or man made.

Background: Communication Theory and Practice

Belief in some common myths often interferes with development of an effective risk communication program. Consider the myths listed below and the actions you can take to develop a risk communication strategy that leaves you and your organization prepared to meet a crisis situation with accurate messages.

Myth: Telling the public about a risk is more likely to unduly alarm people than keeping quiet.
Reality: Decrease potential for alarm by giving people a chance to express their concerns.

Myth: Communication is less important than education. If people knew the true risks, they would accept them.
Reality: Pay as much attention to your process for dealing with people as you do to explaining the data.

Myth: We shouldn't go to the public until we have solutions to health threats.
Reality: Release and discuss information about risk management options and involve communities in strategies in which they have a stake.

Myth: These issues are too difficult for the public to understand.
Reality: Separate public disagreement with your policies from misunderstanding of technical issues.

Myth: Technical decisions should be left in the hands of technical people.
Reality: Provide the public with information. Listen to community concerns. Involve staff with diverse backgrounds in developing policy.

Myth: Risk communication is not my job.
Reality: As a public servant, you have a responsibility to the public. Learn to integrate communication into your job and help others do the same.

Myth: If we give them an inch, they'll take a mile.
Reality: If you listen to people when they are asking for inches, they are less likely to demand miles. Avoid the battleground. Involve people early and often.

Myth: If we listen to the public, we will devote scarce resources to issues that are not a great threat to public health.
Reality: Listen early to avoid controversy and the potential for disproportionate attention to lesser issues.

Risk Communication Rules

You should have a plan in place before a crisis occurs whenever possible. The first 24 hours are critical. Be prepared to do the following:

• Contact local TV and radio stations
• Build or update a web site to disseminate information
• Set up and staff a 24-hour hotline
• Write and distribute educational fliers in the major languages spoken in your region
• Coordinate with police, fire, and emergency services personnel
• Prepare press materials to announce your response to the crisis

Don’t let the issue be defined by someone else. Don’t think that keeping a lid on the story will prevent the public from seeking information.

Accept and involve the public as a partner.
Your goal is to inform the public, not to defuse public concerns or replace actions.

Plan carefully and evaluate your efforts.

Different goals, audiences, and media require different actions.

Listen to the public's specific concerns.

People often care more about trust, credibility, competence, fairness, and empathy than about statistics and details.

Be honest, frank, and open.
Trust and credibility are difficult to obtain. Once lost, they are almost impossible to regain.

Work with other credible sources.
Conflicts and disagreements among organizations make communication with the public much more difficult.

Meet the needs of the media.
The media are usually more interested in politics than risk, simplicity than complexity, danger than safety.

Speak clearly and with compassion.
Never let your efforts prevent your acknowledging the tragedy of an illness, injury, or death.

Risk Communication Theories

One of the most important things to remember in risk communication is that perception equals reality. The following theories help to explain what happens to an individual’s ability to assimilate information when they feel threatened.

risk = hazard + outrage

TRUST DETERMINATION THEORY: When people are upset they often distrust that others are listening, caring, empathetic, honest, open, competent, expert, dedicated, or committed.

Factors that build trust are:

· Caring and empathy

· Competence and expertise

· Honesty and openness

· Dedication and commitment

Your audience will evaluate the credibility of your communications against these factors and over 50% of your credibility will be dependent upon whether or not you are perceived as empathetic and caring. In most communications your audience will decide this in the first 9-30 seconds.

The higher the level of your audience’s emotion or distrust, the more you will need to consistently communicate that you are listening, that you care, and that you are empathetic.

You can build trust and credibility by using support from credible third party sources. A lower credibility source takes on the credibility of the highest credible source that agrees with its position on an issue. When a lower credibility source attacks the credibility of a higher credibility source, the lower credibility source losses additional credibility. Remember, the only information source that can effectively attack the credibility of another source is one of equal or higher credibility.

Who typically has the highest credibility?

· High: health professionals, scientists, educators, advisory groups

· Medium: Media, activist groups

· Low: Industry, paid external consultants

MENTAL NOISE THEORY: When people are upset they have difficulty hearing, understanding, and remembering.

· Send a limited number of clear messages: 3 key messages

· Keep messages brief: 10 seconds or 30 words

· Repeat messages: Tell them what your going to tell them. Tell them. Tell them what you told them.

· Use visual aids: graphics, slides

· Be aware that it takes three positive messages to balance one negative statement

· Avoid unnecessary use of the words: No, Not, Never, Nothing, None

Body Language

Body Language often overrides verbal communication. It can provide up to 75% of message content. It is noticed intensely and is easily negatively interpreted.

• Poor eye contact can leave an audience feeling that you are dishonest, unconcerned or nervous

• Sitting back in your chair can make you look uninterested or unconcerned

• Crossing your arms across your chest can convey that you are defiant, defensive, or uninterested

• Frequent hand to face contact can make you look dishonest or nervous

• Drumming or tapping with hands or feet conveys nervousness, hostility, or impatience

• Resting your head in your hand can make you look bored or tired

• A raised voice can send the message that you are hostile, nervous, or deceitful

Message Maps

Your responses to an individual's questions and concerns will affect your success. Prepare and practice. Consider how to answer questions in general and how to respond to specific inquiries.

Guidelines

• Be prepared. If you know your subject and know your audience, most questions can be anticipated. Develop and practice responses.
• Track Your Key Messages. Use your responses as opportunity to reemphasize your key messages.
• Keep Your Answers Short and Focused. Your answer should be less than 2 minutes long.
• Practice Self-Management. Listen. Be confident and factual. Control your emotions.
• Speak and Act with Integrity. Tell the truth. If you don't know, say so. Follow up as promised. If you are unsure of a question, repeat or paraphrase it to be certain of the meaning.
• Whenever possible develop message maps

Message maps are risk communication tools that are used to help address mental noise. They help organize complex information and make it easier to express current knowledge.

o Limit to 3 key messages

o Maximum of 3 supporting statements for each key message

Several organizations, including the Center for Risk Communication, ORISE and the Centers for Disease Control and Prevention, are working to develop messages for questions relating to smallpox. Work has been based in part on case studies of anthrax, West Nile virus, and influenza. Sample questions are listed below, followed by examples of sample message maps.

Smallpox Questions:

How contagious is smallpox?

Can everyone be vaccinated?

What are the signs and symptoms of smallpox?

Who’s in charge?

Why is smallpox a good weapon?

What makes you think the strategies of the 60s and 70s will work today?

What’s being done to prepare?

What kind of medical care will be available? Is there enough?

What resources will be used to identify and respond to an outbreak?

Could terrorists make a strain that you couldn’t protect against?

Are enough resources available to care for smallpox patients?

Are laboratories able to quickly diagnose smallpox?

How do you know the new vaccine will work?

Isn’t it true that smallpox has been known to be airborne in the past?

Can I get smallpox from water, mosquitoes, pets, or farm animals?