SEARO – CSR Training on Outbreak Investigation Outbreak Communications

SEARO – CSR Training on Outbreak Investigation

Outbreak Communications

Outbreak CommunicationsSEARO – CSR Training on Outbreak Investigation

Learning Objectives

At the end of the presentation, participants should be able to:– Explain the importance of outbreak communications – Describe best practices in outbreak communications– Develop clear and concise message– Identify basic structure in outbreak investigation

report – Discuss benefits of integrating communication in

overall outbreak management


Outbreaks:

Urgent emergencies

Unfolding/ Create anxiety

Socially/ economically disruptive

Behaviour plays role in transmission

strong political dimensions

Newsworthy!

Unpredictable

Unique public health events


Outbreak Communications - challenges

• Public expects access to its government

• Demand for information increases

• Workload increases

• Coordination is crucial


Outbreak CommunicationsBest Practices


Best Practice # 1 – Build Trust

WHO Outbreak Communications Guidelines, 2005

Doctor are you sure this is an approved surgical technique?

The overriding goal for outbreak communication is to communicate with the public in ways that build, maintain or restore

TRUST

Public perceives communicator by:

a. Motivesb. Honestyc. Competence


Best Practice # 2 – Announce Early

• The most critical of all outbreak communication messages

• Must be early• Likely to be wrong

When officials are concerned, the public should be warned.


Best Practice # 3 - Transparency

• Transparency results in higher trust!

• Two main issues

– Defining limits e.g., patient confidentiality

– Information delay (>>>)


Best Practices

Most important in the Asian setting!

Trust Announcing Early

Transparency


Best Practice # 4 – The Public

• It is nearly impossible to design successful messages that bridge the gap between the expert and the public without knowing what the public thinks.


Best Practice # 5 - Planning

* WHO Outbreak Communications Guidelines, 2005

• Outbreak communication plan MUST be a part of outbreak management plan


Message Development


Message Development

• When creating a message, consider

Relationship to the event

Give facts/ update Spokesperson

Demographics Rally to action Print media

Level of outrage Clarify event status

Web

Address rumors Radio

Satisfy media request

Audience Purpose of Message

Channel/ Format


Tips for clear, concise, interesting message

• Use message map – 3 key messages with supporting materials– Each message can stand alone

• Keep messages brief – 27 words (9 seconds)

• Understandable to the audience– 4 grade levels below audience average

• Avoid unnecessary “absolutes”– Leave room for unknown information

• Avoid negative terms– Avoid “No”, “Do not”


Clear and easily understood

Age-adjusted mortality rate

Attributable risk

Carcinogen

Confidence interval Control group

Dose-response

Epidemiology

Incidence rate

Relative risk

Statistical significance

ToxicologyVariance

Prevalence

MorbidityMortality M

utag

en

Odds ratio

Reference dose

Prophylactic

Surveillance

Standard deviation

Vector


Message MapTitle of MapStakeholder: Question or Concern: Overarching Messages (short form):

Key Message 1 Key Message 2 Key Message 3

Supporting Information 1-1 Supporting Information 2-1 Supporting Information 3-1

Supporting information 1-2 Supporting Information 2-2 Supporting Information 3-2


General Public (could be any group, e.g., policymakers, media)

(e.g., what should we know about cholera transmission?)

This message should contain three sentences and three related concepts at most. It should require roughly 27 words. It should be stated as simply as possible.

Most important message here.Least important message here. Second most important message here.

Supporting information should add detail to overarching and key messages.


Message Map – an ExampleTitle of MapStakeholder: Question or Concern:

Key Message 1 Key Message 2 Key Message 3


Supporting information 1-2 Supporting Information 2-2 Supporting Information 3-2


General Public

What is pandemic influenza?

Pandemic influenza is a new type of flu

An influenza pandemic is likely to be more severe than yearly influenza

The timing and nature of pandemics are unpredictable.

It is caused by new viruses or by those that have not circulated among people for a long time.

Illness and death rates are likely to be significantly higher than is normally seen during a seasonal influenza epidemic

Influenza viruses change constantly, so it is impossible to predict their features and the impact on the population 11

It spreads easily from person to person through coughing and sneezing and causes serious illness.

Most people will have little or no immunity to the new virus.

Pandemic influenza viruses can spread worldwide within months, or weeks, and can cause illness and death in all age groups.

Pandemic influenza will last longer than a regular influenza and will come in waves of activity separated by months.

We cannot predict how fast a new influenza virus will spread.

A vaccine cannot be made until the virus has been identified.


He who does not understand a look will not understand a long explanation either.

(Arab proverb)Positively perceived non-verbal communication

Excellent eye contact

honest, open, competent, caring, empathetic sincere, dedicated, confident, knowledgeable, interested

Sitting slightly forward in chair

interested, enthusiastic, concerned, cooperative

Open hands open, sincere

Speaking outdoors in low-wind conditions

dedicated, hardworking, involved, concerned

Hand to chest/heart region

open, honest, dedicated, sincere

Erect posture self-confident, self-controlled, assertive,

determined

Lowering voice self-assured, honest, caring


Basic message component

• Express empathy• What you know• What you don’t know• Dealing with the

problem• Commitment • Sources of information

Basic Message

ComponentBasic Message

Component


Example: Create a Message• A virulent strain of Type A influenza has caused 1500

infections and 150 deaths in Southeast Asia• In the past 3 days, people have become ill in New

York and Los Angeles • Today, 30 area residents were admitted to the

hospital with high fever, difficulty breathing, and severe pneumonia; lab results will be available in 12-24 hours

• No vaccines or drugs are known to be effective• Symptoms are treatable with supportive medical care• Public health is operating on the assumption that this

is the same flu reported in Asia and the US• Public health is working closely with hospitals and

medical staff to identify other cases


Example: Create a Message

1. Expression of empathy and caring“We’ve all been hearing news about the flu, and we’re concerned about what we might be facing in our communities.”

2. Confirming facts“Today, 30 people were admitted to hospitals with high fever, difficulty breathing, and severe pneumonia.”



3. What you don’t know about the situation

“We suspect it is the same influenza that has recently appeared in southeast Asia and parts of the US, but we cannot conclusively identify this disease at this time.”

4. Process to deal with the problem“However, specimens have been sent to the state laboratory and we are awaiting the results. In the meantime, we have brought together the best medical and scientific expertise to care for the sick, learn the cause of their illness, and if it is a contagious disease, work to contain it.”



5. Statement of commitment“This is a process that is going to take a little time. We will update the public on any information as it comes to light.”

6. Where people can get more information“We have established a public health hotline to answer people’s questions and have important information on our Web site. The number to call is 1-800-555-AFLU, or visit www.aflu.com.”


Outbreak Investigation Report

Complexity of the report depends on •the type of investigation,

•the extent of the outbreak, and•the audience of the report


Outbreak Investigation Report: What and Why

• What– Findings during different stages of outbreak investigation

• Why– To document for action – Share new insights– Provide record of performance– To verify and substantiate recommendations

In order to:– To enhance quality of investigations – prevent future outbreaks– assist in investigation and control of similar incidents – provide a document for potential legal issues


Some outbreak reports have become part of history…….


Outbreak Investigation Report:Who writes, when, who reads

• Who writes– The outbreak investigation team– Other authors as assigned

• When – When the investigation is ‘complete’– When the investigation is ‘ongoing’

• Who reads– All agencies involved in outbreak investigation and

response– Policy making bodies, professional colleagues– The public, the lawyers, the media


Outbreak Investigation Report: Basic Structure

• Summary• Introduction and Background• Methods and Results• Discussion and Lessons Learned• Recommendations• Acknowledgements


Outbreak Investigation Report: Challenges

• Writing reports – delay or not writing at all

• Confidentiality – to patients, involved communities

• Accountability – who owns the report/ data


Built on trust,effective outbreak

communication will help speed up control

WHO Outbreak Communication: Best Practices for Communicating with the Public during an outbreak, 2004


ReferencesConducting an Outbreak Investigation. The North Carolina. Communicable Disease Control Manual, North

Carolina Division of Public Health. Accessed at http://www.epi.state.nc.us/epi/gcdc/manual/outbreakinvest.pdf

Crisis and Emergency Risk Communication. Atlanta, Center for Disease Control and Prevention, 2002.Effective Media Communication during Public Health Emergencies: A WHO field guide. Geneva, World

Health Organization, 2005. (WHO/CDS/2005.31a).Message Mapping. PowerPoint presentation in: Risk and Emergency Communication for Avian Influenza

and Pandemic Preparedness Workshop. Center for Disease Control and Prevention (CDC), Thailand, February 2006.

Outbreak Communication Guidelines. Geneva, World Health Organization, 2005. Outbreak Communication handbook for Journalists, Geneva, World Health Organization, 2005. Outbreak Communications Guidelines (Draft). Geneva, World Health Organization, 2008 Risk Communication. PowerPoint presentation in: Risk Communication Workshop, MOPH, Thailand. Ray

Kemp Consulting Ltd., November 2007.Risk and Crisis communication for Avian Influenza Rapid Response Team (AI RRT). PowerPoint

presentation in: Training of Trainers for AI RRT, Thailand, July 2006.The Outbreak Investigation Report. PowerPoint presentation by Arnold Bosman and Meirion Evans. Epiet.

Accessed at www.epiet.org/course/presentations2003.htmlWriting an Outbreak report. PowerPoint presentation in: I is for Investigation, Outbreak investigation from

mystery to mastery. The North Carolina. Communicable Disease Control Manual, North Carolina Division of Public Health. Accessed at: http://www.wvidep.org/Portals/31/PDFs/TrainingResources/2007/Report_Writing.pdf


Documents

SEARO – CSR Training on Outbreak Investigation Outbreak Communications