Reasoning for Public Health Emergency Risk Communication

1
Reasoning for Public Health Emergency Risk
Communication Jacqueline Merrill, RN, MPH 1,
Suzanne Bakken, DNSc 1,2 , Vimla Patel, PhD
2 1School of Nursing and 2Department of
Biomedical Informatics, Columbia University, New
York, NY
SCOPE OF THE PROBLEM
DISCUSSION
RESULTS

• 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