[MUSIC] I'm now going to move on to talking about the communication of surveillance data. And I really want to emphasize the importance of effectively communicating surveillance data. And really having an approach to how one communicates surveillance data given the sensitivity of these data. Doing media interviews is a core part of public health practice, in leadership positions one is often in a position where they need to do media interviews. And for media interviews, it's particularly important to consider three messages that one might want to get across when communicating surveillance data. And there's a mnemonic PIE that can help one do that. Here, p stands for point, what is the decision or point that you are making in this interview? I stands for impact, what's the impact of the decision or point that you are making on the public? And e stands for evidence, what is the evidence supporting your decision? Now while the media may try to take you in different directions continuing to reinforce your point, the impact of your point, or the decision that you've made and the evidence that you have supporting that decision will help you. It's also important to consider either four or five C's. The four C's that are always going to be there are the importance of being calm, clear, credible, and compassionate. The fifth c is consistent, but this can be a challenging one, because sometimes information is evolving. But trying to ensure consistency in your message as much as possible is really going to help with effectively communicating that. Another approach to consider is called the SAMM Communication Framework. SAMM here stands for speaker, audience, medium, and message. Now when we think of the speaker, think about who has the skills and training and who's really credible in the mind of the audience. Is this a scenario where we need the minister of health or can there be a health inspector or a more frontline staff that might be able to communicate this message? And that may really depend on the severity and the importance of the issue at hand. In terms of audience, consider who it is that you're trying to reach and what is it that they need to know. Is this an internal audience of staff or volunteer or boards of health? Or is this an external audience where you're really speaking to the public or other agencies? Now really consider your medium and it's particularly important in this era of rapid evolution of the types of media that we use to engage different audiences. But the medium that you choose will be related to the audience that you're speaking to. For some audiences one still needs to go door-to-door to deliver a message to ensure that people really understand that message. For other audiences one can use print radio and when one is using the Internet, it's important to again, really consider what app, what strategy one is using. It may also be that you still need to do town hall forums and community meetings in order to deliver your message. But again, the medium that you use should be related to the audience that you're trying to reach. Now as you think about your message, it's really important to think about how many messages you're really trying to get across. As I've just talked about in media interviews, one can use the PIE framework or the point, impact, evaluation framework as a way of really controlling messaging. Here again, when you're presenting surveillance information, whether it be an outbreak or something non-emergent, it's important to think about again, controlling your messages. For example, you can present information about what has happened, what are we doing, and what can the public do? But here again, it's important to be as consistent as one can be in the context potentially changing information. Both verbal and nonverbal communication is really important and people will look for nonverbal cues when folks are delivering information. So it's really important to be cognizant of both your verbal and nonverbal approaches to delivering information. Now broadly speaking, there are four types of public also known as the FABI mnemonic. Now fanatics are folks that when you're a public health practitioner, you know their phone numbers off by heart and they know yours. They want input into everything you decide and your issue is their main interests aside from job and family. There are folks that are attentive, they tend to monitor the media and your issue carefully. Once in a while they attend a meeting or answer survey and your issue is likely in their top 20. Most people are browsers, they check out the media from time to time, but they don't want to be bothered providing input. Your issue is on their worry list, but it may be at the bottom. And finally, there are the inattentive, they don't know and they don't want to know. Now the guidelines for public involvement as a practitioner may be that you forget the inattentives. In marketing and elections, of course, they are the ones that make decisions. They are the folks that will ultimately elect people but in risk communication, they are not. Media are critical, these approaches using both traditional non digital media and increasingly digital media are really critical for reaching the browsers and inattentive. Fanatics check the media mostly to see if they were quoted on a particular issue. Now fanatics are important, the decisions that are going to be made are normally influenced by those who care the most. Now public control in a good program people will know how to get more or less involved in a program. And its really the public that has control over the extent of their involvement and not the public health program. There's also an element that people are less desperate to have input when they know they can have input. And if there's a really good public involvement strategy, there may be a lack of interest in getting involved. Now when we think of risk communication, often we're talking about actual risk, which is really hazard and probability. But perceived risk is very different, perceived risk is actual risk multiplied by outrage. So hazard we can't control, that is a function of probability, magnitude, and uncertainty. But there is also a series of different outrage factors that are important to consider is something voluntary versus involuntary? Is this a forced program that somebody doesn't have a choice in engaging in? Is it controlled personally versus being controlled by others? Do I have a choice to get this vaccine or not get this vaccine? Is it familiar versus exotic? So when the Ebola crisis happened this was not something that was familiar to folks. Is it natural versus man-made? Now if these are naturally occurring disasters people are less likely be outraged by it versus something like an environmental disaster. Is it reversible versus it being permanent? Is it statistical versus anecdotal? So we may say that there have been X amount or X percent of case fatality rates. But seeing a single photo of a single child that may have been affected by a condition may have much more power than any of those things. Now is something fairly versus unfairly distributed? Now if something's affecting everybody in the same way, then it's much less likely to cause outrage than something that's particularly affecting small pockets of people. And finally, if something is affecting adults versus affecting children. When something affects children, it elicits different emotion and a different level of outrage than particular health condition or exposure that will affect adults. So CDC has their STARCC Framework and that is another mnemonic that can again, help you really develop a message. And that is to say that a public message in the context of a crisis should be simple. In other words, frightened people don't want to hear big words. It should be timely, frightened people want information now. Should be accurate, frightened people won't understand the nuances and so it's really important to just give it straight and clearly. It should be relevant, in other words, the information should answer their questions and give action steps. It's really important for it to be credible and so it's important that you have empathy and openness in terms of ensuring credibility. And as we've talked about consistency is really challenging but also really important. People will notice the slightest of changes in the messages and those slight changes can be upsetting and will be dissected by all especially in the context of emergencies. So the STARCC Framework also moves forward to say that credibility and trust equals successful communication. Again, credibility is an outcome of accuracy of information and the speed of release. And trust is really related to the empathy and openness presented by the person doing the communication. And if we can ensure effectively accurate information that's released in a timely way and present it in a way that demonstrates empathy and openness we're much more likely to communicate successfully. On the lecture page, I've included a couple of different links of communications examples. One of those are the body bags that were distributed across northern reserves in Northern Canada during the H1N1 crisis. So for a little backdrop Health Canada decided to send body bags in preparation for what was expected to be a really bad outbreak of H1N1 for which at the time there was limited access to the vaccine. However, there was no messaging that was provided to people about these. And so in the mail one day a series of body bags showed up unannounced and obviously resulted in a really challenging communication message for Public Health Canada. In the interviews in response to this there was three key messages that were put forward by the Ministry of Health. One, it happened, in other words, it's real. Second key message, it was part of normal flu planning. Third key message, we don't expect high levels of mortality of influenza. And if you're able to follow those links, you can see that no matter what questions were being asked they kept going back to those three key things. One, absolutely confirming that it happened, confirming that was part of normal influenza planning and that it didn't mean that there was high levels of mortality expected. But again, it shows the importance of developing that communication a priority before sending something out. But if something like that happens, it's also important to really have a clear set of messages that one would be able to move forward with and be consistent with across different interviews. Another example that we posted is the case of Desiree Jennings, also during H1N1. This was somebody who noted after having the H1N1 vaccine that she was only able to walk backwards and speak with a British accent. And while that may at face value not be taken seriously, it was taken seriously by many and received a lot of attention across the United States and internationally. What one can see are that there's a series of different outrage factors. One of them was that this was involuntary, Public Health was telling people to get vaccinated for H1N1. It's also controlled by others, it's exotic, H1N1 is not something that people had really heard about before, Avian Influenza. There was no known cure for H1N1, in other words, it's permanent. Also, it's anecdotal, seeing this example of somebody walking backwards and speaking in a British accent really had an effect on people. I've also posted the response by the CDC published in the MMWR in response to this. But also highlighting the three key messages that they had, which is to say that the H1N1 vaccine was safe. That this is an incredibly uncommon and was most likely psychogenic in nature and it's important to get vaccinated. But taken together the point of these different communications frameworks are to really give you an approach to developing and ultimately delivering your message to a public that is normally in crisis when you're delivering this message. And in those settings, it only reinforces the importance of using an approach to delivering that information as compared to doing it more ad hoc. [MUSIC]
