Analysis of Risk Communication Strategies and Approaches with At-Risk Populations to Enhance Emergency Preparedness, Response, and Recovery: Final Report. Background

12/01/2008

Risk communication plays a critical role in preparing for, responding to, and recovering from public health emergencies.[1] For example, in a chemical spill or radiological incident, exposed individuals need to be informed of decontamination requirements. In natural disasters, individuals need to have information about potential dangers and how and where they can seek safe shelter, while in emergencies with a contagious agent, communication-related to isolation and quarantine procedures is required. In general, risk communication in the context of public health emergencies is a complex process. Messages must be communicated in the appropriate languages, at the right reading level, and disseminated in multiple ways amid significant stress and uncertainty. With the goal of keeping the public safe, to be effective, risk communication must achieve the following goals: individuals must be able to access information, process information, and be able to act upon information provided about the risk.

Vulnerable populations may have special needs related to each of these goals. For the purposes of this review, vulnerable populations include individuals who have disabilities, are institutionalized, are senior citizens, are from diverse cultures, have limited English proficiency or are non-English speaking, are children, are transportation disadvantaged, pregnant, have chronic medical disorders, or have pharmacological dependency (i.e., chemical dependency/addiction). The definition of vulnerable populations used here has been adopted by the Department of Health and Human Services and was determined by recommendations of the Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities, the draft implementation plan for the Pandemic and All-Hazards Preparedness Act (PAHPA), and the draft revisions to the National Response Plan (NRP).

It is critical that public health emergency risk communication is non-discriminatory[2] and that all individuals have equal and ample access to information about the nature of the emergency and particularly about how to respond given the event circumstances. Thus, comprehensive emergency preparedness plans, as well as response and recovery guidelines will include provisions for how to best inform and educate vulnerable populations. Vulnerable populations are often “not able to access and use the standard resources offered in disaster preparedness, response, and recovery.”[3] For example, people with physical disabilities may have mobility limitations and special needs related to access to emergency preparedness communications. Children have less developed communication skills and require differently worded messages to be effectively informed. Children may also be separated from parents or other family members who would typically serve as translators for them. Pregnant women may face physical limitations and communications would need to be sensitive to the needs of their children. Senior citizens may have difficulties with mobility, and with regard to communication, could have hearing limitations and visual impairments suggesting that communication medium and format must be taken into account. Individuals with hearing limitations and visual impairment will require alternate communication strategies suggesting that medium and format also should be taken into account. Those with serious mental illness may have cognitive deficits that limit their ability to comprehend messages. Low-literacy is another limitation that may be a communication obstacle for children, the mentally impaired, individuals with poor literacy, and non-English speaking populations.

While much is known generally about risk perception and communication,[4] these topics have been less well addressed for vulnerable populations, particularly as they relate to emergency preparedness.[1] Yet the outcomes of recent public health events and other emergencies suggest that the unique characteristics of vulnerable populations and the special needs of these groups are not being adequately addressed by traditional emergency preparedness plans. For example, Hurricane Katrina left 5,000 children without their families.[5] In addition, less than 30 percent of a sheltered population had access to American Sign Language interpreters so that individuals with hearing impairment had no ability to receive information about risks and recovery.[6] These circumstances highlight the need for special attention to vulnerable populations before, during, and after public health emergencies.[7]

To support the efforts of public health emergency planners and responders working to successfully address the communication-related needs of vulnerable populations, we conducted a literature review in response to Task Order 07EASPE000074 to identify promising risk communication approaches and messaging strategies that address the communication limitations or barriers facing vulnerable populations before, during, and after a public health emergency. Our review (Task 3) had three aims:

  1. Describe promising communication strategies for public health emergency risk communication with vulnerable populations.

  2. Summarize the quality and content of the peer-reviewed literature and relevant statutes and regulations addressing public health emergency risk communication with vulnerable populations for all stages of emergency preparedness.

  3. Identify gaps in the literature.

For the purposes of this project, we focus on risk communication that includes actionable information related to public health emergency preparedness (PHEP), response, and recovery for vulnerable populations. That is, in keeping with previous definitions of risk communication (See [8]) this review addressed public health emergency communication for vulnerable populations that does not simply describe the nature or consequences of a risk, but rather that provides information on how to prepare for, protect against, or respond to the risk. Such risk communication may include press releases, emergency-related print materials, interactive preparedness websites, and other communications that convey actionable risk-related information.

This literature review informed the development of a compendium of communication materials (Task 4) and case studies of sites with promising approaches to risk communication for vulnerable populations (Task 5). In addition, this review lays a foundation for the final report for this project.

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