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

12/01/2008

We specifically asked site visit informants about challenges or barriers they experienced in conducting or planning risk communication activities targeting at-risk populations. Below we summarize some of the issues that were mentioned. We first address issues that were raised about specific at-risk populations and then address broader, more general challenges and barriers that were raised, such as politics, funding, and government structure.

Lack of resources for addressing diversity. Site visit informants reported that their constituents are very diverse ethnically, making it nearly impossible to translate risk communication materials into all the languages needed. Also, non-native English and non-English speakers often miss a lot of information contained in written materials, requiring direct one-on-one communication, which is not financially feasible. Translation is a necessary (and relatively low-resource) step to reaching non-English speakers. However, as noted above, emergency risk communication must also be culturally competent. Achieving cultural competency in the development and delivery of emergency risk communication is a more resource-intensive endeavor than translation. Cultural competence requires a significant investment of time and training. Partnering with CBOs that are competent to serve their own communities is one way to enhance the competence of the health department staff, build the capacity of the CBO staff, increase trust and credibility, and ultimately strengthen the relevance of the messages, channels and spokespersons.

Informants also mentioned several risk communication challenges or barriers that were not specific to any particular at-risk population, but instead applied to at-risk populations in general. One such challenge was how to prioritize among the many messages that needed communicating. Informants said that the range of messages that need to be communicated to at-risk populations is broad because different at-risk populations may face different issues during emergencies. Similarly, informants from all four sites noted the difficulty of being able to reach at-risk populations both because they are dispersed geographically and because they are hard to find. A third, somewhat related challenge, is that funding to provide adequate risk communication to at-risk populations is limited. For example, many community-based providers serving at-risk populations cannot afford computers, which are necessary to receive emergency information electronically. Also, with cuts in state and county budgets, some government staff reported that it was becoming more difficult to justify conducting risk communication activities specifically for at-risk populations, as one informant put it, “when they are only 25 percent of the population.” Although definitions vary between states, those with functional needs may constitute much more than 25 percent. Finally, many said it was difficult to access at-risk communities because they were difficult to reach or because they mistrusted the government or agencies. More focus on pre-event education is one means to address these barriers and to lay a stronger foundation for preparedness. By providing ongoing risk education and community engagement, communities are likely to be better able to respond during an emergency which in turn, increases community capacity and lessons can be incorporated into subsequent risk education (Quinn, 2008).

At-risk individuals have limited resources for emergency preparedness. Informants reported that lower-income persons often believe that they do not have money to prepare for emergencies. Many lower-income persons reserve their resources for surviving now rather than spending them on preparing for the future. In fact, some persons living in small, crowded areas have no space to store preparedness provisions and, in some cases, low-income persons who receive pre-packaged meals to use in case of an emergency or shelter-in-place may eat those meals ahead of time because they lack food daily under ordinary circumstances. Due to limited resources, individuals at-risk may also be less likely to respond to emergency messages even if they receive them. For example, individuals may not evacuate because they lack transportation or a might need special attention that they feel they are unlikely to receive if they evacuate.

Special challenges for PWD. Sites also reported barriers to conducting or planning risk communication for PWD. One such challenge is finding them. Anyone receiving disability-related state or federal funding can be easily identified, but there are large numbers of people who do qualify but who will not pursue government funding and, as such, are more difficult to locate. Another challenge is the difficulty of getting TV stations to provide ASL interpreters for the deaf. Oftentimes, emergency message text runs across the picture of the interpreter or logos are placed over the ASL interpreters, making them impossible to see. Some informants reported that they have witnessed emergency response personnel not responding appropriately to the needs of PWD during an emergency, which heightens concerns about whether at-risk populations will be properly assisted. Community engagement in planning or the use of community-based participatory research and/or a community advisory board can sensitize first responders and strengthen communication planning (Quinn, 2008).

Poor trust and privacy concerns. At-risk populations may lack trust in the emergency response community. We learned from informants that PWD have experienced challenges when trying to access shelters; not all shelters follow ADA guidelines regarding accessibility. A common concern across the sites was that the disabled community is not always involved in the planning process, which also can damage the community’s trust in first responders and government agencies responsible for public health and emergency response. Informants from all sites also mentioned that undocumented persons have recently witnessed increased deportation activities. As a result, many undocumented individuals have become more reluctant to add their names to at-risk population registries, to seek preparedness information, to respond to evacuation requests, or to ask for emergency assistance. They also mistrust messages from the government or from service messages assuring them that they will not be deported if they do seek assistance. Community engagement would also be a significant step toward addressing the issues of mistrust. For example, in communities that have specific churches with established ministries for immigrants, CBOs, and even immigration lawyers, involving them as partners is essential for reaching immigrant communities.

Difficulty reaching the socially isolated. Few informants reported challenges or barriers to conducting risk communication that were specific to senior citizens. However, we learned that senior citizens may be difficult to reach if they have weak social networks or do not receive any social services. Others informants suggested that some senior citizens cannot easily remember information and may also become easily confused about how to prepare for and respond to emergencies. Their suggested solution was to repeat preparedness messages for senior citizens and also develop messages that target caregivers and providers so that they may be able to intervene on an elder’s behalf.

Negative attitudes about preparedness and planning. Site visit informants mentioned that effectively communicating with at-risk populations was difficult because of the attitudes of their target audience. Not surprisingly, one prominent attitude was complacency. Informants were quick to report that most people, whether or not they belong to an at-risk population, think about emergency preparation after an emergency, not beforehand. Audiences also maintain a certain amount of disbelief about the potential for an emergency to arise. Other informants said it was difficult for people to understand that victims most likely would not receive prompt assistance during an emergency, making their personal preparation essential. A few informants also suggested that some people are suspicious when they receive preparedness information and demand, “Why are you asking us to do this? Is there something you know that we don’t know?” Another challenge was trying to avoid “information overload;” people tend to feel overwhelmed when faced with too much information and disengage. The use of community-based participatory methods is one way to identify some of these obstacles as well as potential solutions from community partners’ perspectives.

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