We asked all site visit informants to tell us, leaving aside any barriers, what would they like to see implemented to further improve risk communication content and strategies for disseminating information to at-risk populations in their state. In this section, we summarize what we learned from the sites as possible actions that could be taken to address the various types of barriers and what they see as opportunities for future risk communication. In some cases, what informants at one site identified as a gap in their current risk communication activities was actually being addressed in practice at another site; we highlight some of these cases in the discussion below. Informants across the sites we visited indicated that they would like more opportunities to learn about activities in other states that could be applied in their state or region. This could be accomplished through the development of networks across states and localities to facilitate sharing of information. Use of existing networks coordinated by the CDC or through state and local government association annual meetings is a potential vehicle for such an effort. Specific partners for whom this report could be useful in developing further training activities are ASTHO and the National Association of City and County Health Officials.
Targeting at-risk populations. A common concern raised by representatives of both Oklahoma and the Metropolitan Washington Area was how best to develop methods for identifying the types and locations of at-risk populations. In Oklahoma, there is no statewide understanding of where at-risk populations are located, making it difficult to target message delivery and develop plans for providing relevant populations with the appropriate response in the event of an emergency. Informants said they would like to see greater use of GIS technology to map, on a statewide basis, where different at-risk populations reside and to relay to appropriate agencies at the state or local level information about targeting response and allocating resources.
The literature review identified GIS as an innovative and promising tool in vulnerability assessments to effectively focus communication campaigns on areas in which at-risk populations are concentrated. Thus, across research and practice, use of GIS may play an increasing role in emergency risk communication for at-risk populations. Informants also stated that they would like to develop a registry for at-risk populations that could be used in the event of an emergency to further target response and allocate resources. Both California and Florida have developed approaches for identifying the location of and developing registries for different at-risk populations. The lessons learned from their efforts may be useful to other states. RAND recently developed a tool that can import local Census data for identifying and locating at-risk populations; this may be useful in assisting states with resource planning.
Informants in Oklahoma would like to see more messages disseminated appropriately for older adults and PWD. For example, it is useful to talk slowly and clearly (e.g., on the radio) for those with hearing impairments to and provide appropriate color contrast and big type for print and Internet messages for those with vision impairments. A California informant also called for developing new technology for the hearing-impaired community to push out information to wireless devices, pagers, TTY (teletypewriter for communication with the deaf), and other social network service systems. The OK-WARN program in Oklahoma may serve as a useful template for developing similar resources in other states.
Oklahoma and Florida informants also thought that the relevant utilities companies (e.g., electricity and gas) may be important partners in identifying where at-risk populations live and in disseminating messages to them. In particular, developing a registry for those who are ventilator-dependent or are otherwise dependent on electrical devices can help identify where at-risk groups reside and help evacuate them to a safer environment if power is lost. In addition, a registry may also serve as a way to prioritize the utility company’s response in the event that power is lost, as it would provide information about who needs power restored most urgently.
Partnering with at-risk populations. Informants from all of the states recognized the value of community partners in message dissemination and suggested that state and local officials recruit them to support risk communication activities. Community partners may be closest to the target at-risk populations and can be a valuable conduit for messaging. They can also help feed information back to state and local officials, who can help respond to the needs of local populations. Informants suggested identifying appropriately trained representatives from various at-risk populations as a way to facilitate access to these populations and to garner trust among the recipients of the message. Another recommendation from informants in Oklahoma was to capitalize on the trusting relationship citizens might have (a trust supported by the literature) in their weather reporters; they are regularly involved in communicating weather-related messages, and their prominence and authority make them well-suited for communicating messages about other types of emergencies.
Among the community partners identified as important collaborators for risk communication, faith communities were singled out as important assets in Oklahoma and DC. In many parts of the country, citizens are often well connected to their religious institutions, and the institutions stay in good communication with their members through the use of bulletins and volunteers. Bulletins can be used to disseminate important messages, and volunteers can also be important for checking in on individuals who may be at-risk in the event of an emergency. Communities could enhance collaboration by training volunteers as a useful resource for helping at-risk groups prepare for an emergency. In addition, there are also opportunities for mutual learning that would allow for formative research, improve health departments’ cultural competence, and enhance the capacity of organizations, including faith-based organizations, to serve their communities.
Formatting messages. Informants from Oklahoma indicated they would like to develop more messages in a graphic form for those with limited ability to learn (e.g., those with intellectual disabilities, children). These could be most easily received by a wide range of at-risk populations, including those who do not speak English. This may also be an efficient use of resources if the same graphic message could be used for multiple at-risk populations. Several of the themes drawn from the compendium echo these assertions, with multi-modal presentations increasing the usefulness to multiple audiences. We learned from informants in California and Florida that they are developing messages in pictorial format in order to reach the broadest audience. Other states and localities could benefit from formatting their risk communication materials for use across multiple at-risk populations.
Tailoring messages. In addition, many of the informants we spoke with would like to see more messages tailored to the needs of the population, recognizing that the same message may not apply to all at-risk groups. Even within the same at-risk population, messages may need to be tailored. For example, there are older adults or people with disabilities who may not speak English. In addition, messages that benefit an at-risk group may need to be targeted to multiple audiences (e.g., the individual, their caregivers, and their providers). In the compendium, 53 percent of the included resources targeted individuals at-risk, 53 percent targeted caregivers, and 38 percent targeted providers (i.e., there was often overlap). As another example, message tailoring for people with vision challenges would necessarily be provided in Braille and be segmented for both the individual and the caregiver. Informants from Oklahoma and Florida wished for greater financial resources to poll their residents to identify needs and learn where different at-risk populations reside. Thus, use of approaches that offer messages in multiple and graphic formats, tailor communication to the needs of specific groups, follow recommendations from the literature to offer frequent messages in multiple modes that are locally and personally relevant, enlist the participation of community members in message development and delivery, may boost communication for at-risk populations.
Training. Informants in Oklahoma and DC also wanted to train direct service providers (e.g., personal attendants, home health care providers, staff in doctor’s offices) on emergency preparedness for at-risk populations, and to encourage them to have their own plans in place and to help prepare their clients (e.g., ensure they have an emergency kit). Informants recommended that direct service providers receive specific training on information management similar to what a PIO would learn so that they could better delegate authority and ensure a positive response. They also suggested empowering clients to make decisions about how they want to respond in the event of an emergency rather than having the provider make all decisions about evacuation, etc. California informants noted the importance of cross-training so that both emergency preparedness and response professionals as well as at-risk populations learn from each other’s perspectives.
Another area of potential is to adapt Functional Assessment Services Teams, which deploy 8-10 people trained to help people with different disabilities during disasters, to focus on risk communication for those groups. Each representative would target an at-risk group and deliver messages to that group in the most appropriate manner. While California and Florida are doing this in some counties at shelters where PWD stay, we know of no adaptations focusing on risk communication.
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