Analysis of Risk Communication Strategies and Approaches with At-Risk Populations to Enhance Emergency Preparedness, Response, and Recovery: Final Report. Gaps in the Literature on Public Health Emergency Risk Communication with Vulnerable Populations

12/01/2008

Along with the themes regarding successful risk communication strategies with vulnerable populations, gaps in the literature were revealed through our review as well.

Vulnerable Populations are Underrepresented in the Public Health Emergency Risk Communication Literature

Only 40 citations--20 percent of the peer-reviewed literature on public health emergency risk communication--contained a substantive focus on vulnerable populations (i.e., vulnerable populations were referenced in the title or abstract). Some vulnerable populations were less well represented than others: only a few citations (less than five) were identified that addressed those who live in institutional settings,[36, 39, 58, 71] who are geographically isolated,[21, 31, 45] those with pharmacological dependency,[7, 71] or individuals with low-literacy.[37, 41] Additional vulnerable populations addressed in only one citation each included developing countries,[66] indigenous persons,[61] those in “poor health,”[57] refugees/immigrants,[62] the rural poor in India,[35] critically ill hospital patients,[58] and socially isolated individuals.[36] None addressed pregnant women.

Thus, there is little evidence upon which to build effective risk communication strategies for many groups within vulnerable populations, including but not limited to individuals living in long-term care facilities, recent immigrants who have limited English proficiency, PWD that affect mobility or cognitive capacity, or pregnant women.

Implications for Tasks 4 and 5: Continued work should determine how much of the available educational and/or outreach materials that are currently available are targeted towards the vulnerable populations largely left out of the peer-reviewed literature (Task 4) and to what degree these groups are represented within risk communication strategies for vulnerable populations (Task 5).

The Literature is Primarily Descriptive and Qualitative in Nature

Qualitative studies were most often represented in the literature on public health emergency risk communication with vulnerable populations,[21, 23, 29, 30, 31, 32, 33, 43, 44, 45, 61, 69, 70, 72] followed by literature reviews[24, 25, 35, 36, 37, 38, 46, 56, 65] and observational studies (survey-based).[22, 27, 28, 39, 40, 57, 68] The remaining studies reviewed were of another type (e.g., content analysis of web-based emergency preparedness materials;[34] multi-method studies incorporating qualitative and observational methods.[7, 26] Most studies relied on a qualitative analytical approach,[7, 21, 23, 24, 25, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 41, 43, 44, 45, 46, 47, 56, 61, 62, 65, 67, 69, 70, 71] while a few employed descriptive or bivariate analyses[22, 28, 40, 57, 58, 68, 72] and two used multivariate analyses.[27, 39] Additionally, one citation used a country case study analytical approach[66] and another used both qualitative and multivariate analysis.[26] For over half of citations reviewed[22, 23, 25, 28, 29, 30, 31, 32, 33, 34, 35, 37, 38, 40, 41, 43, 44, 46, 47, 56, 57, 58, 65, 67, 68, 69, 70, 72] the primary research objective was descriptive. Program/policy development or evaluation was an objective of several references[7, 21, 24, 25, 31, 36, 40, 46, 47, 58, 61, 62, 65, 67, 71, 72] with the remainder of studies being needs assessments,[24, 29, 30, 31, 32, 45, 70] hypothesis driven,[26, 27] or documentation of ways information is exchanged between countries.[66]

Overall, within the small literature on public health risk communication that does address vulnerable populations, most references are descriptive in nature and use only qualitative methods in their study design. Indeed, there are several challenges to the empirical study of public health preparedness given that full scale public health emergencies are (fortunately) rare events.[73] Better representation of different types of studies (e.g., observational studies, experimental studies) and different types of methods or analytical approaches (e.g., representative survey samples, quantitative analysis) would facilitate the growth of a strong evidence base that can offer specific guidance on communication interventions for vulnerable populations.

Gaps Related to Functional Areas Addressed

One of the critical functions of public health emergency risk communication is to provide actionable information about functional areas of importance to vulnerable populations. Though functional areas were well distributed across types of vulnerable populations, some gaps exist; for example, none of the literature we reviewed described emergency communication regarding maintaining independence, transportation, or supervision for individuals with disabilities. Similarly, emergency communication regarding supervision was missing from the literature on the elderly.

Implications for Tasks 4 and 5: Continued work should determine whether a range of functional areas are addressed in existing outreach and educational materials (Task 4) and to what degree functional areas are included within risk communication strategies for vulnerable populations (Task 5).

 

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