Reasoning for Public Health Emergency Risk Communication Jacqueline Merrill, RN, MPH 1, Suzanne...
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Reasoning for Public Health Emergency Risk Communication Reasoning for Public Health Emergency Risk Communication Jacqueline Merrill, RN, MPH 1 , Suzanne Bakken, DNSc 1,2 , Vimla Patel, PhD 2 1 School of Nursing and 2 Department of Biomedical Informatics, Columbia University, New York, NY [1] Association of State and Territorial health Officials. Communication in Risk Situations. Wash. DC: Author, 2002 [2] Reynolds, B. Crisis and Emergency Risk Communication. Atlanta: Centers for Disease Control and Prevention, 2002. [3] Klein, GA, Orasanu, J, Calderwood, R. and Zsambock, CD. Decision making in action: models and methods. Norwood, CT: Ablex, 1993. [4] Hinds, P.S., Vogel, R.J., Clarke-Steffen, L. The possibilities and pitfalls of doing a secondary analysis of a qualitative data set, Qualitative Health Research, 1997, vol. 7(3): 408-24. • Public health risk communication in emergencies and urgent events is often sub optimal because established risk communication theory and principles can be overlooked • The routine steps of public health risk message development are affected by the nature of emergencies and urgent events (illustrated in model below) • Informatics methods can supply decision support tools to aid development of effective theory-based public health emergency risk messages • A foundational step to developing such support is clear understanding of the message development process • Use rapid ethnography to explore contribution of public health organizational culture to message development process during actual urgent event • Model the workflow of message authors to develop algorithms to guide semi-automation of authoring process • Discourse analysis of existing risk messages to identify typical message structures and components of effective messages • Incorporate health communication theory into stages of automated message construction SECONDARY ANALYSIS • Analysis focused on sequence of activities and steps involved • Goals are not ill defined (although problem may be) • Process phases (or themes) and sub-themes were identified • Process phases were cyclical or collaborative, sometimes both • Points of redundancy were message heuristic, standardized template and a strong collaborative approach SCOPE OF THE PROBLEM SCOPE OF THE PROBLEM • Identify theory-based principles and expert recommendations for emergency public health risk communication • Identify features of emergency risk message development in high concern situations • Examine how practice compares with theory-based recommendations • Identify process steps in emergency message development METHODS METHODS DISCUSSION DISCUSSION This work was supported by a National Institute of Nursing Research Training Grant, T32 NR007969. The authors thank Susan Ledlie, RN, DNSc for consultation on secondary data analysis ACKNOWLEDGMENTS ACKNOWLEDGMENTS REFERENCES REFERENCES RESULTS RESULTS OBJECTIVES OBJECTIVES • Think aloud protocol conducted with 3 experienced public health information officers • Subjects asked to describe actions performed while preparing public health risk communication to address a paper based emergency scenario • Preliminary analysis coded responses to published recommendations of emergency risk communication experts • Secondary analysis used open and axial coding to reveal massage process steps FUTURE STUDY FUTURE STUDY PRELIMINARY ANALYSIS • Subjects demonstrated sound conceptual knowledge of risk communication principles and theory • Message development steps were applied in different order than recommended by experts, and steps skipped • Subjects used message templates and heuristics • Message development relied strongly on collaboration and conformed to model of group decision making under stress • Naturalistic Decision Making Model conflicts with deliberate, consultative style of non- emergency decision making typical used in US public health agencies. • Factors associated with sub optimal group decision making in the Naturalistic Model include self censorship and undermined confidence • Sub optimal decisions are likely to contribute to sub-optimal messages • Example: all subjects skipped the message evaluation step recommended by experts, a step intended to expose message weaknesses • Secondary analysis revealed a structured process with well defined goals that could be automated • • Decision support needed, such as partially automated text authoring that will test message completeness and conformance to risk communication theory • Decision support for public health emergency risk message development must address institutional culture and process evaluation consultative, collaborative PH model organizational goals/norms multiple stakeholders & levels of government multiple players high event visibility high stakes need for immediate information time stress agency, public and partner feedback action feedback loops evolving nature of urgent events shifting ill - defined goals uncertain dynamic environment uncertain dynamic environment incomplete information, missing facts ill - structured problems Characteristics of Risk Communication in PH Emergencies/Urgent, High Concern Events Characteristics of Naturalistic Decision Making (Klein, et al., 1993) consultative, collaborative PH model organizational goals/norms multiple stakeholders & levels of government multiple players high event visibility high stakes need for immediate information time stress agency, public and partner feedback action feedback loops evolving nature of urgent events shifting ill - defined goals uncertain dynamic environment uncertain dynamic environment incomplete information, missing facts ill - structured problems Characteristics of Risk Communication in PH Emergencies/Urgent, High Concern Events Characteristics of Naturalistic Decision Making (Klein, et al., 1993) RISK ASSESSMENT CHARACTERIZATION COMMUNICATION MESSAGE DEVELOPMENT MESSAGE DELIVERY Public Health Culture • Collaborative • Factual, Deliberate • Process Oriented • Target Population Focus High Concern Event • Time Sensitive • Incomplete Knowledge • Urgent need for info • Broad Population Focus Concept Model -- Public Health Risk Communication in Emergencies Decision support Decision support needed here needed here RISK ASSESSMENT ASSESSMENT ASSESSMENT CHARACTERIZATION CHARACTERIZATION COMMUNICATION COMMUNICATION MESSAGE DEVELOPMENT MESSAGE DELIVERY Public Health Culture • Collaborative • Factual, Deliberate • Process Oriented • Target Population Focus High Concern Event • Time Sensitive • Incomplete Knowledge • Urgent need for info • Broad Population Focus Concept Model -- Public Health Risk Communication in Emergencies Decision support Decision support needed here needed here Decision support Decision support needed here needed here Means of distribution: website, radio, newspaper, etc. Who’ s in charge Who speaks 6. Give out info Message template guides What’ s the message Who speaks 5. Standardize communication Cyclical Use heuristics Collaboration What’ s the message Who speaks 4. Message content Collaborative Cyclical Who is in charge What’ s the message Who speaks 3. Meeting Cyclical State HD and CDC 2. Info seeking Cyclical Collaborative -- other counties, epi staff, SHD & CDC 1. Info receiving Comments Sub-themes Phase (Themes) Phases of emergency message development Means of distribution: website, radio, newspaper, etc. Who’ s in charge Who speaks 6. Give out info Message template guides What’ s the message Who speaks 5. Standardize communication Cyclical Use heuristics Collaboration What’ s the message Who speaks 4. Message content Collaborative Cyclical Who is in charge What’ s the message Who speaks 3. Meeting Cyclical State HD and CDC 2. Info seeking Cyclical Collaborative -- other counties, epi staff, SHD & CDC 1. Info receiving Comments Sub-themes Phase (Themes) Phases of emergency message development
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Transcript of Reasoning for Public Health Emergency Risk Communication Jacqueline Merrill, RN, MPH 1, Suzanne...
Reasoning for Public Health Emergency Risk CommunicationReasoning for Public Health Emergency Risk CommunicationJacqueline Merrill, RN, MPH 1, Suzanne Bakken, DNSc
1,2 , Vimla Patel, PhD 2
1School of Nursing and 2Department of Biomedical Informatics, Columbia University, New York, NY
[1] Association of State and Territorial health Officials. Communication in Risk Situations. Wash. DC: Author, 2002
[2] Reynolds, B. Crisis and Emergency Risk Communication. Atlanta: Centers for Disease Control and Prevention, 2002.
[3] Klein, GA, Orasanu, J, Calderwood, R. and Zsambock, CD. Decision making in action: models and methods. Norwood, CT: Ablex, 1993.
[4] Hinds, P.S., Vogel, R.J., Clarke-Steffen, L. The possibilities and pitfalls of doing a secondary analysis of a qualitative data set, Qualitative Health Research, 1997, vol. 7(3): 408-24.
• Public health risk communication in emergencies and urgent events is often sub optimal because established risk communication theory and principles can be overlooked
• The routine steps of public health risk message development are affected by the nature of emergencies and urgent events (illustrated in model below)
• Informatics methods can supply decision support tools to aid development of effective theory-based public health emergency risk messages
• A foundational step to developing such support is clear understanding of the message development process
• Use rapid ethnography to explore contribution of public health organizational culture to message development process during actual urgent event
•Model the workflow of message authors to develop algorithms to guide semi-automation of authoring process
• Discourse analysis of existing risk messages to identify typical message structures and components of effective messages
•Incorporate health communication theory into stages of automated message construction
SECONDARY ANALYSIS
• Analysis focused on sequence of activities and steps involved
• Goals are not ill defined (although problem may be)
• Process phases (or themes) and sub-themes were identified
• Process phases were cyclical or collaborative, sometimes both
• Points of redundancy were message heuristic, standardized template and a strong collaborative approach
SCOPE OF THE PROBLEMSCOPE OF THE PROBLEM
• Identify theory-based principles and expert recommendations for emergency public health risk communication
• Identify features of emergency risk message development in high concern situations
• Examine how practice compares with theory-based recommendations
• Identify process steps in emergency message development
METHODSMETHODS
DISCUSSIONDISCUSSION
This work was supported by a National Institute of Nursing Research Training Grant, T32 NR007969. The authors thank Susan Ledlie, RN, DNSc for consultation on secondary data analysis
ACKNOWLEDGMENTSACKNOWLEDGMENTS
REFERENCESREFERENCES
RESULTSRESULTS
OBJECTIVESOBJECTIVES
• Think aloud protocol conducted with 3 experienced public health information officers
• Subjects asked to describe actions performed while preparing public health risk communication to address a paper based emergency scenario
• Preliminary analysis coded responses to published recommendations of emergency risk communication experts
• Secondary analysis used open and axial coding to reveal massage process steps
FUTURE STUDYFUTURE STUDY
PRELIMINARY ANALYSIS
• Subjects demonstrated sound conceptual knowledge of risk communication principles and theory
• Message development steps were applied in different order than recommended by experts, and steps skipped
• Subjects used message templates and heuristics
• Message development relied strongly on collaboration and conformed to model of group decision making under stress
• Naturalistic Decision Making Model conflicts with deliberate, consultative style of non-emergency decision making typical used in US public health agencies.
• Factors associated with sub optimal group decision making in the Naturalistic Model include self censorship and undermined confidence
• Sub optimal decisions are likely to contribute to sub-optimal messages
• Example: all subjects skipped the message evaluation step recommended by experts, a step intended to expose message weaknesses
• Secondary analysis revealed a structured process with well defined goals that could be automated
•
• Decision support needed, such as partially automated text authoring that will test message completeness and conformance to risk communication theory
• Decision support for public health emergency risk message development must address institutional culture and process evaluation
consultative, collaborative PH modelorganizational goals/norms
multiple stakeholders & levels of government
multiple players
high event visibilityhigh stakes
need for immediate informationtime stress
agency, public and partner feedbackaction feedback loops
evolving nature of urgent eventsshifting ill -defined goals
uncertain dynamic environmentuncertain dynamic environment
incomplete information, missing factsill- structured problems
Characteristics of Risk Communication in PH Emergencies/Urgent, High Concern Events
Characteristics of Naturalistic Decision Making (Klein, et al., 1993)
consultative, collaborative PH modelorganizational goals/norms
multiple stakeholders & levels of government
multiple players
high event visibilityhigh stakes
need for immediate informationtime stress
agency, public and partner feedbackaction feedback loops
evolving nature of urgent eventsshifting ill -defined goals
uncertain dynamic environmentuncertain dynamic environment
incomplete information, missing factsill- structured problems
Characteristics of Risk Communication in PH Emergencies/Urgent, High Concern Events
Characteristics of Naturalistic Decision Making (Klein, et al., 1993)
RISK
ASSESSMENT CHARACTERIZATION COMMUNICATION
MESSAGE DEVELOPMENT
MESSAGE DELIVERY
Public Health Culture
• Collaborative
• Factual, Deliberate
• Process Oriented
• Target Population Focus
High Concern Event
• Time Sensitive
• Incomplete Knowledge
• Urgent need for info
• Broad Population Focus
Concept Model--Public Health
Risk Communication in Emergencies
Decision support Decision support needed hereneeded here
RISK
ASSESSMENTASSESSMENTASSESSMENT CHARACTERIZATIONCHARACTERIZATION COMMUNICATIONCOMMUNICATION
MESSAGE DEVELOPMENT
MESSAGE DELIVERY
Public Health Culture
• Collaborative
• Factual, Deliberate
• Process Oriented
• Target Population Focus
High Concern Event
• Time Sensitive
• Incomplete Knowledge
• Urgent need for info
• Broad Population Focus
Concept Model--Public Health
Risk Communication in Emergencies
Decision support Decision support needed hereneeded hereDecision support Decision support needed hereneeded here
Means of distribution: website, radio, newspaper, etc.
Who’s in chargeWho speaks
6. Give out info
Message template guidesWhat’s the messageWho speaks
5. Standardize communication
CyclicalUse heuristicsCollaboration
What’s the messageWho speaks
4. Message content
Collaborative Cyclical
Who is in chargeWhat’s the messageWho speaks
3. Meeting
CyclicalState HD and CDC
2. Info seeking
CyclicalCollaborative--other counties, epi staff, SHD & CDC
1. Info receiving
CommentsSub-themesPhase (Themes)
Phases of emergency message development
Means of distribution: website, radio, newspaper, etc.
Who’s in chargeWho speaks
6. Give out info
Message template guidesWhat’s the messageWho speaks
5. Standardize communication
CyclicalUse heuristicsCollaboration
What’s the messageWho speaks
4. Message content
Collaborative Cyclical
Who is in chargeWhat’s the messageWho speaks
3. Meeting
CyclicalState HD and CDC
2. Info seeking
CyclicalCollaborative--other counties, epi staff, SHD & CDC
1. Info receiving
CommentsSub-themesPhase (Themes)
Phases of emergency message development
