Conducting a Communication Audit

To conduct a communication audit during the precrisis phase, follow these five steps:

1. 1 Identify priority health threats for the community that the health agency serves. These health threats could include the flu season, common foodborne illness outbreaks (e.g., salmonella), or smoke from wildfires. Check with leadership if you are unsure on how to prioritize health threats.

2. 2 Create an inventory of the communication materials available to communicate about the health threat. These communication materials can include communication toolkits, talking points, social media messages, press release templates or previously used press releases, webpage copy, and fact sheets. Using a spreadsheet is a good way to keep track of what materials are available by health threat. It is also a good idea to include when the item was created and last reviewed.

3. 3 Identify what is missing or what is outdated. Make a plan to create and/or edit communication materials and make sure to work in coordination with subject matter experts and leadership. Consider coordinating with community members to gather their feedback on the materials as part of a message testing process.

4. 4 Once the communication materials have been created and edited, hold a briefing meeting to update key communication staff, program staff, and leadership about what materials have been created, where the materials are, and how they will be used during an emergency. You can also work with your preparedness program to identify how the new materials could be tested, such as during a tabletop discussion or functional exercise.

5. 5 Make a note to check and review these materials both annually and following an emergency in which they were employed.

If new messages need to be created, consider testing those messages to ensure they will resonate with and reach target audiences. See later in this chapter for more on message testing.

What Does This Look Like in a CERC Plan?

Within a crisis communication plan, clearly outline who will act as spokespeople and for what emergency response they will be used. Also clarify when particular spokespeople will be used depending on the magnitude and severity of the emergency response. For example, for some foodborne illness outbreaks, having an epidemiologist serve as a spokesperson is appropriate as they will be the expert on the outbreak investigation. However, if the outbreak involves multiple counties or a high-profile organization, having a health officer or health department as spokesperson is more appropriate.

Next, include members of the crisis communication team and identify what roles and responsibilities they will hold. In this, it is critical to identify individuals with specific skillsets related to writing, communication, media monitoring and analysis, media relations, and website and social media management. If you have a small agency, you may need to identify staff from programs outside of the preparedness program. For example, if the preparedness program only staffs three individuals, leveraging staff from the immunization program or nursing division will be necessary during a health emergency. If staff do not have the necessary skills or need to receive training, ensure that the preparedness program facilitates the necessary training and tracks which individuals have received training.

What Does This Look Like in a CERC Plan?

JICs are a part of the National Incident Management System (NIMS), and they were developed to coordinate communication activities across multiple agencies during emergency management disaster responses.^[9] In a traditional JIC, a physical location is set up for public information officers from different agencies to develop messages based on their agency’s role in the response, and the incident commander approves the message before it is released. The virtual form of this coordinating center is called a Joint Information System. This book will refer to both a Joint Information Center and a Joint Information System as a JIC.

CDC and local public health departments often operationalize JICs to organize internal communication functions and coordinate with other health departments. This is called a public health JIC.^[3] The public health JIC functions as the main media distribution point during health emergencies and ensures the distribution of consistent and accurate information.^[10, Reference Conley^11]

The following functions of a JIC were used as part of the CDC 2005 severe acute respiratory syndrome (SARS) emergency response^[10]:

• Issue local public health announcements and updated information on the outbreak and response efforts.

• Disseminate information about the health emergency, its management, and the possible need for travel restrictions, isolation, and quarantine measures.

• Establish a “news desk operation” to coordinate and manage media relations activities.

• Provide a location for state, local, and federal communication and emergency response personnel to meet and work side by side on developing key messages, handling media inquiries, and writing media advisories and briefing documents.

• Respond to frequently asked questions by developing fact sheets, talking points (key messages), and question-and-answer documents.

• Coordinate requests for spokespeople and subject matter experts.

• Issue media credentials to the press.

• Address other local/regional information requests related to the outbreak that require distribution to the media and the general public.

• Develop, coordinate, and manage local websites as required.

Public health JICs are often established to coordinate internal and external emergency risk communication activities. For example, health departments work on outbreaks on a regular basis, with many of them never reaching a declared health emergency status. In these situations, activating an external JIC is not necessary because the outbreak situation does not overwhelm current resources and current resources can handle the public health incident. Instead, the health agency may bring together an internal JIC to coordinate communication across multiple internal programs. However, when outbreaks are larger and require more communications support, creating a JIC will scale up communication activities and the number of people working on communication activities. Remember, emergencies start at the local level. During communication planning and review, it is good practice to develop a threshold or trigger chart that outlines that when certain conditions are reached, a JIC will be activated. Procedures for activating and maintaining the structure of a JIC if one is activated will be outlined in a later section of this chapter.

What Does This Look Like in a CERC Plan?

Within the CERC plan, it is critical to outline such matters as issuing press releases, establishing an incident-specific emergency website, holding media briefings, and establishing call centers. Understanding how the agency will address rumors is important. See Chapter 7 information on addressing rumors.

For health emergency responses, it is critical to streamline communication so that the public, stakeholders, and media inquiries are identified, documented, and responded to in an efficient manner. One way to streamline emergency communication is to funnel emergency inquiries to specific emergency response phone numbers and emails. These emergency-specific communication channels are often used when a JIC is established.

What Does This Look Like in a CERC Plan?

Within the CERC plan, it is critical to outline how and when certain types of media relations activities are used, such as issuing press releases, establishing an incident-specific emergency website, holding media briefings, and establishing call centers. Leverage the agency’s digital channels to share and disseminate information, including the agency website, social media channels, GovDelivery newsletters, and text messaging. See Chapter 5 for more information on communication channels. Coordinating with the public health and preparedness program can help identify the locations of hard-to-reach and socially vulnerable populations. See Chapter 3 for more information on identifying audiences.

What Does This Look Like in a CERC Plan?

This function of the crisis communication plan leverages communication messages such as talking points, webpage copy, social media messages, fact sheets, and webpages about the virus, among others, all of which can be used during an emergency. It is also imperative that communication materials be available in multiple formats. Although not a state requirement, 508 compliance is a federal law that requires US federal agencies to provide accessible information to people with disabilities when using electronic and information technology.^[16]

Finally, the crisis communications plan needs to outline procedures regarding information distribution to stakeholders, the public, and the media. For example, identify what communication channels will be used to send press releases to the media. If a specific media email list is established, identify how that will be used during a health emergency and who has the ability to send such releases. If a GovDelivery email newsletter is established, outline how that will access the system and send the message.

Key Tip: Emergency Communication Clearance Processes, Release Schedules, and Updating Published Materials

As outlined earlier, a crisis communication plan will include communication clearance processes and procedures, including a release schedule and processes for updating published materials. The communication clearance process is a critical step for agency leadership and subject matter experts to review and approve emergency messaging before it is officially released to the public, media, partner agencies, and stakeholders. This final review ensures the emergency messaging is scientifically accurate and does not violate agency policies. The release schedule is managed by the communications team and outlines how often information will be released. For example, during the initial phase of an emergency, information may be updated every 24 hours. As the emergency moves into the maintenance phase, information may be updated weekly. As the emergency moves into the recovery phase, information may be updated monthly. A process for updating published materials ensures that the emergency information available on the agency’s website and social media channels is accurate and up to date. When updating published materials, it is helpful to designate a subject matter expert to review agency web pages in order to ensure the posted information remains accurate. It is also imperative to outline how often the review of published materials will take place (e.g., daily, weekly, monthly). Finally, designate a web or communications team member to make the actual updates.

When developing a communication clearance process, consider the following:

• Who needs to review the document? Consider agency leadership, subject matter experts, and the policy team. Give each reviewer specific instructions on what to look for when reviewing. For example, have subject matter experts look at the accuracy of the content and have a communications specialist focus on proofreading and grammar issues. It is a best practice to have the policy team review the documents to ensure emergency messages do not impact current agency policies.

• How will the review process take place? For example, will you send the materials by email or create a specific SharePoint site to facilitate the review process?

• Who is the final approver? Often the highest-ranking official of the agency gives final approval regarding a message. If the Incident Command System has been activated, the Incident Commander may be the final approver.

• How much time is needed to review? It is a best practice to provide reviewers with clear deadlines and timelines for review. For example, if the information needs to be sent to the media in 2 hours, tell the reviewers they only have 1 hour for review, which provides the communications team with 1 hour to address edits and package the materials for release.

Message Testing and Consensus Recommendations

Message testing emerged in the 1970s as a form of public relations evaluation and measurement. Message testing provides an opportunity to determine whether messages will persuade individuals to take an action, but often message testing does not occur because it can be expensive and time-consuming.^[Reference Kim and Cappella^24] Developing consensus recommendations differs from message testing in that consensus recommendations for public health emergencies are agreed upon by subject matter experts regarding the health, medical, and other strategic recommendations to mitigate health threats.^[Reference Lazarus, Romero, Kopka, Karim, Abu-Raddad and Alemida^25] Consensus recommendations bolster future emergency response efforts. These recommendations ensure that agencies will engage in similar response activities and achieve consistent public messaging regarding these activities. Gathering key leadership, subject matter experts, and communication officers from multiple disciplines and jurisdictions – especially those with shared media markets – to discuss consensus recommendations is a key preparedness activity; however, during the COVID-19 pandemic response – due to the novel virus and its global impact – consensus recommendations were developed during the emergency response.^[Reference Kim and Cappella^24, Reference Lazarus, Romero, Kopka, Karim, Abu-Raddad and Alemida^25, Reference Marie, Thomas, Cassandra, David, Loth and Eva^26] When agencies come together to discuss similarities and differences in activities and messaging, they ultimately must agree upon consensus recommendations. After agencies are clear on response activities and recommendations, message testing can occur.

To engage in message testing, first assess whether there is a budget for message testing. If there is a large budget available, your health agency may consider hiring a public relations firm, communication consultants, or university researchers to conduct formal message testing. If there is a smaller budget or no budget available, there are two options to consider: (1) Assess whether there is any opportunity for pro bono work with public relations firms, communication consultants, or university researchers or (2) if there is no budget, identify partner agencies and stakeholder groups who might be willing to donate some of their time to assist with a scaled-down version of message testing.

Many health departments do not have budgets for formal message testing, so the following recommendations are for real-world applications of message testing with a small or no budget. Even without a budget, low- to no-cost message testing provides the opportunity to get outside of your organizational bubble, check your messaging assumptions, and learn more about the people you are trying to communicate with.^[Reference Sanderson^27]

Internal Audiences

Internal audiences include those people and groups who are considered within the health agency or public health system. Internal audiences for health emergencies include employees of the health agency responding to the incident. Depending on the organization of the public health system within the state and location, county health agencies could also be considered an internal audience. For smaller health departments, many employees will be involved with the emergency response, so internal communication will be easier since most of the health department staff will be involved in the response. But for larger health departments that provide many health programs and services, public health services will continue even during a health emergency. When this occurs, it is important that staff who are not working on the emergency response are aware of what is happening. This is crucial because even though they are not working on the response or serving as spokespeople, they are likely to be asked questions by friends, neighbors, their family, and other people in their personal networks.

External Audiences

External audiences are people and groups who are outside the health agency or the public health system. External audiences will be made up of stakeholders and partners who will have information needs. Audience segmentation can help emergency risk communicators differentiate among segments of external audiences, identify their information needs, and create messaging that resonates with each audience segment.

Audience Segmentation

The general public constitutes several different types and groups of people with their own ways of relating, communicating, and sharing information. To ensure messages reach and resonate with an audience, it is important to identify different audience segments and create messages designed for that audience. During an emergency, early messages will often focus on those most at risk based on health risk, the location of the health emergency, and underlying or chronic medical conditions. The development of emergency messages is discussed in detail in Chapters 6–9.

Audience segmentation has its roots in social sciences and social philosophy, with modern influences from psychology and marketing.^[Reference Slater^3] Public relations scholar James E. Grunig offers a basic definition of audience segmentation: “divide a population, market, or audience into groups whose members are more like each other than members of other segments.”^[Reference Grunig and Salmon^4] The rationale for is that audience segments are more definable, accessible, reachable, and large enough to communicate with in an efficient way.^[Reference Grunig and Salmon^4]

To apply this thinking to emergency risk communication, “segments should be homogeneous with respect to patterns of variables (and values on those variables) determining the attitude and behaviors targeted by a communication effort.”^[Reference Slater^3] The idea is that if audience segments can be identified, messages can be tailored for those groups.

Basic audience segmentation can begin with variables such as demographics, including age, race, gender, education, socioeconomic status, and geographic location.^[Reference Smith^5] Additionally, you should identify channels and ways to reach these individuals as well as determine how likely or able they are to take an action.^[Reference Slater^3, Reference Smith^5] When identifying and grouping segments, it is key to ensure that the segments are distinct from each other, are related to the communication strategy, and are large enough to justify the time and effort required to target them.^[Reference Smith^5]

Understanding who is receiving your information is a critical factor in emergency risk communication planning and in strategic communications planning in general. Identifying audience segments during a health emergency draws upon basic audience segmentation variables as well as other variables unique to a health emergency (see Table 3.2).

Common Information Needs for Internal Public Health Audiences

• General information about the health emergency, approved talking points, and hotline numbers.

• If they are asked questions by stakeholders, where should they direct them? What are the key points of contact for the emergency response?

• What is the likelihood they may be pulled in as surge staff?

• How often will information be updated? Where can they find this information?

• Are there any upcoming media briefings?

• Media and social media policies.

• Human resources and staffing policy changes for health emergency work.

Common Information Needs for Stakeholders

• Best sources of official information about the health emergency.

• Health risk information (what is it, what signs and symptoms to look for).

• What to do to protect health – specific action steps.

• Where to find more information and contact information (website URLs, social media, and hotline/call centers).

• Upcoming media briefings and schedules.

• Upcoming town hall or public input sessions.

• How to provide feedback.

Common Information Needs for Official Partners

• Organizational chart of emergency staff with key contact information.

• Incident command structure meeting frequency.

• Reporting templates.

• Situational awareness information.

• How to report data.

• Approved talking points.

• Joint Information Center contact information.

Common Information Needs for the Media

• Latest information on health emergency (what happened, who is affected, what is the health risk).

• Statistics (fatalities, cases, hospitalizations).

• Costs and expenses related to emergency response activities.

• Attribution of responsibility.

• What the health department is doing to find the source of the outbreak.

• Name and title of spokesperson.

• Upcoming media briefings.

• Opportunities for interviews.

• B-roll related to the health emergency.

• Stock images of the virus (if applicable).

Mini-Case Study: Odwalla Juice Outbreak

On October 30, 1996, Odwalla, Inc. – a fresh juice company – was notified by the Seattle King County Health Department, based in Washington state, of a link between its unpasteurized apple juice and an outbreak of E. coli O157:H7.^[Reference Martinelli and Briggs^13] The company immediately issued a voluntary recall and included 12 other juices in its recall. Although the company’s product distribution was limited to six states in the United States (California, Colorado, New Mexico, Texas, Oregon, and Washington) and one province in Canada (British Columbia), the rise of online media and newswire services heightened global media attention. Odwalla issued refunds to customers and offered to pay for medical expenses associated with the outbreak.^[Reference Martinelli and Briggs^13] Unfortunately, the outbreak led to the death of a 16-month-old and sickened 60 other children. Odwalla ultimately included a flash pasteurization process in its production procedures. This process kills bacteria within the juice but retains the flavor and freshness of the product.

Health Risk

In 2016, the World Health Organization (WHO) declared Zika a public health emergency of international concern due to clusters of microcephaly cases and other neurological disorders reported in Brazil and in French Polynesia.^[3] Epidemiological information helped health officials understand what the illness is, who is affected, how they are affected, and the location of the outbreak, and in turn develop health interventions to deal with the outbreak. Prior to the recent outbreak, Zika virus was primarily carried by monkeys with little “spillover infections in humans.”^[Reference Ibrahim^4] However, since 1952, public health officials have had evidence that Zika can infect humans. Early cases were found in Uganda and Nigeria and later in other African countries and Indonesia. By 2007, an epidemic occurred in Yap Island; another then occurred in French Polynesia in 2013, followed by others in Cook Island and New Caledonia in 2014.^[Reference Ibrahim^4] By 2016, 60 countries were experiencing Zika cases, and by 2017 cities along the US–Mexico border also reported Zika cases. The Zika virus is transmitted to humans by the bite of a female mosquito. Humans spread it to other humans through sexual transmission. Additionally, there is perinatal transmission, meaning the Zika virus can be transmitted in utero to a developing fetus, causing microcephaly – a brain abnormality.^[Reference Ibrahim^4] Zika can also cause Guillain–Barré syndrome. Symptoms of Zika in adult humans include mild fever, joint pain, headaches, rash, and pink eye.^[Reference Ibrahim^4] Symptoms can last for up to 7 days and the incubation period is 3–12 days.

All of this information can be used to develop initial, maintenance, and recovery messages for audiences identified through the emergency risk communication plan. Chapters 6, 7, and 9 provide specific steps for writing and creating emergency risk communications during a health emergency. The following is a sample initial emergency risk communication message about Zika. More information about writing and creating initial messages is presented in Chapter 7.

Interventions

The second message content area where emergency risk communicators and epidemiologists cocreate emergency risk communications is communicating health interventions, or the actions people can take to protect their health during a health emergency. Chapters 7 and 8 provide in-depth information about promoting health interventions during short- and long-term health emergencies. Let us continue reviewing the 2015–2016 Zika health emergency to understand how epidemiologists and emergency risk communications cocreate emergency risk communication messages about health interventions.

Since the Zika virus is transmitted by mosquitoes, looking at the physical environment would be a key intervention in stopping mosquito breeding. This intervention of addressing the environment is critical in reducing the spread of Zika because there is no vaccine available to prevent Zika. Strategies to address mosquito breeding include:

• Elimination of standing water containers

• Use of larvicides (biological or chemical) to disrupt mosquito development

• Chemical control: spraying or toxic baits of adult mosquitoes

• Physical control: trapping female mosquitoes to prevent egg-laying or capturing eggs

There are no specific treatments for Zika; nonpharmaceutical intervention, such as providing supportive care in the form of resting, increasing fluids, and taking medication to reduce fever and pain, are key action steps that can be taken. Additionally, to reduce sexual transmission, wearing condoms is recommended.

All of this information can be used to develop initial, maintenance, and recovery messages for audiences identified through the emergency risk communication plan. Chapters 6, 7, and 9 provide specific steps for writing and creating emergency risk communications during a health emergency. The following is a sample maintenance emergency risk communication message about Zika. More information about writing and creating maintenance messages is provided in Chapter 7.

Maintenance Messages: What They Are and How to Write Them

Maintenance messages are usually sent about 7 days into a health emergency, and this phase can last for weeks, months, or even years. There are four key message components of a maintenance message that will support the CERC principles of Be Right, Be Credible, Promote Action, and Show Respect. Incorporating these message components into emergency risk communication messages allows spokespeople and health agencies to follow the CERC principles.

Maintenance message components include:

• Deeper risk explanations

• Interventions

• Making a commitment to the community

• Addressing rumors and misinformation

Continuing with the Zika virus outbreak, the following sections provide examples of the maintenance message components listed above. In April 2016, CDC released a statement scientifically confirming the link between the Zika virus and microcephaly.^[Reference Akpan^8] This confirming affirmed many of the health interventions the CDC was promoting for pregnant women. The following paragraphs outline maintenance messages used by the CDC to deepen the knowledge regarding the risks to pregnant women by the Zika virus.

Deeper Risk Explanations

The following text is taken from the CDC website “Zika during Pregnancy.”^[9] The intended audience is pregnant women in the United States.

Zika During Pregnancy

CDC recommends you take special precautions if you are pregnant to protect yourself from Zika virus infection.

Because Zika during pregnancy can cause severe birth defects, if you are pregnant, you should not travel to areas with Zika outbreaks (as indicated by red areas on the Zika map). Before traveling to other areas with risk of Zika (as indicated by purple areas on the Zika map), you should talk to a healthcare provider and carefully consider the potential risks of Zika and other infectious diseases.

The only way to completely prevent Zika infection during pregnancy is to not travel to areas with risk of Zika and to use precautions or avoid sex with someone who has recently traveled to a risk area.

We do not have accurate information on the current level of risk in specific areas. The large outbreak in the Americas is over, but Zika is and will continue to be a potential risk in many countries in the Americas and around the world. No local spread of Zika virus has been reported in the continental United States since 2017.

There is no vaccine to prevent or medicine to treat Zika. If you are considering travel to an area with risk of Zika, talk to your health care provider first. It is important to understand the risks of Zika infection during pregnancy, ways to protect yourself, signs of Zika, and the limitations of Zika testing upon your return.^[9]

The CDC website content continued to deepen the risk explanation by including information about travel to and from an area with a Zika outbreak, risk of Zika to future pregnancies, and Zika test results. This information was given in English and Spanish.

Interventions

As discussed earlier, there are no vaccines or treatments for Zika. Instead, prevention activities are key. CDC outlines the following key nonpharmaceutical interventions in an infographic (see Figure 4.1):

1. 1 Increasing awareness about sexual transmission.

2. 2 Steps to take to prevent transmission: wearing insect repellant; wearing long sleeves and pants; staying indoors with air conditioning or using window screens; removing standing water around the home.

3. 3 Increasing awareness about Zika and birth defects and encouraging condom use.

4. 4 Encouraging pregnant women to not travel to areas with Zika.

5. 5 Monitoring return travelers and using safe-sex practices.

Figure 4.1 CDC infographic: Top 5 things everyone needs to know about Zika

CDC created this infographic to explain nonpharmaceutical interventions that the public can take to protect themselves from Zika. Providing information on interventions is a key message component of a CERC maintenance message.

Source: United States Centers for Disease Control and Prevention (CDC). The use of this material does not imply endorsement by CDC, Agency for Toxic Substances and Disease Registry (ATSDR), US Department of Health and Human Services (HHS), or the United States Government of the author. This material is available on the CDC website free of charge: www.cdc.gov/zika/about/needtoknow.html

Making a Commitment to the Community

The following example message was sent out after the outbreak of Zika and shows how the Obama administration communicated a commitment to the community during the health emergency. This example demonstrates how the President make a commitment to the community to monitor the situation and mitigate the health threat to the public.

The Zika virus is a disease spread primarily through the bite of an infected mosquito – the same type of mosquito that spreads other viruses like dengue and chikungunya.

While most people have no symptoms at all, Zika causes mild illness in some. However, the Centers for Disease Control and Prevention (CDC) has established a link between Zika infection during pregnancy and serious birth defects and other poor pregnancy outcomes. We also know that there can be other serious neurological impacts in some people who are infected with Zika.

We are closely tracking and responding to outbreaks of this virus across the Americas. We have seen transmission in Puerto Rico, the U.S. Virgin Islands, and American Samoa, in addition to cases reported in Mexico, Central and South America, the Caribbean, and the Pacific Islands. The Florida Department of Health is tracking cases of non-travel related Zika in one small area in South Florida and is closely coordinating with the CDC as they further investigate this ongoing situation.

And we know that this particular mosquito lives in certain parts of the southern United States, and we now know that Zika can also spread in another type of mosquito that is present throughout much of the United States. So now is the time to prepare as the seasons change and weather gets warmer.

As President Obama said, we all have to remain vigilant when it comes to combating the spread of diseases like Zika. That’s why the President has called on Congress to provide emergency funding to combat this disease, including to

1. a. speed the development of a vaccine;

2. b. allow people – especially pregnant women – to more easily get tested and get a prompt result; and

3. c. ensure that states and communities – particularly those in the South that have experienced local outbreaks of dengue and chikungunya in the past – have the resources they need to fight the mosquito that carries this virus.

Congress needs to act now to ensure that we have the resources we need to take every step necessary to protect the American people from the Zika virus.^[10]

Addressing Rumors and Misinformation

In February 2016, The New York Times wrote an article outlining rumors associated with Zika and providing accurate information.^[Reference McNeil^11] One of the rumors and information correcting this misinformation are provided in the following as an example of how to address rumors that emerge during a health emergency.

Are genetically modified mosquitoes the real cause of the birth defects?

That buzzing sound you hear is a “no.”

A British company, Oxitec, released genetically engineered mosquitoes in Brazil in an attempt to control dengue fever. But the later microcephaly outbreaks were far away. For example, the largest mosquito release was in Piracicaba, which is 1,700 miles from Recife, where microcephaly was most common. The mosquitoes have also been released in the Cayman Islands, Malaysia and Panama without causing problems.

Mosquitoes fly less than a mile in their lifetimes. Also, only male mosquitoes were released. They do not bite humans or spread disease and were genetically programmed to die quickly.^[Reference McNeil^11]

Data Graphics

Another important way for epidemiologists and emergency risk communicators to cocreate emergency risk communication messaging is through data graphics that are used on websites, social media channels, handouts, slide decks, or media briefings. As outlined in Chapter 5, multiple communication channels can be used to disseminate key emergency public health messaging. Each communication channel will have a corresponding communication product that can be created and tailored for that particular channel. For example, when engaging in a media briefing, incorporating data graphs and charts may help enhance messaging and further explain the health risk to the public.

Engaging the crisis communication team, including graphic designer, social media manager, and website administrator, will help ensure the usability of the graphics for multiple communication channels. For example, CDC created a data graphic that visually depicts the percentage of babies that are born to people infected with the Zika virus while pregnant (see Figure 4.2). The graphic shows that 5% of babies are Zika-associated birth defects if the mother was infected with Zika while pregnant. Using contrasting colors and icons of infants, the visual depicts the low percentage of babies born with Zika-associated birth defects.

Figure 4.2 CDC graphic: Babies born to people infected with Zika virus while pregnant

CDC created this figure – a data graphic – that visually depicts the percentage of babies that are born to people infected with the Zika virus while pregnant. Data graphics are often cocreated by risk communicators and epidemiologists and are a visual way to explain the risk associated with a health threat.

Source: United States Centers for Disease Control and Prevention (CDC). The use of this material does not imply endorsement by CDC, ATSDR, HHS, or the United States Government of the author. This material is available on the CDC website free of charge: www.cdc.gov/zika/czs/index.html

During the COVID-19 pandemic, CDC created a community-level map that would track data by county and provide a way for people to interpret the risk of getting COVID-19 in their own community (see Figure 4.3). Available epidemiological data about the number of cases and hospitalizations in the area were used to create the data graphic. The map included an image of the United States and incorporated assorted colors that corresponded to particular levels of risk: black was low level, light gray was medium level, and dark gray was high level.

Figure 4.3 CDC Instagram post of United States COVID-19 community-level map

CDC created this figure – a data graphic – that visually depicts the risk of contracting COVID-19 in different communities across the United States. Data graphics are often cocreated by risk communicators and epidemiologists and are a visual way to explain the risk associated with a health threat.

Source: United States Centers for Disease Control and Prevention (CDC). The use of this material does not imply endorsement by CDC, ATSDR, HHS, or the United States Government of the author. This material is available on the CDC website and Instagram account free of charge: https://covid.cdc.gov/covid-data-tracker/#datatracker-home and www.instagram.com/CDCgov/?hl=en

The key for emergency risk communicators is to ensure that the health risk message can be succinctly explained and does not leave interpretation of the graphic up to the end user. A recent study revealed two common problems with public health graphics and data dashboards related to COVID-19.^[Reference Momenipour, Rojas-Murillo, Murphy, Pennathur and Pennathur^12] First, in charts or graphs that focused on conveying risk, the color graduations were not prominent enough to indicate increased levels of risk. Interpretation of these data and risks was thus left up to the reader. Second, the data dashboards included case counts, interactive charts, and maps with filters, but there were limited to no explanations of what the data meant for people trying to understand their personal risk level within their community.^[Reference Momenipour, Rojas-Murillo, Murphy, Pennathur and Pennathur^12]

Again, by working together, emergency risk communicators and epidemiologists can design website graphics and data dashboards that convey accurate risk information to the public through the use of trend lines, warning signs, and different colors and icons signaling increased or decreased threat. Create interactive features that allow people to select location information in order to understand the health risk by geographical area. Use “conventional urgency colors instead of non-standard color schemes (i.e., red, yellow, green, for high, moderate, and no urgency levels, respectively) so that the colors directly correspond to user mental models representing danger, moderate danger, and no danger. In addition to using colors, including patterned or texture areas could address accessibility concerns for color-blind users.”^[Reference Momenipour, Rojas-Murillo, Murphy, Pennathur and Pennathur^12]

Medical Community as Audience Segment

To understand how the medical community is integrated into public health emergency preparedness, it is helpful to look at the Administration for Strategic Preparedness and Readiness’s (ASPR) Hospital Preparedness Program (HPP). The HPP is designed to support health care delivery system preparedness in the event of a large-scale health emergency and build collaborations between health care delivery and public health agencies.^[14] Within the HPP, Health Care Coalitions (HCCs) are designed to bring together individual health care and response organizations such as acute care hospitals, emergency medical service (EMS) providers, emergency management agencies, and local and state public health agencies to prepare health care delivery systems to respond to health emergencies.

Similar to the Public Health Emergency Preparedness (PHEP) cooperative grants discussed in Chapter 2, HPP cooperative agreements require a particular set of reporting requirements to prepare the health care system for public health emergencies. These requirements include the following:

• Multiyear training and exercise plans

• Infectious disease preparedness surge annexes

• Infectious disease preparedness surge tabletop discussions/exercises

• Financial reporting, including budgets and spend plans

• Annual HCC work plans

• Annual HCC training plans

• Templates

• Annual joint HPP–PHEP vulnerable populations exercises

• Pandemic influenza planning requirements

• Joint exercises between HPP–PHEP partners

• After-action reports and improvement plans

• Crisis standards of care documents

• Hazard vulnerability assessments

• Attending particular public health preparedness conferences^[15]

Since the HPP and HCC represent critical investments into a system’s approach to preparing public and private health care organizations for health emergencies, it is equally critical for emergency risk communicators to consider the information needs of the medical community during a health emergency. As HPP requirements focus extensively on planning, exercising, and coordination between hospital preparedness and public health preparedness, emergency risk communicators also need to understand what to communicate with this particular audience. Additionally, it is important for emergency risk communicators to consider the information needs of the entire medical community. For example, there are health care providers who provide services outside of hospitals. While hospitals are an important partner in public health emergencies, primary and urgent care clinics often get overwhelmed with questions from their patients, and so they need the most up-to-date information. Including all medical providers on Health Alert Network (HAN) messages ensures the entire medical community will receive important emergency risk communication about a health emergency.

In contrast to the general public, the medical community has particular knowledge, skills, and job responsibilities that are technical, advanced, and treatment-focused. While public health is focused on preventing community health harms and carrying out government legislation to support the health of the community, the medical community is generally focused on treating and curing disease at the individual level.

Common Information Needs of the Medical Community during a Health Emergency

The following six information needs of the medical community are based upon systematic literature reviews of scientific research and personal interviews with members of the medical community.

Audience Segments

The medical community is made up of many distinct types of medical professional. These include primary care clinicians (i.e., medical doctors, nurse practitioners, physician assistants), pediatricians, osteopathy doctors, naturopaths, dentists, ophthalmologists, nurses, laboratorians, medical imaging technicians, anesthesiologists. There are also many different types of medical facility, including trauma care and hospital care, including pediatricians, neonatal, OBGYN, cancer treatment and intensive care units, inpatient and outpatient surgeries, physical rehabilitation, primary care, pediatrics, assisted care living, nursing homes, and hospices. It is important to outline the information needed by the various health care facilities.

Key Messages

As outlined earlier, there are six key information needs of the health care community. Ensure key messages to this audience include scientific guidance, data-reporting requirements to public health, epidemiological data, health risks, PPE, and health care interventions and treatments. In comparison, messages for the general public provide general overviews of the health emergency, including health risks and simple actions the public can do to protect their health.

Channels

Key channels to reach the medical community include Epi-X and the HAN. Specific webinars or conference calls can be hosted to share key medical information with the medical community. Additionally, leverage HCCs to share and amplify messaging for the medical community. For example, CDC hosts the Clinician Outreach and Communication Activity (COCA) call during health emergencies to share key information with the medical community.^[25] In comparison with the general public, health departments are likely to use many channels, including news media and social media, to communicate with a broad audience. Specific channels for the medical community or secure channels like HAN and Epi-X may be used to communicate clinical information.

Communication Products

Based upon the key messages and channel identification, the following communication products will be needed to communicate with the medical community: (1) scientific guidance documents; (2) slide decks for webinars; and (3) handouts or videos as supplemental information for training or educational purposes. In comparison to the general public, communication products for the medical community need to include tailored and specific information. Often, emergency risk communicators develop educational materials like posters and infographics for the public and share those with the medical community. It is important for emergency risk communicators to realize that the medical community is looking for specific information from the health department about the health emergency. Often, HCCs will create public education materials that are of no use to the medical community. Instead, leverage preexisting materials from federal or state government agencies for public education and create and tailor communication materials that include key information that the medical community needs on:

• Scientific guidance

• Data reporting

• Health risks

• PPE

• Health care interventions and treatments

Middle Management

Although senior leadership demonstrated the CERC principles, hospital staff reported that middle management seemed to lack understanding of how to implement guidance from senior leadership within their teams. The inability to implement the guidance from senior leadership within teams left hospital staff feeling frustrated and unseen by their managers, and many hospital staff reported a lack of empathy from their immediate supervisor. By using the CERC principles of providing empathy and showing respect, middle managers could have better connected with their staff regarding the uncertainty of the emerging COVID-19 outbreak.

Resource Allocation and Logistics

Hospital staff reported a lack of clarity regarding new and emergent procedures regarding patient screening. The patient screening procedures and locations of patient screening would often change without staff being notified or receiving explanations as to why these changes had occurred. By engaging in the CERC principles of being right and credible and showing respect, hospital staff could have engaged in clear communication and information-sharing and established a communication protocol regarding the patient screening process. By establishing a communication protocol, the staff in charge of patient screening would be able to know how, when, and who to notify when changes were made to the screening process. This type of communication demonstrates the CERC principles by ensuring all staff have the most accurate information about patient screening, and it shows respect by ensuring that no one is left out of the communication loop, ensuring everyone is able to fully engage in their work and understand what is expected of them when carrying out their job responsibilities.

Human Resources and Staff Welfare

One of the biggest challenges staff within public health and the medical community faced regarding COVID-19 was the ability to personally process the evolving situation while simultaneously engaging in their professional work. Further, due to the workload increases, staff had to switch roles or take on other people’s work throughout the outbreak. In the Singapore hospital study, staff reported a lack of empathy regarding their welfare during the outbreak. Further, staff felt that some of the human resources policies were communicated in an authoritarian and rule-based manner rather than with empathy and concern given the evolving health emergency. Engaging in empathy and showing respect to all staff are key CERC principles that can enhance internal human resource policy communications during health emergencies.

Information Overload

During health emergencies, in which uncertainty, stress, and anxiety are high, receiving information is helpful, but there also needs to be a balance in how and when information is shared. Sharing information too often or frequently changing processes or procedures can be hard for people to cognitively process. A balance must be struck regarding higher-priority and lower-priority communications. For example, hospital staff suggested that secure text messaging be used to communicate higher-priority alerts, while emails could be used to share lower-priority alerts. By sending secure text messages for higher-priority alerts, hospital staff could come to understand that a text message meant immediate action was required, while an email indicated action could be instigated later in time.

Audience Segmentation

The Singapore hospital study revealed that emergency communication within hospitals also requires audience segmentation. Specifically in this study, health care professionals who had worked more than 5 years at the hospital responded well to the senior leadership messages, while those who has worked less than 1 year at the hospital were often unsure of what actions to take during the health emergency. Other demographics, including age and job position, also affected how individuals processed information from senior leadership regarding the health emergency. Conducting audience segmentation and tailoring information within a hospital will ensure key health emergency messages are received and acted upon by all staff regardless of demographic differences.

Katrina Hurley, MD, chief of an urban emergency department in Canada, remembers wanting to receive transparent, frequent, and highly specific information about the emerging COVID-19 health threat.^[Reference Hurley^28] For example, when guidance was being issued about PPE for hospital staff, she recalls wanting to receive specific evidence-based information that the recommended PPE would protect her and her staff from getting ill. She felt that evidence-based information would have enhanced her trust in these messages. Dr. Hurley also remembers receiving many questions from patients regarding information they had seen on social media or news media. While she didn’t always know the social media post or news story to which the patient was referring, Dr. Hurley did her best to address patients’ fears and combat misinformation. She even engaged in her own information-seeking, and she would share what she learned with colleagues and staff. A key takeaway here for hospital emergency risk communicators is to engage in news and social media monitoring to identify potential questions that patients might have based on trending news and social media posts. By reviewing these daily media reports, doctors can become more prepared to handle patient questions that arise from news and social media. See Chapter 10 for more information on news and social media monitoring.

Secure Alerting Systems

Within the public health system, there are two specific communication channels – or secure messaging systems – that are used to communicate outbreak information between federal, state, and local health agencies. These are the Health Alert Network (HAN) and the Epi-X (the Epidemic Information Exchange).

Business Collaboration Channels

As outlined in Chapter 2 as part of Crisis and Emergency Risk Communication (CERC) planning and public health emergency preparedness (PHEP) Capability 4: Public Information and Warning, the crisis communication team needs to identify and use a notification system to inform staff and crisis communication team members of an emerging health emergency that will need crisis communication support. The notification system can use different communication channels such as business email or business text notifications. The following subsections outline how these internal notification systems can have multiple functions to support internal communication for public health departments.

Media Briefings

Media briefings are created and organized by government agencies, organizations, and businesses to share a major news announcement with many members of the news media at once. Pre-COVID-19, most media briefings were held in person, but with the rise of streaming technology, online media briefings are now more common.

When organizing a media briefing, there are eight key steps to follow.

The communication tactics associated with media briefings are talking points. Talking points are sets of clear, easily remembered phrases that outline a proposal, project, or idea.^[21] For emergency risk communicators, talking points include the emergency risk communication messages that will be delivered by the spokesperson. Once a set of talking points are developed, they can be tailored to be used on different communications channels (e.g., websites, social media) and by health department staff answering public inquiries or hotline or call center staff to support the development of preparedness responses.

Talking points keep the spokesperson on message whether they’re giving a presentation, talking to a reporter, or in a meeting or elevator discussion. The purpose of talking points is to ease the verbal presentation, as it needs to be short and only to contain the most relevant information. Using bullet points can help condense and organize information.^[21] Ensure the key emergency risk communication messages are included in the talking points. Keep in mind audience and information needs, the phase of the health emergency,^[22] health risks, and the action steps people can take to protect their health. Weave in the CERC principles as appropriate.

Some agencies may have a teleprompter that you can make use of, or for online media briefings spokespeople can read their talking points directly from their computer. In that case, narrative talking points instead of bullet points are needed.

Public Alerting System: Wireless Emergency Alert System

The Wireless Emergency Alert (WEA) system is a partnership between FEMA, the Federal Communications Commission (FCC), and the nation’s wireless service providers. Launched in 2012, the WEA system is designed to enhance public safety by allowing authorized federal, state, and local officials to send 90-character (recently increased to 360-character) geotargeted, text-like messages to the public’s mobile devices during an emergency.

The WEA system is an essential part of US emergency preparedness and has been used more than 56,000 times to warn the public about dangerous weather, missing children, and other critical situations. The WEA system is designed to enable officials to send “imminent threat” alerts, as well as AMBER (America’s Missing: Broadcast Emergency Response) alerts for missing and abducted children. A third type of alert – “public safety messages” – became available for alert originators in July 2019 (related messages include recommendations for saving lives and property). A fourth type of alert – a “presidential alert” – allows the President of the United States to send a message to the entire nation in the event of a catastrophic disaster, such as a nuclear attack.^[22] The benefit of the WEA system over SMS text messages is the WEA system broadcasts use a “push” technology that sends messages to all enabled devices in a designated area, while SMS uses a point-to-point system and requires officials’ prior knowledge of specific phone numbers.^[22]

During the COVID-19 pandemic, no nationwide mobile alert was issued in the United States, but some state and local governments issued WEAs about the COVID-19 health emergency.^[Reference Bean, Grevstad, Meyer and Koutsoukos^23] Specifically, governors in Colorado, Maryland, Michigan, New Mexico, and South Carolina used WEAs to issue stay-at-home orders. In Portland, Oregon, a WEA was used to alert residents to a city-wide curfew (see Figure 5.1). The WEA system is an important tool for emergency risk communicators to consider as WEA messages can provide messages to people in a particular area on how to avoid becoming ill during an ongoing health emergency.

Figure 5.1 A Wireless Emergency Alert sent to Portland, Oregon, residents during the COVID-19 pandemic when the local government issued curfews.

The corresponding tactic or communication product is the alert message template found within the WEA system. The alert message must include location, time frame, and health guidance information for those affected by the health emergency.

GovDelivery

GovDelivery is an electronic system that can be used to share information with citizens about health emergencies and other key government-related information.^[24] Prior to GovDelivery, government agencies would send paper mailings.^[Reference Boerngen^25]

During COVID-19, Kitsap County in Washington state used GovDelivery to send out emails, texts, and social media messages about the outbreak and to counter misinformation.^[26] Kitsap County had been using GovDelivery for 9 years, but during COVID-19 the county saw a double-digit percentage increase in subscribers to GovDelivery. Further, the county’s COVID-19 daily bulletin included key information to answer citizen’s questions received from call centers, media, and other channels.^[26]

This consistent bulletin along with coordinated messaging shared via SMS and social media helped people identify Kitsap County as a trusted source of information during the health emergency. In addition to increased email subscribers, the county’s Twitter (now known as X) and Facebook accounts saw a 10% growth, and its SMS messages reached over 830,000 recipients.^[26]

The corresponding media tactics for GovDelivery are the newsletter, SMS text, and social media post templates that the system has set up. Leverage your agency’s approved talking points and social media messages to create engaging newsletter content and social posts. Ensure message consistency when sending SMS messages about a health emergency and about the actions that the public can take to protect their health.

Town Halls

There are differences between media briefings and town halls or online forums. During a media briefing, the spokesperson is directly communicating with reporters. There’s a set context, and everybody understands that there are reporters, a spokesperson, and set rules of engagement during press conferences. In contrast, in a town hall the spokesperson is communicating with everyone: the public and reporters. When a spokesperson is communicating with everyone including members of the public or those directly affected by the health emergency, the spokesperson must be prepared to interact and engage with the public’s emotions. In a town hall, how the spokesperson communicates is vital.

Town halls can be more difficult for spokespeople than media briefings because town halls usually occur over a longer time frame. Media briefings are often about 30 minutes in length, whereas town halls can last for hours. Typically, the more speakers you have, the more interaction there will be between those attending the town hall.

During a town hall, the spokesperson will deal with multiple narratives and issues. In a media briefing, the spokesperson can control the narrative, but during a town hall, which encourages interaction with the public, multiple narratives will emerge. By conducting a stakeholder assessment prior to a town hall, the communication team will gain a good sense of the condition and emotions of the audience. Finally, there is potential for the spokesperson to be confronted with emotions, especially anger. Anger is not likely to be displayed during a media briefing, but it might very well be present in a town hall, and it is important to know how you can deescalate any such conflicts (see Chapter 11 for more information).

Town halls are created and organized by government agencies, organizations, and businesses to share information with a large group of people, engage in dialogue with the public and key stakeholders, and gather feedback on an issue affecting community. For emergency risk communicators, town halls provide a vital source of feedback for understanding public sentiment regarding the health agency’s management of a health emergency. Like media briefings, most town halls were held in person before COVID-19, but with the rise of streaming technology online town halls are now more common.

When organizing a town hall, there are eight key steps to follow.

The corresponding tactics for a town hall include talking points, slide decks, graphs, charts, and other visuals to support the speakers. Another key communication product is the run-of-show document for the production team – regardless of whether the event is online or in person. The run-of-show document will help orient everyone regarding the purpose of the event, outline speaker order and the roles and responsibilities of the production team, and indicate at what time the event will move to taking questions from the public.

Call Centers and Hotlines

In PHEP Capability 4: Emergency Public Information and Warning, establishing avenues for public interaction and information exchange includes the use of call centers and hotlines. Developing a call center doesn’t have to be organized or managed solely by the public health agency. It is possible to leverage existing poison control centers, crisis hotlines, nurse advice lines, or community connection hotlines such as a 2-1-1 to support health emergency response activities and created a coordinated call center.^[27] Calls centers are important because they provide another way for the information-seeking public to gather information about a health emergency. Further, when a call center is established, it can provide much-needed interaction with the public and build trust between the public and the health agency responding to the emergency.

It is good practice to ensure daily metrics about numbers of calls and the types or categories of calls that are being received, such as vaccination questions, symptoms of the illness, travel, or reporting illness, are shared with the communication team. These data can be used to inform and update communication strategies to ensure the agency is answering questions from the public and continuing to provide the most accurate and credible health information that is available.

The corresponding tactic or communication product for a call center is a prepared response. The prepared response is the official message and approved answered to a particular question. For example, if someone called about the symptoms of an illness, the prepared response would include the symptoms of that illness.

Websites

During COVID-19, state and federal health departments created COVID-19-dedicated websites with information about COVID-19 symptoms, health intervention and self-protection messages, dashboards with case counts by geographic location, testing information, and guidance.^[Reference Momenipour, Rojas-Murillo, Murphy, Pennathur and Pennathur^28]

Websites are important channels for public health practitioners to use to share and disseminate important health and safety information. The key is to ensure that these channels are usable and accessible by all populations. When discussing websites, usability is formally defined as “the extent to which a system, product or service can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.”^[29] Accessibility is defined as the usability of a product, service, environment, or facility by people with the widest range of capabilities.^[29]

Within the context of public health, usable and accessible websites need to communicate real-time and complex health and safety information to the public, partner agencies, community stakeholders, and the media through text, images, and other means to support those with language, hearing, eyesight, or other challenges that impact their ability to receive these materials.

A recent study of state health department COVID-19 websites used 148 evaluation criteria of website usability such as using images, optimizing for mobile device viewing, displaying information in a usable format, placing important information at the top and center, and options to view pages in a language other than English, and the researchers found that websites often were not usable or accessible.^[Reference Momenipour, Rojas-Murillo, Murphy, Pennathur and Pennathur^28] In this study, the researchers found nine common issues that may have hindered emergency risk communication. These are listed in the following subsection, and they include but are not limited to: a lack of action messages, poor web page layout, issues with navigation menus, and a lack of content explanation for data dashboards.

Search Engine Optimization

Search engine optimization (SEO) is often considered to be a tool that is relevant to marketing, but ensuring your agency’s website includes metadata and alt text will help search engines find your agency’s content during a health emergency. Search engines help people find information on the internet, and SEO helps place your website at the top of search results.^[Reference An and Jung^30] Due to the vast number of websites and web pages available, leveraging your site’s metadata, which includes page titles, page text, site URLs, alt text for images, and graphics or images that constitute engaging content, will help make your agency’s website more findable.^[Reference An and Jung^30]

Search engines use two basic algorithms when ranking websites. One algorithm ranks websites based on the quantity and quality of inbound and outbound web links. The other ranks websites according to relevance through search queries or keywords.^[Reference An and Jung^30] Google uses a combination of both of these algorithms.

For those maintaining your agency’s website, there are two strategies to achieve SEO. One is using an on-page optimization strategy, which focuses on leveraging the page title, metadata, the titles of images, and anchor text. The other is off-page optimization, which focuses on web links that link to websites and web pages away from your agency’s website and web links that are coming to your website from other websites (e.g., partners and stakeholders that provide links on their websites to your agency’s website). Using these strategies will improve your agency’s accessibility and findability on the internet. Doing so will also help those members of the public who are searching for credible and accurate health information to find official government sources and response information.

Social Media

When engaging with social media channels, emergency risk communications need to review the health department’s internal policies and ensure that resources are available to support social media platform management (e.g., Facebook, Instagram, X, YouTube, and LinkedIn). Social media accounts require daily maintenance even during nonemergency times. During an emergency, a health department may not want to add a new social media platform unless audience research indicates the agency is missing a key audience by not using a particular platform.

Social media platforms each have their own style, features, and norms of how to create and share content. Each platform will have its own unique way to convey information through text, images, video, use of emojis, hashtags, and @mentions. Each platform has a distinct way for people to follow or subscribe others for content updates. Some channels may allow for cross-posting, meaning that when the agency posts on Facebook, it will simultaneously cross-post on Instagram.

Due to the evolving nature of social media platforms and media technology, make sure to double-check each platform’s guidance and training materials on how best to leverage its functions to disseminate the agency’s key health messages.

The corresponding tactics or communication products for Facebook, Instagram, X, and LinkedIn include text, images, links, videos, hashtags, and @mentions. YouTube, by contrast, is a video-centered platform. To create social posts, review approved talking points and then tailor the talking points for each platform’s unique audience. Setting up a photo or image library with approved images will help reduce the amount of time spent looking for appropriate images to match each social media post. Research on X messages revealed that, during health emergencies, tweets containing details regarding hazard impact, time, location, guidance, and source and that are delivered in a style that is clear, specific, certain, accurate, and consistent have a higher probability of positively impacting protective action-taking among persons at risk.^[Reference Sutton, Spiro, Johnson, Fitzhugh, Gibson and Butts^35]

TikTok

During COVID-19, a new platform rose to prominence: TikTok, a video-based platform. Some 62% of 18–29-year-old Americans say they use TikTok.^[Reference Gottfried^36] While many Americans use TikTok, the Chinese-owned company faced legal constraints prohibiting the use of the app on federal and state government phones based on national security risks regarding the Chinese government’s ability to access American user data.^[Reference Bade^37]

Podcasts

Podcasts emerged in the early 2000s, but during COVID-19 the podcast industry shifted dramatically as telework became the de facto mode of work. Instead of listening to podcasts during the morning commute, listeners tuned in through their computers or mobile devices while multitasking, working out, cleaning, or working in their gardens.^[Reference Bajaj, Singh, Manimekalai and Poulpunitha^38] Podcast types include traditional podcasts, enhanced podcasts, video podcasts, or vodcasting. Enhanced podcasts include slides, animations, or short videos to enhance the audio content. Vodcasting eschews the audio-only tradition of podcasting and includes video footage. According to the Pew Research Center, about half of Americans have listened to a podcast in the past year, and about 20% of Americans listen to podcasts a few times a week.^[Reference Shearer, Liedke, Matsa, Lipka and Jurkowitz^39] While people tune in to podcasts for entertainment or learning purposes, some listeners indicate that they listen to podcasts for news or to stay up to date on current events.^[Reference Shearer, Liedke, Matsa, Lipka and Jurkowitz^39]

Podcasts represent an important channel for emergency risk communications to leverage. While ensuring there are ample resources to maintain a regular podcast, health departments could host and manage their own podcasts. If the health agency does not have a podcast, working with partner agencies or landing an interview for a staff member on a well-known podcast can further spread health information regarding a health emergency. During COVID-19, CNN medical correspondent Sanjay Gupta was interviewed on the Joe Rogan Experience podcast to dispel misinformation about COVID-19.^[Reference Rogan^40, Reference Gupta^41]

Chatbots

Chatbots – computer programs designed to simulate conversation with human users – were used during COVID-19 to help provide answers to questions about the outbreak. During COVID-19, chatbots were used to: disseminate health information and knowledge; aid in self-triage and personal risk assessment; monitor exposures and notifications; track COVID-19 symptoms and other health aspects; and combat misinformation and fake news.^[Reference Almalki and Azeez^42, Reference Amiri and Karahanna^43]

Chatbots can be programmed to ask and answer questions, create health records and histories of use, complete forms, and generate reports.^[Reference Almalki and Azeez^42]

The answers provided by these chatbots were based on information generated by WHO, CDC, and other health sources. Instead of having staff members engage with the public or having people call a hotline, chatbots on a health agency’s website could provide information about COVID-19 symptoms, what people could do to protect their health, and personal risk assessments, as well as address misinformation.^[Reference Almalki and Azeez^42]

The two challenges of using chatbots during COVID-19 were the public’s willingness to engage with a chatbot and the overall functionality of the chatbot. The public’s willingness to engage with a chatbot is based upon whether they trust the technology to provide them with correct information and protect their privacy. Additionally, some people might not have had access to technology and therefore could not engage with chatbots. The overall functionality of the chatbot also impacts the adoption of this technology. Chatbots leverage existing databases (e.g., medical databases, information from WHO and CDC) and natural language capabilities to understand clinical terminology.^[44, Reference Bitran and Gabarra^45] However, it can be hard to ensure that the chatbot has the latest and most accurate health information. Further, chatbots are not yet equipped to handle sensitive issues such as mental health concerns.

There may not be a corresponding tactic or communication product for a chatbot. Agencies ought to weigh the risks, benefits, and costs of deploying a chatbot on their website to determine whether this tool fits their communication and customer service needs.