Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

How We Can Help Children In Rural Communities Thrive

Children Having Fun And Balancing On Tree In Fall Woodland

When children grow up in a safe and nurturing home environment, have opportunities to learn, and time to interact and build relationships with other children, they are more likely to reach their full potential. This is especially true for children with mental, behavioral, and developmental disorders.

Mental, behavioral, and developmental disorders, such as anxiety, attention-deficit/hyperactivity disorder or ADHD, and learning problems, often begin in early childhood and can affect life-long health and well-being. Children with these disorders face challenges at home, at school, and with friends. About 1 in 7 US children aged 2-8 years have a mental, behavioral, and/or developmental disorder reported by a parent.

Previous research has shown that children with mental, behavioral, and developmental disorders and their families face personal, financial, and neighborhood challenges more often than families of children without these disorders. These challenges may make it harder for some parents to give their child the resources they need to thrive. The type of community that families live in, urban versus rural, may increase these challenges.

Overcoming challenges to support children

To better understand the differences between urban and rural areas, Centers for Disease Control and Prevention (CDC) researchers collected information from parents on children’s mental health in both urban and rural areas. Parents were asked questions about their child’s mental health, their own mental health, their neighborhood, and other personal and community factors.

Parents of children with mental, behavioral, and developmental disorders in rural areas (isolated, small rural, and large rural areas combined) more often reported having trouble getting by on their family’s income than parents of children with these disorders in urban areas. Regardless of poverty level and race/ethnicity, these parents more often rated their own mental health or their partner’s mental health as “fair” or “poor;” they also more often reported living in a neighborhood in poor condition and without amenities, such as parks, recreation centers, and libraries. To overcome these challenges, children and their parents living in rural communities may need additional support.

Children with mental, behavioral, and developmental disorders can benefit from better access to mental and behavioral health care, programs that support parents and caregivers, and opportunities to learn, play, and socialize.1,2,3

What might help families and their children with mental, behavioral, and developmental disorders?

States that:Children in rural areas

  • Support the delivery of affordable mental and behavioral health care to families.
  • Foster policies and programs to alleviate financial hardships for families.
  • Expand neighborhood amenities where they are lacking to allow children to play, read, and socialize.

 Healthcare systems that:

  • Collaborate with early learning programs, parenting and caregiver support programs, and primary care clinicians to help improve access to mental and behavioral health care, and community social and recreational resources.
  • Explore ways to deliver affordable mental and behavioral health care services for parents and children, such as integrating these services into primary care settings and schools, as well as using telehealth technology.

Primary care clinicians that:

  • Connect families with mental and behavioral health care, parenting and caregiver support programs, and early learning programs.
  • Screen parents for stress, depression, and other mental health problems to help connect parents to the right resources.

 What is CDC doing?

CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is committed to helping children with mental, behavioral, and developmental disorders and their families get the support they need. NCBDDD studies mental health and developmental disabilities, identifies factors that put children at risk for these conditions, and informs state and local decision-makers and other stakeholders, so that children and families can get the support they need as early as possible.

To learn more, please visit the following resources:

References

  1. National Academies of Sciences Engineering and Medicine. (2016). Parenting Matters: Supporting Parents of Children Ages 0-8. Washington, DC: The National Academic Press.
  2. National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. (M. E. O’Connell, T. Boat, & K. E. Warner Eds.). Washington, DC: The National Academic Press.
  3. S. Department of Health and Human Services, US Department of Education, US Department of Justice. (2000). Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services.

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