How We Decide What to Say in Emergencies

Illustration of Salmonella bacteria.
An outbreak of Salmonella Typhimurium struck 46 states from 2008-2009. Communicators had to work quickly to get the right messages out.
Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious Diseases
Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious Diseases

A few years ago, there was an outbreak of Salmonella infections among people who ate peanut butter and products containing peanut paste, like crackers and cookies. People were scared. They needed to know which products were affected. Were they in their grocery store, or worse, already in their kitchen? They also needed facts about Salmonella infection: what are the symptoms, and how dangerous is it?

Fact: You can’t protect your health if you don’t know what to do and how to do it.

This is the reason I spend my days helping people get the right messages about their health at the right time. During the Salmonella outbreak linked to peanut butter, we worked to quickly gather information and science from lots of sources and get it to the people who needed it. But there’s more to communicating about health than just moving information around. There’s a science behind what we do.

First things first

Before I start writing, I take a minute to put myself in the audience’s shoes. Who are they, and what do they need to know to protect themselves? I begin with the what, why, and how – the basics everyone needs to take the first steps.

In an emergency, geography is also important. If there’s an outbreak or a flood, not everyone may be affected. People need to know if they’re close to the incident or far away, and what the likelihood is that it will affect them.

But we don’t just consider what we need to say. We also look at the best ways for people to hear it. We know that people with different backgrounds will take in health information differently. What people do about a threat depends on several things, including who they are, who we are, and how we talk about it. This is where the communication science comes in.

Applying the science7 things to consider when communicating about health

In my job, we apply a system where we look at the different aspects of getting health information to people who need it. There are seven things we consider when we communicate 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 is 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?

We call this set of questions TIME-CPR. Answering all of these questions before we start communicating lets us make a plan that will help people take action and save lives.

What we know, as soon as we know it

Sometimes we get worried about communicating information before we have all the answers. But it’s okay to say that we don’t know yet, and we’re working on finding out. We’re all in this together, especially in emerging and evolving situations, and people need to trust that we will always share the latest and best information we have, even if we don’t yet understand or know everything. We’re not just experts, we’re expert learners.

When something first happens, we might not know right away exactly how many people or which products are affected. But we need to start talking about it anyway. The risk is too great if we don’t.

Let’s go back to that Salmonella outbreak. Because peanut paste is in so many products, and because those products were already in the hands of so many people, we had to act quickly. Many of the affected crackers had been sent to troops overseas or were foods that get sent as part of school lunches. We immediately reached out to veterans’ communities, daycares, and schools. We developed a searchable database and created a widget to help people figure out if their food had the peanut paste in it. In the end, the outbreak affected over 700 people in 46 states. But without fast communication, many more would have been sick.

Health literacy touches everyone

October is Health Literacy Month, which is a time to focus on how we can help people better receive and understand information they need to stay safe and healthy. When we present our information in a way that makes it difficult for people to understand what they can do to protect their health, they may be more likely to get sick or die.

Health literacy affects everything from how and why medication should be taken, to reading nutrition labels, to what people should do in a major emergency like an outbreak or natural disaster. Everyone – from large agencies to community organizations to family doctors to individuals – is responsible for making sure we all have clear and relevant health information when we need it. We need to stay connected and communicate well. Lives depend on it.

For more information about Health Literacy, visit the CDC Health Literacy website.

Improving the ability to share and use health information is a national priority. The National Action Plan to Improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a connected effort to increase health literacy, and is part of the Healthy People 2020 objective to improve health outcomes and health equity through better communication.

CDC Crisis Communicators: Making Every Message Count

microphones set up for a news conference

An unexpected public health emergency can happen anywhere and to anyone. The right health or safety message at the right time from the right person can save lives. However, poor communication can also make an emergency situation much worse.

CDC’s crisis communicators are trained to speak to the public when the unthinkable happens to them, their families, and their communities. Crisis communicators use evidence-based communication strategies to deliver messages to help people stay safe and healthy during a disaster.

Crisis communicators work with scientists, doctors, and other experts during disasters to deliver information to people. To be ready to share information effectively, building partnerships is critical to reach target audiences, both domestically and globally.

How CDC Crisis Communicators Work

Working with CDC scientists who are experts on disease outbreaks, natural disasters, biological threats, and more, crisis communicators determine the best way to get health messages to the people who need them.

MERS press conference in 2014From scientific research, we know that people process information differently during a disaster than they would otherwise do in their day-to-day lives – they respond better to simple, positive action steps. In an emergency, people need guidance as soon as it’s available, whether it’s complete or not. They need to hear the information from someone they trust, and they need information fast and often. These principles guide how messages are created during an emergency and how and when the messages are sent.

Having a crisis communication plan is critical. Although this plan will likely change as the crisis evolves, the initial outline helps to focus communication goals.

Even the best messages will be ineffective if the target audience does not receive them. Communicators must know who to talk to and how to make advice actionable. To do this, communicators rely heavily on partner engagement, develop messages for specific audiences, and use targeted messages. CDC crisis communicators focus on developing relationships with established community organizations, building relationships with spokespersons who are familiar with affected groups, and targeting at-risk populations.

As communicators, all of the information available is used to measure whether messages are reaching the right people at the right time. Monitoring and analyzing web traffic, social media and media coverage helps identify important information that is missing, rumors that should be addressed, and the impact that communication has on the public’s response to a disaster. Communication plans are adjusted based on these analyses and strategies are developed to improve the distribution of information to the people who need it.

CDC’s Ebola Response

In the last year and a half, CDC’s emergency communication activities have focused on the Ebola outbreak in West Africa. CDC has created over 500 distinct communication materials, including infographics, tutorials, and guidance documents that help people understand how to protect themselves and their families from Ebola. This large number of communications materials were developed to address various in-country needs, including a variety of languages spoken, low literacy levels, and cultural preferences. For Ebola-related communication, cultural considerations have helped us reach more people effectively. For instance, people in West Africa speak several languages, some of which are mainly spoken rather than written. Words were often replaced with pictures and illustrations to address language barriers, and radio, text messages, and social media channels were used to deliver messages.

IMG_7092_smCDC works alongside Ebola experts at home and in West Africa to adapt the content, format, and delivery of public health information. Local clinicians, both in Africa and the United States, needed guidance on how to help Ebola patients while protecting themselves, their staff, and other patients from getting sick with the virus. In West Africa, CDC provided in-person training for journalists, community leaders, and faith healers to help prepare them to protect their communities from Ebola. In the United States, CDC hosted in-person trainings, provided updates to healthcare organization networks, and conducted national-level conference calls that were attended by more than 16,000 healthcare providers and organizations.

Over the course of the Ebola response, CDC has also communicated with public health partners and reached more than 32,000 people and organizations who subscribed to the CDC Emergency Partner Newsletter. The CDC Emergency Preparedness and Response website is updated with the latest event information. CDC’s Center for Global Health has strong connections with health communicators around the world and these channels are used to reach the global public health community.

CDC crisis communicators are committed to lowering the rates of illness, injury, and death when disaster strikes by carefully crafting messages for specific audiences and delivering those messages through effective communication channels. Crisis communicators strive to make every message count.

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