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Research Provides Evidence for Public Health Emergency Communication Strategies

As the Northwest Preparedness and Emergency Response Research Center grant comes to a close, researchers are focusing on translating and disseminating their practice-oriented findings into evidence to be utilized by the larger public health community.

As the Northwest Preparedness and Emergency Response Research Center grant comes to a close, researchers are focusing on translating and disseminating their practice-oriented findings into evidence to be used by the larger public health community.

October 30, 2014

Since 2008, researchers at the Northwest Preparedness and Emergency Response Research Center (NWPERRC), have conducted innovative, community-based research focused on public health emergency communication. Housed within NWCPHP and funded by the Centers for Disease Control and Prevention, the NWPERRC focused on how to best reach essential or vulnerable diverse audiences with critical information in emergency situations.

Mark Oberle, Principal Investigator of the NWPERRC, notes, "After-action reports universally point out the need for better communications to deal with future disasters. Public health emergencies are no exception, which is why the unique focus of our research is so important for public health practice."

Three topics form the overarching umbrella of NWPERRC research:

  1. investigating approaches to improve phone-based emergency communications with limited English-speaking populations;
  2. examining traditional and novel communication strategies for distributing messages between public health agencies and health care providers;
  3. and exploring the efficacy of public health use of cell phone text messaging (SMS) during and after emergencies.

Multiple studies have been conducted in each of these areas. The following overview illustrates the types of evidence, strategies, and tools this research contributes to public health emergency communication systems.

Emergency Communication with Limited English Proficiency Populations
Imagine calling 911 and trying to explain your emergency to an operator who does not speak your language. Knowing that limited English proficient (LEP) populations are at greater risk during emergencies, Hendrika Meischke, PhD, MPH, and her team conducted nine studies (Limited English Proficiency 911) to learn how communication with these populations could be improved. Their methodology included focus groups and surveys with LEP groups, specifically Chinese, Vietnamese, and Spanish speakers; surveys of police dispatchers; analysis of 911 telephone conversations with LEP callers, 911 operators, and language line interpreters; and a Public Information Call Center pandemic flu simulation with Spanish and Chinese LEP callers. Together, the studies identified and suggested strategies for addressing these communication barriers. For example, communication difficulties using phone-based systems pointed to the need to simplify language, re-order questions, and update technology. New telephone protocols were field-tested and evaluated in two dispatch centers in King County, Washington.

Public Health Communication with Health Care Providers
Health care providers play an essential role in public health emergency preparedness and response. However, there is no evidence-based research to guide effective communication of public health messages to health care providers before, during, or after a public health emergency. Janet Baseman, PhD, MPH, and her team addressed this evidence gap by conducting a 4-year randomized controlled trial in which a diverse sample of health care providers across the Pacific Northwest received time-sensitive public health messages via fax, email, or SMS, or were assigned to receive no messages (Reaching Health Care Providers With Emergency Information). Follow-up interviews were conducted 5-10 days after message delivery to elicit information about message receipt and recall, perceived credibility, and trustworthiness of the message and source. Additional sub-studies examined provider preferences for receiving public health communications and the impact of repeated, frequent messages through multiple communication channels on provider recall and the potential for engendering "alert fatigue."

Text Messaging for Emergency Communication
While Short Message Service (SMS) text messaging has quickly become a pervasive, accessible, and relatively reliable method of communication, adoption of this technology by public health agencies requires consideration of numerous design and implementation issues. Given the potential for SMS to reach targeted populations quickly and effectively, Hilary Karasz, PhD, MA, and her team conducted multiple studies (Text Messaging for Public Health Emergencies) to address these issues. Based at Public Health - Seattle & King County, the research team first examined how some traditionally harder to reach population groups (e.g., young adults, deaf and hard of hearing) use SMS and what benefits they derive from it. They then explored the technical, legal, security, financial, and logistical issues involved in designing and implementing an SMS program in a health department, including how to compose HIPAA compliant messages and under what circumstances employees and clients will opt in to receiving public health text messages. Findings from this research are compiled in an online toolkit, Texting for Public Health: Emergency Communication, Health Promotion, and Beyond.

More Breadth and Depth
In addition to the three multi-year projects, NWPERRC supported a number of smaller pilot studies: Continuity of Operations During Disasters, Influenza Vaccine Safety Reporting, Media Campaign to Improve Bystander CPR Skills of Chinese Speakers, and SMS Message Content for Emergency Communication. And over the past two years, NWPERRC researchers have expanded on their core research findings to explore the utility of bi-directional text messaging for communication between public health and its stakeholders, and the information system issues related to implementation of this communication strategy (An Exploration of Bi-Directional SMS Use by Public Health).

Sharing Findings with Researchers and Practitioners
The October 2014 special supplement of Public Health Reports highlights the work of NWPERRC and eight other CDC-funded PERRCs. This special issue includes two NWPERRC articles: "Health-Care Provider Preferences for Time-Sensitive Communications from Public Health Agencies," and "Communicating with the Workforce During Emergencies: Developing an Employee Text Messaging Program in a Local Public Health Setting." Additional NWPERRC publications and the SMS texting toolkit can be found using the project links above.

In the final six months of CDC funding, NWPERRC researchers will focus on translating and disseminating their practice-oriented findings into evidence to be utilized by the larger public health community.

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