Social Marketing Approaches to Bioterrorism Awareness: Informing the Public without Scaring the Hell

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• Social Marketing Approaches to Bioterrorism
  Awareness Informing the Public without Scaring
  the Hell Outa Em

List of Contributors RI Department of Health
Marshall, Robert Caron, Colleen Takach, Mary
Jo Petrone, Laurie Policy Studies Inc Sansonet
ti, Shannon Lewy, Jennifer Baxter, Dawn
American Institutes for Research Lefebver,
Craig Alexander, Jennifer Jones, Michelle
Maine Bureau of Health Kuehnert, Paul
Virginia Department of Health Lee, Trina.
14th National Conference on Social Marketing in
Public Health
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Session Objectives

• Identify the key steps in social marketing
• Understand how 3 states used social marketing in
  a theory-driven framework for bioterrorism
  awareness
  
• Recall the major lessons learned
• Apply social marketing to bioterrorism awareness
  and risk communications in other states

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Focus Area FCooperative Agreement for Public
Health Response and Preparedness for Bioterrorism

• CRITICAL CAPACITY
• To provide needed health risk information to the
  public and key partners during a terrorism event
  . . . .

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Meningitis, 1998 RI Health Care System Gridlock
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Risk Communication -Vince Covello, PhD.

• A Science-based approach for
  communicating effectively in
  
• High-Concern
• Sensitive or
• Controversial Situations

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Trust Determination Factors In High Concern Situ
ations
Assessed in first 30 seconds
Caring/Empathy 50
Competence/Expertise 15-20
Dedication/ Commitment 15-20
Honesty/ Openness 15-20
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Communicating about Bioterrorism and other
Public Health Emergencies Focus Groups with
Rhode Island ResidentsInterviews with
Organizations that Serve Special Populations
RI Department of Health Policy Studies Inc. (PSI)
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Research Goal

• To assess
• What Rhode Island residents want to know about
  bioterrorism before, during, and after an
  emergency
  
• Whom residents trust to deliver the information
• Residents preferred vehicles and formats for
  receiving the information
  
• Residents perception of Rhode Islands readiness
  to respond to a bioterrorism emergency
  

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Methodology

• 12 focus groups with general public in 7 areas of
  the state (age ranges 18-35 36-54 55, AA,
  Hisp.)
  
• 19 in-depth interviews with community program
  staff representing 17 agencies, commissions, and
  programs across the state representing the
  following populations
• Portuguese-speaking
• African
• South East Asian
• English as a second language/Low
  literacy/Immigrant populations
  
• African American
• Hearing Impaired
• Visually Impaired

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RI Residents want information NOW, before an
emergency occurs

• How is the state preparing to respond?
• Basic information without too many details
• Information on how schools and hospitals are
  preparing
  
• Plans for communicating with the general public
  before/during/after
  
• Plans for equal access to medical care and
  information (Spanish-speaking and African
  American)
  
• Plans for equal access to vaccine/treatment
• What to do and where to go in the event of an
  emergency

Westerly 55 I would like to know all of the
informationI would want to know where to go,
what to do, just like, all of the information as
soon as possible please.
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Whom Residents Trust to Deliver Information about
a Bioterrorism Emergency

• Before an emergency, residents want to hear from
  
  
• Government sources
• Media personalities
• NOT from medical providers or religious leaders
• During and after an emergency
• Authorities and officials
• President
• Governor of RI
• Director of Health
• Always want to hear from someone with
• Credibility, Expertise, Track record,
  Familiarity, Appearance of not reading from a
  script

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Residents preferred vehicles and formats for
receiving the information

• Before an emergency, residents want to hear from
  
  
• Print materials
• Television and radio
• Internet
• Other
• During and after an emergency, residents want to
  hear from
  
• Television and radio
• Sirens, megaphones (55 groups)

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Information During Previous Public Health
Emergencies
Interview Findings

• Past emergencies mentioned
• Participants from six populations mentioned
  discussion about the following
  
• Anthrax, West Nile Virus, meningitis, sniper
  attacks, Y2K (SE Asian), September 11th
  
• I think before 9/11, people felt safe, and
  now they dont. People are scared. They didnt
  say anything that wasnt said by the rest of the
  population. They wanted to know what else could
  possibly happen, who was responsible, what their
  state was doing to protect them

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Information During Previous Public Health
Emergencies
Interview Findings

• Most heard of these events through the news or
  word-of-mouth
  
• SE Asians held workshops on Y2K and anthrax
• Portuguese-speaking held workshops on anthrax and
  meningitis
  

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Information During Previous Public Health
Emergencies
Interview Findings

• Few participants had heard their clients talk
  about current or future public health threats
  
• I have heard no talk about a bioterrorist
  emergency from our clients. They tend to talk
  more about what has already happened rather than
  what might happen. SE Asian

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Information Wanted BEFORE a Public Health
Emergency
Interview Findings

• All would want information BEFORE an emergency
• Where?accurate, credible information
• Protect themselves and their families
• Community resources
• Specific biological or chemical agents (SE Asian,
  Hearing Impaired, Portuguese-speaking)
  
• Channels to disseminate information DURING an
  emergency (Which will have sign which will have
  SAP)
  

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Vehicles for Delivering Information BEFORE an
Emergency
Interview Findings

• Community Organizations
• Television and radio (Ch.6/10 for hearing
  impaired)
  
• Word-of-mouth from trusted individuals (school
  nurses, coaches, peers)
  
• Religious organizations
• Newspapers
• Pediatricians (when taking kids)
• Internet (NAACPProv.org Visaonews.com
  turnto10.com)
  
• An informational booklet translated into several
  languages including Braille
  

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Vehicles for Delivering Information BEFORE an
Emergency
Interview Findings

• Few get information from health care providers.
  Few access healthcare due to lack of insurance or
  translation barriers
  
• Hearing impaired do not have access to
  translators in health system
  
• Get info from service providers within their
  community organizations, friends and family, CC
  Television, email and internet
  
• Visually impaired use health system more than
  others
  
• Primary care physicians and VNA
• Get information through school system, radio, and
  community agencies
  
• Visual materials in large print or Braille

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Information Wanted DURING and AFTER a Public
Health Emergency
Interview Findings

• What to do and where to go
• I think they just want to know what to do, where
  to go, you know, safe places to go.
  
• Where to go to get information
• In the event that something happens, people need
  to know how to act or react properly, and where
  they should call for help. Establish a central
  location so people can call. Keep in mind
  availability of interpretation for people who do
  not speak English well.

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Vehicles for Delivering Information DURING and
AFTER an Emergency
Interview Findings

• Most would go to
• Television or Radio
• Television or radio is the best and fastest way
  to get information out. But, it has to be very
  simple, and on TV visuals or pictures should
  accompany it. Information should be provided in
  both English and Spanish. ESL/Low literacy
  participant
• Community agencies
• Newspapers
• Websites
• Hearing Impaired
• SAP radio
• Portuguese-speaking
• TV/Radio (Cabo Video and others)
• Agencies would call their members

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Vehicles for Delivering Information DURING and
AFTER an Emergency
Interview Findings

• SE Asians
• Simple text to agencies to translate, mail out,
  and broadcast on TV
  
• African American
• Radio 106, 94.5, WBRU on Sundays, WPRO
• Office of case management services at Urban
  League
  
• Visually Impaired
• E-mail list (RI Commission on Deaf and Hard of
  Hearing)
  
• RI Registry of Interpreters for Deaf
• Live interpreters using American sign on TV
• Internet
• Text messaging

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Trusted Sources of Information
Interview Findings

• All trust service providers and cultural
  organizations associated with their community
  
• Most trust religious organizations and local news
  media
  
• The most trusted sources of information during
  an emergency would be the community leaders, at
  these organizations as well as within the
  specific communities in which they reside,
  religious leaders, and probably the media. I
  think this population tends to believe most of
  what they see and hear on the news or radio,
  especially during an emergency.
• A few trust public officials

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Trusted Sources of Information
Interview Findings

• Portuguese ? media broadcast in their language,
  churches, pediatricians
  
• Hearing impaired ? police and fire personnel,
  newscasters on CC TV Ch. 10, former Mayor and
  Governor
  
• Deaf/Blind individuals mostly trust their
  families to provide information
  
• Visually impaired ? federal and state officials,
  Department of Health
  
• The most trusted sources of information would
  be the government or state officials, members of
  the Department of Health, and our staff. This
  population calls us all the time looking for
  information, or looking to clarify information.
  They really trust us.

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Recommendations Made Regarding Information
Delivery DURING an Emergency
Interview Findings

• Many thought that their population would trust a
  public official endorsed by their community
  organizations more than other officials
  
• Most recommended that public officials and
  trusted service providers in the seven
  communities of interest work together to identify
  effective means of reaching these populations and
  communicating messages to them

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Barriers to Information for Special Populations
Interview Findings

• Literacy
• Ability to understand English or health
  terminology
  
• Lack of or low quality translations
• Usually they get a poor version of whatever has
  been done in English. It never looks as good.
  Its a piece of paper and not a brochure like in
  EnglishThe quality of the translations is bad.
  People assume that because many
  Portuguese-speaking people understand Spanish
  when they hear it, that they can also read it and
  most cant.

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Barriers to Information for Special Populations
Interview Findings

• Cultural/religious appropriateness and
  sensitivity
  
• If a Southeast Asian woman goes to the
  hospital, the nurse or doctor doesnt understand
  the culture. American trained doctors, they
  dont speak the language.
• Distrust of public and government officials
  (recent immigrants)
  
• Limited Internet Access
• Hearing impaired Access to TTY lines,
  inaccessibility of radio
  
• Visually impaired Inaccessibility of written
  information and televised information (can hear
  but not see visuals)

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Requests that Special Populations are Likely to
Follow
Interview Findings

• Explaining the rationale behind the directions
• I think since 9/11, everyone, including the
  visually impaired would be willing to follow any
  advice, recommendations, or orders given from the
  state or federal government. I think the
  critical things here is that this population
  would have to know and understand why it is that
  they are being asked to do or not do these
  things.
• Stay home and not drive
• Some might leave and drive to be with their loved
  ones
  
• Most would be vaccinated

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Requests that Special Populations are Likely to
Follow
Interview Findings

• Avoid hospitals unless seriously injured
• Some might use phone to contact loved ones
• Hearing impaired use phones for Internet access
  
  
• Visually and hearing impaired call police or
  fire departments out of fear or to ask for
  protection
  
• Almost all thought that parents would go anywhere
  they needed to be with their children
  
• They would most definitely not leave their kids
  at school. This population is extremely
  family-oriented and the first thing they would do
  is go get their kids and bring them to where they
  can all be together.

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Recommendations for Proceeding
Interview Findings

• Network with community agencies to reach special
  populations
  
• Use their everyday channels to get health
  information to special populations
  
• Public officials should partner with community
  leaders to deliver information to special
  populations
  

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Recommendations for Proceeding
Interview Findings

• Be prepared to inform people about
• where to get information
• how to protect themselves and their families
• what resources are available in the community
• Develop high quality translations of materials
• Ask special populations to take steps to protect
  themselves that are feasible during emergencies
  and explain the rationale for such requests

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BT Awareness Campaign

• Use news media re smallpox vaccine
• Short run (2003) direct mailing campaign
• 500,000 households
• Long run (2004) newspaper inserts, etc.
• Information
• Update on bioterrorism and smallpox vaccine
• State preparedness
• Where to go what to do
• home readiness tips
• listen to media for instructions

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The End