Title: How does trust influence response to public health messages during a bioterrorist event?
1How does trust influence response to public
health messages during a bioterrorist event?
- Lisa S. Meredith, Ph.D., RAND
- AcademyHealth
- June 27, 2006
2Coauthors
- David P. Eisenman, M.D., M.S.H.S., UCLA and RAND
- Hilary Rhodes, M.Sc., RAND
- Gery Ryan, Ph.D., RAND
- Anna Long, Ph.D., Los Angeles County Department
of Health Services
Funded by the RAND Corporations continuing
program of self-sponsored independent research
from donors and development funds through
contracts for the operation of its U.S.
Department of Defense federally funded research
and development centers and from the Centers of
Disease Control and Prevention Bioterrorism
Cooperative Agreement awarded to Dr. Eisenman.
3Background and Motivation
- Trust is crucial for insuring appropriate public
health response during crises, including
bioterrorism - Trust varies by racial/ethnic group
- Particularly low among African Americans who
recall adverse treatment in historical events - Postal workers affected by the 2001 anthrax
attacks perceived lack of fairness - African Americans report that the public health
system will respond unfairly in a bioterrorism
event - Need to know what specific components of trust
influence responses to public health messages
during an evolving bioterrorist attack
4Study Objectives
- Characterize the components of trust in public
health identified by African Americans - Understand which specific components of trust
need to be addressed in public health
communications - Investigate the importance of characteristics
that might influence attitudes and attitude
change - Source or messenger (expertise, credibility)
- Message (content, structure)
- Medium (media vs. the internet)
- Audience (age, sociodemographics)
5Study Design
- 8, 2-hour focus groups stratified by age and SES
- 7-11 per group (total N75)
- Recruited from the community during June, 2004
- Eligibility requirements
- African Americans living in Los Angeles
- Age 18-65
- Able to participate in a discussion group
- Exclusion criteria
- LA County employees
- First responders (fire, police, emergency
services) - Paid 50 for their time
6Escalating Bioterrorism Scenario
Stage 1
Stage 3
Stage 2
Media reports a potential bioterrorist attack
with increased hospitalization utilization due to
rashes
Public Health Officials identify illness as
smallpox introduce plan for targeted
ring-vaccination near site of exposure
quarantines
Reports of people trying to get vaccinations and
being turned away if not exposed or sick
Stage 4
Stage 5
Stage 6
Rumor of people in high SES neighborhoods getting
vaccinated even though they were not exposed
Two conflicting reports by the media
Local health workers assigned to communities
Stage 7
Local community representatives assist people in
their immediate neighborhoods
7New Information Presented in Each Stage
- For each stage we asked
- What is your first reaction to this information?
- What would you do?
- How would you decide what to do?
- Would you trust this information?
- Would you try to get more information?
- What type?
- From who or where?
8Participant Characteristics
Focus group stratification characteristic
9Data Analysis
- Verbatim transcripts entered into text-management
software - Investigators marked all passages related to
trust - To identify themes, investigators cut out and
then sorted trust passages into thematic
categories based on similarity - Fiduciary responsibility
- Honesty
- Competency
- Consistency
- Faith
- Other
- To assess theme salience, frequency of mention
was calculated - To assess the distribution of themes, theme
frequency was crossed with - Scenario
- Group socio-demographic characteristics
(Lincoln Guba, 1985 Ryan Bernard, 2003)
10Description of Trust Themes
And the bottom line is we dont have another
choice but to trust them youve got no choice
but to trust them.
I wouldnt trust just one website. I think I
would just check out different sites on the
smallpox disease. Because only one, something
might be different, just like its picking up
different information So to feel comfortable,
you cant stick to just one site.
I think a person coming to my home and talking
to me is more comforting than trying to call a
hotline number or trying to wait for the news to
tell me something else. At least I'm getting
some more one-on-one personal information.
I dont trust the information at all. I remember
what happened in the World Health Organization
with the AIDS virus. And at Tuskegee with
Syphilis and smallpox with the Indians. Our
government has a history of using bioterrorism as
a method of population control, so why would I
suddenly trust them to save my life?
If theyre going to send someone out in to the
community, you have to hope that these people
have the credentials to prevent the community
from panicking and you can ask for the
persons credentials.
The people at the top are only giving the people
at the bottom maybe 30 percent of the truth, so
youre only working with what theyre telling
you, which is probably not even half because they
dont want everybody panicking. Because they
have been known to not put the truth out or
to hold the truth back and give you bits and
pieces of things and sometimes give you bits and
pieces of things that are not even true.
11Patterns of Trust by Stratification Group
Group Fiduciary Honesty Competency Consistency Faith Other
Younger (18-39)
Low SES 37 37 14 32 7 2
High SES 38 60 10 40 22 11
Older (40-65)
Low SES 25 25 11 38 10 7
High SES 15 21 23 30 20 11
Total (across all groups) 115 143 58 140 59 31
12Patterns of Trust by Scenario Stage
Scenario Stage Fiduciary Honesty Competency Competency Consistency Consistency Faith Other
1. Initial Report 6 20 5 13 13 5 5 1
2. Illness Identification 12 34 12 22 22 4 4 4
3. No Vaccination 6 6 15 4 4 0 0 2
4. Others Get Vaccinated 28 22 2 13 13 5 5 2
5. Conflicting Reports 2 12 5 15 15 2 2 5
6. Local Health Workers 19 22 7 27 27 10 10 11
7. Local Community Representatives 12 9 7 27 27 12 12 5
Total (across 7 stages) 85 125 53 121 121 38 38 30
13Conclusions
- Trust is a complex and multi-dimensional concept
- Honesty and consistency of information were the
most common trust-related concerns - Government and public health officials were seen
as less trustworthy than personal health
clinicians - Trust components differed by scenario stage
- honesty? competency? fiduciary? consistency
14Implications
- To build trust and promote health and safety
during a bioterrorist event - Use social marketing (audience segmentation)
- Information tailored to specific populations
- Present information that is accurate, complete,
and consistent across multiple sources - Protective measures that the public can take
- Use trusted sources
- Medical professionals, CDC officials, CNN, NPR
- Demonstrate sincerity
- Eye contact, personal risk to help the public
- Involve the public early on in the process
- Make them a legitimate partner
15Citation
Meredith, L. S., Eisenman, D. P., Rhodes,
H., Ryan, G., Long, A. (in press). Trust
influences response to public health messages
during a bioterrorist event. Journal of Health
Communication.