Nonpharmaceutical Interventions for Pandemic Influenza: An Assessment of Communication, Training, and Guidance Needs of State, Tribal, Local, and Territorial Public Health Officials December 12, 2013 Jasmine R. Kenney, MPH Health Communications Specialist Eagle Medical Services Community Interventions for Infection Control Unit

Overview Background Project Overview Key Informant Interviews Web-Based Survey Limitations Summary of Key Findings Recommendations

Background: What are Nonpharmaceutical Interventions? Nonpharmaceutical interventions (NPIs) are measures, apart from getting vaccinated and taking medicine, which help slow the spread of respiratory illnesses like influenza.

Project Overview Collaborated with Oak Ridge Institute for Science and Education (ORISE) Overall Goal: Identify needs of State, Tribal, Local, and Territorial Health Departments (HDs) related to communicating, implementing, and monitoring NPIs during influenza pandemic Phase 1: Key Informant Interview Objectives Discuss pandemic influenza NPI communication and training needs Solicit input on survey development and process Phase 2: Web-Based Survey Objectives Inform development of pandemic influenza NPI materials Identify preferred channels and format for NPI communication Identify types of NPI training and guidance needed

Phase 1: Key Informant Interviews Recruited 8 key informants from 5 partner organizations Association of State and Territorial Health Organizations (ASTHO) Council of State and Territorial Epidemiologists (CSTE) National Association of County and City Health Officials (NACCHO) National Public Health Information Coalition (NPHIC) Society for Public Health Education (SOPHE) Survey topics recommended by key informant interviews Current and Future NPI Communications NPI Training NPI Guidance

Phase 2: Web-Based Survey Methods Used MrInterview™ platform to create web-based survey Recruited respondents by emails sent by key informant interview partners (ASTHO, CSTE, NACCHO, and NPHIC) to pre-selected membership categories Topics included: Respondent characteristics NPI communications and training NPI guidance needs for NPI planning and implementation Monitoring for NPI implementation Stratified data analysis by: Type of Health Department: State/Territorial, Local/Tribal Primary Duty: Science, Non-Science, Communicator, Non-Communicator Locale: Urban/Suburban, Rural

Web-Based Survey Results: Respondent Characteristics 346 people received the survey 267 (77%) completed the entire survey Type of Health Department 208 (78%) Local/Tribal 55 (22%) State/Territorial Top Primary Duties 89 (33%) Emergency preparedness/response 64 (24%) Health communication/education 48 (18%) Policy Population Served by Health Department* 175 (66%) Rural 91 (34%) Suburban 91 (34%) Urban * Option to choose more than 1 since some HDs serve more than 1 population

What audiences would be most helpful for CDC to target in their NPI messages? 1. General Public/Families 2. K-12 School Administrators 3. Business Owners and Employers

What are the top 3 materials you find most effective in communicating NPI guidance and messages to audiences? Printed Handouts Business owners and employers Childcare program/K-12 school administrators Mass gathering organizers Broadcast Media General public/families Social Media Institutions of higher education administrators Websites Other public health professionals

What are the top 3 areas you/your agency would like to have additional NPI information and training? 1. NPI strategies and triggers for use 2. Communicating NPI recommendations to families and community settings 3. Decision-making strategies for NPI recommendations Health departments (HDs) varied in how they ranked NPI strategies and triggers for use. Rural HDs ranked them higher than urban/suburban HDs.

NPI Guidance 145 (49%) aware of 2007 Community Mitigation Guidance (2007 CMG)* Urban/suburban HDs more likely to report awareness of guidance compared to rural HDs 105 (72%) used 2007 CMG for general reference and planning during 2009 H1N1 response Respondents would have been more likely to use 2007 CMG if it had more practical orientation; for example, Case studies Decision-making guides Communication samples *Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions (www.pandemicflu.gov/plan/community/community_mitigation.pdf)

What are the top 3 kinds of pandemic influenza NPI guidance information that you/your agency would like from CDC? 1. Triggers for implementing NPIs 2. Health messaging for various populations and settings 3. Legal authority for implementing NPIs HDs varied in how they ranked policy issues concerning implementation of NPIs. Urban/suburban HDs ranked them higher than rural HDs.

Monitoring NPI Implementation STLTs reported having the ability to monitor: 165 (62%) school dismissals 180 (67%) school absenteeism 167 (93%) ILI related absenteeism in schools However, most STLTs reported NOT having the ability to monitor: 217 (81%) mass gathering cancellations 251 (94%) workplace closings during a pandemic 261 (98%) workplace absenteeism

Limitations Convenience sample: respondents recruited from membership categories pre-selected by 4 partner organizations Timing of survey (summer); however, high participation rate (>70%) Majority of respondents from local HDs; however, also analyzed data by type of health department, primary duty, and locale Limited outreach to tribal/territorial HDs

Summary of Key Findings (1) NPI Communication Priorities Target Audiences: General public/families, childcare/K-12 schools, and workplaces Materials and Channels: Broadcast media and printed handouts NPI Training Needs NPI strategies and triggers for use Communicating NPI recommendations to families and community settings Decision-making strategies for NPIs

Summary of Key Findings (2) Updated NPI Guidance Practical orientation Triggers for implementing NPIs Health messaging for various populations and settings Legal authority for implementing NPIs Monitoring NPI Implementation School dismissal/absenteeism monitoring capabilities high (>60%) Workplace and mass gathering monitoring capabilities low (<20%) Differences by Type of Health Department Urban/suburban and rural HDs varied on how they ranked their training and guidance needs

NPI Communications and Training Recommendations NPI Communications and Training Refine channels for NPI materials distribution Develop pandemic influenza NPI training for HDs NPI Guidance Provide practical orientation for pre-pandemic NPI planning Planning scenarios NPI triggers Decision-making guides “Tool Box” for communication Dissemination Develop social media and dissemination plan for NPI communications and guidance

Thank You! Contact Information: hbu2@cdc.gov