Office of Public Health & Environmental Hazards Speaking with Veterans about Exposure Concerns: Risk Communication Implications Susan L. Santos, PhD, M.S.

Slides:



Advertisements
Similar presentations
NICE Guidance and Quality Standard on Patient Experience
Advertisements

Session 151 Risk Perception Fallibility Conclusion 1 Cognitive limitations, coupled with the anxieties generated by facing life as a gamble, cause uncertainty.
Risk Perception The fundamental dilemma of health risk communication  The risks that kill people and the risks that alarm people are completely different.
1 Family-Centred Practice. What is family-centred practice? Family-centred practice is characterised by: mutual respect and trust reciprocity shared power.
Session A Crisis and Emergency Risk Communication* *Adapted from CDC Crisis and Emergency Risk Communication (CERC) Training.
How to conduct an environmental exposure assessment for Veterans Ron Teichman, MD, MPH, FACP, FACOEM Associate Director – Clinical, Education and Risk.
Setting the Stage for CBPR: Theories and Principles
Office of Public Health & Environmental Hazards Environmental Exposure Concerns of Veterans: Agent Orange and Beyond What You Need to Know Caring for Veterans.
IAEA International Atomic Energy Agency EPR-Public Communications L-04 Risk Perception.
1 Families and Seniors Together: Building Relationships (FAST – 2)
Returning Veterans with Health Concerns and Emerging Problems: How can they get help? William M. Keyes, QMC (SW) U.S. Navy (Retired) Program Support Specialist/Outreach.
1 Patient – Doctor Communications Shlomo Mizrahi Rutgers University.
LtCol Roger Gibson Office of the Assistant Secretary of Defense Health Affairs DoD/VA Clinical Practice Guideline Toward Improved Quality of Post-Deployment.
1 Introduction to PBS Positive Behavioral Supports Orientation DDS April 2013.
Exposures of Concern to Veterans of Operation Enduring Freedom/ Operation Iraqi Freedom Exposures of Concern to Veterans of Operation Enduring Freedom/
Environmental Impacts On Health Dorothy Cumbey, Ph.D., RN Jerry Dell Gimarc, MA with the special help of Lill Mood, MPH, RN, Community Liaison, EQC South.
Office of Public Health and Environmental Hazards Part Two of the 2011 WRIISC Webinar Series March 16, 2011 Risk Communication and Communicating with Patients.
Psychological Aspects of Risk Management and Technology – G. Grote ETHZ, Fall09 Psychological Aspects of Risk Management and Technology – Overview.
Risk communication Introduction to risk communication Children’s Health and the Environment CHEST Training Package for the Health Sector TRAINING FOR THE.
Risk Communication RD October Risk Communication “An interactive process of exchange of information and opinion among individuals, groups,
This material was developed by Compacion Foundation Inc and The Hispanic Contractors Association de Tejas under Susan Harwood Grant Number SH SH0.
Risk and Resilience: A Canadian Perspective on Climate Change Adaptation Donald S. Lemmen, PhD Climate Change Impacts and Adaptation Directorate Natural.
Coaching Workshop.
Office of Public Health & Environmental Hazards The War Related Illness and Injury Study Center (WRIISC) Susan L. Santos, PhD, M.S. Assistant Director,
Chapter 3: THEORIES BASED ON ATTITUDES AND BELIEFS Active people have attitude!
SAFETY AND HEALTH PROGRAMS 1. This presentation is adapted from the OSHA Safety and Health Programs presentation available on the OSHA website. CREDITS.
Learning Objectives State the importance of communication with older adults. Identify effective and ineffective communication strategies. Understand how.
Presented by Vicki M. Young, PhD October 19,
Organizational Environments and Cultures
Bridging Cultures: Delivering Culturally Appropriate Care.
Interstate New Teacher Assessment and Support Consortium (INTASC)
What do patients and families need to know when errors occur? Susan Moffatt-Bruce MD, PhD, FACS, FRCS(C) Chief Quality and Patient Safety Officer Associate.
Caring for Veterans with Post Deployment Health Concerns: Past, Present and Future War Related Illness & Injury Study Center (WRIISC) US Department of.
Background and Some General Considerations. The Basic Dilemma in Risk Communication The risks that kill people and the risks that alarm them are completely.
Organizational Conditions for Effective School Mental Health
Crosswalk of Public Health Accreditation and the Public Health Code of Ethics Highlighted items relate to the Water Supply case studied discussed in the.
© 2007 by Thomson Delmar Learning Chapter 10: Promoting Good Health for Quality Early Childhood Education Environments.
Office of Public Health & Environmental Hazards RETURNING VETERANS WITH HEALTH CONCERNS AND EMERGING PROBLEMS War Related Illness & Injury Study Center.
Basic principles on Risk Communication Cristiana Salvi Information and Outreach Unit Special Programme on Health and Environment WHO Regional Office for.
AN INTRODUCTION Managing Change in Healthcare IT Implementations Sherrilynne Fuller, Center for Public Health Informatics School of Public Health, University.
1 Three Key Risk Communications Messages P=R (Perception = Reality) G=T+C(Goal=Trust+Credibility)C=S(Communication=Skill.
How to conduct an environmental exposure assessment for Veterans Ron Teichman, MD, MPH, FACP, FACOEM.
12/24/2015Miss Samah Ishtieh1 Managerial Ethics Patient Rights & Nursing Ethics Prepared by: Miss Samah Ishtieh.
Theories of Health Behaviors Gero 302. Health Belief Model Has intuitive Logic and clearly stated central tenents Behind the HBM values and expectancy.
Chapter 14: Affective Assessment
Mount Auburn Practice Improvement Program (MA-PIP)
بسم الله الرحمن الرحیم.
1 Trust A state involving positive expectations about another’s motives with respect to oneself in situations entailing risk. A willingness to be vulnerable.
Learning Objectives State the importance of communication with older adults.
Educational Outcomes Service Group: Overview of Year One Lynne Tomasa, PhD May 15, 2003.
Carol A. Miller, MD Professor, Pediatrics UCSF Benioff Children’s Hospital And the Asthma Task Force Team.
Building Health Skills (3:04) Click here to launch video Click here to download print activity.
Henry M. Sondheimer, MD Association of American Medical Colleges 7 August 2013 A Common Taxonomy of Competency Domains for the Health Professions and Competencies.
©SHRM SHRM Speaker Title Bhavna Dave, PHR Director of Talent SHRM member since 2005 Session 2: Relationship Management Competencies for Early-Career.
PROMOTING SPECIALTY CROPS AS LOCAL Module 5: How do you talk to consumers about your locally grown food? – Part 1.
This grey area will not appear in your presentation. Non-cosmetic Pesticide Use and Cancer An innovative model for precautionary policy development Heather.
6 th Grade  Physical & Personal Wellness  Emotional & Social Wellness  Prevention & Risk Management.
ETHICAL ISSUES IN HEALTH AND NURSING PRACTICE CODE OF ETHICS, STANDARDS OF CONDUCT, PERFORMANCE AND ETHICS FOR NURSES AND MIDWIVES.
Unit 4 Working With Communities
National Immunization Conference April 19, 2010
Peculiarities Of Emotional Communication In Bachelor Practice
Coaching.
Unit 5 Working With Communities
utah
Module 4 Learning goals Module 4
Critical Care I hope to continue my career as a nurse in the critical care setting. The Quality and Safety Education in Nursing (QSEN) practice standards.
High reliability & Practice Transformation
SAMPLE ONLY Dominion Health Center: Your Community Partner for Excellent Care (or another defining message) Dominion Health Center is a community health.
R. Clinton Crews, MPH, Amy Paulson & Frances D. Butterfoss, Ph.D.
utah
Presentation transcript:

Office of Public Health & Environmental Hazards Speaking with Veterans about Exposure Concerns: Risk Communication Implications Susan L. Santos, PhD, M.S. Assistant Director, Risk Communication & Education War Related Illness & Injury Study Center VA NJ Healthcare System East Orange, NJ

Disclaimer  The views expressed in this presentation are those of the author and do not necessarily represent the position of the Department of Veterans Affairs or the United States Government  I have no known conflicts of interest other than that I work for the Department of Veterans Affairs

Presentation Overview  Understanding Veterans’ exposure concerns  What is Risk Communication and when needed  Key principles of risk communication  Understanding risk perception and the importance of trust and credibility  Developing messages  Do’s and Don’ts of provider-Veteran communication

Top Ten Environmental Exposures of Concern: OEF/OIF 1.Smoke from burning trash or feces (44.6%) 2.Sand and dust storms (41.5%) 3.Gasoline, Jet Fuel, Diesel Fuel (21.1%) 4.Depleted Uranium (19.0%) 5.Paint, solvents, other petrochems (15.2%) 6.Oil well fire smoke (14.9%) 7.Contaminated food and water (14.4%) 8.Anthrax Vaccine (14.2%) 9.Multiple Vaccinations (13.9%) 10.Vehicular Exhaust (10.3%)

Top Ten Environmental Exposures: Gulf War 1.Protective gear/alarms (82.5 %) 2.Diesel, kerosene & other petrochemicals (80.6%) 3.Oil well fire smoke (66.9%) 4.Ate local food (64.5%) 5.Insect bites (63.7%) 6.Harsh weather (62.5%) N=651 7.Smoke from burning trash/feces (61.4%) 8.Within 1 mile of missile warfare (59.9%) 9.Repellants & Pesticides (47.5%) 10.Paint/solvents & petrochemicals (36.5%) Schneiderman AI, et al. American Public Health Association, 133 rd Annual Meeting, Philadelphia, PA, December 14, 2005.

Data from Risk Perception Pilot Survey and Focus Groups  Sensory cues are viewed as evidence of exposure  Protective measures (alarms, suits) are seen as evidence of exposure vs limiting the potential for exposure  Dread, uncertainty and lack of trust exacerbate health concerns  Veterans aware of media coverage of exposure concerns  Having information on exposure potential is important

What is Risk Communication?  “… an interactive process of exchange of information and opinions among individuals, groups, and institutions.”  “It involves multiple messages about the nature of risk and other messages… that express concerns, opinions or reactions to risk messages… as well as information on what to do to control/manage the (health) risk.” - National Research Council, 1989

Why Risk Communication?  High concern  Low trust  Differential relationships of power  Communicating complex information  High uncertainty or expert disagreement

Principles of Effective Risk Communication  Know why you are communicating - Have clear goals  Identify and understand Veteran’s concerns, beliefs, perceptions, and prior knowledge  Recognize that trust and credibility are key  Structure provider-Veteran communication to respond to Veteran’s concerns and provide information to facilitate collaborative decision- making  Good risk communication is two-way - listening not risk speak

Know the Veteran  Important principle of risk communication is to know with whom you are communicating  Ongoing research suggests we need to take into account the Veteran’s overall social network and experiences – not just exposures and symptoms  Be careful about assumptions – e.g. why a Veteran associates exposures with health concerns

Importance Of Risk Perceptions  Related to health behavior, medical-decision making, and the processing of health information  Influenced by a wide variety of cognitive, motivational, and affective factors  Often lead to errors in risk perception among laypeople (including Veterans), media, “non experts”  Information does not cure “wrong” perceptions

Understanding Risk Perception Less Risky  Voluntary  Individual Control  Familiar  Low Dread  Affects Everybody  Naturally Occurring  Little Media Attention  Understood  High Trust  Consequences Limited/Known  Benefits Understood  Alternatives Available More Risky  Involuntary  Controlled by Others  Unfamiliar  High Dread  Affects Children  Human Origin  High Media Attention  Not Understood  Low Trust  Catastrophic Consequences  Benefits Unclear  No Alternatives

What Makes a Source Credible Empathy and/or Caring Competence and Expertise Honesty and Openness Commitment and Dedication Assessed in First Seconds Assessed in First Seconds

Institutional Trust and Perceived Risk  In addition to individual trust need to look at “Institutional trust” (trust in authorities)  Institutional trust domains include: openness, honesty, reliability, fairness, caring and integrity - Metlay 1999  Two primary factors: affective is most important (caring, openness, reliability, honesty, credibility and caring); 2 nd factor-competence

Institutional Trust and Perceived Risk  Numerous studies indicate that as institutional trust increases –perceived risk decreases -Flynn et. al., 1992; Siegrist et. al.,2000,2002; Allum, 2007  Magnitude of effect depends on population and hazard Perceived Risk Institutional trust

Who The Public Perceives As Credible  Local citizens perceived as neutral, respected, informed about the issue  Health/safety professionals (nurses, physicians, firefighters)  Professors/educators (especially from respected local institutions)  Clergy  Non-profit organizations  Media  Environmental/advocacy groups  Federal government  State/local government  Industry  “For profit” consultants MOST CREDIBLE LEAST CREDIBLE

Establishing Trust & Credibility  Third party endorsements from credible sources  Demonstrating supporting characteristics  Caring  Honesty  Competence  Dedication  Organizational credibility  Consistency  Accessibility  Track Record

5 Stage Model for Responding in Situations of High Concern and/or Low Trust

Designing Your Message  What your patient/Veteran want to know  What you think is critical  What they are likely to misunderstand, if you don’t address  Sensitivity to emotions, concerns, values, etc. Messages should include:

What Do You Think? “It wasn’t our accident, but we are absolutely responsible for the oil, for cleaning it up and that’s what we intend to do.” “What has failed here is the ultimate safety of the drilling rig…There are many barriers of protection that you have to go to before you get to this. It isn’t designed to not fail.” “There is limited or suggestive evidence of no association between deployment to the Gulf and lung disease … “

Example: Operation Enduring Freedom Veteran  24 year old healthy Veteran  Deployed to Afghanistan for 1 year  He was given 1 dose of anthrax vaccination prior to temporary suspension of the vaccine  He has concern about why this occurred  Vaccine safety  Quality control/approval of the vaccine  Involuntary

Risk Communication Approach  Listen to Veteran’s concern about vaccine safety  Explain the risk and benefits of vaccine  Explain vaccine safety with appropriate language  Acknowledge any “errors”  Understand concern about voluntary vs. involuntary risk  Check back on Veteran’s understanding

Differences Between Gulf War 1 & OEF/OIF Veterans  GW1 Veterans have health problems or symptoms they often relate to past exposures  OEF/OIF Veterans have questions and concerns, not necessarily linked to health problems or symptoms  Different communication goals  Inform/educate OEF/OIF Veterans  Understand perceptions and shift behaviors of prior Veterans

Do’s and Don’ts  Listen: Risk communication is two-way  Veteran has much information to offer  Recognize empathy and trust are extremely important  Convey caring before information/science  Explain concepts of exposure  Explain how exposure is determined  Translate dose-response  Assist with knowledge gap (belief that any level of exposure may cause harm)

Do’s and Don’ts  Explain uncertainty  Provider/Veteran perception of uncertainty likely differs  “We have no data to suggest that…”; “It doesn’t appear that…”  Important to “bound it” with explanation  Reflect Back  The Veteran’s understanding of what you find and do not find  Be collaborative  Goal is to increase Veteran participation in decision-making  “Let’s work on this together”

Do’s and Don’ts Treat Veterans with dignity and respect Their worldview/perception is valid, not misperception Don’t rely on your position of authority Not a substitute for good communication Don’t try to convince them you have more knowledge: Instead, explain why you believe Don’t use medical short- cuts

Summary  Risk communication is an important part of addressing Veterans’ exposure concerns  There are things you can do to improve communication  Recognize our goal is to assist the Veteran in making the best decisions to support their health and well-being