How Public Perceive Health Messages? ASEAN Risk Communication TOT, IHM, December 2012, Kuala Lumpur. Hjh Zawaha Hj Idris Institute for Health Behaviour Research Ministry of Health Malaysia

Structure of Presentation  Understanding Public Perception on Health Messages  What are their needs in crisis  Audience Judgments on messages  Tips in Preparing Health Messages

Perception references how individuals understand and view a stimulus or an event.

How the Public Perceives Health Messages  Health risk is an intangible concept.  The public responds to easy solutions.  People want absolute answers.  The public may react unfavorably to fear.  The public doubts the verity of science.

Continue…  The Public has other priorities.  Individuals do not feel personally susceptible.  The public holds contradictory beliefs.  The public lacks a future orientation.  The public personalizes new information.  The public does not understand science.

Public Perception on HINI

Health Belief Model (HBM) on H1N1 Outbreak HBM Construct Part 1 n(%) Part 2 n(%) Part 3 n(%) Part 4 n(%) Part 5 n(%) Perceived susceptibility (Are you are susceptible to H1N1?) 412 (30) 367 (25.5) 505 (36.0) 477 (36.7) 414 (53.7) Perceived severity (In your opinion, if infected with H1N1, does it harm you?) 1130 (82.2) 1123 (78.0) 1158 (82.5) 1055 (80.1) 877 (84.9) PERCEIVED THREAT 380 (28) 339 (24) 480 (34) 450 (34) 386 (37) Perceived risk (If infected with H1N1, have other people at risk of infection if you do not cover your mouth/nose when coughing/ sneezing?) 1166 (84.8) 1156 (80.3) 1229 (87.6) 1093 (83) 824 (89.6) Perceived Benefit (if infected with H1N1, does it pay benefits if you isolate yourself > 1 meter.) 998 (72.6) 987 (68.6) 1062 (75.7) 970 (73.7) 824 (79.8) 8

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In a serious crisis, all affected people take in information differently, process information differently and act on information differently (Reynolds, 2002)

What the public seeks in a crisis  Gain the wanted facts needed to protect them, their families and their pets from the dangers they are facing  Make well-informed decisions using all available information  Have an active, participatory role in the response and recovery  Act as a “watch-guard” over resources, both public and donated monies  Recover or preserve well-being and normalcy, including economic security

5 Communication failures that kill operational success  Mixed messages from multiple experts  Information released late  Paternalistic attitudes  Not countering rumours and myths in real time  Public power struggles and confusion

Audience judgments about your message  Speed of communication Speed of communication  Trust and credibility of the message Trust and credibility of the message  Empathy and caring  Competence and expertise  Honesty and openness  Commitment  Accountability

Preparing Health Messages 1. Identifying stakeholders early in the communication process 2. Anticipating stakeholder questions and concerns before they are raised; 3. Organizing our thinking and developing prepared messages in response to anticipated stakeholder questions and concerns; 4. Developing key messages and supporting information within a clear, concise, transparent, and accessible framework; 5. Promoting open dialogue about messages both inside and outside the organization; 6. Providing user friendly guidance and direction to spokespersons; 7. Ensuring that the organization has a central repository of consistent messages; 8. Encouraging the organization to speak with one voice.

Outbreak area Affected people Outbreak area: Affected people Primary Affected Population i.e. Close contact/ family members/ neighbours/ caretakers olicy makers, politicians Decision Makers/ Regulators i.e Policy makers, politicians General population of the affected country, Neighboring countries, WHO, CDC, Active Interests i.e. General population of the affected country, Neighboring countries, WHO, CDC, Local/ International media, Other agencies Local/ International media, Other agencies Other audiences

7 steps are involved in constructing a message map 1. Identify who are affected? Identify who are affected? 2. Identify a complete list of specific concerns for each important stakeholder group. 3. Analyze the lists of specific concerns to identify common sets of underlying general concerns. 4. Develop key messages in response to each stakeholder question, concern, or perception

5. Develop supporting facts and proofs for each key message 6. Conduct systematic message testing using standardized message testing procedures. 7. Plan for the delivery of the prepared message maps through: (1) a trained spokesperson; (2) appropriate communication channels; and (3) trusted individuals or organizations

Solutions to mental noise theory that guide key message development specifically, and message mapping generally, include: Developing 3 key messages or one key message with three parts for each underlying concern or specific question (conciseness) Keeping individual key messages brief: ideally less than 3 seconds or less than 9 words for each key message and less than 9 seconds and 27 words for the entire set of three key messages (brevity) Developing messages that are clearly understandable by the target audience: typically at the 6 th to 8 th grade readability level for communications to the general public (clarity)

Additional solutions include: Placing messages within the message set so that the most important messages occupy the first and last positions Citing third parties that are perceived as credible Developing key messages and supporting information that address important risk perception and outrage factors such as trust, benefits, control, voluntariness, dread, fairness, reversibility, catastrophic potential, effects on children, memorability, morality, origin, and familiarity

Using graphics, visual aids, analogies, and narratives (e.g., personal stories), which can increase an individual’s ability to hear, understand, and recall a message by more than 50 percent Balancing negative key messages with positive, constructive, or solution oriented key messages, employing a ratio of least 3:1 Avoiding unnecessary, indefensible, or non- productive uses of the words no, not, never, nothing, none

Tips to Ponder  Who is perceived to be most trustworthy  Who is best suited to communicate risk messages  What messages are most effective  What messages are most respectful of different values and worldviews  What messages raise moral or ethical issues  What messages are most respectful of process  Where, when, and how the risk information should be communicated

In Summary………  Identifying audience  Audience segmentation.  Prioritize audience according to risk  Audience knowledge, perception and motivation.  Develop messages based on audience perception.

Touch Heart - Message Development  Simplicity  Timely  Adequate  Relevance  Credible

Ask Me Four  What is the problem?  How does the problem affect me?  What I need to know?  What I need to do?

Target Group. Main concern Key message 1 How Influenza A (H1N1) Spreads Supportive message 1 Supportive message 2 Supportive message 3 Key message 2 What your child can do to avoid getting influenza A H1N1 Supportive message 1 Supportive message 2 Supportive message 3 Key message 3 What Pregnant Women Should Know About Influenza A(H1N1)Virus Supportive message 1 Supportive message 2 Supportive message 3 AREA of CONCERN

Sources: Cavello V.T 2002.

References 1. Cavello V.T., 2001, Journal of Urban Health: Bulletin of the New York Academy of Medicine,Volume 78, No. 2, pg , June Cavello V.T, 2002, Message Mapping, Risk and Risk Communication, Invited Paper Presented at the World Health Organization Conference on Bio- terrorism and Risk Communication, Geneva, Switzerland. 3. Bennett, P. (1999) Understanding responses to risk: some basic findings. In Risk Communication and Public Health (eds P. Bennett and K. Calman), pp. 3–19,Oxford University Press, Oxford. 4. Bennett, P., Coles, D. and McDonald, A. (1999) Risk communication as a decision process. In Risk Communication and Public Health (eds P. Bennett and K. Calman), pp. 207–221, Oxford University Press, Oxford. 5. Communicating in a Crisis: Risk Communication Guidelines for Public Officials Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Washington D.C.