1. 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

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

3. 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.

4. 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

5. 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

6. Phase 2: Web-Based Survey Methods
Used MrInterview™ platform to create web-based survey
Recruited respondents by s 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

7. 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

8. 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

9. 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

10. 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.

11. 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 (

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. Thank You!
Contact Information: