Micerc a guide for Developing Crisis Communication Plans Office of Public Health Preparedness

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Section Two

Specific Audiences


It is imperative to recognize that with every event, there are multiple audiences and that you need to develop custom tailored messages for all of them. When considering the audience the essential features to look for are: relationship to the event; proximity to the event; demographics (age, culture, language, education); level of concern; level of vulnerability; those baring a disproportionate share of the risk or harm; and the relatives of the former.

Audience analysis: A basic method used by professional communicators to ensure effective communication is audience analysis. Audience analysis involves examining various features of the audience so that messages may be targeted specifically to those features. For example, the age and educational level of the audience may indicate something about the audience’s interests and the level a message should take. Older individuals will have different kinds of health interests than younger individuals while those with higher educational levels may be able to follow more technical messages.

Individuals’ proximity to an event or their degree of vulnerability are important factors to consider.

The process of audience analysis may also help avoid making simple but critical mistakes in messages. Many of the communication problems associated with the management of the anthrax attack can be traced to misunderstanding the interests, needs, and values of the audience. In one case, a great deal of anxiety was created for the public because the explanation for a health recommendation was not included in a CDC press release.

Hundreds of callers flooded a health communication hot line to ask why this decision had been made.

Audience analysis may range from simply thinking about who the audience is and what their needs and interests are, to developing sophisticated survey questionnaires, interviews and focus group techniques. Audience analysis may also involve message testing. In these cases, messages are developed based on an analysis of the target audience and then tested with a sample of that audience. This allows the communicator to refine the message so that it has the desired outcome. You may wish to talk to some members of your target audience to determine their interests and health information needs. After you have developed a health message, such as a fact sheet on West Nile virus, you may want to show it to some members of the target audience and ask about its effectiveness or any areas of confusion. Most health communicators do not have the resources to conduct the higher-level audience analysis for every message they prepare and during a crisis may simply not have the time. Consequently, pre-crisis planning of messages is very important, as is some minimum examination of target audiences.

Minimally, during a crisis it is important to consider the audience factors mentioned above. These include relationship to the event (including family, friends, pets, property, travel, business and jobs); proximity to the event; demographics (culture, language, education); level of concern; and level of vulnerability. In addition, gender, income level, and age should be considered in the development of all health messages.

Avoiding Stereotypes: In considering the nature of an audience, it is easy to fall into broad generalizations and even stereotypes. While it is perhaps understandable that professional communicators try and find common features for a group and use these features to build messages, it is important to make sure that generalizations are both accurate and that they allow room for variation. In considering age, for example, it is true that as people grow older they develop more health problems. It is also the case that not all older people have chronic health problems. It is also true that past experience has shown that elderly people may, in some instances, be more adaptive and resilient than younger populations. When in doubt about a generalization regarding a particular audience, seek more information.

Audiences for Public Health During a Crisis or Emergency:

First there are inter-agency audiences, then intra-agency audiences, followed by the media, the general public, stakeholder organizations, neighboring nations and the international community. Specific populations like minorities, the sight-impaired, the hard of hearing, the elderly and the young, etc., must be given special consideration. For many situations you should anticipate many of these audiences and have prepared at least some messages for all as part of a crisis plan. You also need to have specific strategies for getting your messages to the target audiences. Topic specific, pre-crisis materials for identified public health emergencies are crucial for timely responses.

One way to do this in advance is to identify all the major languages (there are over forty in Michigan alone) and ethnic groups in the state and specifically those in immediate proximity to your agency. Have lists of those populations that require specific messages including the sight and hearing impaired, the elderly, children, Native Americans, Hispanic populations, Arab Americans and Afro-Americans, among others. Also be aware that different cultures sometimes have different help seeking behaviors, different perceptions about risk, and different health behaviors. Because of these potential differences, a strict literal translation of a crisis message may not be effective.

Be sure to identify all the stakeholder organizations with which you interact, including organizations to which you are directly accountable, or other chains of command.

With all audiences in both the public and private sector, including journalists, community members, etc., be sure to have “back-door” phone numbers (cell phone or home phone numbers). Events may well occur in “off” hours and formal contact numbers may be of little value in these instances. Spend some time fact checking the accuracy of all contact numbers. All too often agencies discover a significant number of contact numbers are outdated or “corrupted” during a crisis event when both time and accuracy are of the essence. Research has demonstrated that informal community networks are a vital link during a crisis. Be sure to include these networks in your over-all planning.

Stakeholders to Consider:

  • Employees

  • Families

  • Retirees

  • Board members

  • External advisors

  • Your organization’s client/consumers

  • Local residents

  • Business and community leaders

  • Elected officials

  • Consumer action groups

  • Union or labor organizations

  • Competitors

  • Legal advocates

  • Media

  • Public

Specific Audiences

Specific audiences have unique information needs. The groups listed below each have specific questions they want answers to.

First responders: What is the nature of the event and associated hazards? Are there any secondary threats? What specific activities are underway? Are they mandated, such as evacuation, shelter in place, rescue? What sources and channels of information will be used? Who is in command? Which agencies/organizations are responding?

Medical community: What is the nature of the event and associated hazards? What level of harm is anticipated, so that staffing levels may be addressed? Which management guidelines, diagnosis guidelines, and recommended treatments will be used? Where can we get required supplies, if we run out? What secondary assessment, treatment facilities are available? Is there specific information available for family members and the worried well?

Media organizations: What is the nature of the event and of the threat? (Who? What? Where? When? Why?) How will the news be disseminated? When is the next press conference? Who are the experts? Are there additional sources of information?

General public: The general public will seek information via the media and through other channels; web, hotlines, flyers, etc. They will want information regarding the nature of the risks, and the level of threat. They will want advice from health experts about how to protect themselves and their families. They may ask for information about who is in control and seek credible, authority figures?

Children: Children process information in very literal ways and are more directly affected by the information. Adults need to explain what happened and offer reassurances. For example children may not realize the danger is over, or that the people in harms way were only those in a specific geographical area. Parents need to tune into their children’s arousal level and limit exposure to media coverage, when fears are escalating.

Elderly: The elderly may experience a heightened level of threat due to existing health problems, and reduced ability to respond. They often express concerns about family safety and disrupted connections to family members.

Minority Groups: The record of the last fifty years of disaster preparedness and response clearly demonstrates that all too often minority populations have been slighted in both outreach and the delivery of care during a crisis event. For a variety of socioeconomic reasons, minority groups have historically been more vulnerable during catastrophes. It is also important to recognize that crises often have cultural overlays. For example during the SARS outbreaks Asian populations in the west were stigmatized. During the anthrax crisis many African-Americans were at greater risk because of their employment in postal delivery centers in the Capital District area. During the hantavirus outbreak in the early 1990’s Native Americans were at greater risk and were sometimes stigmatized.

It is imperative to include such groups in your crisis communication plans. Become knowledgeable about minority groups in your region. Get to know the essential community leaders and organizations and be sure to give them a place at the table along with other stakeholders. Community owned and operated media should be included in your contact lists. Informal communication networks also often play a vital role.

African Americans: African Americans may feel less connected to the mainstream news sources, and may tend to rely on personal relationship structures for information; community leaders, religious leaders, etc. Some may be more suspect of mainstream authority figures and the established medical community.

Arab Americans: Michigan has the largest Arab-American population in the United

States. This population is comprised of many different cultures. Arab Americans tend to rely less on mainstream media sources and turn to personal relationships for information, such as, community leaders, Religious leaders, family leaders. They may be suspicious of traditional authority figures, and language barriers are common.

Native Americans: Michigan has one of the highest Native American populations in the nation. Native Americans can be distrustful of mainstream media sources and rely more on interpersonal relationships and community leaders for authoritative information. Specific band and communal affiliations are of paramount importance.

Hispanic Americans: While it needs to be recognized that there are many distinctly different Hispanic communities within the United States, research suggests that

Hispanic populations in general also rely less on the mainstream media. Community and religious leaders are an important source of reliable information as well as community owned and operated news media. Spanish translation is of paramount importance even for bi-lingual speakers.

Resources for Special Population

Non-English Health Documents are posted in the Risk Communications folder, in the

MichiganHAN. The translated materials are web based, and will be updated regularly.

OPHP is working with Michigan State University, Department of Arts and Letters to have emergency materials translated into priority languages. The 2000 U.S. Census Bureau data for Michigan on languages spoken in the home revealed high numbers of Spanish, Arabic, Polish, French, Chinese, and German speaking residents. MSU faculty believe the number of Russian speakers in the state in need of the translated materials exceeds the number of German speakers because most Germans also speak English. Thus, they propose that the sixth language targeted for this project be Russian. MSU faculty will translate fact sheets, FAQ’s and risk communication materials into the six languages listed above. The category A biological agents and three chemical agents will be prioritized.

Michigan State Police Operations Division, Language Line Service

517-336-6100 (Operations set up the service for the caller)

AT&T Language Line, Phone: 1-800-528-5888, (Need to give credit card number to use)

CDC Post Exposure Prophylaxis CD-ROM

Patient Drug information sheets and dosing instructions

For anthrax, plague and tularemia, in 48 Languages

Electronic Translation Tools

A number of companies are developing computer systems that can translate between two languages. If you go to http://babelfish.altavista.com/ and enter a website in the ‘Translate a Web Page’ box, Babel Fish translates all of the documents posted on that site into one of nine foreign languages (French, German, Spanish, Chinese, Japanese, Russian, Italian, Korean or Portuguese). For example try entering www.bt.cdc.gov in the web page box in the language of your choice. If you use this type of translation tool, be sure to have the translated materials carefully reviewed for accuracy and cultural sensitivity before distributing them. The University of Southern California computer scientist Franz Och has developed software that can quickly translate between any two languages. Och’s translations proved to be the best in head-to-head tests against 21 other off the shelf products.  

TTY Interpreter Services:

Moreen Wallace, State Interpreter Coordinator

Family Independence Agency, Division on Deaf and Hard of Hearing

320 N. Washington Suite 250, Lansing MI 48909

Phone: 517-334-7446 Fax 517-334-6637

Intertribal Council of Michigan: http://www.itcmi.org/healthservices.html.

Tribal Chairmen: http://www.itcmi.org/chairman.html

Understanding Special Populations

The Colorado Department of Public Health and Environment conducted a study of their special populations and published their finding in July 2003. They used surveys, focus groups and interviews to gather first hand information about the best ways to reach the groups they felt were vulnerable. A summary of the findings are described below.

  1. Research has shown that television is the best medium to use to communicate to all groups.

  2. Major languages spoken such as Spanish, Arabic, and American Sign Language should be used.

  3. Various ethnic groups want to hear emergency messages from their own leaders, government officials and public health authorities.

  4. Many of the target populations need to have both written and oral messages presented in non-technical language (i.e., short words, short sentences and simple questions).

  5. Repetition is important.

  6. Familiar emergency signals such as flashing lights and sirens should be used in TV and radio broadcasts to indicate an emergency.

  7. While immigrants generally trust the government and the media, some African-American, Native American and homeless are highly suspicious of government activities and announcements. People from these groups as well as migrant workers need to be assured that service provision is equitable across income and ethnic lines.

  8. Undocumented immigrants and homeless persons need to be reassured that personnel identification such as drivers license, social security number will not be mandatory to receive emergency services.

  9. Groups such as latchkey children, frail elderly and the developmentally and physically disabled will benefit from assistance from neighbors. The Neighborhood Watch program could be expanded for use during public health emergencies.

Based on the feedback Colorado got from the groups interviewed they made the following observations and recommendations for specific groups:

African-Americans said they used conventional media and this is a good way to reach them. Fears of unequal treatment often exist. They prefer to hear from a diverse group of well known, ethically grounded people, rather than one spokesperson. Partnering with community agencies like NAACP, Urban League, and other neighborhood groups was recommended.

Deaf and Hearing Impaired said they need access to American Sign Language or captions at the bottom of a TV screen or messages written by a TTY operator. The best way to communicate with signers during emergency is to have someone on the TV screen translating messages into sign language. If captions are used sentences should be simple. Visual aids like maps would also be helpful. Most deaf persons drive and have no intellectual impairment and would have no trouble following emergency directions.

Elderly individuals mentioned changes in their ability to hear and see, which led to isolation. Most of the frail elderly surveyed, said they have TVs and telephones. TV was the best medium through which to reach them. Some said directions need to be presented one step at a time. Transportation is often a problem for the frail elderly. The best plan would be to have family, friends and neighbors in place to help during an emergency. Many elderly have a high level of confidence in local police and sheriff’s department and they would trust any emergency message coming from either organization. Adopt a Grandparent programs could be expanded to connect elderly to younger people in their community.

Homeless people said they turn toward shelters and food banks for information and support during emergencies. There is some access to television at shelters and food lines. Many of the homeless do not trust police officers. The best way to communicate with the homeless is to be plugged into the organizations that serve them. Local services like homeless shelters, food banks, medical clinics and social service organizations have high levels of legitimacy. You may want to recruit ”homeless outreach” workers in your community who could go out, find the homeless and bring them to the dispensing sites (bus and train stations would need to be covered). Many of the homeless interviewed said they believe the information they hear on TV and trust health officials. Some spend time in libraries. In any media announcement they would need to be reassured that showing up for treatment would not require identification as many of them do not have drivers licenses or permanent addresses. Very few have cars and would need help with transportation. Unfortunately many of the untreated mentally ill are homeless and may have difficulty following emergency directions.

Latchkey Children need messages to be uncomplicated. Most children have their TVs on and would receive messages through them. Some of these children do not read, so messages need to be verbal and accompanied by a noise like a siren that means emergency. Children who stay home alone have been instructed not to open the door to anyone. Therefore, any door-to-door alert, even involving uniformed personnel may not be effective. Families with latchkey children need to develop safety plans that include having emergency numbers, such as parents work numbers and a neighbor’s number, by the phone. Parents should check with a neighbor to see if their child can go there during emergencies, and keep their contact numbers updated with their child’s school.

Low Income/Single Parents who were interviewed said they had TVs and telephones and would call their family, church, child’s school or Head Start program for information. Research suggests that when socioeconomic concerns are high many adopt more fatalistic orientations toward the future and use passive rather than active coping strategies. “People living in poverty or in circumstances of inadequate resources may be less likely to perform prescribed or necessary actions to mitigate the effects of hazardous agents because a sense of personal control over outcomes may be lacking. Perceptions of control have been shown to be an important precursor to active participation in efforts to reduce a dangerous environment” (Vaughn, 1995, p. 174). Family Independence Agencies can be helpful with reaching this population.

Undocumented Immigrants in Colorado said they watch Spanish speaking television and would trust those announcers; that messages should be simple and visual, showing every step that needs to be taken; and suggested using repetition. Stay at home mothers and seniors in this group often do not drive and may need help with transportation. Emergency information must specify that immigrant status would not lead to deportation. Many reported that their first reaction would be fear, but they would follow directions anyway. They worried that any services provided to them will not be as good as what is being offered to others.

Studying Michigan’s Special Populations

If you are interested in conducting surveys, focus groups or interviews, here are some tools that can be adopted and used to gather information from local individuals or organizations who are familiar with the groups you identify as vulnerable.

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