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Life-saving communication

If a flu pandemic strikes, psychologists' expertise could help keep society running and ensure that the people who need treatment get it. By Christopher Munsey

A U.S. House of Representatives briefing called for more attention to the role social science research can play in communicating with the public, as part of the national strategy for dealing with a potential flu pandemic.

Rep. Brian Baird (D-Wash.), a committee member and clinical psychologist, hosted the briefing in December, pointing out that if a flu pandemic occurs, it is unlikely there will be sufficient vaccines or antiviral drugs to slow its spread.

"Social distancing, effective communication and other public health measures will be our only realistic line of defense, and this is the realm of social science," he said.

The briefing, sponsored by Rep. Bart Gordon (D-Tenn.), ranking member of the Committee on Science, featured presentations from three experts, including psychologist and APA Fellow Baruch Fischhoff, PhD, Clete DiGiovanni, MD, a physician and scientist with the Defense Threat Reduction Agency, and Monica Schoch-Spana, PhD, a medical anthropologist at the University of Pittsburgh's Center for Biosecurity.

Worldwide, health officials worry that the H5N1 avian flu virus, which has caused outbreaks among poultry flocks in Asia and Europe, will evolve into a form easily transmissible from person to person. Since 1997 when the virus was first detected in Hong Kong, there have been cases of bird-to-human transmission, usually among people living and working near poultry flocks. So far, about half of the people who have been infected by the H5N1 virus have died.

With no vaccine yet developed to protect people against such an outbreak, containing it may depend on enlisting the public's cooperation in public health measures to control its spread. The potential toll in human life from such a flu pandemic could be high. Historically, the 1918–1919 flu pandemic was the deadliest, killing as many as 50 million people worldwide, including more than 500,000 Americans.

If and when the next influenza pandemic strikes, knowledge about effectively communicating with people about health risks could help government authorities stem the death toll and keep society functioning, the panelists agreed.

Based on research about how people best evaluate risk and respond to threats, psychologists can help public decision-makers craft effective messages, said Fischhoff at the briefing. The public needs clear, concise and truthful messages about the scope of a pandemic and information about what they can do to stem its spread, experts said.

Sending the right message

Among the most important social science research findings on effective communication in such situations is the need to speak with candor, said Fischhoff, a social and decision sciences professor at Carnegie Mellon University and past-president of the Society for Risk Analysis.

"People want to know the truth, even if it's worrisome," said Fischhoff during his remarks at the briefing. "They want to know what they're up against in order to have the best chance of figuring out what to do for themselves, their loved ones and those they're responsible for."
Besides candor, Fischhoff included the following points as key to effective communication:

People absorb only a limited amount of new information at a time, so messages should include only the most critical facts.

• People have difficulty understanding how small risks mount up over repeated exposure, so messages have to reflect that weakness.

• Audiences must be treated respectfully to avoid provoking emotional reactions that can interfere with well-reasoned decisions.

To design effective messages, Fischhoff recommends officials pull together experts from four groups, specifically: specialists in social services, law and education; experts in risk and decision-making; psychologists and cognitive scientists who can identify audience beliefs; and communications specialists who can ensure that the messages get through to the right audiences.

At the briefing, DiGiovanni supported Baird's contention that communicating with the public, and public health measures, represent the best available choice for dealing with a flu pandemic.

"In the absence of pharmacological agents to deal with pandemic influenza, we're going to have to rely on public health measures to control its spread in the human population," DiGiovanni said.

In her statement, Schoch-Spana called for more attention to the role that civic groups and social networks could play in responding to such a pandemic, given the way people mobilize on their own to confront crises in their communities.

False positives

Fischhoff's emphasis on giving people information is echoed by other psychologists studying risk communication, such as Len Lecci, PhD, a psychology professor at the University of North Carolina, Wilmington, who studied people's reactions to the anthrax attacks in the fall of 2001.

With fellow psychology professor Dale Cohen, PhD, Lecci and a team of students evaluated people after asking them to read news articles about the event, in which someone deliberately spread anthrax spores through the mail to media figures and congressional offices. Of the 22 people infected by anthrax, five died.

Locally, Lecci and his students found high levels of fear about anthrax, despite the fact that there were no recorded cases of infection anywhere near the university. His findings and other psychological research illustrate the damage that fear can cause: Too many people may think they are sick and seek medical attention, bogging down the medical system and preventing those who are really infected from getting treatment.

To prevent those problems, messages about a flu pandemic from authorities should be specific about what's understood about the outbreak, where outbreaks have occurred and steps people can take in their daily lives to reduce their risk of exposure, he says.

The goal of such communication, says Lecci, is warning the public about the threat, motivating everyone to take steps to avoid infection and emphasizing information about who is most at risk, so that treatment remains concentrated on people who might actually be infected.

"If it really is a high-threat situation," says Lecci, "we make sure the public perceives it as a high-threat situation, and ideally, we give them something to do"–such as recommending hygiene measures to avoid infection or listing symptoms of the feared condition that they can evaluate themselves for. That helps reduce anxiety and keeps people functioning, he said.

Communication failures

Psychological research can inform decision-makers about better ways to communicate with the public. One example that has not benefited from such research is the U.S. Department of Homeland Security's (DHS) color-coded terrorist attack alert system, says Roxane Cohen Silver, PhD, a trauma researcher and professor of psychology and social behavior at the University of California Irvine, currently serving on a senior advisory committee for DHS.

The system is color-coded to communicate terror risk, with green for "low" risk rising to red for "severe" risk. The system wasn't designed for alerting the public, she says, but as a way to advise law enforcement agencies about conditions for possible terrorist strikes in the aftermath of Sept. 11, 2001. Silver says that system is flawed because it tells people that there's a terrorist threat, but doesn't give them specific actions they can take in response.

If no attacks occur after repeated warnings, she says, and if those warnings don't advise specific actions for responding to a threat, people may stop listening to them.

"If the messages are not appropriately framed, if they're not seen as trustworthy, if they're not tied to something people can do, I think they will be dismissed or not attended to appropriately,"she says.

If a flu pandemic occurs, telling people some actions they can take to control its spread is an important aspect of helping them maintain their psychological health, she says. Giving people a way to focus on taking action helps them adjust and prepare for unsettling events, Silver says.

People will want to know about measures they can take to lessen their chances of contracting flu and their family's risk, she says.

And keeping people healthy psychologically will help keep society functioning in the event of a flu pandemic by encouraging people to "press forward" with their daily lives.

"Feeling some sense of control facilitates coping," she says.

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