Damian Sendler: The H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic offer insights into how health authorities communicate health risk information to the general public. During a pandemic, public health officials use a variety of methods to communicate with the public about the dangers posed by a disease.
Damian Jacob Sendler: A wide range of studies in the interdisciplinary field of health risk communication were included in this review. The H1N1 and COVID-19 pandemics received the majority of attention. It was found that three categories for modes of communication emerged from a content analysis: I communication channels, ii) source credibility, and the way the message is communicated. Only a few studies on social media and self-protective behavior have been found, whereas the majority of studies on content and engagement have been found. There aren’t enough studies on communication methods that account for the wide range of receivers that can be found in the field. The use of graphic and audio-visual means by health authorities has been the subject of a few studies, but none of these looked at or evaluated the creative communication options.
Dr. Sendler: There is a need for experimental studies to examine the impact of health authorities’ social media videos and messages on self-protective behavior. At a time when online digital communication is crucial for reaching the public, more studies in the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, are needed.
An epidemic known as a pandemic is one that spreads across a large geographic area, crosses international borders, and affects a significant number of people.
A disease-causing agent must be able to infect and spread easily among humans” [[1] p. 2019]. This includes the “Spanish flu” pandemic of 1918–1919, AIDS, swine flu, and COVID-19, a coronavirus disease that was brought on by a strain of the SARS-COV-2 virus that has recently emerged in 2019. (2019-). Responses to pandemics are unique in that they rely on organizations with a staff of subject matter experts (SMEs). During the H1N1 swine flu pandemic, for example, pandemic responses were driven by bureaucratic expert judgment rather than by politicians guided by political survival principles [2]. People who perceive a disease as more serious are more likely to engage in protective behavior during pandemics and infectious disease outbreaks, according to a review of demographic and attitudinal factors [3–5]. Geographical and virological factors, rather than severity, define pandemics, which can make it difficult to communicate the risks of low-lethality pandemic infections [6]. In addition, pandemics spread across the globe, resulting in disease outbreaks at various points in time and in various places. The pathogen’s effects can last for years and change in severity over time [7], and it has the potential to have devastating effects on human health, the economy, and quality of life all over the world [8–11]. In order to effectively communicate pandemic risk to the general public, health authorities face numerous challenges [12, 13].
Research and practice in risk communication are both multidisciplinary [14]. The literature that uses the term “health risk communication” emphasizes that “health communication” is an integral part of risk communication in the context of public health emergencies [13, 15–18]. When dealing with a public health emergency, such as a pandemic, health communication and risk communication aims to improve health outcomes by influencing, engaging, and reaching out to various at-risk audiences [12, 19, 20]. The term “health risk communication” is used in this review due to the literature’s integrative nature. In health risk communication, trust, engagement, and tailored communication are all critical concepts, and a lack of any of these could impede effective communication [12, 20].
Different modes of communication can be used to communicate health risk information. Health authorities’ methods of informing the public about risk are referred to as “mode” in this review. Mode is a way of being or doing things [21]. [22] Health risk communication has been significantly influenced by new modes of communication as the public seeks information via online and social networks. A significant impact on traditional mass media has been the rapid evolution of communication technology, including the nearly universal adoption and widespread use of mobile phones and digital media (television, radio and newspapers). Access to and trust in health information are both changing as a result of the internet [12]. An important role was played by online newspapers and social media in spreading information about the health risks of the H1N1 pandemic [23, 24] and the COVID-19 pandemic [25–27]. There are new opportunities for two-way communication on social media platforms, such as speaking with and not just to people [12, 27, 28]. However, these aren’t the only ways health officials communicate with the general public. In addition to traditional print and broadcast media, health officials also use videos, mass media, websites, and social media to communicate health risk information to the general population.
For emerging infectious diseases [12, 28] and for the H1N1 pandemic [7, 13, 18, 29], previous systematic reviews synthesized knowledge on risk communication. However, the role of social media during emerging infectious diseases and the COVID-19 pandemic [23, 26] and the role of mass media and public health communication in COVID-19 [25, 27] have also been examined in other reviews. Pandemic risk communication, however, does not currently have the same level of synthesised knowledge as other aspects of public health. Consequently, the goal of this rapid scoping review was to synthesize all evidence regarding the various modes of communication used by health authorities during a pandemic to communicate health risks to the public. A scoping review is a type of systematic review in which a researcher aims to gather a wide range of evidence from a variety of sources, regardless of the study’s quality, in order to identify research gaps and clarify some key topics and outcomes (e.g., knowledge, trust, health literacy, adherence to recommendations).
Of the 48 articles, 33 dealt with the COVID-19 coronavirus pandemic, 12 with the H1N1 swine flu pandemic, and three with pandemic influenza in general. For the studies, data collection occurred in North America (N = 15), Asia (N = 13), Europe (N = 9, of which N=9 was collected in multiple European countries), Africa (N=1), and Australia (N=1). There were no studies from South America. A total of nine studies, three of which collected data across continents, five of which collected data on global media use, and one of which looked at the WHO, were conducted.
Results and risk communication are broken down into categories based on the types of outcomes and key topics. All of this was categorized into three main groups: In addition to I communication channels and ii) source credibility and iii) how the message is communicated, these two additional categories describe how and why health authorities use these media types:
Damian Jacob Markiewicz Sendler: Pandemic information can be disseminated through a variety of communication channels, including the traditional mass media, governmental websites, social media platforms, and YouTube clips. Framing, engagement, misinformation, health literacy, self-efficacy, accessibility, and timeliness of the updates were among the most important topics. Survey methodologies with self-reported use of communication channels were used in 14 of the included studies [36–51]. Health authorities were among the information sources. According to these studies, people get information about pandemic health risks from a wide range of sources, including newspapers, television, printed materials, government websites, scientific articles, radio, and text messages (SMS) [36–50]. They also get information from other people in their personal and professional networks, such as family members and close friends, as well as from health care professionals and social media [36–50]. There is no one-size-fits-all approach to educating the public about health risks; rather, people are influenced by the totality of their exposure to various and multiple communication channels and information sources.
Using traditional mass media (TV and newspapers) as a communication channel, five studies of health authorities’ health risk communication reported on outcomes related to framing and use [52–56]. Message framing was a major topic of discussion at the meeting. According to Nisbeth [[81], p. 216], “interpretative story lines that set a specific train of thought in motion, conveying why an issue might be a problem or pose a threat, and what should be done about it” are examples of framing. H1N1 media coverage during this pandemic used sensationalist framing of their messages, conflict frames, and war metaphors [52–54]. During the H1N1 pandemic, tabloids in ten European countries used risk-amplifying frames to present press releases from the WHO and health authorities. When distributing the press releases, conflict and damage were emphasized [53]. According to Hall and Wolf [52], German public health experts attributed public fear and panic due to sensationalist media reporting.
Damian Sendler
Health professionals, regional public health officers, epidemiologists and public health experts across eight European countries following the H1N1 pandemic all reported poor collaboration with the media and feeling misunderstood by the media, according to a qualitative study. Public trust in public health authorities must be improved before a pandemic occurs, according to the stakeholders [55].
Even though studies on mass media framing have found it to be an important topic, there are no studies on the relationship between framing and public responses. No studies have examined the effects of health officials’ communication with the public via radio, and no studies have examined the outcomes.
Readability, accessibility, and timeliness of updates on government websites were examined in six studies included in this collection of research [57–62]. It was found that COVID-19-related information was difficult to read on government, hospital, and WHO websites [57, 58] in cross-sectional Google search studies of the readability of websites. The Centers for Disease Control and Prevention’s websites during the first months of the H1N1 pandemic were classified according to their intended audience and reading level in a prospective study of the websites. Using instruments for evaluating the suitability of materials, such as layout, typography, graphics, and surrounding context, and their accessibility to an intended audience, the study examined the content’s readability. The format and layout of the webpages (i.e., text-heavy and densely formatted) made the material difficult to understand, according to the authors [59]. In the absence of non-text alternative content for people with vision problems, a WHO website accessibility study found that information on the website was not accessible to the elderly [60]. During the COVID-19 pandemic [62] and the H1N1 pandemic in the United States [61], local governments in China complained about the difficulty of keeping their websites up to date with the latest information.
The evidence suggests that information accessibility is not determined solely by adjusting the reading level of the audience. Additionally, factors such as readability, design, format, usability, and timeliness have been considered when evaluating the quality of health authorities’ and governments’ official websites.
Damien Sendler: Studies on Twitter and Sina Weibo focused on message content, engagement, and misinformation [15, 16, 63–68]; all eight of these studies reported on these three aspects of social media messaging. There has been research done by Sutton et al. [63] looking at the use of Twitter by government officials and they discovered that the content and features of a tweet, as well as its organization type, followers and time of day all influence how often a tweet is retweeted (i.e. reposted or forwarded). Surveillance, technical information, self-efficacy, or symptoms of collective efficacy were the most popular topics for retweets. Video-enabled messages were retransmitted 63% more frequently than text-only ones [63]. According to Sutton et al. [15], public health agencies’ Twitter messages during the first 60 days of the COVID-19 pandemic shifted from instructive messages to motivational messages to sustain action, which focused on protecting vulnerable populations.
Damian Jacob Sendler
The lack of viewer engagement in health authorities’ social media posts related to COVID-19 was examined in five studies. On behalf of the world’s health authorities, Kamiski et al. [64] conducted an infodemiology study on Twitter messages published by them. There was a higher level of engagement with health authorities’ use of negative framing in Twitter messages about pandemic information than with celebrities’ and politicians’ positive framing. It is possible that while more positive posts from healthcare providers may increase engagement, they may also diminish the message’s perceived importance. In order to effectively communicate pandemic risk, the authors argue that health authorities and opinion leaders must work together [64]. Inconsistencies and inconsistencies in the communication of COVID-19 information were found in a study of information dissemination on Twitter conducted by the U.S. health authorities. There was no mention of message inconsistency and people’s self-protective behavior in the study [65]. Sina Weibo posts from the Chinese government were found to have a low level of engagement. Media richness was not used properly, and non-personal and non-narrative content was used instead, according to the studies [66, 67].
The evidence suggests that social media posts about pandemic health risk information are not getting much attention from the public. Twitter and Sina Weibo users are more likely to engage with messages that include narratives and a sense of self-efficacy. As far as pandemic health risk communication and self-protective behavior are concerned, no studies have been conducted.
Five studies [69–73] looked at how people use the world’s most popular video-sharing website, YouTube. Online video has grown in importance as a supplement to traditional television. However, YouTube is vulnerable to the spread of misinformation because credible government sources and the WHO are underrepresented [69–71]. Among the most popular COVID-19 videos with more than 62 million views, Li et al. [69] found that 25% contained misleading information. Only 11% of the videos and 10% of the views on COVID-19 were produced by the government, despite the fact that these videos contained more accurate and factual information. A higher percentage of YouTube views were found for COVID-19-related videos with misleading content than those from credible sources [70]. Government and health agency videos on COVID-19 information on YouTube were often found to be credible across nations, but they received a low number of likes and comments [72] and represented a low share of their videos [70]. According to YouTube’s reliance on the English language in videos and the fact that public agencies have low subscriber numbers, health authorities may not be able to reach a large number of people through social media.
These studies [69–72] show that YouTube is a source of misinformation for COVID-19, and health authorities’ videos on YouTube are underrepresented and have low engagement. Studies on YouTube videos used by health authorities to communicate pandemic health risk were not found that also reported on their impact on self-protective behavior.
One study [37] found that people were more likely to trust government and health care professionals, compared to those who were more likely to trust non-formal sources like the media or their friends and family. Trust in official government sources has been linked to better self-protective behavior and accurate knowledge of pandemic risk [46, 47]. In a survey of Hong Kong adults, trust in official government sources about influenza was linked to better reported understanding of H1N1 causes and more self-reported hand hygiene among males than those who trusted informal and interpersonal information sources [46]. Trust in government sources was found to be positively associated with accurate knowledge of the disease COVID-19 in a survey of the US population. The younger generation has a greater faith in non-official sources like CNN and social media (like Twitter) than the older generation, which has a greater faith in official US government sources. Since young people place a high value on informal information, the authors contend that they are more susceptible to being duped by false information [47].
Credible sources, on the other hand, may not always agree with the most commonly cited sources. According to Jardine et al. [37], people in Canada relied on mass media and friends for information about the H1N1, but found public healthcare professionals to be the most trustworthy. Australian mass media was the most important source of health risk information for parents during the H1N1 pandemic, despite its lack of reliability, according to King et al. [48]. Medical doctors, authoritative hospitals, and government websites, on the other hand, were perceived as the most trustworthy.
It was found in a survey of Slovenian adults that medical professionals and scientists were viewed as the most trustworthy sources of information, but that news portals, television news and social media were the most frequently accessed sources of COVID-19 information.
Failures in China’s government risk communication were the subject of two qualitative studies [51, 68]. During the early Wuhan COVID-19 outbreak, Chinese authorities failed to disclose their uncertainties, according to Zhang et al. [51], which the authors argue undermined their institutional trust. Zhang et al. [68] investigated the spread of misinformation about the effectiveness of a Chinese herb on COVID-19 prevention in a qualitative study. The message was delivered by one official health expert through the Chinese authoritative media, which influenced the perception of the message’s credibility. Social media disseminated the information with misleading titles, which sparked rumors and hoarding [68].
Formal health risk information has been shown to have both positive and negative behavioral effects, according to research. Even though studies show an association between higher levels of knowledge and self-protective behavior when people place their faith in formal sources, these studies lacked controls for educational level, which could moderate the relationship between sex and age differences in knowledge output. For pandemic health risk information, there appears to be a discrepancy between the sources people trust and the ones they report using.
There has been a lot of research done on the use of narratives in the risk communication literature [14]. It was examined in six studies that how health officials’ messages are received and acted upon during pandemics is affected by the narrative tone of communications. It has been discovered that the narratives people hear can influence their level of fear and apprehension [49], their understanding of the pandemic [73], their level of involvement [16, 66, 67], and even their own behavior to protect themselves [76]. It has been found that people’s anxiety is exacerbated when hospitals report a need for financial donations because this reflects a lack of beds in hospitals [49]. Seeing that the Chinese government was opening schools gave people a glimmer of hope [49]. People who watched non-narrative health videos about pandemic influenza reported greater knowledge and greater pandemic influenza prevention measures than those who watched narrative videos [73]. [16, 67] Two studies of the Sina Weibo platform in China found that people were more engaged with narrative posts than non-narrative posts, both by the government and by personal sources. There were strong negative correlations between the number of shares and posts with new evidence and a nonnarrative style [16].
Factual, evidence-based messages about pandemic influenza from the health authorities were found to be the most persuasive, particularly those that included cost-benefit comparisons of H1N1 vaccine safety. Patronizing and unprofessional were the most commonly perceived characteristics in messages intended to invoke feelings of regret for not getting vaccinated. Positive emotions and posts with high levels of media richness (both in text and video) increased citizens’ engagement with government social media, while posts with high media richness and negative emotions depressed citizens’ involvement. So the authors concluded that when reporting content eliciting negative emotions, plain text should be used; when reporting content eliciting positive emotions, video should be attached to the text.
While people learn more from non-narrative information than narrative information, the use of narratives in health authorities’ pandemic health risk communication leads to public engagement, according to evidence. People’s emotions may also be negatively affected by negative narratives, according to the evidence.
Researchers have found a wide range of communication channels are used to disseminate health-related information, as well as a variety of informal and formal sources that influence the meaning-making process [85]. As a result, health officials are urged to spread information via multiple channels, including social media [12, 84]. Inconsistency may arise from the rapid dissemination of health officials’ social media messages, which may confuse the public [37, 65]. There’s nothing wrong with getting your information from multiple sources as long as it helps you make smarter decisions, reduces confusion, and increases your trustworthiness. [37] Misinformation is a major problem on social media sites related to pandemic risk communication, according to the findings of the review. Confusion and even panic can result as a result of this [23, 26, 27,] for the general public. It has been difficult for health authorities to combat the “infodemic,” or an epidemic of misinformation and rumors spread through social media sites, which has resulted from an overabundance of publicly available information [12, 23, 27, 86]. Meanwhile, their own messages, which are disseminated quickly and in parallel across numerous communication channels, lack consistency. According to Ratzan et al. [20], in order to effectively communicate global health issues to the general public, it is essential to develop a communication strategy focused on social media. To ensure or avoid risk amplification of their messages through mass media, health authorities across nations face challenges in creating social media engagement, providing the public with websites that are accessible, updated, and tailored to varying reading levels and with a readable layout.