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To prevent panic, promote efficacy and reliability

Health Minister Greg Hunt and Chief Medical Officer Brendan Murphy came under fire from the host and panel on the ABC’s Insiders program for the Government’s inconsistent and poorly targeted messaging on the novel coronavirus and COVID-19.

The Twittersphere has also not held back in calling out every piece of contradictory advice or behaviour from politicians and health authorities.

But is this criticism fair, given the challenges of this complex and rapidly changing environment?

How should governments present information and advice on COVID-19 in a way that reduces, rather than incites panic, and helps people make decisions which support their health and those of the people around them?  

Below, health promotion practitioner and PhD student Daniel Reeders answers these questions in the first of a planned series on health promotion relevant to the pandemic.

This piece first appeared on Daniel’s blog www.badblood.blog and is re-posted here with permission.


Daniel Reeders writes:

The coronavirus pandemic is a rapidly evolving situation. Much remains unclear about how the virus behaves in the body and how it moves in the community. 

Here is an excellent summary of what we know, and what we can all do.

Governments have been muddled in their messaging, and with a few exceptions, slow and indecisive in their responses to the outbreak. 

In the absence of effective messaging, some commentators have taken to social media, writing blog posts, tweet threads, and even making memes to communicate information about the pandemic. Some are better than others, and some efforts are downright misleading or actively counter-productive. In some cases, we have people communicating outside their usual scope of practice, and beyond the limits of their experience and expertise. 

A particular concern is that some of these DIY educators are communicating in a tone and style that encourages panic.

Photo by Hello I’m Nik ? on Unsplash

One notorious example is Dr Eric Feigl-Ding. In a now-deleted tweet about a since-retracted article, his intemperate language courted panic:

“HOLY MOTHER OF GOD — the new coronavirus is a 3.8!!! How bad is that reproductive R0 value? It is thermonuclear pandemic level bad — never seen an actual virality coefficient [like that] outside of Twitter [research] in my entire career. I’m not exaggerating.” (January 2020)

A much more careful example is FlattenTheCurve.com by Julie McMurry, a masters in public health graduate who has experience in epidemiological modelling of infectious and genetic diseases — not health education. This provides a vast amount of information, in a hierarchical format, with lots of graphs. To put it mildly, this is not readable and accessible for most.

The resource includes suggestions on creating a ‘hot zone’ in case your household members become infected. Another section begins ‘I’m developing guidance on this right now and others are welcome to weigh in, but a few things off the top of my head…’ 

During crises of all kinds, people wade into education and service provision because they feel pressure to ‘do something—anything!’ Recent examples include Tracey Spicer during the #MeToo moment, and during the recent bushfire crisis, comedian Celeste Barber’s mis-targeted fundraiser and Erin Riley’s #FindABed. 

The common attitude seems to be ‘how hard can it be?’ And then the wheels come off when the answer becomes apparent. In this case:

At worst, this just looks messy and it might work for some and not others. It is much more damaging when doctors—whom the community see as experts—advocate their needs and views in ways that promote panic. Dr April Armstrong, who runs a Facebook group, posted the following:

I manage a group of 27500 Australian Doctors [sic]. We almost unanimously have declared that we are not prepared for what is upon us. Not coming, it’s here. I urge you to continue to read and start planning your family’s safety as soon as possible.

Ominous. The post continues:

Medical people in these countries (Italy and Iran) are communicating with us and begging us to listen and ACT NOW. Tomorrow is too late, even today might be too late. (…) We have already got community transmission and thousands of overseas visitors walking the streets.

Later in the post, when Dr Armstrong urges people not to ‘panic buy’ goods, it sounds incongruous, because it doesn’t fit with everything leading up to it. The broad theme is ‘protect yourselves because the government won’t.’

Speaking of Italy… it is clear the country left it very late to roll out testing and to adopt control measures like travel restrictions and bans on public events. We are hearing vivid stories of heartbreaking situations in hospitals, but very basic parameters — timing, prevalence and incidence — remain unclear. 

As a result, we can’t ground our interpretation of those narratives in a clear understanding of the underlying epidemic. Are they seeing more cases with more serious illness, or do they have a lot more cases than they realise? This makes it hard to know if their experience is, in fact, a taste of things to come in Australia — and whether we should make planning decisions based on those narratives. (More in these considerations on part two.) 

This post is the first of three, focused on best practices for online communication about pandemic risks and preparedness. This first post looks at efficacy messaging. 

Across all three posts the take home message is this:

When communicating about the coronavirus, avoid creating panic by promoting efficacy, reliability, and equity.

Efficacy is the antidote to panic

This post from a Sydney immunologist could not be more different from Dr Armstrong’s post (above). It emphasises the need for effective governance and collective action without encouraging people to panic:

Panic is a barrier to effective pandemic control. 

Why is panic a problem?

  • It encourages ineffective behaviourslike panic buying. The run on toilet paper is silly and inconvenient, but shortages of masks, handwash, and essential medicines are grave problems.
  • High energy emotional states, like distress, alarm, and panic, prevent people from carefully processingwhat they read or hear. This makes it much harder to communicate what action we need people to take.
  • Panic puts people in a ‘me-and-mine first’ frame of mind, at a time when we need everyone to pull together and take collective action.
  • When people are panicking, they dismiss ‘emotionally dissonant’ messages— such as health experts giving calm, measured advice. People in this state may turn to hyper-emotive rumours and conspiracy theories.

So we need an antidote to panic. 

Efficacy is the opposite of panic.

There are ample studies of how people respond to fear-based communications.

Research by Witte and colleagues (20002008) tells us that people targeted with scare tactics tend to engage in panic or denial when two key conditions are not met:

  1. Response efficacy— the person believes the recommended course of action will work against the threat;
  2. Self efficacy— the person believes they can carry out the recommended action.

All our communication should support efficacy over panic.

What people need

People living their everyday lives don’t need detailed, plain language explanations of the science. They need two things:

  1. Assistance to understand what’s happening in general terms — this is not just more information but explanatory frames;
  2. Translation of the science and technical advice into clear, concrete, personal, everyday advice about what they can do.

The two goals are semantic (sense-making) and pragmatic (action-focused). Achieving the sense-making goal helps to support the pragmatic goal. 

When people understand the rationale behind recommended action, they hold stronger response efficacy beliefs. Protective behaviours require information, and motivation, and behavioural skills (Fisher and Fisher, 2002). Perceived efficacy is a more effective motivation than fear/alarm.

Best practice examples

Here is a great example of an efficacy-promoting message developed by Dr Siouxsie Wiles and The Spinoff cartoonist Toby Morris:

This visualises the relationship between individual actions that protect against infection and population-level strategies for epidemic control—more on that below. It communicates actions to take as well as their rationale.

Collective efficacy

So far we have talked about self and response efficacy — I can do this, the action is manageable, and it will be effective. 

There is one more dimension, known as collective efficacy (Bandura, 2000).

People don’t simply follow advice from experts if they don’t understand it. People can understand the same advice in different ways. In my view of the public conversation over coronavirus, there are two big differences:

  1. Some people understand ‘flatten the curve’ as an argument for primary prevention via individual behaviours, such as hand-washing, that protect against getting coronavirus in the first place. Other people understand that there are going to be a lot of infections, and the goal is to slow the infection rate and space out the most serious cases over time, so the hospital system can cope.
  2. Some people understand social distancingand self-isolation as strategies for protecting yourself from getting coronavirus from others. Other people take a more collective view of social distancing as something we all do because it reduces the overall size and pace of the outbreak.

In these two examples, the first understanding is ‘me-first,’ focused on personal protection, while the second one takes a collective perspective, recognising that individual practices also contribute to collective strategies.

These understandings have different consequences. 

Low perceptions of collective efficacy can lead to mistrust of governance — people not listening to advice and recommendations from local health experts. 

It can also lead to ‘me-first’ behaviours, such as stocking up on food and medicines, and fighting to get tested despite having low risk, when experts are encouraging sensible moderation.

The collective perspective, by contrast, makes it easier to recognise the beneficial aspects of taking action together. This can lead to people taking action that puts community benefit ahead of personal convenience.

Collective action

My colleague Trent Yarwood posted about the difference between treating individual patients and making population health decisions. The difference between personal protection and epidemic control is a matter of emergent effects. The collective perspective makes these effects easier to recognise.

If a single person washes their hands and stays home, yes, that reduces their own risk of catching the coronavirus. If most people do it, for long enough, the pattern begins to affect the shape of the overall outbreak:

  • people with unrecognised mild and asymptomatic cases of coronavirus stay home
  • more of these cases progress to immunity without causing any new infections
  • the reproductive rate trends lower and the outbreak comes under control.

The implications of this perspective for personal decision-making are profound. If I’m young and healthy, the prospect of getting coronavirus might not scare me into staying home. But if my action can contribute to ending the outbreak, now I am motivated.

Health altruism is a powerful thing. However, given it involves emergent effects, how can we communicate the rationale for collective action?

Here is an 18-second explanation of social distancing as an outbreak control strategy. What I want you to notice is the calmness of the delivery—even though he’s inviting people to imagine getting the virus:

Imagine you already have coronavirus and change your behaviour accordingly to protect others. @GrahamMedley @BBCNewsnight

Our full interview with Professor Graham Medley is here:

https://www.youtube.com/watch?v=blkDulsgh3Q …

Note that, in the longer video, Prof Graham Medley explains herd immunity. I don’t see this as a practical epidemic control strategy, as the UK government apparently does (!).

And here is Dr Wiles and cartoonist Toby Morris’ follow-up to their first meme, illustrating the potential consequences of different collective responses. It is spectacularly good health promotion.

Conclusion

Panic is a major barrier to an effective pandemic response. It is easy to cause panic and extremely difficult to unwind. The antidote to panic is promoting efficacy. Efficacy has self, response, and collective aspects: it means personal confidence that together we can take effective action.

The action focus is important. Focusing on actions the reader can take—and identifying the practical consequences of the information—helps to avoid leaving readers feeling helpless, and the panic that can follow from that. 

There is always personal action that can be taken. If controlling the outbreak requires government intervention, then the recommended personal action is political—advocating for effective governance!

This is why health promotion is bigger than communication. It involves personal skills-building and mobilising people and communities. 

It is also why communication strategists hate ‘raising awareness’ and insist on identifying what you want the audience member to do differently. 

The next post in this series focuses on reliability — how can we increase the likelihood that sensible, moderate advice will be seen as credible?

Daniel Reeders has worked in health promotion for over a decade and been involved research and practice in social marketing and communication strategy around health issues like HIV, cancer screening and sexual and reproductive health. He is currently studying in the PhD program at the ANU School of Regulation and Global Governance (RegNet), and working as a researcher at the UNSW Centre for Social Impact developing methods to evaluate NDIS markets.

See Croakey’s coverage of the novel coronavirus outbreak.

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