Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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Appendix B3: Mixed-Method Review of Channels for Communicating Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency
Appendix B3: Mixed-Method Review of Channels for Communicating Public Health Alerts and Guidance with Technical Audiences During a Public Health Emergency
Pages 357-386
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practice is to ensure that technical audiences are aware of and understand up-to-date information about a particular public health threat. As depicted in the analytic framework in Figure B3-1, awareness of current alerts and guidance may influence the behaviors of information recipients (e.g., changes in diagnostic testing protocols, use of 1 This appendix draws heavily on three reports commissioned by the committee: "Data Extraction and Quality Assessment: Methodology and Evidence Tables" by the Brown University Center for Evidence Synthesis in Health; "Communicating Public Health Alerts and Guidance with Technical Audiences: Qualitative Research Evidence Synthesis" by Julie Novak and Pradeep Sopory; and "Information Sharing with Technical Audiences: Findings from After Action Reports and Case Reports" by Sneha Patel (see Appendix C)
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for the mixed-method review of channels for communicating public health alerts and guidance with technical audiences during a public health emergency. A search of the gray literature, reference mining, and a call for papers contributed an additional 599 articles.
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» Improved coordination with response partners Population Technical audiences Intermediate Outcome Intermediate Outcome Outcome External facing Improved knowledge and attitudes » Increased reach of alerts and Improved response Improved transparency and trust guidance » Increased appropriate » Increased reporting and feed- use of public health back from target audiences guidance » Increased perceived credibility » Economic impacts of shared public health infor Potential Effect Modifiers mation » Improved audience awareness » Knowledge and use of risk communication principles and understanding of up-to date public health information » Different types of technical audiences » Frequency, timeliness, and content of alerts/messaging Outcome » Designated point-of-contact/liaison Reduced morbidity » Coordinate and exercise plans with response partners and mortality Potential Harms Alert fatigue or overwhelmed feelings leading to ignored/ missed information FIGURE B3-1 Analytic framework for communicating public health alerts and guidance with technical audiences during a public health emergency. NOTES: Arrows in the framework indicate hypothesized causal pathways between interventions and outcomes.
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. Consistent with the methods described in Chapter 3, in making its final judgment on the evidence of effectiveness for electronic messaging channels for communicating public health alerts and guidance with technical audiences during a public health emergency, the committee considered other types of evidence that could inform a determination of what works for whom and in which contexts, ultimately reaching consensus on the certainty of the evidence (COE)
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APPENDIX B3 361 FIGURE B3-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of channels for communicating public health alerts and guidance with technical audiences during a public health emergency.
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The two studies were not classified as qualitative research studies and are not included in the qualitative study count for this table. As described in Chapter 3, the findings from these sources were extracted and considered separately in the qualitative evidence synthesis to affirm or question those findings from the more complete qualitative studies.
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. The committee reviewed six case reports containing quantitative data related to electronic messaging systems used for communicating public health alerts and guidance with technical audiences during public health emergencies.
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Few AARs addressing the use of communication channels report quantitative data, and among those that do, the findings regarding the effectiveness of electronic messaging channels are mixed. Two of the AARs in the sample collected for this mixed-method review report survey results regarding the perceived "effectiveness" of or satisfaction with electronic communication channels used during a public health emergency.
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Summary of the Evidence: Technical Audience Awareness The committee concluded that there is moderate COE that electronic messaging systems such as email, fax, and text messaging are effective communication channels for increasing technical audiences' awareness of public health alerts and guidance during a public health emergency. Two quantitative comparative studies (Baseman et al., 2016; van Woerden et al., 2007)
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= mixed effect/conflicting findings. Summary of the Evidence: Technical Audience Use of Guidance The committee concluded that there is very low COE that electronic messaging systems are effective communication channels for increasing technical audiences' use of current public health guidance during a public health emergency.
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Based on the evidence described above, the committee concludes that there is evidence of differential impact of different technologies employed as electronic messaging systems for communicating public health alerts and guidance with technical audiences during a public health emergency to increase awareness and appropriate use. However, data are insufficient to conclude what technology is best for which audiences in which scenarios.
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Gamache and colleagues (2010) also identify timeliness as a benefit of sending public health alerts through Health Information Exchange platforms.
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Qualitative Evidence Synthesis The body of qualitative evidence shows that technical audiences prefer email and fax as channels for communicating public health alerts and guidance (Khan et al., 2017; Ockers, 2011; Revere et al., 2015)
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for communication channels and sources of alerts and guidance during a public health emergency. This survey evidence supports the finding from other evidence streams that email is the preferred channel for communicating this information.
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survey mentioned above expressed the view that local health departments, but not the state health department, should customize CDC messages and updates to incorporate local information. 4. Feasibility and PHEPR System Considerations Qualitative Evidence Synthesis The body of qualitative evidence included in the review suggests that some communication channels are presently more feasible than others.
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. Case Report and AAR Evidence Synthesis Overall, the body of case reports and AARs does not address equity issues associated with different channels for communicating public health alerts and guidance with technical audiences, highlighting an important evaluation gap.
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The United States may be able to apply similar approaches when developing communication channels for technical audiences to promote greater equity. 7. Ethical Considerations3 In addition to the equity concerns noted above, which are often considered as reflecting ethical values, the primary value of communication using appropriate channels is often considered to be instrumental, meaning that it is important because using appropriate channels to convey information presumably leads to better information delivery, which can facilitate better decision making.
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Feasibility and PHEPR System Considerations Sources of Evidence Some communication channels are more feasible than others for public health agencies • ualitative Q and technical audiences to implement. The widespread use of traditional channels (e.g., evidence email, fax, phone calls)
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As in considering the instrumental value of using more effective channels for communication, one should remember that while communication using ineffective channels is obviously disrespectful, overloading effective communication channels is also disrespectful during crises, when recipients have limited time and bandwidth. In sum, selecting appropriate communication channels is ethically important, and so is careful selection of the information to be delivered over those channels.
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. Case Report and AAR Evidence Synthesis Although few of the case reports and AARs examined in this review address whether technical audiences were engaged in the development of communication plans, protocols, or channels, several AARs point out the need for better stakeholder engagement in the future (Blue Earth County Public Health, 2014; Capitol Region Council of Governments, 2016; Delaware Division of Public Health, 2010; Metropolitan Medical Response System, 2016; Minnesota Department of Health, 2013b; Ohio Department of Public Health, 2010; Public Health -- Seattle & King County, 2009; Wisconsin Hospital Emergency Preparedness Program, 2010)
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9. Considerations for Selection of Communication Channels Qualitative Evidence Synthesis Table B3-5 summarizes considerations that can inform the use of the various channels for communicating public health alerts and guidance with technical audiences that are discussed in the qualitative studies included in this review. Both public health and health care stakeholders describe using judgment to select the optimal communication channel depending on the context at hand, such as the level of uncertainty or urgency (Khan et al., 2017; Staes et al., 2011)
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. Electronic Health Enabling guidance to arrive directly at the point of individual care and monitoring, Records electronic health records have the potential to serve as a channel for communicating public health alerts and guidance with health care audiences.
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10. Barriers to and Facilitators of Communicating Alerts and Guidance During a Public Health Emergency Qualitative Evidence Synthesis Target audiences have noted the difficulties that they experience when there are multiple sources of guidance -- international, national, state, and local public health agencies, as well as institutional sources -- and often inconsistencies in guidance information resulting from uncoordinated messaging (Filice et al., 2013; Khan et al., 2017; Leung et al., 2008; Staes et al., 2011)
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. Case Report and AAR Evidence Synthesis Given the often dynamic nature of public health emergencies, the ability to maintain consistent messaging remains a substantial challenge (ASTHO, n.d.; Capitol Region Council of Governments, 2017; Chicago Department of Public Health et al., 2011; Multnomah County Health Department, 2010; New Hampshire Department of Health and Human S ervices and New Hampshire Department of Safety, 2009b; Texas Department of State Health Services, 2010; Wisconsin Hospital Emergency Preparedness Program, 2010)
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. Unclear vetting processes, roles and responsibilities, and communication channels can also hinder the effectiveness of communication (Florida Department of Health, 2010)
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for facilitating communication with technical audiences. Note that the following compilation of these strategies, although potentially of use to public health stakeholders, should not be viewed as an exhaustive list and that additional evidence is needed before these strategies can be recommended as evidence-based practices: • Given the need for increased coordination of messaging, public health authorities should consider routing notifications regarding alerts and guidance through pre ferred institutional communication channels (Staes et al., 2011)
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2011. Characterization of public health alerts and their suitability for alerting in electronic health record systems.
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2007. An integrated information system for all-hazards health preparedness and response: New York State health emergency response data system.
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May 22, 2014. Multnomah County Health Department.
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2008. Ethical guidance for public health emergency preparedness and response: High lighting ethics and values in a vital public health service.
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