Patient and Physician Perspectives on Cardiovascular Risk: A Multicenter Survey of Communication Gaps Among Hospitalized Patients in Spain.

Uncertainty, insufficient information or information of poor quality, limited cognitive capacity and time, along with value conflicts and ethical considerations, are all aspects that make risk management and risk communication difficult. This paper provides a review of different risk concepts and describes how these influence risk management, communication and planning in relation to forest ecosystem services. Based on the review and results of empirical studies, we suggest that personal assessment of risk is decisive in the management of forest ecosystem services. The results are used together with a review of different principles of the distribution of risk to propose an approach to risk communication that is effective as well as ethically sound. Knowledge of heuristics and mutual information on both beliefs and desires are important in the proposed risk communication approach. Such knowledge provides an opportunity for relevant information exchange, so that gaps in personal knowledge maps can be filled in and effective risk communication can be promoted.

* Abbreviations: AAP = : American Academy of Pediatrics • ACIP = : Advisory Committee on Immunization Practices • IPV = : inactivated polio vaccine • FDA = : Food and Drug Administration • DTwP = : diphtheria and tetanus toxoids and whole-cell pertussis vaccine • DTaP = : diphtheria and tetanus toxoids and acellular pertussis vaccine • DTP = : diphtheria, tetanus, and pertussis vaccine • CDC = : Centers for Disease Control and Prevention • NCVIA = : National Childhood Vaccine Injury Act • VICP = : Vaccine Injury Compensation Program • IOM = : Institute of Medicine • OPV = : oral polio vaccine • VIS = : Vaccine Information Statements Concern over vaccine safety has been a major determinant of immunization policy—from passage of the Biologics Control Act in 1902 to the recent American Academy of Pediatrics (AAP) and Advisory Committee on Immunization Practices (ACIP) recommendations for expanded use of inactivated polio (IPV) and acellular pertussis vaccines.1-4 With the availability of new vaccines and vaccination options comes the challenge of how best to communicate these options to patients and their parents. Lessons from the field of risk communication on predictors of risk acceptability and vaccination decision heuristics provide insight into why some parents resist vaccination. This article provides a historical perspective on vaccine adverse events and applies lessons from risk communication research to help physicians improve their ability to discuss vaccine risks. Immunizations have been described as the single most effective health intervention after clean water and sewage disposal,5 and have an extraordinary safety record. However, public policy has long reflected concern for the safety of vaccines and related biologics. In 1902, Congress passed the Biologics Control Act in response to the death of 13 children who had received injections of diphtheria antitoxin contaminated with tetanus toxin.6 This act required biologics to be manufactured in a manner that assured their safety, purity, and potency. Responsibility for these regulations was assigned originally to the Hygienic Laboratory of the Public Health Service, which evolved into the National Institutes of Health. The regulation of biologics including vaccines was transferred to the Food and Drug Administration (FDA) in 1972. The first published accounts of serious adverse events after whole cell pertussis vaccine occurred in 1933 with Madsen's7 report of two deaths within 48 hours of immunization, and in 1948 with the report in Pediatrics by Byers and Moll8 of encephalopathy after diphtheria and tetanus toxoids combined with whole-cell pertussis …

Risk Communication During COVID-19

Climate change increases the average temperature and reduces precipitation, leading to an increased risk of rural fires around the world, but mainly in regions with a Mediterranean climate, such as Portugal. Despite the high risk of rural fires, fire is still a traditional land management practice. Beyond fire misused risk, the accumulation of fuel loads, due to the high population dispersion and lower interaction of communities with the land, also drives rural fires risks. Thus, researchers have sought to understand the key features of communication practices to achieve the most desired natural risk management results in relation to rural fires. According to the Committee on Risk Perception and Communication, in 1989, risk communication is defined as “an interactive process of exchanging information and opinions between individuals, groups, and institutions”. However, there is a need for dialogue between the responsible for communication and relevant stakeholders. The Carnegie Mellon mental-models approach encompasses participatory processes to translate the nature and magnitude of the risk, allowing for a deeper understanding of what can be done to mitigate social and environmental impacts in the future. Considering rural fires risks and risk communication challenges, this study aims to design an effective risk communication plan oriented to the rural population, in the context of rural fires. For this objective to be achieved, the mental models approach was developed, exploring the underlying reasons for resistance to behavioral change and defining guidelines to support the design of new risk communication strategies, including the dissemination of new behaviors and practices that mitigate the ignition of rural fires. This systemic approach has been applied and tested in the rePLANT project, whose purpose is the development of research activities, innovation and transfer of knowledge and technology, to increase sustainable forest management, the competitiveness of the Portuguese forestry sector and reduce the impact of rural fires. Preliminary findings show what must be communicated about rural fires risk, how must be communicated, target audiences' profiles, the role of actors for effective risk communication on rural fires, attributes of good risk communication on rural fires, evaluation of the risk communication results. Finally, it is expected that this research provides guidelines to help decision-makers and stakeholders to design an effective risk communication plan oriented to prevent traditional burning practices, as well as to mitigate socioeconomic and environmental impacts in the future. This approach also highlights the importance of exploring the underlying reasons for resistance to behavioral change and defining guidelines to support the design of new risk communication strategies.

Risk communication plays a central role in epidemiology to provide information for disease surveillance and outbreak control. It is one of the of the eight core functions that WHO Member States must comply with as part of the International Health Regulations (2005) ensuring national and global preparedness for health threats. It refers to the timely and accurate exchange of information between public health experts or authorities and individuals who are confronted with a threat to their survival, health, economic or social well-being. At its core, risk communication is about empowering people exposed to a risk to make well-informed decisions in order to mitigate potential risks and adopt preventive actions and measures. Risk communication considers political, social, and economic factors; it analyses risk and risk perception; and it places a great emphasis on dialogue with impacted and targeted populations to help them make the best decisions they can. Therefore, it requires an understanding of stakeholders’ perceptions, concerns, and beliefs, as well as their knowledge and practices. In the context of the COVID-19 pandemic, the need for effective and efficient risk communication has become even more evident than before. Risk communication should be able to recognise and deal with rumours and disinformation, and reach the most vulnerable groups, who have a higher risk of contracting the virus and suffering from COVID-related consequences. Lately, increasing attention has been given to this topic. The WHO set-up, in April 2023, a technical Advisory Group for Risk Communication, Community Engagement and Infodemic management (TAG-RCCE-IM) to provide independent review and technical advice in the context of emergency preparedness and response in Europe. The Joint Action PreventNCD aims to also build a framework for country-specific communication strategies for non-communicable diseases (NCD) patients in health crises in one of the Work Packages, by collecting and analysing health communication strategies in different European countries targeting NCDs. In this interactive skills-building seminar, we will share with the participants the knowledge, skills, and process of effective risk communication by using case studies from experts in the field. The session will start with a presentation on the core elements of risk communication followed by examples from the field. This workshop will foster an inclusive interactive environment where participants will hear from panellists sharing their experiences from different settings such as international organisations and national public health institutes. Participants will be split into groups and will be provided with a piece of scientific output, such as a research study or epidemiological report and encouraged to translate this technical message into a clear, concise message that can effectively communicate the key points to the general public. Key messages • Risk communication is essential to fight disinformation while empowering the public to make informed decisions related to their health and well-being. • Epidemiologists and researchers should be encouraged to employ efficient and targeted communication strategies when disseminating their findings. Speakers/Panelists Stefan Schaub Bundeszentrale für gesundheitliche Aufklärung (BZgA, Cologne, Germany Federica Rossetti Sciensano, Brussels, Belgium Stefan Adrian Voinea WHO/Europe, Copenhagen, Denmark

An important element in the prevention of marine oil spills, accidents, and injury, is the effective communication of the risks and hazards present. Risk and hazard communication is typically accomplished through the application of labels, signs, markers, graphics, color codes, and through other warning or alarm devices. The type, size, physical characteristics, content, and placement of risk and hazard communication devices is directly related to the utility, persistence, and effectiveness of the intended message. The precise selection of words, phrases, and characters directly impacts the intelligibility and comprehension of the risk or hazard being identified. Confidence and compliance levels of those to which the message is directed, are also affected by poorly designed, worded, or placed visual and audible signals. Regulations requiring or defining the content of risk communications do not adequately account for these factors. Risk and hazard communications are further complicated by cultural factors. Current trends in vessel construction and manning will only exacerbate these issues. Guidelines have been published for hazard and risk communication devices, equipment, and marine systems. This guidance should be used to evaluate and improve risk and hazard communication however possible. The goal of risk and hazard communication should be to promote or support Situation Awareness, (SA). Education should be conducted in the proper interpretation, application, and maintenance of communication devices.

Effective risk communication is essential for government and health authorities to effectively manage public health during the Coronavirus disease (COVID-19) pandemic. Understanding the factors that influence people’s perceptions of crisis-related risk messages is critical to identify gaps and inequalities in population risk communication. Using a longitudinal survey of a representative adult sample, we examined risk communication about COVID-19 during April-June 2020 in Australia across sociodemographic groups especially the at-risk groups, accounting for and exploring the effects of risk attitudes and media engagement. Our findings showed that individuals who were younger, more left-wing, more risk-tolerant, and had a current or a history of mental disorders perceived risk communication of the Australian Government to be lower quality. On the other hand, greater consumption of information from televisions was found to be associated with more positive attitudes toward government risk communication. Our results also revealed the importance of effective and high-quality risk communication in gaining the public endorsement of various public health directions. We discuss the implications of results in terms of the development of effective public communications that lead to health-protective behaviors and effectively scaffold public understanding of risk.

The SRP held a very interesting meeting in June at the Daresbury Laboratory in Warrington on the social and political implications of communicating radiation risk. In today's risk-aware society, effective communication is just as important as the control measures introduced to prevent or restrict exposure.

DEAR EDITOR, Over the years, multiple number of health emergencies (such as disease-outbreaks – H1N1 or Ebola disease, chemical accidents, radiation leaks, natural disasters, conflicts, wars, etc.), have been reported worldwide, which have claimed the lives of thousands of people.[1,2] However, in most of the instances the mental sufferings can be avoided, or lives of susceptible people can be saved, provided the local population had access to fast, effective and transparent communication.[1,2,3] In fact, realizing the scope of risk communication in preventing disease, disability, and even mortality, it has been considered as one of the eight integral functions, which the World Health Organization (WHO) member states must develop to effectively respond to both public health emergencies and humanitarian crises.[4] In general, risk communication refers to the real-time exchange of information, advice and opinions between experts and masses exposed to the threat, which can compromise their survival, health, economic or social well-being.[4] The primary objective of effective risk communication is to enable people at risk to take well-informed decisions not only to protect themselves, but even their loved ones from the emergency by taking appropriate and timely protective and preventive actions.[4] However, the success of risk communication is eventually dependant on thorough understanding of people's (in terms of their knowledge, practices, perceptions, concerns, beliefs, etc.); experts attributes (such as their credibility, caring and empathic nature, level of trust between experts and affected persons, etc.); and ability of the communicator to promptly detect the prevalent rumors/myths/misconceptions and address them before it starts interfering with the preventive and control measures.[4,5] Risk communication has been acknowledged as one of the lifesaving intervention, especially in public health emergencies.[1,2,3] This is so because people do have a right to know how to protect themselves and their relatives’ health by understanding and adopting protective behaviors by taking well-informed decisions.[2,3,4] Furthermore, the communication at times of emergencies has even benefited other stakeholders like local program managers (in assessing health impact of the emergencies and providing them evidence to develop an effective health response), donors and concerned public across the globe.[4] In addition, at times of emergencies, effective risk communication can empower nations/local communities to preserve their socioeconomic and political stability, and even prevent the loss of trust of people on public health authorities by enabling health officials to address people's concerns and needs so that relevant and acceptable advice can be communicated to the masses.[4,5] A wide range of communication techniques (viz., mass media, social networking, etc.) have been adopted to facilitate risk communication.[2,5] However, a wide range of challenges such as globalization; extensive international trade and travel; a complex animal-human interface; rise in threat of bioterrorism; enormous popularity of the social networking sites (because of which the reliance on health experts/authorities has seriously decreased, and at the same time it even encourages spread of rumors and incorrect information); and changes in the field of journalism (like 24-h journalism where most of the news consists of opinions rather than facts) and approach of journalists, have been identified which have seriously questioned the effectiveness of risk communication.[4,5] In the modern world, the need of the hour is to strengthen the existing risk communication capacity so that the existing challenges and the health emergencies can be tackled better.[4] The primary strategy is to implement the WHO guidelines released to cover different aspects of risk communication.[4,5] This includes components such as establishing a comprehensive policy and plans for risk communication; ensuring training of the health professionals/local officials so that they can acquire appropriate skills and be competent; conducting training sessions for journalists on how to report on health emergencies; devising a mechanism to discourage people to advertise incomplete or wrong information on social networking websites; and running simulation exercises to assess the extent of preparedness of nations.[4,6] In addition, the approach to constitute an Emergency Communications Network (ECN) system with an aim to identify, train, assess and deploy risk communication experts also deserves immense significance, so that the members (who have the ability to work in coordination with national and local authorities) of the network can be deployed at times of emergencies.[7] In fact, since the constitution of ECN, the members have been deployed in disease outbreak settings, humanitarian emergencies and in natural disasters.[7] To conclude, risk communication is an integral element of any public health emergency response and thus all efforts should be taken by the nations to strengthen the same, so that lives of numerous people can be saved at times of emergencies.

Risk communication is a keystone in crisis prevention and mitigation. For that purpose, many institutions worldwide have the task of translating scientific risk information into actionable messages for public safety. As a collaboration among international risk and crisis communication scholars and practitioners, we sought to identify what risk communication practitioners at higher education organizations in the Global South and North identify as essential elements of effective risk communication, based on 32 interviews in 16 countries during the first wave of the COVID‐19 pandemic (June–August, 2020). Results exemplify a shared vision for addressing the stickiest, most wicked challenges to effective risk communication globally. The interviews revealed globally shared best practices related to form, function, and process leading directly to what we consider the keystone of effective risk communication: saving lives (outcome).

Development of an effective tool for risk communication about food safety issues after the Fukushima nuclear accident: What should be considered?

Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. The Risk Communication Team of the Natl. Center for Food Protection and Defense has developed a list of 11 best practices recommended for effective risk communication. These practices, designed for a food defense crisis, are currently applied to food safety issues, since fortunately a food defense crisis has yet to occur. IFT examined the utility of these best practices and the limitations on their use during food safety and food defense crises by academics, trade associations, and the government. It was hypothesized that legal and business considerations as well as the nature of the event would determine the implementation of the best practices. Through the use of focus group meetings, it was discovered that there was a low level of awareness of the best practices. However, stakeholders practiced some aspects of the recommended practices. Participants felt some of the practices were related and could be consolidated. They also agreed that a food defense event will increase the urgency of the communication and include players not typically involved in food safety issues. The challenges reported by the stakeholders varied, but legal liability, as well as the impact their communications could have on an industry, were often cited. From the government perspective, their need to act within their authorities drove some of their actions with respect to communication. Determining the differences in communication limitations during food safety against food defense events can provide key information to further developing and refining risk communications and specific messages targeted for a food defense incident. Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. Determining the differences in communication limitations during food safety against food defense events can provide key information to further developing and refining risk communications and specific messages targeted for a food defense incident.

<p>On April 6, 2009, a magnitude 6.3 earthquake struck L'Aquila, Italy, causing extensive damage and loss of life, and raising significant issues around the communication of scientific risk. In the preceding weeks, increased seismic activity had alarmed the population, prompting authorities to seek expert advice. Public authorities reassured the population that the chances of a dangerous shock were slim. These assurances given by officials led many to remain in their homes when the earthquake struck. The subsequent legal actions against the scientists involved ignited a global debate on the responsibilities and challenges in scientific communication. This paper explores the complexities of conveying probabilistic risk information to the public and decision-makers. It highlights how different formats for presenting probabilistic data can significantly influence understanding and decision-making. In particular, it canvasses how the use of natural frequencies to convey probabilistic information makes it cognitively easier to understand and manipulate them, given how they make more salient and transparent the so-called base rate. However, the benefits of using natural frequencies decrease when dealing with low-probability, high-consequence (LPHC) events like major earthquakes, where even significant increases in relative probability remain small in absolute terms. Moreover, the paper investigates the social dimensions of earth science, examining the multifaceted role of scientists as both technical experts and social actors. The L'Aquila case exemplifies the need for integrating scientific accuracy with an understanding of its social implications. Effective risk communication must address cognitive limitations and the presence of social context to reach appropriate public behavioral responses. In order to achieve that, communication should be handled by actors that have specific expertise in its complexity.</p>

Crisis and emergency risk communication lessons from the Elk River spill.

Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms. A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data. Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication. Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.