Evaluating Risk Communication Research Articles

Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach.

To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.

Risk communication: lessons from an ethnographic, pragmatic, and Canadian regulatory perspective

In a regulatory context, it is important to understand how effective risk communication fits into the overall risk assessment, management, and decision-making process. This includes recognizing the intersections between risk analysis and the 3Ps: policy, politics, and publics, and understanding the barriers to effective communication. Risk communication is especially challenging when it requires the audience to follow and act on authoritative information or advice. Risk communicators must factor attributes such as risk perception, tolerance, and behaviors, and tailor the delivery of messages to diverse audiences. This paper captures the discourse from an intradepartmental workshop on risk communication with participants from Health Canada and the Public Health Agency of Canada. The workshop provided an opportunity to discuss and share references to existing frameworks, pertinent documents, and examples of effective risk communication strategies based on the authors' ethnographic and pragmatic experiences. The workshop aimed to strengthen risk communication by better understanding the value in collaborating with interdisciplinary teams, applying a systems thinking lens, and finding opportunities to experiment and evaluate risk communication strategies for regulatory purposes.

Field testing Australian bat lyssavirus risk communication resources.

Australian bat lyssavirus (ABLV) is a fatal zoonosis, which can be transmitted to humans through scratches or bites from infected bats. Currently, there is a lack of research evaluating risk communication resources about ABLV or the dangers from handling bats. The purpose of this study was to field test resources aimed at educating the public about risks to humans and bats from human-bat interaction, then update these resources based upon feedback to ensure they were relevant and appropriately targeted to the public. Thirteen semi-structured interviews with a purposive sample of participants chosen for maximum variation of age and sex were conducted. Two investigators analysed the data independently using a deductive approach and then came to consensus by discussion. The main themes were a wide-ranging level of knowledge and opinions about bats, the resources having an effect on people, and messaging in relation to children and pets being particularly important. This study highlighted the complexities of risk communication to a broad audience with varied experience and knowledge about bats, and the importance of evaluation prior to implementation to ensure risk communication is relevant and appealing to the intended audience. SO WHAT?: Field testing of health education material prior to implementation is an effective way to ensure key messages are understood, and is important when communicating about fatal but preventable zoonoses such as ABLV.

Social Network Analysis of COVID-19 Public Discourse on Twitter: Implications for Risk Communication.

The purpose of this study was to demonstrate the use of social network analysis to understand public discourse on Twitter around the novel coronavirus disease 2019 (COVID-19) pandemic. We examined different network properties that might affect the successful dissemination by and adoption of public health messages from public health officials and health agencies. We focused on conversations on Twitter during 3 key communication events from late January to early June of 2020. We used Netlytic, a Web-based software that collects publicly available data from social media sites such as Twitter. We found that the network of conversations around COVID-19 is highly decentralized, fragmented, and loosely connected; these characteristics can hinder the successful dissemination of public health messages in a network. Competing conversations and misinformation can hamper risk communication efforts in a way that imperil public health. Looking at basic metrics might create a misleading picture of the effectiveness of risk communication efforts on social media if not analyzed within the context of the larger network. Social network analysis of conversations on social media should be an integral part of how public health officials and agencies plan, monitor, and evaluate risk communication efforts.

Wildfire Smoke Risk Communication Efficacy: A Content Analysis of Washington State's 2018 Statewide Smoke Event Public Health Messaging.

Wildfire events are increasing in prevalence and intensity in the Pacific Northwest. Effective communication of health risks and actions to reduce exposure to wildfire smoke is imperative. We assessed the content of wildfire smoke risk messages from government organizations and mainstream media during a major wildfire smoke event in August 2018. We conducted a content analysis of wildfire smoke risk information communicated by local and state government organizations and the mainstream media. Eight Washington State counties during a statewide wildfire smoke event in August 2018. Leveraging the Extended Parallel Process Model and information in the existing literature on wildfire smoke and health, we assessed messages for the presence of information regarding health risk, personal interventions, administrative interventions, vulnerable populations, and trusted sources of information. Summary statistics were calculated to identify common messages about recommended interventions, vulnerable populations cited, and trusted sources of public health information. Of the 273 identified government and media messages on wildfire smoke, the majority (71% and 66%) contained information about health risks. However, only 46% and 33% of government and media messages contained information about personal interventions to reduce risk, and 37% and 14% of government and media messages contained information about administrative interventions to reduce risk. Less than half of government and media messages (28% and 31%) contained information specific to vulnerable populations, and 58% and 46% of government and media messages contained any reference to a trusted source of information. While information about wildfire smoke and health risks was communicated during Washington's August 2018 wildfire smoke event, there remains considerable opportunity to include additional information about interventions, vulnerable populations, and trusted sources of information. We recommend several opportunities to improve and evaluate risk communication and risk reduction before, during, and after future wildfire smoke events.

Interactive Landscape Design and Flood Visualisation in Augmented Reality

In stakeholder participation workshops, digital and hard-copy maps, alongside other representation formats in 2D and 3D, are used extensively to support communication, spatial evaluation and interactive decision making processes. In this paper, we present a novel tool to enhance traditional map-based workshop activities using augmented reality. Augmented reality technology is gaining momentum as a tool for visualising environmental design choices in planning and design, and is used in a range of applications including stakeholder participation, design evaluation and flood risk communication. We demonstrate interactive and collaborative 3D cartographic visualisations which enable real-time multi-user exercises in landscape intervention design and flood visualisation.

Evidence synthesis - Evaluating risk communication during extreme weather and climate change: a scoping review.

Communicating risk to the public continues to be a challenge for public health practitioners working in the area of climate change. We conducted a scoping literature review on the evaluation of risk communication for extreme weather and climate change to inform local public health messaging, consistent with requirements under the Ontario Public Health Standards (OPHS), which were updated in 2018 to include effective communication regarding climate change and extreme weather. Search strategies were developed by library information specialists and used to retrieve peer-reviewed academic and grey literature from bibliographic databases (Medline, Embase, Scopus and CINAHL) and Google country specific searches, respectively. The search strategy was validated through a workshop with experts and community stakeholders, with expertise in environment, health, emergency management and risk communication. A total of 43 articles were included. These articles addressed issues such as: climate change (n = 22), flooding (n = 12), hurricane events (n = 5), extreme heat (n = 2), and wild fires (n = 2). Studies were predominantly from the US (n = 14), Europe (n = 6) and Canada (n = 5). To meet the OPHS 2018, public health practitioners need to engage in effective risk communication to motivate local actions that mitigate the effects of extreme weather and climate change. Based on the scoping review, risk communication efforts during short-term extreme weather events appear to be more effective than efforts to communicate risk around climate change. This distinction could highlight a unique opportunity for public health to adapt strategies commonly used for extreme weather to climate change.

Light me up: power and expertise in risk communication and policy-making in the e-cigarette health debates

This paper presents a detailed account of policy-making in a contemporary risk communication arena, where strong power dynamics are at play that have hitherto lacked theoretical analysis and empirical validation. Specifically, it expands on the understanding of how public health policy decisions are made when there is a weak evidential base and where multiple interpretations, power dynamics and values are brought to bear on issues of risk and uncertainty. The aim of the paper is to understand the role that power and expertise play in shaping public health risk communication within policy-related debates. By drawing on insight from a range of literatures, the paper argues that there several interacting factors that shape how a particular narrative gains prominence within a wider set of perspectives and how the arguments and findings associated with that perspective become amplified within the context of policy choices. These findings are conceptualised into a new model – a policy evaluation risk communication (PERC) framework – and are then tested using the Electronic cigarette debate as a case study.

Developing an evaluation tool for disaster risk messages

Purpose– Risk communication is a critical component of individual health decision making and behavior. In disaster situations, it is crucial that risk-related messages are communicated accurately and that they reach and inform target audiences about the steps they can take to protect their health. Despite a global recognition of the importance of risk communication in responding to disasters, there remains a dearth of evidence on how to evaluate the effectiveness of risk communication messages. The purpose of this paper is to develop and assess a pilot tool to evaluate the effectiveness of disaster risk messages.Design/methodology/approach– A pilot evaluation tool was developed using the existing risk communication literature. An expert assessment of the tool was conducted using an open-ended survey and a focus group discussion with 18 experts at the Public Health Agency of Canada in February 2013.Findings– The tool measures content, reach, and comprehension of the message. It is intended to be a quick, internal evaluation tool for use during a disaster or emergency. The experts acknowledged the practicality of the tool, while also recognizing evaluation challenges.Research limitations/implications– This pilot exploratory tool was assessed using a relatively small sample of experts.Practical implications– This tool offers public health and disaster preparedness practitioners a promising approach for evaluating and improving the communication and management of future public health emergencies.Originality/value– This is the first practical tool developed to evaluate risk communication messages in disaster situations.

Evaluating bovine tuberculosis risk communication materials in Michigan and Minnesota for severity, susceptibility, and efficacy messages

AbstractCommunication programs are a tool available to wildlife managers for managing risks associated with wildlife diseases such as bovine tuberculosis (TB). Evaluating these communication efforts is vital for successful disease management planning; yet, systematic evaluations of wildlife disease‐related communication programs are lacking. To this end, we analyzed the content of 41 print and electronic TB risk communication materials (e.g., brochures, handouts, websites) available to stakeholders in Michigan and Minnesota, USA, during April 2010 to 1) describe and compare the materials; 2) make data‐based recommendations to improve existing messages; and 3) highlight the ability of the extended parallel process model (EPPM), a well‐known health communication theory, to serve as a framework for evaluation of wildlife disease issues. All message components central to the EPPM were identified in our sample of TB risk communication materials. More than 80% of materials promoted ≥1 behaviors believed to reduce the risks of TB transmission among and between wildlife and livestock in Michigan and Minnesota. Messages conveying severity and susceptibility of TB‐related risks were present in 73% and 56% of the materials, respectively; whereas, efficacy messages promoting the ease and effectiveness of recommended behaviors were far less prevalent. Results provide insights for future TB and wildlife disease‐related risk communication efforts (e.g., design messages that enhance stakeholder perceptions of efficacy) and demonstrate the utility of the EPPM as a framework to evaluate risk communication materials and messages for wildlife disease‐related stakeholders. © 2013 The Wildlife Society

Framework model of product risk assessment

Risk assessment has been a vital tool in the consumer product safety arena. However, the challenges have been to ensure scientific and robust assessments and to eliminate diverging risk results. Back in year 2005, EuroSafe took the initiative and orchestrated a working group (WG) on risk assessment (EuroSafe WGRA). The WG includes subject experts from regulatory bodies and industry. In the past 2 years the WG has devoted itself to vigorous research in the harmonisation of nomenclatures and the identification of basic principles of non-food consumer product risk assessment. More importantly, it has undertaken the groundbreaking work of the establishment of a risk assessment framework model. The framework model took a step-by-step approach to exemplifying a disciplined thought process: defining the objective, hazard identification and characterisation, exposure assessment, risk characterisation, risk evaluation, risk reduction and residual risk communication. The model is enriched with information source inventories and resource recommendations that can be consulted to develop practical risk assessment methods.

Assessing risk communication in breast cancer: Are continuous measures of patient knowledge better than categorical?

Objective To compare the performance of categorical and continuous measures of patient knowledge in the context of risk communication about breast cancer, in terms of statistical and clinical significance as well as efficiency. Methods Twenty breast cancer patients provided estimates of 10-year mortality risk before and after their oncology visit. The oncologist reviewed risk estimates from Adjuvant!, a well-validated and commonly used prognostic model. Using the Adjuvant! estimates as a gold standard, we calculated how accurate the patient estimates were before and after the visit. We used three novel continuous measures of patient accuracy, the absolute bias, Brier, and Kullback–Leibler scores, and compared them to a categorical measure in terms of sensitivity to intervention effects. We also calculated the sample size required to replicate the primary study using the categorical and continuous measures, as a means of comparing efficiency. Results In this sample, the Kullback–Leibler measure was most sensitive to the intervention effects ( p = 0.004), followed by Brier and absolute bias (both p = 0.011), and finally the categorical measure (0.125). The sample size required to replicate the primary study was 18 for the Kullback–Leibler measure, 23 for absolute bias and Brier, and 37 for the categorical measure. Conclusions The continuous measures led to more efficient sample sizes and to rejection of the null hypothesis of no intervention effect. However, the difference in sensitivity of the continuous measures was not statistically significant, and the performance of the categorical measure depends on the researcher's categorical cutoff for accuracy. Continuous measures of patient accuracy may be more sensitive and efficient, while categorical measures may be more clinically relevant. Practice implications Researchers and others interested in assessing the accuracy of patient knowledge should weigh the trade-offs between clinical relevance and statistical significance while designing or evaluating risk communication studies.

Psychosocial aspects of risk communication and mutation testing in familial breast-ovarian cancer

As cancer genetics services develop, psychosocial research evaluating risk communication and mutation testing for familial breast-ovarian cancer has expanded rapidly. It is timely to review findings in key areas. These will inform risk counselling practice and help prepare women making risk management decisions. The psychological effect of risk communication and genetic counselling has been elucidated and women's risk perceptions explored. Knowledge of optimal risk communication strategies is lacking, but recent research shows both consistency in information giving and deficiencies in specific communication skills; the need for personally tailored risk information, which addresses counsellees' concerns, is highlighted. Outcome assessments of risk communication, such as risk perception and psychological distress, are useful but insufficient to evaluate the complex communication process, and decision making in this context is underresearched. Subsequent diffusion of risk information and interfamily communication pose difficulties for high-risk individuals. The short-term psychological consequences of predictive mutation testing are an important focus of research and are largely reassuring, but long-term outcomes are sparse. Our understanding of the psychological benefits and limitations of risk counselling and mutation testing can now inform clinical practice, but insufficient knowledge exists of long-term outcomes. Most women are unlikely to be distressed following risk communication, but some may need psychosocial support in the short term following predictive testing for BRCA1/2. Different approaches to risk communication need to be developed and evaluated in parallel with communications skills training to ensure an adequate focus on the women's agenda.

The development of COMRADE—a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations

Some instruments have been developed to evaluate ‘decision effectiveness’ such as the ‘satisfaction with decision (SWD)’ and ‘decision conflict (DCS)’ scales and are validated for the US context. Patients identify further outcome domains that are not fully covered in these scales. We developed a patient-based outcome measure to evaluate risk communication and decision making effectiveness, addressing these further domains and validated for use in the UK. Formulation of items was based on literature review and key informant interviews. The instrument was piloted and developed (including psychometric assessment) in the context of a trial of decision making and risk communication interventions in general practice. Patients were recruited to the trial with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms. High response rates (96% in first phase) indicated acceptability to patients. A 20 item patient-based outcome measure, with two sub-scales for ‘risk communication’ and ‘confidence in decision’, was produced. It allows for paternalistic, shared or informed choice decision making models. Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer.

New directions for risk communication research: a discussion with additional suggestions.

The papers by Huerta and Macario and Kreuter share the theme of suggesting new directions for risk communication research in cancer prevention and control. Huerta and Macario remind us once again that sociocultural factors must be considered when conducting risk communication research on underserved populations. Of special note is their recommendation to target the family, which could introduce a compelling new chapter in risk communication research in cancer prevention and control. In contrast, Kreuter challenges us to consider multiple cancer risks and risk-reducing behaviors in our research and provides a provocative framework for achieving this goal. Given this common theme and the need to position specific recommendations within the larger context of other competing research questions, this paper also highlights several additional recommendations for future research. These recommendations include the following: more research on risk presentation; establishing guidelines for measuring risk; additional research testing strategies to de-bias optimistic and pessimistic perceptions of risk and evaluating risk communication as a strategy for behavior change; more research investigating the sociology of risk communication, with a special emphasis on the family as the unit of investigation; and, finally, more research that specifically targets underserved populations in diverse community settings.

Evaluating Risk Communication: Examining Target Audience Perceptions About Four Presentation Formats for Fish Consumption Health Advisory Information

Information format can influence the extent to which target audiences understand and respond to risk‐related information. This study examined four elements of risk information presentation format. Using printed materials, we examined target audience perceptions about: (a) reading level; (b) use of diagrams vs. text; (c) commanding versus cajoling tone; and (d) use of qualitative vs. quantitative information presented in a risk ladder. We used the risk communication topic of human health concerns related to eating noncommercial Great Lakes fish affected by chemical contaminants. Results from the comparisons of specific communication formats indicated that multiple formats are required to meet the needs of a significant percent of anglers for three of the four format types examined. Advisory text should be reviewed to ensure the reading level is geared to abilities of the target audience. For many audiences, a combination of qualitative and quantitative information, and a combination of diagrams and text may be most effective. For most audiences, a cajoling rather than commanding tone better provides them with the information they need to make a decision about fish consumption. Segmenting audiences regarding information needs and communication formats may help clarify which approaches to take with each audience.

Improving Risk Communication in Government: Research Priorities

Despite the increased interest in risk communication among government agencies, there is evidence that agencies’risk communication practices lag. We conducted a study to explore which risk communication research would be most important to improve government agencies’risk communication practices. Qualitative interviews and a survey of 145 risk communication experts based in academic institutions and government agencies explored how important research on each of 48 topics would be to improving agencies’risk communication efforts. Respondents identified topics within three areas as priorities for further research: 1) involving communities in agency decisionmaking; 2) communicating with communities of different races, ethnic backgrounds, and incomes; and 3) evaluating risk communication. Both practitioners and researchers responded to additional statements about agencies’risk communication practices with reservations about staff and managers’commitment to effective communication about environmental issues. We discuss the implications of these findings.