By Arunima Rajan

HE explores strategies to elevate public health communication.

Misinformation (false or inaccurate information) and disinformation (false information that is intended to mislead) have plagued public health, especially since the COVID-19 pandemic when these terms gained popularity.

1937 Philip Morris Advertisement Touting Its Brand's Ability to Soothe Nose and Throat Irritation Source: https://tobacco.stanford.edu/cigarettes/

Audience and Pain points

“For healthcare professionals who function in risk communication, there are several steps they should consider to ensure efficacy.

They need to understand their audience. They should be able to answer questions about cultural practices, beliefs, common fears, etc. Audience understanding helps professionals tailor effective messaging. One of the biggest mistakes that communication professionals make is messaging that isn't tailored; therefore, it becomes irrelevant to the individual.
Professionals should work with community leaders to amplify their message. Communities can be the most powerful force for change. Working with the leaders who know the community best, and even having them deliver the message, builds trust with community members.
Plain language (reading level between 6th and 8th grade) and culturally relevant visual assets are a must. Individual learning styles and reading comprehension vary greatly. Therefore, designing messaging and assets that meet individuals where they are makes a remarkable difference.
When you combine these strategies, it can be an effective way to counter misinformation and disinformation. However, it's important to note that public health has become needlessly polarized and there may be a small subset of the population whose minds cannot be changed,” says SriVani Ganti, Director of Health Equity, mPulse.

Communication Tools and Media

Comic book issued by Ministry of Health to spread awareness about corona virus.
SOURCE: https://www.mohfw.gov.in/pdf/Corona_comic_PGI.pdf

She points out that visual and digital media are powerful tools that need to be leveraged more in health communications. “Health communication tends to focus on traditional media—newspaper, print ads, radio, TV, some social media—but doesn't recognize the power of digital channels like SMS, email, and interactive voice response (IVR). Digital channels, when done right, can deliver timely, personalized, and relevant content, at scale. They are also significantly cheaper than physical mailers. Visual assets are a requirement for effective health communication. If we look at a digital trend on social media, see “Health Tok,” you see people using informal expert-led videos to convey information succinctly. But not all Health Tok can be considered accurate as some people may not be healthcare providers. Compelling visuals with clean design are incredibly effective when conveying important information. Animations can also be used to share complex medical information in a way that feels more accessible and appealing,” she adds.

How can risk communication strategies be designed to effectively combat health-related misinformation and disinformation? The proliferation of inaccuracies not only exacerbates health risks but also diminishes the inclination towards positive behavioral change, hampers adherence to public health guidelines, and either instills undue fear or unwarranted complacency.

Infodemic Management

To counteract this, adopting an evidence-based approach akin to the World Health Organization's infodemic management strategies is imperative. These strategies draw parallels between the dissemination of information and the transmission of infectious diseases, offering insights into effective containment measures. Tools like the United Nations Children’s Fund's "Risk Evaluation Matrix https://vaccinemisinformation.guide/," offer a proactive stance that employs targeted interventions, such as pre-bunking for low-risk misinformation and debunking for medium to high-risk misinformation.

Effective Communication Techniques

Didier Choukroun, founding partner, president, and CEO at SPHERE Investments, highlights four key communication strategies for addressing health-related misinformation:

Emphasizing evidence and scientific consensus, especially through visual aids, has been effective in reducing misconceptions and improving perceptions about vaccines.
Implementing misinformation warnings on digital platforms, including social media and search engines, has proven effective in reducing belief in misinformation and promoting informed attitudes.
The credibility of the message source, not just its expertise, significantly influences the reduction of reliance on misinformation.
Timing of message delivery is critical, with early anti-conspiracy messaging demonstrating greater effectiveness in mitigating the impact of subsequent exposure to misinformation.

Overcoming Communication Challenges in Diverse Population

Successfully communicating risk to diverse populations in public health faces challenges due to varying factors like health literacy, cultural backgrounds, socioeconomic status, and technology access. Overcoming these challenges involves simplifying complex health data into clear, engaging visuals tailored to different audience needs and contexts. This approach improves message understanding, retention, and encourages informed public health discussions.

Role of Digital Platforms

Digital platforms are key influencers in shaping public opinion and behavior, especially in public health. Their wide accessibility, fast information sharing, and echo chamber effect, which reinforces users' beliefs, magnify their influence. This contributes to the rapid spread of unverified and false information, posing significant challenges for public health efforts.

Choukroun, the Member of the Editorial Board of Population Health Management at Jefferson College of Population Health suggests several strategic measures to mitigate the impact of misinformation on digital platforms:

Utilizing social media for Public Health: Harnessing social media's broad reach to disseminate accurate health information through data visualization can combat misinformation.
Applying Design Principles: Effective visuals should incorporate artistic elements like colour, style, arrangement, and references to improve the clarity, relevance, and aesthetic appeal of health communications, making them more impactful and memorable.
Engaging in Social Listening: Systematically monitoring and analysing digital conversations through social listening can inform and adapt communication strategies, creating culturally and contextually relevant communications that address diverse audience concerns and preferences.
Establishing Rumour Logs: A practical community engagement approach involves providing a platform for the public to report rumours directly, such as a dedicated section on a health department's website, enabling authorities to track misinformation trends and proactively address them.
Utilizing Google Trends and Analytics: Monitoring search trends and queries can offer insights into public concerns and misinformation themes, enabling health authorities to tailor their communications and keyword strategies effectively.
Collaborating with Digital Platforms: Partnering with digital platforms to implement measures such as misinformation warnings, promoting authoritative content, and reducing the visibility of false information can significantly reduce the spread of health-related misinformation.

Collaborative Approaches

Collaboration between healthcare authorities, media, and technology companies can significantly enhance the dissemination and impact of health information. By uniting authoritative health data with media amplification and technological innovation, this partnership can ensure that health messages are accurate, engaging, and widely accessible. Key strategies include unified messaging for consistency across platforms, media amplification to prioritize health narratives, personalized content through technology, the development of innovative digital health tools, robust fact-checking to combat misinformation, capacity building for better health communication, active community engagement for feedback, and coordinated emergency responses. Such collaborative efforts are pivotal in fostering an informed public ready to embrace positive health behaviors.

Building Trust and Accurate Communication

Sarah Lemert, a patient advocate at Platinum Patient Advocates, emphasizes the importance of building trust in health authorities and reliable media sources. She explains that when the public trusts these sources more, they are more inclined to believe and act on the information they receive. This trust also helps in combating misinformation and ensuring that accurate, trustworthy information reaches the public.

Lemert points out that rural and underprivileged populations may have limited access to reliable information sources, often have lower levels of health literacy, suffer from language barriers, and distrust in government and healthcare institutions. “Risk communication can be tailored to these groups by engaging trusted local leaders such as community leaders, local and trusted healthcare providers, or community organizations. Community members in these populations must also be empowered to voice their concerns, ask questions, and be included in the discussion. By making the community part of the discussion we can increase their understanding of accurate healthcare information,” she adds.

Lemert says that accuracy is the number one ethical dilemma of risk communication. “We must make sure that we are communicating accurate information to maintain trust and credibility with the public. We must make sure that we are communicating accurate information to maintain trust and credibility with the public. AI has provided valuable in numerous ways since its development. A huge value is using AI for monitoring and detection – by utilizing AI to identify patterns and trends on social media, news sources, etc., we can detect the spread of false information early on,” she concludes.

Data Driven Insights to Drive Behavioral Change

“Public education and communications about health risks may sound too repetitive to at-risk individuals who may tune out after a while: after all, who could argue with 'watch your diet and exercise more?',” asks JX Tan, Head of International PR at BGI Genomics.

“To avoid sounding too 'preachy,' I suggest using data-driven insights to drive behavioural changes. For example, in the BGI Genomics State of Colorectal Cancer Awareness Report 2023, we emphasized that Saudi Arabia has a high percentage of respondents (62.7%) who never took colorectal cancer tests, far higher than the global average of 54.1%. Another point that is being addressed by global health organizations such as the WHO is local language communications. By emphasizing points that matter to at-risk audiences in their local languages, industry media are more likely to publish these stories and amplify these messages. For example, Nature Middle East published an Arabic story with the headline that 62.7% of Saudi Arabia respondents have never taken colorectal cancer tests,” he adds.

Real World Evidence in Health Communication

Justin Manjourides is a biostatistician and observational health researcher focused on cultivating the next generation of real-world evidence (RWE) researchers. “Proactively explaining health risks, aligns with a strategy of “prevention” over “treatment.” Preventing disease usually has a much more significant impact on health outcomes than treating disease,” he explains.

Manjourides elaborates that visual aids play a crucial role in communicating the significant implications of a study. However, it's important to ensure that these visualizations are clear and easily understandable. When researchers condense study findings into tables and figures, they strive to present all results concisely, which can sometimes result in dense and complex visuals. Crafting figures for scientific journals demands a high level of nuance, detail, and accuracy. When sharing study findings with participants, researchers should focus on highlighting one or two key pieces of information rather than overwhelming them with every detail. These studies are often complex, involving various exposures, outcomes, and controlling for multiple factors. The language used in peer-reviewed journals to report results is nuanced, with precise effect descriptions, specified study populations, and clear assumptions and limitations. However, when communicating these results to communities, researchers must translate the medical journal language into a more accessible and friendly format.

He explains that there's a dilemma in accurately translating experimental findings to real-world applications while maintaining clear and concise communication. As an illustration, he references Doll and Hill's 1954 study, which found a 40-fold increase in the likelihood of death from lung cancer among men who smoked 25 or more grams of tobacco daily. They also noted a strong correlation between lung cancer risks and smoking duration. However, in public health campaigns addressing tobacco, this complex information is simplified to the key message "Smoking causes cancer."

He adds that many AI-generated black box models excel at predicting health outcomes or generating patient-specific risk scores related to a condition. However, the challenge lies in understanding how these models weigh each piece of input data. This lack of transparency makes it difficult to explain why someone might be at risk for a disease or how changing behaviors could alter that risk. In contrast, traditional statistical models commonly used in public health research prioritize explain-ability and interpretability. This emphasis makes it easier to illustrate how behavior changes, such as quitting smoking, could directly influence health risks like lung cancer for an individual or a population.

Risk Communication: Tackling Misinformation And Disinformation In Public Health