Communicating Your Message Pertussis Outbreak

Communicating Your Message – Pertussis Outbreak 1

Communicating Your Message – Pertussis Outbreak

Amber France

Concordia University Communicating Your Message – Pertussis Outbreak 2 Health communication is the generation and dissemination of health information that affects individuals, communities, institutions, and public policy (Harvard School of Public

Health, 2013). According to the CDC (2011) health communication and social marketing are important to the process of confronting public health challenges. Both health communication and social marketing create social change through changes in attitudes, behavior, and external structures (CDC, 2011). This paper will focus on health communication surrounding a pertussis outbreak in Wood County, Wisconsin.

Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by bacteria, which most commonly affects infants and young children (CDC, 2013).

Pertussis is spread by coughing or sneezing while in close contact with others, which others can then breathe in the bacteria droplets. Infants are often infected by their siblings, parents, and caregivers. Symptoms usually develop 7-10 days after being exposed, but sometimes can manifest for up to 6 weeks. Symptoms include cold-like symptoms and after 1-2 weeks a severe cough develops and can continue for weeks. Often times the cough is violent and rapid until air from the lungs is gone causing a whooping sound. Vomiting and fatigue can also be present.

With infants, symptoms may be absent but apnea, a condition where there is a pause in the breathing pattern, may be present making this illness very dangerous for infants. The most effective way to protect against pertussis is immunization. According to the CDC (2013), during an outbreak immunized persons can develop symptoms of pertussis but infection is less severe.

Since pertussis mirrors the common cold in the early stages it can be easily undetected until severe symptoms appear and many others may have been infected during that time period (CDC,

2013). Pertussis can be treated with antibiotics, if given in the first 3 weeks, to help decrease symptoms and decrease the spread of disease. According to the CDC (2013) the most important Communicating Your Message – Pertussis Outbreak 3 steps to take in an outbreak are to ensure all family members are up-to-date on their pertussis immunizations (DTap and Tdap) and to keep infants away from anyone with a cough or cold symptoms.

In order to assure that health communication is being properly conveyed and understood a series of health strategies must first be done including planning, outreaching, and budgeting

(NPIN, 2013). First, health communication must be planned using a strategic plan. The strategic plan includes identifying the problem and whether communication is needed, identify the target audience and the best ways to reach them, develop and test communication methods with representatives from the target audience, implement the most effective health communication method, and assess the effectiveness of the communication and modify as needed. Considering this incidence deals with a pertussis outbreak and the information should be relayed in a time conducive manner to all populations, it may be more effective to utilize data from past event sources or research data on effective communication methods within the community, instead of testing a small target audience for the most effective messaging. In 2012, Incourage Community

Foundation of South Wood County did a survey with county residents on where they receive their information. They gave the general county results and also broke the results down to individual communities of the county. The Incourage Community Foundation (2012) found that the local newspapers, school folder inserts and newsletters, Nixle alerts, text, and email were among the highest ranking information sources. Nixle is a Community Information Service that sends important information alerts from local police departments, children’s schools, community agencies and organizations, and other important information sources that are relevant to a given area (Nixle, 2012). Nixle alerts can be received through text message, email, and over the web.

The Incourage Community Foundation (2012) also found that local libraries were a good source Communicating Your Message – Pertussis Outbreak 4 of communication along with individual community businesses that are frequented by many. In one community a local radio station was ranked as a top source for information.

The second health strategy for effective health communication messaging is choosing outreach methods identified based on the target audience (NPIN, 2013). Given the Incourage

Community Foundation survey results local newspapers and other media outlets should be utilized and sent press releases on the threats of pertussis to the community and the importance of vaccination. Information on upcoming vaccination clinics and locations would also be important to include in the press release. Since pertussis most commonly affects infants and young children, it would be important to notify parents through a school insert to be sent home with children (CDC, 2013). It would also be important to utilize local businesses as a source of communication by putting out flyers and brochures. The Incourage Community Foundation

(2012) also indicated that Nixle alerts, texting, and email were effective methods of communication in the community. Nixle alerts should be sent out with information on pertussis outbreaks and vaccination clinics being offered. Texting and email could be a method of reaching WIC participants since the program utilizes both for program-based information, but this method would be time consuming and only reach a small percentage of the community.

Social media outlets such as Facebook and Twitter could be used as a cheap method of getting information to a large number of the target populations in a short period of time.

News media serve as a primary source of risk communication for much of the public, as an effective way to draw public attention to risks (Fung, NamKoong, & Brossard, 2011). These messages have great potential to influence public perceptions and judgments towards risks through dread, catastrophic potential, perceived controllability, familiarity, and uncertainty.

According to Fung, Namkoong, & Brossard (2011) media in the appropriate context can convey Communicating Your Message – Pertussis Outbreak 5 a message that will help steer public reactions to the risk in the appropriate manner. Media instilling feelings of dread and fright from consequences of risk exposure and catastrophic potential can cause the public influence to comply with recommendations. Utilizing media to influence the perception of controllability can be done in two ways: messaging regarding potential symptoms and personal protection measures. According to Fung, Namkoong &

Brossard (2011) empowering people with knowledge and ability to recognize symptoms will lead to greater prevention measure compliance. Familiarity and uncertainty also play into the picture. If the public is unfamiliar and uncertain about the disease they will more likely comply with recommendations being offered (Fung, Namkoong, & Brossard, 2011).

There are many different types of mass communication theories, including

Communication for Persuasion Theory and Cultivation Theory of Mass Media. Mass communication theories are explanations and predictions of social phenomena in relation to mass communication pertaining to aspects of our personal values and cultural systems (Baran, 2002).

What Fung, Namkoong, & Brossard have discussed is similar to the Persuasion Theory. The

Persuasion Theory is a communication strategy that uses messaging to influence the audiences’ attitudes and beliefs (McGaan, 2010). The information being given does not merely provide information but is done in a way to persuade the receiver to change their beliefs and actions.

According to McGaan (2010) messaging should take into consideration beliefs, values, and motives to influence an audience. For example with pertussis it would be important to send multiple different messages that focus on each population group and some of the focus would be on the fatal risks for infants, how easily it can be spread by all, and how it doesn’t show symptoms until 7-10 days after exposure, how the community can control the outbreak, and what you can do to protect your family. Similar to Fung, Namkoong & Brossard, McGaan (2010) Communicating Your Message – Pertussis Outbreak 6 expresses the importance of the persuader selecting a general purpose of persuasion, which include creating uncertainty, reduce resistance, change attitude, amplify attitude, and gain behavior. Creating uncertainty is used when the audience is strongly opposed to the persuader’s view and the persuader would use messaging that leaves the audience less certain they are right, and reducing resistance can be done through moving the audience to a neutral view (McGaan,

2010).

Cultivation Theory of Mass Media suggests that high frequency television viewers are more susceptible to media messages and believe they are real and valid (University of Twente,

2013). The theory suggests that mass media plays a significant influence on attitudes and beliefs, by media playing on attitudes already present in the audience and tailoring the messaging towards those. In the event of a pertussis outbreak it would be important to partner with the

CDC and a private organization such as a hospital or clinic to do a mass media campaign. The

CDC would be an important partner to provide a credible source of information for the messaging to the audience and a private local organization would be able to provide funding and a trusted source of care. This message could also be used for radio messages on the local radio station. The local public health department has a great working relationship with the local radio station and radio ads are often donated. The health department also has a Friday Morning

Magazine on the radio station that could be used as a tool for getting the information about pertussis out to the community.

Flyers and brochures would be an important tool for communicating information about the pertussis outbreak. The flyers should be placed at local businesses that the Incourage

Community Foundation outlined as key local businesses where people get their information. The

Incourage Community Foundation (2012) also suggested that local libraries were ranked high for Communicating Your Message – Pertussis Outbreak 7 where people get their information. Brochures and flyers should also be placed in these locations. Utilizing existing programs and facilities that reach a large number of the population would also be important. The WIC program and doctors clinics in Wood County would reach a large number of the population. The doctor’s clinics would be key partners not only for relaying information but also providing pertussis vaccination. The WIC program is housed in the Wood

County Health Department so immunizations could be provided to WIC participants at their

WIC appointments.

Another popular venue of communication Wood County is billboards. A partnership could be made with Every Child By Two and the CDC to utilize existing billboards with pertussis information (See Appendix A for sample billboards). According to the Evidenced- based Practice Manual (2004) billboards are shown to be an effective, evidence-based method of communicating health information.

Regardless of which health communication tool is being utilized it is important to send a message that will not instill panic in the public. According to O’Leary (2004) situations that can trigger panic typically occur because the victim perceives an immediate threat, the escape route appears to be closing rapidly, flight seems to be the only way to survive, and no one is available to help. O’Leary (2004) states that public panic is actually rare and when it does occur it usually only among a few people and is short-lived. According to O’Leary (2004) as long as the message is clear, meaningful and accurate, has specific outcomes, and gives the public direction, panic is rare and can be avoided.

In order to assure the message is reaching all populations and is being understood, all avenues of health communication pertinent to the community will be exhausted and pertussis rates and immunization rates will be tracked. This information and rates should also be Communicating Your Message – Pertussis Outbreak 8 communicated with the State Department of Health Services and the CDC to effectively determine if the messaging needs to be spread to other locations and aid in tracking the disease.

All information will be provided in English, Spanish, and Hmong to accommodate the racial diversity in the community. Hmong and Hispanic translators will be available at all immunization clinics and made available during phone triage, and if the public calls with questions. The literacy level of the information will be at a 5th-8th grade reading level to help increase the understanding for the public. According to the National Assessment of Adult

Literacy (2013) 36% of adults in the US have limited health literacy, with 22% having basic and

14% having below basic health literacy. There is a National Action Plan to Improve Health

Literacy (2010) which states that the health information should be accessible, clear, basic, and accurate.

Finally as part of the health strategy for effective health communication messaging, a budget for health communication should be considered (NPIN, 2013). With the pertussis outbreak, public health would need to consider partnering with other resources such as the local doctors clinics and hospitals to get the word out that there has been a pertussis outbreak and share resources. Utilizing existing public health communication plans, such as mass clinic plans, would be most cost effective and efficient. During the pertussis outbreak all avenues of existing communication, such as media press releases, radio announcements, social media alerts, and flyers and brochures would be used. Key partnership communication, with organizations such as hospitals, doctor’s clinics, CDC, state government, and private organizations in the community, would also be necessary to help decrease costs and ensure a clear and accurate message is being sent. In the process of all the open communication and planning between hospitals, clinics, and the local health department, it will be necessary to develop immunization clinic plans to Communicating Your Message – Pertussis Outbreak 9 immunize those who have not already been immunized and plan triage clinics and treatment for those who have been exposed. The Health Officer would also have to consider shutting down schools and other large gathering establishments for a period of time and determining the best communication methods for this precaution.

Health communication and social marketing are important tools for public health messaging during an outbreak. It is important to make a plan keeping in mind budget constraints and then utilize effective methods of outreach to notify the public. Collaborating with partners in the community is an important part of effectively communicating health information and eliminating an outbreak. Communicating Your Message – Pertussis Outbreak 10

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20based&f=false Communicating Your Message – Pertussis Outbreak 12

Appendix A

(2013). Pertussis. Vaccinate Your Baby. Retrieved from http://www.vaccinateyourbaby.org/why/history/pertussis.cfm

(2013). Pertussis. CDC. Retrieved from http://www.cdc.gov/pertussis/outbreaks/about.html