Risk communications and engagement
In this article Hana Rohan, Assistant Professor in Social Science for the UK Public Health Rapid Support Team, gives an overview of risk communication and community engagement. As you read it consider the public health information and messages you have seen. Are there some examples you think are effective?
Risk communication and community engagement (RCCE) is a critical component of the response to any infectious disease outbreak. What this looks like depends very much on the context and the disease in question: it could range from targeted radio campaigns to social mobilisation staff having face to face discussions with community members at their doorsteps, all the way through to large mass and social media campaigns, sponsorship of public events like football matches, or even community theatre performances that help describe the risks of catching a particular disease and how to protect ourselves. In a respiratory pandemic like COVID-19, many of these face-to-face activities are hampered by the specific transmission mechanisms of the disease. As a result, creative approaches to ‘remote’ RCCE have to be identified, and this means an increasing reliance on media and social media communications, as well as on collecting community feedback through remote means like SMS surveys, rather than face-to-face interactions.
Community engagement is the process of supporting communities to consider themselves partners in an outbreak response, and to have ownership in controlling an outbreak1. It is a principle rather than a defined set of activities, and the approaches to this vary depending on factors such as local social structures, community coherence, preferred communication methods, and relationships with authority. Risk communication without proper community engagement takes a more ‘top down’ approach and risks ignoring local needs and mores, and ultimately being less effective as a result.
UNICEF have been working on developing a set of minimum standards and indicators for community engagement, and define it as follows:
“A foundational action for working with a wide range of traditional, community (including vulnerable groups), civil society, opinion leaders; and expanding collective or group participation to address the issues that affect their lives. Community engagement empowers social groups and social networks and improves the responsiveness of development and humanitarian actors. By combining these principles and strategies, all stakeholders gain access to processes for assessing, analyzing, planning, leading, implementing, monitoring, and evaluating actions, programs, and policies that will promote the survival, development, protection and participation of children and women.”2
Risk communication and community engagement is a critical component of the response to COVID-19. It helps people make the right decisions about how to protect themselves, when to seek care, and to avoid contributing to panic about the disease and its effects:
- It is very important to make sure people have the right information, delivered in the right way, to take appropriate and proportionate steps to protect themselves.
- Where possible, effective risk communications should be clear and easy to understand3 e.g. by focusing on easily achievable tasks (such as handwashing or avoiding face touching).
- A proportionate response to illness is critical to preventing health facilities from becoming overwhelmed with the ‘worried well’, and at the same time, appropriate care-seeking is critical for those who actually are sick (either with COVID-19, or other health concerns), so that they can get the care they need.
- Managing the ‘infodemic’4 (an excess of information that makes it hard to know what’s trustworthy and what’s not) and maintaining trust in public health authorities is critical to ongoing management of the outbreak
- Panic about COVID-19 has its own consequences that are harmful both to outbreak control, and to societal cohesion. For example, panic-buying food and other domestic products affects shops’ ability to re-stock, creating a false sense of shortage and feeding back into further panic. Panic and fear can result in the stigmatisation of particular ethnic groups – the COVID-19 has seen an explosion of racism targeted against those of Chinese origin5
The speed at which COVID-19 is spreading means there is an imperative to try and develop risk communications materials that are applicable in many different settings. This is extremely difficult, as different contexts and communities have different communications needs. Further, while messaging for some aspects of COVID-19 risk communication materials will be similar in most countries (i.e. handwashing), guidance on care-seeking may differ based on health system capacity and structure, as well as other diseases that are prevalent locally. Clear risk communication and community engagement is crucial to making sure that community physical distancing (or ‘social distancing’) measures are understood and observed. It should include information about what is planned and how long for (so that communities and households can prepare themselves), and it should comprise identification of barriers to adherence, and the provision of relief measures (e.g. rent holidays, the provision of food and hygiene supplies, tax relief for businesses etc). As far as possible, community consent will be necessary for these kinds of measures to work, and therefore good RCCE is a central aspect of the implementation of population level public health interventions and restrictions, which have been termed ‘lockdowns’. Risk communications also needs to consider specific guidance for vulnerable or potentially vulnerable groups, whose experiences and risk will also vary depending on location (for example those with existing health problems, pregnant women, and the elderly).
Updated guidance on risk communication and community engagement can be found using the links provided in the See Also section of this step.
© London School of Hygiene & Tropical Medicine 2020