1. Why is risk communication planned?

Before traveling to the place where you plan to carry out risk communication work, it is important for you to understand the situation and concerns of the community. It is not your diplomas or institutional links that will give you credibility; you will achieve credibility in the measure in which you know and understand the community’s problems.

The planning stage is the basis for the risk communication process. Lack of planning can lead you to develop an inappropriate program that could cause problems in the community.

If you define the problem carefully at the beginning, this will reduce the need for corrections afterwards; remember that corrections are costly. For a systematic knowledge of the problem and subsequent development of your risk communication plan, start the process by answering the community’s questions and relating those questions to its inhabitants. As the implementation of the risk communication plan progresses, it is important to plan how you are going to evaluate the process and the activities you carry out, how you will provide information on the progress of the program, and whether there will be any need for adjustments to the program.

2. Background investigation

When you start gathering information on the background of the health risk and the threatened community, bear in mind that other government institutions in the area may be familiar with the situation or have useful information.

2.1 Sources of information

• Documents of the Environmental Protection Agency (EPA) of the United States
  • Archives of administrative registers (for National Priorities List [NPL] or Superfund sites)
  • Community relations information repository
  • Community Relations Plan or CRP
  • Archives of sites of CERCLIS (Comprehensive Environmental Response, Compensation and Liability Information System).

In other countries it is suggested that you contact the Ministry of the Environment or the environmental health area of the Ministry of Health.

2.2 Other sources

• Departments or Ministries of Health
• Municipal health services
• State health services
• Local hospital or medical communities
• Local media.

Keep your goals and objectives in mind while gathering information during this process, so that the information will be pertinent.

3. Forming the communication team

If risk communication is to be effective, an effort is required in which all the members of the team support each other. Work with the members of the communication team to support the main goals.

The information gathered during the investigation into the background of the health risk and the community’s concerns will be the basis for the communication plan. The communication team will be formally or informally made up to include experts on the specific needs associated with the risk to be dealt with.

3.1 Composition of the team

In most cases, the work team requires the following members to be included:

• Regional representatives
• Risk advisors
• Health educators
• Epidemiologists
• Environmental health researchers
• Your organization’s press officers or external relations officers
• Health personnel from State and local institutions

Whenever possible, involve communication personnel from other institutions and organize regular meetings to share information and ensure the consistency of the messages.

3.2 Steps for forming the health risk communication team

• Seek diversity of skills to address the topic of communication effectively.
• Determine who will be involved in responding to the communication needs and who will be those responsible.
• Assign communication responsibilities to all the team members: to develop information sheets, help design the communication materials, report to other governmental organizations, or take part in public meetings.
• Emphasize the importance of good risk communication among all the members of the team.
• Clearly define the roles to be played by each team member. This will prevent confusion, duplicated work, or lost opportunities.
• Design the communication plan and delegate responsibilities to the whole team.
• Keep a centralized file of information so that all team members have access to it when they need it. This will prevent delays if a team member is absent.
• Set up effective internal communication tactics, including weekly meetings, weekly conference calls, and e-mail messages.
• Hold meetings and prepare communiqués to keep the team regularly informed.
• Conduct training sessions and communication drills for your spokespersons.

3.3 How to build trust

The trust-building process with a community takes time, patience, persistence, and a great deal of communication. It is rather like a relationship between a couple, where time and effort must be invested to develop the necessary trust to believe openly in each other. It will sometimes be necessary to fight against prejudices or preconceived ideas about employees of government and official institutions.

3.4 Steps for building trust

To establish a relationship of trust with the community, the following steps should be followed:

• Show sincerity in your efforts and in your role with the community. Be visible in the community. If you have any reservations about the usefulness of what you are doing or if you are hesitant in your decisions, the community will notice it.
• Involve the members of the community and ask them what they think about the situation. If you consider their remarks significant, ask them if you can quote them in your reports or conversations with other people.
• Maintain confidentiality. Do not repeat comments made by a person or a group without first obtaining their consent.
• Be honest with the members of the community and with yourself. Explain information carefully. If you do not know the reply to a question, say so. Try to find the answer to the question and give it to the persons who asked you as soon as possible. Share information promptly. Do not minimize the level of risk.
• Meet your obligations with the community. If you answer telephone calls, be honest with the questions that you cannot answer; this will increase your credibility.
• Spend time finding out what is happening in the community, what has happened in the past, and how the community members feel with respect to the facts. They will believe you if they consider you a reliable source of information.
• Always note down the community’s questions and doubts and provide follow-up. Take their suggestions into account for future activities.
• Treat the community members with respect and patience. Listen carefully and acknowledge the ideas and contributions of the community.

4. Developing the health risk communication plan

The health risk communication plan will help you to clarify your approach to the situation and ensure that you don’t leave out any necessary steps. It will also enable you to maintain consistency in your messages, and save time and money.

If you are working in a crisis or emergency situation and you do not have time for a complete risk communication plan, take a few minutes to outline your communication strategy.

Your risk communication plan should:

• Be based on knowledge of the local community.
• Provide a referential framework for addressing the community’s concerns.
• Focus on the approaches and techniques of risk communication rather than on generic program goals.

4.1 Steps for developing your health risk communication plan

• Develop your plan in advance and always before introducing yourself to the affected community.
• Be flexible and take into account any unexpected issues and situations that may arise.
• Review and update the plan as any changes occur, to keep its strategy relevant.
• Consider and note down all interesting data, so that you will have notes to refer to whenever necessary.
• Continue to develop the plan as you learn more about the situation and the community.

4.2 Defining the community and segments of the target population

A community can be segmented and each of the segments can have different concerns, needs, and interests. Some community members are more articulate than others. Those who do not express themselves so well must always be taken into account and their ideas included. Make sure you do not define a community only by the opinions of the group or individuals who are the most outspoken.

4.3 Identifying your target population

Consider the groups who:

• Have useful ideas and can facilitate action.
• Have been involved in the issue previously.
• Can be affected, or perceive themselves to be affected.
• May feel relegated or annoyed if they are not included.

4.4. Questions to ask

• Do the community members have anything in common? (age, language, place of residence, etc.).
• What do you know about the knowledge, attitudes and behavior patterns of the community?
• Are there any cultural or social practices that we need to consider?
• Are there any communication channels for specific groups (groups with a low educational level, minorities that speak a different dialect)?

4.5 Potential target groups

• Government employees in the areas of health, the environment, natural resources, or ecology.
• Local personnel and elected authorities (municipal health personnel, the mayor or other town authority, and officials of the local environmental health council, committees, and planning council).
• Representatives of groups of citizen organized to address these issues.
• Neighbors and individuals with no particular affiliation who live near the affected area or in the vicinity.
• Health professionals (doctors and nurses).
• Representatives of local businesses (Chamber of Commerce or local government).
• Civic groups or neighborhood associations.
• Principals of local primary schools.
• Potentially responsible parties.
• The media, both as audience themselves and as media for other audiences.
• Other government institutions.
• Attorneys who represent citizens in lawsuits associated with the matter at hand.
• Members of professional associations.
• University professors.

Once you have identified the population you want to reach, divide your audience into a primary group and a secondary one. The primary target group is made up of persons whom you wish to influence in some way with your messages. The secondary target group is made up of those who have an influence on the primary group.

4.6 Setting priorities for your audience

Once you have identified and defined your audience by groups, you can set priorities and decide the following:

• Which segment of the target audience is the most important?
• Which segment of the target audience is important, but less critical in terms of its influence, its effect in this matter, or relationship with the primary group?
• Which segment of the audience is not going to be targeted by the messages of your communication program?

This will help you make sound decisions about the messages and channels by which to transmit them. It will ensure that the program’s resources are used productively.

5. Identifying the community’s concerns

Once you have divided your target audience into groups, it is important that you identify the characteristics and particularities of each group. It is most likely that you will have to prepare different messages and communication tools to reach the different community groups.

5.1 How to identify the issues that make the community react

Communities respond positively or negatively to something that affects them, depending on their perception of it and its relevance to their lives. Some of the concerns usually observed are the following:

• Health: When a health problem arises, the community turns to individuals who can provide information. When their children’s health is at risk, the community react strongly against the individuals or organizations who are in some way jeopardizing the children’s well-being.
• Safety: When a community’s safety is threatened (for example, by exposure to a toxic substance), its members join together to fight against the potential hazard.
• Economy: Some communities accept and back up companies that do not have environmental protection measures, because they are sources of employment and they help the local economy. However, they react negatively when the value of their properties is affected. The owners of businesses, for example, can be worried about the economic impact of a specific risk.
• Environment: Everyone wants a clean environment, so the support of the community can always be expected in this reference.

5.2 Other community concerns

The population may express its concern about the following:

• Aesthetic aspects
• Commercial development
• Development of green areas and recreation sites
• Issues that may give rise to possible lawsuits
• Politics
• Tourism
• Property values.

5.3 Response of the community to specific concerns

The best way to understand the concerns of the community is to ask the residents directly. First check with the representatives of the participating institutions what information is already available. Then plan interviews with the community, during which you can include the following questions about risk communication:

• What are your main concerns about this place (or issue)?
• What kind of information do you need or would you like?
• How frequently would you like to be informed and updated on the matter?
• Where do you obtain most of your information at present?
• How do you want the information to be given to you?
• How do you want us to communicate with you?
• Do you know whether there is any particular group that requires special information?
• Do you know whether a different language or dialect is spoken in the community?

The information resulting from the interviews should be incorporated into the health risk communication plan and the messages that you design. Try to meet the expectations and needs of your community, although you may have to warn them that you will not be able to respond to every one of their requests.

5.4 Calendar of interviews with the representatives of your target audience

An informal atmosphere is better for the interviews. Remember the following points when conducting interviews with members of the community:

• Be familiar with the issues most relevant to the community.
• Prepare questions that will help you understand the community’s concerns better.
• Make a list of those invited to your interviews and include representatives of different community groups to explore their concerns.
• In the group interviews explain the purpose of the interview clearly so that the participants know what to expect.
• Make a calendar for the individual interviews so that your time will be efficiently organized.
• Whenever possible have a technical person with you, since he or she will be able to help you reply to any technical questions that may come up in the interview.
• Do not invent or try to guess answers to the questions you are asked. Do not make promises that you cannot keep, or which might be inappropriate for your institution.
• Write down your findings from the interviews and refer to your notes when preparing your risk communication plan.

To obtain information you can do the following:

• Discuss the concerns of your community with colleagues who have dealt with similar situations.
• Conduct informal meetings with members of the community interested in the matter at hand, so that you will have a better idea of their concerns.
• Prepare a survey on the concerns and hand it out at the meetings or send it by mail.
• Ask the participants at the meetings to write down their concerns or to write their questions on slips of paper given out for this purpose at the beginning of meetings.

5.5 Community participation

Involving the community frequently and as soon as possible is a determining factor in the risk communication process. Not only will this help you to gain the trust and support of the community, but it will also provide you with important information about the concerns and viewpoints of your audience.

Your contact with the community begins the moment you establish a direct communication or telephone link with its inhabitants. Contact the representatives of the community and ask them how they want to interact with you or your institution before you make any communication decisions.

5.6 Steps for interacting effectively with community members

• Make contact with the key authorities and community leaders. Give them your name and contact data (address of the agency, e-mail, telephone, and fax).
• Set dates and times for the meetings. Try to make sure that the times are convenient for those attending (meetings could be held in the evenings or at the weekend).
• Give the dates of the meetings to those involved sufficiently in advance, and use appropriate channels to disseminate the information.
• Contact any other institutions involved and give them the information about the meetings.
• Conduct meetings for the public and distribute informational material (general and specific fact sheets and your personal card). Make a summary of the situation and share it with your key contacts and other representatives of the community.

5.7 Follow-up of community concerns

Sometimes the concerns of the community vary depending on information received by the population; and occasionally there is simply a change of position. For example, if a contaminating firm closes, workers will be indignant because they have lost their jobs. Sometimes they will then be willing to tell how they threw toxic wastes into the public sewer obeying orders from their superiors, or how they deactivated the pollution control mechanisms. Thus, a change in their personal situation causes them to rethink their priorities, and this can influence others in their community.

To keep abreast of changes in community concerns:

• Call your local contacts and key community leaders frequently.
• Review local newspapers and news programs.
• Maintain informal contact with community members.

6. Evaluation of health risk communication

Unless you systematically assess your health risk communication activities, you will have no way of knowing whether you have reached your target audience, communicated your messages effectively, and achieved a change in behavior in the community.

The evaluation can have effects on the planning (formative) and determine the immediate effects (process), medium-term effects (products), and long-term effects (impact) of the risk communication activities.

• Formative evaluation: This is done before a program starts or during its early stages and permits revisions to be made in response to audience feedback. One of the tools used is focus groups to try out the comprehension of the messages. The formative evaluation can also be made at different times as changes may occur in the issue addressed, the messages, or the target audience.
• Evaluation of process: This involves a review or audit of the activities carried out and helps to document whether the activities have been carried out as planned. Verifying merely whether a certain number of pamphlets were distributed does not mean that communication was established. The different levels of evaluation include surveys of reading, evaluation sessions, and requests for feedback.
• Evaluation of products: This determines whether the short-term objectives have been met, that is, whether there have been changes in the knowledge, attitudes, and behavior of the beneficiaries. It uses surveys, focus groups, one-on-one meetings; and door-to-door interviews.
• Evaluation of impact: This determines the long-term effect of the program. Since field work tends to be of short duration in the communities, it is difficult to measure long-term changes in the population’s health or changes in policies due solely to risk communication. However, the risk communication activities certainly can result in measurable changes in the long term. It is the evaluation of impact that measures changes in morbidity and mortality rates, sustained changes in behavior, and policy changes. The tools for measuring these changes are reviews of secondary information and policy analyses.

Note: Develop an evaluation strategy as you plan your health risk communication activities in order to determine what you have achieved with regard to your original objectives.

See the Appendix “Guide for Planning Health Risk Communication” and the “Planning Tools” at the end of the Guide which will help you plan your communication activities.

7. The quick guide for planning health risk communication

Although it is always preferable to use the long planning guide presented in the Appendix, there are times when we have little time to prepare our risk communication activities (an hour or less). In such cases we use the quick planning guide (see the Appendix) presented on the following pages as a referential framework for developing our risk communication plan. However, try to develop your plan with the long guide (see the Appendix) when the crisis situation permits it. Remember that it is usually possible to foresee situations that may occur and prepare ourselves accordingly to prevent unnecessary crises or emergencies.

8. Planning of the evaluation and checklist

Before arrival in the community

• Review results of evaluations of similar situations.
• Think how you can apply things that worked well in similar situations. Consider the following:

• Is there any similarity between the community experiencing this situation and other communities? (demographic characteristics, income, educational level, rural or urban residence, ethnic groups, language, etc.).
• Is the situation the same? (toxic substances, etc.).
• Is the exposure route similar to previous situations?

Once you have arrived in the community

• Gather information to determine the base line. Some examples include:
• Make a survey of the population’s knowledge at an initial public meeting.
• Review logs of phone calls to health services, or interview medical personnel.
• Gather information on the number of children who have been taken the health services

• Plan and implement the formative evaluation.
• Make outlines of posters, pamphlets, data sheets, and other written material. Conduct two focus groups with different community segments to try out your material.
• Request feedback on the design, readability, cultural adaptation, and understanding of the material. Adapt the material in accordance with the feedback.
• Use computer software to test the level of reading of the written material, such as information sheets (applicable only to material in English).

• Develop a system of follow-up documentation for the evaluation of the process. Some examples include:
  • Keep log books of phone calls to the emergency numbers or help numbers.
  • Make lists of attendance at meetings.

• Plan and implement an evaluation of products. Some examples include:
  • Conduct your survey of knowledge at a public meeting as a final test.
  • Do a small number of interviews from door to door with members of specific communities.
  • Review statistics of the health services with regard to the number of children presenting the situation in question since you began your activities.
  • Compare the numbers with the base line information you obtained when you first arrived in the community.

After the field activities

• Continue to evaluate products.
  • Conduct follow-up surveys by mail with a sample of community members to determine changes in knowledge, attitudes or behavior.
  • Continue reviewing statistics of the health services to determine changes in behavior
• Consider whether it is appropriate to make an impact evaluation:
  • Can changes in the state of health of the population be expected as a result of the risk communication activities that have been carried out?
  • Think how those changes can be measured.
  • Record the findings in the evaluation section of your health risk communication plan.