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Messages and Audiences 2018 Update 2 CERC: Messages and Audiences Explanations of figures for accessibility is found in the Appendix: Accessible Explanation of Figures on page 10.

This chapter will introduce:Understanding your Audiences Making Facts Work in Your Message Building Credibility and Trust Gathering Audience Feedback Conclusion During an emergency, the right message, from the right person, at the right time can save lives. Emergency communication is more than simply giving information to the “general public.” You must understand your audiences and the factors that can influence their comprehension and acceptance of your messages. Different audiences have different priority information needs based on their relationships to the emergency . And, while the facts remain the same, you may need to adapt message delivery and context for different audiences to address cultural and accessibility needs. You should ensure that your messages are concise, prompt, accurate, and delivered with empathy. Finally, you must gather audience feedback to ensure that your audiences receive and understand your messages.

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Doing so will help you reach more people—and deliver messages that are accepted, understood, and acted upon.

Audience segments—groups within an audience defined by shared qualities.

Members: 1. share similar knowledge, concerns, and motivations that determine health behaviors and inform tailoring of messages; and 2. can be reached through similar media, organizations, or interpersonal channels. 1 Understanding Your Audiences Different audience segments will have different needs and perspectives in an emergency. Consider each segment’s relationship to the emergency, in terms of their experience and level of risk from the hazard, and their role in the response. Pay attention to cultural background when developing messages and outreach strategies.

CERC: Messages and Audiences 3 Accessibility refers to the ability to receive and understand communications.

Physical access to communications depends on availability and use of certain communication channels , which can vary due to infrastructure, personal choice, social norms, and economic levels. Some different channels include ■ T V ■ Radio ■ Text messages ■ Social media ■ Print media A person’s ability to accurately receive a message depends on ■ Language ■ Literacy ■ Education and vocabulary ■ Vision and hearing capabilities Adapting messages and using different channels helps overcome accessibility challenges. Audience segments based on relationship to the emergency People’s needs and concerns are influenced by how close they are to an emergency. 2 The table on the next page shows some of the groups that need information in an emergency and their primary concerns.

CERC: Messages and Audiences 4 Table 1. Groups that need information in an emergency and their primary concerns.

Audiences Affected by Emergencies Primary Concerns Community directly affected by the emergency ■ Personal safety ■ Family safety ■ Property damage ■ Loss of livelihood ■ Disruption to normal activities (e.g., travel restrictions, businesses closed, voluntary quarantine) Community immediately outside of the affected area ■ How they can keep the emergency from affecting them ■ How they can help ■ Risks to self and family ■ Disruption to normal activities Emergency responders and public health officials ■ Professional responsibilities ■ Availability of resources ■ Personal safety ■ Family ■ If they are directly affected by the emergency: family safety and property damage Civic leaders ■ Responsibilities ■ Liability and reputation management ■ Resource allocations ■ Opportunities to express concern Partners (organizations who have an official role in the response) ■ Understanding their role in the response ■ Coordinating with other response organizations ■ Involvement in decision-making process ■ Access to information, reputation management Community leaders (faith-based organizations, non- governmental organizations, cultural groups, etc.) ■ Safety of communities ■ Representing community needs ■ Listening to community members ■ Taking part in decision-making Media ■ Getting access to information right away ■ Meeting rapid deadlines ■ Keeping the public informed Businesses, trade, and industry ■ Employee safety ■ Interruptions in business ■ Loss of revenue ■ Liabilities and reputation International community (international organizations and other countries may be partners in the response and provide aid or assistance) ■ Their level of readiness for a similar emergency ■ Any restrictions on trade and travel to protect their citizens ■ Their role in response partnership CERC: Messages and Audiences 5 Culture and Your Message Culture is a complex set of values, ideas, attitudes, and symbols that shape behavior. 3 Although cultural traditions are generally passed down between generations, cultures can adapt to meet the changing needs of a community. And emergencies rapidly introduce change. Communicators need to be aware of how an emergency specifically affects a cultural group and how cultural factors affect the way communities take in a message and perceive the recommended actions. 4 Before an emergency, assess the demographic and social traits of your potential audiences. Some factors that affect how people take in messages include ■ Age ■ Languages spoken and read ■ Education and reading level ■ Income level ■ Religious beliefs ■ Cultural values, beliefs, and practices ■ Level of trust in response organizations and agencies Cultural differences in the way people communicate, understand, and react to information in emergencies include the following:

■ Perception of risk and risky behaviors: Different cultures have very different experiences with risk. 5 Some cultures have practices that put them at greater or lesser risk in certain circumstances, such as dietary and food preparation habits and religious traditions. When cultural practices are risky behaviors, you face the challenge of demonstrating how something that may feel important or safe to a cultural group can put them at risk.

■ Emphasis on the individual versus the group: Some cultures naturally think in terms of the group and feel the needs of the group should be prioritized. 6 Audiences belonging to these cultural groups often respond well to messages that show how actions can benefit or protect the community. In other cultures, individuals are more inclined to think of their choices, behaviors, and risks as independent.

■ Trusted institutions and credible sources of information: Cultural groups often develop, identify with, and trust their own institutions, such as faith-based organizations, nongovernmental organizations, and political organizations. Take into account that some cultural groups have had different experiences with government agencies and organizations and some may be more ambivalent in accepting your messages.

You still need to be able to reach these groups with lifesaving information. Consider sharing your messages with trusted institutions so that they can reach these populations. Be sure to include ethnic media outlets in your media outreach activities.

During the 2014 Ebola virus disease (Ebola) outbreak in West Africa, traditional burial practices were spreading the infection to family and friends of Ebola victims who touched and washed the dead bodies. CDC worked with the ministries of health in Sierra Leone, Guinea, and Liberia to establish standard operating procedures for safe and dignified burials.

Community and family interviews helped inform how to make the medically sound burials dignified and consistent with a person’s custom. One way to do this was community burials where the chiefdom leader would select the location for the burial and community members could look on while official burial teams carried out the safe burials. 7 You may need to turn to cultural agents, people who belong to a certain cultural group, who can help you understand how a particular culture will view an issue. Cultural gatekeepers can take this a step further and help introduce communicators and responders to their community, making members more receptive to unfamiliar people and messages.

At the same time, be careful not to overgeneralize. Do not assume that one person’s views represent everyone in their cultural group, and be aware of subgroups.

CERC: Messages and Audiences 6 Making Facts Work in Your Message Communicating during an emergency is different than routine communication. Under stress, people face greater challenges understanding and remembering messages. The following factors are important to consider when creating initial messages about an emergency:

■ Present a concise message: When people are scared or anxious, they have a hard time taking in and remembering large amounts of information.

Keep the first messages simple and only include immediately relevant information. Do not start out with a lot of background. Avoid jargon and technical terms.

■ Repeat the main message: Reach and frequency are essential for protecting the public with your first messages. Repetition helps people remember the message, especially during an emergency when memory retention is shorter due to anxiety and racing thoughts.

■ Give action steps in positives (when feasible): Whenever possible, use positive messages such as, “drink bottled water” or “boil drinking water,” instead of negatives like, “do not drink the water.” Words like no and not can be easily confused or forgotten in moments of heightened emotions and background noise. Additionally, simply telling someone not to do something can leave them looking for/unsure of acceptable action steps.

» Note: Sometimes action can only be conveyed clearly by using the negative. One example is the message to pregnant women to protect them from the Zika virus: “Pregnant women should not travel to areas with risk of Zika.” Saying, “Pregnant women should travel to areas without risk of Zika” does not clearly convey what pregnant women need to do to stay safe. ■ Create action steps in threes or fours: During normal times, people tend to only remember three to seven pieces of information at a time. 8 In an emergency, this drops down to only three simple directions. Some good examples are “stop, drop, and roll,” for response to fire, and “separate, cook, and chill,” for food safety.

■ Use personal pronouns: Using personal pronouns when communicating on behalf of your organization personalizes the message and helps with credibility and cohesion. Use phrases such as, “We are committed to…” or “We understand the need for…” ■ Respect people’s fears and perceptions: Do not judge or use condescending phrases. Instead say things like “It is normal to feel anxious in times like this.” ■ Give people options: Avoid being paternalistic. Instead of just telling them what to do, give people options and inform their decisions.

■ Avoid humor: Humor is never a good idea in emergency communication. Be cautious not to offend others and remain sensitive, especially in public. Be aware that microphones left live and cell phones can easily capture “behind-the- scenes” moments.

CERC: Messages and Audiences 7 Building Credibility and Trust People receive, interpret, and evaluate messages before they decide to take action. Expect your audience to immediately judge the content of your message as well as the delivery. Successful communication depends on credibility and trust.

Credibility Your message delivery can make or break your credibility. This will affect how audiences react to your initial message and all communications that follow. Two influencers of credibility are the speed of release and the accuracy of information . Speed of Release: As soon as lifesaving information is confirmed, it should be released. Even if you do not have all of the details, do not wait to share the information that you do know that can save lives or prevent injury. The speed of a message also indicates how prepared your organization is to respond. If you do not communicate about your response, as far as the public knows, you are not responding.

Accuracy of Information: People will depend on your organization for accurate information about the emergency and what they can do to stay safe or help respond. Therefore, you should ■ Get the facts right. Before releasing messages, validate them with subject matter experts and people familiar with the incident.

■ If facts change based on new information, you should quickly update information and coordinate messaging changes with other organizations.

■ Repeat facts and action items often, using simple, easy-to-understand language.

■ State what you know, what you don’t know, and what you are doing to find out more. Do not speculate.

■ Ensure that all communications from your organization and its partners share the same facts.

Inconsistent messages increase anxiety and quickly undermine expert advice and credibility.

» In reality, you cannot control what another organization says. By fully and clearly explaining your messages and their reasoning, your audiences will be less likely to doubt you. ■ Competence and experience lend themselves to accuracy. Spokespersons should hold high positions and have education demonstrating subject matter expertise. For example, a doctor could appear in the front of your audience on behalf of your organization in an infectious disease response.

CERC: Messages and Audiences 8 During a blackout in Michigan in 2003, two neighboring health departments gave conflicting messages 9,10, ■ County A announced that restaurants would close until they had been inspected.

■ County B did not close restaurants, because their food managers were already certified in their emergency food safety program. This led to intense media scrutiny, public confusion, and worry over what was safe. Some restaurants lost business. Trust One of the most important factors in effective communication is how much your audience trusts you and your organization. Establish trust through empathy and openness . Empathy: Empathy is the state of actively considering and recognizing how someone else feels and perceives a situation. 11 Statements of empathy and commitment to the response demonstrate that you understand the situation and are working in the best interests of the affected populations. Your audiences will be more likely to receive and act on your messages if they see you as being empathetic and acknowledging fear, pain, suffering, and uncertainty.

Openness: If you have information you are unable to share, tell the public why the information is not available for release at the time (i.e., you are verifying information, or you are notifying your organization, or the information is not your organization’s information to release). Be open to questions and two-way conversations. “But the people, by and large…these are families that are just waiting to get out of here. And they are frustrated. I would be too. I get frustrated at the cash register counter when the paper runs out. This is not an instant solution. And it’s hard work, and they are frustrated. And in a way, we are too. But we’re doing our best. We got the resources started, and we’re going to continue to flow them now we’re at the Convention Center.” 12 —Lieutenant General Russel Honoré on Hurricane Katrina relief efforts in 2005.

CERC: Messages and Audiences 9 Gathering Audience Feedback Feedback allows communicators to understand how audiences receive and interpret messages. Audience feedback and message testing play an important role in emergency and risk communication preparedness and response.

During the preparedness phase you can ■ Research what your audiences know about potential threats. Knowledge, attitude, and practice (KAP) surveys are one good way to learn what people know about a specific health threat or issue and how they would respond if that event occurred right now.

■ Test your messages and communication projects to find out how they are understood by different audience segments and how they can be adapted.

■ Plan ahead of time how you will monitor the media and social media during an emergency. During an emergency, receive and respond to your audiences by ■ Rapid message testing.

■ Monitoring media and social media regularly to track misinformation, identify common concerns, and find information gaps.

■ Ask for feedback from community leaders and advocates and congressional representatives.

■ Have open channels between the public and your organization. Solicit public feedback and take phone calls from the public through an agency hotline. Audience feedback can help you adapt your messages for different audience segments. This allows you to refine your messages so that your audiences receive and understand them. Conclusion Effective emergency communication requires an understanding of target audiences’ differing needs, perceptions, and characteristics. In crafting and disseminating a message, carefully consider the cultural components of all audience segments. To prioritize information needs, consider audiences’ relationships to the emergency event. Delivering short, action-based messages and strategizing to build credibility and trust impacts the effectiveness of your messaging. Audience analysis, feedback, and message testing allow you to adapt messages so that they are clearly understood and received by your audiences. Relevant, credible, and culturally- appropriate messaging in an emergency offers audiences the information they need to make lifesaving decisions.

CERC: Messages and Audiences 10 References 1. Slater, MD (1995). 10 Choosing Audience Segmentation Strategies and. Designing health messages:

Approaches from communication theory and public health practice, 186. 2. Trope Y, Liberman N. Construal-level theory of psychological distance. Psychol Rev 2010 Apr;117(2):440–63. 3. Purnell LD. Transcultural diversity and health care. In: Purnell LD, Paulanka BJ, editors. Transcultural health care: a culturally competent approach. 3rd ed. Philadelphia (PA): FA Davis; 2008. p. 5–10 4. Renn, O, Burns WJ, Kasperson JX, Kasperson RE, Slovic, P. (1992), The Social Amplification of Risk: Theoretical Foundations and Empirical Applications. Journal of Social Issues, 48: 137-160. doi:10.1111/j.1540-4560.1992.

tb01949.x 5. de Zwart O, Veldhuijzen IK, Elam G, Aro AR, Abraham T, Bishop GD, et al. Perceived threat, risk perception, and efficacy beliefs related to SARS and other (emerging) infectious diseases: results of an international survey. Int J Behav Med 2009 Jan 6;16:30–40. [online ]. [cited 2018 March]. Available from URL: http://www. ncbi.nlm.nih.gov/pmc/articles/PMC2691522/ . 6. Porter C, (2015). Revisiting Precede-Proceed: A leading model for ecological and ethical health promotion.

Journal of Health Education, 75 (6): 753-764. [online] [cited 2018 March]. Available from URL: http://journals. sagepub.com/doi/pdf/10.1177/0017896915619645 7. C. Improving Burial Practices and Cemetery Management During an Ebola Virus Disease Epidemic — Sierra Leone, 2014. MMWR. [online]. Jan 2015.[cited 2018 March]; 64 (01); 20-27; Available from URL: https://www. cdc.gov/mmwr/preview/mmwrhtml/mm6401a6.htm 8. Broderick, PC, Blewitt, P. (2003). The Life Span: Human Development for Helping Professionals. Chapter 6.

Realms of Cognitive Development. Page 201. 9. Berg R. Food safety in the dark. J Environ Health. 2004 Jan–Feb;66(6):55–60. 10. Nye DE. When the lights went out: a history of blackouts in America. Cambridge(MA): MIT Press; 2010. 11. Ioannidou F, Konstantikaki V. (2008) Empathy and emotional intelligence: What is it really about?

International Journal of Caring Services. [online] [cited 2018 April]. Available from URL: http:// internationaljournalofcaringsciences.org/docs/Vol1_Issue3_03_Ioannidou.pdf 12. CNN’s Kyra Phillips talks to Lt. Gen. Russel Honoré about the military effort to restore the chaos in New Orleans [online transcript]. CNN.com. September 2, 2005. [cited 2018 March]. Available from URL: http:// www.cnn.com/TRANSCRIPTS/0509/05/lol.02.html . Appendix: Accessible Explanation of Figures Audience relationship segments in relation to an emergency: . This is a diagram showing how different audiences have different relationships to an emergency event. The audiences’ relationship to the emergency determines message priorities, needs, and interests. Those closest to the emergency, those who need action and safety messages first, are first responders, survivors, and the local public health and medical communities. The public immediately outside the emergency, the media, and the families of survivors and responders are less likely to need to take any immediate actions, however they are concerned and want facts. In some emergencies, international and national media and communities and federal officials will be interested in the event and may begin thinking about this event happening in their own community and how they can prepare.

Building Credibility and Trust, Successful Communication Diagram: This is a Venn diagram created by two overlapping speech bubbles demonstrating that credibility and trust combined, result in successful communication. Credibility is characterized by accuracy of information and speed of information release. Trust is characterized by empathy and openness.

CERC: Messages and Audiences

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