PSI Biot presentation

Communicating about Bioterrorism and other Public Health Emergencies Focus Groups with Rhode Island Residents&Interviews with Organizations that Serve Special Populations: 

Communicating about Bioterrorism and other Public Health Emergencies Focus Groups with Rhode Island Residents & Interviews with Organizations that Serve Special Populations Prepared by: Policy Studies Inc.

Research Goal: 

Research Goal To assess: What Rhode Island residents want to know about bioterrorism before, during, and after an emergency Whom residents trust to deliver the information Residents’ preferred vehicles and formats for receiving the information Residents’ perception of Rhode Island’s readiness to respond to a bioterrorism emergency

Methodology: 

Methodology 12 focus groups with general public in 7 areas of the state (age ranges: 18-35; 36-54; 55+, AA, Hisp.) Providence, Smithfield, Coventry, North Kingstown, Middletown, Westerly, Narragansett 19 in-depth interviews with community program staff representing 17 agencies, commissions, and programs across the state representing the following populations: Portuguese-speaking African South East Asian English as a second language/Low literacy/Immigrant populations African American Hearing Impaired Visually Impaired

RI Residents want information NOW, before an emergency occurs : 

RI Residents want information NOW, before an emergency occurs How the state is preparing to respond Basic information without too many details Information on how schools and hospitals are preparing Plans for communicating with the general public before/during/after Plans for equal access to medical care and information (Spanish-speaking and African American) Plans for equal access to vaccine/treatment What to do and where to go in the event of an emergency Westerly 55+: “I would like to know all of the information…I would want to know where to go, what to do, just like, all of the information as soon as possible please.”

Whom Residents Trust to Deliver Information about a Bioterrorism Emergency: 

Whom Residents Trust to Deliver Information about a Bioterrorism Emergency Before an emergency, residents want to hear from … Government sources Media personalities NOT from medical providers, religious leaders During and after an emergency, residents want to hear from … “Authorities and officials” President Governor of RI Military official BT expert Always want to hear from someone with: Credibility, Expertise, Track record, Familiarity, Appearance of not reading from a script

Residents’ preferred vehicles and formats for receiving the information: 

Residents’ preferred vehicles and formats for receiving the information Before an emergency, residents want to hear from … Print materials Television and radio Internet Other During and after an emergency, residents want to hear from… Television and radio Sirens, megaphones (55+ groups)

Information During Previous Public Health Emergencies : 

Information During Previous Public Health Emergencies Past emergencies mentioned: Participants from six populations mentioned discussion about the following: Anthrax, West Nile Virus, meningitis, sniper attacks, Y2K (SE Asian), September 11th “Since 9/11, everyone in this population has been talking about the event that occurred just the same as the rest of the population. Everyone talks about anthrax scares and the collapse of the World Trade Center. I think before 9/11, people felt safe, and now they don’t. People are scared. They didn’t say anything that wasn’t said by the rest of the population. They wanted to know what else could possibly happen, who was responsible, what their state was doing to protect them…” Interview Findings

Information During Previous Public Health Emergencies : 

Information During Previous Public Health Emergencies African Americans: concerned about tuberculosis, gonorrhea, and some other STDs Hearing impaired: Concerned about lack of communication during severe weather conditions “They said many negative things about accessibility and communication provided by the state officials and the media industries. [They were] very upset for not informing the Deaf and Hard of Hearing people [about] such things as hurricanes…” ESL/literacy services participants did not recall clients discussing previous emergencies Interview Findings

Information During Previous Public Health Emergencies: 

Information During Previous Public Health Emergencies Most heard of these events through the news or word-of-mouth SE Asians held workshops on Y2K and anthrax Portuguese-speaking held workshops on anthrax and meningitis Interview Findings

Information During Previous Public Health Emergencies: 

Information During Previous Public Health Emergencies Few participants had heard their clients talk about current or future public health threats “I have heard no talk about a bioterrorist emergency from our clients. They tend to talk more about what has already happened rather than what might happen.” – SE Asian “Many people only know about the big things that are happening, and most people do not follow the news on a daily basis. I don’t think the deaf and hard of hearing are any different.” One participant for visually impaired recalled discussion about smallpox and water contamination Interview Findings

Information Wanted BEFORE a Public Health Emergency: 

Information Wanted BEFORE a Public Health Emergency All would want information BEFORE an emergency: Where to turn for accurate, credible information How to protect themselves and their families What resources are available to the community Information about specific biological or chemical agents (SE Asian, Hearing Impaired, Portuguese-speaking) What channels will be used to disseminate information DURING an emergency (Which will have sign; which will have SAP) Interview Findings

Vehicles for Delivering Information BEFORE an Emergency: 

Vehicles for Delivering Information BEFORE an Emergency Community Organizations Television and radio (Ch.6/10 for hearing impaired) Word-of-mouth from trusted individuals (school nurses, coaches, peers) Religious organizations Newspapers Pediatricians (when taking kids) Internet (NAACPProv.org; Visaonews.com; turnto10.com) An informational booklet translated into several languages including Braille “Some sort of booklet or information in their own language, something they can refer to in case something happens, something handy in their house.” Interview Findings

Vehicles for Delivering Information BEFORE an Emergency: 

Vehicles for Delivering Information BEFORE an Emergency Few get information from health care providers. Few access healthcare due to lack of insurance or translation barriers Hearing impaired do not have access to translators in health system Get info from service providers within their community organizations, friends and family, CC Television, email and internet Visually impaired use health system more than others Primary care physicians and VNA Get information through school system, radio, and community agencies Visual materials in large print or Braille Interview Findings

Information Wanted DURING and AFTER a Public Health Emergency: 

Information Wanted DURING and AFTER a Public Health Emergency What to do and where to go “I think they just want to know what to do, where to go, you know, safe places to go.” Where to go to get information “In the event that something happens, people need to know how to act or react properly, and where they should call for help. Establish a central location so people can call. Keep in mind availability of interpretation for people who do not speak English well.” Interview Findings

Vehicles for Delivering Information DURING and AFTER an Emergency: 

Vehicles for Delivering Information DURING and AFTER an Emergency Most would go to: Television or Radio “Television or radio is the best and fastest way to get information out. But, it has to be very simple, and on TV visuals or pictures should accompany it. Information should be provided in both English and Spanish.” – ESL/Low literacy participant Community agencies Newspapers Websites Hearing Impaired SAP radio Portuguese-speaking TV/Radio (Cabo Video and others) Agencies would call their members Interview Findings

Vehicles for Delivering Information DURING and AFTER an Emergency: 

Vehicles for Delivering Information DURING and AFTER an Emergency SE Asians Simple text to agencies to translate, mail out, and broadcast on TV African American Radio: 106, 94.5, WBRU on Sundays, WPRO Office of case management services at Urban League Visually Impaired E-mail list (RI Commission on Deaf and Hard of Hearing) RI Registry of Interpreters for Deaf Live interpreters using American sign on TV Internet Text messaging Interview Findings

Trusted Sources of Information: 

Trusted Sources of Information All trust service providers and cultural organizations associated with their community Most trust religious organizations and local news media “The most trusted sources of information during an emergency would be the community leaders, at these organizations as well as within the specific communities in which they reside, religious leaders, and probably the media. I think this population tends to believe most of what they see and hear on the news or radio, especially during an emergency.” A few trust public officials Interview Findings

Trusted Sources of Information: 

Trusted Sources of Information Sources mentioned specifically: African American  trust black public officials, Providence mayor, Dr. Nolan, and Patrick Kennedy; and trust black reporters on Ch. 10 and 6; John Hope Settlement House; Urban League; NAACP Southeast Asian  religious officials, newscasters, Governor of RI and Mayor of Providence African  mosques and churches ESL/Literacy services  religious organizations, media “The most trusted sources of information during an emergency would be the community leaders, at these organizations as well as within the specific communities in which they reside, religious leaders, and probably the media. I think this population tends to believe most of what they see and hear on the news or radio, especially during an emergency.” Interview Findings

Trusted Sources of Information: 

Trusted Sources of Information Portuguese  media broadcast in their language, churches, pediatricians Hearing impaired  police and fire personnel, newscasters on CC TV Ch. 10, former Mayor and Governor Deaf/Blind individuals mostly trust their families to provide information Visually impaired  federal and state officials, Department of Health “The most trusted sources of information would be the government or state officials, members of the Department of Health, and our staff. This population calls us all the time looking for information, or looking to clarify information. They really trust us.” Interview Findings

Recommendations Made Regarding Information Delivery DURING an Emergency: 

Recommendations Made Regarding Information Delivery DURING an Emergency Many thought that their population would trust a public official endorsed by their community organizations more than other officials Most recommended that public officials and trusted service providers in the seven communities of interest work together to identify effective means of reaching these populations and communicating messages to them Interview Findings

Establish relationships of trust NOW: 

Establish relationships of trust NOW “I don’t think the Department of Health should necessarily be the ones providing the information directly to the people. They should provide organizations like ours with the information they want to get out, and we can make it culturally appropriate, and simplify it so people will understand it. To be better prepared, these people need to be trained on what might happen and where to go, etc. They have to establish trust before something happens. Establishing trust is the most important thing. For example, we do a lot of work on crime reduction. I have police officers come in and meet with the clients so they can develop a relationship and trust, before something happens where the police will actually be needed. This kind of training must take place.” – Provider of ESL/Literacy services Interview Findings

Barriers to Information for Special Populations: 

Barriers to Information for Special Populations Literacy Ability to understand English or health terminology Lack of or low quality translations “Usually they get a poor version of whatever has been done in English. It never looks as good. It’s a piece of paper and not a brochure like in English…The quality of the translations is bad. People assume that because many Portuguese-speaking people understand Spanish when they hear it, that they can also read it and most can’t.” Interview Findings

Barriers to Information for Special Populations: 

Barriers to Information for Special Populations Cultural/religious appropriateness and sensitivity of information disseminated and requests made “If a Southeast Asian woman goes to the hospital, the nurse or doctor doesn’t understand the culture. American trained doctors, they don’t speak the language.” Distrust of public and government officials (mostly among recent immigrants) Limited Internet Access Hearing impaired: Access to TTY lines, inaccessibility of radio Visually impaired: Inaccessibility of written information and televised information (can hear but not see visuals) Interview Findings

Requests that Special Populations are Likely to Follow: 

Requests that Special Populations are Likely to Follow Most emphasized the importance of explaining the rationale behind the recommendations made “I think since 9/11, everyone, including the visually impaired would be willing to follow any advice, recommendations, or orders given from the state or federal government. I think the critical things here is that this population would have to know and understand why it is that they are being asked to do or not do these things.” Nearly all would stay inside their houses or in RI, and not drive Some might leave and drive to be with their loved ones Most would be vaccinated Interview Findings

Requests that Special Populations are Likely to Follow: 

Requests that Special Populations are Likely to Follow Most would avoid hospitals unless seriously injured Some might use phone to contact loved ones Hearing impaired would use phone lines to access information on the internet, which is a main source of information for them Visually and hearing impaired are likely to call police or fire departments out of fear or to ask for protection Almost all thought that parents would go anywhere they needed to be with their children “They would most definitely not leave their kids at school. This population is extremely family-oriented and the first thing they would do is go get their kids and bring them to where they can all be together.” Interview Findings

Recommendations for Proceeding: 

Recommendations for Proceeding Develop a network of community agencies with whom HEALTH can partner to plan strategies for reaching special populations Utilize mechanisms of accessing health information already used by the special populations to distribute information on bioterrorism and other health emergencies Seek endorsement for public officials through community leaders and utilize their assistance to deliver information to special populations Interview Findings

Recommendations for Proceeding: 

Recommendations for Proceeding Be prepared to inform populations about where to turn for accurate and credible information in the event of an emergency, how to protect themselves and their families, and what resources are available in the community Develop high quality translations of materials Ask special populations to take steps to protect themselves that are feasible during emergencies and explain the rationale for such requests Interview Findings