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Communicating Health Risk Uncertainty: Busting the myths Cindy Jardine University of Alberta S. Michelle Driedger University of Manitoba

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Page 1: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Communicating Health Risk Uncertainty: Busting the myths

Cindy Jardine University of Alberta

S. Michelle Driedger University of Manitoba

Page 2: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

© Mischa Richter / The New Yorker Collection

Page 3: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Cartoon by Bradford Veley/bradveley.com

Page 4: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Study Objectives

To evaluate empirical studies of communicating uncertainty to the public in environmental health risk

To produce evidence-based recommendations that can be used by health practitioners

Page 5: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Methods

English language articles Published between January 1985 and Sept.

2008 Input from collaborators representing

regional, provincial and national health agencies

Page 6: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Search Techniques

Database search 38 databases in range of disciplines 38 related terms and synonyms

Key journal search e.g. Risk Analysis, Journal of Risk Research, Health Risk

and Society

Key author search 109 key risk communication authors

Page 7: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Health Sciences (6) e.g. Medline

Business/ Commun. (3) e.g. Business

Source Complete

Science/ Technology (5)

e.g. BioOne Abstracts

Interdisc (10) e.g. Academic

Source Complete

Agric/Env (4) e.g. Agricola, Environment

Complete

Psych/Soc/Ed (3)

e.g. ERIC, PsycINFO

38 DATABASES SEARCHED

Page 8: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Search Techniques

Database search 38 databases in range of disciplines 38 related terms and synonyms

Key journal search e.g. Risk Analysis, Journal of Risk Research, Health Risk

and Society

Key author search 109 key risk communication authors

Page 9: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Environment, health, pandemic, genetic,

etc.

Uncertainty, probability,

chance, credibility, etc.

Risk, hazard, crisis, etc.

Communication , disclose, inform,

etc.

Environmental Health

Risk Communication Uncertainty

Page 10: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Search Techniques

Database search 38 databases in range of disciplines 38 related terms and synonyms

Key journal search e.g. Risk Analysis, Journal of Risk Research, Health Risk

and Society

Key author search 109 key risk communication authors

Page 11: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Search Techniques

Database search 38 databases in range of disciplines 38 related terms and synonyms

Key journal search e.g. Risk Analysis, Journal of Risk Research, Health Risk

and Society

Key author search 109 key risk communication authors

Page 12: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Volume of Applicable Literature Screening Level Total

Quick Exclusion 29,499

Broad Screening 23,104

Sorting Paper Types 2,365

Review with Full Text 1,026

Literature Used for Extraction

282

Final 28

Page 13: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Methods – Data Extraction

Inclusion: Explicit focus on the public and uncertainty

Exclusion: where uncertainty is only mentioned in passing no empirical evidence; and studies about occupational health or economic risk

Page 14: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Results – Overview of research

28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Most studies from the US(14) and the UK (5)

Quantitative, qualitative and mixed methods

Disciplinary perspectives: Public Health, Health Policy, Communication studies, Risk Management, Medicine, Social Sciences, Nutritional Sciences

Page 15: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Myth #1: All uncertainty is the same

Page 16: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

One size (doesn’t) fit all

Cartoon by Bradford Veley/bradveley.com

Page 17: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Variability vs. Uncertainty

Page 18: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Conflicting knowledge vs not knowing

Page 19: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Source of uncertainty

Page 20: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Consequences of uncertainty

ScienceCartoonsPlus.com

Page 21: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Presentation of uncertainty

ScienceCartoonsPlus.com

Page 22: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Interpretations of uncertainty

Copyright © Alex Alexeev. Awaiting artist’s permission.

Page 23: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Interpretations of uncertainty

ScienceCartoonsPlus.com

Page 24: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Policy default assumptions

ScienceCartoonsPlus.com

Page 25: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Myth #2: People will not accept uncertain information

Page 26: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

People need some information

ScienceCartoonsPlus.com

Page 27: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Importance of plain language

ScienceCartoonsPlus.com

Page 28: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Unambiguous information

© 2009 Dave Granlund politicalcartoons.com

Page 29: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Know your audience

Cartoon by Bradford Veley/bradveley.com

Page 30: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Myth #3: Admitting uncertainty undermines credibility

Page 31: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Different demands for certainty

Cartoon by Bradford Veley/bradveley.com

Page 32: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Withholding information

Cartoon by Bradford Veley/bradveley.com

Page 33: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Not saying doesn’t mean people don’t know

Page 34: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Myth #4: Information should be withheld until there is reasonable certainty

Page 35: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Timing matters

www.CartoonStock.com

Page 36: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

10 day hypothesis re: timing

ScienceCartoonsPlus.com

Page 37: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

5/22/2013 37

10 days to full year - Walkerton

35% 37% 40%

77%

23%

8%

27%

46%

31% 36%

80%

34%

16% 19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Inquiry Blame Descriptions & control actions

Health Govt. response General (mis)trust

stories

Other

Story Reference Categories

10 days Full Year

Page 38: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

5/22/2013 38

10 Days to full year - BSE

81%

27%

64%

31%

22%

3%

27%

80%

14%

2%

20%

37%

66%

26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Economy Blame Descriptions & control actions

Health Govt. response

General (mis)trust

stories

Other

Story Reference Categories

10 Days Full Year

Page 39: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Myth #5: The media never get it right

Page 40: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

The media ‘bad dog’

Cartoon by Bradford Veley/bradveley.com

Page 41: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Need to cultivate media relationships

www.CartoonStock.com

Page 42: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Filling the information void

5/22/2013 42

Page 44: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

The spokesperson matters

ScienceCartoonsPlus.com

Page 45: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

The spokesperson matters

Page 46: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Take home messages

© Mischa Richter / The New Yorker Collection

Page 47: Communicating Health Risk Uncertainty: Busting the myths · Results – Overview of research 28 articles from 1985 to 2008 (Sept.) 22 articles from 2000 to 2008 6 articles from 1985-1999

Acknowledgements Funded by: Canadian Institutes of Health Research,

Knowledge Synthesis & Knowledge Translation Research Assistants: Alison Watson, Chantal Ritcey,

David Sulz, Darby Love, Andrea Milne, Elizabeth Deblois, Erica Wright, Amanda Boyd, Bhavnita Mistry, Elizabeth Cooper, Stephanie Kowal

Collaborators: Dr. Mike Routledge (Manitoba Health), Dr. Maura Ricketts (Canadian Medical Association), Mr. Alex MacKenzie (Alberta Health and Wellness), Mr. Nelson Fok (Alberta Health Services), Ms. Tamara Magnan (Health Canada)