Abstract
The ongoing COVID-19 pandemic and its accompanying “infodemic” lend new urgency to the study and practice of risk communication. Especially prior to the distribution of vaccines in early 2021, our primary means of responding to the pandemic has been to communicate accurate information about risks and protective actions to the public. It is particularly crucial to effectively communicate such information to vulnerable groups, which is to say those that are especially susceptible to harm: this includes persons with underlying health conditions or disabilities, elderly people, the socioeconomically disadvantaged, and ethnic and linguistic minorities, among others. This task, however, is complicated by the facts that these groups are often difficult for risk communicators to reach and sometimes vulnerable to disinformation as well as to disease. After highlighting the role of risk communication in COVID-19 governance, this chapter examines the Protective Action Decision Model (PADM) as an appropriate tool for assessing the impact of individual- and group-level vulnerabilities on information channel access and preference, perceptions of threats, and assessments of risks and protective behaviours. Particular attention is given to the way vulnerabilities intersect to aggravate both negative health outcomes and information deficits. The chapter closes by advocating empirically-grounded risk communication strategies that take social complexity and the lived experiences of vulnerable groups into clear and intentional account.
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Keywords
- Inclusive communication
- Communication during COVID-19
- Vulnerable groups
- Information deficits
- Protective action decision model (PADM)
13.1 Introduction
Risk communication is at the core of successfully assessing and managing risks (International Risk Governance Council—IRGC 2005). It refers to the process of exchanging risk-related information between actors and communicating it to the public (Reynolds and Seeger 2005; IRGC 2017). However, risk communicators often address “the public” as a homogeneous group (Purohit and Mehta 2020). This is counterproductive, as different groups within society have differential information needs and behaviours. Risk communication strategies and measures that focus only on the needs of the majority may unwittingly exclude minority groups, or even aggravate their vulnerabilities.
This chapter identifies vulnerabilities—defined as “conditions determined by physical, social, economic, and environmental factors or processes, which increase the susceptibility of [an individual or] a community to the impact of hazards”—as crucial considerations in risk communication in general, and in communication on health crises such as COVID-19 in particular (UN/ISDR, Geneva 2015; cited in the Hyogo Framework for Action 2005–2015). Policymakers and public health experts unanimously recognise the disproportionate impacts of pandemics on vulnerable groups, including persons with underlying health conditions (Heffelfinger et al. 2009); elderly people (Gerst-Emerson and Jayawardhana 2015); pregnant women (Rasmussen et al. 2009); children (Stevenson et al. 2009); persons with disabilities (Campbell et al. 2009); Black, Asian Minority Ethnic (BAME) groups (Khunti et al. 2020); low-income and socially disadvantaged persons (Bouye et al. 2009); immigrants and refugees (Truman et al. 2009); and homeless persons (Leung et al. 2008). Many of the same factors that increase vulnerability to pandemics also impact information behaviour, and accordingly, if and how risk communication is received, understood and acted upon. This chapter views the information needs of vulnerable groups from a risk governance perspective. After highlighting the role of risk communication in COVID-19 governance, the authors examine the Protective Action Decision Model (PADM) (Lindell and Perry 2012) as a promising tool for assessing the impact of individual- and group-level vulnerabilities on information channel access and preference, subjective perceptions of threats, and subjective assessments of risks and protective behaviours. Particular attention is given to the way discrete vulnerabilities intersect to aggravate both negative health outcomes and information deficits. The chapter closes by advocating empirically-grounded risk communication strategies that take social complexity and the lived experiences and decision-making heuristics of diverse target audiences into clear and intentional account.
13.2 Governing COVID-19 Risks Through Communication
Since its emergence in December 2019, COVID-19 has had a profound global impact. The ongoing response requires actions from a variety of stakeholders to identify and adopt both policies to reduce infection rates and countermeasures to minimise the adverse side-effects of these policies. Risk governance is the gestalt process of coordinating all such actions concerned with “how to deal with demanding public risks” (van Asselt and Renn 2011, p. 434). The risk governance concept provides a framework for examining the complex processes and decision chains involved in identifying, assessing, managing, and communicating risks such as pandemics (IRGCa n.d.).
The International Risk Governance Council (IRGC 2005) has developed a risk governance framework that recommends an inclusive approach involving multiple stakeholders (IRGCb no date). This framework has subsequently been revised by Klinke and Renn (2012) and Renn et al. (2011) to include the following activities: (1) pre-estimation; (2) interdisciplinary risk estimation; (3) risk characterisation; (4) risk evaluation; and (5) risk management. Risk communication measures necessarily cross-cut all five activities. Situating COVID-19 responses within this framework provides a structured means of analysing communication gaps that have emerged as the crisis unfolds.
The first element of the risk governance framework, pre-estimation, is concerned with the ways in which different stakeholders select and interpret different phenomena as relevant risk topics (Renn 2008). It is human actors that create and select risks, with some risks being deemed worthy of consideration and other risks being ignored (Renn et al. 2011). This selection ultimately determines the risks that are communicated to the public. However, even when risks are identified as being worthy of consideration, there can be gaps in communicating them to relevant stakeholders. For instance, while the UK Cabinet Office identified pandemic influenza as being highly likely and having the largest possible impact in its 2008 National Risk Register, gaps still existed in terms of communicating this to the public. The UK government undertook “Exercise Cygnus” in October 2016 to assess the domestic preparedness for and response to an influenza pandemic (Public Health England 2017). Lessons that Croydon Council, a UK local government organisation, learnt from Exercise Cygnus included the need for “a better understanding of the likely public reaction” to a pandemic to “help the development of a robust communications strategy to assist the response” (Nuki and Gardner 2020). While there have been many debates over whether COVID-19 constitutes a “black swan” event, the fact that multiple governments included pandemics in risk registers and warned of pandemics being a question of “if” and not “when” suggests that it is not. Thus, any communication gaps are not a result of COVID-19 being entirely unanticipated, but are instead due to a lack of planning and preparedness that failed to consider different groups within society, their medical and socioeconomic vulnerabilities, and their different information needs.
The second element of the risk governance framework, interdisciplinary risk estimation, involves (1) assessing risks to human health and the environment, and (2) assessing concern (Renn et al. 2011). Different levels of complexity, uncertainty, and ambiguity can pose challenges to the risk assessment process and ultimately the communication of risk. As outlined above, pandemics disproportionately impact different vulnerable groups, and while it is understood that a number of factors influence the spread and/or impact of COVID-19, there is a need for further research to understand the complexity of these different factors. Additionally, COVID-19 is characterised by limited and changing knowledge, which underscores the need to provide clear communication updates. For example, in the early stages of the COVID-19 crisis, the expert consensus on using ibuprofen to treat symptoms changed (Day 2020). If such changes are not communicated clearly and carefully, they can sow ambiguity and undermine trust. In terms of ambiguity and conflicting views of risk, the emergence of COVID-19 deniers who share misinformation and do not follow protective measures highlights the need for parallel communication strategies to target disbelief on the one hand and counter misinformation on the other.
Interdisciplinary risk estimation also involves examining the ways in which different individuals, social groups, and stakeholders perceive the risk, the issues they associate with the risk (Klinke and Renn 2012), and the asymmetrical social and economic implications of the risk (IRGC 2005). With COVID-19, there has been a disconnect between the policies that governments have communicated and the groups that are impacted by these policies. For instance, research undertaken in the UK by Atchison et al. (2020) found that some groups (e.g., lower income, BAME) were less likely to be able to follow protective measures such as working from home and self-isolation without suffering social and economic tradeoffs. The differential impacts of COVID-19 highlight the critical need to develop inclusive communications, based on empirical concern assessments, that address the information needs of different groups within the context of their living conditions. Furthermore, as Slovic (2020) makes clear, the concern assessment process must take account of different experiences, feelings, and social, cultural, and political values alongside quantifiable demographic and economic factors.
In terms of the third, fourth, and fifth elements—risk characterisation, evaluation, and management—it is crucial to recognise that judgements about risks, their tolerability, and their societal acceptability can change over time (Renn et al. 2011). COVID-19 provides a clear example of this: changing evaluations of the COVID-19 risk lead to changing risk mitigation recommendations and the need for frequent communication updates, some of which appear contradictory and have resulted in public confusion (Blouin-Genest et al. 2020). Different types of risk will require different risk management strategies, which can range from implementing strict risk reduction measures to doing nothing.
Risk communication, stakeholder engagement, and the consideration of context are cross-cutting aspects that run through all five elements of the risk governance framework (IRGCb n.d.). These cross-cutting aspects are key to creating conditions for the society-wide uptake of risk mitigation behaviours, as well as to building public confidence in the risk management decisions taken by authorities (EPFL IRGC 2020). The next section of this chapter focuses on reducing risk through the use of risk communication to achieve behavioural change.
13.3 Targeting Risk Communication to Achieve Behavioural Change
The crucial element of any risk communication activity is to reach a specified target audience in a timely manner, thereby helping to ensure compliance with risk management measures and other positive behavioural changes. As outlined above, different risks may require different management approaches, and risk communication enables relevant stakeholders to understand the risk, the justification for the management approach adopted, and their role within this approach (IRGC 2017). A typical risk communication activity, for instance, is informing citizens of preparedness actions they can take to enhance their response to different types of disasters (e.g., creating an emergency grab bag, making a plan, and identifying local and regional resources).
As the COVID-19 pandemic makes clear, however, the importance of effective risk communication is not limited to acute disasters. In the absence of a vaccination or approved treatment prior to December 2020, the response to COVID-19 required rapid and widespread behaviour change to reduce the spread of the virus (Betsch et al. 2020). Authorities can use different tools to facilitate behaviour change, including risk communication and restrictions (Betsch 2020). Across the globe, countries are implementing different communication and different restriction policies with varying degrees of success. Risk communication is at the core of all such responses, providing citizens with knowledge of the protective behaviours recommended or mandated in order to reduce the spread of coronavirus. Examples of the different types of desired behaviours being communicated by governments include:
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Wearing a face mask
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Washing hands
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Maintaining a specified distance (e.g., 1–2 m) away from others
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Working from home where this is possible
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Restricting activities and contact with others through lockdowns, self-isolating and physical distancing.
13.3.1 The Protective Action Decision Model (PADM)
Research has highlighted a number of factors influencing the adoption of protective actions such as the above (Anson 2015). The Protective Action Decision Model (PADM) is one model that outlines different factors influencing individuals’ adoption of protective actions (Lindell and Perry 2012). It provides a framework that examines the different factors, in addition to risk communication, that influence the likelihood that a person will undertake protective actions. This chapter draws on the relevant components of the PADM and relates them to recent literature and research being undertaken in the context of pandemics and COVID-19.
The PADM includes a number of factors that influence the adoption of protective actions; environmental cues, social cues, information sources, channel access and preference, warning messages and receiver characteristics (Lindell and Perry 2012). Environmental cues include sights, smells or sounds that directly indicate a threat, whereas social cues include behaviours by others, which are taken in response to a threat or imply the presence of a threat (Lindell and Perry 2012). Related to the concept of social cues, Van Bavel et al. (2020) highlight how behaviour is influenced by social norms, the perception of what others are doing, and the expectation of social approval or disapproval. Approaches to COVID-19 in many countries have focused on appealing to existing social norms (e.g., washing hands) and creating new norms (e.g., staying at home) to facilitate behaviour change (Habersaat et al. 2020). Conformity to social norms can be a powerful motivating factor: a March 2020 survey conducted in Japan, for instance, found it to be “the most prominent driving force for wearing masks” (Nakayachi et al. 2020, p. 3). Of course, social norms can also spread unsafe behaviours: examples are the promotion of faith-based and ritual healing in some religious communities (Hashmi et al. 2020; Desta and Mulugeta 2020) and the false belief within anti-vaxxer circles that scepticism in vaccinations is widespread (French et al. 2020). Making safe behaviours normative requires authorities to engage community members in encouraging safe behaviours and discouraging unsafe behaviours, thereby making collective safety central to the group self-definition (Templeton et al. 2020).
In addition to environmental and social cues, the process of deciding whether to undertake protective action is often cued by warning messages sent from an information source, through a channel, to a receiver (Lindell and Perry 2012). With regard to the information source, research has shown that trust in both the authorities responsible for risk communication and others in general (interpersonal trust) plays a role in fostering compliance with the messages issued (in this case, regulations and measures to limit the negative effects of the pandemic). This is particularly evident in Sweden, where the initial government strategy to curb the pandemic was based upon voluntary compliance with expert advice rather than hard regulations: Esaiasson et al. (2020) demonstrate the importance of high institutional and interpersonal trust to the success of such an approach.
While limitations of the PADM, including conflicting and counterintuitive findings and untested propositions, have been identified by Lindell and Perry (2012), it provides a useful framework for considering the different factors involved in deciding to adopt protective actions. Four further elements in the model—receiver characteristics, channel access and preference, threat and protective action perceptions, and situational factors and impediments—are explored further in the next two sections (13.4 and 13.5).
13.3.2 The Need for Targeted Risk Communication
The World Health Organization’s 2020 Call for Action on managing the COVID-19 infodemic establishes the importance of communicating information about COVID-19 “in ways that are actionable, and, where necessary, in ways that target specific vulnerable groups” (WHO 2020, p. 5). Targeting is crucial because many of the same social and individual factors that determine people’s health vulnerabilities also impact their information behaviour and threat perceptions. Since the late 1980s, researchers and practitioners have paid increasing attention to the impact of such variables on risk communication in particular (Plough and Krimsky 2020). It is widely acknowledged that to increase the effectiveness of communication and adherence to the desired behaviours, authorities should take into account the social norms, information behaviour, and experiential realities of the particular groups they are targeting (Habersaat et al. 2020).
Targeting is particularly important because differing receiver characteristics can impact receivers’ ability to follow the risk mitigation behaviours recommended by health authorities. Physical disabilities such as sight or hearing impairment, for instance, present hard barriers to the receipt of certain kinds of information. In addition to hard physical barriers, a range of demographic and sociocultural factors must be taken into account. Variables such as age, gender, level of education, race/ethnicity, language ability, technical ability, socio-economic status, religion, political orientation, and social milieuFootnote 1 can all impact information behaviour, group interest, and group self-definition. For instance, as outlined above, research undertaken in the United Kingdom found that despite a high willingness to self-isolate, respondents in the lowest household income bracket were six times less likely to be able to follow the recommended behaviour of working from home and three times less likely to be able to self-isolate (Atchison et al. 2020). Sociodemographic disadvantage is also associated with lower levels of trust in social institutions, including the healthcare system. Racial and ethnic minority communities, in particular, have often been subject to longstanding and pervasive discrimination, leading to differing patterns of trust. Members of these communities may be more likely to be wary about the public health information they receive, less likely to adopt recommended safety measures and potentially more susceptible to ‘fake news’, misinformation and conspiracy theories. This suggests the need for more targeted public health information and for partnerships between public health authorities and trusted organizations that are internal to these communities (Van Bavel et al. 2020). Health communication scientists indeed acknowledge that health disparities are driven by social and structural factors; the COVID-19 crisis has shown the need for new communication approaches, which move beyond a narrow focus on ‘individual responsibility’ (Dutta 2008; Viswanath 2006; Hull et al. 2020).
13.4 Intersecting Vulnerabilities and Information Behaviours
One complicating factor here is the intersectional nature of health vulnerabilities (Giritli Nygren and Olofsson 2014). The term intersectionality was first coined by critical race theorist Kimberlé Crenshaw (1989), and can be described as the “lens through which you can see where power comes and collides, where it interlocks and intersects” (Crenshaw 2017). Crenshaw describes how multiple dimensions of vulnerability often intersect in ways that complicate redress: for instance, black women face both gendered and racial employment barriers—or in this case, health vulnerabilities—whereas policy responses often assume a subject who faces only one such barrier or vulnerability (Crenshaw 1989, 1991). Risk communication needs to take into account the intersecting vulnerabilities that might prevent messages from being received by certain groups (Vardeman-Winter and Tindall 2010). Research on inclusiveness in science communication shows that failing to consider intersectional identities and the history that produced them can contribute to the reinforcement and reproduction of the systems that have marginalised people in the first place (Dawson 2019; Torres-Gerald 2019; Canfield et al. 2020; Kuran et al. 2020).
Three areas of particular concern which we will address below are channel access and preference, threat perceptions, and protective action perceptions.
13.4.1 Channel Access and Preference
Both empirical research and practical experience demonstrate that different groups often have different levels of access to various information channels (e.g. print, television, radio, and online). Different groups also often demonstrate usage preferences for certain channels or sources.
Physical disabilities offer a clear example of the variance in channel access and its impact on risk governance. Effectively communicating risks to the seeing-impaired, for example, not only requires developing audio-focused channels in addition to visually-focused channels such as online portals and television; it also requires tailoring the content of messages to ensure a high level of verbal description, including of information usually presented visually, such as geographic location (Sherman-Morris et al. 2020). Comparable challenges exist in relation to reaching the hearing-impaired (Engelman et al. 2017).
Language and cultural barriers are another clear example: risk communication messages will “be comprehended to the degree that [they] are conveyed in language that risk area residents understand” (Lindell and Perry 2003, p. 125). The disproportionate impact of disasters like Hurricane Katrina in the United States on minority and immigrant-background communities shows the importance of integrating non-majority languages and perspectives into risk communications planning from the ground up (Andrullis et al. 2007). It is not enough to simply translate majority-language materials: active input from minority communities is required to ensure that values and cultural factors are also taken into account, as these can impact trust (Perry et al. 1982).
Digital divides present an equally significant and in some ways more complex challenge. Van Dijk (2005) distinguishes between four interlinking categories of digital divides: motivational, material, skills, and usage. Early studies often focused on material access divides, for instance rural/urban infrastructure gaps or the availability of devices and subscription plans that low-income populations can afford (Selwyn 2004). However, motivational, skills, and usage divides can be equally significant (van Deursen and van Dijk 2015). The different types of access often correlate with each other, as well as with a range of demographic and sociocultural variables. For example, younger age groups are often more highly motivated and skilled in the use of social media, making channels like Facebook, Twitter, and Instagram potentially effective channels for youth-targeted risk communication, whereas television and radio are more appropriate means of reaching older groups (Collins et al. 2016).Footnote 2
The intersectional nature of vulnerabilities can impact digital channel access in both expected and unexpected ways. In the Netherlands, for instance, income, education, age, and gender all directly affect material access, with education and age—but not income—additionally affecting skills and usage (van Deursen and van Dijk 2015). In the United States and other super-diverse countries, ethnicity/race has also been shown to impact ICT use, often in intersection with gender and socioeconomic status (Jackson et al. 2008). Such research casts doubt upon the assumption that improving material access to key information channels is alone sufficient to improve communications to vulnerable groups. Indeed, it highlights the harmful potential of such assumptions to place responsibility on vulnerable groups for improving their own information behaviour, while leaving unexamined the social causes of ingrained gaps in motivation, skills, and usage.
13.4.2 Threat Perceptions and Protective Action Perceptions
Health, demographic, and sociocultural variables affect risk communications on the level of content as well as channel. Insofar as such factors condition human experience as a whole, they also invariably impact subjective perceptions of threats and protective actions (Lindell and Perry 2012). Vaughan (1995) describes this as a matter of framing and weighting risk issues and dimensions. Framing refers to the way a risk is initially conceptualised and defined, while weighting refers to the attachment of different degrees of importance to different dimensions of the risk situation, including the expected positive and negative outcomes of protective actions (Fischhoff 1983; Krimsky and Plough 1988). While risk communicators generally strive to present risk issues and protective actions in objective terms, their target audiences will invariably frame and weight these issues and actions in accordance with their subjective experiences, values, and concerns.
Physical disabilities offer perhaps the clearest example of the way different groups frame and weight risk dimensions differently. For instance, many of the measures taken to mitigate COVID-19, such as physical distancing and the avoidance of touch, are significantly less feasible for the Deaf-Blind community, who sometimes rely on touch for both communication and assistance with everyday tasks (Goggin and Ellis 2020). For some sight- and/or hearing-impaired citizens, the perceived risk of COVID-19 transmission through physical contact may not outweigh the perceived psychosocial and medical risks of recommended protective actions such as physical distancing. Failing to take such perspectives into account when designing communication strategies can easily lead to ableism, or the assumption of a “default subject” of policy who does not have disabilities (Mitchell and Snyder 2015, as cited in Goggin and Ellis 2020). While promoting measures such as physical distancing to the public as a whole is crucial, this must not be done in a way that presumes the universal capacity to take such measures or leads to the stigmatisation of groups with different risk complexes.
13.5 Barriers Within the Information to Behavioural Change Loop
As Sect. 13.3 stresses, the purpose of risk communication is often to motivate changes in behaviour, e.g. to promote protective behaviours and risk mitigation measures. The PADM, however, emphasises that the uptake of such measures depends on numerous factors other than access to the message: predecisional processes, situational factors (such as access to resources), perceived control over future outcomes, and perceptions of risk communicators and other stakeholders can all play a role as well (Lindell and Perry 2012).
13.5.1 Predecisional Processes
Receiving information about a hazard, such as COVID-19, will trigger the predecisional processes of exposure, attention and comprehension. Predecisional processes are semi-conscious cognitive and affective processes that condition whether people receive information, to what extent they pay attention to it, and how they comprehend it (Lindell and Perry 2012). Such processes are grounded in prior experiences, beliefs, and values: as Vaughan stresses, “individuals are not passive receivers of risk information, rather, communications are actively filtered through the ‘lens’ of a priori belief and value systems […] A priori beliefs may moderate the relationship between particular communications and eventual outcomes or responses” (1995, p. 175). Beliefs about risk in particular are often deeply rooted in the conditions of everyday life and past subjective experiences of well-being and distress, upon which inferences about the importance of certain kinds of information and the positive and negative outcomes of future behaviours are based (Dow and Cutter 2006). A different set of life experiences will inevitably lead to different ways of processing risk information and framing and weighting risk factors (Wachinger et al. 2013).
Debates over the trade-offs of lockdowns and physical distancing offer a salient example. On the one hand, lockdowns have been fairly conclusively shown to reduce COVID-19 transmission rates and deaths; at first glance, the bioethical case for lockdowns appears to be a simple matter of health over wealth (Li et al. 2020). However, this framing assumes a certain default position: that of subjects who might suffer economically and socially due to a lockdown, but whose lives and basic well-being would not be put at risk. This default position does not match the living conditions and experiences faced by numerous groups: for instance, those in absolute poverty (Broadbent et al. 2020); the mentally ill (National Academies of Science, Engineering and Medicine 2020); or women in abusive relationships (Gosangi et al. 2020; Schulz and Mullings 2006). For such groups, the health-vs.-wealth risk frame is radically insufficient, and attempted behavioural interventions that assumed such a frame would stand a chance of being rejected.
13.5.2 Situational Impediments and Facilitators
Even in cases in which risk communication audiences accept the communicators’ framing and perceive the negative consequences of the risk as outweighing the potential negative consequences of the recommended protective actions, they do not always take these actions. Here, situational factors are often at fault: “the actual implementation of behavioral response depends not only on people’s intentions to take those actions but also on conditions in their physical and social environment that can impede actions that they intended to take or that can facilitate actions that they did not intend to take” (Lindell and Perry 2012, p. 624). Risk communicators must take account of the fact that socioeconomically disenfranchised individuals and groups have less access to some resources and a narrower range of options available to them in some spheres of life, including with regard to risk aversion and mitigation. For example, poor communities are sometimes more likely to accept development projects that entail environmental and health hazards as long as they are also advertised as yielding economic benefits (Otway 1990). Likewise, individuals threatened with poverty are often more likely to accept or keep hazardous work—which, under COVID-19 conditions, could mean any job in front-line sectors. Taking an intersectional interpretive framework here is crucial, as demographic variables such as minority status often correlate negatively with access to resources and options (Iacobucci 2020; Duque 2020). In the UK, The Intensive Care National Audit and Research Centre “found that 35% of almost 2,000 [COVID-19] patients were non-white, nearly triple the 13% proportion in the UK population as a whole” clearly showcasing that Black, Asian Minority Ethnic (BAME) individuals are more heavily affected (Booth 2020). The reason for this is socio-economic, as well as the fact that BAME people are more likely to be employed in front-line positions. As outlined above, women are also at higher risk of exposure and risk of infection than men due to a higher proportion of women being employed in health care and caring roles.
13.5.3 Perceived Control Over Outcomes
Another, pervasive and pernicious barrier is a lack of perceived control. In general, individuals with limited socioeconomic resources tend to express more passive attitudes in the face of risk, less certainty about the quality and actionability of different data on risk, and a generally more precarious sense of control over outcomes in their lives, including health outcomes (Vaughan 1995). In many cases, beliefs about limited control must be deemed rational, as they are based on concrete experiences of disenfranchisement or suffering: for instance, experiences of racial discrimination (Peterson et al. 2020) and aging-related health problems can both degrade perceived control (Robinson and Lachman 2017). This fact poses a challenge to risk communicators, as prior beliefs about risk and perceptions of control over future outcomes tend to be quite resilient, and broader questions of resource distribution are outside their scope of action. Enhancing perceived control is a significantly more difficult task than ensuring that accurate information is readily available, especially when intersecting vulnerabilities are in play. In some contexts, participatory communications approaches focused on collaborating with and empowering communities have proven successful (Weinger and Lyons 1992).
13.5.4 Stakeholder Perceptions
Target audiences’ perceptions of risk communicators also invariably impact their framing of risk issues and their likelihood of taking recommended protective actions. Here, power relations and trust are particularly crucial (Raven 1965, cited in Lindell and Perry 2012, p. 621). Individuals with a higher baseline level of trust in the authorities responsible for risk communication will be more likely to trust the information that they receive and be able to use this information to adopt recommended behaviours. A study of 25 European countries by Oksanen et al. (2020) identified institutional trust as a protective factor. This is consistent with findings on COVID-19 responses in China (Ye and Lyu 2020) and the United States (Sibley et al. 2020) as well as with research on the communication of other natural hazards such as floods and volcanic eruptions (Wachinger et al. 2013).
Here, again, an intersectional perspective is crucial insofar as it foregrounds the impact of power hierarchies and systems of discrimination (Schulz and Mullings 2006). For example, historical experiences of discrimination of racial and ethnic minority groups can lead to distrust in social institutions. Differences in the quality of health care—in terms of access, treatment options, prevention and health outcomes—reflect social inequalities across groups (Grabovschi et al. 2013; Duque 2020). Communities of colour and people with disabilities have historically been undertreated or abused through the medical system, and undocumented immigrants fear punitive measures should they present at a clinic or hospital (Berger et al. 2020).
13.6 Conclusion and Recommendations
The COVID-19 pandemic has had a profound impact on risk communication, validating some established theories and practices while bringing others into question. First, the magnitude and scope of its effects on a global scale are unique: while there are tested and agreed-upon strategies for communicating about natural disasters (e.g., flooding, wildfires) and man-made hazards (e.g., terrorism, industrial accidents), COVID-19 is a uniquely multifaceted crisis that requires multiple simultaneous approaches. Second, the ubiquity and unprecedented diversity of information and communications technologies distinguishes COVID-19 from other historical pandemics (Beaunoyer et al. 2020). Online networking has circumvented traditional gatekeepers and exponentially increased the number of channels and vectors along which good and bad information can flow, forcing a re-examination of risk communication as a practice and field of study. Existing group-level vulnerabilities aggravate these challenges significantly: even in countries with well-developed COVID-19 responses, the outbreak and its repercussions threaten the basic well-being of social groups whose lives and livelihoods are already precarious, while the uneven distribution of risk and suffering threaten to deepen inequalities and further divide societies. It is also possible that feedback effects can emerge between vulnerabilities to the pandemic itself and intersecting vulnerabilities to its accompanying infodemic, exponentially worsening both—this is among the questions that the European Commission-funded Horizon 2020 project COVINFORM will take up.
The complexities that distinguish COVID-19 will almost certainly characterise future systemic crises as well. Accordingly, it is imperative that researchers and practitioners approach the pandemic as a global living laboratory in which good and bad practices play out in real time. In the absence of a vaccine, government responses to COVID-19 at national and regional levels have largely focused on communication practices: e.g. disseminating accurate information, clarifying public health policies and guidelines, and encouraging risk mitigation behaviours such as ‘social distancing’ and proper hygiene (Fakhruddin et al. 2020).Footnote 3 The very different COVID-19 communication strategies being implemented by national and regional governments have yielded very different results. This provides scholars and practitioners with a unique opportunity to conduct comparative cross-national research and generate insights on the effectiveness of communication practices targeted toward different groups in different contexts. For instance, while the communication approaches of leaders such as New Zealand’s Prime Minister Jacinda Arden have been evaluated positively, the approaches of leaders in other countries have been branded as failures (McGuire et al. 2020).
One factor distinguishing successful from unsuccessful communications strategies has been attention to the lived experiences of the intended audiences. With regard to at-risk groups and individuals, experiences of inequality, discrimination, and lack of control often shape the context within which messages about risks are framed and weighted. Such experiences can negatively impact the motivation and/or capacity to adopt recommended protective actions. Accordingly, focusing on the intersecting nature of vulnerabilities, inequalities, and the power structures that instantiate and reproduce them should be applied as a guiding principle, not only in everyday prevention, but particularly in risk and crisis management (Kuran et al. 2020). While this certainly challenges aspects of the existing crisis management playbook, a deeper understanding of intersectional vulnerability “allows [stakeholders] to tackle problematic power hierarchies and imbalances, take more specific and targeted actions in crises to protect so far neglected individuals, and formulate better and more targeted legislation” (Kuran et al. 2020, p. 6).
Bearing this in mind, several general recommendations can be made for communicating measures and practices during the COVID-19 crisis in an inclusive way to achieve desired behavioural changes. As mentioned above, the COVID-19 crisis was unprecedented in a number of ways: the risk situation and social risk awareness evolved and scaled up quickly, and due to the overwhelming presence of ICT, communication was carried out in an extraordinarily diffuse way. To effectively communicate in such a situation, first, a clear aim and objective of the communication is needed; this also influences the selection of the channels through which messages will be communicated. Aims and objectives include, for example, raising awareness; influencing perceptions of the risk; counteracting misperceptions of preventive measures (Geldsetzer 2020); instigating socially productive and resilience-based actions (e.g., in the form of two-way communication with different stakeholders to understand the benefits and barriers of recommended measures; see Atchison et al. 2020); or building trust and resolving conflict, as demonstrated by New Zealand Prime Minister Jacinda Arden (Wilson 2020). It is important to adapt such aims and objectives as the situation evolves and changes.
Second, it is crucial to understand the context in which target audiences receive risk communication messages, as well as their drivers and barriers to action. Empirical research and direct engagement with target audiences can best achieve this goal. Levels of awareness and trust are relevant categories, as are differing behavioural norms and the social structures and power dynamics within a society. Conducting participatory research and proactive outreach in cooperation with groups that are particularly vulnerable to COVID-19, such as people with black and minority ethnic backgrounds, can help lead to a better understanding of how policies and communication can be developed (Devlin 2020). The authors would go so far as to argue that it is imperative for risk communicators to achieve an empirical understanding of their target groups, and to engage these groups in proactive outreach and cooperation, in order to ensure that risk information is received, understood, and acted upon as intended.
Risk communication can take place through a variety of communication channels, and research (Kano et al. 2011; Tanaka 2005) highlights the importance of using multiple channels. However, the nature of the COVID-19 crisis has restricted the use of certain channels. Face-to-face communication (e.g., in the form of community meetings), which traditionally facilitates two-way interaction and exchange with the public, has not been possible to the same extent as before the COVID-19 pandemic. As such, an increase in one-way communication via mass media, social media, online advertising, brochures, and direct mail has been inevitable. Such channels allow governments to share information, but they only allow audience voices to be heard to a limited degree. Social media, as an alternative or supplement to traditional media that enables two-way communication, has shown a significant increase in engagement compared to normal use during crises. While social media allows two-way communication with a large audience, an increasing amount of misinformation has also been shared, resulting in an infodemic (WHO n.d.). Persisting digital divides furthermore mean that certain audiences are excluded from information distributed via social media entirely, whereas the filter bubble phenomena means that certain audiences are excluded—or self-exclude—from certain (formally or informally closed) sub-networks and channels.
Finally, it is crucial to understand the effectiveness of COVID-19 communication. As such, ongoing research conducted with target audiences is needed to monitor and evaluate the effectiveness and impact of different communication strategies. Messages should be audience-tested and may include information on COVID-19 risks and symptoms; advice on which actions to take and which to avoid (e.g., physical distancing, washing hands, wearing face masks); indications of where to access trustworthy information; and briefs on the types of support available, etc. To be effective and avoid confusion, messages should be short, clear, and concise (Kuhlicke et al. 2016). In this context, it is important to consider the intersecting vulnerabilities that influence the interpretation of messages and uptake of protective actions, in order to understand barriers that may impede effective risk communication to particular vulnerable groups.
This being said, researchers and practitioners should avoid applying ‘vulnerability’ as a reified (i.e., static) category, and should take a constructively critical stance toward developmentalist and humanitarian narratives about the importance of reaching ‘the most vulnerable’. Rather, they should place a sharp focus on questions of power and hierarchy, aiming to understand how power relations and inequalities shape life experiences. This means challenging normative narratives about the homogeneity of communities and seeking to critically situate human experience within a systemic analysis of power (Schulz and Mullings 2006). In this sense, risk communication researchers and practitioners need to heed the voices of vulnerable individuals and groups—while simultaneously challenging the concept of vulnerability and avoiding generalisations about vulnerability (Kuran et al. 2020), in order to avoid ontological assumptions of ‘typical’ or ‘predefined’ vulnerable groups (e.g., socio-economic status, demography). This imperative is delicate, but no more so than the social situation engendered by the pandemic.
Notes
- 1.
A social milieu is a group of people united by shared values and status, the interplay between which help determine everyday lifestyle (Hradil 2006). COVINFORM partner SINUS-Institut has conducted studies on the relationship between social milieu and information behaviour regarding health (Wippermann et al. 2011), career orientation (Calmbach and Edwards 2019), electoral politics (Vehrkamp and Wegschaider 2017), and other areas of life.
- 2.
This being said, age-based usage patterns are not the only factor that should be taken into account when planning social-media-based risk communication. Channel-specific perceptions also come into play: for instance, research highlights how Twitter is an effective channel to distribute government strategies, but not to spread factual information about viruses (Thelwall and Thelwall 2020). In part due to this, traditional mass media remains a crucial source for information about emerging health threats and disease outbreaks (Jardine et al. 2015; van Velsen et al. 2014).
- 3.
At the time this chapter was finalised in mid-December 2020, Pfizer-BioNTech vaccine distribution had just begun in the United States. The UK had just approved the Pfizer-BioNTech vaccine for emergency use, and the European Commission had announced its intention to reach an approval decision by the end of the month.
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Acknowledgements
This article is the result of research activities of the COVINFORM project that has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 101016247.
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Anson, S., Bertel, D., Edwards, J. (2021). Inclusive Communication to Influence Behaviour Change During the COVID-19 Pandemic: Examining Intersecting Vulnerabilities. In: Linkov, I., Keenan, J.M., Trump, B.D. (eds) COVID-19: Systemic Risk and Resilience. Risk, Systems and Decisions. Springer, Cham. https://doi.org/10.1007/978-3-030-71587-8_13
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