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SARSControl deliverable D5.9
Conclusions and Recommendations for Risk Perception and
Risk Communication
Thomas Abraham1, Johannes Brug2, Gillian Elam3, Xinyi Jiang3, Irene Veldhuijzen4,
Hélène Voeten2, Yi-Chen Wu5, Cicely Yuen4 and Onno de Zwart, 2, 4
Journalism and Media Studies Centre, University of Hong Kong, Hong Kong
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam,
The Netherlands
Health Protection Agency - Centre for Infections, London, United Kingdom
Municipal Public Health Service Rotterdam Area, Rotterdam, The Netherlands
Advertising of Public Relations Department, Fu-Jen Catholic University, Taiwan
November 2006
SARSControl: Effective and acceptable strategies for the control of SARS and new emerging
infections in China and Europe, a European Commission project funded within the Sixth
Framework Programme, Thematic Priority Scientific Support to Policies, Contract number:
This document is based on the final reports of SARSControl Work Packages 5 and 6 listed below.
The contents are grouped by topic and the conclusions are followed by the accompanying
recommendations. Part 1 ‘Risk perception and efficacy’ and part 2 ‘Information sources’ are
directly based upon the research conducted in both work packages. Part 3 ‘Other’ and part 4 ‘For
further research’ result from group discussions among all work package participants informed by
the study results and other scientific experiences. At the end of this document we have
summarized all conclusions in a table.
SARSControl reports that informed the conclusions :
Work Package 5, Risk Perceptions
− Risk Perceptions Survey; General description and international comparison and Country
− Qualitative Stage: Impact of SARS on vulnerable communities; The United Kingdom and
The Netherlands
Work Package 6, Risk Communication
− Risk Communication during the SARS epidemic of 2003; Case studies of China, Hong Kong,
Vietnam and Singapore
− Risk Communication during the SARS outbreak in Taiwan: What did we do and what have
we learned?
1. Risk perceptions for emerging infectious diseases appear to be high enough across most
countries in Europe represented in SARSControl. This is especially the case if people
envision an outbreak in their own country. However, efficacy beliefs, i.e. beliefs about
personal control to reduce risks (‘self-efficacy’) and beliefs about efficacious measures to
reduce risk (‘response efficacy’), are relatively low. Concerns arising from fear of stigma or
fear of causing adverse reactions contribute to reduced self-efficacy beliefs; lack of
international consistency and of locally available relevant guidance reduce response efficacy.
In the Chinese communities that were assessed in the UK and the Netherlands, risk
perceptions appear to be lower on average than in the general population, especially in the
UK. However, even within the overall seemingly lower risk perceptions among the Chinese
populations in the UK and the Netherlands, the avoidance strategies adopted as precautionary
behaviour of those with higher risk perceptions had an adverse impact on the community,
particularly in crowded, urban areas.
Risk communication should therefore focus on:
− improving specific precautionary behaviour and the efficacy beliefs necessary for this;
communicating about what people can do to appropriately and effectively reduce their
− Risk communication messages to the public and the media should contain answers to
the following questions that are uppermost in the public mind
- what is happening?
- what risk is it to me?
- what should I do?
- what is the government and the public health system doing?
2. In the affected Asian countries, efficacy beliefs are higher. Respondents from these countries
have had first hand experiences of SARS, including clear instructions regarding precautionary
behaviour. Most importantly, they experienced ‘surviving’ SARS. Risk communications that
draw on first hand experiences and evidence-based effectiveness may therefore carry more
weight with the public. Experience and feedback are important ways to (re) assesses risks and
efficacy beliefs.
3. At the first stages of an outbreak, effective precautionary actions are often not clear or
evidence based, since much information about the disease and its modes of transmission are
not yet known. Nevertheless rising risk perceptions, particularly vulnerability, create a desire
to take precautionary actions, and thus a demand for risk communications. The need for quick
risk communication in countries with the outbreak is clear, however, this may also be
necessary in unaffected countries because of the presence of ethnic communities from
affected countries. In the case of SARS, delays in risk communications from official sources
in unaffected regions led vulnerable residents, like Chinese communities, to seek information
from affected regions when relevant local information was absent. Sensational media
coverage focusing on the seriousness of SARS and lack of scientific knowledge, together
with perceived contradictions in advice from affected and unaffected regions undermined the
reliability of local risk communications.
Theoretically priorities for communication on precautionary actions should be:
I Communicate about effective actions as soon as possible
II Communicate about actions that may have detrimental effects
III Communicate about non-effective non detrimental actions
4. Mass media such as television and newspapers are used most often as information sources for
emerging infectious diseases, and are well trusted. Use of and confidence in both television
and newspapers are higher in Asia than in Europe.
Governments and health agencies can use mass media to communicate risk management
information to the general public;
Governments and health agencies should learn how to use the media effectively. This
includes that agencies are prepared to approach mass media, have a designated spokes person
to address the mass media and can suggest independent experts next to government
5. In the minority communities in unaffected regions with strong familial and business links
with affected regions, the social network appears to be an additional important and
trustworthy source and medium for risk and risk management information. This includes
networks both in the country of residence and from affected regions.
A community-based communication approach can therefore be helpful to reach such
communities in an effective way. This means that a community-communication strategy
including contact with community organizations, key figures and media from communities,
needs to be in place. Existing networks need to be identified that can be used for communitybased risk communication.
6. Chinese communities in the UK and the Netherlands used Chinese-based mass media
intensively alongside European media. The Chinese mass media included media originating
from affected regions, from unaffected countries of residence in Europe and other regions.
Vulnerable and minority communities will use a variety of information sources due to
language barriers and a desire for ‘first hand’ information from affected regions.
Governments and health agencies should take the communications in the Chinese media into
account when addressing the Chinese communities. In general it is important to take into
account media from countries of origin of ethnic communities.
7. In the absence of prompt and rapid information from the authorities, rumours spread during
infectious disease epidemics. This is clear from the SARS experience in both Hong Kong and
Singapore. Public health authorities need to be geared for the rapidly correct rumours.
8. Health communicators should make sure that relevant risk communications from respected
sources coincide with reports of serious and threatening emerging infections. This means that
communication channels and sources should be in place, including international networks to
facilitate consistency and appropriateness of risk communications in both affected and
unaffected regions.
9. Risk communication should be dialogue. Feedback from the public and from health workers
is necessary in order to learn how the public respond to such communications and what
additional information is required to effect appropriate precautionary actions. Vulnerable
communities need to be identified and relevant communications developed for them.
10. Governmental and/or health agency’s risk communication strategies and infrastructure should
be in place before a new infectious disease emerges. Risk communication for emerging
infectious diseases is often ‘crisis communication’. A risk communication infrastructure and
culture that are effective globally and locally cannot be created in a short time span.
11. A risk communication strategy and infrastructure of governments and health agencies should
include a strategy and infrastructure for communication with different target groups, like
different ethnic communities / immigrants. Especially in light of their links with countries
where an actual outbreak may take place. In developing such a strategy and infrastructure for
communication it is important to also include strategies to reach groups like newly arrived
immigrants, students and seasonal workers and those with ‘irregular’ status.
12. More research is needed to look at cultural differences in general perceptions of risk and
efficacy beliefs and how these differences may influence precautionary actions.
13. The European Union, maybe through the ECDC, and member states should have a survey
system in place to monitor risk perceptions, efficacy beliefs and precautionary actions, to be
able to react timely and tailored to risk perceptions in the general population and special
interest groups. The experience gained through the SARSControl project working with both a
survey and focus groups are a good starting points for such a survey system.
14. Further research on new media such as text messaging, www, e-mail, blogs, for risk
communication is needed.
Risk perception and efficacy
In Europe: risk perceptions are high; but
efficacy beliefs are relatively low
In Asia efficacy beliefs are higher, likely
because of first hand experience with SARS
Among communities originating from affected
regions, lower RP at population level still led to
take up of PB with adverse impact; RC from
affected regions used in unaffected regions
Risk communication delivery
Impact of delays in RC on info seeking and PB
Impact of global media and international-social
Implications for risk communication content
Specific precautionary behaviour and the
efficacy beliefs necessary for this
Implications for effective content
Specific needs of such communities and subgroups; timely communication about effective,
detrimental, non-effective actions
Implications for risk communication delivery
Timing of risk communication
Need for global media strategy and
networks on RP & PB in vulnerable group;
Multiple sources of media used from different
origins; needs relate to: language; cultural
communication; relationship to affected region
Sources of info (influential and trusted)
Evolution of RP and PB
Crisis communication; time needed to
communicate effectively to different subgroups
infrastructure; relevance; use of social
networks; consistency; heterogeneity; use of
community channels; language; don’t rely on
one source
Communication channels
Need for dialogue
Risk communication strategies and
infrastructure should be in place before a new
infectious disease emerges
Implications for further research
More research is needed to look at cultural differences in general perceptions of risk and efficacy
beliefs and how these differences may influence precautionary actions
Have survey system to monitor risk perceptions, efficacy beliefs and precautionary actions in
place; SARS control survey and focus group outline are good starting points for that.
Further research on the use of new media such as text messaging, blogs, etc. is needed.
RC – risk communication
RP – risk perception
PB – precautionary behaviour