The Road to Preparedness Starts with AwarenessWe have a problem. Pandemic flu is not on the radar for most people in this country. It’s not even in the solar system. I am embarrassed to admit this in the face of all I’ve been learning this week, but until I was invited to participate in this blog, I had never given much thought to pandemic flu. I consider myself pretty knowledgeable about health issues, I’m a member of my local Community Emergency Response Team, I have all my earthquake supplies ready to go, I get a flu shot every year. But I was almost entirely unaware of the likelihood of a flu pandemic, let alone how I should protect my family. If someone like me, with a background in public health no less, is so unaware, we have a lot of work to do. We can’t realistically expect to jump from a state of almost total ignorance to community readiness in a short period of time. We need to be in it for the long haul. A useful way of thinking about the behavior change process is with the Stages of Change theory, or Transtheoretical Model, that we often use quite effectively in social marketing. This model says that behavior change is not a one-step process, in which first someone is not doing a behavior and then they are. Behavior change is a continuum, in which people move from stage to stage, or they may stop at any point without actually making the change. Knowing what stage they are in helps us determine the correct approaches to use to help them move to the next point. The first stage is called precontemplation. People at this point are not aware that there is a problem or that they may be at risk, and do not intend to make any changes in their behavior. On the issue of pandemic flu, most people would fall into this group. To move them to the next stage, we need to make them aware of the issue. Greg Dworkin’s excellent post lays out the basics that people need to know before they will be willing to even consider taking action. The next stage is contemplation, where people now know about the problem and are considering whether they want to do something about it. For this group, show the benefits they will receive from taking action, and demonstrate that people like them, as well as others they look up to, have already made this change. So, we might emphasize the benefits of protecting their family and community, staying healthy and alive, the security of feeling prepared, avoiding the inevitable rush to purchase supplies — whatever works with the different groups we need to reach. We could also share testimonials from real people who have already prepared for a flu pandemic and use spokespeople that each audience sees as credible on this issue. Once someone decides they want to take the target action, they move into the preparation stage. They start to think about what it will take to do it, whether they are able to do it, and they start to bump up against barriers that will keep them from moving forward. At this point, people need the barriers removed — make it easy for them to do what you are asking and take away all the reasons why they will tell themselves they can’t do it. Someone in the preparation stage might acquire a list of items they need to buy, intending to get them, but run into problems like not knowing where to go to purchase face masks or not having the storage space in their home for so much food and water. We could offer things like prepackaged supply kits that obviate the need to go from store to store looking for the items on the list, tips for how to build up an emergency food supply and store it unobtrusively, fill-in-the-blank preparedness plans that businesses can customize to their own situations, and other effort-reducing approaches. Once they are prepared and barriers are removed, then people can take action. For a one-time behavior, the action step is the end of the process. But for an action that has to be done more than once over a period of time, they will move into the maintenance stage, which may not have an end-point. Once people build up their food and medication supplies, they will eventually need to replace them with fresh items, and as they move through various life stages their needs may change as well. They will require positive feedback and ongoing motivational messaging to avoid becoming burned out on the process. Our challenge, then, is to help people move through all of these stages. The first priority, based on where the majority of the population lies, is in raising awareness of the issue — not in getting individuals to take action (yet). We need to use all methods available to shout the message from the mountaintops so that people are as knowledgeable about pandemic flu as they are about the lives of Paris Hilton and Britney Spears. We can work with the news media, professional organizations, schools, entertainment TV (like E.R. or 24), TV and radio talk shows, local emergency response organizations, physicians, boy scout troops, online social networks, blogs, and other means of disseminating information. HHS should consider using the Surgeon General as a prominent spokesperson to underscore the seriousness of this public health issue, as C. Everett Koop did with his brochure on AIDS that was sent to every American household in 1988. The awareness communications should include a website or phone number, which will then offer the types of messaging and social reinforcement that will bring people to the next step. Different types of approaches can be devised for people in each behavior change stage, as well as for different audiences. Leaders in each sector will need to play an important role in getting the word about about the existence of the threat of pandemic flu to their constituents, and HHS can help to facilitate that. The volume of communications to create the necessary level of awareness will not be cheap. So far, there have been many great ideas coming out of this blog as to how to get people to take action. But let’s not get ahead of ourselves. The focus right now needs to be on getting the words “pandemic flu” onto the tips of hundreds of millions of tongues.
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Great post, I highly value your engagement, and now three comments: speed, what-first, and let’s-work-together.
First, speed:
Many of us see this whole process as a race between influenza viruses and humans: we’re all getting ready for a fight to the death. They are evolving (at unknown speed), and we should adapt too (as fast as we can, at least for the essentials).
Nobody really knows how much time we have. So maybe it would be a good thing to try and look into ways to speed the whole process up.
Is it a matter of more money (to buy bandwidth), a stronger voice from above (as has repeatedly been suggested, requested, demanded, hinted, counted, begged, yelled, stated), many more voices from the side (here’s to hoping this blog gains readership and makes it into the press), new and better ideas, all of that, other things I haven’t mentioned?
You have kindly (and candidly) provided your professional guidance after acknowledging you’re at an early stage in your own process. Thank you! And may I ask you to keep expressing your thoughts and ideas as you learn along? I think it would be extremely helpful.
Many who have been into this for “too long” cannot be good role models for the early steps of change.
Now, my what first comment:
The way you’ve outlined it, it looks as if we people go through all the stages sequentially.
But couldn’t it also be that we “dance between stages”? Maybe we should first stock up for a week, then reflect on why, then buy for another week, and so on?
Whatever works, of course; but what would be your thoughts on this?
Thirdly, how could we work together on this?
Specifically, you’ve outlined a number of strategies for each stage. Would you let us copy what you’ve written onto (ours and everybody’s) wikipages (those are under a wikipedia-compatible license), and flesh your advice nuggets out?
I think the flublogian communities have lots of stuff that could be linked from your scaffolding ideas. We’ve been collecting lots of stuff that could be used. I’m hopeful that you’ll feel amazed, and that we’ll feel amazed too.
Would you help us directly (yes, this is an invitation, and would be matched by appropriate technical help as needed), and tell your also highly skilled professional friends to help us, by working on a set of strategies on the forum (there are many other forums) or directly on the wiki?
It would be great to go on getting your input on all of this.
We have a lot to learn if we want to become effective at engaging wider and wider circles of people.
Again, a big Thank You!
Posted June 3rd, 2007 at 5:03 amNedra - What a great blog!
You are exactly right. All the “preparedness” ideas in the world people can come up with will have no effect at all on a public that isn’t yet aware this is something to take seriously.
You said:
“The volume of communications to create the necessary level of awareness will not be cheap.”
Again, exactly right. States and local public health agencies, civic groups, health care groups — everyone is fighting the same battles with very little cash left over from everything else they need to do.
A strong message from the federal government — with press releases, interviews — would jump start the outreach project and allow local groups to maximize their funds and concentrate on “hard-to-reach” groups.
Posted June 3rd, 2007 at 5:54 amNedra, thank you for that enlightening post, and thank you for reading the comments from our well-informed readers. It is an education, isn’t it?
Well, at least we won’t be starting from scratch. Many have educated themselves out of a sense of enlightened self-interest. But you are right to point out that people can’t always do this in one jump, or at least that different people move at different speeds.
In week three, I plan to lay out some examples of excellent efforts by local or county government, and by some interested individuals. We can certainly think of as where we want to move to rather than where we expect everyone to be.
Our hope is to have local and state public health officials reinforce the idea that “pandemic flu” really should br on the tips of our tongues. There will always be other problems, other issues, to address as well, as some have pointed out in comments, but this isn’t either-or. People can multi-task (ask any mom!). So, this ‘new normal’ of awareness becomes ‘in addition to’ rather than ‘instead of’ doing something else.
For public health officials and for docs and for community leaders, there’s a need for creative and achievable ways to do this. As you point out with the idea of having pandemic flu on people’s minds, the public can be part of the solution, and can be a great resource. That doesn’t need to be doubted… we can see that here in the comments.
Thanks again for an excellent post.
Posted June 3rd, 2007 at 6:23 amHi Nedra,
Great post! This is very informative and I appreciate your humility. Pandemic flu definately presents a humbling problem in its scope, impact and the sheer amount of work that needs to be accomplished. There is so much to learn from each other.
Lugon mentions speed…
We may not have the luxury of educating the public at their or our comfort level. There are definate ramifications to this psychologically. There are also the stages of adjustment reaction that need to be thought about. People deny, accept and embrace differently…
It has taken me 2 years of first mentioning the word pandemic and then explaining what it is to get through to my neighbors (who now carry hand sanitizer in their vehicle).
As has been mentioned in so many ways on these blogs…validation and credibility.
In my case, the problem is that little ole me is educating people who wonder, hmmm she isn’t an MD or scientist, how would she know?…
In order to get the word pandemic on the tips of peoples tongues they need to hear from that “legitimized source of information”, as Greg Dworkin points out. There is reluctance mention the word pandemic, it seems because people do not want to sound the alarm and have it be a false one…no one will listen the next time. So we do the all-hazards thing, which is not a specific enough preparation for a pandemic. If we announce with a caveat, again no one will listen, we have given them their out.
Also, when educating about pandemic flu it is hard to have a sense of urgency but yet on the other hand say the “not if but when” message. People expect that if you are telling them about something, well, it best happen within the next 3 months or its off the radar and once again your credibility is shot….
Thanks again for opening this topic of “conversation”.
Posted June 3rd, 2007 at 8:43 amNedra Weinreich, first, (wink) welcome out of the mushroom farm into the challenging change at pandemic preparedness.
I, too, would like to consider Speed, but first, those “stages of grief” that Kubler-Ross originally called “the Five Stages of Receiving Catastrophic News”.
Have these come into play at all levels of govt, and, as this blog experiment progresses?
In no particular order, for they have none:
Denial,
Anger,
Depression,
Bargaining,
Acceptance
Sound familiar? (Show of hands?)
Somehow this Pandemic year alert was not put on the public radar, perhaps for reasons that seemed good to those at the time.
If you had just found out scientists had said, a few years ago that there was a big “overdue” fault in the floor of the ocean that could make earthquake/tsunami “at any time” on your beach, or that vulcanologists had said your Mt. St.Helens was not a dormant volcano, and was bulging and bulging and continuing to bulge, and could go “at any time”, or, that your New Orleans levees were not strong enough three years ago, and much of the city will flood with a direct hurricane strike and there’s a Cat.5 hurricane sitting and sitting in the Gulf, that could come in “at any time”, a long haul political process may be important, but,
isn’t also a “What can we do today and every day to be better prepared just in case, (since we missed the early preparation time and events are closer and more likely, since none of those problems are going away)?” approach indicated?
Catch up a bit on household preparedness first; why wait?
Just because we use things up before they spoil (and ideal temp/humidy/containers help a lot) and restock as we use, doesn’t mean we stop when pandemic hasn’t happened. Need still exists. (Buying more things at last years prices was not a bad idea, either.) Waiting and being able to shop the sales, because you still have the item at home is saving money. Many people have found being prepared at home helped keep them comfortable during a storm, job loss, or sudden hospitalization and recovery, or skipped a trip to a pharmacy or clinic because they had some good first aid supplies or medicines (or plenty of TP!) at home and didn’t have to get to the store in the middle of a norovirus or other problems when the family’s needs suddenly increased for certain items.
So many large problems (over-reliance on imports, regional food and power grid and water issues) but, the local and household issues can be being addressed now, while slower wheels are, elsewhere.
The recent light on unregulated and dangerous food imports is a wake-up call for how long widespread and under the radar problems can go unaddressed.
If any of the past year’s sick passengers had turned out to have H5N1, or a panflu strain, as the recent “he looked healthy” XDR-TB case shows, we are not going to have much, if any, more, warning time.
Quote: “Michael Osterholm, an expert in emergency preparedness at the University of Minnesota, said the most recent case was most troubling because of the implications it had for a wide scale epidemic.
“What would happen in the opening days of a flu pandemic where instead of one patient there were dozens? The system would implode quickly. We have no plan for this”
Individuals need to be acting now, and word needs to be getting out to communities now; any unpleasant adjustment effects now, while medical care, supply chains, law enforcement, communications, power grid are unaffected are going to be easy compared to a mass casualty year from all causes with a blindsided public.
Uncover the radar screen and show the public; we don’t know when but we know we aren’t really prepared as communities and individuals for other disasters we know we should be. Better a year too early than a day too late, since H5N1 is still killing children this year.
We can do this; it will be easier the more of us are past the Denial stage and trying.
Posted June 3rd, 2007 at 9:58 amSense of urgency?
It took me almost 2 years to prepare my home… and not completely… just enough so I can sleep soundly at night.
Your thoughts are dead on however this process must move at lightning speed or we may get caught with our pants down.
Posted June 3rd, 2007 at 9:58 amThank you, Nedra, great post!
You are at the beginning of an adjustment reaction. The biggest hurdle that will face you will be denial. It is so very easy to tell yourself that a pandemic isn’t really a threat. Fight this one hard! It is easy to get stuck at this stage and fail to prepare. Denial may also return again and again. It does help to share your thoughts with others as we do frequently on the flu boards. We reenforce each other’s coping skills and lend a hand to anyone that needs help.
I agree that people need to be motivated to begin the process of getting ready for a pandemic. Awareness messages need to bring home to folks that a pandemic is coming: ‘It may be soon or possibly later. No one knows for sure but many scientists believe that…’ Personalizing the message in terms of ‘what this might mean to you and your family’ is essential.
IMO, the awareness message needs to occur sooner rather then later. Right now, masks can still be ordered, food, bottled water are abundant. Can you imagine the panic buying that will happen if everyone reacts to a ‘pandemic is imminent message’ and only begin to stock up?
I fear we have lost essential time in letting individuals make their emotional adjustments and begin preparations.
It would help if Pandemic Awareness messages were ramped up enough in frequency and in content in the media to move through the communities quickly.
(Boy, would I love to be on the message writing committee! :- ))
I was at the ASTHO Community Control Measures meeting in Syracuse and what really impressed me was to watch how folk’s were able to rethink the beliefs they carried into the conference. After the CDC and HHS leadership presented pandemic information and rationale behind the mitigation measures and discussion ensued, it was heartening to note that most participants left the conference with a developed sense of pandemic awareness and understanding of steps their communities could take to mitigate pandemic effects at a local level. It is important to note that the learning that occurred happened in a relatively short period of time. No one there pan iced and I think almost everyone left with plans to learn more.
Many people asked me for information on how to prepare so I stood up and gave out a few web sites. I cite this experience of an example that people can develop pandemic awareness over a short period of time. It is all in the message and in how it is told.
As I sat in the ASTHO meeting I kept thinking that this conference was structured as a Town Hall type meeting. It even had the city mayor and local health department officials. Can you imagine all of the learning that could occur if this format was used in town halls and community centers all across America?
Thank you Nedra for your transparency, valuable input and courage.
Nedra
Posted June 3rd, 2007 at 11:29 amGood Morning Nedra!
I whole-heartedly agree with your post. I have been saying that we need to EDUCATE the public in the basics for a long time, now!
When folks hear ‘flu’ they think ‘bad cold w/ aches’ they don’t really know what ‘real flu’ is … never mind what ‘pandemic flu’ is. Heck … I didn’t really know, till I started reserching PanFlu!
I have said to one of our local newspaper reporters(who ‘doesn’t have the time’ that is needed to address this (and his paper is relegated to the space they have available!!!–hmmm … seems to me that they have plenty of space for fluffy news items!) that this education needs to begin.
I have also addressed this issue with our Central Penna. Regional Dept. of Health Coordinator for Pan Flu. I told her (will withold name for embarassment purposes
)that the public needs this same basic knowledge as well. Have we seen it? NO! They are giving their obligatory ‘hit & run’ presentations to the counties under their responsiblity and then wiping their hands clean.
FIRST People need to know:
What is flu?
What is a Pandemic?
What is Pandemic Flu?
What is happening overseas with the current H5N1 virus?
– How many are folks are suspect of this virus? (give our American public a chance to see that this virus is evolving!)
–How many folks are dying from this virus? (show them the deaths that are occuring …. even if sporadic, at this point. Let our American public see that this virus is a KILLER! Let the public watch GRADUALLY how the virus is progressing.) This will eleviate SUDDEN PANIC at the news of a developing PanFlu, as the #’s increase — should that happen.
This is substantial BASIC information that needs to get out to the public to spur their interest in preparing.
Currently all I hear from folks is that ‘there’s nothing in the news’ …. ‘I don’t hear anything’ … ‘I haven’t seen anything about this’ … ‘I thought that was all done’ … ‘That just happens in flu season. Flu season is over’ …or just get a blank stare.
So what have I begun to do? I send headlines to folks.(I want them to see that YES, it IS in the news. Just NOT OUR NEWS! — By the way … can I tell you that there are a LOT of headlines to send them!!!) I send the confirmed WHO death notices to folks. That’s MY way of trying to keep it in front of those I know. This should be what the rest of the citizens should be getting as well … unfortunately … I don’t have all their addresses, or I’d be sending it to them as well! {BIG sigh} -k
Posted June 3rd, 2007 at 11:31 amMrs Weinreich,
Wow, reading all these posts must be like trying to drink from a fire hose. Please stay with it.
It is because there is more to life than disaster, that we prepare for disaster. We have families, full time jobs and still find time to post because we are concered - not board.
If it helps it took me several decades and over seven years in scouting to get where I am. We can help you and others prepare in far less time.
Awareness of what?
Awareness of it- flu, tornado,etc
Awareness of me- my skills, my health etc
Awareness of supplies- food, water, etc
Awareness of us - family, city, etc
Awareness of help - will they come?, etc
Awareness of Spirit - those who believe they will live do. Those who believe they will die do.
To each of these is they must go through the many steps you outlined. Yes we need TV. With out that I would never have know Britney Spears or Anna Nicole Smith had a problem.
Like CRFullMoon said -” people worry about others, even the south pole. ” Now they need to worry about themselves.
IMHO, this will be hardest. So many feel like “it can not happen here” or “It can not happen to me”
If we can get that message across - lest do it kindly so as not to overwhelm them.
I have only convinced on neighbor to take wilderness first aide - a three day course. Till they complete the course people take me camping - so they are safe. If I get hurt - so sorry, I’m on my own. This goes for CPR and AED training.
Yes both are taught by Red Cross. We should be very aware we need each other.
Thanks for the blog
Posted June 3rd, 2007 at 5:20 pmRegards,
Kobie
“Life often gives the test before the lesson.”
Thank you Ms. Weinreich for an excellent post. I am familiar with the Stages of Change/Transthoretical Model and will not argue any of that with you. I first heard about pan flu about a year and a half ago and it personally took me a long time to move through the process until I got to the point where I began actively prepping. I have no doubts but that I’d of moved through it a whole lot faster if there had been a consistent and loud govt. message that this is something that I should both be concerned about and hearing tthem say I am capable of doing something about it. Those on limited budgets can only move so fast once they do get the message which makes it all the more imperative that the message come soon. Money wasn’t the limiting factor for me but even then I spent months prep shopping to bring my family readiness to 3 months because I kept having to think through how much of what to buy, what will keep, what could be prepared without electricity, what non-food items do I need etc. Even now there are a couple outstanding issues I still need to address.
Yes it will be expensive and yes it will be hard but the prospect of pandemic flu has been so poorly managed to date that we have a lot of time to make up. We may not have the luxury of a couple more years.
Thank you for your efforts in this project.
Posted June 3rd, 2007 at 7:11 pmMs. Weinrich –
Excellent post. I think it is a perfect example of how we must use practices from various discplines to move the population forward. As you articulated, we know a few things about how humans work and think in business. I would like to see us continue along the scaffold you laied out in wiki land.
Posted June 3rd, 2007 at 8:32 pmNedra -
As disussions on Secretary Leavitt’s most recent blog have shown, it seems at least possible that one government strategy for getting people to prepare for a pandemic is to get them to prepare for “All-Hazards”. That means, get people prepared for all problems in general (hurricane, flood, blizzard, terrorist attack, pandemic) rather than any one in particular.
I think this may be a politically popular approach, because it avoids having to use the controversial word (”pandemic”) prominently in messaging to the public, tucking it in among the list of “all natural and man-made disasters.)
I am concerned about using this approach, because I do not think it will work.
Planning for a pandemic requires much more effort and time and logistical thinking than planning for something that would be of only a few days duration.
And I do not think the indirect approach would work well, in other social marketing campaigns.
Can you, as a social-marketing expert, give us your poinion as to how effective this all-hazards approach would be, in a different context?
Would this anti-smoking campaign be effective, in getting people to stop smoking?
It is important to maintain an All-Health approach to your lifestyle, including good nutrition, exercise, hygiene and not ingesting drugs or smoking.
As for smoking, it could be dangerous to you, but we don’t know for sure if smoking will hurt any particular individual. Some smokers live to a ripe old age, and people die of lung cancer who do not smoke. So keep your risks in perspective.
One way you can prepare to quit smoking is to get an “anti-smoking” kit, with some nicotine gum in it, to help you quit, if you decide that’s the right approach for you.
There are prescription medications that may help yo uin quitting, but they will be in short supply if people actually do decide to quit smoking en mass. But don’t stockpile ahead of your decision to quit smoking, as that would not be ethical.
Above all, try to enjoy your life, and don’t worry about things too much, as worry increases the need to smoke. And remember to eat healthy, get exercise, and wash those hands!”
Posted June 4th, 2007 at 8:28 amI invite all groups to contact your local Radio and Television stations and have these folk ON your “flu-team”. I’m on our local Northwest Kansas Team and have three radio stations to cover updates for Northwest Kansas, Northeast Colorado and Southwest Nebraska. Get your media involved, they’re the ones getting the information out to the public, and the media MUST understand how serious this will be. Don’t put this off. Contact your media today and invite them to be on your side. When this strikes, you’ll be glad you made the critical contact.
Posted June 4th, 2007 at 11:32 amHi, Curtis,
I agree with your ideas. Last year on the Fluwikie I began a Red Ribbon Pandemic Awareness Campaign as part of FW’s annual Pandemic Awareness Week. Many people participated in the week long project. We designed business sized cards with a picture of the red ribbon and links for essential information. We circulated them in the areas we live in. FW members put tremendous effort into providing information to promote Pandemic Awareness and provide factual information. It was placed on the front page of the website. A second part of the effort was to publicize the project in order to draw more viewers in to learn about a pandemic. Long hours were spent by many to develop a press release. Members then sent it to TV, radio, newspapers, etc. across the country.
Very few, if any, official media sources picked up the story although quite a few blogs did.
We want partnerships with the media to get our awareness message to more people. Any suggestions Nedra, you and others have in being successful in this would be appreciated.
“Grassroots” is a language that more people in government, business and media need to learn to read.
Posted June 4th, 2007 at 12:19 pmNedra: Welcome to Flubogia and thank you for your excellent post. A couple of questions:
Which tells me that you had heard about a pandemic threat or H5N1, maybe even understood the potential damage a pandemic could bring, but because you did not think it was likely enough, you had not taken the threat serioiusly. Is this accurate?
What in particular about reading this blog persuaded you that the likelihood was high enough to be taken seriously?
At this point, where are you in the Stages of Change contiuum?
Precontemplation, contemplation, preparation, action, or maintenance.
You were, in essense, required to jump into the water because you had agreed to swim in it. Your receptivity to becoming ‘aware’ was most likely a product of professionalism - once you agreed to participate, you would need to immerse yourelf to some extent - to be able to provide your advice.
While your experience cannot tell us how to get people to inquire (can’t invite them all to blog here), it can give us insight on how best to persuade. What is it that you read in these blogs that sticks out - what internal impressions or feelings motiviated your change of perspective?
If a person’s world-view is inconsistent with a set of facts, it is most often the facts that are discarded, not the world-view.
In the world-view of most Americans (including you not long ago), a pandemic is neither possible nor problematic enough to merit their time or attention.
So what changed in your world-view that allowed the facts on this blog to register?
Posted June 4th, 2007 at 1:18 pmMs. Weinreich,
The HHS Pandemic Influenza plan was issued-via the Internet- in November of 2005. Precious few people are aware of this document much less have read it.
That so little mainstream attention has been drawn to this plan shows that the past 2 years have been a failure to educated and prepare those who would/could prepare. Yes, we need clear, coordinated communication, coordinated preparation efforts globally to locally-but how much has really been done? And without strong leadership from a national to a local level, who will ever hear this message?
It’s not just the message, it also has to be the messenger. Very few people locally will listen to me because, well, what qualifications do I have? I have not been directed to do this by the President of the United States or the Governor of New Jersey.
My mayor still believes that we will be “rescued” by the feds, the state or county, so no local governmental preparations have been made. No one in power has notified her to prepare, so why should she?
Posted June 4th, 2007 at 9:20 pmAfter reading more knowledgeable and insightful comments and poking around a bit in the flu blogs/forums/wikis, I am convinced that our greatest asset in the fight against pandemic flu is all of you — the concerned citizens who spend so much time educating each other and your communities. Clearly when it comes to “leadership” on this issue, HHS should look at what you have been doing and include your perspectives in the upcoming leadership forum. A key to the success of any awareness program will be its ability to tap into existing social networks and spread the word from person to person, as many of you have been doing. I’ll be thinking about how best to extend your grassroots efforts and will expand upon it in a future blog post.
I hope you’ll forgive me for not responding to each person’s comment individually. You are all so prolific I just can’t keep up. But I will try to respond to the themes that have emerged.
First, some background on how my thinking related to pandemic flu has evolved over time… Prior to being invited to be part of this blog, I had seen headlines about avian flu (though usually not with the word “pandemic”), but it seemed to be part of the media’s usual hype cycle. I have seen so many health and environmental issues come and go from the news that at some point it just becomes background noise. It’s hard to tell what is a real threat and what is the faux hysteria story of the week. And at no point had I ever been given the basic facts about why to take pandemic flu seriously, nor did I see it as a real enough concern to seek out information.
What changed my mind about the severity of the issue were two things: seeing a major agency like HHS discussing pandemic flu as an urgent and imminent threat, and seeing that other “regular people” are way ahead of me in terms of knowledge and preparedness on this issue.
What stage of behavior change am I at now? Well, I’ve gone through precontemplation (I’m aware of the problem) and contemplation (I’ve decided I need to do something about it). Now I’d say I’m in the preparation stage, and am ready to start figuring out what I need to add to my existing earthquake supplies to be ready for a pandemic.
I suspect that there are many other people like me, who just need someone we respect and find credible to let them know that this is an important issue to pay attention to. Perhaps my inexperience with the issue will come in handy in this process, since sometimes people who are intimately familiar with a topic can have trouble communicating about it in the simple way that people new to the issue require.
Please do feel free to use and expand upon anything I write on this blog in the wiki. I’m hoping that my contributions will give you a new way of looking at what you’re already doing. I am happy to continue to be involved in these discussions as they evolve over time (even beyond this blog) to provide my thoughts and feedback. Just know, though, that I will likely not be monitoring the conversations on the wiki and forums on a day-to-day basis, so please feel free to email me as you want to bring me in.
Lugon is right that people can move back and forth between stages. Someone might start preparing but run into a roadblock that sends them back to the previous stage, where they might stay indefinitely until something else comes along to motivate them again. And they can pass quickly from stage to stage, so right after learning the facts, someone might decide that they need to do something about it and be ready to start preparing. That’s why any marketing piece needs to have an immediate trigger that helps people who are ready for the next step get closer to taking action, such as providing a website or toll-free phone number, supply purchase list or preparedness plan.
We can address people at different points in the process simultaneously, but I do think we need to concentrate most of the initial efforts on building awareness so that we can create a critical mass of people to reach a tipping point at which pandemic preparedness is an accepted and normal activity.
I liked the analogy of the stages of grief to what people go through when dealing with the bad news of a potential disaster. I would agree that many stay in denial, and very few so far have made it through to acceptance.
The question about whether to use an all-hazards preparedness approach or pandemic-specific appeal is a good one. I can see pros and cons to each, but the fact that if someone is prepared for a pandemic, they are pretty much de facto prepared for any other types of disaster that might come around makes me lean toward that. In fact, I think that would seen as a benefit to many people. Because of the disease-specific precautions that a pandemic would require, we can’t entirely lump it in with other types of disasters. But — let’s face it — the type of person who is likely to prepare for other hazards is also someone who would be more likely to decide to become prepared for pandemic flu as well, so the all-in-one readiness message might work for them.
We really need some audience research to learn more about how different groups think about pandemic flu and emergency preparedness to be effective in our messaging. Without research, we’re relying on our own inclinations and biases to come up with what we think will work. And the people who are reading, writing and commenting on this blog may not be representative of those out there who we most need to reach. If anyone out there can provide me with information about research that has been done about knowledge, attitudes and current behaviors related to pandemic flu, it would help me avoid groping around in the dark for solutions.
Posted June 5th, 2007 at 4:35 amNedra — thank you so much for your thoughtful reply. And thank you for seeing “us” as practical experts; I knew you were a smart woman! (-:
In answer to your last question — I believe there has been a little research done on how many people do prepare for all-hazards emergencies (who has 3 days of food and water, etc.) and possibly even someone has studied whether those who have lived through a severe hurricane prepare more than those who don’t etc.
But usually the results are along the lines of “20% of people will prepare in advance, 20% will try to prepare the day they hear the hurricane is coming, and the remaining 60% will not prepare, no matter what they are told.”
I am sure these results are true, for hurricanes and earthquakes, but I am equally sure that these results have nothing to do with pandemic flu, especially the POSSIBILITY of a very severe pandemic. So please interpret them with caution! (-:
I believe people WILL prepare for severe pandemic flu in a way that they will not, necessarily, for any other, if only they can be told the scientific facts, they can be allowed to see what the possibilities are, and then could be encouraged to prepare.
I do base this on my own experience — I have never had so much as an extra gallon of water in the house, and I used to shop pretty mmuch every day for dinner or take out — but I changed because I realized I had to. I have children, it was that important, and it was better for me, anyhow.
I have also had similar experiences with my completely mainstream family and most of my friends. EVERYONE I’ve spoken to (given them the “full picture” — which probably takes about 30 to 60 minutes of explanations and charts — it isn’t a quick message — )everyone has 2 to 4 weeks of supplies now at home, and would be willing to work on more, if they heard the message from anyone besides me.
Similar responses have been reported by most people on the flu forums — once people get a message they deem CREDIBLE they do not have a problem preparing.
Anyhow I just thought I would point that out — research on how to get the message out would need to be conducted specifically for pandemic flu — maybe do some follow up on people who are attending this Pandemic Flu Leadership summit meeting, and see if anything gets the to start preparing their families and homes?
Posted June 5th, 2007 at 6:47 amThanks, Nedra, for your usual thoughtful approach. Several surveys of public attitude have been published. The most specific for pandemic flu comes from The Public Engagement Project on Community Control Measures for Pandemic Influenza Report from Keystone Center, May 2007 (based on meetings in late 2006). This .pdf summarizes the process used to build CDC’s Non-pharmaceutical Implementation Plan (NPI). Note on p.13 major differences between Seattle, WA and Lincoln, NE in terms of implementing control measures!
Also of note is data from the Harvard School of Public Health from October 2006 looking at the public and TFAH/Mailman School of Public Health looking at Media Attitudes and Coverage of Pandemic Flu.
And thank you for your comments about the wiki and online community! We are interested in sharing helpful information, not stealing intellectual property, so that is a wonderfully generous offer.
Posted June 5th, 2007 at 7:36 amOne more social survey reference. ACM refers, I believe, to a generic National Preparedness Public Opinion Survey from Feb 2007 prepared for the APHA by Peter D. Hart Research Associates, Inc.
Posted June 5th, 2007 at 7:40 amOh, and inspired by Nedra’s comments, I’ve made a Flu Wiki page here, where all the surveys are summarized at one location. That’s how the wiki can be used… and anyone can add to it if there’s more out there (or send material to an editor if you want something added).
Posted June 5th, 2007 at 8:01 amNedra Weinreich, you are probably my bright spot for the day.
(She “gets” it; I think she “get’s” it!)
(Sorry, it’s just that if everybody netizens had approached about it, the past couple of years, had asked enough questions and thought about the answers, we might have 20% of the public set for the first few months already!)
(And could have been enough people to start public PPCC’s even without the officials.)
If only we could get others to dialog about the issue enough they wouldn’t get stuck on, “Oh, that can’t happen. There’s no way it could be that bad. We’d get help if it did. Just hype; we’re not around chickens and they say they’re making a vaccine.”
Without dialog from authorities, things are not happening. Don’t worry about “wonder what will work?” just start getting basic facts you were lacking out. Which ones started turning the lights on for you?
Correct misleading or incorrect articles, and “popular myths”. Get H5N1 cases age/outcome graphs, maps in the public eye.
If the govt. would update some webpages and remove the “Speaker-ese” wiggle room in the language, so when the public (or a local politician) does look, a cursory glance makes it sound like things are well, it would help preparation. Speeches too, the public has been interpreting everything they hear in the most positive light; whether they believe “ATAMO” (and then a miracle occurs) and vaccine gets handed out that protects the whole neighborhood/nation, or, that it is just big pharma/political hype, and no one can have depopulating plagues “in this day and age” “because we’re so modern”.
The people who like to do 30-day menu planning - apart from the reliance on freezers and microwaves - can any of that be tweaked; could they get “into” food that keeps well, can be prepared even during prolonged power cuts? Can the public use some of the work already done on The Flu Wiki and elsewhere, as they want to start to prepare, and what/how question arise? No need for each person to try and reinvent the wheel alone.
Where are the journalists? Can the local media be shown having the public getting regular pieces on pandemic year preparedness and more science/medical/practical issues is a good thing?
Posted June 5th, 2007 at 8:18 amMr. Secretary,
I would like you to request that H5N1 be classified as the most likely candidate for causing the next pandemic and the virus we need to be watching.
I keep reading news stories where they say it could be any virus.
H5N1 is the only one that has passed 2 of the 3 WHO criteria and it is making progress into the 3rd as we blog.
Posted June 5th, 2007 at 9:27 amThanks, all, for your feedback. Glad to hear you think I’m on the right track. And thank you, Greg, for the research links — I’ll check those out.
Average Concerned Mom, I think you’re onto the model that will be necessary to get people moving. Consistent messages from (Credible Authority Figure + Person Like Me) must happen in synch — one without the other is probably not enough.
CRfullmoon, I think you are so right about the step in the process where people assume ATAMO, but I hope that our collective experience with Katrina has increased realization that it doesn’t always happen that way.
And how to get the media to pay attention? Perhaps when they see the government is taking this seriously and putting a lot of resources into spreading the preparedness message. Luckily for us, we don’t have to rely only on the mainstream media to reach a big chunk of Americans. Social media like blogs, social networking sites, YouTube and other nearly free and totally accessible tools are there for regular people to get the message out too. I’ll be talking more about what we can do with these types of media at some point.
Posted June 5th, 2007 at 11:44 amEven the new media needs immediate clear governmental voices saying pandemic year threat is real. Some older people even say, Well, you can’t trust anything on the internet (I met one who doesn’t even believe govt sites, “because anyone could just make a fake site” - and no, it wasn’t that judge in the news who asked the lawyer to explain what a “webpage” was and how crime could be committed over the internet.) Younger people think things are entertainment and hype.
Have you seen what serious attempts are already on YouTube? (surprise!)
Here is one collection:
www.youtube.com/prof…
and the excellent, “Hospitals “Full-Up”: The 1918 Influenza Pandemic” www.youtube.com/prof… (up since 6 months ago) People have tried other social networking sites, too, yes.
The public isn’t paying attention; too much noise not enough clear signal.
Officials leaders have what we lack.
Posted June 5th, 2007 at 12:18 pm(It does not take a lot of resources to tell people; they talk to the press every week; really educate the press -not tell them their responsibility is just to prevent “panic” - but, Promote Pandemic Year Preparedness- and they’d want their communities preparing, too, once they understand what can happen to our way of life if they don’t.)
Mrs Weinreich,
With so many unprepared folks it seems any Ad agency would jump on an untapped market. Creating an awareness of vulnerability and solution. It is largely non FDA regulated. Most of the parts can be made cheaply in China.
With the number of snake oil salesmen out there, it would be nice to have informed Ad folks driving the message. People will find what they want - with or without Ads.
For example, last week a truck carrying jaw breakers was stopped and found to carrying several hundred pounds of pot. With no advertising, warehouse or distribution system how do you find that many customers??? I really wish it had been a truck load of N-95 masks.
Regards,
Posted June 5th, 2007 at 1:21 pmKobie
Hi Nedra, Readers,
The best action we take to support the awareness campaign, is word of mouth.
This campaign must be viewed like any other marketing campaign and word of mouth is the most effective method.
Keep up the good work.
FB
Posted June 7th, 2007 at 2:04 pm