Integrating emergency risk communication (ERC) into the public health system response: Systematic review of literature to aid formulation of the 2017 WHO Guideline for ERC policy and practice.

The World Health Organization (WHO) commissioned a systematic review of literature to facilitate evidence syntheses for the development of emergency risk communication (ERC) guidelines for its member states. The goal of this review was to integrate ERC best practices into governmental and non-governmental health systems for all emergencies of public health concern, by addressing three questions: (1) to identify best practices for the integration of ERC into national and international public health preparedness; (2) to identify mechanisms to establish effective intra-agency, inter-agency, and/or cross-jurisdictional information sharing; and (3) to identify methods to coordinate risk communication activities between responding agencies across organizations and levels of response. The review covered scientific and grey literature publications between January 2003 and February 2016, and searches were conducted in 17 English language electronic libraries besides Chinese, Portuguese and Spanish language databases. A mixed deductive-inductive process was used to synthesize findings across studies through identifying thematic areas. While 8,215 articles were initially retrieved, after a sequential screening process, the final evidence syntheses comprised of 21 articles for question (1) and 24 for questions (2) and (3) combined (due to overlap of themes). The confidence in findings was assessed by the Qualitative Evidence Syntheses (GRADE-CERQual) tool. PRISMA guidelines were followed to the extent possible given the limitations inherent to a review largely based on qualitative studies. The identified literature was very context-specific and referred to mechanisms, practices from the field, and recommendations that were derived from planning or response efforts implemented at the national or local levels in specific countries. Integration of ERC functions into public health emergency preparedness, planning and response activities was influenced by reforming components of the leadership structure when needed, modifying organizational factors, and nullifying restrictions (including amending laws/ regulations) that might have been an obstacle to the timely release of information. Exercises and trainings were recognized as effective strategies to identify the barriers and successes in this process of integration. Key elements to enhance information sharing and coordination across organizations included the creation of networks, task-forces and committees across disciplines, organizations and geographic areas. Engagement of local stakeholders was also important to guarantee the flow of information up and down the incident command system. On the whole, few empirical studies, especially from low- and middle-income countries, related to the WHO research questions, demonstrating the need for research in these areas. To facilitate an accurate identification of the gaps, the authors suggest integrating current findings with case studies across the WHO regions to better understand the specific evidence that is needed in practice across the multitude of ERC functions

Engaging Communities in Emergency Risk and Crisis Communication: Mixed-Method Systematic Review and Evidence Synthesis

The World Health Organization (WHO) commissioned systematic reviews to assist with the development of new emergency risk communication guidelines that will impact responses and distribution of resources at all levels. This mixed-method evidence synthesis, guided by Cochrane principles and methods, examined the extant research in countries throughout the world, published from 2003 to 2016, related to the best practices to engage communities in preparing for and responding to emergency events with public health implications. Although few studies directly examined which strategies or tactics effectively engage public participation, many studies reinforced the importance of community participation. The findings support the perspective that emergency events are communicatively understood by all publics and that they benefit from emergency risk communication before, during, and after such events, especially when grounded in local contexts. Although the importance of local context limits the generalizability of risk communication, it is important to continue studying strategies and tactics to cultivate participation among all stakeholders

Trust and Public Health Emergency Events:A Mixed-Methods Systematic Review

The systematic review examined the phenomenon of trust during public health emergency events. The literature reviewed was field studies done with people directly affected or likely to be affected by such events and included quantitative, qualitative, mixed-method, and case study primary studies in English (N = 38) as well as Arabic, Chinese, French, Russian, and Spanish (all non-English N = 30). Studies were mostly from high-and middle-income countries, and the event most covered was infectious disease. Findings from individual studies were first synthesized within methods and evaluated for certainty/confidence, and then synthesized across methods. The final set of 11 findings synthesized across methods identified a set of activities for enhancing trust and showed that it is a multi-faceted and dynamic concept

Harnessing technology to respond to the global demand for learning during the COVID-19 pandemic

The COVID-19 pandemic generated an unprecedented global demand for learning about the disease and how to manage it. This paper draws on theWorld Health Organization (WHO)'s experience of COVID-19 knowledge-transfer to a worldwide audience of millions of learners registered on OpenWHO, WHO's massive open online course platform. It aims to illustrate the technological solutions that WHO, in collaboration with the Hasso Plattner Institute (HPI), OpenWHO's platform provider, employed in response to the unique challenges this surge in demand for learning engendered. Data on OpenWHO use, including geographic patterns and certificate attainment, were extracted from OpenWHO's internal and external reporting systems. Descriptive analysis was employed to identify trends and compare OpenWHO use with COVID-19 caseload in each WHO region. Data on the OpenWHO system load were obtained from the OpenWHO load balancer (HAProxy). The OpenWHO team responded to the need for trustworthy, evidence-based knowledge on COVID-19 via three main avenues: increased scale, targeting the needs of affected and underserved communities, and prioritising multilingualism. Each approach brought novel problems, which WHO and HPI leveraged their collaboration to meet by employing technology. This included increasing server bandwidth, expanding support teams, adding new language capabilities, and deploying functions to streamline workflows and boost learner experience. In doing so, the ability to effectively and efficiently harness technology became a critical step towards empowering learning's life-saving potential during the COVID-19 pandemic.publishedVersionPeer reviewe

Communicating Uncertainty During Public Health Emergency Events:A Systematic Review

To answer the question, "What are the best ways to communicate uncertainties to public audiences, at-risk communities, and stakeholders during public health emergency events?" we conducted a systematic review of published studies, grey literature, and media reports in English and other United Nations (UN) languages: Arabic, Chinese, French, Russian, and Spanish. Almost 11,500 titles and abstracts were scanned of which 46 data-based primary studies were selected, which were classified into four methodological streams: Quantitative-comparison groups; Quantitative-descriptive survey; Qualitative; and Mixed-method and case-study. Study characteristics (study method, country, emergency type, emergency phase, at-risk population) and study findings (in narrative form) were extracted from individual studies. The findings were synthesized within methodological streams and evaluated for certainty and confidence. These within-method findings were next synthesized across methodological streams to develop an overarching synthesis of findings. The findings showed that country coverage focused on high and middle-income countries in Asia, Europe, North America, and Oceania, and the event most covered was infectious disease followed by flood and earthquake. The findings also showed that uncertainty during public health emergency events is a multi-faceted concept with multiple components (e.g., event occurrence, personal and family safety, recovery efforts). There is universal agreement, with some exceptions, that communication to the public should include explicit information about event uncertainties, and this information must be consistent and presented in an easy to understand format. Additionally, uncertainty related to events requires a distinction between uncertainty information and uncertainty experience. At-risk populations experience event uncertainty in the context of many other uncertainties they are already experiencing in their lives due to poverty. Experts, policymakers, healthcare workers, and other stakeholders experience event uncertainty and misunderstand some uncertainty information (e.g., event probabilities) similar to the public. Media professionals provide event coverage under conditions of contradictory and inconsistent event information that can heighten uncertainty experience for all

A Conceptual Framework for the Evaluation of Emergency Risk Communications.

OBJECTIVES: To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). METHODS: The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. RESULTS: We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. CONCLUSIONS: Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies