How many times were you told to wear a mask in 2020?
“Let’s see, about 4 times a day x 315 days February to Dec….minus that week where I was in the fetal position during the election returns…carry the 5…”
Communication is not just about repetition. On any given day of the pandemic, we are bombarded with information. Vaccine news, text notifications about varying levels of lockdown, re-targeted ads for hand sanitizer, and the ever-present shaming of people on social media who threw large gatherings for the holidays. Is it possible to cut through the noise with evidence-based health information in an era entrenched in deep institutional mistrust? What if a majority of your audience lacks a belief in science?
Maybe you go for shock and awe, like the American Legacy Foundation’s :truth: campaign, which successfully lowered the smoking rate amongst teens with their memorable “Singing Cowboy” ads. “No, you don’t always die…from tobaccoooooo….” Catchy, right?
Or do you go the route of putting traditional gender norms to work to combat mental health stigma, like Man Therapy from the Colorado Office of Suicide Prevention?
Making it culturally relevant, like Mahindra Rise’s PSA , took a behavior that women were already doing and co-opted it for breast cancer screenings.
Leading up to the digital age, governments often took to radio as their single mode of communication in times of public health crisis. Television then emerged as a trusted medium, and the government was able to provide a central message to the public, as in the case of the U.S. Department of Health and Human Services’ special report on the safety of the Salk polio vaccine in 1955.
Today, the ubiquity of mobile devices and an explosion of digital channels have made it easier than ever to get information out into the world. Faced with modern infectious diseases like SARS, H1N1, Ebola, or the novel coronavirus, it is increasingly more difficult to cut through misinformation, particularly to reach our most vulnerable global communities. For example, as COVID-19 spread to India, a wave of misinformation (including unverified home remedies such as avoiding chicken) prompted the government to issue an advisory to citizens. Here in the U.S., when the President touted a two-drug cocktail on Twitter (hydroxychloroquine and azithromycin) as a potential cure for COVID-19, hundreds of thousands of prescriptions followed, when in fact, that combination can lead to heart failure and death. I mean, as of this post, the President also incited terrorists to dismantle our democracy, but one thing at a time.
We seem to be re-learning the lessons of the past. In 2003, the World Health Organization provided a list of lessons learned from the SARS pandemic. Along with the importance of rapid detection and contact tracing, risk communication was listed as a critical step to addressing public health emergencies. Activities such as rumor management, communication with international agencies and consistent messaging with healthcare and private sectors were all said to have improved in China between the SARS outbreak and the H7N9 avian influenza. This resulted in an increased level of trust in their National Health Commission, but where did those lessons go at the start of the COVID-19 pandemic?
As governments now race to keep control of their message to the public, NGOs and other community-based organizations are taking up the charge to get credible health info to those who need it most. An org I’ve been lucky to work with, Noora Health, pivoted their expertise in promoting healthy behaviors in hospitals in India and Bangladesh to helping governments mobilize a rapid response to COVID-19. Their primary goal is to get high quality, accurate information to as many at-risk patients and families as quickly as possible. Splashy ad agencies and gimmicks need not apply.
Through this work, Noora Health learned a few tenets of strong health communication during a pandemic:
First, meet people where they are. India has a complex socioeconomic and cultural context, in addition to a range of rural and urban geographies. The team knew they had to create health information materials that spanned languages, cultural norms, and a variety of topics, so they worked with partners to translate into Hindi, Bengali, Marathi, Punjabi, Kannada, Tamil, and Telugu.
Second, quality design matters. It’s not enough to put language out into the world, the content needs to compete with other sources in terms of being eye-catching, engaging, and “sticky”. Data show that between 40-80% of medical information provided by healthcare practitioners is forgotten immediately and the greater the amount of information presented, the lower the likelihood for recall. Their free COVID-19 resource library provides short, simple, and visually appealing content that promotes retention.
Last, building trust means working with trusted partners. To scale their health content, Noora Health worked in partnership with turn.io and The Government of Bangladesh to set up the official COVID-19 WhatsApp support line for home caregivers and healthcare workers, based on the World Health Organization (WHO) platform that includes local news, content, and a symptom checker. They are also actively training high-risk groups (60+ or heart disease) over the phone to share proactive guidance. None of this would have happened without collaborations with state governments, microfinance groups, and large NGOs.
Through these campaigns and partnerships, Noora Health has reached 15 million people to-date. But in the months ahead, there will be a need for educating the public about the vaccine and mitigating the conspiracy theories that digital platforms can spread like wildfire. In the U.S., the fatigue around the lockdowns has given way to exponential spikes in cases and close to 370,000 deaths. Evidence-based health information must continue to play a key role in the global fight against COVID-19. Otherwise, we may find misinformation to be just as deadly as the illness.
So, pick your favorite Fauci meme and let’s stay safe.
