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ORIGINAL ARTICLE
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Risk communication in COVID-19 pandemic: Perceptions and insights of health-care professionals


1 Clinical tutor, Department of Community Medicine, AFMC, India
2 Associate Professor, Department of Community Medicine, AFMC, India
3 Prof and HoD, Department of Community Medicine, AFMC, India
4 Junior Resident, Dept of Pathology, SGRD Medical College, Amritsar, India
5 Independent researcher, Department of Community medicine, SGRD Medical College, Amritsar, India
6 Associate Professor, Department of Community medicine, SGRD Medical College, Amritsar, India
7 Resident, Department of Community medicine, SGRD Medical College, Amritsar, India

Date of Submission09-Jun-2020
Date of Decision12-Aug-2020
Date of Acceptance12-Aug-2020

Correspondence Address:
Arun Kumar Yadav,
Associate Professor,Department of Community Medicine, AFMC, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_325_20

  Abstract 


Introduction: Risk communication is a vital component of the management of health-care crisis including the present pandemic. The health-care professionals play an important role in risk communication; however, health-care professionals have been found wanting when it comes to risk communication during any health-care crisis. The doctors/health-care professionals, being the technical personnel, are required to provide the technical information in a nontechnical or laymen language to the relevant authorities, which in turn are expected to share this knowledge to the people at risk. This study attempts to unravel the perceptions of health-care professionals on this important topic concerning public health. Methodology: A cross-sectional descriptive study was designed for the study question. An online survey was conducted based on Google Forms using snowball sampling technique. The data, collected using a pilot-tested questionnaire, were compiled in MS Excel and analyzed using SPSS software version 23. Requisite permission was taken from the institutional ethic committee. All participants were informed of the voluntary nature of the study, and the data collection was done in an anonymous manner. Results: A majority of participants (61.5%) answered in affirmative when asked if they know what risk communication is and 13 (7.7%) were not aware of it. A majority of the participants (60.9%) perceived risk communication as an exchange of information between health experts and general public, whereas 23 (13.6%) participants felt that risk communication is exchange of information between health experts and other health-care workers. Rumor management was not considered an essential part of risk communication by about half (48.5%) of the participants. Conclusion: We found significant gaps in the knowledge and perception of risk communication in the health-care professionals, which can be attributed to lack of training. Risk communication needs to be incorporated as a part of formal medical education to plug this gap.

Keywords: COVID-19 pandemic, healthcare professionals, risk communication



How to cite this URL:
Kumar S, Yadav AK, Kunte R, Kaur S, Yadav J, Bhaskar V, Mithun, Mahajan S. Risk communication in COVID-19 pandemic: Perceptions and insights of health-care professionals. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 13]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=316417




  Introduction Top


The World Health Organization formally defines risk communication as “the real-time exchange of information, advice, and opinions between experts or officials, and people who face a threat (hazard) to their survival, health, or economic or social well-being.”[1] In times of an epidemic or pandemic, when relevant risks must be conveyed efficiently and rapidly, risk communication plays a major role in the management of the public health crisis.

As the world right now is battling a threat like never before, against novel coronavirus infection, which has spread across more than 185 countries with 3,062,557 confirmed cases and 212,221 deaths, there was never a greater need for effective and timely risk communication.[2]

The current situation is complicated by the novelty of the disease, which brings uncertainty about its basic parameters. Uncertainty, or when there is the insufficient scientific knowledge to fully understand a disease, poses a significant challenge to effective risk communication and the management of an epidemic or pandemic. Uncertainty can cause officials to seem weak or incompetent, which creates room for dissent and chaos. In addition, uncertainty promotes the spreading of rumors and false information that escalate public anxiety.[3]

Still, risk communication has been widely recognized as an important pillar in the management of COVID-19 pandemic. The doctors/health-care professionals, being the technical personnel, are required to provide the technical information in a nontechnical or laymen language to the relevant authorities. Afterward, the relevant authorities are expected to share this knowledge to the people at risk. The role of the doctors assumes a greater significance in handling the crisis posed by the present pandemic. However, efficient and successful risk communication is still a challenge in many areas of the world. Risk perception plays an important role in the communication process. Barriers such as lack of resources, coordination, and staff are the usual reasons for a nonestablished risk communication plan.[4] Furthermore, during informal interaction with fellow health-care workers of diverse specialties, the authors realized that the doctors have little or no knowledge of the concept or process of risk communication. The authors were unable to find any literature on perceptions of risk communication among health-care professionals; hence, the study was conducted to assess the perception of health-care professionals on risk communication.


  Methodology Top


A cross-sectional descriptive study was designed to answer the study question among health-care professionals. The operational definition of health-care professionals is medical doctors working in government or private setup. It did not include traditional and complementary medicine professionals, paramedical practitioners, dieticians and nutritionists, or physiotherapists. This definition is in conformity of the definition given by the World Health Organization.[5] An online survey was conducted using Google Forms. The study population was not limited to any geographical area. The data collection was done from April 6, 2020, to April 20, 2020; snowball sampling technique was used for data collection.

The questionnaire for health risk communication was designed with the help of experts. The same was widely distributed among peers for comments. After the questionnaire was designed, it was pretested among thirty health-care professionals using cognitive technique. A minor correction was made in the questionnaire to ensure the understanding and comprehension of the respondent.

The questionnaire was then sent to the health-care professionals all over India, with a request to further send it to other known health-care professionals. The location of the professionals was divided into metropolitan area, nonmetropolitan area, and rural areas. Any professionals, who are residing in Chennai, Delhi, Mumbai, Kolkata, Bengaluru, Hyderabad, Ahmedabad, and Pune, were termed as metropolitan. Rural areas were defined as per definition in census 2011 or for the professionals working in Primary Health Care (PHC). Rest others were classified as nonmetropoliton.

In the preamble of the questionnaire, the study population was informed about the volunteer nature of the study and assured confidentiality of the data. The Google Form was so designed to avoid multiple entries from the same respondent by making Google login mandatory and unique. The researchers had no access to the login id/e-mail of the participants. The study was approved from the institutional ethics committee of the institute.

Statistical analysis

The data from the Google Forms were downloaded in MS Excel. The data were cleaned and coded. The continuous variables were described as mean and standard deviation and categorical variables as number and percentages. The contingency table was made, and Chi-square test was used for association. The data were analyzed using SPSS software version 23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). The P < 0.05 was considered statistically significant.


  Results Top


A total of 169 participants responded to the study. The mean age of participants was 33.14 (±4.88) years (range from 22 to 55 years) [Table 1]. Mean years of medical practicing were found to be 8.275 (±4.41) years among our participants. Women participants represented about one-fourth (23.7%) of total participants. The majority of the participants were practicing in metropolitan cities, followed by nonmetropolitan urban areas. Only 4.7% of the participants were working in rural areas. The majority of the participants worked in government-run hospitals (62.7%), whereas 67 (39.64%) were employed in a teaching hospital.
Table 1: Socio-occupational variables of the health-care professionals studied (n=169)

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A majority of participants (61.5%) answered in affirmative when asked if they know what risk communication is, 13 (7.7%) were not aware of it, and remaining (30.8%) were not sure or preferred not to answer. A majority of the participants (60.9%) perceived risk communication as exchange of information between health experts and general public, whereas 23 (13.6%) participants felt that risk communication is exchange of information between health experts and other health-care workers; there were 26 (15.4%) participants who considered risk communication as a process of informing patients about their disease or the procedure [Figure 1]. Only 29 (17.2%) participants acknowledged having had any training in risk communication ever. About half of the participants (48.5%) believed rumor management as not essential for risk communication. About one-third of participants could identify interaction/communication with patient's relatives/patients is a not part of risk communication. Transparency (47.9%) was perceived as the most important thing in effective risk communication, followed by timely dissemination (26.6%), trust in the agency sharing the information (14.8%), and credibility of the information (10.7%). Even though 162 (95.9%) respondents agreed with risk communication as one of the core capacities to combat present pandemic and 156 (92.3%) agreed that an effective risk communication strategy can help minimize the effect of COVID-19 pandemic, only about half of them (54.5%) were sure about the purpose of risk communication as to enable people at risk to take informed decisions.
Figure 1: Bar diagram showing an understanding of risk communication by health-care professionals (n = 169)

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Perceived provider side and receiver side barriers were also studied. Lack of training was perceived as the most commonly recognized provider side barrier (63.3%) [Table 2]. A large number, i.e., 120 (71%) believed that risk communication, in a rapidly evolving pandemic such as COVID-19, should be carried out as frequently as possible when the new knowledge is available rather than waiting for complete information to become available. The availability of unverified info on social media was perceived as leading receiver side barrier by 129 (76.33%) participants, followed by a lack of understanding of the subject by recipients (70.41%) [Table 3].
Table 2: Perceived provider side barriers in risk communication (n=169)*

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Table 3: Perceived receiver sider barriers in risk communication (n=169)*

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Chi-square test was used to calculate the association of knowledge on risk communication with certain socio-occupational variables [Table 4]. Association of knowledge of risk communication with sex of the participant was found to be statistically not significant. There was a statistically significant association between knowledge of risk communication and nature of employment, in terms of government or private employment with P = 0.03. Training of participants on risk communication had a statistically significant association with the knowledge (P = 0.001).
Table 4: Association of perception about risk communication with selected variables (n=169)

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  Discussion Top


Risk communication is widely recognized as an important vertical for the management of any disaster situation; the present pandemic has once again highlighted the role of risk communication in mitigating the effect of the pandemic. Health-care professionals are the most important link in risk communication, as they are being extensively utilized by the executive authorities in risk communication not only because of the technical knowledge on the matter but also due to the faith public reposes when the risk communication is done by a health-care professionals. In our study, only 61.5% of the participants claimed to know what risk communication is; a significant chunk of participants (30.8%) was not sure if they know or not about risk communication. There were 37 (21.89%) participants who perceived risk communication as communication of treating physician with patient or patient's relatives; only 103 (60.9%) participants were aware about risk communication.

Almost half of our participants (47.9%) believed that transparency is the most important thing in risk communication, rightly so, as many governments world over are being criticized for lack of transparency, which erodes public trust in the health-care system of the country.

These perceptions need to be viewed in light of the fact that only 29 (17.2%) participants had ever received any training in risk communication, which brings about the gaps which our medical curriculum has. The medical curriculum in India was given an overhaul in the year 2019, with rolling out of competency-based medical curriculum, but sadly risk communication has been left out of medical curriculum, yet again. The study, while highlighting the perceptions of health-care professionals on risk communication, also implicates the lack of training to health-care professionals on risk communication. Training in risk communication as a part of the medical curriculum can be a game changer the way we manage public health emergencies.

Strengths of the study are the representation of health-care professionals from vast geographical regions in India, including from rural areas. Our study was also successful in identifying an important gap in medical education in the country. Limitations of the studies include its generalizability and its relatively small sample size.


  Conclusion Top


The risk communication is a cardinal aspect of managing present pandemic; however, health-care professionals have varied perceptions about the concept of risk communication. The present pandemic must be taken as an opportunity to improve our existing medical curriculum, and risk communication must be given its due importance in medical teachings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO | Risk Communication: Frequently Asked Questions. WHO. World Health Organization. Available from: http://www.who.int/risk-communication/faq/en/. [Last accessed on 2020 Aug 04].  Back to cited text no. 1
    
2.
”COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)”. ArcGIS. Johns Hopkins University. [Last retrieved on 2020 Apr 28].  Back to cited text no. 2
    
3.
Communicating During an Outbreak or Public Health Investigation | Epidemic IntelligenceService | CDC; 2019. Available from: https://www.cdc.gov/eis/field-epi-manual/chapters/Communicating-Investigation.html. [Last accessed on 2020 Aug 04].  Back to cited text no. 3
    
4.
Xiang D, Kontos C, Veloudaki A, Baka A, Karnaki P, Linos A. Risk communication in times of an epidemic or pandemic. Asset Paper Series Epidemics and Pandemics: The Response of Society; Vol. 14. September, 2017.  Back to cited text no. 4
    
5.
Information NC for B, Pike USNL of M 8600 R, MD B, USA 20894. Definition and List of Health Professionals. Transforming and Scaling Up Health Professionals' Education and Training: World Health Organization Guidelines 2013. Switzerland, World Health Organization; 2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK298950/. [Last accessed on 2020 Aug 03].  Back to cited text no. 5
    


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