TABLE 3.

Recommendations for Public Health Planners and Risk Managers to Enhance Health Risk Communication Preparedness for Vulnerable Populations

Goal	Recommended Action
Strengthen the personal relevance of communications.	Adapt communications to the language, spokespersons, cultural references, outreach strategies, daily life conditions, and cultural values of vulnerable populations to promote the adoption of risk reduction behaviors. Gather relevant information through partnerships with organizations and individuals who serve or interact routinely with vulnerable groups.
	Obtain prepandemic knowledge of relevant perspectives, priorities, and vulnerabilities of families, groups, and communities by interacting with community organizations, researchers, and other individuals and agencies that can provide a resilience and vulnerability profile of at-risk populations. Efforts should go beyond segmenting vulnerable individuals into typical sociodemographic groups and consider psychological perspectives, geographic factors, social media use, and other life circumstances that affect influenza risk and health-protective behavior.
	Use concrete message imagery (rather than just risk statistics) in a way that is compatible with the reasoning strategies of targeted groups (e.g., risk–benefit assessment of interventions, decision heuristics) and communications that reflect the particular risk circumstances of a targeted population.
	Plan for multifaceted, prolonged, and repeated communication, as well as direct and indirect (e.g., through community organizations) communications. As part of a preparedness plan, prepandemic messages will need to be justified to vulnerable populations and present clear information about what individuals are being asked to do or consider.
Build self-efficacy and trust regarding pandemic interventions.	Involve trusted members of the targeted population or respected outsiders in communication products, and present clear steps to perform recommended actions to enhance self-efficacy.
	During and preceding a pandemic episode, provide clear advice about what can be done personally to reduce influenza risk or secondary complications. Anticipate and explicitly address barriers to implementing recommended interventions. Reduce stress or negative emotions about performing these actions by designing interventions that are feasible and by using positive messages about how actions can be successfully performed.
	Anticipate possible variability in compliance, trust, and self-efficacy over time and plan to reengage vulnerable populations if necessary as the pandemic progresses (or successive waves occur). Build flexibility into communication processes to deal with a possible loss of trust and self-efficacy because of rumors or unanticipated difficulties in implementing intervention strategies. Communications should be open, clear, transparent, and culturally relevant when conveying information about the challenges of some recommended interventions.
	To encourage trust in public health officials, be open and honest about any disturbing aspects of the pandemic and any uncertainties regarding influenza risk or mitigation strategies, but juxtapose these messages with communications about the specific steps taken by public health and government officials to minimize risk, treat the afflicted, and rapidly detect or monitor exposure patterns. Explicitly address the value priorities of audiences (e.g., fairness and equity in health services distribution and explanations for any differences in mitigation strategies for particular populations).
Prepare for a dynamic risk event and uncertainty management.	Prepare public health officials, service providers, the media, and the general public in advance for some uncertainty in communications during various stages of an evolving influenza pandemic.
	Generate early initial messages that reorient expectations for immediate, certain risk information regarding infection rates, morbidity, and unfolding events.
	Prepare for unanticipated developments during the course of a pandemic by building into communication plans flexibility, ongoing evaluation and timely feedback from service providers and targeted populations, and drills and exercises that test the capacity for adaptation of communication processes, channels, and content.
	Build capacity for communication adaptability in the event of changes in recommendations about when to seek care, new information about vaccine or medication availability and distribution, unanticipated presenting symptoms associated with the pandemic influenza strain, unforeseen conflicting information about the pandemic, and needed adjustments in outreach strategies for difficult-to-access populations.
	Develop formal plans to update information, incorporate evolving knowledge about the pandemic into messages, and correct previous errors or missteps in communications in a time-sensitive, transparent, and open manner. For example, early warnings could result in false-positive errors, whereas premature reassurances could result in false-negative information.
	Prepare to identify and rapidly respond to emerging public concerns about interventions or the risks presented by the influenza pandemic. Communications about unanticipated complications should be timely and ongoing. A strong foundation of trust among vulnerable populations, service providers, and public health officials is crucial for uncertainty management during a pandemic, and the capacity for partnerships should be strengthened during the prepandemic period.