Importance of effective communication during COVID-19 infodemic

Abstract

The impact of COVID-19 on vulnerable groups would rely in part on the quality of communication regarding health risk and danger. Strategic planning should take full account of the way life conditions, cultural values, and risk experience affect actions during a pandemic. Concept of information education communication, Social behaviour change communication, social marketing usually technology and media is recapitulation. Ignorance with sociocultural, economic, psychological, and health factors can jeopardize effective communication at all levels. We summarized the framework for effective communication during pandemic. Understanding and practicing various communication strategies is crucial for physicians and health care workers to develop therapeutic relationships with COVID-19 patients. Addressing psychology in all people is vital during a pandemic and effective communication network is key to it. Effective communication, if ignored, will generate gaps for vulnerable populations and result in added difficulty in combating COVID-19 pandemic.

Introduction

Novel coronavirus (COVID-19) was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 30 January 2020. WHO declared the COVID-19 outbreak as a pandemic on 11 March 2020. As per WHO worldwide, as of 3:19 pm CEST, 19 July 2020, there have been 8,385,440 confirmed cases of COVID-19, including 450,686 deaths due to COVID-19.[1] According to the Ministry of Health & Family Welfare, a total of 168,269 active COVID-19 cases, and 12948 deaths have been reported in 32 states/union territories, as on 20 June 2020, 08:00 IST.[2] COVID-19 pan endemic exposed people to psychological distress, fatigue, occupational burnout, fear, stigma therefore it is of utmost importance the effective communication should be ensured at workplace, families and communities. The health systems aggressively stepped up the response measures like find, isolate, test, treat and trace transmission to save people's lives from COVID-19. In this situation, media and social conversations are primarily dominated by the large amounts of information about COVID-19. Responding to COVID-19 requires critical preparedness and response which includes effective communication as an essential strategy. Communication is a mode of the imparting or exchanging of messages by speaking, writing, or using some other medium. During a pandemic, communication is not only conveying messages to people but has a much wider approach.

Current scenario

The most important factor in preventing the spread of the COVID-19 is to empower the people with the right information. Today in the era of COVID-19 pandemic there is an overabundance of information leading to 'infodemic'. During a pandemic there is a lot of false information around therefore it is vital to have a dedicated COVID-19 information portal. India owns its dedicated integrated COVID-19 web portal, national and state wise helpline number, authentic email ID, government social hub on WhatsApp, Twitter, Facebook, New Desk Telegram, Instagram, Twitter, LinkedIn, and YouTube. Government of India developed Aarogya Setu mobile application aimed in proactively reaching out to and informing the users regarding risks, best practices and relevant advisories related to COVID-19.[2]

The government changed the default telephone caller tune in India from “tring-tring” to “cough-cough” followed by a message about Coronavirus. This is a multilingual and understandable 30-second audio clip to create awareness among masses.[2] This a practical application of information and education communication (IEC) strategies. Paintings with awareness messages on walls, roads and other common places, images on social media, memes, newspaper clips are other examples of IEC.

The primary modes of prevention are covering the mouth while coughing and sneezing, hand washing, social distancing, and seeking health care advised if unwell. Targeting behaviour change communication (BCC) during a pandemic is an interactive dialogue by a popular figure. Actor Amitabh Bachchan has been roped in by the government to promote positive behaviours about COVID-19. A campaign on television that imparts education of home quarantine for a COVID-19 suspect is also a BCC strategy.[2]

Worldwide social marketing is used in breastfeeding, personal hygiene, immunization, Tobacco control and others.[3] Currently in India social marketing is used by multiple multinational companies and brands to spread messages for handwashing, social distancing and restricted movement during COVID-19. For example, “Sirf lifebuoy nahi bulky kisi bhi sabon se haat doye”. In this video, a branded soap is advocating to wash hands with their soap or any soap available. Surf Excel “Abhi ke liye! Daag Ghar Pe Rahenge”. In this video, a branded washing powder is advocating social distancing and restricted movement. The video is acted by kids to give simple and clear messages to the children audience. Another example is “Ghar baithe baithe kya hi kar sakte hai? Bahut kuch! Ab Tata Sky ke saath, seekhiye aur sikhaye kuch.” This is motivating people to be active and engaged in their homes during the restricted movement period of COVID-19.

Webinar links pertaining to coronavirus are floating across all social media. It is difficult for a common man to choose the link for standardized knowledge acquisition. Integrated Government of India Online training, iGOT Corona is a portal to achieve access, equity and quality coronavirus literature.[2]

Factors Affecting Effective Communication

Effective communication is proactive, polite, imaginative, innovative, creative, constructive, professional, progressive, energetic, enabling, transparent and technology friendly. However, there are multiple factors playing a key role in accepting information, like social and cultural characteristics. Gender, generational contrasts, language inclinations, strict convictions, religious beliefs, and varying literacy influence the action of masses. Difficulty and attitudes towards initiatives in public health communication is crucial to improving awareness and eventually acceptability or unacceptability of government advisories. Presence of treatment, and vaccines have significant consequences for vulnerable people as it would allow individuals and organizations to take decisions and acts that may be incompatible with their health beliefs and values during a pandemic. Individuals with minimal financial resources needing to work on a daily basis may have trouble following advice to stay at home. Reliability, affordability, accessibility, availability, and appropriate use of personal protective equipment are key concerns from health care workers to common man.[4,5]

Framework for effective communication during pandemic

Effective communication system during a pandemic includes content, method, people and partners. Content is phased and situation specific ensuring communication precedes and monitors the operational and community response during the various pandemic stages. Process includes various platforms such as blogs, call centres, webinars, conference calls, online health group videos, digital news media are the means to ensure communication.[6] People are community participation approach from message conception to delivery. Fear, distrust, and resistance are common reactions during pandemic, trusted and credible information sources are critical for moving people from awareness to action. Communications before, during and after a pandemic are directed to partners, places and networks viewed by vulnerable populations as accurate, trustworthy and accessible.[7,8]

Communication strategies for family physician in different scenario

Effective doctor-patient contact is a key clinical role in establishing a partnership between doctor and patient for developing treatment plans, which is the center and art of medicine.[9] The various styles for effective communication by doctors in different COVID scenarios[10] are summarized in Table 1.

Table 1.

Styles for effective communication by doctors in different COVID scenarios

Medical interviews	Breaking bad news to patients and family members	Discussing a medical error	Any encounter where emotions present	Challenging conversations
C-L-A-S-S	S-P-I-K-E-S	C-O-N-E-S	E-V-E	B-U-S-T-E-R
C – CONTEXT Physical Space, Family Members/ Friends, Body Language, Touch. L - LISTENING Open Ended Questions Eg: “Who all have you recently met?” Clarifying Eg: “That must have felt terrible when…” Eg: “So, if I understand you correctly, you are saying…” Time & Interruptions A – ACKNOWLEDGE Empathic Response S – STRATEGY The Plan S – SUMMARY Final Thoughts	S- Setting Up the Conversation Secure an appropriate area for the discussion. P- Perception I- Invitation Assess the patient’s understanding of the seriousness of their condition. Eg: “Tell me what you understand about COVID so far.” K- Knowledge Explaining the facts Eg: “Are you with me so far?” E- Emotions The Empathic Response – Be Supportive Eg: “Can you tell me more about how you feel?” S -Strategy and Summary Eg: “Does this mean you are undertaking a test?”	C - Context O- Opening Shot Eg: “This is difficult. I have to tell you what I found out about why your mother is COVIDl.” N- Narrative Eg: “As you know, your mother came in back in…” E- Emotions Eg: “I know it’s upsetting for you and it’s awful for me too.” S -Strategy & Summary Eg: “I am the doctor responsible for your mother so it is important that I found out what happened.”	E- Explore the Emotion Eg: “Can you tell me more about how you feel?” V- Validate the Emotion Eg: “I can understand how that would make you angry.” E- Empathic Response Eg: “I’m sorry this has happened and I understand how it would make you feel that way.”	B-Be prepared U-Use non-judgmental listening. Eg: “So let me see if I understand…” S-Six second rule. T-“Tell me more” statements. Eg: “Tell me more about your contacts.” E-Empathize and validate. Eg: “I can see you weren’t expecting this.” R-Respond with a wish statement. Eg: “I wish I had better news…”

Psychology to COVID-19 Communication

In the COVID-19 pandemic, people are marked, stereotyped, discriminated against, viewed negatively, and suffered status loss due to a perceived contact with a disease.[6] In addition, high levels of stress and anxiety is experienced by adults due to significant changes in their day-to-day life and social structures and movements. Messages must be sensitive to and relevant for the audience.[11] Viewing, reading or listening to COVID-19 news may cause nervousness. The sudden and near-constant flood of news stories can cause one to feel worried. At the workplace, feeling under pressure is a probable experience. Seeking effective coping mechanisms is imperative. Unfortunately, some healthcare workers face rejection because of stigma or fear by their families or friends. Help kids find positive ways to express feelings such as fear and sadness. Participating in a creative activity like playing or drawing may often promote the process. Self-care for parents is central to helping the children. Older adults may become more anxious, angry, depressed, irritated and withdrawn during the pandemic. Engage in the safe things that people love, relax, daily exercise, normal sleep schedules and eating nutritious food is all important. Effective communication about COVID-19 has important benefits for workers, children, elderly, and the long-term psychological well-being of their families.[12,13,14]

Mistakes to avoid ensuring effective communication

Everything in pandemic revolves around effective communication, both internal with employees, co-workers or team members and external with people, communities and nations. It is utmost important to avoid mistakes during communication. Some of them are mixed or late messages, paternalism, ignoring rumours or myths, power struggles between governments, unrealistic expectations, scientific terms and acronyms, negative allegations, unclear, abstract, blame and others.[5,13]

Role of Family physician during Infodemic

One of the important strategies during this fearful COVID-19 pandemic is deep engagement of family physicians with sick, sometimes dying, patients and their families. Core guiding principle for this is patient and families must trust the doctor. Pandemic is affecting both the physical and psychological health of a community. Stress and fear arising from pandemic is controlled by guidance and counselling from trusted family physicians. Physician-patient relationships have significant positive and negative implications on treatment outcome. Family physicians must be competent for effective consultation techniques depending on the scenario. Owing to the rapid advancement of technologies, patients are exposed today to bulk of information. Family physicians are gatekeepers as “ First in, Last out” in the fight against COVID-19.[15] As respected members of communities, family physicians may enhance awareness and perception of COVID-19 risk. Family physician's effective communication helps to mitigate families of COVID-19 information in a clear and honest way. Family physician support reduces risks by advising and educating patients regarding the ways and modes to access authentic information from government or non-governmental organisations. Ultimately, the overarching goal of effective communication is to provide clear thoughts and true facts to improve patients and their family's health.

Conclusion

Pandemic demands strengthening the personal relevance of effective communications. It is mandatory to prepare for a dynamic risk event and uncertainty management during pandemic. To achieve this comprehensive framework for effective and integrated communications for COVID-19, which is technology friendly is critical at a national level. Success in containment of COVID-19 pandemic also mandates effective communication and interpersonal skills of a doctor and other health care workers that include the ability to collect information to facilitate accurate diagnosis, proper advice for isolation and quarantine, provide clinical advice and develop relationships with patients. People should seek knowledge of COVID-19 from reliable sources only and, in particular, to take practical action as per government advice to make plans and protect vulnerable populations.

Summary

Any communication in COVID-19 is crucial whether from government to people, from media to people, people to people, doctor to patient, within families and so on. Effective communication emphasizes the importance of content, accuracy, comprehensive signs, symbols, language, culture, and semiotic rules.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.