Determine Who’s At Risk | Clinical Evaluation | Risk Communication | Specialists | Treatment and Management

Risk Communication

• Effective risk communication allows the populations affected to improve decision-making; it also can relieve tension.
• Perception of risk is affected by many factors and can be unrelated to actual risk.
• Good communicators establish trust by getting factual, timely information to the community and including all stakeholders early in the process.

During the Three Mile Island release in 1979, the population in the area perceived a high risk associated with the release. Poor management of the situation and poor communication with the population in the affected area led to mistrust and increased levels of psychosocial stress that remained elevated for many years.

The field of health risk communication has developed science-based approaches for communicating effectively in high-concern, low-trust, sensitive, or controversial situations. Good risk communication involves a dialogue among all persons and groups concerned to communicate the nature and level of risk and the steps to take to change that level. The goal of risk communication is to increase knowledge and understanding, to enhance trust and credibility, and to resolve conflict.

Risk communication is of critical importance in the evaluation and management of persons with concerns about past exposure to I-131. It involves the characterization of information with the involvement of individuals and communities who might have been exposed. These individuals and communities are stakeholders in the risk communication process. In this process the risks are effectively communicated, relieving tension and anxiety, improving subsequent communications, and increasing the effectiveness of risk management decisions.

The perception of risk by individuals or communities can be affected by several factors other than how the risk is communicated. This includes cultural, social and economic level, geographic location, previous experience, and other variables inherent to the individual, such as personality. In matters of high concern and low trust, perception equals reality. Peter Sandman (1993) developed a framework for dealing with risk. Risks that are:

• natural are more readily accepted than those that are man-made;
• visible and avoidable are more readily accepted than those that are unseen and imposed by others;
• voluntarily assumed are more acceptable than those that are involuntarily imposed; and
• familiar are more acceptable than risks that are exotic or unfamiliar.

The public might be distrustful and upset because a real threat to their health has occurred. They expect to receive information about the incident, about who is exposed and what dose was received, and about how the exposure will affect their health. The level of trust a source has developed with a community will determine how credible the community will perceive the message to be.

Empathy and caring, dedication and commitment, competence and expertise, and honesty and openness are important trust and credibility factors. Health care providers are among the top third in surveys on trust and credibility on health and environmental issues.

Key issues within communities are health, safety, environment, quality of life, fairness, legality, and economics. The media has an important role in communicating risks to the general public and should be included as partners in a risk communication plan. Government officials and health care and public health professionals often seek out the media, or are sought out by the media, to explain risk resulting from catastrophic events. A communications plan must be in place before such an event to maximize the opportunity to promptly and accurately inform the public.

In communicating information about health risks, it is important for messages to be consistent. Coordinate with your local medical association, local or state public health department, emergency response organizations, and elected representatives to ensure that all segments of the community receive clear and consistent messages.

Persons with concerns about exposure to I-131 might have fear and anger that need to be addressed in a timely manner by health care providers. The health care provider can encourage trust and credibility by getting the facts of the exposure straight, being forthcoming with information that meets the needs of the individuals, coordinating efforts with public health agencies, and avoiding giving mixed messages.

In persons with concerns about I-131 exposure, great uncertainty exists about the risk. Uncertainty exists with respect to previous and present exposures, the dose received by individuals, the clinical significance of exposure and dose, and who might be legally and morally responsible for the financial costs of the exposure. The health care provider needs to anticipate this uncertainty to effectively help the patient recognize the risks. It is important to deal with the uncertainty; listen to and deal with specific concerns; convey the same information to all segments of your audience; and explain risk in language people understand, simplifying language and presentation, but not content.

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Sandman P. 1993. Responding to community outrage: strategies for effective risk communication. Fairfax, VA: American Industrial Hygiene Association.