Impact Case: Enhancing Risk Communication for Pandemic Response

This research has informed debates and decision-making at key municipal and governmental departments and agencies, including Ministry of Health and Care Services, Norwegian Institute of Public Health, Directorate for Civil Protection and Emergency Planning, the County Governor of Rogaland, the County Governor of Agder, Stavanger municipality and Bjørnafjorden municipality. By bringing together some of Europe’s most competent researchers on risk communication, societal safety and health emergencies, this comparative research has also enhanced competencies among national and local authorities and health institutions on how to practice socially and culturally sensitive risk communication during pandemics.

Underpinning research

The Risk Analysis and Governance Group at UiS has a proven track record in studying large-scale crises such as climate and health emergencies, with a special focus on which social factors (such as gender, age, education etc.) might influence vulnerability and resilience in such circumstances. Right after the COVID-19 outbreak, they have received a grant from the Research Council of Norway’s urgent call for research projects aiming at enhancing preparedness for future crises . The research project, PAN-FIGHT, has investigated the authorities’ risk communication practices in Norway, Germany, Sweden, Switzerland and the United Kingdom during the period of first lock-down in Europe to the commencement of mass vaccinations between March and December 2020 . Although these countries may seem similar at first glance, with some differences in their governance models (federal vs. state-run public health administration), the research has uncovered many interesting findings for practitioners.

In particular, this research has led to better understanding about: i) How to prepare for the next crisis now by both addressing social inequalities and vulnerabilities as well as strengthening civil capacities as part of public contingency planning; ii) Importance of clear risk information: ensure well-functioning communication channels between professionals and decision-makers as well as rehearse the importance of clear and consistent messages; iii) The many facets and levels of a crisis: contingency planning should include mapping of how various crisis scenarios may affect different groups of the population, and as such, identify ways to support civil contingency capacities among different population groups, and how to mitigate new vulnerabilities; and iv) Effect of risk perception on behavior: establish or activate two-way communication channels customized for different parts of the population. In this regard, learning about risk perception among the population and its determining factors is crucial [1].

The research has uncovered a significant insight into how different types of trust affect people's response to crises. While the findings confirm the substantial role of trust in public authorities, they also show that Norwegians followedthe COVID-19 rules due to informal peer pressure. This means that what often motivated citizens’ behavior was a sense that their actions sent ‘correct’ signals to the people around them, to their social networks and fellow members of their local community. The comparative survey has further revealed that unclear and inconsistent official messages lead to a loss of trust in public authorities, which can cause centrally managed communication plans to fail and weaken societal resilience [2]. In addition, the lower compliance of some specific groups such as men over the age of 55 has been linked to high degree of the so-called ontological trust. This form of trust stems from a fundamental belief in the stability and predictability of the world and other people, making these men feel confident in their interactions and relationships because they believe that others will act in reliable and predictable ways.

Further, they have investigated how different population groups in these countries have translated risk communication messages into adjustments of their daily routines. Multiple types of data including a comparative study, online survey about peoples’ attitudes towards government risk communication, interviews with authority representatives (at national, regional and municipal levels), in addition to an ethnographic fieldwork in Norway, has been used. The results clearly showed that four major types of risks drove people’s perceptions: personal health, public health, personal economic risk and societal risk perception [3]. Beliefs about effective risk communication directly influence how often people engage in risk mitigation behaviors. If individuals perceive risk communication as ineffective, they're less likely to follow institutional advice for risk reduction. This decreased compliance is linked to how society perceives risks of different nature, creating a complex relationship between communication effectiveness and behavior. This strongly confirms the need to develop effective integrated risk communication that articulates messages on personal health, public health, personal economic risk and societal risk perception. In simple terms, this mean that people are worried by many more things than direct impact on personal health.

Several findings in PAN-FIGHT indicate the necessity of risk communication strategies that are socially, culturally, geographically and gender-sensitive. For example, men, except those aged 30-39, showed lower concern for health risks, possibly leading to lower compliance. Additionally, men were generally more reluctant to seek information and more dissatisfied with the information provided by authorities, except in the U.K [4]. Another example is the significance of immigrant background and how this translates into variation in both short and long-term mental health issues that should be considered for more effective risk communication strategies [5]. In terms of geography, PAN-FIGHT has uncovered an unexpected finding: individuals in remote areas were the least affected and experienced the smallest decline in quality of life. This difference can be attributed to social inequalities, resulting in an uneven distribution of the "cost" of adhering to mitigation rules. [6 ]. For instance, consider an adult couple with a detached house in a suburb of Oslo and a cabin in the mountains versus a family living in a three-room apartment in central Oslo; isolating oneself is far less challenging for the former than the latter.

References to the research

[1] Scharffscher, K. S. (2022). Fighting pandemics with enhanced risk communication: Messages, compliance and vulnerability during the COVID-19 outbreak (PAN-FIGHT): Summarised findings and recommendations. UiS Scholarly Publishing Services. https://doi.org/10.31265/usps.256

[2] Shapiro, M., Arora, S., & Bouder, F. (2023). Reassessing social trust: gossip, self-policing, and Covid-19 risk communication in Norway. Health, Risk & Society, 25(3–4), 180–198. https://doi.org/10.1080/13698575.2023.2202686

[3] Kompani K, Deml MJ, Mahdavian F, Koval O, Arora S and Broqvist H (2022) Who Said What: A Multi-Country Content Analysis of European Health Organisations’ COVID-19 Social Media Communication. Int J Public Health 67:1604973. doi: 10.3389/ijph.2022.1604973

[4] Arora, S., Gunnarsdottir, H.M. and Scharffscher, K.S. (2022). Gendered dimensions of the COVID-19 Pandemic. UiS Scholarly Publishing Services. DOI: https://doi.org/10.31265/USPS.255

[5] Arora S, Bø B, Tjoflåt I, Eslen-Ziya H. Immigrants in Norway: Resilience, challenges and vulnerabilities in times of COVID-19. J Migr Health. 2022;5:100089. doi: 10.1016/j.jmh.2022.100089. Epub 2022 Mar 5. PMID: 35280118; PMCID: PMC8897975.

[6] Bourrier MS and Deml MJ (2022) The Legacy of the Pandemic Preparedness Regime: An Integrative Review. Int J Public Health 67:1604961. doi: 10.3389/ijph.2022.1604961

Details of the impact

PAN-FIGHT has contributed to the evidence base on various social aspects affecting resilience and vulnerability in different European countries and has thus informed policy making and increased competence among risk communication practitioners. Bent Høie, who served as Norway's Health Minister during the COVID-19 pandemic, highlights the project’s impact in this way: “Communication was a main management tool during the COVID-19 pandemic. The PAN-FIHGT project results have given us useful insights in risk communication that are of high value for future pandemics” [A].

In particular, the project has i) Improved preparedness, resilience and societal safety in Norway and potentially also other European countries through increased understanding about individual dimensions of risk perception and behavioral responses to crises., ii) Enhanced risk communication strategies through evidence-based advice on how to better integrate gender, socio-economic, cultural and geographical considerations and iii) Reinforced the national authorities’ capacity for early warning, risk reduction and contingency planning for health risks. Several national agencies have undergone their communication strategy during and right after the pandemic and corroborate the contribution of PAN-FIGHT to this effort: I am currently working on evaluating our communication efforts during the pandemic and how we should utilize what we have learned in future work - both what we can do here and now and what we should emphasize in planning for crises in the future. For me, this [findings from PAN-FIGHT] was right on target [B].

Throughout the project, the research team consulted with various national, local, and professional authorities in the five aforementioned countries. These authorities provided information on their COVID-19 communication practices and expressed their needs for new knowledge. As key stakeholders, they also contributed to the study by offering feedback on the practical applicability of the project outputs. The research team recognized that, to make the research relevant to practitioners, findings needed to be described clearly and tangibly, and recommendations had to be actionable. This involved both the language used to disseminate the research results and the channels through which the results were made available. Consequently, a digital resource bank containing a curated collection of research outputs has been made available for risk communication practitioners, and there has been continuously increasing interest in these digital resources published on the project’s website.

PAN-FIGHT has demonstrated a profound impact on fostering international collaboration and facilitating the exchange of knowledge and experiences, extended beyond the partners involved directly in the project. "I went home from PAN-FIGHT's final meeting in Oslo with a positive feeling, as if I had settled a dispute. Bent Høie was no longer a minister, and I was no longer a state epidemiologist. Our conversation had helped me shake off the uneasy feeling that something had gone wrong between Norway and Sweden during the pandemic, and that I played a role in it. Instead, I felt strengthened in my belief in the Nordic context. I had been reminded of how important it was to exchange experiences" [C]. As illustrated by this reflection, PAN-FIGHT has provided a platform for resolving cross-national tensions and reaffirming the importance of cooperation. As such, it not only bridged professional and political divides, as highlighted by the stakeholder's renewed sense of solidarity with former Norwegian Minister Bent Høie, but also strengthened the belief in the value of shared experiences in addressing pandemic challenges. This underscores PAN-FIGHT's role in creating an arena where mutual understanding and collaborative learning thrive, ultimately contributing to a more cohesive and resilient regional response to public health crises.

Since the initial research findings were obtained, PAN-FIGHT researchers have been invited to directly engage with decision-makers at healthcare agencies and civil protection authorities, offering evidence and recommendations. As one of stakeholders in Stavanger municipality pointed out: “We are keen to develop new knowledge in order to be able to deliver services of good quality. Early involvement, a broad interdisciplinary approach and a large degree of flexibility in the implementation of PAN-FIGHT led to this being a positive collaboration, despite major resource challenges linked to the pandemic" [D]. This has resulted in increasing awareness among decision-makers about the somehow ignored aspects of risk communication, such as moral responsibility and solidarity. In 2022, Scharffscher was invited to two municipality (Stavanger and Bjørnafjorden) run events to discuss their research conclusions on how to develop an effective pandemic/crisis communication strategy. The two events drew in representatives from several municipal units including health and welfare, civil protection and communication.

Sources to corroborate the impact

[A] Bent Høie, Norway's Health Minister during the COVID-19 pandemic

[B] Jo Heldaas, Senior advisor, Communication department, The Norwegian Directorate of Health

[C] Anders Tegnell, state epidemiologist of Sweden during the COVID-19 pandemic

[D] Bente Gunnarshaug, special advisor, Stavanger municipality