How We Decide What to Say in Emergencies

Posted on by Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious Diseases
Illustration of Salmonella bacteria.
An outbreak of Salmonella Typhimurium struck 46 states from 2008-2009. Communicators had to work quickly to get the right messages out.
Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious Diseases
Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious Diseases

A few years ago, there was an outbreak of Salmonella infections among people who ate peanut butter and products containing peanut paste, like crackers and cookies. People were scared. They needed to know which products were affected. Were they in their grocery store, or worse, already in their kitchen? They also needed facts about Salmonella infection: what are the symptoms, and how dangerous is it?

Fact: You can’t protect your health if you don’t know what to do and how to do it.

This is the reason I spend my days helping people get the right messages about their health at the right time. During the Salmonella outbreak linked to peanut butter, we worked to quickly gather information and science from lots of sources and get it to the people who needed it. But there’s more to communicating about health than just moving information around. There’s a science behind what we do.

First things first

Before I start writing, I take a minute to put myself in the audience’s shoes. Who are they, and what do they need to know to protect themselves? I begin with the what, why, and how – the basics everyone needs to take the first steps.

In an emergency, geography is also important. If there’s an outbreak or a flood, not everyone may be affected. People need to know if they’re close to the incident or far away, and what the likelihood is that it will affect them.

But we don’t just consider what we need to say. We also look at the best ways for people to hear it. We know that people with different backgrounds will take in health information differently. What people do about a threat depends on several things, including who they are, who we are, and how we talk about it. This is where the communication science comes in.

Applying the science7 things to consider when communicating about health

In my job, we apply a system where we look at the different aspects of getting health information to people who need it. There are seven things we consider when we communicate about health:

  • Trust: Will people trust the information? Who is the best source to put the information out?
  • Information: What information is necessary, and how will people find it? How much is enough, or too much?
  • Motivation: How relevant is the information is to the people we’re trying to reach?
  • Environment: What are the conditions that surround and affect the audience?
  • Capacity: What is people’s ability to act on the information? Are there barriers?
  • Perception: What will the audience think about the information? What will inspire them to act on it?
  • Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?

We call this set of questions TIME-CPR. Answering all of these questions before we start communicating lets us make a plan that will help people take action and save lives.

What we know, as soon as we know it

Sometimes we get worried about communicating information before we have all the answers. But it’s okay to say that we don’t know yet, and we’re working on finding out. We’re all in this together, especially in emerging and evolving situations, and people need to trust that we will always share the latest and best information we have, even if we don’t yet understand or know everything. We’re not just experts, we’re expert learners.

When something first happens, we might not know right away exactly how many people or which products are affected. But we need to start talking about it anyway. The risk is too great if we don’t.

Let’s go back to that Salmonella outbreak. Because peanut paste is in so many products, and because those products were already in the hands of so many people, we had to act quickly. Many of the affected crackers had been sent to troops overseas or were foods that get sent as part of school lunches. We immediately reached out to veterans’ communities, daycares, and schools. We developed a searchable database and created a widget to help people figure out if their food had the peanut paste in it. In the end, the outbreak affected over 700 people in 46 states. But without fast communication, many more would have been sick.

Health literacy touches everyone

October is Health Literacy Month, which is a time to focus on how we can help people better receive and understand information they need to stay safe and healthy. When we present our information in a way that makes it difficult for people to understand what they can do to protect their health, they may be more likely to get sick or die.

Health literacy affects everything from how and why medication should be taken, to reading nutrition labels, to what people should do in a major emergency like an outbreak or natural disaster. Everyone – from large agencies to community organizations to family doctors to individuals – is responsible for making sure we all have clear and relevant health information when we need it. We need to stay connected and communicate well. Lives depend on it.

For more information about Health Literacy, visit the CDC Health Literacy website.

Improving the ability to share and use health information is a national priority. The National Action Plan to Improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a connected effort to increase health literacy, and is part of the Healthy People 2020 objective to improve health outcomes and health equity through better communication.

Posted on by Christine Prue, MSPH, Ph.D., Associate Director for Behavioral Science, National Center for Emerging & Zoonotic Infectious DiseasesTags , , , ,

6 comments on “How We Decide What to Say in Emergencies”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    This is a fascinating topic and one of great interest to me, as a registered professional nurse. Thank you for presenting this blog post, and for posting a site where I can get more information on this topic.

    Thank you for the very interesting post. I have always wondered how the CDC decides to announce important information to the public. I am pleased to know that it is so well thought out. As a health professional, it is great to have a little more background on public health departments and how they operate. I am curious to know if your announcement strategy changes as you get more information. It seems like keeping the public abreast of ongoing developments is a full time job!

    Thank you for this information. I found this post to be comforting and informative. It is great to know that the public can rely on the CDC for up to date information regarding the safety in our food supply. I’m sure it takes a lot of hands and brilliant minds to develop policies for the necessary steps and direction in informing the general public when these sort of events occur. Again, thank you for the educational post and I look forward to reading more on this, and related, issues.

    I appreciate the inner look into your thought process when releasing information. Your 7 steps to consider paint an accurate picture and if answered properly will provide good information to the public. As a nurse I was always curious how the determination was made to pass on knowledge that is learned about a particular instance. It is good to know that information dissemination is not held up by the “wait until we know everything” curse. The article was good and I feel like the broader base knowledge will be helpful to me in the future.

    I’ve seen some version of “don’t be scared, be prepared,” in event-based and ongoing campaigns, and continue to wonder whether that’s actually a relevant concept. For crisis comms, when there’s something actually happening that could generate fear, I could see it being useful, but in that case preparedness really isn’t the issue – it’s taking one or more specific protective actions. For most preparedness campaigns, overcoming fear isn’t the challenge – it’s overcoming apathy, inertia, or just competing priorities. Good evidence that one can’t scare people into preparing, and I’ve seen no evidence that simply telling people not to be afraid works – and in fact may seem dismissive. So if it weren’t a short rhyming phrase, would we even be using it?


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Page last reviewed: December 12, 2016
Page last updated: December 12, 2016