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Responding to Emergencies One Behavior at a Time

Posted on by Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating 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 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?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Posted on by Dr. Stephen Redd, Director, Office of Public Health Preparedness and ResponseTags , , , , , , ,

8 comments on “Responding to Emergencies One Behavior at a Time”

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 ».

    Are there behavior change campaigns or research to change selfishness to compassion?
    The belief underlying selfish behaviors seems to be that anything goes if it increases my money, power, or happiness, regardless of effects on others.
    Can anyone influence another to change that belief?
    Doing so could improve the health and safety of people in the United States and around the world, couldn’t it? A great many public health problems might be solved in that way.

    In approaching people to influence them into changing a certain behavior, one must first inquire from them their reasons for carrying such a behavior to be important. Use their understanding and what they know to deduce and reveal them the implications.
    Every behavior has and origin, fine it out. There’s no justification to what we’ve originally misconceived. More also, teaching the way out is most important.

    Muy importante. Cuando ocurrió el desastre tras el paso del Huracán Maria por nuestra Isla, hubo una falta de comunicación de las autoridades sanitarias con respecto a como responder ante la emergencia. Como salubrista, entiendo que esto es vital y debemos trabajar en equipo para lograr el mejor bienestar para la población.

    Utilizing Motivational Interviewing is one of my favorite approaches when working with patients! I appreciate the above graphic highlighting “7 Things to Consider When Communicating About Health!” Public Health Social Workers are a wonderful resource to collaborate with while exploring behavior change.

    The behaviors attached to health crises must be addressed, when communicating any type of health information. Public health leaders must take the time to get to know communities and members within them, and be able to relay information about risks that may be attached to infections/diseases. Using a model such as the transtheoretical model of behavioral change, leaders can help re-invent people’s way of living; this starts with them thinking about the choices that they make on a daily basis. The level of communication is important as well, as some people may not be as “open” or “receptive” to health information because of their beliefs. All in all, societal norms, environment, behavioral habits, and trust are the most important things to be mindful of when relaying health information to any community. Ethics must be attached to the entire process from planning to implementation. If any public health leader wishes to make a long-lasting, beneficial change, knowing how to communicate effectively will be the key.

    This all assumes people are logical to begin with. Which we all know isn’t necessarily true. Behavior change is not always linear in that enhanced education doesn’t necessarily drive behavior change. There are many reasons that is true and some are mentioned in this post. Culture and education are just a few. We also must admit people can be lazy and self serving and by the definition of crisis we don’t necessarily have time to understand why people are behaving a certain way. Behavior economics has uncovered several of the irrational means in which people behave. It’s a combination of approaches that are most effective in a crisis. Immediate and deliberate barriers to unwanted behavior may be require but sustained change does call for a deeper understanding of human behaviors.

    The topic treated in the papers presented are very valuable in public health communication which will impact corrective changes in public behavior that encourages spreading of infection. When investigation is done on knowledge base evidence of people traditional beliefs that contradicts health well being of individual and public it’s very easy to fashion out program that can correct such behavior for the safety of the community at whole. In my research project on HIV /AIDS regards undergraduate students in Nigeria west of Africa, it’s base on knowledge, attitude and behavior informing change and preventing spreading HIV/AIDS. The more informed people are about the wrong influence their behavior is actually help to accept corrective behavior measure in mitigation against spreads of infection, and I want to say that education is definitely important in this public health approach.

    Being an RN, part of my responsibility is to educate patients. I feel like education is the best way to modify behavior. There are some barriers of course, given the person’s education level, willingness to learn, and compliance with current therapies. Even more difficult – language barriers. When discussing disease prevention with a patient, it is important to highlight their risks. I feel this brings the reality of possibly to the patient. Stressing the importance of not only protecting themselves, but their family and friends. Using plain language is also important. Because of 9/11, emergency responders had a hard lesson to learn. Departments and cities responding from outside the area all used different codes, with different meanings. Since then, the use of plain language has been used. The only code still used is “10-4”. Using this example, behavior change can not only take time, but some times disaster to reveal there is a problem. Disaster is the unfortunate way we change a lot of our behaviors, such as this article presents.

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