Risk Communication

In

Obstetric Practice

Risk Communication in

Maternal Care

• Definition

• Principles of Risk Communication

• Process of Risk Communication

• Intervention

• Evaluation

• Perception

• Soft skills training

What is Risk Communication?

• The purposeful exchange of information

about the existence, nature, form, severity

or acceptability of health risks between

policy makers/health care providers and

public/media with the intention of changing

behaviours and inducing action to

minimise/reduce the hazard.

Risk Communication

• Interaction with internal and external

stakeholder groups about risk.

• Aims at mobilizing action. Is evidence of an

organization’s commitment to health and

welfare

Principles Of Risk Communication

• Effective risk communication (RC) is an essential element of Risk Management (RM)

• RC and RM are inextricably linked

• Understanding how people perceive risks and how to communicate risk information e effectively are keys to improve risk management

Principles of RC

• Interactive and participatory approaches

offer greater risk reduction.

• Critical elements are:

– trust and credibility of message source,

– quality and clarity of message,

– effective and efficiency of delivery channel,

– and involvement of target audience

Principles of RC

• Relevant agencies have an important role.

• Individuals and communities have a right to know about the risks to which they are exposed and to participate in decisions that affect their lives and property.

• RC is no substitute for regulation or action

• Risk communicators are accountable to the public and should base their actions on principles of ethics.

• RC is often an exercise in Public Relations

Process of Risk Communication

.

Situational analysis

Research the high risk mothers

• Who are they?

• Where do they come from?

• What is their educational background, occupation?

• What is their mode of communication, channels?

• How do we reach them?

• Where do they meet us?

• What are the resources available for intervention?

• What is their K, A, Practice, Perception, Motivation towards the risk?

• Who influences them in their decision making?

Risk Communication Process

• Problem diagnosis – Demography

– Psychography

– Behaviour contributing to risk

– Education, knowledge, attitude

– Perceptions and motivation

– Cultural practices

– Belief system

– Community Resources

– Communication channels and the various local vehicles

– Identification of Opinion Leaders

Objectives: Addressing the gap

General Objectives:

• To ensure effective communication to

mothers at risk and those who influence

them to reduce risk

• To contribute to effective management of

risk to reduce morbidity and mortality

Objectives

• To disseminate accurate and timely information.

• To maintain and strengthen credibility of the

health care providers and MOH

• Motivating individuals to act.

• To get immediate feedback and to take

appropriate remedial actions.

• To resolve conflicts/threats in managing patients

Specific Objectives

• Must be measurable for purpose of

evaluation

• Addressing the gaps in knowledge, attitude,

perceptions, motivation and actions by

quantifying

• Stated in the form of who, what, when

where, how.

Strategies

• Strengthening existing plan of action

• Develop new strategies in keeping with current trends especially the trend from education to promotion (Ottawa Charter 1986)

• Laws governing maternal deaths

• Policies

• Social support

Strategies

• To seek the cooperation of related

government agencies and non-government

organisations (NGOs) involved in maternal

health

• To provide accurate, timely,

comprehensible information through the

use of appropriate technology and channels

of communication utilised by the mothers

Strategies

• To coordinate flow of information to

internal and external stakeholders. This

includes relevant government agencies and

NGOs.

• To obtain feedback of mothers at risk from

the program managers, health care workers

and researchers so as to provide the relevant

information to the target groups.

Strategies

• To develop effective partnership with

groups who have the support of the high

risk mothers

• To provide in-house training programmes

in communication to health care providers

handling high risk maternal cases

Communication Model

• Source

• Channel

• Message

• Feedback

Message Sources:

To identify relevant personnel who communicate

with the mothers to work as a team and provide needed assistance

• Specialists, Registrars, MOs, Interns

• Hospital nursing staff

• Public health personnel who have contact with mothers

• Spouse, Family members, influential community members

Message Sources:

Webpage

• Creation and updating of MOH

Webpage: The mothers as well as

health care providers would be able to

gain the latest information on maternal

care

Website

• Growing trend of DIYDS playing little doctors aided by the advent of the internet. 136 million Americans access the net for health information.

• They research their own symptoms, diagnose their own illness and administer their own cures. Some buy their own machines and monitor their fetuses every night. No need to visit the doctor

• Increase in over the counter drugs

• Increase in Complementary and Alternative Medicine 1 in 3 Americans resort to CAM

– Mark J. Penn Microtrends 2007 pgs 91-95

Message Design: Educational

materials

• The development and dissemination of

relevant messages and educational

materials on maternal health such as

personal health care diary

• This covers both for the internal and

external stakeholders and should be easily

readable and have personal relevance to the

target group.

Educational Message Design:

Drafting a fact sheet

Content of fact sheet eg.

• Nature of problem (eg, cause)

• Management of the problem

• Prevention

• Important contact numbers

Delivery Channels

• Obtained from Initial Assessment

• Maximize effective and efficient utilization of delivery channels in terms of reach and frequency

– Face to face in clinical settings

– Home visits

– Occupational settings

Target Audience: Feedback

• To carry out analysis on all feedback

from mothers and others especially

frequently asked questions (FAQ) so as

to improve the information on

explaining risk

Organizational Activities

Human Resources: Training

• Competence in communication skills:

– Interpersonal skills

– Persuasion, Motivation

– Appealing to fear, emotional and rational

– Counseling (on prevention of pregnancy,

anxiety)

– Conflict resolution

– Negotiation

Organizational Activities:

Training

Module

• There must be a training manual, regularly

updated, with learning outcomes, content,

skill development and case studies

Community Organization

• Communication should be targeted

towards relevant individuals, groups of

individuals, specific subgroups or

institutions.

• The following should be taken into

consideration.

Community Organization:

Influential or Opinion leaders

• Needless to say the time tested

communication method through such

leaders of communities should be

employed where and when considered

best and opinion leaders need to be

identified and utilized fully.

Community Organization:

Inter-agency collaboration

• An integrated approach is sometimes the most

effective solution when individual persuasion fails

The need to collaborate and form partnerships

with women's group and to work together with

other relevant agencies should be made to discuss

strategies best suited.

Evaluation

• Process evaluation (Formative)

– to evaluate the activities.

• Outcome evaluation (Summative)

– to assess the reduction in morbidity and

mortality.

– changes in knowledge, attitude and practice of

target groups.

– attainment of communication objectives

Review and proposals for

change

• Preparation of report

• Distribution of report

• Storage for later retrieval

• Use of report for case studies and

research

• Learning from past mistakes

Guideline for agency

spokesperson • Spokesperson should be good in presentation and

interaction

• No names of the affected to be given until next of kin informed.

• Assure media results of the investigation will be given.

• Prepare press statement.

• No exclusive interviews.

• Be accessible.

• Be calm.

Media’s Role

• Assist in education

• Convey warnings.

• Convey instructions.

• Reassure public.

• Defuse rumors.

• Assist in the response effort.

• Provide the agency with updated information.

• Solicit help from others.

Dealing with the Media

• Prepare fact sheets, keep reporters updated.

• Avoid jargon.

• Respect reporter’s deadlines.Be polite and straightforward.

• It is good to tell the truth.

• Have your own agenda.

• Stick to facts you know. No opinions.

• Relevance of message, make notes and provide feedback.

Public Relations

• Organization put under public spotlight, management competence is questioned

• Employees, public and media need to be communicated

• Difficult for managers to make god decisions and to communicate well

• PR practitioners, legal, technical experts make a vital contribution

Effective risk communication

• Depends on the providers’ and recipients’

understanding more than the risks and benefits.

• Background experiences and values also influence

the process.

• The goals of the communication is advocacy,

education and decision making partnership.

• Multidirectional

• Debate instead of lecture

Our target group

Target Audience

• If you do not listen to people, you cannot expect them to listen to you.

• Target group have their own interests, information needs and channels, concerns and priorities.

• People need to be sufficiently motivated to understand complex risk information

• Information about the audience characteristics can be obtained through surveys, focus group discussions, demographic profiles and in-depth personal interviews

Risk Perception

• Conditions associated with increased public concern are

– Catastrophic potential

– Unfamiliar mechanisms

– Uncertainty

– Uncontrollable

– Involuntary exposure

– Children specifically at risk

Public Risk Perception

– Risk to future generation

– Identifiable victims as opposed statistical victims

– Effects dreaded

– Lack of trust in responsible institutions

– Much media attention

– Major accidents also minor

– Inequitable distribution of risks

Public Perception of Risk

– Effects irreversible

– Individual personally at risk

– Risk estimates based on human evidence

– Origin caused by human actions or

failures

Different categories of people

• Bandwagon: choosing the decision of the

majority.

• Free riding: gain by the doing of others.

• Altruistic: willing to take personal risks if

others will benefit from them.

Perception regarding risk

• Health belief model:

– Perceived susceptibility.

– Perceived seriousness of the disease/issue.

– Perceived benefits.

– Perceived barriers.

– Perceived threat of the disease.

Soft skills Training

• Soft skills are something that you have or don’t

• But it can be developed as we go along

• Soft skills separates a good doctor from a great doctor

• Soft skills include interpersonal skills and social skills such as listening, diplomacy, goodwill, flexibility, problem solving, smile, humour and empathy towards a caring professional doctor patient relationship (list is non exhaustive)

Methods used in soft skills training

• Role play

• Observation where the senior doctors become their role model Marcus Welby M.D., Dr. Kildare

• Young doctors given hands–on experience like breaking bad news to family members

• Interaction with the senior doctors

• Peer group discussion in sharing experience

Soft skills

• Doctors with better interpersonal skills are

sued less

Thank You