2003 Model Practice Application (Public)

Rhode Island Bioterrorism Risk Communication Program

Rhode Island Department of Health

Preparing for bioterrorism is a national homeland security objective invoking unique collaboration among local, state, and federal agencies. Toward this end, states involved in CDC's Bioterrorism Preparedness and Response Planning: Focus F were required to plan and implement a public awareness program focusing on bioterrorism. Research suggests that the success of public health campaigns hinge, in part, on (1) the degree to which the public participates in its design, (2) the campaign reach, and (3) the extent to which the messages resonate with the target audience. For this reason, Rhode Island used an approach that applies both social marketing and risk communication theories to population-centered bioterrorism awareness.

Applying the principle of target audience and audience segmentation, the RI Department of Health (HEALTHri) and its contractor, Policy Studies Inc. (PSI), conducted focus groups and in-depth interviews with diverse populations cutting across age, ethnicity, race, and geographic location. Focus group themes explored the public’s levels of awareness, preferred communications platforms, and preferred information networks. Based on both focus groups and in-depth interview findings, Rhode Island and PSI designed a consumer-driven public awareness campaign on bioterrorism. The initial intervention involved a single-page of basic information about bioterrorism, which was mailed to more than 420,000 households. The information addressed the following questions: What is bioterrorism? What is the state doing? How can I protect myself and my family from bioterrorism?

The chief objective of terrorists is not necessarily to sicken or kill people but to create terror. A panicked and terrorized population also can obstruct efforts to respond to biological, chemical, or natural disasters. By developing a bioterrorism awareness initiative based on both social marketing and risk communication, public health builds on the strength of both theories. Social marketing is consumer-based and asks the public what information they want and can use, in what formats, and how often. To prevent panic, the causes of panic need to be investigated. Risk communication acknowledges the trust-anxiety dimensions of public reaction. Information can help build trust in the government’s response, even as it provides new instructions to citizens.

In Rhode Island, the Department of Health acts as both state and local health department. The agency worked closely with the vendor, PSI, to organize, conduct, and analyze both the focus groups and interviews with executives of 19 key community-based agencies. The community agencies described what role they might plan for in a bioterrorism event. For example, members of the African American population indicated that the involvement of local church and community leaders was an important component of their reaction. Community-based organizations such as these will play a role in subsequent awareness interventions.

The market research component of this intervention cost about $95,000, including 12 focus groups (video and transcripts) with RI residents in seven areas of the state and 19 in-depth interviews with leaders of community based organizations. This research will provide a foundation for bioterrorism awareness interventions through at least the first two years, with the possible exception of a small number of “reality check” focus groups in the event of exceptional national or international events. The direct-mail information initiative cost approximately $0.23 per household, including developmental costs. Options for next year include purchased media (TV, radio, or newspaper ads), newspaper inserts, bus cards, billboards, and other interventions.

Evaluation, using shopping mall intercepts (N=105), indicates that most Rhode Islanders who received the information reported that they read it and thought it was easy to understand. Most Spanish-speaking (52%) but not English-speaking (38%) readers reported taking some action (e.g. stock food and medications, family contact plan) as a result.

As an added benefit, RI collaborated with two other states (ME and VA) to explore and compare experiences with developing public awareness initiatives using a social marketing approach. The states are comparing approaches, experiences and results from their interventions.

One of the key challenges was to convince colleagues in other areas of public health of the efficacy of interventions using a social marketing approach. Some criticized the amount of effort, expense, and perceived impact of the intervention even after the consultants presented professional-level seminars on the project design, implementation, and results. Another lesson learned was that it was important to use a consultant experienced in social marketing.

Social marketing is an approach to designing and implementing public health interventions. At a minimum, practitioners need to address the following elements of the logic model: Who is the target audience? What is the desired behavior? What determines the behavior? What strategies can be used to influence these determinants? In addition to focus groups, which RI used extensively, agencies can use existing data, key interviews, and community-based coalitions to inform the intervention.