Megan Brooks

May 26, 2015

TORONTO ― The way the US Centers for Disease Control and Prevention (CDC) provided information to the public on the risk for Ebola shows "significant room for improvement," new research suggests.

The media often reports potentially distressing news regarding infectious disease outbreaks or other events affecting public health.

"The way information is conveyed to people directly affects their mood, thinking, and behavior. Risk perception about potentially dangerous situations is very anxiety provoking, and anxiety that's inappropriately treated can lead to maladaptive behavioral responses," Daniel Witter, MD, PhD, from the Department of Psychiatry, University of Florida, Gainesville, commented during a press briefing here at the American Psychiatric Association (APA) 2015 Annual Meeting.

Guiding Principles

Following the 2003 outbreak of severe acute respiratory syndrome (SARS), the World Health Organization (WHO) offered risk communication guidelines for relaying information to the public.

Developed by a psychologist and psychiatrist, these guidelines are divided into consensus recommendations, which advise not to overreassure the public or put reassuring information in subordinate clauses and offer actionable items for the public to undertake. Debatable recommendations included creating alarm, acknowledging opinion diversity, and showing a willingness to speculate.

"The Ebola epidemic provided a unique opportunity to see if these guidelines were followed. It was a different organization, but we felt that the WHO guidelines would be an appropriate measure to look at the CDC's actual coverage of the Ebola situation," Dr Witter noted.

"One of the guiding principles of risk communication," he explained, "is to establish and maintain trust with the public. And the way a message is conveyed is frequently as important as the message itself."

Dr Daniel Witter

Dr Witter and colleagues did a qualitative analysis of three transcripts of televised news conferences in which CDC director Thomas Frieden, MD, related information about the Ebola crisis. They went through line by line looking for examples in which the guidelines had been appropriately followed or not.

Empowerment Over Reassurance

They found several examples in which the guidelines were not followed, particularly in the first news conference. They also found a shift from debatable recommendations early on to consensus recommendations in later conferences.

The investigators note that the biggest strength of the CDC's risk communication strategy was offering people things to do; the biggest weakness overall was overreassurance about the risk of Ebola spreading.

"Dr Frieden was at his best in establishing humanity and in acknowledging deficiencies about specific aspects of how the Ebola crisis was handled, especially in the United States and in Texas. We felt his weakest area was overreassurance. We found a couple examples of that," Dr Witter reported.

The investigators suggested that the CDC would have benefited from following the WHO guidelines. The researchers also recommend that "psychiatrists take a more active role in educating the public health and elected officials on effective risk communication as a major tool for demand management of health services."

They add that "empowerment, rather than assurance, should be the goal of risk communication."

Monday Morning Quarterback

The CDC did not respond to a request for comment from Medscape Medical News.

Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation, in New York City, and chair of the APA Council on Communications, who moderated the press conference here, said, "This is an important and very useful study."

"It's always easy to be a Monday morning quarterback. From my perspective, the purpose of this study is really for all of us to step back and look and see what happened, use this as a case study, and look at the potential areas that were strengths as well as potential areas that can be improved upon moving forward, because there will be other crises. I see that as a real opportunity, and that is why I think this is very important research," Dr Borenstein said.

Dr Witter noted that risk communication can be a "game changer," and he cited the sarin gas attack in Tokyo in the mid-1990s as a "good example."

"Dozens of people were killed, hundreds were directly affected, but the emergency services in Tokyo were overwhelmed by multiple thousands of people with vague symptoms who thought they may have some kind of sequelae from the sarin gas attacks, and they could not deal with all these people. This is an example where if appropriate risk communication had gotten out very quickly and if well done would hopefully limit the demand on management on medical services," Dr Witter said.

He views this initial study on Ebola risk communication as a "jumping off point" and said that he would next like to develop a metric based on the guidelines to evaluate any given media message about an infectious disease outbreak to provide feedback to help develop more appropriate risk communications in the future.

"Ultimately, we would like to see if improved risk communications could enhance public response in infectious disease outbreaks."

Dr Witter and Dr Borenstein report no relevant financial relationships.

American Psychiatric Association (APA) 2015 Annual Meeting. Presented May 17, 2015.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.