Reaching Out: An Evolving Communications Strategy

The emergence of H1N1 flu in the spring of 2009 posed unique communications challenges for state and local health departments nationwide. Media focused attention on the potential health threats of a new pandemic flu virus. Public concern escalated quickly, and in Rhode Island, local healthcare providers, community organizations, and businesses looked to the state Department of Health for guidance. Despite many uncertainties, state officials had to act quickly to get key information to the people who needed it.

The state health department quickly realized that it would have to evolve its strategy to meet changing information needs. In late April and early May, it established a core set of tools to communicate with the public and partners in a timely, consistent, and reliable manner. These often included daily e-mail briefings, an emergency information line, media briefings, conference calls, web postings, and regular meetings with state policy leaders.

Once the health department had developed its tools, it adapted the focus, frequency, and timing of messages in response to vaccine availability, media attention, and public perception of the dangers of the virus. Partnering organizations learned how to receive updated information from the department, which in turn learned how to effectively respond to partners' needs and concerns. Over time, the state expanded its core communication strategies to include direct mailings, community presentations, and media campaigns. Communication and collaboration with community partners proved to be key in Rhode Island's H1N1 response efforts. The vaccination of almost 427,000 Rhodeislanders is a testament to the effectiveness of the collaborative relationships that characterized this communication strategy.

Initial information about the H1N1 virus was limited and changing rapidly. In late April, the Rhode Island health department started sending out daily situational updates in the form of email briefings to healthcare providers and community partners. The list of people receiving the information grew, as awareness grew and more asked to be included. Partner briefing recipients included school officials, community-based organizations, the media, politicians, city and town leadership, the Governor's Cabinet membership, state employees, and business partners. The standard format included Rhode Island, New England, and national data, references to new guidance for healthcare providers, and contact information. The briefs were kept to two pages in length, assuring a quick read, and were also posted on the state's website via a newsfeed. The health department aimed to get new messages published by 2 p.m. daily.

Director of Health David Gifford and other department representatives began reaching out to groups by giving on-site presentations. They spoke at schools, churches, senior centers, business meetings, childcare centers, parent groups, healthcare professional associations, advisory committees, to local media, and in Rhode Island Senate meetings. They also made presentations before minority outreach workers, and a minority professionals association. Translators interpreted when they addressed non-English speaking audiences.

The benefits of these engagements were two-fold. They helped the department understand the concerns of Rhode Islanders, and provided groups with factual H1N1 information to pass to the populations they serve. This is just one example of the successful collaboration that occurred between the Health Department and community-based organizations during the pandemic.

Regularly scheduled conference calls with providers, hospital administrators, school superintendents, insurers, higher education, and state health officials provide another example of such collaboration. The conference calls offered a means of receiving feedback from partners and, later, for explaining plans for vaccine distribution. They usually opened with updates on the status of H1N1 and on the state's plans and ended with a question-and-answer period.

In the spring and summer months, the health department focused its messaging on flu prevention, diagnosis, and treatment. Throughout the response, it continued to reinforce key public health messages, such as the importance of washing hands, covering coughs, and staying home when sick. When the federal government announced plans for developing and distributing an H1N1 vaccine, it shifted its focus to vaccine availability and eligibility.

Since initial supplies of vaccine were prioritized for high-risk groups, the health department organized its outreach in terms of different target groups. It added H1N1 flu-related pages to its website and organized them to target specific groups, including parents and caregivers, pregnant women, people with underlying health conditions, seniors, healthcare providers, and young adults. Website content included prevention messages, vaccine safety information, frequently asked questions, and downloadable CDC and in-house materials, such as vaccine information statements, brochures, posters, and fact sheets. Rhode Island made the decision to target initial distribution at pregnant women and children. Schedules for school-based vaccination clinics and clinics for pregnant women were posted on the health department's website.

With help from community partners, the health department distributed a number of direct mail communications to publicize vaccination opportunities for different target audiences. For example, the Rhode Island Department of Education assisted the Department of Health by sending letters and informational packets to parents announcing plans for school-based vaccination clinics. Other mailings in the form of toolkits were sent to school nurse teachers, child-care centers, college and university public information officers, and community-based organizations such as libraries, senior centers, housing networks, homeless coalitions, chambers of commerce, and minority and multi-cultural outreach programs. The toolkits contained print materials in a variety of formats and languages, depending upon the populations served by the partnering agency. The health department also had regular media briefings to provide updates on vaccine availability and clinic schedules. Existing relationships with many of these partners proved to be an enormous asset in helping to raise awareness of the pandemic in Rhode Island.

The health department intensified its regular communications as flu activity increased and peaked in the fall of 2009. Briefings to healthcare providers increased from weekly to up to three times a week at the height of flu activity. In early November, the partner briefing became an important tool for communicating weekly updates about school-based clinics for H1N1 flu vaccine. It was re-named the Partner and School Briefing.

Additional staff and volunteers were trained to answer calls on the H1N1 Information Line, which received approximately 1,000 calls a day during the peak of the pandemic. The department also had three special H1N1 television broadcasts. Viewers could call in to a phone bank with flu-related questions. Press releases were issued as needed, and health officials began having weekly press briefings to keep the media up-to- date on the latest developments. A health department representative also made several appearances on Spanish radio stations. In response to intense media focus on H1N1, message distribution staff began closely monitoring the media to keep call center representatives and other staff informed of possible rumors or misinformation.

With the winter months came a shift from a situation of low vaccine availability and high public demand to high vaccine availability and lower public demand. As vaccine became more widely available to additional populations, the CDC flu clinic locator was added to the health department's website. The department also ran a paid media campaign to encourage vaccination among a wider Rhode Island audience. The campaign consisted of posters, billboards, bus shelter ads, newspaper ads, and public service announcements in English and Spanish. The health department also took advantage of social media tools, such as a Twitter account and a blog, to reach additional audiences and provide a means for the public to interact with the Director and other Health Department professionals.

The increase in vaccine availability during the winter presented a new messaging challenge for the health department. Early on, it had stressed that healthy adults and senior citizens were at lower risk from H1N1 and not prioritized to receive vaccine. When vaccine was more readily available, the department staff found themselves trying to convince people in these same groups that H1N1 still posed a threat and that healthy adults and senior citizens should receive vaccine. The health department again turned to its community partners to help it direct and reinforce the new messages. It held a joint press conference with the Director of Elderly Affairs and a prominent business executive to encourage seniors and healthy adults to receive H1N1 vaccines and to encourage businesses and community-based agencies to offer on-site clinics for employees and constituents. It also relied on senior organizations and businesses to relay information about free public vaccination clinics to their target populations.

The Rhode Island Health Department relied on a variety of communication tools to promote vaccination opportunities and to keep healthcare providers, partners, and the public aware of the H1N1 flu situation. The continual flow of information through established channels enabled its partnerships to move and evolve in response to changes in the availability of vaccine and public demand for information. Communication with providers and partners gave the department immediate feedback, which the agency used to address concerns through the media, website postings, and additional targeted outreach. The H1N1 communications strategy in Rhode Island represented a truly collaborative effort that strengthened existing relationships, allowed new partnerships to form, and continued to evolve in response to shifting information needs.

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