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RISK SCIENCES ANALYTIC REPORT

Instructional Messages During Health-Related Crises: Essential Content for Self-Protection

CASE SUMMARY

The Centers for Disease Control and Prevention (CDC) “estimate that each year roughly 1 in 6 Americans (or 48 million people) gets sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.” Failures at the food processing and packaging stages lead to product recalls due to contamination by such agents as Salmonella, E. coli, and Listeria monocytogenes. Food recalls occur with frightening regularity and put the general public health at risk. Likewise, The National Center for Food Protection and Defense (NCFPD) in the United States warns that tremendous harm can occur due to the intentional contamination of the food supply in the form of economic adulteration or terrorism. Clearly, contamination of the food supply, whether accidental or intentional, is a significant health threat.  The CDC and other government agencies engage in consistent communication campaigns to encourage consumers to inspect their food and to follow recommendations for cleaning and cooking food products appropriately. In a foodborne outbreak, these agencies seek to warn the public of the contamination to prevent further illness. This study examines warning messages delivered through the media once an organization or government agency discovers that a food product is unsafe for consumption.  

We define crisis as a situation in which the welfare of consumers is threatened, the threatening conditions arise as a surprise, and responsible parties have a short response time to avert the escalation of harm. From this perspective, warning messages to consumers in a foodborne outbreak constitutes a critical form of crisis communication. Thus, understanding how and why some messages during crises are more compelling than others can help communication practitioners better mitigate harm.

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INSTRUCTIONAL MESSAGES IN HEALTH CRISESFrameworkResearch by Mileti and colleagues (Mileti & Fitzpatrick, 1991; Mileti & Sorensen, 1990) explained that there are key elements to consider when crafting a message during a crisis. The recipient of the information must: 

a. Receive the informationb. Understand that informationc. Understand that the message relates to them

directlyd. Understand the risks they face if they do not

follow the protective action providede. Decide that they should act on the

informationf. Understand the actions they need to takeg. Actually be able to take action

 Simply informing the public that a contaminated food product is being recalled is not enough. In order to protect the public during a crisis that increases health concerns, communicators must embrace the instructional dynamic of risk communication. Thus, effective instructional messages during health related crises should include content explaining the threat and its relevance for the audience as well as advice on how to avoid the threat or to begin treatment once exposed.

Working with the Media in CrisesThe media plays an essential role in providing instructional messages in a health related crisis. The Pew Research Center (2010) reports that local television news and national television news are still the two most popular news platforms. The inclusive reach and capacity for rapid information dissemination makes traditional media, particularly television, ideal resources for sharing instructional messages during crises.  Crisis communicators must therefore work closely with the media to get instructional messages to the public in a health related crisis. Unfortunately, while the public relies on the media for instructional messages, the messages needed for individuals to actually protect themselves during a foodborne crisis may not be reaching the public.

TABLE OF CONTENTS

Case Summary................1

Instructional Messages in Health Crises...............2

Case Analysis..................3

Methods..........................3

Instrumentation..............4

Results............................4

Conclusion......................5

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CASE ANALYSISIn our analysis, we provide a two-fold assessment of instructional messages at the onset of a foodborne crisis. Our data set is derived from the 2010 Salmonella outbreak in shell eggs shipped throughout the United States by two Iowa farms.

This study examined instructional messages during the 2010 egg recall. Actual news broadcasts from the recall were content analyzed for instructional messages and then experimentally tested to determine if level of instruction effects risk knowledge and self-efficacy for taking self-protective actions in a foodborne contamination.

Case Description and Context In April 2010, authorities began to see a rise in reported cases of Salmonella Enteritidis. Salmonella is a type of bacteria that can cause infection with fever, diarrhea and abdominal cramps. Infants, the elderly, and those with weak immune systems are typically more prone to severe cases of the disease. Both Wright County Egg and Hilldale Farms, based in Iowa, were found to be suppliers of the contaminated eggs. Wright County Egg found traces of Salmonella on three of its five farms and voluntarily issued a recall of its shell eggs. This recall included eggs shipped on or after May 16, 2010, which was approximately 380 million eggs sold under multiple brand names. Hillandale Farms affected eggs were sold under five different brand names and may have been repackaged by customers. Hillandale Farms furthered their recall to include eggs sold under four additional brand names, bringing the Hillandale recall to well over 170 million eggs.Both the CDC and the FDA posted press releases and official statements on their respective websites, including tips to reduce their risk of contracting Salmonella from eggs.

METHODSThis study was conducted using mixed methods. Content analysis was first used to determine what instructional messages were provided in the broadcast news coverage of the recall. The content analysis results were then used to select two messages for experimental stimuli to quantitatively examine the effect of instructional level on self-reported risk knowledge and self-efficacy using a pre-test-post-test experimental design.

Egg Recall Message Assessment and Stimulus SelectionThe University of Kentucky Digital Content Analysis (DCA) lab tracked all media coverage on major news networks from August 13 – 20, 2010, resulting in 566

unique news stories.

Subject matter experts from the NCFPD were consulted to determine what messages were most needed by the public for self-protection. The most important messages included three instructional directives:

1. Wash hands and cooking surfaces thoroughly after handling raw eggs

2. Cook eggs thoroughly

3. Check cartons and Julian date numbers to determine if eggs are part of the recall

 

FREQUENCY OF INSTRUCTIONAL MESSAGES OF SELF PROTECTIONFREQUENCY OF INSTRUCTIONAL MESSAGES OF SELF PROTECTIONFREQUENCY OF INSTRUCTIONAL MESSAGES OF SELF PROTECTION

RESPONSE FREQUENCY PERCENTAGE

Wash Hands N=19 3%

Recall Information

N=49 9%

Cook Thoroughly

N=95 17%

N=566

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Egg Recall Message Assessment and Stimulus Selection (continued)Using the subject matter experts’ key instructional messages, each broadcast television video was coded for the absence or presence of the three messages. Additional instructional messages provided in the broadcasts were also identified such as what to do with recalled eggs, what to do if you have eaten contaminated eggs, and how to locate more information on the recall. All videos were then rated for level of instruction on a scale of 1 – 5. Based on the analysis, two videos were selected as the stimulus materials based on level of instruction to create two conditions:

a. standard media messageb. high instructional message

 These two videos were of real news coverage, and thus, provided ecological validity to the stimulus used in this pre-test post-test experiment. The stimuli were chosen to compare the type of message most often broadcast and a message that included all of the recommended instructions.

Participants included 344 males and 307 females. Of the participants, 56.7% reported that they had never had food poisoning before. The participants were randomly assigned to see a standard media message about the egg recall or a message that was rated as having all three instructional messages present.

RESULTSPreliminary Data AnalysisTo examine the two groups for potential differences in efficacy and knowledge prior to beginning the experiment, a Multivariate Analysis of Variance (MANOVA) was used. The model revealed that the two groups did not significantly differ from one another on either efficacy or knowledge at pre-test.  Data AnalysisA repeated measures MANOVA was used to compare each condition over time on participants’ self-reported risk knowledge and self-efficacy. The first repeated measures MANOVA examined foodborne illness knowledge from pre-test to post-test and revealed a significant interaction effect. Those who viewed the high instructional video significantly increased in knowledge from pre-test to post-test. Those who watched the standard video demonstrated a slight but significant change in knowledge from pre-test to post-test.

INSTRUMENTATION

Perceived Risk KnowledgeParticipants’ knowledge of the risk associated with foodborne

illness was measured using Wrench’s Risk Knowledge Index. The scale is a10-item Likert-type that participants respond to using

a scale ranging from strongly disagree (1) to strongly agree (5).

The scale was modified to be more specific to the risk we were

targeting (e.g., I feel knowledgeable about the risks involved with foodborne illness).

Food Illness EfficacyThe Foodborne Illness Efficacy Scale is a 7-item Likert-type scale (e.g., I believe I can do things to protect myself from foodborne illness) that participants respond to using a scale ranging from very uncertain (1) to very certain (5).

Risk SaliencePrevious research indicates individuals with direct risk

experience (risk salience) are influenced less by media

coverage of a risk than individuals without that experience. In

addition, personal experience contributes to an individual’s belief that he or she can take

action to mitigate a risk. Therefore, we also examined the potential for differential outcomes

on risk knowledge and self-efficacy based on personal risk

experience with foodborne illness after viewing one of the mediated

instructional messages.

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CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

CHANGES IN EFFICACY AND KNOWLEDGE FROM PRE-TEST TO POST-TEST          

Changes in Efficacy from Pre-test to Post-test

 N

Pre-testMean (SD)

Post-testMean (SD)

t-statistic

p value

High Instruction Message – All 326 4.19 (.60) 4.41 (.60) -7.59 <.001

Standard Message - All 325 4.18 (.66) 4.05 (.79) 3.91 <.001

High Instruction – Low Salience 175 4.18 (.64) 4.40 (.60) -5.41 <.001

Standard Instruction – Low Salience 196 4.21 (.66) 4.11 (.71) 2.69 <.01

High Instruction – High Salience 149 4.21 (.56) 4.43 (.60) -5.29 <.001

Standard Instruction – High Salience 128 4.13 (.79) 3.96 (.89) 2.88 <.01

Changes in Knowledge from Pre-test to Post-test

 N

Pre-testMean (SD)

Post-testMean (SD)

t-statistic

p value

High Instruction Message – All 326 3.14 (.87) 3.98 (.68) -18.63  <.001

Standard Message - All 325 3.06 (.90) 3.18 (.94) -2.79 .01

High Instruction – Low Salience 175 3.04 (.84) 3.91 (.64) -14.21 <.001

Standard Instruction – Low Salience 196 3.06 (.87)  3.23(.90) -3.49 <.01

High Instruction – High Salience 149 3.27 (.88) 4.06 (.71) -12.06 <.001

Standard Instruction – High Salience 128 3.06 (.94) 3.08 (1.00) -.30 .76

Data Analysis (continued)The second repeated measures MANOVA examined foodborne illness efficacy at pre-test and post-test and revealed a significant interaction effect. Those who viewed the high instructional video significantly increased in efficacy from pre-test to post-test. Those who viewed the standard instructional video demonstrated a significant decrease in efficacy from pre-test to post-test. Thus, both groups demonstrated changes based on the video that they viewed. The groups were not significantly different at pre-test. A significant change over time within groups after the treatment exposure does not provide insight into whether the two groups significantly differ at post-test. To examine this, a MANOVA was used. The model revealed that the two groups significantly differed at post-test from one another. Those who viewed the high instructional video were significantly higher on post-test knowledge when compared to those who viewed the standard instructional video.  Further, those who viewed the high instructional video were significantly higher on post-test efficacy when compared to those who viewed the standard instructional video.

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Risk SalienceThe data file was split by salience (low salience vs. high salience), and a repeated measures MANOVA examined participants who viewed the high instructional video and the standard instructional video. The first MANOVA examined participants who reported low risk salience.  Participants who had low risk salience and viewed the high instructional video increased in knowledge. Those who viewed the standard instructional video also increased in knowledge. Participants who had low risk salience and viewed the high instructional video increased in efficacy. Those who viewed the standard instructional video decreased in efficacy. The second MANOVA examined participants who reported high risk salience. Participants who had high risk salience and viewed the high instructional video significantly increase in knowledge. Those who viewed the standard instructional video did not significantly increase in knowledge. Participants who had high risk salience and viewed the high instructional video significantly increased in efficacy. Those who viewed the standard instructional video decreased in efficacy. While the high instructional message significantly increased knowledge and self-efficacy both for those with and without personal and direct experience with foodborne illness, the standard message only increased participant knowledge for those without experience with foodborne illness. Therefore, the standard message did create differential outcomes based on risk salience.

CONCLUSIONWhen comparing the self-efficacy measures for those who saw the standard media message to those who saw the high instructional message, the differences provided even more compelling evidence for providing instructions to the public.  Viewers who saw the high instructional message significantly increased in self-efficacy regardless of their prior experience with foodborne illness, suggesting that they would have the confidence to enact behaviors to protect themselves. While previous research has shown that personal experience contributes to an individual’s belief that he or she can take action to mitigate a risk, participants who viewed the standard media message demonstrated a significant decrease in self-efficacy. That is, viewing the standard media message actually created harm for viewers and decreased their confidence in protecting themselves, even for those with prior experience with foodborne illness.  When the media provides instruction, this may be viewed as advice or even encouragement that helps viewers perceive the directive actions as something that can and will protect them from the health risk.

Given the dependence of the general public on the media as a health message resource, it is essential that the media provide the best possible information during situations that pose risk, or elucidate a crisis, to consumers. Media coverage that simply provides information about a threat to the food supply does not align with the best practices.  This study further illustrates the need for purposeful and ongoing media relations during health related crises. The somewhat passive acts of submitting key information in the form of standard press releases or posting information on a Web site were clearly not sufficient in this case. Thus, this study provides further support for forming and maintaining relationships with the media before and during crises.

These relationships can assist reporters in providing the accurate and essential information needed for viewers to engage in self-protection. The argument for establishing a partnership with the media is further supported by this study, especially considering the significant increases in viewer knowledge and efficacy when watching media coverage that does provide adequate instruction.

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This study revealed the troubling observation related to previous experience is that both the high risk salience and low risk salience groups actually decreased in their perceptions of self-efficacy after viewing only the standard message.  One might assume that having experienced a similar event in the past, in this case a food related illness, would provide the viewer with some degree of perceived capacity for managing a similar event. This was clearly not the case in the current study.  Rather, the standard news broadcast that emphasized the growing impact of the crisis without giving clear instructions for self-protection were disempowering for viewers regardless of previous experience. This observation serves as further support for advocating instructional messages in media coverage of health related crises. Failure to do so may actually contribute to the crisis rather than resolving it. Knowledge and efficacy are especially important to consider when constructing and delivering health messages because of their associations with individual behavior. Taken together, efficacy theories, social learning theories, behavioral change models, and protection motivation theory often include both knowledge and efficacy as precursors to behavior. Future research should examine whether a standard media message and a high instructional message actually yield different behavioral results. It would be important to examine whether the increase in knowledge or efficacy are short term or persist over time. Additional methods for enhancing efficacy could also enhance behavioral intentions.

For the ongoing NCFPD Robust Case Study project, the University’s of Kentucky’s Media Tracking Center and Digital Content Analysis (DCA) Lab are used to streamline the process of tracking and analyzing an overwhelming number of traditional and online media channels. These resources allow researchers to provide immediate feedback to organizations and individuals who need to know how their messages are being communicated by the media and received by the public. “During a crisis, we’ve been able to look at media coverage and track specific messages that were released to see how often they appear and whether they’re accurately interpreted,” says Dr. Tim Sellnow, primary investigator for the Advancing the Robust Case Study research project with the NCFPD. “And we can gather that information in hours instead of days, so companies can find out immediately if they need to correct their message or change their crisis response plan.” The DCA Lab perpetually records 20 U.S. television channels, including seven network (ABC, CBS, CW, FOX, NBC, and two PBS affiliates) and 13 cable (A&E, CNBC, CNN, CNN Headline News, Comedy Central, CSPAN, ESPN, E!, Fox News Channel, MSNBC, MTV, TNT, and USA) channels. Using key words, the database can be primed only to include transcripts where a pair of search terms appeared within 200 words of one another, so as to limit the occurrence of irrelevant content. The frequency of key word combinations or phrases can be can be automatically run, followed by more in-depth human coding. Online, print, and social media tracking can also be incorporated in the analysis. If you are interested in learning more about the Media Tracking Center and DCA lab at the University of Kentucky, please contact Dr. Tim Sellnow at tim.sellnow@uky.edu.

UNIVERSITY OF KENTUCKY MEDIA TRACKING CENTER

AND DIGITAL CONTENT ANALYSIS LAB

For more information on this study, contact Co-PIs: Timothy L. Sellnow, PhD (tim.sellnow@uky.edu) or Shari R. Veil, MBA, PhD (shari.veil@uky.edu) at the Division of

Risk Sciences, College of Communication and Information 310 Little Library, Lexington, KY 40506-0042

or visit their website at http://risk.uky.edu.

This material is based upon work supported by the U.S. Department of Homeland Security under Grant Award

Number 2007-ST-061-000003-02. through a grant awarded by the National Center for Food Protection and Defense at the University of Minnesota. The views and

conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or

implied, of the U.S. Department of Homeland Security or the National Center for Food Protection and Defense.