How Do You Communicate Uncertainty and Promote Public Health — During COVID-19 and Beyond?

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During COVID-19, the public has been flooded with potentially contradictory information that has led to an info overload. How do professionals communicating public health information manage the deluge?

Despite a vast amount of research, there are many aspects of COVID-19 that continue to be perplexing. From the more transmissible variants of the virus to the necessity of mask-wearing after vaccination, the protocols of the pandemic continue to evolve — and inherent uncertainty about the virus will continue. Even when officials delivering information are as accurate as they can be, they might learn something new that makes their previous advice outdated or inaccurate.

Therein lies a core problem of communicating uncertainty around public health information. “What people need to understand is that science is ever-changing and mutable. All knowledge is partial knowledge, and this is an illustration of that,” says Vish Viswanath, Lee Kum Kee Professor of Health Communication and director of the Applied Risk Communication for the 21st Century program at the Harvard T.H. Chan School of Public Health. The members of the public who receive this much-needed information may want facts and certainty, but this may either not be possible or change as knowledge changes.

In the case of COVID-19, many members of the public may be so inundated with potentially contradictory information that it has led to information overload. Viswanath uses the analogy of drinking from the firehose. At this point, he says, there’s a simple question that professionals communicating public health information need to ask themselves: “How do you manage the deluge?”

In other words, how do professionals provide need-to-know information that will help an audience make smart decisions, while remaining a credible source of information and acknowledging that they don’t know everything? How do they communicate facts and uncertainty simultaneously?

What are the sources of uncertainty in science communication?

There are actually two kinds of uncertainty that offer unique and separate challenges. The aforementioned change in knowledge seems easier to convey but can be disconcerting. At the beginning of the pandemic, for example, some public health officials encouraged people to wash any groceries that had been delivered, due to the virus’ potential ability to spread from inanimate objects to humans. Later on, the recommendation changed: washing groceries was no longer deemed necessary, as there didn’t appear to be a correlation between disease spread and unwashed items coming into the home.

This type of uncertainty can be frustrating because individuals who used the recommendation may feel confused and angry. Did they waste their time cleaning their groceries? Why did they integrate the practice into their lives? Were they being lied to? And what should they do now that the recommendation has changed?

Another form of uncertainty occurs when leaders and public figures contest or debate scientific findings in public.

It’s easy to do damage to the credibility of a public health source by sowing the seed of doubt in an audience.

This has the potential to impact large groups of people at a time, since the uncertainty comes from a seemingly trustworthy source, potentially in a public and shareable format. It’s also harder to correct the information once the sources have voiced that perspective. As Viswanath puts it, “When public recommendations are contested, we pay a heavy price for that skepticism.”

Because social media users do not have to abide by journalistic standards, posts can amplify and further distort both types of uncertainty — doing more damage to public health credibility in the process. Misinformation (drawing conclusions based on insufficient or incorrect information) and disinformation (spreading lies to further an agenda) are rampant on social media platforms. The sheer amount of information makes containing false information highly challenging, although efforts are being made by the social media platforms to slow the spread.

Before public health professionals take on uncertainty, they need to understand both forms, identify information people may have already received, and assess how to combat potential resistance to new, accurate information.

Ineffective communication strategies in disclosing uncertainty in science and public health

As has become common during the pandemic, even reputable sources of information have relied on fear and guilt to incentivize behavior. Such tactics could include TV footage of overcrowded hospitals or morgues, or graphic descriptions of ill or dying people who contracted COVID-19.

This tactic is not always effective, according to Viswanath, because it’s more likely to make an audience more resistant to the information.

Attempting to denigrate audience members only serves to alienate them further.

In a similar way, talking down to an audience as if they’re stupid will result in their failure to listen.

Another common mistake is making the advice too general, and not tailored to a particular audience. Aside from the obvious problem that it makes an audience less likely to listen to advice if they don’t feel it applies to them, this mistake has a deeper resonance in the midst of a pandemic that has disproportionately affected people of color and other marginalized groups.

Different communities might need different messages: that they can trust medical professionals and the vaccine, for example, or that they have access to a vaccination site that’s close to where they work. Understanding an audience’s locations and perspectives means that one can customize a communications strategy for groups that have suffered more than others and may have diminished access to information or treatment.

“When we communicate science without openly acknowledging issues of ethnicity, race, place, and class, it impacts people negatively,” says Viswanath. “If we don’t have active awareness of these issues, our strategies will increase those inequalities. We need to get the right groups at the table.”

What are effective communication strategies in disclosing uncertainty around science, research, and public health?

There are two levels of effective communication for any type of critical public health information, and particularly when the information includes uncertainty. Information needs to be assessed at both the systems level and the message level, and each requires its own strategy:

  • Systems-level:
    • How do you engage with key leaders in the community?
    • How do you allow them to provide feedback on the information and how to communicate it?
    • What should be the process to roll out information?
    • How does this rollout instill trust and likelihood of adopting changes?
  • Message level:
    • What do you say?
    • How do you say it? What are the elements of message construction? How do you construct facts to be clear, concise, and honest?
    • Where do you say it — what methods of communication do you use?
    • What are the audiences? Are they active or indifferent consumers of information? Do they have science literacy?
    • How do you tailor your message so that it reaches and is optimized for each audience?
    • How do you address backlash, mis-, and disinformation?

To communicate uncertainty effectively, especially in a crisis, Viswanath offers a few more ways to customize information. When there is information overload and changing recommendations, the message for the audience needs to narrow.

What is important to their regular, everyday existence right now? Envision this audience question: “What do I need to do so I can live my life with some degree of certainty and safety?” and seek to answer it. Anything outside of this information, though it may be important, should take a backseat to need-to-know information.

Additionally, Viswanath explains, public health professionals need to operate from a place of total and utter transparency. When you don’t know something, or it’s unclear, say so. “Audience members won’t be happy if you don’t know everything, but they’ll appreciate that you’re being completely open with them,” he says. This might be challenging, and might lead to backlash, but it’s the only way to maintain long-standing trust. “It’s not about us. It’s about understanding what the challenges are in their lives. Our message should solve their problems.”

Harvard T.H. Chan School of Public Health offers Applied Risk Communication for the 21st Century , an online program designed to provide you with the knowledge and skills you need to design effective risk communication messages..