Enhancing How Governments Assess Awareness of Zika

On August 31st, twenty-four experts from ten countries joined two dozen public officials from four Latin American countries in the first of six two-hour online conversations. In this first session, we focused on identifying novel strategies that governments can use to understand what different groups within the population do and do not understand about Zika. With limited resources for combatting Zika, governments the world over are eager for more evidence-based approaches. But quickly ascertaining levels of public awareness will depend on doing more than going door-to-door with clipboards.

In a lively dialogue on Wednesday that meandered from English to Spanish to Portuguese and back, the assembled professors, technologists, data scientists, and public health officials brainstormed and deliberated about how new technology, in particular, might be brought to bear to make ascertaining public understanding faster, easier, cheaper and more accurate.

We used the Internet to help governments get more diverse expertise faster. First the participants asked questions of the governments of Argentina, the City of Rio de Janeiro, Columbia, and Panama about how they assess awareness currently. We learned that there are already novel approaches underway, such as Argentina’s use of hotlines to collect and identify public “perceptions, definitions, fears” and to know how “rumors are circulating, myths, erroneous understandings about the particularities of these diseases” are proliferating.

Then the tables turned and governments asked questions of the innovators, probing them for ideas: Are there less expensive, faster ways to gauge awareness? How do we distinguish between what different populations groups do and do not know? What are the best ways to frame the questions to elicit more accurate responses?

The Issue

It is critical for policy makers and public health officials to know what their constituents understand and misunderstand about diseases such as Zika and Dengue, including whether the public knows how to combat the diseases, and whether they feel enough motivation to do so.

Misinformation and apathy are rampant in every public health crisis. Public health communicators have to cope with “infodemics” — a term coined by David Rothkopf to define “a few facts, mixed with fear, speculation and rumour, amplified and relayed swiftly worldwide by modern information technologies, that can affect national and international economies, politics and even security in ways that are utterly disproportionate with the root realities.”

For example, in the context of mosquito-borne diseases, it is of paramount importance that the public understand that mosquito-borne diseases (MBDs) like Zika are transmitted by mosquitos and that mosquitos can breed in any amount of standing water. They need to recognize the symptoms (mild fever, headache, joint pain) as well as the fact that Zika can be asymptomatic and how to respond as well as how to prevent Zika by eliminating standing water, using repellant and the right clothing to avoid bites.

Yet evidence suggests that misperceptions and half-truths abound. Especially in the context of an epidemic, public health officials do not have the capacity and time to conduct extensive public perception research using a range of different methods. They need rapid access to reliable data on public perceptions and issues that affect public trust, along with methods for analyzing such data.

Currently, governments primarily rely on face-to-face surveys and polls using landlines and mobile phones; focus group discussions involving population samples representative of diverse genders, ages, and socio-economic groups; interviews using structured questionnaires and conducted through face-to-face household visits; community dialogues, where neighbors meet face-to-face to deliberate about a public health issue as a means to surface misperceptions. In Brazil for example, the most widely used method is that of face-to-face household surveys, where Community Health Agents (within the Family Health Program) interview inhabitants about what they know of MBD and what their prevention practices are. Beyond the traditional face-to-face household surveys, governments usually struggle to fund a diverse set of qualitative methods (as mentioned above) needed to capture local indicators of public perception and factors that affect public trust. (For more about the issue, read the conference backgrounder here).

Novel Approaches

The conference resulted in several concrete proposals, especially for using social media to track public awareness. Joshua Tucker said “the most exciting possibility of the social media is this low cost early warning system. Fabro Stiebel added that “the monitoring of social media is easy to do, although it provides just a sample of the population.”

This discussion on using social media for “digital listening” included a robust conversation about how to use Facebook to surface information from aggregated posts to inform the messages governments and health organizations send.

Another approach is to explore explore more granular uses of Twitter to gain a better understanding of who knows and understands what. There are new approaches that can be applied to understand who is saying what about MBDs and identify the sources of both information and misinformation in communities using social media. Identifying sources of influence within communities can help with targeting messaging to improve understanding. Manuel García-Herranz from UNICEF talked about the importance of tracking the networks through which information travels (people to people, media to media) so as to identify messages before they become people’s beliefs, as it is more challenging to change what people believe than to modify opinion formation. UNICEF has done some efforts on mapping “the highways of information”, doing network analysis to identify trending topics which is emerging information that can be corrected before it becomes a belief. See, e.g.Global Pulse’s work on mining vaccine sentiment.

Rafael Obregon shared that UNICEF Brazil has been using a digital listening approach, in collaboration with Google, to identify trends in public awareness, rumors, information seeking, etc, which in turn informs their approach to engaging with the public on risk perception.

The conversation went beyond digital listening using social media to address how to use SMS tools like UReport to understand what people know as well as more conventional approaches. Prof. Elder reiterated “the importance of face to face communication in changing behavior.” Gaya Gamhewage from WHO talked about how the World Health Organisation is training responders to conduct and use simplified social science research in epidemics using a WHO KAP toolkit.

Bringing the Mountain to Mohammed: Creating More Agile Ways of Bringing Expertise to Governments

The Internet enabled the convening of this extraordinary array of diverse supporters to collaborate with government officials on refining new ideas and taking them from the realm of research into the realm of the possible. Participants included:

1. Dr Juliet Bedford, Director, Anthrologica
2. David Broniatowski, Assistant Professor, School of Engineering and Applied Science, The George Washington University, USA
3. Huiling Ding, Associate Professor of Technical Communication, Department of English, North California State University, USA
4. John P. Elder, Distinguished Professor, Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, USA
5. Dr. Gaya Gamhewage, Medical officer, Infectious Hazards Management, Health Emergency Programme, World Health Organization, Switzerland
6. Manuel Garcia-Herranz, Lead Research Scientist, UNICEF Office of Innovation, USA
7. Molly Jackman, Public Policy Research Manager, Facebook, USA
8. José Ignacio Mata, Expert in Communication for Behavioral Change,Salud Mesoamerica 2015, Honduras
9. Esteban Moro, Visiting Professor, MIT Media Lab, USA; Assistant Professor, Department of Mathematics, Carlos III University of Madrid, Spain
10. Mario Mosquera-Vasquez, Chief, Communication for Development, UNICEF-India
11. Dr. Adriana Naim, Health Programs Coordinator, RTI International, Guatemala
12. Monserrat Naranjo, Project Director, Curarse en Salud, Mexico
13. Wendy Nilsen, Program Director, Smart and Connected Health, National Science Foundation, USA
14. Brendan Nyhan, Professor, Department of Government, Dartmouth College, USA
15. Rafael Obregon, Chief, Communication for Development, UNICEF, USA
16. Nancy Pendarvis Harris, Vice President, JSI, USA.
17. Mathias Pollock, Social and Behavior Change Technical Advisor, Population Services International, USA
18. Lee Rainie, Director of Internet, Science and Technology Research, Pew Research Center, USA
19. Alex Rutherford, Data Scientist, UNICEF Innovation Unit, USA
20. Esmily Yusmary Ruiz Varón, Consultant, Transmissible Diseases, Ministry of Health and Social Protection, Colombia
21. Dr. Magdalena Serpa, Senior Program Officer, Maternal, Newborn, Child Health & Nutrition, PATH, USA
22. Fabro Steibel, Executive Director, Institute for Technology and Society, Brazil
23. Joshua Tucker, Co-Director, Social Media and Political Participation Lab(Smapp), NYU, USA
24. Dr. Lynn Weekes, CEO, NPS Medicinewise, Australia
25. Allison Wolff, Facebook, USA

What’s Next

Assessing understanding is only one part of the Zika communications conundrum. On September 7th from 10 am — 12 pm EST, we hosted another session focused on the most effective ways to communicate about Zika to promote the behavior changes needed to reduce infections. Upcoming topics include Trash and Standing Water Mitigation and Information Governance. To request an invitation to participate, Click HERE