1. Partner Insights
FAO Risk Communication Seminar
Susan Mackay, Senior C4D Specialist (Health) UNICEF

2. “Business unusual”

3. AI - What was learned (or not!)
• Multiple KAP studies conducted between
2006-2007 (Unicef research in at least 16
countries)
• Different methodology and designs made it
impossible to compare or generalize results
• Interesting insights for designing
communication strategies, and general
planning
• However insufficient qualitative or
participatory research to help address the
critical „WHY‟ question

4. What the KAPs showed
• High awareness but low understanding
– High media coverage likely to be a significant
factor
• Low level of knowledge about
transmission (at best one or two modes of
transmission) and many „incorrect‟ beliefs

5. Challenges
• Rural and less educated populations less
knowledgeable and less aware
• Studies largely descriptive
– Lacking plausible explanations for
demographic variables or varying levels of
knowledge about different forms of
transmission
– Lack of nuanced analysis unfortunate as
would have been key to improving design

6. Impact
• Communication campaigns did contribute to
increased awareness
• Knowledge (transmission, symptoms, methods of
disposal, and prevention) increased after exposure
or participation in communication interventions eg
– Meetings and outreach activities increased perceptions
of the seriousness of AI in Laos
– Substantial knowledge increases recorded (transmission
modes and prevention) between 2006 and 2007 in
Thailand and Egypt

7. Significant knowledge-practice gap
• Although awareness and knowledge of
prevention and transmission behavioural
change was much lower
– Some actions (cooking and handwashing)
easier to implement than others (biosecurity
and reporting behaviours) – also linked to low
perception of risk
– Need for a much deeper understanding of
social, economic and political barriers to
change

8. Risk perception
• Even though awareness and understanding
increased, risk perception and sense of urgency
generally remained low
• However in urban areas sudden drops in
consumption reported during outbreaks
– Yet in rural areas consumption even increased
suggesting low risk perception
• AI “only has relative importance”, “people are used
to it”
• Lower risk perception than issues such as dengue,
malaria, malnutrition, diarrheal diseases and
limited access to sanitation

9. Challenges
• Studies identified variations in risk perception
but did not (or were not sensitive enough) to
investigate highs and lows
– a better understanding of the drivers and timings
of changing attitudes and behaviours is needed
– more „dynamic‟, innovative approaches needed to
tracking changing perceptions of risk
– need to explore relationship with media coverage
(animal and human cases) and of economic
drivers

10. “… tools are still needed
to address the
challenges of
communicating in these
difficult circumstances.
These tools can be
developed by looking at
alternative paradigms of
risk that exist within the
social sciences.”
Abraham, T, Bull World Health Organ 2009;87:604–607

11. “Risk Society”
Beck, Giddens etc
Epidemic
Psychology
“Psychometric Strong
paradigm”
Slovic et al.; Covello and
Sandman
Social
Amplification of Culture, Risk and
Risk Blame
Douglas
(See Murdoch et al.)

12. But how does this translate in
low resource settings?

13. Behaviours
Reality check (1)
Studies showed that the four behaviours are
rarely practices in high risk communities in
„real life‟
But too much emphasis on „educating‟ rather
than finding the „locks‟ and „keys‟ to
behaviour change
– Lack of link with „programme‟ and community
developed solutions

14. Reality check 2
Reality check (2)
“The idea that one should have to protect
oneself from one’s poultry is literally exotic”
“birds and humans have mingled for
generations without any negative impact as far
as they could see ….”
We must constantly work within peoples social,
cultural, political and economic realities.

15. Reality check 1
Reality check (3)
“AI prevention and control faces formidable
obstacles, including disbelief in the existence of
the disease, lack of economic means to
implement recommended practices, and
distrust of the authorities and health services.
“It is important to distinguish between obstacles
that can be addressed through communication
alone, and those that need different and
complementary programme interventions””

16. If we were starting again …
• Much more emphasis on addressing
attitudes, such as low risk perception and
stigma around reporting
• Total integration with technical programming
to reduce structural obstacles that discourage
health practices (eg grant subsidies,
economic aid to strengthen bio-security, as
well as incentives to promote community
surveillance and reporting)

17. Design shortcomings
• Not enough adjustment of the four key
behaviours to local settings and realities –
need for dialogue and consensus
• Initial outbreak responses were inevitably
„general‟, but later interventions should
have been more tightly focused and
nuanced to address specific needs and
concerns (or lack of!) in segmented high
risk populations

18. Potential solutions
Participatory approaches to build local
perspectives into design of activities and
solutions

19. Lessons learned
• Too much emphasis on promoting the
actual behaviour but not enough on
„selling‟ the benefits and / or risks eg
– Local beliefs
– Social attitudes eg stigmatization
– Agreeing feasible, low cost solutions
– Encouraging self and collective efficacy
– Credibility - understanding the context of trust
in local authorities

20. Social determinants
• Interesting gender, religious and cultural
insights, but in many cases the data was
available only after the bulk of communication
interventions had been designed or
implemented eg
– Women primary handlers of poultry and eggs
spending more time with backyard poultry
– Men involved in handling slaughter, and cock-fighting
in particular countries
– Particular ethnic and or religious practices

21. Some highlights
Innovative work with schools eg. Thailand,
Indonesia, Turkey

22. What worked
• High level advocacy with government officials and
decision makers
• Training of print and broadcast journalists at
national and subnational levels
• Training frontline workers and volunteers, rapid
response teams and poultry farmers
• Orientation and training of government
spokespersons, school teachers and community
influencers
• Folk theatre and rural media
• TV and radio campaigns featuring public service
announcements

23. Limitations
• Frantic pace of activities
– Emergency response to outbreaks
– Pressure from donors to implement quickly
when more time was needed for participatory
research, design and implementation
– Lack of existing capacity at all levels
We were aware of most (if not all) of the
limitations at the time but limited capacity to
change course!

24. Institutional context
• Level of government commitment, ownership and
capacity varied
• Coordinating committees a problem in some areas
• Working relationships within and between
agencies varied – where it was good generally the
quality of work and impact was higher
– These relationships work best where they are built in
advance
• Participatory planning processes involving multiple
stakeholders was greatly appreciated

25. Resource issues
• Some programmes had much more than
funding than they were used to, others had
to work with very limited resources
• Limited human resources within country
offices and country teams – some had to
be pulled from other teams, others had to
be recruited quickly without the necessary
experience or training

26. AI and Pandemic Influenza
• Much of the AI surge capacity was no
longer in place when the H1N1 pandemic
emerged
• Confusion about the differences between
AI response and pandemic preparedness
– should have been delinked!
• Much longer term investment is required in
building „C4D‟ capacity – best way to be
ready for an emergency

27. Wish list (1)
• Interagency vision and leadership required to
make long term communication investments
towards „One Health‟
• Capacity for evidence based communication
planning and implementation in all agencies
– correct balance of quantitative and qualitative
research (including PLA, rapid surveys),
implementation, monitoring and evaluation

28. Wish list (2)
• More emphasis on achieving change
through analysis of „locks‟ and „keys‟ to
change, as well as careful use of
appropriate risk communication approaches
for developing country settings
• Stronger partnership between the agencies
– understanding each others roles,
responsibilities, strengths and weaknesses

29. Thank
you