Tuesday, October 28, 2014

"Sick" "Infected" "Symptomatic" and "Contagious" - Tangled up in Ebola Messages

Task: still working to clarify the NYCDOHMH explanation  "How Does Ebola Spread" from the previous post.
Let's tackle the statement explaining when someone is contagious.
 "People only become contagious after they begin to have   symptoms, such as fever."[Revision goal: explain the distinction between when a person is contagious and when they are not]

You can only get (catch) the Ebola virus from another person when that person has symptoms.  This means that the sick person is vomiting, throwing up, or has fever.    If the sick person is in the early part of Ebola they have the virus but they may not have any symptoms yet. You cannot get Ebola from a person who does not have symptoms. 

The above revision was working well until two colleagues showed me a  Palm Card the DOH produced recently.  
Ebola - Am I at Risk?  
Excerpt from NYCDOHMH Palm Card
In this consumer message they are not making any distinction between a sick person (a person with Ebola) and a contagious person. 

Which message should we be communicating to the general public when it comes to concepts of  "sick" "infected" "symptomatic" and "contagious".

A person can have the Ebola virus but not be sick. 
A person with Ebola is not sick until they have symptoms.
A person can only spread Ebola when they have symptoms. 
You can only get the Ebola virus from a sick person who is having symptoms.
?   ?   ? 

Monday, October 27, 2014

Ebola Transmission: Can we explain it better?

Two Doorman on the upper east side late one recent night, talking about Ebola:

Miguel:      It gets passed from bodily fluids – blood, sweat, saliva, I think.
Hal:           So if I get a sick person’s saliva on my ankle can I get it?
Miguel:    Let’s say you had a cut, then the germs can go into your body through the cut.
Hal:       So, if I touch my ear with my hand and the saliva is on my hand, can I get it?
Miguel:  I don’t know.  I don’t think so.  Can it seep right through your skin? 
Hal:       Geeeee.  That's creepy.  Right through your skin! 

Communicating and educating the public about Ebola transmission is critical to keeping the virus controlled and in controlling panic.  Amidst seas of misinformation the NYCDOHMH has tried to bring reason and an evidence-base to its Ebola communications. 
However given that 50% of the US public is low health literate/ and 50% have trouble reading, we would like to add our expertise to suggesting readable and health literacy appropriate clarifications.   Here's an example.

Excerpt from “Ebola Frequently Asked Questions”
[Second Q/A listed]

How does Ebola spread?
Ebola is spread by direct contact (through broken skin or your mouth, eyes or nose) with
       Body fluids (such as blood, vomit, urine, feces and sweat) of a person sick with Ebola. People only become contagious after they begin to have symptoms, such as fever.
       Objects soiled with the body fluids of a person sick with Ebola.
       The body of a person who died from Ebola.
Ebola is not spread through the air or simply by being near someone who is infected.
During outbreaks, the disease can spread within health care settings if workers do not wear protective gear and take proper precautions.

Health Literacy Load Analysis: (where we identifcomplex language and health/science concepts that need to be clarified for the general public / 50% of whom are low health literate/50% have difficulty reading)

 While the word/syntax reading level hovers at about 7th grade key concepts require more sophisticated understandings and are not adequately explained in the text itself/

       What are bodily fluids
 Where these bodily fluids can remain dangerous – on sheets, clothing, on dead bodies
 Concept of sick versus contagious
Rewrite Attempts
I've started it off here but could use some help: 

10/27/14 - [explaining contact with bodily fluids]
Ebola spreads from one person to another when a healthy person comes into contact with a sick person's bodily fluids.  
Bodily fluids are saliva,sweat, semen, urine, feces (poop).

                                                                                  to be continued...

Thursday, October 23, 2014

Is My Car's Airbag Safe or Deadly?

 In the “ ever changing landscape of fear” that is life on earth, we now have ( when it breaks the Ebola media frenzy) the discovered deadly hazard regarding Takata Air Bags.  It's estimated they're installed on roughly 8 millions cars driven in the US. One of them could your yours- mine!

NHTSA ( National Highway Traffic Safety Administration) says they’re going to leave “no stone unturned” in the Takata investigation.

Today, October 23, 2014. 
Search:  Does it have an airbag problem? Is it safe to drive today?

Click Google search 10/23/14: NHTSA Air Bag Recall

I guess it's encouraging to know that "NHTSA supports efforts by automakers to address the immediate risk in areasthat consistently hot, humid conditions over extended periods of time."
The language is just a tad difficult and obtuse. ( roughly 12th grade reading level)

Undaunted I click on Honda:
 (The first part of a 3 page letter appears in PDF!)

Well, is my car / am I in immediate danger?  

I Click Safecar.gov  and type in air bag recall (*powered by NHTSA)

I don't think I have an item of motor vehicle equipment on me at the moment. 
(Long, complex sentence, multiple interruptive phrases and clauses/ approximately 20th grade level. 

WOW  NHTSA has a Facebook page!! That’ll tell me if my car has this dangerous problem.

Another example of "Communication that Isn't - with the consumers as losers. 

Wednesday, October 15, 2014

Ebola Messages:the blame game when we need truth and justice

The four young women I interviewed yesterday said that the nurse who contracted Ebola  (first nurse in Texas) must have "disrespected" the medical protocols.

Well, this headline on CNN tonight will do nothing to help them and countless others taking in Ebola information broaden their perception - move it beyond the idea of "bad actors" acting badly, or irresponsibly.

And I don't hold out too much hope that the ubiquitous streaming videos  explaining how to don and doff protective medical gear aren't inadvertently reinforcing the blame model that people are developing.

I can imagine someone saying:
"If it's so clear what the nurses and doctors have to do, then [those nurses and doctors]  must not be following  the rules [protocol]. 

In public health there has always been a tension between using messages that empower people,  and blaming people for failures.  AIDS, Smoking, Diabetes, Obesity, Teen Pregnancy.....( I wrote about a while back)

What is lacking rather completely from the content and tone of just about all the messaging from experts and the media coverage of Ebola is a social or behavioral justice story.  Adler and Stewart present such a model regarding obesity (2009, Milbank).  Their study, "Reducing Obesity: Motiving Action While Not Blaming the Victim"concludes:
A behavioral justice approach to communicating can "convey the principle that individuals are responsible for engaging in health-promoting behaviors but should be held accountable only when they have adequate resources to do so. This perspective maintains both individuals' control and accountability for behaviors and society's responsibility to provide health-promoting environments."

When Ebola protocols are "disrespected"

It's Tuesday.  The day after a Texas nurse is diagnosed with Ebola. The day before the news tells us that a second healthcare worker is likely infected.

It’s a warm day and four gregarious HS seniors, young black women, indulge me as I interrupt their animated talk about some celebrity’s breakup. They’re on their way home from school.  We’re at the Harlem Meer. And I’d like to talk to them about Ebola.

Are you aware of the Ebola outbreak?  
“Yes, sure”
Do you watch the news on TV?
“Not really.” [unanimous response]
“Through the wall…my mother watches in her room and I can hear    it.”

So, where are you getting most of your information about Ebola?
         “Instagram [unanimously]. There’s a hashtag”  
At some point I mention that health officials said that the Texas nurse likely got infected because of “breaches in protocol.” And the head of a national nurse association said that,  "The protocols that should have been in place in Dallas were not in place, and that those protocols are not in place anywhere in the United States as far as we can tell."

What does a “protocol” mean to you?
They are the rules
Something mandatory
         Something that you have to follow
I don’t think it’s generally written down – not a rule of law.
One young woman explains how some people are “disrespecting the protocols of protecting everybody around them.”  She heard that a TV news journalist who is also a doctor didn’t stay home after she returned from Africa, “like she promised.”  
         She broke the rules and  “is putting everyone else in danger.”

We know that the public’s understanding is a moving target.  We take in, mull over, and make meaning relentlessly.

Protocol = rules
People who don’t follow the rules =disrespecting

Is this meaning making about to change, elaborate?

My Instagram tweets reads: