A scientist’s opinion : Interview with Professor Enny Das about health communication and persuasion

Interview with Professor Enny Das, Professor of Communication and Persuasion, and Principle Investigator of the Persuasive Communication Research Group of the Centre for Language Studies at Radboud University in Nijmegen, Netherlands.

How can the public be motivated and persuaded through health and risk communication to take effective responsive and preventative actions, such as physical distancing, and how can this help to contain an epidemic?

Enny Das: A framework called the Extended Parallel Process Model (EPPM), which is commonly used in health communication to persuade the public to adopt healthy behaviours, proposes that the health risk has to be communicated effectively and specifically applied to the targeted risk group. The risk is usually well-communicated, but often officials fail to communicate how people need to deal with that risk. The model then defines four main factors to predict the likely outcome of communications: self-efficacy, response efficacy, susceptibility, and severity. This means people need to understand that the response recommended is effective in controlling the risk, which should be explicitly mentioned, and people should also be able to carry out the tasks needed. This sounds easy, but the reality is that it is often very difficult for people to understand how exactly they should behave. For example, in COVID-19, I learnt how to properly wash my hands through a video that clearly showed how to do it and then felt I have been washing my hands wrong all my life. ‘Showing’ is probably more important than just ‘telling’ people what to do. Susceptibility refers to a person’s perception on how likely the threat is going to impact them, whilst severity is their perception of the threat’s magnitude. People often understand severity, but underestimate susceptibility, assuming that ‘this only happens to other people’.

There are many difficult concepts in this pandemic, such as ‘herd immunity’ or how the virus spreads, but if we manage to find good ways to visualise or frame these, then this can help get the message across to the public. Good communication is not only what you say, but what form you choose to communicate the message. For example, using films and storytelling to show how to carry out a certain action and its consequences can help people feel how the measures are relevant to them personally and how it impacts overall. It is difficult for people to understand that their behaviour is going to affect the entire group; with social dilemmas during epidemics, it is very important to stress that each individual’s action affects others and their contribution is making a difference. For this, research on narrative persuasion and narrative communication show that storytelling can be effective. Once people see or read the real life stories of ‘normal’ people like you and me, how they are affected and why it is important to do this or that, this usually has a much bigger impact on the public than enumerating the facts and figures, because it matches the natural way of how people understand their information. People are storytelling animals so if you give them figures, they will just go ‘oh I don’t understand’, but if you give them a story, then that hits home. Narratives are important to make people ‘feel’ the message.

In the case of COVID-19, with many unanswered questions and rapidly-evolving scientific research, authorities have had to change their advice (e.g. use of face masks). So how does communication remain credible and trustworthy?

Enny Das: This is difficult because with pandemics everything is new and there is a lot of uncertainty. Actually, that is the essence of risk: it’s uncertain. I think the solution is for authorities not to pretend that they know everything and then change their advice. In the case of using face masks, the Dutch government communicated the uncertainty from the beginning and contextualised their measures based on evidence. Contextualisation is key in health communication. Authorities should explain why they are doing this, why they do not have all the information, and why they are changing their advice. It’s easy to criticise authorities from the sideline, but it’s very difficult to do a good job in the midst of all this chaos. Authorities have to be honest, consistent and transparent to make sure that the public remains with them, explaining the steps they took to reach a certain decision.

How can communication change people’s behaviours (e.g. when they are non-compliant or sceptical), and whom do citizens tend to trust more in times of crisis?

Enny Das: As part of the ECOM project, we looked at four European countries’ communication during the H1N1 pandemic and found huge differences in trust from country to country. In some countries, people had really high trust in the government or institutions, while in others they had very low trust. So in a country where the government has known trust issues, it would be wise to resort to less controversial sources to communicate the messages and instead find sources that are already perceived as trustworthy and credible. If sources start manipulating messages, telling half-truths or behaving unethically, then people will sense it and they will lose the trust. It is also important that people do not perceive the source as being staged, for example using a celebrity to gain trust. A Dutch proverb says “Trust comes on foot, but leaves on horseback”. Trust takes time to build but you can lose it instantly with one mistake or violation.

Communication also has to be tailored to different target groups, and in this respect communication can still be improved as we tend to underestimate or overestimate how well different target groups are reached by what we communicate.

What is the role of media amid infectious disease outbreaks and how do the different mediums of communication impact people’s behaviour? What can we learn from the ECOM project?

Enny Das: In the ECOM project, where we looked at media reporting during the 2009 A/H1N1 pandemic in four different European countries, we found that media attention peaked very early in the outbreak, long before the pandemic started spreading significantly. News was on the increase as it was responding to the uncertainty — we are seeing this now with the COVID-19 crisis too. But after phase one, when people were getting tired of the pandemic and wanting to go back to ‘normal’, we saw media attention gradually declining and other topics creeping back into news reports, both in television and newspapers. But there was a paradox: when there was hardly any news attention, this is when the pandemic started peaking and when people were dying. This was a problem because it was the same time when the vaccine was introduced and people thought the pandemic was already over so felt that they didn’t need the vaccine. This resulted in low vaccination rates, whereas higher rates could have saved more lives. The media is a proxy for how interested we are in the news and vice versa, but that can lead to a false perception of safety.

What is new with COVID-19, compared to the A/H1N1 pandemic, is the way social media is used. There is currently research about the risk of “echo chambers”, environments where you have subgroups talking to each other online and sharing very extreme views about, for example, conspiracy theories. We are not sure if this is a new phenomenon as it might have also occurred offline in the past, but because of the internet it is much easier to get access to those messages. We also do not know the impact these have on the public. The whole problem with “echo chambers” — and perhaps the rise of social media platforms like YouTube and Facebook — is that we do not have much control over the content that might influence perceptions, regardless of whether they are true or false. For example, the power of image and videos to persuade the public is much more subtle compared to text and news media like newspapers. So if you watch YouTube videos about the pandemic that are funny or have really dramatic consequences, this could have an impact on the way you view a risk, even if it is not true or you think you are only being entertained.

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