WHO Rapid Review: clear communication critical in the battle against COVID-19
WHO Rapid Review sources from around the globe
It’s hard to believe that just over a year ago, lockdowns, quarantining and strict social distancing were completely unfamiliar to us. Yet in a matter of months, these measures came to define the daily life of people all over the world. For Coordinating Editor of Cochrane Consumers and Communication Dr Rebecca Ryan, this was a time when the professional and the personal began to intersect.
As Australian borders closed and lockdowns began across the country, Rebecca started work on a WHO rapid review on the best approaches to promote acceptance, uptake and adherence to physical distancing measures to prevent and control Covid-19. At the same time she experienced the practical impact these measures had on everyday life, as she began the formidable juggle of working from home and home schooling her two primary-school aged boys.
‘This was such a challenging time, particularly as so little was known about Covid and how it would change our lives,’ she says. ‘But one thing that was clear early on was that physical distancing was one of the few tools available to help control and stop the spread of the virus. Our WHO review aimed to help governments to understand the best approaches to communication to ensure these measures would be taken up across diverse communities. We used McMaster rapid methods to look at evidence from guideline recommendations, systematic reviews (including reviews of quantitative, qualitative and mixed-methods studies), primary studies directly related to COVID-19, and relevant reviews on other diseases.’
‘In a nutshell our findings confirm what we already know about the critical ingredients for effective communication in public health campaigns. That is, information has to be clear, accurate, consistent, current and non-conflicting. It needs to include actionable content in understandable language so that people know what to do and how to do it, and the information needs to be tailored for diverse audiences within and across populations.’
While on face value this might sound quite straightforward, the challenges of getting clear and up-to-date information to every person on the globe during a pandemic is anything but, as Rebecca explains.
‘It’s incredibly challenging for governments because with a new disease, evidence and information changes so quickly and at the same time, the need to keep people and communities up to speed is critical. So we're talking about needing to have really clear, accurate, consistent and up-to-date messaging at many different time points as the situation changes, communicated in really targeted, effective ways to different people. And that's just within one population. Policy makers need to consider different demographics, cultural and linguistic backgrounds, levels of health literacy, and social and educational disadvantage – among many other factors. It’s a huge challenge, but on the upside I do think there’s a growing awareness of how critical good communication is now – people need help to understand how and why they need to do things for their own health and safety, and that of their communities.’
Other key findings of the review highlight the need for practical support to undertake physical distancing (such as access to food, medicines and financial support), as well as the importance of consistency of information across different media and platforms. Information is more likely to be trusted and acted upon when it’s provided from different sources rather than from a single source. For example, people need to see that what’s on social media is the same as what’s in the paper, in news reports and government media releases.
‘This consistency helps to build trust because you don’t have people just hearing one isolated message that's in conflict with another message. The evidence suggests that public trust is critical, and that it’s built by providing clear, transparent and consistent information adapted to local contexts and settings. Clear and open acknowledgement of uncertainty (what is known and what’s not) at a given point in time is also important, particularly for an emerging disease.’
‘Overall this review underscores the need for greater global recognition that information and clear communication isn’t just a ‘nice-to-have’, it’s a critical part of the pandemic response and is actually core to getting Covid under control. Communication isn’t just an ad-hoc thing – you can do it well or you can do it badly. To do it well, you need resources, planning and expertise.’
‘There may be the occasional brilliant communicator who can convey complex ideas to lots of people, but when you're talking about a public health crisis, that's not enough to change behaviour at a population level. And as we know from our own personal experiences with Covid, physical distancing required a really significant and sudden behavioural change. So providing clear information about what’s needed, why it’s needed and how to go about it continues to be essential. This rapid review aimed to support public health decision-makers to do just that, wherever they may be.’
Looking ahead to the next challenge, Rebecca and a team of local and international authors are turning their attention to the latest evidence on this topic and hope to publish a Cochrane rapid review later this year, providing additional findings and much-needed guidance for policy makers around the globe.
Physical distancing measures include:
Contact tracing
The identification and follow-up of people who may have come into contact with an infected person, usually in combination with quarantine of identified contacts.
Crowd avoidance
Measures to reduce virus transmission in crowded areas/mass gatherings, including restrictions on gatherings and approaches for individual distancing in homes, shops, workplaces, public transport and public places.
Isolation
Reduction in virus transmission from an ill person to others by confining symptomatic people for a defined period, either in a special facility or at home.
Quarantine
Isolation of individuals who contacted a person with proven or suspected viral illness, or travel history to an affected area, for a defined period after last exposure (with the aim of monitoring them for symptoms and ensuring the early detection of cases).
School measures
Closure of schools when virus transmission is observed either in the school or community, or an early planned closure of schools before virus transmission initiates
Work measures, including closures
Measures to reduce virus transmission in the workplace, or on the way to and from work, by decreasing the frequency and length of social interactions.
Rebecca Ryan has been a Research Fellow with the Cochrane Consumers and Communication Review Group since 2004, an Editor with the group since 2011, Deputy Coordinating Editor since 2013 and Joint Coordinating Editor since January 2019. Her role currently includes writing and editing Cochrane reviews and developing guidance to support authors of Cochrane reviews. Rebecca's background is in pharmacology and neuroscience.
