COMMUNICATIONS AND WHAT BEST PRACTICES EXIST TO ADDRESS THESE CHALLENGES?

Risk communication has evolved, from initial formulation as educating the public with accurate scientific information, to paternalistic persuasion, to a paradigm shift that recognizes ongoing partnership and exchange. All three views inform contemporary risk communication and demonstrate that

there is no one-size-fits-all approach to communication or its evaluation. Recognizing this diversity, evidence-informed practices related to effective risk communication typically involve:

• characterizing risk with larger context and population needs in mind; • focusing on the importance of presentation and employing strategies for

making information accessible and clear, accounting for literacy and numeracy, and addressing influence of framing effects, emotional responses, core values, and the ways that individuals process information;

• ensuring ongoing partnership and multi-level/multi-way communication that takes into account multiple concerns, factors, and needs at varying socio-economic levels;

• committing to sustained communication and relationships that evolve and change when new information is available;

• developing communications to be open, transparent, and honest about the level of (un)certainty and the evidence that is guiding decisions; and • embedding evaluation in the planning and implementation of risk

communication and not leaving it as an end-stage task.

Recognition of the importance of an ongoing and strong relationship between the senders and receivers of risk communication and other stakeholders has led to an emerging paradigm that builds on the learning from the past to address new challenges relevant for evaluation of health product risk communication: • Governance: addressing the challenges that stem from shared responsibility

within the risk management and communication environment.

• Complexity: navigating the inherent complexities of the risk and the communication environment that comprises multiple players and priorities. • Uncertainty: communicating uncertainty and multiple interpretations of

the evidence.

• Empowerment: moving from providing prescriptive statements to enabling solutions and empowerment.

• Timeliness: ensuring timely and proactive responses that build trust over time. • Transparency: ensuring reasoned transparency that increases the public’s

access to and ability to understand health information.

The complicated governance around health products in Canada includes all three levels of government, industry, and many other groups. This shared responsibility for risk communication and evaluation demands establishing roles and responsibilities for the exchange of information, planning and coordination of communications, and strong relationships and cooperation between different senders and receivers of information and other stakeholders. It also means navigating the sometimes competing motivations of regulators and other groups. Depending on the nature of the situation, regulators

must facilitate cooperation and coordination between groups while at other times compel and act independently of those groups. Within such shared governance structures it can be challenging to gain institutional commitment and resources for evaluation. Factors that could address this key challenge include: (i) fostering a learning culture; (ii) demonstrating the value of evaluation relative to other spending priorities; (iii) standardizing communication appraisal tools and checklists to limit resources needed, improve comparability, and make evaluation more routine; and (iv) encouraging peer learning and sharing of experiences across jurisdictions.

Risk communication is an inherently complex exercise. Beyond the involvement of multiple players and mediums for communication that may play dual roles of sender and receiver of information at any given point, there are also inherent complexities associated with risk itself. This complexity stems from the hazards, the probabilities and uncertainties in the effects, the interactions between effects, and other political, ethical, economic, and social dimensions. The complicated environment for health product risk communication therefore requires coordination, collaboration, and ongoing dialogue between many different groups. Furthermore, the complexity associated with risks themselves needs to be considered and acknowledged when developing and disseminating risk communications.

Although there is sometimes debate about the best way to present uncertainty, it is an important consideration for any risk communication. It depends on the type of uncertainty and the objectives of the communication. Communicators must therefore distinguish the type of uncertainty associated with a given risk and present uncertainties in a manner that supports decision-making. Although further research is needed on best practices (i.e., when it matters and when it can be harmful), evidence suggests that communicating uncertainty can often help get the message through and build the trust and relationships needed for ongoing exchange. Improved evaluation can help reduce the challenges associated with uncertainty by creating a strong evidence base. Evaluations that integrate and use different data sets and methods would improve reliability and reduce uncertainty of the evidence.

Empowerment of individuals to make informed decisions (i.e., to support existing behaviours in line with recommendations, to change behaviour, or to make an informed refusal) involves messaging appropriate for understanding and comprehension as well as for effective and meaningful dialogue. It is an important way to mitigate or avoid negative responses from populations receiving information. Within the context of communication this means collaborating with and empowering individuals, communities, and various affected groups

to act as platforms for further coordinated communication efforts. Within the context of evaluation, this involves engaging affected populations and other relevant stakeholders as members of the decision-making process at all stages of a continuous and ongoing evaluation process, thereby focusing on long-term relationships. Those sending and evaluating a risk communication must also respect informed individual decisions that may go against messaging. Empowerment during evaluation can help build strong relationships over time, which can support the proactive and timely delivery of future communications in the face of new risks.

While what is considered timely will be different for each risk communication situation, communicators can lay the groundwork to ensure that they are able to respond to risks quickly. Having clear guidelines and established relationships can enable organizations to act proactively in the face of new risks. In addition, using new communication sources such as social media to strengthen relationships and engage with affected populations can help set a strong foundation to deal with future risk situations. Similarly, the public and policy-makers around the world are increasingly recognizing the importance of transparency for governments, industry, and other communicators of risk. Reasoned transparency moves beyond simply releasing large amounts of data and increases the public’s ability to access and understand health information. It can build empowerment, trust, and relationships between the senders and receivers of information. When done effectively, it can also lay the groundwork for timely communication efforts by striking a balance between openness, on the one hand, and urgency and confidentiality, on the other.

5.5 FINAL REFLECTIONS

The evaluation of health product risk communication is rare. The complexities associated with health products, and the scarcity of dedicated resources, make this type of evaluation challenging. It is, however, no more difficult than the evaluation of other health interventions, which also have a unique set of challenges. That the Panel found a dearth of publicly available evaluations should not be taken as evidence that these evaluations lack real-world importance. In fact, failing to evaluate can be a dangerous oversight since ineffective communication may lead to negative health outcomes and erosion in the credibility and trust of those who communicate. Moreover, the lack of guidance and consensus does not diminish the need for evaluative efforts using available principles and knowledge.

Like other regulators and government institutions around the world, Health Canada has the opportunity to conduct and publicly release more evaluations on health product risk communication and to engage relevant stakeholders in the process. While this assessment has outlined a range of methods, some of which require significant time and resources, the Panel firmly believes that even a minimal evaluation can provide benefits. With commitment and sufficient resources, however, Health Canada could become a world leader in the area, conducting relevant, well-planned, comprehensive, systematic, and rigorous evaluations that apply appropriate and best available methods. A commitment to publicly accessible and publicly conducted evaluations would put Health Canada ahead of the curve on open government policy, which is an apparent global trend. Overall, the Panel believes that there is significant room for improvement in the volume and quality of evaluations on health product risk communication, conducted both in Canada and elsewhere. While there are numerous challenges, even when taken together, they are far from insurmountable. Evaluation can fundamentally improve the health of Canadians, now and in the future. Engaging in the challenges associated with evaluation is therefore worth the effort.