Incident(s)-Based and Error Communications

Taking Advantage of New Mediums

Social media provide new opportunities to improve risk communication, and the Panel identified several examples of tools that take advantage of social media to disseminate risk information. These include Twitter feeds, Facebook pages, smartphone apps, podcasts, and YouTube videos. Social media have several benefits for dissemination, including speed and accessibility (Rutsaert et al., 2014). Although these tools take advantage of different media, they often present the health product risk information in the same manner as established tools. For instance, Health Canada’s recall app, Recalls and Safety Alerts, takes advantage of smartphone technology, but simply has links to public advisories and recalls already available on the Health Canada website. Similarly, the FDA’s Consumer Update YouTube videos describe a risk in a similar manner to the text of the corresponding consumer update document, either through a voiceover or an expert discussing the issue on-screen.

10 In children, antibiotic prescriptions, rather than consumption, are used as a proxy for antibiotic usage (Do Bugs Need Drugs?, 2014).

Social media, however, are more than simply a new way to disseminate information. Used properly, social media can enable meaningful dialogue, free of any filter, between the senders and receivers of information (Veil et al., 2011). As Veil et al. (2011) explains, “the greatest reason for communication practitioners to use social media [...] is that stakeholders are already using social media to communicate.” Direct discussions with different groups receiving information allow communicators to monitor how these groups are feeling about and reacting to a particular risk and to respond quickly to rumours or misinformation (Waters et al., 2009). This type of dialogue can build trust and increase satisfaction in communicators. For example, the CDC encouraged a dialogue with the public during the H1N1 pandemic, even among people with beliefs counter to the CDC recommendations. This was associated with an increase in the CDC American Customer Satisfaction Index, with those who used social media giving CDC higher ratings than those that did not (Reynolds, 2010; Veil et al., 2011). Improving Dissemination

Some regulators are using different approaches to ensure that risk communications reach desired groups. In the United Kingdom, for example, communications meant for healthcare professionals are delivered via the Central Alerting System (CAS). The CAS is defined as, “a web-based cascading system for issuing patient safety alerts, important public health messages and other safety critical information and guidance” (U.K. Department of Health, 2015). Messages are delivered electronically to hospitals and other healthcare facilities, which can then distribute them further. The CAS, however, is only a delivery system, and the documents delivered are of the same type as those described above (e.g., recalls, dear doctor letters). In a survey of 1,800 respondents, 42% found CAS alerts “always relevant,” while receiving too many irrelevant alerts and the time of day when alerts were received were identified as problems (MHRA, 2013).

Alert (or message) fatigue occurs when people start tuning out risk messages because of the large amount of information to which they are exposed (much of which may be minor or irrelevant to their lives) (FDA, 2012; CBC News, 2014). Baseman et al. (2013) found, for example, that for each additional public health message to which healthcare providers are exposed (per week) there is a decrease in the odds that they will be able to recall the content of that message. This can lead to important warnings being missed. Emerging practices could help overcome the challenges of alert fatigue by directing communications at the point of care and decision-making. Requiring that all prescribing be done electronically, for example, would ensure that physicians see warnings when they make the initial prescription (CBC News, 2014). Other healthcare partners could also be used to amplify the dissemination of information beyond the

direct healthcare prescriber. For example, at the pharmacy level, software that cannot be disabled and requires a user to give a reason for overriding warnings could ensure that pharmacists consider all relevant advisories (CBC News, 2014). Furthermore, software could ensure that more serious warnings are given first and could distinguish them from minor risks in some way.

3.3.3 Summary and Comments on Evaluation

Although the emerging tools described above are not in widespread use, they have often been subjected to important evaluation efforts including using pre-testing data to improve reach and understandability and measuring the initial impact of tools to assess changes in health outcomes. Such new tools may be perceived as unproven and therefore in need of more evaluation than established tools. The developers may also wish to publish articles about them in peer-reviewed journals, which often require some type of evaluative evidence. Needs evaluation and pre-testing are especially important for emerging tools, as there is an opportunity, and even an expectation, that the tools can be improved. Similarly, process evaluation can be used to audit and improve the development and release plan. As many of these emerging tools are not yet being used on a wide scale, outcome evaluations will be limited but, as demonstrated by the evaluation results discussed above, important observations for a range of communication goals can be obtained with concerted efforts.

Emerging tools provide new opportunities for communication, and for evaluation. For example, online access opens the door to online surveys before and after a communication is released. Social media, in particular, allow collection of feedback from a wide range of populations and stakeholders quickly and directly (Rutsaert et al., 2013). This enables regulators to monitor public opinion on a risk before and after a communication is released. Online resources also provide new metrics that could be useful in evaluation, such as website hits, downloads, search terms, or retweets. The FDA has recognized the usefulness of social media for evaluation, and has recently requested proposals from companies to carry out social media monitoring (Anonymous, 2014). This monitoring will be used to evaluate the effectiveness of the FDA’s risk and benefit communications through social media listening (Anonymous, 2014).