ASEAN Training Manual on

Risk Communication
ASEAN Training Manual on
Risk Communication

ASEAN Secretariat
and
Malaysian Technical Working Group
i
Advisors, Technical Working
Groups & Contributors

ii
Advisors for the Risk Communication Training Manual
· Y.Bhg. Dato’ Sri Dr. Hasan Abdul Rahman
Director General of Health, Malaysia
Ministry of Health Malaysia

· Dr. Lokman Hakim Sulaiman

Deputy Director General (Public Health)
Ministry of Health Malaysia

· Dr. Chong Chee Kheong

Director of Disease Control
Ministry of Health Malaysia

· Ms Siti Sa’adiah Hassan Nudin

Director of Institute for Behavioural Research
Ministry of Health Malaysia

Technical Working Group on Risk Communication, Malaysia.

· Dr. Norhizan Ismail
· Thavaraj Subramaniam
· Dr. Sulaiman Che Rus
· Dr. Husnina Ibrahim
· Dr. Devan Kurup
· Zawaha Hj. Idris
· Abdul Jabar Ahmad
· Munshi Abdullah
· Mohd Nasir Abdullah
· Suraiya Syed Mohamed
· Ricky Gayoh
· Vanitha Subramaniam
· Sasitheran Krishnan Kutty Nair
· Norrafizah Jaafar

iii
 Contributors
1. The ASEAN Emerging Infectious Diseases Programme Secretariat
70A Jalan Sisingamangaraja, Jakarta 12110,
INDONESIA

2. Brunei Darussalam
Environmental Health Services
Department of Health Services
Ministry of Health
Commonwealth Drive
Bandar Seri Begawan BB3910
Negara Brunei Darussalam

3. Cambodia
Communicable Disease Control Department
Ministry of Health
No 151-153 Kampuchea Krom Blvd., Phnom Penh

4. Indonesia
Directorate General of Disease Control and Environmental Health
(DG DC & EH)
Ministry of Health
Jl. No State Printing. 29, PO Box 223,
10560th Jakarta - Indonesia

5. Laos PDR
Department of Hygiene and Prevention
Ministry of Health
Samsenthai road, Ban thatkhao, Sisattanack District,
Vientiane Capital, Laos PDR

6. Malaysia
Disease Control Division
Department of Public Health
8th Floor, Block E10, Kompleks E
Federal Government Administrative Centre
62590, Putrajaya

7. Myanmar
Department of Health(Disease Control)
Ministry of Health

iv
8. Philippines
National Center for Disease Prevention and Control (NCDPC)
Department of Health
San Lazaro Compound, Sta. Cruz,
Manila

9. Singapore
Communicable Diseases Division
Ministry of Health
College of Medicine Building
16 College Road, Singapore 169854

10. Thailand
Department of Disease Control.
Ministry of Public Health
Tivanon. Talat Kwan.
Muang., Nonthaburi Province.
11000.

11. Vietnam
Department of Communicable Diseases Control and Vaccine
Management,
Administration of Preventive Medicine,
Ministry of Health
138A Giang Vo, Ba Dinh, Ha Noi.

v
 ACKNOWLEDGEMENT
This ASEAN Training Manual on Risk Communication was developed under
the auspices of the ASEAN Plus Three Emerging Infectious Diseases (EID)
Programme. It showcases the Training Module developed by the
representatives of the ASEAN Member States during the workshop held on
21-23 October 2008 in Kuala Lumpur. This Module was used in a Regional
Pilot Training on Risk communication participated by public health
professionals, animal health experts and disaster management officers held
on 21-23 April 2009 in Kuala Lumpur.

Sincere appreciation goes to all the representatives of the ASEAN Member

States who participated in the series of activities that led to the development
and production of this Training Manual.

Special acknowledgement is extended to the Ministry of Health of Malaysia,

especially to the Technical Working Group, for taking the lead role in the
ASEAN Initiatives on Risk communication.

The development of this Training Manual was made possible with the support
of the Australian Agency for International Development (AusAID) through the
ASEAN Plus Three EID Programme, managed by the ASEAN Secretariat.

vi
PREFACE BY ASEAN SECRETARIAT
Emerging infectious diseases (EIDs) pose a constant threat to countries in
this region. ASEAN countries have developed a regional plan to meet the
threat of EID. One of the important strategies of the EIDs Regional Plan is on
communication and information. Risk communication has thus been identified
as one of the important element of the communication and information
strategy.

Malaysia and Philippines are identified as proponent countries in leading on

the strategy for risk communication. The Philippines conducted a survey
among member countries on risk communication preparedness. The result of
the survey was utilized by Malaysia to formulate the Regional and Country
Risk Communication Strategic Plans. Malaysia’s expertise and training
experience on risk communication was utilized for a regional workshop to
formulate the Regional Risk Communication Training Module. Subsequently a
Regional Training of Trainers (TOT) on risk communication was conducted by
Malaysia.

This training module is the culmination efforts of the Risk Communication

Technical Working Group of Malaysia and the ASEAN Secretariat who
reviewed and improved the ASEAN Regional Training Module on Risk
Communication. The generic training module will be use by ASEAN member
country as a training reference and tailor accordingly to their own needs. Over
time ASEAN member countries would develop a critical mass of trainers to
enable member countries have sufficient capability and capacity in risk
communication in preparedness of potential threat of outbreaks due to EIDs.

The ASEAN countries have also agreed for the establishment of Risk
Communication Resource Centre to be located in Malaysia. Therefore,
Malaysia will continue to conduct the Regional Training Workshop on Risk
communication, collate risk communication resource materials, conduct
applied research and responsible for updating the training module.

However, other countries are welcome to use this training module for their
training needs. Malaysia welcomes any inquiries or comments for
improvements of this module.

ASEAN Secretariat

vii
PREFACE BY MINISTRY OF HEALTH MALAYSIA
Outbreaks due to Emerging Infectious Diseases (EIDs) remain a continuing
health threat globally as well as to this part of the region. Malaysia had its
own experiences of managing various outbreaks due to local and imported
infectious agents. The experience of managing a serious outbreak due to a
novel virus (Nipah virus) in 1998, highlighted the importance of risk
communication as an integral component of the disease outbreak
management.

Building on this and past experiences prompted the Ministry of Health to

initiate its capability and capacity building on risk communication among its
local staff through an organised training programme since 1999. The training
programme is conducted for relevant personnel at the national, state and
district levels. Therefore, Malaysia accepted the ASEAN proposal as the
proponent country for ASEAN in leading the strategy for risk communication
by virtue of its experiences and expertise on risk communication gained over
the years.

Malaysia is glad to contribute towards the development of the ASEAN

Regional Risk Communication Training Module through the participation of its
two local experts on risk communication and the adoption of its National Risk
communication Training Module as the main resource material. Malaysia’s
commitment to regional capacity in risk communication will be further
enhanced with the formal establishment of the regional Risk Communication
Resource Centre under the Ministry of Health, Malaysia. The centre is
envisaged to be a premier centre for training and research on risk
communication. The current training module which is in an initial phase will
then be regularly revised from time to time to ensure its relevance and
address the changing regional needs.

Malaysia would like to thank member countries and international

organisations in supporting its role as the lead proponent on risk
communication. Malaysia also welcomes contributions by member countries
to share their experiences on risk communication in managing local
outbreaks. The inputs from member countries will be incorporated in the
Regional Risk communication Training Module which will be revised on a
regular basis. This coordinated regional effort will contribute significantly
towards its preparedness and effectiveness in swiftly managing future
regional EID outbreaks.

Regards,

Director General of Health, Malaysia

viii
TABLE OF CONTENTS

Advisors, Technical Working

ii
Group And Module Contributors

Acknowledgement vi

Preface vii

Table Of Contents 1

Introduction To Publication 3

Training Strategies 5

Introduction To Module 6

1.0 Facilitators’ Guide: 7

1.1 Introduction 7

1.2 The Role Of Facilitators 8

1.3 Pre Requisites Of Organising Workshop 9

1.4 Suggestion For Facilitators 12

1.5 Summary 14
Workshop Requirements
2.0 Workshop Organization: 15

2.1 Overview Of Workshop 15

2.2 Pre-Workshop Checklist 15

2.3 Workshop Objectives 16

2.4 Proposed Workshop Schedule 17

2.5 Ice-Breaking 19

Introduction To Risk Communication 20

Unit 1: Risk, Crisis And Health Crisis

Management
Module 1
Unit 2: The Concept And Principles Of Risk
Communication

Unit 3: Outbreak Management And

Experiences

1
 Risk Communication Strategies 32

Unit 1: Advocacy With Government

Stakeholders

Unit 2: Encouraging Community

Module 2 Participation And Forging
Partnerships.

Unit 3: Reaching Vulnerable Groups

Unit 4: Collaborate With International

Organisations And Neighbouring
Countries, Including Cross Border
Issues

Communicating Health Risk 59

Unit 1: Identification And Understanding The

Audience

Module 3 Unit 2: Message Development

Unit 3: Basic Skills Of Media Spokesperson

Unit 4: Media Management And Engagement

Ethical And Legal Implication Of Risk

73
Communication

Unit 1: Ethical Implication In Risk

Communication
Module 4
Unit 2: Legal Implication In Risk
Communication

Unit 3: Politics in risk communication

Annexes 80

References 116

**- Powerpoint presentations of the lectures is in the folder

2
INTRODUCTION TO THE PUBLICATION
In response to epidemics and threats to human lives, ASEAN Countries have
developed The ASEAN Plus Three (China, Korea and Japan) EID Programme
which is funded by the Australian Government through the Australian Agency
for International Development (AusAID). This Programme is also in line with
the WHO Asia Pacific Strategy for Emerging Diseases (APSED). Phase I
(2004-2006) of the ASEAN Plus Three EID Programme focuses on
Epidemiological Surveillance and Response, Networking and Laboratory
Surveillance and Institutional Strengthening.

Building on the gains of Phase I, the ASEAN Plus Three Health Ministers, at
their 2nd Meeting in June 2006 in Yangon, Myanmar, endorsed Phase II of the
Programme (2007-2009). One of the important strategies implemented in
Phase II is the Communication, Information Sharing and Networking. The
Communication Focal Points of the ASEAN Plus Three Countries were
identified and are tasked to share information regarding outbreaks, under the
guidance of an agreed regional protocol on communication and information.
The communication workshop also recognized an urgent need for the
application of risk communication in engaging the public for their perceptions
and opinions and the need for decision makers to integrate risk
communication in managing the epidemic itself.

Past regional outbreak experiences and experiences in managing epidemics

in other parts of the world, have clearly shown the failure to practice risk
communication resulted in negative perceptions by the public of the
responsible health authorities and less effective control of the epidemics.

Therefore, in meeting the challenges and the delicate situation, ASEAN Plus
Three Countries have come up with a regional risk communication
mechanism and operational strategy to ensure policy makers and
stakeholders as well as international bodies are well informed and prepared
for the rapid response and containment whenever the threat occur. The
project is implemented with Malaysia and Philippines as the main
coordinators. Malaysia is entrusted for developing risk communication
mechanism and operational strategy.

A workshop to formulate a regional and country risk communication plan was

hosted by Malaysia on 24-26 March 2008 and attended by representatives of
all ASEAN Plus Three Countries. The Regional Risk communication Plan
which outlines strategic plans based on three Phases (Pre-, During and Post-
crisis), the risk communication mechanism and the operational strategy was
successfully developed. Based on the regional strategic plan, participants

3
also developed country specific risk communication plans in the same
workshop. The ASEAN Secretariat subsequently obtained official
endorsement of the Regional Risk communication Plan by all ASEAN Plus
Three Countries.

A follow-up workshop to formulate a generic training module on risk

communication for use by the region was also hosted by Malaysia on 21-23
October 2008. The workshop was attended by members from ASEAN Plus
Three countries, Malaysia Technical Working Group (TWG), ASEAN
Secretariat, partner organizations {WHO Western Pacific Region (WPRO),
WHO South-East Asia Regional Office (SEARO), World Organization for
Animal Health (OIE)} and Indonesia National Committee for Avian Influenza
Control.

Recognizing the importance of risk communication to hasten the containment

of a public health emergency and to mitigate the social and economic impact
of a crisis, a Training of Trainers (TOT) on Risk communication using the
generic regional risk communication training module was successfully
conducted for officers of the Human Health and Animal Health sectors from all
10 ASEAN Member States and hosted by Malaysia. The module that was
used for the TOT training was further refined by the Technical Working Group
(TWG) from Malaysia and with the cooperation of the ASEAN Secretariat.

This module is indeed the culmination efforts of many sectors within and
without ASEAN. This module will be invaluable to assist ASEAN member
countries in conducting risk communication training locally. However,
member countries are at liberty to tailor the module according to their training
needs.

The ASEAN Secretariat wishes to record its appreciation to Malaysia and all
member countries for their contribution in developing the module which is one
of its kinds and a pride of ASEAN Countries.

Thank you.

4
TRAINING STRATEGY
A multi-pronged strategy will be instituted to meet the objectives of this
training programme.

o Training will be conducted at various levels from national level, state and
district levels.
o Training will be conducted in three phases. The first phase will be the
training of programme managers at national level. The second phase will
encompass the training of managers at state level. Finally, the training
will involve field staff at district level. Participants may also include other
government agencies and non-governmental organizations (NGOs).
o The training programme should utilize interagency collaboration for
expertise including from universities, Legal Training Institute, Media
Consultants besides expertise from the Ministry of Health.
o Findings on regional research on risk communication will also be utilised
to enhance the training module.
o Further exposures on risk communication will be made through
seminars, conferences, fellowships and attachments locally and
overseas.

5
INTRODUCTION TO MODULE
Risk communication has evolved from a simple one way communication to an
approach that requires multidiscipline involvements. However, in United
Kingdom and United States of America, the requirement to inform the public
of health risks is required by the law. The concept, scope and need for risk
communication have expanded to critical events such as health emergencies,
crisis and disasters for which risk communication is an integral part of
managing the emergency/crisis/disaster. ASEAN countries have recognized
the need for building capability and capacity in risk communication to manage
the continued threats of Emerging Infectious Diseases (EIDs) which pose
significant health risks to ASEAN Countries in view of the ever expanding
global economies and travels.
ASEAN Countries have developed a training manual on risk communication
as a result of various technical meetings and workshops. The objectives of
this training module are to provide skills in planning for risk communication
action plan, preparing appropriate messages, media planning, and working
effectively with various stakeholders such as the media. This training module
which is meant for facilitators could be tailor made or custom made to cater to
the various categories of staff in the health or health related sector and non
health sector. Although this is the first training manual of its kind in risk
communication, it is hoped it can be further improved from time to time to
cater to the needs of changing times and types of emerging diseases.

This training manual consists of four modules. The objectives of these

modules are:
i. Module 1 - to familiarize trainees with the definitions, concepts,
principles and implications of risk communication;
ii. Module 2 - to equip trainees with the knowledge of various strategies
that could be employed in risk communication;
iii. Module 3 - to provide trainees with specific knowledge and skills in
conducting risk communication; and
iv. Module 4 - to expose trainees to the implications of risk
communication.

6
 WORKSHOP REQUIREMENTS

1.0 FACILITATORS’ GUIDE

1.1 Introduction

Risk communication currently has been widely accepted as a

key strategy for the management of risk of public health
importance particularly risks that resulted in health emergency,
crisis or disaster. The concept and practice of risk
communication has been evolving since 1980s due to the
complexity and diversity of risk, the development in the arts of
communication and the complex nature of stakeholders, media
and the well-informed community. Failure to communicate the
risk may mitigate control measures for the management of
disease outbreak and may affect the credibility and image of the
health authority.
Risk identification, quantification and its management may not
be an exact science particularly with increasing incidence of new
emerging infectious diseases. This resulted in the difficulty by
health care provider in devising the appropriate information and
action which the public may view as over or under reaction.
The art of communication and the ever demanding media are
further challenges to the health care providers. The target
audience comprises of various segments of the community with
different perceptions and information needs. Public risk
communication information may result in different responses by
the various segments of the population. The ever demanding
media for information that are newsworthy may not be easily
met on risk that is ongoing and chronic in nature in spite of its
important to public health. Transparency of information may also
be an issue when it affects the national interest or has legal
implication.
Public perception and response to risk may not directly
correspond entirely to the magnitude or importance of the risk.
Risk communication need to address the outrage factor in
formulation of messages. It is critical that the information needs
assessment of the public be conducted prior to any delivery of
public health messages particularly during health crisis where
public tolerance is very low.
Therefore, all countries must have the capability and capacity in
risk communication in meeting the potential outbreaks due to
emerging infectious diseases (EIDs). Every country should
develop a training module on risk communication suitable to the
7
 needs of the country. In meeting this challenge, regional and
global cooperation is needed in providing experts resources to
the training programme.

1.2 ROLE OF FACILITATOR

1.2.1 Who is a facilitator?

A facilitator is a person who helps the participants to

acquire the skills presented in the course materials,
usually through individual discussions. The ideal
facilitators should have expertise in both risk assessment
and communication. However, it is acceptable to have
facilitators with separate expertise on risk assessment
and risk communication.
As a facilitator, you will need to be very familiar with the
materials being taught. You should answer questions, talk
with participants about the exercises, lead group
discussions, and generally give participants any help they
need to successfully complete the course. You will be
expected to use various training methodology to teach
the course contents.

1.2.2 What does the facilitator do?

A facilitator should:

1.2.2.1 Instruct
o Make sure that each participant understands how to work
through materials of each module and exercise.
o Answer the participant’s questions as they occur.
o Clarify any information that the participant finds confusing
and help the participants to understand the main purpose
of each exercise.
o Guide group activities, such as group discussions and
FGD to ensure the learning objectives are accomplished.
o Evaluate each participant’s work and giving correct
answers.
o Identify weaknesses in the participant's skills or
understanding and providing explanation or practice to
correct them.

8
 o Help the participant to understand and apply concepts
taught in the course to practical problems.

1.2.2.2 Motivate
o Compliment the participant on his/her correct answers,
improvements, or progress.
o Provide a conducive learning environment (such as not
too noisy or inadequate lighting).
o Promote a friendly and co-operative relationship.
o Respond positively to questions.

1.2.2.3 Manage
o Make sure that each participant has access to the right
supplies and materials.
o Be receptive to each participant's questions and needs.

1.3 PRE REQUISITES OF ORGANISING WORKSHOP

1.3.1 Selection of facilitators/organising committee:

o All facilitators/organising committee should have

undergone risk communication training. In the absence of
a trained facilitator, seek assistance from ASEAN
Secretariat.

o Facilitators/organising committee should have basic

knowledge of risk communication.

o Facilitators/organising committee should have

involvement in risk communication related programmes.

o Select appropriate resource persons for specific topics

(e.g. epidemiologist, communication specialist, legal
advisor, physicians, etc).

1.3.2 Selection of participants

o Risk communication is a tool that can be used in many
areas of public health.

9
 o The level of knowledge and skill on risk communication
varies according to the various levels of category of work
and functions.
o Therefore, the content of the training module and the
training methods need to be tailored according to local
requirements and suitability of participants.

1.3.3 Preparing for training workshop

o One month before the course:
· Appoint a chief facilitator and ensure co-facilitators
are identified for the workshop.
· Meeting with facilitators - to identify role and functions
during workshop.
· Meet to identify training venue and layout of the
workshop.
· Acquire the necessary audio visual aids e.g.
computers, LCD and course materials for use in the
workshop.

o Two weeks before the course:

· Ensure checklist for workshop is ready.
· Prepare training schedule.
· Prepare Pre & Post course participants’ assessment
questionnaires.

· Prepare Evaluation Form for the conduct of Risk

communication Workshop.

1.3.4 Beginning of the workshop

o Participants should be in groups of eight with a

facilitator for each group. Ideally, a workshop should
consist of thirty two participants with at least four
facilitators.

o Facilitators should read through the training manual to

ensure that they are familiar with the workshop manual.

10
1.3.5 During the training workshop

o To facilitate the workshop, all facilitators should:

· Read the topic before each exercise.

· Meet at the end of the day to review daily activities

and plan schedule for the next day.

· Plan how to implement the module.

· Identify and overcome controversial issues and

anticipate questions from participants.

· Identify skills taught in the manual and its application

in the participants’ area of work.

· Anticipate questions from participants on how to

utilise and apply these skills in their area of work

o Keep presentations lively :

· present information conversationally rather than

read it
· move around room
· use gestures
· speak clearly. Vary pace and pitch of voice
· use variety of methods to present information

1.3.6 Post Workshop Activities

It is extremely important to plan some workshop follow-up

activities to determine the impact that the training has had
on the performance of each participant. This should
determine whether the participants are able to apply the
skills they learned in the workshop.

o Review Pre-workshop performance

o Conduct Post-workshop Evaluation
o Maintain a register of:
· Resource persons
· Facilitators
11
 · Lecturers
· Participants trained
o Facilitate networking among participants by providing
address list
o Review and update training manual according to
feedbacks from the participants to improve future training
workshops
o Identify and improve weaknesses of workshop

1.4 SUGGESTIONS FOR FACILITATORS

1.4.1 Techniques for motivating participants

Interact at least once with every participant, and

encourage the participants to interact with you frequently.
In response, the participants will overcome their shyness
and will continue to interact with you throughout the
remainder of the course.

Check to see if participants have any problems. Show

interest and give each participant attention to motivate
them. They are more likely to ask for help if they need it.
Be available and approachable to the participants at all
times.

1.4.2 Do’s and don’ts

o Ask questions to check participants’ understanding and to

keep them actively thinking and participating. Ask open
ended questions.

o Avoid questions that can be answered by just one word.

o Give participants time to think and formulate a response.

A common mistake is to ask a question and then answer
it yourself.

o If no one answers your question, rephrasing it can help to

break the tension of silence.

12
 o Acknowledge all participants' responses. This will make
the participants feel valued and encourage them to
participate.

o Call participants by name.

o Maintain eye contact when interacting with reticent

participant.

o Write key ideas on a flip-chart board to acknowledge

responses from participants.

o Do not turn your back to the group for long period of time.

o Paraphrase and summarise frequently to keep

participants focused.

o Do not let several participants talk at once. When this

occurs, stop and assign an order for speaking.

o Thank participants whose comments are succinct and to

the point.

o Encourage quiet participants to talk.

1.4.3 Key points in handling difficult participants

1.4.3.1 Participant who talks too much

o Walk towards the participant when he is talking to

make him feel self-conscious.

o Walk away from the participant or turn your back to

him to focus attention away from him.

o Do not ask the talkative participant too many

questions.

o Divert the attention to other participants.

1.4.3.2 The quiet participant

o Encourage quiet participants to talk by directing

questions to him/her.

o Keep eye contact.

13
 o Give positive reinforcement verbally and non-
verbally.

o Give time for participants to answer questions.

1.5 SUMMARY

In training workshops for Risk communication, the emphasis

must be on the practical rather than theoretical aspects of risk
communication. This is to provide an effective means of active
learning. Facilitators should work as a team, assisting each
other in providing individual feedback and conducting group
discussions. This joint effort will enable the objectives of the
workshop to be met and make each workshop a success.

14
WORKSHOP ORGANIZATION

2.1 OVERVIEW OF WORKSHOP

This section contains typical learning objectives and schedule

for a 4-days training workshop on Risk communication. Each
daily schedule includes references to various activities, which
are described within each day’s schedule and are grouped
together at the end of the Manual. Facilitators will need to review
chapters assigned to them and prepare the materials and space
as needed in order to assure the smooth progress of the
training.

2.2 PRE-WORKSHOP CHECKLIST

Prepare at least 2 weeks before date of workshop. Checklist of

supplies and space needed for the workshop are as below:

2.2.1 Supplies needed for each participant

o Name tag with pin
o Paper
o Ball point pen
o Pencil
o Folder with Programme schedule, Course outline and
information leaflet on venue of workshop, meals and
other facilities.
2.2.2 Supplies needed for each group

o Copies of workshop references

o Flip-chart stand with paper and felt pens
o Computer and LCD
2.2.3 Supplies needed for workshop

o Photocopy machine
o Camera to record activities

15
 2.2.4 Space required for workshop

o A large room for plenary session

o 4 small rooms for group work
o Adequate tables and chairs
o Room for secretariat

2.3 WORKSHOP OBJECTIVES

2.3.1 General Objective

The training programme on risk communication aims to

achieve the following objectives:

o To provide knowledge, strengthen skills and develop

appropriate mechanism in communicating health
risks
o To develop a country specific risk communication
training programme

2.3.2 Learning Objectives

o To familiarize participants with the concepts,

definition, framework, application and process of risk
communication.

o To equip the participants with knowledge of the

general principles, concepts and application of risk
communication within the framework of the public
health system

o To develop appropriate knowledge and skills in

engaging stakeholders in advocacy and
communication about Emerging Infectious Diseases
(EID).
o To equip participants with relevant knowledge and
skills for effective risk communication.

16
2.4. PROPOSED WORKSHOP TRAINING SCHEDULE

Arrival Day : Arrival of participants.

2.00 pm : Accomodation check-in (distribute workshop
programme and pre-workshop evaluation form).
Day 1
8.30 am : Registration of participants.
9.00 am : Opening ceremony.
9.45 am : Tea break.
10.15 am : Introduction of participants and workshop
10.45 am : “Introduction to Risk, Crisis and Crisis
Management”
11.45 am : Group discussion and presentation on Identification
of risks, crises and prioritization of health crises.
1.00 pm : Lunch.
2.00 pm : “Introduction to Concepts and Principles of Risk
Communication”.
3.00 pm : Group discussion and presentation on the
definitions, scope and elements of risk
communication and related terms: Health
Promotion, Health Education, Communication for
Behaviour Impact (COMBI) and Social Marketing.
4.30 pm : Tea.

Day 2
8.30 am : Lessons learnt of Day 1.
9.00 am : “Outbreak Management and Experiences”.
10.00 am : Tea.
10.30 am : Group discussion and presentation on
stakeholders mapping.
11.30 am : Presentation of ASEAN countries experiences on
risk
communication in disease outbreaks.
1.00 pm : Lunch.
2.00 pm : “Strategies in Risk communication”
3.00 pm : “Communicating Health Risk”
4.00 pm : Tea
17
4.15 pm : Group work and presentation on:
i. Audience mapping and perceptions.
ii. developing risk communication messages.
iii. Identifying channels of communication.
iv. Identifying feedback mechanisms.

Day 3
8.30 am : Lessons learnt of Day 2.
9.00 am : “Handling Media during Health Crisis”
10.00 am : Tea.
10.30 am : Group work on preparing press statement.
11.45 am : “Managing Crisis Communication Centre”:
· Hotlines
· Preparing press releases
· Provide information
· Coordinating information.

1.00 pm : Lunch.
2.00 pm : “Legal implications of Risk Communication”.
3.00pm : “Ethics in Risk Communication”.
4.00 pm : Tea.
4.30 pm ; Group work on developing National Risk
Communication Training Plan.

Day 4
8.30 am : Lessons learnt Day 3 and distribution of post
workshop evaluation form.
9.00 am : Continue group work on developing National Risk
Communication Training Plan.
10.00 am : Tea.
10.30 am : Country Presentations on Risk Communication
Training Plan.
1.00 pm : Lunch.
2.00 pm : Continue country presentations.
4.00 pm : Post-workshop evaluation, course summary and
closing ceremony.
18
2.5 ICE-BREAKER

Objective

To introduce participants, initiate interactions and facilitate

grouping of course participants.

Example:

Step 1

· Assemble participants into one big circle.

· Randomly select a participant to introduce his/her name

· The chosen participant is required to enquire the names

of the participants seated on his/her left and right and
announce them to the group.

Step 2

· The next participant seated to the right of the chosen

participant is then required to enquire the names of two
participants seated on his/her left and right and announce
them to the group.

Subsequent steps

· Step 2 is repeated with additional participants added on

the left and right of the prior participants

· The process is repeated until each participant have to

remember the names of all other participants of the
workshop.

19
MODULE 1: INTRODUCTION TO RISK COMMUNICATION

1. Introduction:
Risk communication currently has been widely accepted as a key
strategy for the management of risk of public health importance
particularly risks that resulted in health emergency, crisis or disaster.
The concept and practice of risk communication has been evolving
since 1980s due to the complexity and diversity of risk, the
development in the arts of communication and the complex nature of
stakeholders, media and the well-informed community. Failure to
communicate on the risk may mitigate control measures for the
management of disease outbreak and may affect the credibility and
image of the health authority.
Risk identification, quantification and its management may not be an
exact science particularly with increasing incidence of new emerging
infectious diseases. This resulted in the difficulty by health care of
provider in devising the appropriate information and action which the
public may be viewed as over or under reaction.

2. Purpose/Goal of module:

At end of Module 1, participants are able to appreciate and apply risk

communication as an important tool in managing health
crisis/emergencies.

3. Objectives:

3.1. Appreciate the importance of Risk, Risk Management & Health

Emergencies/ Crises/ Disasters.
3.2. To understand the evolution of the concepts of risk
communication.
3.3. To identify the key elements of risk communication based on the
definitions by WHO, Peter Sandman and US National Research
Council.
3.4. To expose participants on outbreak management and the role of
risk communication in managing health crises.
3.5. To share experience with the other countries in outbreak
management.

20
4. Contents of Module 1:

UNIT 1: Risk, Crisis and Health Crisis Management:

· Hazard, its identification, dose-response assessment,

exposure assessment & risk characterization.
· Risk management.
· Health Crisis.
· Management of Health Crisis.

UNIT 2: The Concepts and Principles of Risk Communication:

· Evolution of concepts of risk communication.

· Definitions, scope and essential elements of risk

communication and comparison to other related terms.

· Goals of Risk communication:

o Vary according to situation.
o Why Risk communication is important.
o How RC is useful?

· Risk perceptions (scientific risk, and emotional assessment)

and responses towards risk messages of public and media.

· Types of Risk Communication (Peter Sandman):

o Precaution advocacy.
o Crisis communication.
o Public relation (health education).
o Outrage management.

· Risk Communication Best Practices (WHO):

o Trust
o Transparency
o Announcing early
o Listening
o Planning

21
 · Seven Cardinal Rules of Risk communication:
o Accept and involve the receiver of risk information as a
legitimate partner.
o Plan and tailor risk communication strategies.
o Listen to your audience.
o Be honest, frank and open.
o Coordinate and collaborate with other credible sources.
o Plan for media influence.
o Speak clearly and with compassion.

· What is not risk communication?

Different concepts and terms related to risk communication:
o Health education.
o Health promotion.
o Communication for Behavioural Impact (COMBI).
o Social mobilization.
o Social marketing.
o Public information.
o Public relations.
o Media relations.
o Community participation, citizen involvement.
o Advocacy.
o Include other terminology as needed.

UNIT3: Outbreak Management Experiences

· Presentation of a typical outbreak management.

· Sharing country experiences in risk communication during

health crisis by ASEAN member countries..

5. Instructional Guide:

UNIT 1: Risk, Crisis, and Health Crisis Management.

Learning Objectives:
· Recognize the importance of Risk, Crisis and Health
Crisis Management.

Methodology:
· Lecture, brainstorming and discussion.

22
Learning Process:
· Activity 1 - Lecture.
· Activity 2 – Brainstorming & Group Discussion.

Activity 1: Lecture Topic (“Risk, crisis and crisis management”).

Content:

1. Hazards and exposures.

2. Risk assessment and characterization.
3. Risk management.
4. Risks leading to health crises.
5. General principles of health crisis management

Activity 2: Brainstorming & Group Discussion on risks

and health crises identification.

Content:

1. Break into groups.

2. Identify health risks in the work settings.
3. Identify risks that have potential of leading to health
crises.
4. Prioritize health crises of importance.
5. Present to the group in power point or flip chart.

Teaching Aids:
· Power-point.
· Hand out notes.
· Case studies.

Duration:
· Activity 1: 45 minutes.
· Activity 2: One and half hour.

Evaluation:
· Q & A.

Technical Resource:
· Occupational Health Specialist.
· Epidemiologist.
· Public Health Physician.

23
UNIT 2 – The Concepts and principles of Risk Communication.

Learning Objectives:
· Able to explain the evolution of the concepts of risk
communication.
· To identify the key elements of risk communication
based on the definitions by WHO, Peter Sandman and
US National Research Council.
· Apply the usage of risk communication especially in
the context of health crises.

Methodology:
· Lectures.
· Group discussion and presentation.

Learning Process:
· Activity 1 - Lecture
· Activity 2 – Group work.

Optional:
o Simulation video
o Animation Spot (e.g. clip of press statement)
o Illustration of concepts
o Checklist to review the content
o Short quizzes

Activity 1: Lecture Topic (“Concepts and Principles of Risk

Communication”)

Content:

1. Evolution of the concepts of risk communication.

2. Definitions and essential elements of risk
communication.
3. Goals of Risk communication.
4. Risk Perceptions.
5. Types of Risk communication.
6. Complexities of risk communication.
7. WHO Best Practise in Outbreak Communication.
8. Seven Cardinal Rules of Risk communication.

Activity 2: Group Work

1. Break into groups.

2. Group discussion on the definitions of risk
communications.
24
 3. Identify the important scope/elements of risk
communication.
4. Present to the group in power point or flip chart.

Teaching Aids:
o Power-point.
o Hand out notes.

Optional:
o Compact Disc.
o Video.
o Audiovisuals.

Duration:
· Activity 1 – 45 minutes.
· Activity 2 – one and half hour.

Evaluation:
Q & A.

Technical Resource:
· Occupational Health Specialist/Epidemiologist.
· Communication experts

UNIT 3: Outbreak Management experiences

Learning Objective

At end of the session, participants will be able to:

a) Exposure and sharing experience on outbreak

management
b) Identify the various existing mechanisms in
information management.
c) Role of risk communication in outbreak
management.

Methodology

a) Lecture (45 minutes)

b) Country presentation on outbreak experiences
(one and half hour)

Learning Process

Activity 1: Lecture
25
 Content:
a) Information management during crisis
b) Mechanisms in managing information
c) Information management in risk
communication

Activity 2: Country Presentations on Outbreak

Management of each member country.

Teaching Aids

a) Computer
b) LCD
c) Power point presentation
d) Handouts

Duration

Activity 1 – 45 minutes and Q&A.

Activity 2 - One and half hour.

Assessment Method

Pre and post test

26
 LESSON PLAN:

UNIT 1:”Risk, Crisis and Health Crisis Management”.

Objectives: Appreciate the importance of :”Risk, Crisis and Health Crisis Management”.

TOPIC CONTENTS METHOD RESOURCE DURATION

Risk, Crisis · Risk: Hazard · Lecture Power-point 1 hour

and Health issues, presentation &
Crisis identification, hand out.
Management. does-response
assessment,
exposure
assessment &
risk
characterization.
· Risk management
Health Crisis.
· Management of
Health
Crisis.
· How risk
communication
fits in. Facilitators
· Group and Flip charts 1 ½ hours
discussion
· Identifying risks,
and health crises
of importance in
the country

27
UNIT 2: “The Concepts and Principles of Risk communication”

Objectives:
1.1 To understand the evolution of the concepts of risk communication.
1.2 To identify the key elements of risk communication based on the
definitions by WHO, Peter Sandman and US National Research
Council.
1.3 To appreciate the usage of risk communication especially in the
context of health emergencies.

TOPIC CONTENTS METHOD RESOURCE DURATION

Overview of - Evolution of · Lecture · Power- 1 Hour

risk concepts of risk point
communicatio communication Optional: presentatio
n (you may already · Simulation n and hand
be doing risk video outs.
communication, or · Animation
parts of risk Spot (e.g.
communication) clip of press
- Definitions and statement)
essential · Illustration
elements of risk of concepts · CD
communication · Checklist to · Video
and comparison. review the · Audiovisua
- Goals of Risk content ls
communication: · Short · Copier
· Vary according quizzes
to situation. · TV Spot
· Why Risk (e.g. clip of
communication press
is important statement
· How RC is
useful? · Illustration
- Risk perception of concepts
(scientific risk, and
emotional · Checklist to
assessment) and review the
responses towards content
risk messages of
public and media

28
Types of Risk · Group work Facilitators 1 ½ hours
communication and flip
(Peter Sandman) charts
· Precaution
Advocacy
· Crises
communication
· Public relation
(health
education)
· Outrage
management

Risk
communication
Principles (WHO)
· Trust
· Transparency
· Announcing
early
· Listening
· Planning

Seven Cardinal
Rules of Risk
communication
· Accept and
involve the
receiver of risk
information as a
legitimate
partner.
· Plan and tailor
risk
communication
strategies.
· Listen to your
audience.
· Be honest, frank
and open.
· Coordinate and
collaborate with
other credible
sources.
· Plan for media
influence.

29
What is not risk
communication?

Different concepts
and terms related to Man:
risk communication: · Expertise
· Health in RC &
education media
· Health relations.
promotion · Experience
· Communication d trainer.
for Behavioural
Impact (COMBI) · Money:
· Social · Fund for
mobilization consultanc
· Social marketing y fees
· Public · Travel,
information accommod
· Public relations ation &
· Media relations training
· Community materials
participation,
citizen Material:
involvement · Handouts
· Advocacy · CD
· Include other · Video
terminology as · Audiovisu
needed. als
· Copier
· Flip chart

30
UNIT 3:” Outbreaks Management and Experiences”.

Objectives: Appreciate the importance of risk communication in outbreaks

management”.

TOPIC CONTENTS METHOD RESOURCE DURATION

Participants · Exposure on how · Lecture · EID 1 hour

will expose to to manage Program
outbreak outbreak manager
management
and the · What is · Health
important role management of Education
of risk information? Department
communicatio
n · Who will manage · Communic
information? ation
Expert
· Effective delivery
channels for · Public
information Relation
Officer
· Disclosure of · Country 1 ½ hours
information presentation

· Risk assessment · EID

of public health Program
threat and manager/
dissemination of · Epidemiolo
information, gist
Interpretation and
verification of the · Communic
information (real ation
and perceived Expert
threat) /Health
promoter
· Preparing
communities for · Health
actions to take Education
with information Department

· Communicating
risk with
information to
prevent panic.

31
MODULE 2: RISK COMMUNICATION STRATEGIES

1. Introduction

Risk communication strategies are known as seeking cooperation

from governmental, non governmental agencies and stakeholders
in order to elicit advocacy, networking and community participation.
The strategy should obtain and gather feedback during crisis,
building up partnership and collaboration with the respective
organization. A customized training programme need to be carried
out as well as conducting process and impact assessment.

2. Purpose of module

Participants will understand and apply the risk communication

strategies during health crisis.

3. Module Objective

In this module, participants will acquire knowledge and skills on how

to identify and advocate to the stakeholders, build networking, using
appropriate risk communication strategies in reaching vulnerable
groups and empower community for active participation during
health crisis

32
4. Contents of Module 2

UNIT 1 - Advocacy and networking with stakeholders

· Definition of advocacy
· Elements of advocacy
· Levels and process of advocacy
· Definition of networking for risk communication
· Definition of stakeholders and Identify key stakeholders
· Types of stakeholders.
· List of internal and external stakeholders involved in health
crisis
· Needs and preferences of stakeholders
· The role of networking and advocacy in the context of risk
communication

UNIT 2 - Encouraging community participation and forging

partnerships

· Definition of community & community participation

· Community mobilisation for risk communication
· Community and public meetings
· Peer education
· Generating support from stakeholders and others

UNIT 3 - Reaching vulnerable groups (e.g., migrant workers

and indigenous groups, mothers, children etc)

· Identification of vulnerable groups and their information

needs.
· Message development and dissemination – access
community
and local radio.
· Enabling mechanisms for preparedness response and
recovery.
· Identification and networking with local NGOs and leaders
of
migrants/workers and others

33
 UNIT 4 - Collaborate with international organisations and
neighbouring countries, including cross border issues

· Orientation on existing protocol and mechanisms for

sharing information on public health emergencies.
· Maximising web-based information dissemination to reach
others.
· Developing and sharing messages (e.g., cultural
considerations, translation / language, etc.) for cross border
relevant sectors (e.g., customs, quarantine, livestock,
health, police, tourism, etc.)

5. Instructional Guide

UNIT 1 - Advocacy and networking with stakeholders

Learning Objective 1

At end of the session, participants will be able to:

1. Discuss advocacy and networking in the context of risks

communication in health crisis
2. Explain the importance of advocacy and networking plan
for risk communication
3. Identify collaborating partners for risk communication
4. Define roles of partners in risk communication.

Methodology

1. Brainstorming (10 minutes)

2. Lecture (40 minutes)
3. Discussion (10 minutes)

Learning Process

Activity 1: Brainstorming

Sharing ideas’ session among participants in order to

understand the concept of advocacy and networking in the
context of risk communication in health crisis before starting the
lecture.

34
Activity 2: Lecture

Contents:
· Definition of advocacy
· Elements of advocacy
· Level & Process of advocacy
· Definition of networking for risk communication
· The role of networking and advocacy in the context of risk
communication

Activity 3: Discussion

1. Discussion on advocacy and networking in the context of

risk communication in health crisis.
· Divide participants into groups.
· Discuss the scenario given within the group’s member.
· Present group’s findings to other groups.
· Q&A

Teaching Aids

Computer
LCD
Power point presentation

Duration

1 hour

Assessment Method

Q&A

35
Activity 1: Brainstorming

Brainstorming activity can be a useful approach for generating participants existing understanding on
advocacy, its level and process of advocacy. The facilitator shall pair or group participants to make
suggestions with no restrictions on the extent of their understanding.

Participants in the exercise use the Post-It Notes to write down additional ideas. Participants stick the
notes on the wall - randomly at first - and then moved and grouped together as the exercise plays out.

The participants will encounter ideas of (limit the probing according to the needs and preferences):

a) What do you understand about advocacy?

b) What are the elements of advocacy?
c) Explain the level and process of advocacy.

In order to ensure a successful exercise, it is vital that participants feel comfortable about sharing ideas.
This technique is ideal for participants who have not encountered scenario planning before as it offers
the opportunity to become actively involved very quickly before the lecture.

Activity 2: Lecture

Prepare Power Point presentation based on the key contents, Exercise Notes Unit 3.1 and Appendix 1.

36
Activity 3: Discussion

Scenario: Adapted from Crisis and Emergency Risk Communication, CDC 2002

Case Study. H5N1 Virus Outbreak Investigation, Hong Kong, 1997–1998

In May 1997, a 3-year-old Hong Kong boy became ill with fever, dry cough, and a sore throat. He was
hospitalized, continued a downward course, and died. Only influenza A virus was cultured from this child.

Scientists identified the virus as influenza A/(H5N1). This virus had never before been cultured from a
human specimen. The subsequent investigation ruled out laboratory contamination, and concluded that
the child’s illness was consistent with influenza complicated by viral pneumonia. Investigators believed,
based on laboratory evidence, that the virus was transmitted directly from an avian source to the child,
possibly in the outdoor garden area of his school. This was the first reported case of an avian virus being
transmitted directly to a human. During the August–September investigation, no other cases were found.

In late November, the Hong Kong Department of Health contacted CDC’s Influenza Branch to report that a
second H5N1 infection had been detected. CDC sent a team of medical epidemiologists and field
investigators.

CDC and health organizations around the world engage in ongoing, active surveillance to attempt to
quickly detect the possibility of a pandemic influenza virus spreading among humans. Influenza viruses
mutate easily. Most often the mutation is slight and occurs over time, a process called “drift.” Occasionally,
an influenza virus will suddenly mutate significantly; this is called “shift.” A virus that shifts is a potential
pandemic strain. To qualify as a potential pandemic strain, the virus must meet 3 criteria: (1) it must be
genetically novel, (2 ) it must be virulent, and (3) it must be efficiently transmitted between humans.

In late December, cases were accumulating and young healthy adults were dying of this viral infection.
The H5N1 virus in this outbreak met 2 of the 3 criteria: it was novel and it was virulent. CDC, Hong Kong
DOH and a number of collaborators began an intense investigation to determine whether this was the start
of an influenza pandemic. Indeed, public health officials know, based on trend analysis, that a pandemic is
overdue. Investigators concentrated on determining the virus’ ability to transmit from person to person. An
increase in person-to-person virus transmission would have suggested that the virus was adapting to
humans, with the potential for epidemic spread.

In mid-December, a veterinarian virologist collaborating on the investigation held a telephone worldwide

news conference and announced this was the “pandemic” strain that health officials were expecting. The
immediate media uproar severely disturbed the investigators’ attempts to collect information in Hong
Kong. The Hong Kong DOH and the CDC field team requested that a CDC public information officer (PIO)
join the team in Hong Kong, the first time CDC had assigned a PIO on an overseas field investigation.
During the field assignment, the CDC PIO represented CDC, DHHS and WHO on public information
issues.

37
Learning Objective 2

At end of the session, participants will be able to:

1. Identify role & responsibilities of key stakeholder groups.

Methodology

1. Mapping Exercise (15 minutes)

2. Group Presentation (5 minutes per group)
3. Lecture (40 minutes)

Learning Process

Activity 1: Mapping Exercise & Group Presentation

· Divide participants into groups

· Groups to identify & list down internal and external stakeholders
involve in health crisis
· Present group’s findings to other groups.

Activity 2: Lecture

Contents:
· Definition of stakeholder
· Types of stakeholder
· Needs and preferences of stakeholders
· Advocacy to the key decision makers – budget, finance,
parliament, veterinary, tourism, education, quarantine,
manpower/interior (e.g., legal and illegal migrant workers),
customs, national defence, police, trade, industry, information,
etc.

Teaching Aids

Kraft / Mahjong paper

Marker pen
White board
Computer
LCD
Power point
Pointer

38
 Duration
1 hour
Assessment Method
Q&A
Resources
1. Manpower - the field experts.
2. Please refer to Annex 1

Activity 1: Mapping Exercise & Group Presentation

Steps in Stakeholders Mapping

39
 EXAMPLE: STAKEHOLDERS MAPPING DURING OUTBREAK OF INFLUENZA IN MALAYSIA

Surveillance CDC PHL

CRC
CDC
HED
IHBR
NIH
MDD
PHI
Ministry of Health
Malaysia
NGOs
MMA
FHDD
Public Relation Community MAHEO
Division, MOH organization

National
Security Council
Employment
External agencies
INTERNAL stakeholders (Foreign
STAKEHOLDER STAKEHOLDERS workers)
Ministry of
Education

Media
HED: Health Education Division
MDD: Medical Development Division
FHDD: Family Health Development Division
PHL: Public Health Laboratory
IHBR: Institute for Health Behavioural Research Internal External media
PHI: Public Health Institute
40
CRC: Clinical Research Centres
 EXAMPLE IN THE PROVINCE/STATE:
(adapted from Health Department, Pahang, Malaysia)

ROLES AND FUNCTIONS OF OTHER DEPARTMENTS AND NON-GOVERNMENTAL

ORGANISATIONS IN PAHANG DURING INFLUENZA PANDEMIC

STATE GOVERNMENT

a) To ensure co-ordination in issues related to security and public order on the Influenza
pandemic
b) To give advice on security issues related to the Influenza Pandemic.
c) To provide security cover, if needed during enforcement of PCIDA 1998.
d) To facilitate all matters pertaining to security and public order e.g reduce spreading of
myths related to the Influenza Pandemic.

DEPARTMENT OF AGRICULTURE

a) To help in all matters on international relation pertaining to the Influenza Pandemic.

b) To obtain information on the latest situation and updated development on the Influenza
Pandemic in the affected countries.
c) To facilitate all matters related to the control of the Avian Influenza.

ROAD AND TRANSPORT DEPARTMENT

a) To ensure compliance of all control measures on the Influenza Pandemic agreed upon
regarding public transportation in and out of entry point in the country.
b) To co-ordinate issues in the control of the Influenza pandemic, related o the movement of
public transportation and people.
c) To facilitate all transportation issues related to the Influenza Pandemic.
d) To ensure all passengers boarding airplanes from country affected by the Influenza
Pandemic to Pahang have their medical screening prior to departure, completed health
declaration forms on board the planes before disembarking and isolation on board if the
passengers are suspected cases of Influenza.

41
DEPARTMENT OF INFORMATION

a) To disseminate relevant information to the community regarding the status of outbreak

and educational materials and public information on the Influenza Pandemic.
b) To coordinate press conferences and all mass media activities on the Influenza
Pandemic.
c) To facilitate all matters as regards the print and electronic media related to SARS.

DEPARTMENT OF SOCIAL WELFARE

a) To help in the Influenza Pandemic control measures by printing and disseminating

information on the Influenza Pandemic.
b) To implement and enforce preventive and control measures in all childcare centre under
its jurisdiction.
c) To coordinate all activities for the families related to Influenza.
d) To facilitate all matters concerning families and community related to Influenza.

EDUCATON DEPARTMENT/ DEPARTMENT OF HIGHER EDUCATION

a) To disseminate updated information on the control measures of the Influenza Pandemic

to all teachers and students.
b) To remind all students, their parents or guardians that student who are ill with symptoms
and signs similar to Influenza to be examined and treated by doctors and not to allow
them to attend school during in the period of illness.
c) To request parents or guardians to monitor the health status of their children and to refer
to doctors if they are ill.
d) To facilitate all measures on the prevention and control of Influenza at the school level
and especially college and university level where many foreign students come to study
in the state.
e) To help implement the screening of foreign students returning to the colleges and
universities after their holidays from affected Influenza Pandemic countries.
42
MINISTRY OF RURAL DEVELOPMENT

a) To help disseminate information of the Influenza Pandemic to the rural communities.

b) To facilitate all matters related to the Influenza Pandemic in the rural areas.
c) To implement and enforce preventive and control measures in the childcare centre under
their supervision.

STATE TOURISM BOARD

a) To help print and disseminate all official information issued by the Ministry Of Health to all
those related to the tourism industries.
b) To help give feedbacks the State Inter - sectoral Committee on Influenza pandemic on
matters concerning tourism.
c) To facilitate all matters on the influenza Pandemic related to the tourism sector.

DEPARTMENT OF IMMIGRATION

a) To facilitate the screening process of people/travellers at entry points into the country.
b) To help coordinate all health Influenza issues related to the movements of all aliens
especially foreign workers into the country.
c) To help identify ill individuals/travellers coming through immigration check points.
d) To facilitate all matters on the Influenza Pandemic related to immigration.
e) To be stringent in the issues of visa/temporary visa of travellers from the Influenza
Pandemic affected countries.

DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH

a) To monitor the health of workers and to take remedial action to rectify if needed.
b) To help print and distribute education materials on Influenza Pandemic and to advise on
the risk factors in the work place and surroundings.
c) To facilitate all matters concerning dangers of the surroundings related to the spread of
the Influenza.

43
ROYAL MALAYSIAN POLICE

a) To ensure coordination of security and public order in the control of the Influenza
Pandemic.
b) To give advice on security matters pertaining to the Influenza Pandemic if any.
c) To provide security cover, if needed, in the enforcement of PCIDA 1998.
d) To facilitate all matters concerning security and public order if any pertaining to the
Influenza Pandemic e.g. rumour mongering.

ASSOCIATION OF PRIVATE HOSPITALS, MALAYSIA (PAHANG BRANCH)

a. To disseminate all information regarding Influenza including the hospital management of

Influenza to all members of the association.
b. To coordinate all activities and measures on Hospital Infection Control in private hospitals in
dealing with infectious diseases.
c. To quickly refer all suspected / probable Influenza patient/s to the nearest Influenza Pandemic
Designated Hospital/s when indicated in the guidelines of MOH.

PAHANG PRIVATE PRACTITIONERS SOCIETY (MMA)

a. To help disseminate all information regarding Influenza and the pandemic to its members.
b. To help teach the community who are ill to come for early treatment.
c. To help detect early any person/s who may present with symptoms of Influenza for referral to
designated hospitals when indicated by MOH guidelines.

MALAYSIAN MEDICAL ASSOCIATION (PAHANG BRANCH)

a. To help disseminate all information regarding Influenza and the pandemic to its members.
b. To help teach the community who are ill to come for early treatment.
c. To help detect early any person/s who may present with symptoms of Influenza for referral to
designated hospitals when indicated by MOH guidelines.
d. To facilitate all matters pertaining to the primary care Influenza.

44
PAHANG VETERINARY SERVICE DEPARTMENT

a. To develop their own risk communication for those involved in handling poultries activities.
b. To disseminate information on Good Farming Practices in Poultry .
c. To reinforce Guidelines an Acts on Poultry activities to prevent Avian Influenza.

MEDIA (RADIO, TV AND LOCAL NEWSPAPERS)

Some general Guidelines were put forward to keep the media on tract and help avoid sensational
reporting.

a. To anticipate media needs; to get full cooperation and support in disseminating correct
information to the public on Influenza Pandemic latest situation.
b. To help Local Authority /Health Department to disseminate Health Educating Materials.
c. To concentrate on facts and figures but humanize the situation with metaphors and anecdotes.

45
PAHANG MALAYSIA RED CRESCENT SOCIETY

a. To help in transporting the Pandemic Influenza patient (when needed), especially during Phase
5-6.
b. To help in logistics (e.g. Preparation food and shelter for the affected people).

PAHANG ST JOHN AMBULANCE

a. To help in transporting the Pandemic Influenza patient (when needed), especially during Phase
5-6.
b. To help in logistics (e.g. Preparation food and shelter for the affected people).

PAHANG CIVIL DEFENSE DEPARMENT (JPA3)

a. To help in transporting the Pandemic Influenza patient (when needed), especially during Phase
5-6.
b. To help in first aid and logistics (e.g. Preparation food and shelter for the affected people).

DISTRICT OFFICE

a. To get good support in regards of security, logistic, welfare of local people.

b. To develop District Committee on Influenza Pandemic Preparedness Plan.
c. To coordinate with other agencies on Influenza Control activities.

LOCAL AUTHORITY

a. To highlight issues in council meeting regarding Influenza.

b. To coordinate Public Health activities within their authority.
c. To enforce Local Authority Act on Disease Prevention Control.

46
 WORKSHEET:
STAKEHOLDER REACTION ASSESSMENT
(adapted from CDC, 2002)

Stakeholder group_____ Importance to the success of public health communication (1–5) ____ Severity
of likely reaction (1–5)____ Advocate ____ Adversary ____ Ambivalent ____

Importance of this stakeholder group?

__________________________________________________________________________________
Likely initial reaction?
__________________________________________________________________________________
Turning point?
__________________________________________________________________________________
What would cause a change in position?
__________________________________________________________________________________
Key messages:
__________________________________________________________________________________
Key contacts:
__________________________________________________________________________________
Opportunities for feedback:
__________________________________________________________________________________
Strategies to inform/involve stakeholders:
__________________________________________________________________________________
Strategies to help keep them from getting involved (satisfy needs early):
__________________________________________________________________________________
Products to provide:
__________________________________________________________________________________
Contact updates:
__________________________________________________________________________________
Date, with whom, and how:
_____________________________________________________________

47
UNIT 2: Encouraging community participation and forging partnerships.

Learning Objective 1

At end of the session, participants will be able to:

1. Identify the community’s perception and needs, thus respond
to them
2. Develop knowledge and skills on how to encourage
community participation and forging partnership

Methodology

1. Lecture (40 minutes)

2. Sharing the experiences / country’s (60 minutes)
experiences & lesson learnt

OPTIONAL

3. Case study
4. Role Play

Learning Process

Activity 1: Lecture

Contents:
· Definition of community
· Definition of community participation
· The importance of community participation / involvement
· Factors that influence public perception
· Skills on how to encourage community participation &
forging partnership
· Community mobilisation for risk communication
· Community and public meetings
· Peer education
· Generating support from stakeholders and others

48
Activity 2: Sharing the experiences / country’s experiences & lesson
learnt

Participant sharing experience & lesson learnt on encouraging

community participation & forging partnership.

· Q&A

OR (for country’s experiences)

1. Invite spokesperson from the chosen country & sharing

experiences on encouraging community participation &
forging partnership.
· Q&A

OR through video presentation

(OPTIONAL)

Activity 3: Case Study

· Divide participants into groups

· Discuss the scenario given with your group members
· Present group’s findings to other groups
· Q&A

(OPTIONAL)

Activity 4: Role Play

· Request volunteers or select participants

· Discuss the scenario given with your group members
· Conduct the role play
· Evaluate and Q & A

Teaching Aids

Computer
LCD
Power point presentation
Video
49
Duration

1 hour & 40 minutes

Assessment Method

Feedback on presentation
Q&A

Resources

1. Manpower - the field experts.

2. Please refer to Annex 2

50
UNIT 3: Reaching vulnerable groups

Learning Objective 1

At end of the session, participants will be able to:

1. Identify vulnerable groups in the community

2. Identify correct messages for vulnerable groups in the
community

Methodology
1. Lecture (40 minutes)
2. Sharing the experiences / country’s
experiences & lesson learnt (30 minutes)

Learning Process

Activity 1: Lecture

Contents:
· Definition of vulnerable groups
· Identification of correct messages for different target
audience and dissemination
· Enabling mechanisms for preparedness response and
recovery
· Identification and networking with local NGOs and leaders of
migrants/workers and others.

Activity 2: Sharing the experiences / country’s experiences & lesson

learnt

1. Participant sharing experience & lesson learnt

· Q&A

OR (for country’s experiences)

2. Invite spokesperson from the chosen country & sharing

experiences
· Q&A

51
Teaching Aids
Computer
LCD
Power point presentation

Duration
1 hour 10 minutes

Assessment Method
Feedback on presentation
Q&A

Resources

1. Manpower - the field experts.

2. Please refer to Annex 3

52
UNIT 4: Collaborate with international organisations and
neighbouring countries, including cross border issues

Learning Objective 1

At end of the session, participants will be able to:

1. Identify networking between international and neighbouring

countries
2. Develop knowledge on maximising collaboration between
international organisation and neighbouring countries, including
cross border issues

Methodology
1. Lecture (40 minutes)

Learning Process

Activity 1: Lecture

Contents:
· Orientation on existing protocol and mechanisms for sharing
information on public health emergencies.
· Maximising web-based information dissemination to reach others.
· Identify, developing and sharing messages

Teaching Aids
Computer
LCD
Power point presentation

Duration
40 minutes

Assessment Method
Q&A

Resources

1. Manpower - the field experts.

2. Please refer to Annex 4 and 5

53
LESSON PLAN

LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 1: Advocacy and networking with stakeholders

LQ 1:- 1. Definition of advocacy 1. Brainstorming Guidance notes 10 minutes

2. Elements of advocacy
i. Discuss advocacy 3. Level & Process of advocacy 2. Lecture Power point 40 minutes
and networking in the 4. Definition of networking for risk presentation
context of risks communication
communication in 5. The role of networking and 3. Discussion Q & A sequencing 10 minutes
health crises advocacy in the context of risk
communication
ii. Explain the
importance of
advocacy and
networking plan for risk
communication

LQ 2:-

i. Identify collaborating 1. List of internal and external 1. Mapping Exercise Kraft / Mahjong 15 minutes
partners for risk stakeholders involve in health crisis paper
communication Marker pen
2. Group Presentation Loytape 5 minutes per
ii. Define roles of 2. Definition of stakeholder White board group
partners in risk 3. Types of stakeholder Pointer
communication. 3. Lecture Computer

54
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES
iii. Identify role & 4. Needs and preferences of LCD 40 minutes
responsibilities of key stakeholders advocacy to the key Power point
stakeholder groups. decision makers – budget,
finance, parliament, veterinary,
tourism, education, quarantine,
manpower/interior (e.g., legal
and illegal migrant workers),
customs, national defence,
police, trade, industry,
information, etc.

55
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 2: Encouraging community participation and forging partnerships

1. Identify the 1. Definition of community 1. Lecture Computer 40 minutes

community’s 2. Definition of community LCD
perception and participation Power point
needs, thus 3. The importance of community presentation
respond to them participation / involvement
4. Factors that influence public 2. Sharing the Video
2. Develop perception experiences / country’s 60 minutes
knowledge and 5. Skills on how to encourage experiences
skills on how to community participation & & lesson learnt
encourage forging partnership
community 6. Community mobilisation for
participation & risk communication OPTIONAL
forging 7. Community and public
partnership meetings 1. Case study
8. Peer education
9. Generating support from 2. Role Play / Game
stakeholders and others

56
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 3: Reaching vulnerable groups

1. Identify 1. Definition of vulnerable 1. Lecture Computer 40 minutes

vulnerable groups LCD
groups in the 2. Identification of correct Power point
community messages for different target presentation
audience and dissemination
2. Identify correct 3. Enabling mechanisms for
messages for preparedness response and 2. Sharing the 30 minutes
vulnerable recovery experiences / country’s
groups in the 4. Identification and networking experiences & lesson
community with local NGOs and leaders learnt
of migrants/workers and
others.

57
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 4: Reaching vulnerable groups

1.Identify networking 1. Orientation on existing protocol 1. Lecture Computer 40 minutes

between international and mechanisms for sharing LCD
and neighbouring information on public health Power point
countries emergencies. presentation
2. Maximising web-based
2.Develop knowledge information dissemination to
on maximising reach others.
collaboration between 3. Identify, developing and sharing
international messages
organisation and
neighbouring
countries, including
cross border issues

58
MODULE 3: COMMUNICATING HEALTH RISK

1. Introduction

The right message at the right time is a resource multiplier which is

needed to assist response officials to get their job done. Many of the
predictable harmful individuals and community behaviours can be
mitigated with effective crisis and emergency communication. Officials
need to anticipate what mental stresses the population will be
experiencing and apply appropriate communication strategies to attempt
to manage these stresses in the population.

Hence, officials managing crisis situation need to be equipped with

appropriate risk communication tools.

2. Purpose

The purpose of this module is to enable the participants to develop skills

essential for communicating health risk.

3. Module Objective

To equip participants with relevant knowledge and skills for effective risk
communication

4. Module Contents

UNIT 1 - Identification and understanding the audience

UNIT 2 - Message development
UNIT 3 - Basic skills of media spokespersons
UNIT 4 - Media Management and Engagement

59
UNIT 1 - Identification And Understanding The Audience

1. Define the audience

2. Analyze the audience
3. Carry out audience segmentation

Duration

1 hour

UNIT 2 - Message Development

1. Discuss factors that help determine audience acceptance of

messages.
2. Identify and apply the steps in developing messages

Duration

2 hours

UNIT 3 - Basic Skills Of Media Spokesperson

1. Identify principles of a good spokesperson

2. Identify the Skills and requirement for effective communication

Duration

1 hour

UNIT 4 - Media Menagement And Engagement

1. Describe how media people work.

2. Identify the media needs
3. Describe process of handling media
4. Develop skills in preparing materials for media
5. Discuss preparation to meet the media

Duration

3 hours

60
5. Instructional Guide

UNIT 1: Identification And Understanding The Audience

Learning Objectives

At end of the session, participants will be able to:

1. Define the audience

2. Analyze the audience
3. Carry out audience segmentation

Methodology

1. Brainstorming (10 minutes)

2. Lecture (20 minutes)
3. Discussion (30 minutes)

Learning Process

Activity 1: Brainstorming

1. Break into groups.

2. Each group list down on how to carry out audience
segmentation.
3. Present to the group in power point or flip chart.

Activity 2: Lecture

Content:

1. Define audience Analysis

2. Identify the purpose of Audience Analysis
3. Describe the steps in Audience Analysis
4. Explain Audience Segmentation
5. Enumeration the classification of Audience

Activity 3: Group Discussion

1. Break into groups.

2. Do exercise 1 & 2
61
 3. Present to the group in power point or flip chart.

Resource

Please refer to Annex 6

Teaching Aids

Computer with Microsoft Power point presentation LCD

Checklist

Duration

1 hour

Assessment Method

Q&A

62
UNIT 2 - MESSAGE DEVELOPMENT

Learning Objectives

At end of the session, participants will be able to:

1. Identify factors determining audience acceptability of health

messages
2. Identify and apply the steps in developing messages
3. State the steps in developing messages (using message
mapping as tool)

Methodology

1. Lecture (30 minutes)

2. Brainstorming (30 minutes)
3. Discussion (1 hr)

Learning Process

Activity 1: Lecture

Content:

1. Factors determining audience acceptability of health messages

2. Identify and apply the steps in developing messages
3. State the steps in developing messages (using message
mapping as a tool)

Activity 2: Brainstorming (refer to exercise 3 in Appendix 5.3 )

1. Break into groups.

2. Each group list out;

a. The factors determining audience acceptability of health

messages.
b. State the steps in developing messages (using message
mapping as a tool)
3. Present to the group in power point or flip chart.
63
Activity 3: Group discussion (refer to exercise 4 in Appendix 5.4)

1. Break into groups.

2. Do exercise 4

3. Present to the group in power point or flip chart.

Resource

Please refer to Annex 7

Teaching Aids

Computer with Microsoft Power point presentation

LCD
Checklist

Duration

2 hrs

Assessment Method

Q&A

64
UNIT 3 - BASIC SKILLS OF MEDIA SPOKESPERSONS

Learning Objectives

At end of the session, participants will be able to:

1. Identify principles of a good spokesperson

2. Identify the skills and requirement for effective communication

Methodology

1. Discussion (60 minutes)

Learning Process

Activity 1: Group discussion

1. Break into groups.

2. Do exercise 5
3. Present to the group in power point or flip chart.

Resources

Please refer to Annex 8

Teaching Aids

Computer with Power point

LCD
Checklist

Duration

1 hr

Assessment Method

Q&A

65
UNIT 4 – MEDIA MENAGEMENT AND ENGAGEMENT

Learning Objectives

At end of the session, participants will be able to:

1. Describe how media people work.

2. Identify the media needs
3. Describe process of handling media
4. Demonstrate skills in preparing materials for media
5. Describe the steps to prepare to meet the media

Methodology

1. Brainstorming ( 1 hour)
2. Discussion ( 1 hour)
3. Lecture ( 45 minutes)

Learning Process

Activity 1: Brainstorming

1. Break into groups.

2. Each group list out;
a. The needs of the media.
b. Describe the process of handling media.

Activity 2: Group discussion

1. Break into groups.

2. Do exercise 6, 7 & 8
3. Present to the group in power point or flip chart.

66
 Activity 3: Lecture

Content:

1. Explain the important of media in Risk communication- national

and local media
2. Describe preparing the media:
· Pre crisis (e.g. encouraging the media to write features story
on EID, etc.
· During crisis
· After crisis
3. State how to deal with media
· The dos and the don’ts
· Empathy & caring
· Competence & expertise
· Honesty & openness
· Commitment
· Accountability
· Good listener
· Confidence
· Humility
4. Describe Media monitoring
5. State Media Needs
6. Describe the processes involved in handling media

Resource

Please refer to Annex 9

Teaching Aids

Computer with Power point and design soft ware

Flip chart
Sample materials
LCD

Duration

3 hrs

Assessment Method

Q&A
Peer Critics and feedback
67
 LESSON PLAN:

LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 1 - IDENTIFICATION AND UNDERSTANDING THE AUDIENCE

Define the · Audience analysis Brainstorming Communication 10 min

audience · Purpose of audience Expert
analysis

Analyze the · Steps in audience Lecture 20 min

audience analysis
· Audience segmentation
· Steps in audience
segmentation
· Classification of
audience
· Important
characteristics of the
audience
o Interest
o Knowledge
o Attitudes
o Skills
o Media behaviours
o Risk perception
Tools for analysis
o FGD
o Rapid assessment
o Media scanning
o Secondary data

Carry out Concepts of audience Discussion 30 min

audience segmentation based on
segmentation certain characteristics
· Demographic
· Psychographic

68
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

Discuss Factors determining Discussion 30 min

factors that audience
help
determine acceptability of health
audience messages
acceptance of
messages

UNIT 2 – MESSAGE DEVELOPMENT

Identify and Steps in developing Group activity 1.5 hr

apply the messages (using message
steps in mapping as a tool)
developing · List target audience
messages and concerns
· Analysis of
concerns and
confirm with
audience
· Network with
experts
· Develop solutions
· Develop key and
supportive
messages
· Test messages
· Make necessary
improvement.

69
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES
UNIT 3 - BASIC SKILLS OF MEDIA SPOKESPERSONS

Identify STARCC principles: Discussion 30 min

principles of a · Simplicity,
good · Timeliness,
spokesperson · Accuracy,
· Relevance,
· Credibility,
· Consistency
· Tips for media
appearance

o Personal grooming
o Communication
style
o Mental
preparedness
o Subject knowledge
o Etiquette

Identify the Tips in effective Discussion 30 min

Skills and communication
requirement · The dos and the
for effective don’ts
communicatio · Empathy &
n caring
. · Competence &
expertise
· Honesty &
openness
· Commitment
· Accountability
· Good listener
· Confidence
· Humility

70
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

UNIT 4 - MEDIA MENAGEMENT AND ENGAGEMENT

LEARNING
OBJECTIVES CONTENT METHOD RESOURCE DURATION

Describe how Understanding the media- Discussion Media 30 min.

media people national and local media. practitioners.
work.

Preparing the media: Discussion

o Pre crisis (eg.
Encouraging the
media to write
features story on
EID, etc.
o During crisis Lecture -
o After crisis

Working with the media Discussion

(building relationships)
o Pre crisis
o During crisis (eg.
Center for information
and advocacy on
EIDs, including
equipment)
o After crisis
Preparing transparent,
timely, accurate, reliable,
interesting and creative Lecture
information for media to
ensure coverage through:
Press release
Press Conference
Media Briefing
Other means (e.g. Hotline,
Super Chicken in
Cambodia)

71
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

Identify the Media monitoring and Brainstorming 30 min

media needs analysis
o Know their needs,
timelines & selling
points
o Difference between
media & media
people

Describe · Guidelines in handling Brainstorming 30 min

process of the media
handling · Communicating with
media the media
· Preparation before
meeting the media
· Response to media Lecture -
· Dos & Don’ts

Develop skills · Features of effective Practical 30 min

in preparing materials for the media Discussion
materials for · Press conference
media · Press release
· Press kit
· Media briefing

Discuss · Logistics preparation Discussion 30 min

preparation to o Basic requirements
meet the o Invitation list Lecture 30 min
media

72
MODULE 4: ETHICAL AND LEGAL IMPLICATIONS OF RISK
COMMUNICATION

1. Introduction
It is important that the health staff be aware of the political, legal and
ethical implications inherent to public health in handling risk
communication in a health crisis situation. They should also be aware of
the existing mechanisms for inter-sectoral collaboration, roles and
responsibilities of key actors involved, and management of information
with regard to risk communication during a health crisis. This module
therefore addresses the political legal and ethical considerations in risk
communication. In terms of the mechanism the personnel involved are
identified and how information is managed during a crisis is also dealt
with. This is appropriate during every level of the crisis that is pre, during,
and post crisis. The areas discussed are also applicable at the national,
state and ground levels. The key personnel trained need to have a good
understanding of the various elements discussed so that the rights, dignity
and honour of the target group is not compromised. They need to know
the existing mechanism and their role in it so that can participate
effectively in bringing the crisis to a quick end.

2. Purpose

The participants should know how to use the existing laws to assist in their
handling of the crisis. At the same time they need to be aware of the
limitations within the laws, so that individual rights are not compromised.
It is essential that the trainee-participants realize at the end of the module,
that the core principals of ethics must always be upheld within the context
and requirements of the law.

3. Objective
3.1 General Objective

To expose participants to the ethical and legal implications of risk

communication.

3.2 Specific Objectives

3.2.1 Participants to familiarize themselves with political, ethical and

legal considerations and principles for a pre-crisis/crisis
situation

73
 3.2.2 Participants to apply political, ethical and legal considerations
and principles in a crisis situation

4. Contents of Module 4

UNIT 1: Ethical Implication In Risk Communication

a) Definition and principles of political, ethical and legal issues

b) Application of the ethical principles in a crisis situation
c) Public’s right to know about information
d) Ethical Dilemmas due to legal constraints
e) Consequences of breaches of ethics
f) Issues related to human rights and liberty
g) Issues related to animal welfare
h) Perceptions about ethics in different societies
i) Importance of transparency and early announcement

UNIT 2: Legal Implication Of Risk Communication

a) What are the relevant laws?

b) Enactment of new laws to new situations (emerging
diseases)
c) Understanding of various existing regulations at the national
and international levels, provisions under the various
enactments that empower the officer-in-charge to handle the
crisis, legal instruments which enable enforcement,
International convention: IHR 2005 dealing with Public Health
Emergencies of International Concern
d) Possible breaches of the law
e) Consequences and dilemma of disclosure and non-
disclosure of information
f) Legal implications for false media reporting and
sensationalism

UNIT 3: Politics In Risk Communication

a) Information disclosure and/or non-disclosure with political

consideration
b) How to deal with political interference
c) Advocating (educating) to politicians
d) Seeking political support for community actions and
behaviour change

74
 e) International relations, i.e. information sharing with
neighbours, border committee and international
organizations
f) Engaging the politicians.

5. Instructional Guide

UNITS 1-3: Political, Ethical And Legal Issues In The Pre-

Crisis/Crisis Situation

Learning Objectives:

At end of the session, participants will be able to:

a) Familiarize themselves with political, ethical and legal
considerations and principles for a pre-crisis/crisis
situation.
b) Apply political, ethical and legal considerations and
principles in a crisis situation.

Methodology
a) Brainstorming/Discussion ( 30 minutes)
b) Lecture ( 45 minutes)
c) Case illustration/studies ( 30 minutes)
d) Debate ( 30 minutes, optional)
e) Workshop ( 30 minutes)

Learning Process
Activity 1: Brainstorming/ Discussion
Brain storming/discussion session among participants in
order to understand the principles of ethics and the law in
the pre-crisis/crisis situation in the context of risk
communication in health crisis.

Activity 2: Lecture
Content:
a) Principles of law
b) Application of law and conflicting rules
c) Ethical principles
d) Application of the ethical principles in a crisis
situation
75
 Activity 3: Case Illustration/studies
a) The ‘law’ facilitator is to discuss relevant court
decisions in workshop/discussion.
b) The “ethics” facilitator will discuss consequences of
breaches of ethics based on past crisis and scenarios
c) The “politics” facilitator will discuss pointers on how to
engage with politicians to get their support and also
overcome political interference based on previous
experiences and scenarios too.

Activity 4: Debate (optional)

Participants will present opposing views on issues
and dilemmas that are likely to arise or has arisen in
the past crisis but focused on risk communication.

Activity 5: Workshop
a) Break into groups.
b) Each group list down on how the participants actively
formulate response to the ethical and legal issues
with created scenarios.
c) Present to the group in power point based on their
own scenarios.

Teaching Aids
a) Computer
b) LCD
c) Power point presentation
d) Handouts

Duration
4 hrs

Assessment Method

Pre and post test

Resource

Please refer to Annex 10

76
 LESSON PLAN:

LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES
· Ethics
Participants to · Definition of ethics Lecture and Experts in 30minutes
familiarize · Ethical principles case illustration philosophy and
themselves Brain storming ethics.
with political,
ethical and · Application of the ethical Case studies 30 minutes
legal principles in a crisis and workshop
considerations situation
and principles
for a pre-
crisis/crisis · Public’s right to know Discussion, Experts in 60 minutes
situation about information debate philosophy,
· Ethical Dilemmas due to ethics and law
legal constraints
· Importance of Lecture, case Communicatio
transparency and early studies, n Specialist &
announcement workshop Policy Makers

· Consequences of Case studies, Experts in

breaches of ethics discussion philosophy and
ethics.

· Issues related to human Case studies*

rights Discussion
· Infringement of human
liberty
·

· Issues related to animal Lecture Representative

welfare from
Veterinary/
Animal Health
Department

· Perceptions about ethics Case studies Experts in

in different societies philosophy and
ethics.

77
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

Participants to · Law Lecture Legal Experts 2 hour

apply political, · What are the relevant of respective
ethical and laws? areas.
legal
considerations · Enactment of new laws Discussion, Legal Experts.
and principles to new situations Brain storming
in a crisis (emerging diseases)
situation

· Understanding of various Lecture, Case · Legal

existing regulations at the Studies Experts
national and international · Enforceme
levels, provisions under nt officer/
the various enactments Policy
that empower the officer- makers
in-charge to handle the · Internationa
crisis, legal instruments l Health.
which enable
enforcement,
International convention:
IHR 2005 dealing with
Public Health
Emergencies of
International Concern

· Possible breaches of the Case studies, Enforcement

law workshop, officer
discussion Legal experts

· Consequences and Workshop, Legal and

dilemma of disclosure case studies ethics Experts
and non-disclosure of in respective
information areas.

· Legal implications for Discussion, Legal Experts

false media reporting and debate, case of respective
sensationalism studies areas.

78
 LEARNING
CONTENT METHOD RESOURCE DURATION
OBJECTIVES

· Politics Discussion Communicatio Incorporate

· Information disclosure n Specialist & d in
and/or non-disclosure Policy Makers workshops,
with political discussions
consideration ,
brainstormi
Communicatio ng and
· How to deal with political Discussion, n Specialist & debates in
interference case studies Policy Makers combinatio
n with
Communicatio ethics and
· Advocating (educating) to Lecture, case n Specialist & the law
politicians studies, Policy Makers
workshops

· Seeking political support

for community actions
and behavior change

· Legal
· International relations, Discussion Experts
i.e. information sharing · Enforceme
with neighbours, border nt officer
committee and · Internationa
international l Health.
organizations

Communicatio
· Engaging the politicians Discussion n Specialist &
Policy Makers

79
Annexes

80
 Annex 1
Notes on Advocacy with government stakeholders

1.1 Definition of advocacy

Advocacy is defined as an act or process to demand, defend and

maintaining a cause. It involves trying to get others to support the cause
so it also entails speaking up, drawing attention to the issue and directing
decision makers towards a solution. The ultimate goal of advocacy is
social change form of, among others, behaviour modification, policy or
legislative acts, etc (Regional training course on risk communication in
health emergencies).

Advocacy occurs when a person in authority or an agency in position of

influence represents the interests on behalf of an individual, group or
community in order to change or improve their situation (Tabbot &
Verrinder, 2005).

• An advocate is a person who speaks up for and defends the rights of

him or herself or of another person

• A self-advocate is a person who speaks up for him/herself and

defends his/her own rights.

Why Advocate?

§ Mobilise resources
- Advocacy usually argues for a different distribution of funds to
what is currently in place during crisis

§ Change opinions
- Advocacy may involve persuading those in decision making
positions to see an alternative perspective during a crisis

§ Catalyse change
- Sometimes individuals or agencies may wish to change their
perspective or approach , but need guidance to commence or to
implement new policies that are appropriate to another
worldview

§ Cause action
- Advocates can act as mentors to guide implementation of
different strategies.
81
1.2 Elements of advocacy

The essential elements in advocacy are basically the same elements of

risk communication.

1.3 Types of advocacy

• Ideological advocacy: in this approach, groups fight, sometimes

during protests, to advance their ideas in the decision-making circles.

• Interest-group advocacy: lobbying is the main tool used by interests

groups doing mass advocacy. It is a form of action that does not
always succeed at influencing political decision-makers as it requires
resources and organisation to be effective.

• Mass advocacy: is any type of action taken by large groups

(petitions, demonstrations, etc.).

• Media advocacy: is “the strategic use of the mass media as a

resource to advance a social or public policy initiative” (Jernigan and
Wright, 1996).

• Bureaucratic advocacy: people considered “experts” have more

chance to succeed at presenting their issues to decision-makers.
They use bureaucratic advocacy to influence the agenda, however at
a slower pace.

• Legislative advocacy: legislative advocacy is the “reliance on the

state or federal legislative process” as part of a strategy to create
change (Loue, Lloyd and O’Shea, 2003).

• Budget advocacy: Budget advocacy is another aspect of advocacy

that ensures proactive engagement of Civil Society Organizations
with the government budget to make the government more
accountable to the people and promote transparency. Budget
advocacy also enables citizens and social action groups to compel
the government to be more alert to the needs and aspirations of
people in general and the deprived sections of the community.

• Health advocacy: Health advocacy supports and promotes patient's

health care rights as well as enhance community health and policy
initiatives that focus on the availability, safety and quality of care.

82
1.4 Definition of stakeholders

Stakeholders are people or organizations with a special connection to you

and your involvement in the emergency. Anticipate and assess the
incident from the stakeholders’ perspective (CDC, 2002).

1.5 Identify key stakeholders

In crisis communicating planning, the first step in responding to

stakeholders is to identify them (CDC, 2002).

· Who are the internal and external stakeholders

· What are their needs and preferences

1.6 Networking for risk communication

Focusing on the structure of relationship between people from various

stakeholders including primary, secondary and tertiary audience and
mobilizing the skills and resources that are already available both in
disaster areas and non-disaster areas.

1.7 The role of networking and advocacy in the context of risk

communication

The rule of networking and advocacy in risk communication is presented

in the figure.

83
Notes on Networking and Advocacy in The Context of Risk communication
Act as a TEAM

Key Actors
(who can influence
behavior)

CHANGE

Crisis Situation Risk Communication Network of collaborating

Plan partners

CHANGE

Key Actors
(Directly affected by the
problem)

84
Act as a TEAM
 Annex 2

Notes on Encouraging community participation and forging Partnerships

2.1 Definition of community & community participation

Community defined as a group of individuals who regardless of the diversity of

their backgrounds or society as a group of people with common
characteristics, identity and belonging and culture.

Active community participation is a key to building an empowered community.

Monitoring of target participation is essential for programs wherein
acceptance and participation are voluntary. Any intervention or treatment that
requires the target population to change their habit/behaviour, learn new
skills, procedure, or take instructions may encounter difficulty in attracting
target groups. Monitoring is needed to verify whether a program of such
nature is reaching individuals with specified and appropriate characteristics for
which the program was designed.

The issue encountered in soliciting of target participation is often overlooked

by planners during the development phase of the program. It is assumed that
targets are motivated to participate.

2.2 Community mobilisation for risk communication

· Community and public meetings and briefings

Identify and establish networking between community leaders, local

committee, religious leaders, community representative (e.g women, youth,
and senior citizens), political wings, etc.

A public meeting is a large meeting open to the public, where experts present
information and answer questions, and community members ask questions and offer
comments.

2.3 Arranging a public meeting

§ Create an agenda. Involve citizens in developing the agenda.

§ Hold the meeting in a public, comfortable setting that is easily accessible,

well lit, and has adequate parking and seating, especially for persons with
disabilities.

§ Be sensitive to special needs of community members. Consider

translations for non-English speakers or sign language for hearing-impaired
participants.

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 § Announce the meeting in local media 2 weeks in advance if possible.
Distribute flyers to community members and groups interested in attending.
Clarify that the meeting is not a formal public hearing, but rather, a place to
exchange information and comments.

2.4 Community – level education

Education at the level of the community or population is a more complex

process than education at the individual, group or organisational level-even
more planning and teamwork is needed if it is to be successful. (Tablot &
verrinder, 2005).

The World Health organization (1988 p.175) suggests three points:

a) Get the support of influential people in the community-those who are

called “opinion leaders” or key people”.

b) Be sure that all the people of the community are informed about the
problem and are kept up to date on plans and progress. All available
channels of communication should be used for this purpose.

c) Get the maximum number of people involved so that the community will
really strengthen its capacity to do things for its health. This can be done
through community health committees, advisory or planning boards, etc

2.5 Peer self-help groups

Peer self-help groups may work for social change or for personal change in
their members, or a combination of both. Their roles include “mutual support”,
education, advocacy, lobbying, research and information and service
provision to both their members and other consumers of the health system
(Markos 1991, p4).

Mutual support is given to group members with similar problems of a personal

nature that affect them directly. The members share experiences and identify
common needs and areas for social action for themselves or on behalf of
others in similar situations (Tabbot & Verrinder, 2005).

2.6 Generating support from stakeholders and others.

2.7 Community social responsibility programmes (CSR).

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 Annex 3
Notes on Reaching Vulnerable Group

3.1 Identification of vulnerable groups and their information needs

Vulnerable groups are population with special needs, including individuals

who have disabilities, medical disorders, specific dependencies, are
institutionalized, senior citizens, are from diverse cultures and have limited
language proficiency.

Vulnerable group are often not able to access and use the standard resources
in crisis preparedness, response and recovery. e.g: migrant workers and
indigenous groups, children, pregnant mothers, senior citizens, children etc)

Information needs

§ It is critical that public health emergency risk communication is non-

discriminatory (2) and that all individuals have equal and ample access
to information about the nature of the emergency/crisis, comprehensive
emergency/crisis preparedness plans, response and recovery
guidelines will include provisions for how best to inform and educate
vulnerable group.

3.2 Identification of correct messages for different target audience and

dissemination

Effective risk communication can promote trust, awareness and motivation to

act among the vulnerable group.

The message dissemination

§ Two way communication and interactive

§ Messages should be locally and personally relevant to the vulnerable
group
§ Avoid technical jargons
§ Precise and easy understanding to specific groups
§ Appropriate Language for each specific groups

Medium of dissemination

§ Appropriate medium and format for dissemination of information e.g

senior citizens may have difficulties with mobility, could have
hearing limitations and visual impairments) in multiple formats (e.g
television, print (verbal, pictorial), audio, internet, interpersonal)
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 § Offer frequent communication in multiple modes :
o Messages shall be provide early and often
o Messages shall be accessible and credible

Enabling mechanisms for preparedness response and recovery

· Prepare communication plans all phases of crisis. Pre-crisis, Initial,

Maintenance, Resolution and evaluation for vulnerable group or
incorporate with national/state communication plan for crisis.

· This is where all of the planning and most of work should be done to
enabling vulnerable group during health crisis. Reasonable questions
can be anticipated pertaining issues on vulnerable group and
preliminary answers sought. Spokespersons and resources,
mechanisms can be identified. Training and refinements of plans and
messages can be made. Vulnerable group alliances and partnerships
can be fostered to ensure that experts are disseminating messages
with one voice.

3.3 Identification and networking with local NGOs and leaders of

migrants/workers and others.

· Identify the NGOs (local organization) and the organization objectives.

Prepare a list of local NGO’s and organizations representing vulnerable

group and their objectives. Identify their expertise, manpower, resources to
act during health crisis.

o Study the background of their manpower to solicit their

expertise in communication and information dissemination.
o Identify the employers of workers in risk
o Identify agency dealing migrant workers

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 Annex 4

Notes on Collaborate with international organisations and neighbouring

countries, including cross border issues

4.1 Orientation on existing protocol and mechanisms for sharing

information on public health emergencies.

The Protocol provides the basic guidelines to the ASEAN Countries towards
institutionalizing a fully functional information sharing mechanism for issues
related to prevention and control of emerging infectious diseases (EID).

§ ASEAN countries shall establish a common protocol for sharing

information on public health emergencies with neighbouring countries, The
protocol shall outline neighbouring technical support, provision of expertise
, laboratory coordination and supplies and logistics

§ Develop a checklist for communication process with international

organisations and neighbouring countries

§ Identify the mechanisms for sharing information between neighbouring

countries : e.g country’s crisis web site, cross boarder meetings, reports
etc

The Communication and Information Sharing Protocol addresses five

main questions:

§ What kind of information to share (content areas)

§ How should the information be shared (mechanism)

§ Who/what institution should ensure that information sharing happens

(responsibility)

§ How often should information sharing occurs (regularity)

§ How should we disseminate and monitor compliance to the protocol

(mainstreaming)

4.2 Maximising web-based information dissemination to reach others.

The web-based information has been demonstrated to be a successful

communication tools in sharing information between neighbouring countries.
Internet-based messaging is especially effective at overcoming
communication barriers commonly encounters within neighbouring countries.
Each ASEAN countries should;

§ Establish web site information

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 § Update and enhance the current web site
§ The design shall be made user-friendly, and easily accessible.

4.3 Developing and sharing messages

The following areas need to be considered when developing and sharing

messages:

§ Cultural and religious considerations.

§ Appropriate language with translation.
§ Customs regulations, international health regulation (quarantine),
livestock regulation, health policies, international security act, tourism
regulations, etc.

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 Annex 5

Notes on Stakeholders To Consider

· Employees

· Families

· Retirees

· Board members

· External advisors

· Your organizations’ clients/consumers

· Local residents

· Business and community leaders

· Elected officials

· Consumer action groups

· Union or labor organizations

· Competitors
· Legal advocates
· Media
· Public
· Others

Consider plans to provide advance notice to important audiences. Prioritize

stakeholders according to the type of emergency.

5.1 Partnership Development

A partner may be defined as anyone with a role in aiding in the response.
Partner relationships should be developed in advance of the crisis. One
of the best methods of building partnerships is to start building relationships
informally through community and social networks. Strong, collegial
relationships can be very helpful when emergency coordination is
required. Partnerships should be based on the partners’ common purpose of
serving the community.

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 Each potential partner should play a specific role during a crisis, and this role
should be determined and agreed upon before a crisis situation occurs (or at
the very least, in the first few hours of a crisis event). It is helpful to assess
what each partner brings to the table, including strengths, weaknesses, and
unique abilities.

The partner organization will most likely choose its representative. That
representative should be someone who will be able to execute the partner’s
role and has the organization’s authority to make decisions and speak on
its behalf. Usually this person is not the head of the organization, but
typically will keep the leader of the organization informed.

Tips for developing partnerships:

§ Design a plan for building relationships before the crisis.

§ Create a partner contact sheet with every available phone number and
e-mail address (e.g., work, home, cell, etc.), Obtain permission to contact
the people by any means necessary in an emergency.

§ Draft a plan for partner communication during a crisis (e.g., e-mail alerts,
twice-daily faxes, conference calls) to which everyone agrees.

Reality Check: Despite every good intention to allow partners a preview of a

press statement or release, it may be impossible to do so. With some time
sensitive issues, you may have to consider the increased risk of leaks and
choose not to share. If possible, consider telling partners to expect a release
on a subject or ensure that they get the release and any supporting
documents at the same time as the media.

5.2 Community relations

Research indicates that community leaders and institutions (e.g., schools,

employers, community organizations, churches/religious institutions, and
major employers) can be valuable partners in gaining support for public health
actions, distributing information, or countering rumors surrounding an
emergency event. These partners may be familiar, trusted, and influential with
your target audience, and may be more likely than media alone to motivate
the public to take recommended actions. Also, the partners can reach groups
of people in a familiar setting.

In pre-event planning, make an effort to reach out to these groups. Consider

memoranda of understanding with partners to engage them as information
disseminators during a public health emergency. Consider supplying them
with background information before or soon after an emergency occurs.
Develop fast and reliable channels of communication directly to these
community leaders so that they will have the facts when their constituencies
begin to ask questions. Invite them to tour emergency facilities. Brief them on
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 such issues as the national pharmaceutical stockpile or public health
emergency laws.

5.3 Strategies to navigate a process for consensus building

Don’t leave it to the media to negotiate public controversies during an

emergency response effort. Instead, consider engaging a neutral party to
speak for the diverse group of stakeholders to help resolve differences. The
neutral party can speak to the media on behalf of all involved or facilitate a
face-to-face meeting. The neutral party can express both consistent and
inconsistent points of view from the entire group in an effort to find consensus.

5.4 Convening a citizens’ forum

A professional facilitator, comfortable with the culture of the community, who

is perceived by all sides as neutral, should convene the public forum. Conduct
a needs assessment to determine the stakeholders in this issue.
Representatives from all elements of the community must be considered, not
just those from a vocal advocacy group.

5.5 Empower group decision making with the following steps:

· Identify the options and discuss the pros and cons of each alternative.

· Analyze the costs and benefits, weaknesses and strengths of each.

· Present all known scientific or technical information about the alternatives.

· Choose the “must” versus “want” criteria for the decision.

· Be able to express why one alternative was chosen over the others (e.g.,
the highest number of people will be helped with a minimum disruption to
self-reliance and community sovereignty).

· Reach a clear, justifiable decision.

5.6 Quality listening

Asking questions shows that you care. The first step in solving problems is to
know what’s really going on. Questions can do that. Good listeners are
perceived as more intelligent. Listening actively reduces mistakes—like
believing you understand what is being asked of you, only to discover later
that you are mistaken.

· Listen for intent (feeling).

· Listen for content (facts).

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 · Listen for who is speaking.

o Is this person qualified to give expert opinions on this subject?

o Does this person have underlying motives?

o Does this person have prejudices or beliefs that will compromise

objectivity?

5.7 Dealing with an angry public

When risks are uncertain, because science has not reached an answer or a
consensus answer, controversies will arise. Add the need to make decisions
under the enormous time pressure of a crisis, and the uncertainty may seem
unbearable to both response officials and the public. When science cannot
lead to a clear path, decision-makers must make choices about what is and is
not acceptable. In non-pressure environments, the public may turn to the
courts to settle differences about the amount of acceptable or perceived risk.

In a crisis, as in the emergency room, where imperfect decisions must be

made in minutes, not months, the fallout can be incredibly harsh, especially
after the crisis is resolved and the decisions are reviewed with the omniscient
power of hindsight. With the strongly held sense of self-determination among
Americans, the struggle of imposing some risk on individuals or suspending
some civil liberties to protect communities may be great. Great, unless, even
in the crisis situation, response officials make an effort to empower the public.

At the community level, that may mean a face-to-face meeting. Involving

stakeholders and building consensus is the most powerful way to advance
compliance with public safety requirements before and during an emergency.
Anything less will invite civil unrest and greater mistrust of the institutions or
government responding to the crisis. These public forums sooth tempers and
help the community to work toward a mutually agreeable solution to the
common problem.

Communication experts and psychologists agree that anger is a defensive

response to pain or the threat of pain. Experts identify three basic
circumstances where anger is likely to arise:

· When people have been hurt

· When they feel threatened by risks not of their own making

· When they believe that their fundamental beliefs are being challenged.

The intensity of that anger can be confounded by related factors. For

example, when people feel weak in the face of others who are more powerful,
their anger is increased. When people feel that they have not been treated
fairly or with respect, their anger multiplies. If they have been manipulated,
trivialized, ignored—or worse still, lied to—anger and a sense of unfairness
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will build. However, don’t forget that displays of anger may be a form of
manipulation by another party, especially in public, to bully others into
accepting their demands. Of course, more than one anger-causing element
can be involved in a single situation.

Don’t make the error of defining anger as either rational or irrational. That’s
judgmental, counterproductive, and truly in the eye of the beholder. It’s
dangerous to label others as irrational because you may then feel justified in
dismissing them, which will only heighten their sense of injustice.

Don’t lecture! Let the audience discover the answer.

No one willingly accepts a lecture, and seldom have lectures changed

anyone’s mind or behavior. Lecturing is easy—the lecturer gets to vent his or
her emotions and doesn’t have to take others’ points of view into account.
That which makes it easy also makes it ineffective. A lecture does not engage
the audience. Telling is easy, asking is tougher. Asking questions is a
deliberate action. It forces the process to slow down and forces everyone to
stop and think before replying.

Instead of attempting to persuade an individual or community group to take an

action, allow them to persuade themselves through a self-discovery process.
The key is to not give the solution, but help your audience to discover its own
solution.

How do you help an audience discover its own answers? By asking the right
questions using feedback as your tool, you can ask the audience questions
that will create awareness about the situation in such a way as to empower
them to make a difficult choice. As many therapists will attest, a person who
comes up with his own answer and says something in his own voice will take
ownership of that idea. It’s better for you to ask a leading question than to
make an interpretation. The right questions can help an audience to make the
necessary connections. This strengthens the audience’s tendency to claim
ownership for the insight.

For example, was a severe communicable disease outbreak to occur, a

challenge for officials in emergency response and public health is the
possibility that civil rights may need to be temporarily suspended to control the
spread of disease. A extreme case would be the need to quarantine
individuals or communities. It makes sense that a population that understands
the need to quarantine will be more likely to uphold the curfews or quarantine
requirements.

Questions to help people persuade themselves:

■ Start with broad, open-ended questions.

Example: What challenges have (you or your community) faced that required
consensus building to solve the problem? How did it go? What did

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 you learn from those experiences? Were there difficult choices to
make?

■ Then, ask questions to discover the explicit wants, needs, and desires of
your audience.

Example: What is most important to (you or your community) when faced with
a problem to solve? Consensus building? Putting the greater good
for the greater number first? Avoiding conflict?

That the solution is fair and equitably distributed? Ensuring that everyone has
a voice and is heard? Those reasonable alternatives are fully explored?

■ Follow with questions that are more specific to the situation now being
faced by the audience.

Example: What are the ramifications to (you, your family, your community, the
nation) when faced with this current problem? What consequences
are you hoping to avoid? What do you see as the worst outcome for
(you or your community)? What courses of action do you believe
could mitigate this outcome?

■ Then, ask questions that encourage audience members to state the benefits
they would like to see result from a course of action.

Example: What benefits would (you or your community) expect if this disease
did not spread further? Since you’ve brought up quarantine, what
benefits would (you or your community) expect if you accepted
quarantine as a course of action to reduce spread of disease?

■ Once the audience sees and expresses the benefits, it will be much easier
to demonstrate how your strategy can solve the problem.

Example: “From what I understand, you are looking for a way to protect
(yourself, family, community) from more illness or death? If I can go
ahead and explain how quarantine will meet those needs, are you
open to implementing it? If you think quarantine would work in this
effort, how do you see the quarantine being explained to the entire
community and implemented?”

Allowing people to persuade themselves is not an easy process. Done poorly, it

can seem condescending or manipulative. It takes practice and a great deal of
empathy. However, it’s worth the effort, because it is truly the most effective way
to gain acceptance in thought and behavior.

How to de-escalate the conflict?

Start by trying to agree on issues that may not be core to the conflict—not the hot
button issue that anyone is willing to concede. Agree whenever you can. It is hard

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to attack someone who agrees with you. You don’t have to concede a thing. Find
the elements that bring some agreement among both groups. Set up guidelines
for interaction and make an effort to “humanize” each side for the other.

· At all times, seek common principles on which to base a common

dialogue.

· Remain open to reason and allow yourself to consider that you might be
wrong.

· Strive for fairness in the process, especially where a real or perceived

inequity has occurred.

· Work to get input from all stakeholders.

· Leave the community or population better off than how you found it.

· Decision makers in the community should have access to open and

complete scientific information.

Try to get as many “yeses” as you can. If someone says, “Your proposal is totally
unrealistic,” try this response: “Are you saying that you don’t see how my
proposal can (respect citizens’ rights and stop the spread of disease)?” When
person says “yes,” this transforms the relationship. Each question you offer that
allows a “yes” answer from the other side further reduces the tension.
Don’t say “but”—say “yes, and.”

Typically, people express their differences by prefacing their responses with,

“but.” The other group will be more receptive if you first acknowledge their views
with a “yes” and then preface your view with an “and.” Example: “Yes, we want to
protect people’s rights and we want to keep them alive to enjoy those rights.”

5.8 Notes on Selecting And Using Communication Channels During A

Public Health Emergency

Here are two major communication issues beyond working with the media that
must be addressed in preparation for crises. First, at the community, state,
and national level, the public expects access to its government during an
emergency. One of the most effective ways to give them this access is
through e-mail and toll-free information telephone lines. Second, as a public
health crisis evolves beyond 24 to 48 hours, the demand for information
outside traditional media channels—radio, TV, newspaper, and news Web
sites—increases. The public information official must choose the right method
of delivery to address various audiences. This module addresses both of
these important issues.

Public telephone and e-mail services during an emergency Consider the

following when planning for toll-free number services (or building capacity
inhouse).
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 · Decide between rapid expansion of an existing phone number or a
“new” toll-free number generated specifically for the emergency.

· The service must be expandable in terms of number of calls managed

per hour or day and the hours of operation.

· The toll-free number must be answered by trained people who can

reassure callers, provide requested information, and/or refer callers as
needed.

· Precleared materials on multiple subjects should be easily accessible

during an emergency. The following are concerns about predeveloped
materials:

– Materials must be specific to the emergency and the community

impact.

– They must be easy to read and understand.

– They must be available in multiple languages based on

community needs.

– They must be field tested for cultural sensitivity and preferences.

· Standards of performance and evaluation should be considered:

customer satisfaction, response capacity, accuracy, etc.

· Call managers must be able to quickly integrate new information into

their emergency responses.

These issues must be considered for your public e-mail response service.
State up front how long it will be before the public gets a response to an e-
mail (2 hours, 24 hours, same week) and provide a way to reach your
organization if the need is more urgent. Be sure to advise people to seek out
their health care providers or 911 for a personal medical emergency.

The CDC Public Response Service (PRS) began in October 2001, and is
available free-of-charge to local and state health departments. PRS provides
a rapid, turnkey toll-free hotline and interactive e-mail service that will provide
both local information specific to the emergency (e.g., where to get shots in
your community) and CDC-approved background health and medical
information. This service is available to help a community or state manage its
public information requirements during a public health emergency.

The service works with the general public, public health professionals, and
emergency response teams. Service is available for Spanish and English
speakers and the deaf and hearing impaired.

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Achieving effective communication with your audiences depends on selecting
methods of communication that will reach them. This is especially important in
health risk communication, where the audience participants can become
disenfranchised quickly if they do not feel they are getting information.

Message delivery channels include:

· Face-to-face (e.g., health care professional to patient, or your

organization’s staff member to state partner organization or individuals
in the community)

· Group delivery (e.g., small group or public meetings)

· Organizational (e.g., constituents of influential community

organizations)

· Mass media (e.g., radio, television, newspaper, or direct mail)

· Community (e.g., employers, schools, malls, health groups, or local

government agencies)

· Combination of any or all of these (i.e., most likely to work best).

Questions to ask:

· Which channels are most appropriate for the health risk problem/issue
and messages?

· Which channels will the target audience find credible and accessible?

· Which channels fit the program purpose (e.g., inform, influence, allay
fears, influence attitudes, or change behavior)?

· Which channels and how many channels are feasible, considering your
schedule and budget?

Identifying Specific Communication Tools

The tools you will use depend on your audience, how participants prefer to
receive information, and the information you need to communicate. Possible
tools include:

Briefings

Briefing is a session with key state and local officials, media representatives,
and community leaders. Agency staff conduct sessions in person. Briefings
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help to notify key state and local officials, media representatives, and
community leaders of developments at the site, such as results of studies or
actions that should be taken to protect health. A briefing can be used to
introduce your organization and explain its role and work process. Briefings
are not usually open to the general public.

Conducting a briefing:

· Schedule the briefing in a small public room, such as a hotel meeting

room or a conference room.

· Hold the briefing in a neutral location, particularly when dealing with an

antagonistic situation.

· Prepare a factsheet or question and answer sheet.

· Present a short, official statement about the agency’s findings, health

concerns, or recent developments.

· Use simple language.

· Avoid jargon, acronyms, and overly technical terms.

· Answer questions about the statement.

· Work with your organization to coordinate briefings.

Benefits of a briefing :

· Allows state and local officials, the media, and citizens to question your
organization directly about any activity before the public release of
information

· Prepares officials and citizen leaders to answer questions from their

constituents when the information becomes public

· Allows for the exchange of information and concerns.

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Limitations of a briefing:

· Although briefings can be effective, they could become the only means of
communicating with site communities. Briefings should always be
complemented by activities to inform the general public, such as small group or
public meetings.

· Negative feelings or bad publicity could result if some people believe that they
should be invited to the briefing and are not. Be sure not to exclude such
persons or convey favoritism toward certain parties.

Community mailings

A community mailing sends information to key contacts and concerned or involved

members of the community. It disseminates information quickly and easily in writing,
and it is particularly useful when you have updates for the community.

If the updates are straightforward, non controversial, and easy to understand,

the mailing can stand on its own. However, if the updates are more complicated and
require discussion or further explanation, the mailing should augment a public
meeting or small group meetings. The community mailing can announce upcoming
meetings and provide advance information or serve as a follow up for people who did
not attend previous meetings.

Developing a community mailing

Compile a mailing list and include:

· State and local officials (check with city clerk for assistance)

· Community leaders (check with local chamber of commerce)

· Local residents of the site area (check with city clerk for assistance)

· Community members who have signed up to receive information.

Creating mailing materials

Include:

· A cover letter that introduces you, briefly explains the purpose of the mailing,
and provides contact information for comments or questions

· A factsheet, newsletter, report, or other documents

· First-class postage to deliver the mailing quickly.

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5.9 Notes on Evaluating Your Plan after Crisis

o Evaluate how useful the plan was.

o Identify any problems revealed during the incident

o Determine if the plan’s procedures were followed and if they were

effective. If not, examine ways to improve them.

o Determine how quickly the Crisis Action Team was able to organize and
begin to function.

o Determine the adequacy of the facilities and resources provided to the

Crisis Action Team. Consider how they can be improved.

o Determine if information was shared effectively and fully within the Crisis
Action Team and identify any reasons for a negative answer.

o Determine if the team members and support personnel were familiar with
the organisation’s operating procedures and chain of command.

o Determine if your organization’s personnel were familiar with the

procedures of other involved organizations.

o Examine the effectiveness of your organisation’s liaison(s) with external

actors such as government officials, families and the media.

o Determine if routine matters were referred to appropriate personnel or

whether the Crisis Action Team allowed itself to be distracted by them.

o Review your reports and statements to determine if information was

reported accurately, on a timely basis, and in the proper fashion.
Determine if appropriate analyses were prepared as required. Check that
the proper people and organizations were kept informed.

o Determine whether your supplies were adequate.

o Review the effectiveness of your public affairs management.

o Determine the effectiveness of your rumours control mechanism.

o Examine the composition of your crisis action team to determine if

personality factors impeded effective crisis management.

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o Review the involvement of your Crisis Action Team in planning and
preparation of your emergency procedures to determine its adequacy and
effectiveness.

o Review the composition of your Crisis Action Team to determine its

adequacy.

o Review the training of your emergency personnel to determine its

effectiveness, completeness and adequacy.

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 Annex 6
Notes on Exercises

Exercise 1:

Audience Analysis

o Audience are not always the same

o Audience can be segmented
o Each segment possesses certain characteristics and should be considered when
preparing messages and material.

Instruction to participants:

1. Divide into groups at least 5 members.

2. Each Group will be given one set of communication messages.
3. Read the messages carefully
4. Discuss with the group members the intended audience for each message and
your reason for the choice.
5. To facilitate sharing, prepare your presentation using the table below:

Message Target Audience Reason

Message 1

Message 2

Summarizing key points:

1. Risk communication messages should fit needs of the intended audience.

2. Therefore it is important that the intended audiences are segmented an
analyzed.

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Exercise 2

Audience Analysis and Segmentation

Instruction to the participants:

1. Using the data gathered during situational analysis, conduct audience

segmentation.
2. Identify the possible target audience.
3. Rank the target audience according to priority and classify them as primary,
secondary, or tertiary.
4. State reasons for identifying targeted audiences.
5. Write your analysis on the flip chart or power point presentation
6. Use the following template for presentation of outputs:

Time allocated: 30 minutes

Objective: Participants will be able to do audience analysis audience segmentation.

Name of disaster:

Place:

Audience segmentation

Audience Prioritization Classification Reason for choice of

this audience group

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 Annex 7

Notes on Exercises

Exercise 3

Message development

The crucial concern is how to develop messages that can mobilize target groups into
specific action. In this unit participants will be introduced to the importance of
audience segmentation and the processes or steps involved in developing
messages.

Instruction to the participants:

1. Divide into groups at least 5 members.

2. Each Group will be given one set of white board.
3. Discuss with the group members the factors determining audience acceptability
of health messages and your reason for the choice.
4. Write your analysis on the flip chart or power point presentation
5. To facilitate sharing, prepare your presentation using the table below:

Time allocated: 30 minutes

Factors audience acceptability Target Audience Reason

Factor 1
----------------------------------------------------------------------------------------------------------------
Factor 2

Summarizing key points:

1. Successful health risk communication involves communicating the right message

to the right audience at the right time with the right tone using the right channel
for the right purpose.
2. Developing Risk communication messages should fit needs of the intended
audience.

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Exercise 4

Developing messages.

To develop key messages:

o Brainstorm – Think freely and jot down all pieces of information you wish to
communicate.
o Select key messages – Identify the most important ideas. Repeat the process
until you list it down to three items.
o Identifying supporting data – Review your brainstorming ideas and
background materials for information that provides support to you key
messages.

Instruction to the participants:

1. Divide into groups at least 5 members.

2. Each Group will be given one set of communication messages.
3. Discuss with the group members the main concern of the target group and
develop key messages and supporting messages.
4. Write your analysis on the flip chart or power point presentation
5. To facilitate sharing, prepare your presentation using the table below:

Time allocated: 1 hour

Target Audience Message Main Concern Supporting

objective (Key Message) messages
1.
Target group 1 Objective 1 Key message 1 2.
Objective 2 3.
1.
Target group 2 Objective 1 Key message 2 2.
Objective 2 3.

Summarizing key points:

1. Understand the specific communication objective, and tailor your messages to

the specific audience.
2. The key messages are the points that you want your audience to have in mind.
3. A key message may consist of a whole sentence or just 2 or 3 keywords, which
were later being develop into full messages.
4. The messages should be relevant, clear, simple, concise, consistent, timely,
accurate, acceptable and complete to your audience.
5. Pre testing provides useful information about accuracy, acceptability, relevancy,
credibility and completeness of the messages.

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 Annex 8
Notes on exercise

Exercise 5

Skills for Media Spokesperson.

The media are the primary means for communicating with the public. Forming
positive relationships with journalist and understanding their needs is crucial to the
communications success.

Instruction to the participants:

1. Divide into groups at least 5 members.

2. Each Group will be given one set of communication messages.
3. Discuss with the group members about:
a. ”What makes a good spokesperson?
b. Role as a spokes person.
4. Write your analysis on the flip chart or power point presentation
5. To facilitate sharing, prepare your presentation using the table below:

Time allocated: 1 hour

Table 1: What makes a good spokesperson?

Characteristics of a good spokesperson Reasons

Table2: Role as a spokes person

Roles and responsibility as a spokesperson Reasons

Summarizing key points:

Positive relationships with journalist and understanding their needs are crucial to the
communications success.

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 Annex 9
Notes on exercises

Exercise 6

Working with the media.

Media practitioners need information fast. Public also rely on them for information,
which can sometime console or cause panic. They need to be provided timely and
correct information. In this session participants will be introduced to the media
process and get some tips on how to manage and work with media practitioners.

Instruction to the participants:

1. Divide into groups at least 5 members.

2. Each Group will be given one set of scenario.
3. Discuss with the group members
a. The role of media
b. How the media works.
4. Write your analysis on the flip chart or power point presentation
5. To facilitate sharing, prepare your presentation using the table below:

Time allocated: 1 hour

Discuss what are the opportunities of media in health crisis?

Opportunities of media in health crisis Reasons

Summarizing key points:

Media like most on stories that are;

o Front page news stories

o Human interest stories
o People’s perspectives
o Yes or no/safe or unsafe answers

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Exercise 7

Communicating with the public

When communicating to the general public during an outbreak or any crisis situation,
people have different concern and needs. They were concern about their family’s
safety or just want to know what is going on. This session will look into these
differences and how they can be addressed when preparing risk communication
messages.

Instructions to the participants

1. Divide into groups at least 5 members

2. Each group will be given one case study
3. Based on the scenario prepare talking point for the media
4. Choose one of the participants within the group member.
5. Do the practical session facing the media.

Time allocated: 1 hour

Work in groups of about five.

Goal:

Using the risk communication strategies discussed in this workshop, write some
talking points for the officials who are going to announce the disaster to the media.

Scenario: Adapted from Crisis and Emergency Risk communication, CDC 2002
Case Study. H5N1 Virus Outbreak Investigation, Hong Kong, 1997–1998

In May 1997, a 3-year-old Hong Kong boy became ill with fever, dry cough, and a
sore throat. He was hospitalized, continued a downward course, and died. Only
influenza A virus was cultured from this child.

Scientists identified the virus as influenza A/(H5N1). This virus had never before
been cultured from a human specimen. The subsequent investigation ruled out
laboratory contamination, and concluded that the child’s illness was consistent with
influenza complicated by viral pneumonia. Investigators believed, based on
laboratory evidence, that the virus was transmitted directly from an avian source to
the child, possibly in the outdoor garden area of his school. This was the first
reported case of an avian virus being transmitted directly to a human. During the
August–September investigation, no other cases were found.

In late November, the Hong Kong Department of Health contacted CDC’s Influenza
Branch to report that a second H5N1 infection had been detected. CDC sent a team
of medical epidemiologists and field investigators.

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CDC and health organizations around the world engage in ongoing, active
surveillance to attempt to quickly detect the possibility of a pandemic influenza virus
spreading among humans. Influenza viruses mutate easily. Most often the mutation
is slight and occurs over time, a process called “drift.” Occasionally, an influenza
virus will suddenly mutate significantly; this is called “shift.” A virus that shifts is a
potential pandemic strain. To qualify as a potential pandemic strain, the virus must
meet 3 criteria: (1) it must be genetically novel, (2) it must be virulent, and (3) it must
be efficiently transmitted between humans.

In late December, cases were accumulating and young healthy adults were dying of
this viral infection. The H5N1 virus in this outbreak met 2 of the 3 criteria: it was
novel and it was virulent. CDC, Hong Kong DOH and a number of collaborators
began an intense investigation to determine whether this was the start of an
influenza pandemic. Indeed, public health officials know, based on trend analysis,
that a pandemic is overdue. Investigators concentrated on determining the virus’
ability to transmit from person to person. An increase in person-to-person virus
transmission would have suggested that the virus was adapting to humans, with the
potential for epidemic spread.

In mid-December, a veterinarian virologist collaborating on the investigation held a

telephone worldwide news conference and announced this was the “pandemic”
strain that health officials were expecting. The immediate media uproar severely
disturbed the investigators’ attempts to collect information in Hong Kong. The Hong
Kong DOH and the CDC field team requested that a CDC public information officer
(PIO) join the team in Hong Kong, the first time CDC had assigned a PIO on an
overseas field investigation. During the field assignment, the CDC PIO represented
CDC, DHHS and WHO on public information issues.

Task: You are communication officers. Your technical experts tell you about the
outbreak/crisis.

Prepare talking points for the media. Think about what you want the public to know,
and also list some of the questions you think they will ask. Consult other
departments in deciding what to say? Sources of the outbreak, steps taken,
prevention, others? Use risk communication strategies from this workshop.

Summarizing key points:

Preparing messages must address the needs and concern of the public.

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Exercise 8

Preparing media materials

As a risk communicator, you will be tasked to write standard press releases. The
media will be looking for feature releases with human interest angle. These releases
are about individuals or unit involved in the response or outcomes and their
successes.

Instruction to the participants

1. Divide into groups at least 5 members

2. Based on the scenario at exercise 7, prepare the press release.
3. Write your analysis on the flip chart or power point presentation
4. To facilitate sharing, prepare your presentation using the table 1 and 2 below.

Time allocated: 1 hour

Table 1: Situational analysis of an outbreak

Action Points Details News Release

How bad is it? How sure are you?

Coping with the emotional side of the crisis.
Involving the public
Errors, misinterpretations and half-truths

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Table 2: Format for preparing press release

Media Release Template

FOR IMMEDIATE RELEASE

Name of contact (name):

Phone number:

Date of release:

Headline - Insert your primary message to the public

Dateline (your location) - Brief description of current situation. (What is known as well
as unknown)
Insert quote from an official spokesperson demonstrating concern for victims.
Insert actions being taken by your agency and its partners to control outbreak and to
find answers to unresolved question.
List information on ways citizens can help themselves, their families and their
communities.
Insert quote from an official spokesperson (with credentials).

Insert time when information on outbreak will be updated by your agency.

Insert phone number, agency web site or other credible resource where the public
and media can go for more information.

Summarizing key points:

Consider who, what, where, when, why, how when preparing talking point for the
press release.

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 Annex 10

Notes on Brainstorming/ Discussion

Brainstorming/Discussion activity can be useful approach for generating participants

existing understanding on advocacy, its level and process of advocacy. The
facilitator shall pair or groups participants to make numbers of suggestions with no
restrictions on the extent to their understanding.

Participants in the exercise use the Post-It Notes to write down additional ideas.
Participants stick the notes on the wall - randomly at first - and then moved and
grouped together as the exercise plays out.

The participants shall encountered ideas of (limit the probing according to the needs
and preferences:

a) What do you understand about advocacy

b) What are the elements in advocacy
c) Explain the level and process of advocacy

In order to ensure a successful exercise it is vital that participants feel comfortable

about sharing ideas. This technique is ideal for participants who have not
encountered scenario planning before as it offers the opportunity to become actively
involved very quickly before the lecture.

Notes on Debate

Debates allow participants to take part in an interactive way and assimilate the
knowledge that they have gained during the course. It allows the facilitator to gauge
the understanding the participants have of the topic and allows them to identify gaps
in their knowledge.

Participants can be divided into two groups of three each. Other participants who are
not in the selected group can contribute ideas from the floor at the end of each
participant’s presentation or at the end of each group’s presentation.

It is suggested that each participant speak for five minutes with another five minutes
for the group leader to rebut and summarise the points raised.

The debate can be concluded with points of observation and summary from the
facilitator.

Suggested topics of debate for the ethics component:

· Ethics is incompatible with risk management

· Ethics cannot be considered at a time of disease outbreak.

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 · All the principles of ethics must have an equal weight-age in risk
communication
· The principles of ethics were not used during the disease outbreaks that
happened in the country.

Facilitators are free to choose any other suitable topic for the debate that would allow
the participants to utilize the principles of ethics and the law.

Notes on Role Play

Participant to involve in Role Play will be based on the given scenario or previous
experience. Each participant will be given certain roles related relevant stakeholder.
The participants execute their functions in risk communication according to the given
scenario

Role Play activity can be useful approach for generating participants to understand
on the management of information pertaining to risk communication and how to
apply it in pre crisis or crisis situation. The facilitator shall break the participants into
groups with specific position or task and need to act and respond according to their
position or task.

The participants shall encountered and internalized the situation and have a better
understanding of the needs of different stakeholders

In order to ensure a successful role play it is vital that participants feel comfortable
about sharing ideas and try to simulate as the given position or task for each
particular stakeholder.

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References

116
References

Module 1

1. American Health Organization. Communicating the Risk. Regional Office of

the WHO, Washington, Perspectives in Health, Volume 10 No. 2: 2005
(Reprint 2007).

2. Chartier J, Gabler S 2001, Risk communication and Government; Theory

and Application for the Canadian Food Inspection Agency,
http//www.inspection.gc.ca/English/corpaffr/publications/riscomm/riscomme.s
htmal retrieved on 27/8/2008.

3. Covello VT, Sandman P, Slovic P (1988). Seven cardinal rules of risk

communication. Washington, D.C.:U.S. Environmental Protection Agency.

4. Covello VT, McCallum DB, Pavlova MT. Effective Risk communication.

Lenum Press, New York, 1989.

5. Case Definition for Infectious Diseases in Malaysia 2nd Edition Jan 2006.

6. Department of Health, November 1997. Communicating about Risks to

Public Health – Pointers to Good Practice. Department of Health, London.

7. Directive 20, National Security Council, Prime Minister’s Department.

8. Ed-Pres Communications Bhd. (2000). Media Relations Workshop for

Ministry of Health. Institut Kesihatan Umum, Kementerian Kesihatan,
Malaysia.

9. Infectious Diseases Outbreak Rapid Response Manual, 1st Edition June 2003

10. Institute of Public Health (2002). Risk communication Training Module for
Facilitators. Ministry of Health, Malaysia.

11. Lanard J. Strengthening Risk communication: An introduction to the

principles and skills. Presentation at ASEAN Plus Three Risk communication
Workshop, 24-26 March 2008, Kuala Lumpur, Malaysia.

12. Lee TR 1986, Effective communication of information about chemical

hazards. The Science of the Environment 51, 149-183.

13. Lum MR, Tinker TL (1994). A Primer on Health Risk communication:

Principles and Practices. Atlanta, Georgia, U./S. Department of Health and
Human Services.
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 14. Mitroff I, Alpaslan M. Thinking the unthinkable. In: Boss, June 2003.

15. National Research Council (1989). Improving risk communication.

Washington, D.C., National Academy Press.

16. Renn O.”The Role of Risk communication and Public Dialogues for
Improving Risk Management, Risk, Decision and Policy, 1998, vol.3, No.1,
pp.5-30.

17. Sandman PM. Responding to Community Outrage. American Industrial

Hygiene Association, Fairfax, 1996.

18. Standard Operating Procedure for Potential Infectious Disease, 1st Edition
2004

19. The Royal Society (1993). “Risk: Analysis, Perception and Management.
London, Royal Society.

20. University of Kentucky, College of Agriculture. AGRIPEDIA,

http://frost.cas.uky.edu/agripedia/.

21. Vohra D (1996). Communication in crisis situations. In: Readings and Notes
in Crisis management. Institut Tadbiran Awam Negara (INTAN)
(Unpublished).

22. WHO, Europe. Sixth Futures Forum, Reykjavik, Iceland, 10-11 May 2004.
WHO Regional Office for Europe, Denmark, 2004.

23. WHO 2005. Outbreak communication – Best practices for communicating

with the public during an outbreak. Report of the WHO Expert Consultation
on Outbreak Communication held in Singapore, 21-23 September 2004.

Module 2

1. Borman, Ernest G. (1975). Discussion and Group Methods. Second Edition.

New York: Harper and Row Publishers, Inc.

2. Communication in risk situations: Responding to the communication

challenges posed by Bioterrorism and Emerging Infectious Diseases, 2002.

3. Crisis and Emergency Risk communication, CDC,September 2002.

4. Leeds, Dorothy. (2000). The 7 Powers of Questions. New York: Berkley

Publishing Group.
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 5. Smith, Larry. (2001). The ICM Crisis Management Certification Course.
Louisville, Kentucky: Institute for Crisis Management.

6. Ury, William. (1993). Getting Past No: Negotiating your way from
confrontation to cooperation. New York: Bantam Books.

Module 3

1. Anon. (2009). Effective Risk communication: A Message- Centered

Approach, New York.

2. Davis, M & Macdowall, W. (2006) Health Promotion Theory, Open University

Press.
3. Department of Human Services. (2007).Risk communication Plan:
Environmental Public Health Tracking Program, State of Oregon.
4. Department of Health (2001).Communicating Health Risk to the Public,
Planning Conference Report WHO/UK
5. ILGRA Inter-Departmental Liaison Group on Assessment. (1998). Risk
communication: A Guide to Regulatory Practice W HO. (2008). WHO
OUTBREAK Communication Planning Guide
6. Lundgren, R. E. , McMakin, A. H. (2009). Risk communication: A Handbook
for Communicating, Environmental, Safety and Health Risk, Forth Edition,
New Jersey.
7. US department of Health.(2002). Communicating in a crisis: Risk
communication Guidelines for public officials.

Module 4

1. Beckmann CRB, Ling FW, Herbert WNP, Laube DW, Smith RP, Barzansky
BM. Obstetrics & Gynaecology. 3rd Edition. Williams & Wilkins, Baltimore
1995: 25-30.

2. Code of Medical Ethics. Malaysian Medical Association; 2002

3. Medical Ethics Today – The BMA’s Handbook of ethics and law. 2nd Edition.
British Medical Association Ethics Department. BMJ Publishing Group 2004

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