Risk, rhetoric, and response
: effective communication with at-risk groups to improve health outcomes during an influenza pandemic

Student thesis: Doctoral ThesisDoctor of Philosophy


Pandemic influenza poses a significant risk to public health and safety, though not every population group will be equally at-risk. It is therefore important to study how communication with the public can be used to encourage the uptake of protective behaviours both in the public at large and, particularly, with at-risk groups, in order to improve health outcomes during a future pandemic. The aim of this project is to understand the likely perceptions of risk, behavioural responses, and communication needs for groups who may be particularly at risk during an influenza pandemic. Using an analytical framework based on Protection Motivation Theory and the COM-B model, this project examines two potentially at-risk groups. Older adults (>70 years) are traditionally considered at-risk or vulnerable during extreme events whilst younger adults (18-25 years) are not. In the event of an influenza pandemic, however, there is the potential for older adults to be less affected than with seasonal influenza whilst younger adults may find themselves at greater risk. By exploring perceptions of risk and vulnerability and likely behavioural response in these groups, this project aimed to determine how public health communication can be adapted to result in better health outcomes in the event of a future pandemic. 
Following a review of relevant published literature and emergency preparedness planning guidance, interviews were conducted with emergency planners responsible for universities, facilities catering to older adults, London boroughs, and the UK in order to gain a better understanding of existing pandemic planning challenges. Individual and small group interviews were then conducted with London-based university students and older adults to better understand their perceptions of risk, likely responses and communication needs during an influenza pandemic. Participants across both population groups were largely consistent in their perceptions of at-risk groups. Whilst participants were broadly open to adopting protective behaviours, social isolation received slightly more support amongst older adults. Additionally, preferred communication methods varied between the population groups with older population favoured traditional communication methods rather than new media. A further set of interviews were then conducted with an older adult population group to test the effectiveness of providing information to address likely misperceptions about risk profiles as identified in Phase 1. Participants in this second set of interviews expressed similar views around risk perception, behavioural intent and communication needs as the first set of interviews. Participants in the second phase of interviews were divided into two groups with Group B receiving additional information on public health decision making. Participants in both groups expressed a desire for further explanatory information but participants in Group A were more inclined to assume utilitarian rather than risk-based motivations thereby highlighting the importance of effective communication with the public during an extreme event. 
The findings of this research would suggest that perceptions of response and selfefficacy around recommended protective behaviours are consistently high amongst older and younger adults. Social isolation, however, appears to be the most challenging behaviour to adopt, particularly for younger adults. Additionally, both older and younger adults expressed similar perceptions of at-risk groups. Information needs vis-a-vis content were consistent between the population groups and in line with practitioner assumptions. Preferred media routes, however, varied between older and younger adults, highlighting the need for a multi-media approach to communication in a pandemic.
Date of Award1 Feb 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJulia Pearce (Supervisor) & Richard Amlot (Supervisor)

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