Revere Debra, Calhoun Rebecca, Baseman Janet, Oberle Mark
Northwest Center for Public Health Practice, School of Public Health, University of Washington, 1107 NE 45th St, Suite 400, Seattle, WA, 98105, USA.
Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195-7236, USA.
BMC Public Health. 2015 Jul 8;15:621. doi: 10.1186/s12889-015-1980-2.
Communication technologies that enable bi-directional/two-way communications and cell phone texting (SMS) between public health agencies and their stakeholders may improve public health surveillance, ensure targeted distribution of alerts to hard-to-reach populations, reduce mortality and morbidity in an emergency, and enable a crucial feedback loop between public health agencies and the communities they serve. Building on prior work regarding health care provider preferences for receiving one-way public health communications by email, fax or SMS, we conducted a formative, exploratory study to understand how a bi-directional system and the incorporation of SMS in that system might be used as a strategy to send and receive messages between public health agencies and community-based organizations which serve vulnerable populations, health care providers, and public health workers. Our research question: Under what conditions and/or situations might public health agencies utilize bi-directional and/or SMS messaging for disseminating time-sensitive public health information (alerts, advisories, updates, etc.) to their stakeholders?
A mixed methods (qualitative and quantitative) study was conducted between April and July 2014. Data collection included a survey distributed to health care providers and semi-structured interviews with providers, community- and government-based organization leaders and directors, and public health agency internal workforce staff. Survey respondents and interviewees were asked about their exposure to public health messages, how these messages are received and how the information in these messages are handled, and in what situations (for example, a local vs. a national event, a pandemic or emergency vs. a health update) a bi-directional and/or SMS messaging system might improve communications between public health agencies and their stakeholder group. Interview and survey data were qualitatively analyzed. Thematic codes were quantitized into dichotomous variables of 0 or 1 on a per respondent basis to enumerate the presence or absence of each thematic code, enable quantitative analysis, and inform interpretation of findings.
Five major themes emerged from synthesizing survey and interview results: 1) Regardless of situational context (emergency vs. non-urgent) and message recipient (stakeholder group), e-mail is a favored modality for receiving public health messages; 2) The decision to use bi-directional, SMS or multiple communication strategies is complex and public health agencies' need to manage messaging concerns/barriers and benefits for all parties; 3) Both public health agencies and their stakeholders share similar values/uses and concerns regarding two-way public health messaging and SMS; 4) Public health is highly trusted, thus thoughtful, effective messaging will ensure continuation of this goodwill; and 5) Information reciprocity between public health agencies and stakeholders who share their information is essential.
Multiple communication strategies might be utilized but the choice of a specific strategy needs to balance message content (emergency vs. routine communications), delivery (one- vs. two-way), channel (SMS, email, etc.), and public health agency burden with stakeholder preferences and technical capabilities, all while mitigating the risk of message overload and disregard of important communications by recipients.
能够实现公共卫生机构与其利益相关者之间双向通信和手机短信（SMS）的通信技术，可能会改善公共卫生监测，确保向难以接触到的人群有针对性地发布警报，在紧急情况下降低死亡率和发病率，并在公共卫生机构与其服务的社区之间形成关键的反馈回路。基于之前关于医疗保健提供者对通过电子邮件、传真或短信接收单向公共卫生通信的偏好的研究，我们开展了一项形成性探索性研究，以了解双向系统以及该系统中短信的纳入如何作为一种策略，在公共卫生机构与服务弱势群体的社区组织、医疗保健提供者和公共卫生工作者之间发送和接收信息。我们的研究问题是：在哪些条件和/或情况下，公共卫生机构可能会利用双向和/或短信消息向其利益相关者传播时间敏感的公共卫生信息（警报、建议、更新等）？
2014年4月至7月进行了一项混合方法（定性和定量）研究。数据收集包括向医疗保健提供者分发的一项调查，以及对提供者、社区和政府组织的领导人和主任以及公共卫生机构内部工作人员的半结构化访谈。调查对象和受访者被问及他们接触公共卫生信息的情况、这些信息是如何接收的以及这些信息中的内容是如何处理的，以及在哪些情况下（例如，本地事件与全国性事件、大流行或紧急情况与健康更新）双向和/或短信消息系统可能会改善公共卫生机构与其利益相关者群体之间的沟通。对访谈和调查数据进行了定性分析。主题代码在每个受访者的基础上被量化为0或1的二分变量，以列举每个主题代码的存在或不存在，以便进行定量分析并为研究结果的解释提供信息。
综合调查和访谈结果出现了五个主要主题：1）无论情况背景（紧急情况与非紧急情况）和信息接收者（利益相关者群体）如何，电子邮件都是接收公共卫生信息的首选方式；2）使用双向、短信或多种通信策略的决定很复杂，公共卫生机构需要管理所有各方在消息传递方面的问题/障碍和益处；3）公共卫生机构及其利益相关者在双向公共卫生消息传递和短信方面具有相似的价值观/用途和关注点；4）公共卫生受到高度信任，因此深思熟虑、有效的消息传递将确保这种善意的延续；5）公共卫生机构与分享信息的利益相关者之间的信息互惠至关重要。
可以采用多种通信策略，但具体策略的选择需要在消息内容（紧急情况与常规通信）、传递方式（单向与双向）、渠道（短信、电子邮件等）以及公共卫生机构的负担与利益相关者的偏好和技术能力之间进行平衡，同时还要降低消息过载和接收者忽视重要通信的风险。
