“At the end of the day, public health requires trust to get anything done,” said Tara Kirk Sell (pictured), associate professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health and Senior Scholar at the Johns Hopkins Center for Health Security. “If you want people to take protective actions, to do the permitting, have the health inspection of the restaurant, follow guidance for septic systems or other environmental hazards, you need people to trust in public health and be willing to actually do what they say.”
With support from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS), Sell currently leads the Region 3 Public Health Preparedness and Response Center, NWPHEPR’s equivalent for Region 3 (serving Delaware, District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia).
“Trust in public health has taken a hit since the pandemic due to the politicization of public health and some communication mishaps where guidance changed or there was a lack of understanding of how science works,” said Sell, who focuses her work on public health preparedness and risk communication.
Sell and her team have worked to combat this erosion in trust by developing the “Checklist to Build Trust, Improve Public Health Communication, and Anticipate Rumors During Public Health Emergencies” with funding from the CDC. NWPHEPR’s new Communications Community of Practice (CoP), the second of three such CoPs we have stood up aligned with each of our primary focus areas, identified the checklist as an important evidence-informed tool of interest to our regional partners.
Sell’s team started to develop the checklist by conducting interviews and focus groups with health department personnel and staff from local community organizations from across the U.S. to get recommendations on how to build trust in the public health profession. They used an iterative process by formally coding interviews to extract themes that they then discussed with focus groups.
Sell says a lot of what’s in the checklist reflects existing public health guidance that’s put together in a new way to make it more useful to practitioners. “In some ways it’s a little bit of communication 101,” said Sell. It starts with an assessment of whether a health department can do the things that are needed to build trust. “For example, if we need to have an agreement with an outside organization, do we or can we contract that agreement in a reasonable period of time? Do we have the people on staff that we need to be able to communicate with the populations we know we need to reach? Can we do these things in the right language? Do we know our audiences?”
Sell emphasized the importance of thinking about secondary messengers. “The public health department is not directly communicating with a ton of people,” she explained. “These messages are passed through secondary messengers like local media, trusted organizations or even informal secondary messengers who pick it up and think ‘Oh, that’s interesting, let me share that with my WhatsApp group.’” The checklist accounts for the role of secondary messengers by walking through things like how to construct effective messages and anticipate potential rumors.
The checklist is meant to be adapted by the groups that adopt it. “People can walk through the list and say ‘We do this. We do this. We don’t do that. I don’t want to do that.’” That’s fine according to Sell. “It’s a good way to sort through and organize what kinds of activities might need to happen in a health district or to identify what might need to be advocated for with leadership.”
“It’s really important that people feel empowered to do whatever it takes to make it work for them,” said Sell. “I hope that people will find that they can use this tool in a modular way, picking out what they like about it and leaving the things they don’t like to implement it in a way that fits their scenario.”
Sell says she’d also love to hear suggestions on how to improve the checklist or see people come up with new plans, standard operating procedures, training slides, evaluation processes or any other materials designed to complement the tool. Similar materials have been developed by other groups for the Practical Playbook for Addressing Health Rumors that Sell developed with her colleagues and such contributions have improved the playbook.
“Processes need to be in place to do this work,” said Sell. “You can’t just magically make it happen when you decide ‘oh yeah, I’d like to do this.’ Things take time. Things require processes. It’s the ability to think ahead about this kind of stuff that makes [the checklist] practical.”