The challenges of communicating Tuberculosis research and risks to decision-makers

Over the past year I have on a number of occasions been so fortunate to work for the World Health Organization’s Regional office for Europe (WHO/EURO) on various communication tasks related to Tuberculosis (TB).

TBincidenceEurope2011

Although we in Europe tend to worry mostly about non-communicable diseases and many perceive infectious diseases as something we have pretty much under control, Tuberculosis is actually a big problem in many countries of the region. Especially the incidence of Multi-Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB) is worrying – to me actually a bit frightening. Incidences of MDR-TB and XDR-TB in Europe are the highest in the world, and do not only present a problem to the countries mostly affected (se figure) but in a globalized world with lots of mobility also a growing problem in the rest of the region. And as the name implies, treating (and thus controlling) the disease is becoming increasingly difficult as our current range of medicine is no longer proving effective.

Tuberculosis as a Public Health Risk Communication example

TuberculosisSo why bring up this issue on a blog focused on Public Health Science Communication? The answer is simple: Because it is a good example of the complexity and challenges of communicating public health science to divers audiences. Next week I will as mentioned earlier be giving a short lecture on public health risk communication to a group of public health students at University of Copenhagen, and I have been asked to try to integrate some ‘practical experiences’ with risk communication. My plan is to use tuberculosis as an example. Unfortunately, I can’t bring many solutions to the challenges, but my aim is to draw attention to some real life, practical obstacles to convert scientific public health knowledge to action.

The big challenge: Reaching decision makers!

In my assignments for WHO I have not worked specifically with risk communication, but having attended several meetings and contributed to a number of WHO reports I have gained an insight into the many challenges in TB control, the people involved and been struck by TB experts’ difficulties in communicating what science deems necessary to control the disease, including the risks of not acting or acting incorrectly, to the people responsible for making key decisions and allocating resources to it.

As with any other disease the findings and outcomes of TB-related research has to reach many different audiences: TB-patients, relatives of TB-patients, the general public, the media, health care workers, nurses, medical doctors, laboratory technicians, health care planners, policy makers, politicians etc. What is necessary and relevant to communicate differs of course depending on who you are trying to reach and the mechanisms to reach them are naturally also different.

I will in this blog post not reflect too much on communicating risks to patients and relatives to TB patients nor the general public, but draw attention to the challenges which TB experts face in communicating scientific findings, risks and arguments to public health decision-makers – ranging from senior doctors, hospital managers to politicians. This is an area I feel is often overlooked when talking about public health science and risk communication and definitely a challenge for TB-control in Europe. There are many books, courses, guidelines etc. on how to reach individuals and the general public, but it is at least my impression that literature and discussion on how to reach decision-makers is much more limited or at least difficult to find.

Some examples

For almost all the TB-related meetings organized by WHO, which I have attended the problem of getting messages and identified risks through to the decision-makers has been brought up. Just a few examples:

  • Laboratory and biomolecular specialists know what is needed in terms of laboratory tests, which are the most efficient (also in term of costs) and how for example testing TB strains for their susceptibility to different drugs is essential in controlling TB and the risks that arise from not doing so. They know what resources are needed in terms of staff, training and maintenance of equipment. Their problem: Explaining the highly complicated (even to me) techniques, their use of very technical language and abbreviations, their lack of communication training in general and risk communication specifically, their lack of direct access to communicate to and with decision makers. The result: under-prioritization of the laboratory needs in TB programmes and/or half solutions without proper maintenance of machines, continued training of staff etc. All contributing to increased risk of spreading TB – especially X/MDR-TB.
  • Researchers in TB, Heads of national TB programmes, international advisory organisations etc. know and have evidence for the importance of moving towards out-patient care of TB patients rather than relying on placing them in hospitals for the duration of their treatment (which can be move than 12 months). Not only for the sake of the individual patient but also for the public in general. Their problem: Communicating this knowledge convincingly to policy-makers and senior doctors is difficult in an Eastern European context where the old ways of the Soviet times, where hospital treatment was the preferred option, are still present. There seems to be a lack of opportunities or ideas on how to communicate with decision-makers and a fear that advocating for fewer hospital beds and more outpatient care will only lead to fewer resources for TB. In addition, they are in many countries up against stigma towards TB patients and the fact that TB often affects people with low social status (migrants and prisoners) and therefore not very attractive for politicians to spend time on. Form how I see it the experts lacks skills in communicating their knowledge effectively, partly due to lack of understanding of the incentives of decision-makers to go into this area. The result: Reluctance to speak up. Non-effective communication and status-quo for TB-patients’ treatment and care which again only risks to fuel the epidemic.
  • Researchers in TB, Heads of national TB programmes, international advisory organizations etc. know the importance of involving civil society in TB control and especially in explaining risk, risk preventive strategies etc. Their problem: difficulties in getting messages and knowledge across to civil society organization (if they exist), and find a common language to communicate in. Trouble gaining political support for the establishment of civil society organization and, if these already exist, lack of success in coordinating messages and missions. The result: Missed opportunities of being a joint voice that together can work to convince decision-makers to react to the risks of a more widely spread TB epidemic and have them make the right decisions. Waisted resources due to uncoordinated efforts

Acknowledging the role of science communication

The above examples are just a few of the communication related problems I have encountered and they may to some extend be specific to the European Region. The trouble is that they are in my experience actually often not articulated as communication problems, but rather as problems of securing funding, getting political support, engaging civil society, old-fashioned doctors etc. But from my perspective a lot of this really has to do with a lack of ability to communicate public health research, including public health risks to decision-makers.

So how do we deal with this? Well first of all, I guess it is a matter of acknowledging that communication is essential to convert scientific knowledge to actual action – also in TB control. It’s difficult to pursued decision-makers of the importance of paying attention to the TB situation and react accordingly, but there is a need to look into how it can be improved. Improved science and risk communication does in no way solve the problem on its own, but I do believe that a better understanding of how TB risks can be communicated, and an understanding of the position and incentives of the audiences (in this case decision-makers) can contribute a great deal. The experts need to been given some training and insights into science communication, so that can contribute to the discussions themselves – it is not enough to just hire a bunch of communication people to take care of it. Science communication theories and research have a lot to offer. The link just has to made and prioritized already from future experts enter into the academic training in universities etc.


Experiences with teaching Public Health Science Communication

On my list of things to do writing a blog post about my experiences with teaching Public Health Science Communication to graduate students at the University of Copenhagen has been high-up for a while. However, moving to Bonn, Germany and other minor things have somehow managed to overrule the writing of this post. But its time – also to avoid the experiences being stored too far back in my mind to be brought forward.

So how did it go? Did the students find it useful? What went well? Would I repeat a course like this again? And if so, what would I do differently? There are lots of questions to answer, so I thought I’d go through them one by one.

How did it go?

Overall, I think it went quite well. At least all students passed and it wasn’t criticized apart by the students. I’d even like to think that the students learned something new and useful. And just as important: I learned a lot! Both about science communication in relation to public health and about teaching public health science communication.

Did the students find the course useful?

It is very often difficult to get a clear impression of whether students found a course useful or not, and the fact that only few students filled in the online evaluation questionnaire and that only about half of the class attended the last module, where we did a short oral evaluation of the course, makes it even more difficult. However, based on the students who did participate in the evaluation I think it would be alright to conclude that the students on the whole were happy with the course. From the online evaluation most of them indicated that the study objectives of the course were met (and I assume they to some extend joined the course on the basis of these), and they rated their overall study-relevant benefit as ‘very good’ or ‘good’. I was also very happy to see that a most of the students who filled in the online evaluation found the course very relevant to their general Public Health education.

From the oral evaluation the comments were also in general positive. The students expressed that it had in many ways been a very different course, with much less hardcore theory than many of their other graduate courses. Some also mentioned that the fact that the centre of attention to a much higher degree than in other courses had been on themselves as individuals and researchers, had been interesting but at the same time a challenge. They expressed that they were more used to focus on the objective of Public Health, which is usually the public and not so much on their own role in this. I found this interesting, and recalling my own time as a Public Health student it is true that it was rarely about ourselves and our current and future roles in public health (one could talk about our subjective role), but much more about all the other players in public health, of course including the public itself.

examAnother thing I found interesting, was that when asked about the syllabus, the students in general seemed happy with the selected literature, except many of them expressed that they found the blog posts too chatty and recommend them taken out in future courses. I myself had put a lot of thought into allowing different kinds of literature. In part to illustrate that science communication is not just about text books and peer-reviewed journals. I guess they as university student have by now just been a little brainwashed to prefer good old scholarly texts over the more ‘chatty’ and personal writing styles…

What went well?

videnskab.dkMedical museionIn my own opinion, many things went well. The balance between having myself as the main lecturer and having great guest lectures (thank you to them!) was good (I taught about half of the modules). It also worked well and was a good change to get out of the class room and go on field trips. One to Videnskab.dk, a Danish popular science news website, and to Medical Museion.

I’m happy also that I chose to make a compendium rather than assigning a textbook. Partly due to the fact that there isn’t yet a book out there on Public Health Science Communication, but also because it was good to be able to through different kinds of texts to illustrate the many forms of science communication.

Another things I found was successful was trying to use as many real life examples. Ranging from case studies (although it would have been nice to have more), to YouTube clips, podcasts, blogs etc.

Despite some worrying comments from some of the participants prior to finishing the exam, I also think that the task of writing an introductory chapter on Public Health Science Communication worked well. Some students expressed that they found that an exam more focused on actually trying to communicate a specific public health challenge would have been more appropriate and useful instead of what they regarded being an assignment to refer theory of science communication. I (of course) tend to disagree. Writing an introductory chapter on Public Health Science Communication is also an example of communicating a scientific field – it just happened to be a field (and a way of thinking) that was new to them.

What would I do differently? 

It is funny what time does. Looking back at the course now, with some months having passed, I have a hard time recalling all the things I would have changed. Because at one point I thought there were many. However, some do come to mind:

I think I would have tried to include more real life examples of science communication – both good and bad examples, and perhaps have challenged the students to analyse both and suggest why they worked and why the didn’t.

Despite having the primary focus on the communicator (the public health professional) rather than looking at the receiver, I think I would in a future course try to incorporate a little more on how publics benefits from public health science communication, and perhaps try to allocate some more time to going through how one can become better at understanding and writing to a specific target group. This will present a different challenge, because the course is not a writing course.

Actually, I found the that finding a balance between being a course on principles, trends and theories in science communication and a writing, hands-on course quite difficult. I am sure that in a repetition of the course, this would again be a difficult balance to get right.

It’s always difficult to get students to discuss, but in a future course I’d try to make room for more discussion and student involvement. My own take-home message from teaching this course, is that I should keep in mind, that science communication is not an exact science and that I, despite being the teacher, does not have all the answers…

Would I repeat a course like this again?

Yes, I think I would. For many reasons. One, I thought it was fun and inspiring to teach. Second, I was confirmed in my belief that introducing public health students to the importance of science communication is very much relevant – if not essential. And finally, I learned a lot from the process and I would love to see how a version 2.0 of the course would go about.

Did I forget to mention something important in the post? Probably – but I promise to add them (or do an additional post) if and when things come to mind. I also welcome my students to share their views and correct me if I’m wrong, and I would be happy to answer questions from anyone interested in hearing more of my experiences with teaching Public Health Science Communication.

Public health science communication


2013, Science Communication, Public Health, Bonn

Some new years bring with them just a change of numbers – other new years bring bigger changes. 2013 seems to be of the later categories. At least if you consider moving to a different country a change. Starting from later this January, I will exchange my Copenhagen address for an address in Bonn, Germany. I guess you could claim that I’ll start a new life as a Bonn-girl.

To those who are unfamiliar with German geography

To those who are unfamiliar with German geography

I have on previous occasions moved abroad to take on new jobs (in China, Switzerland and Japan) but this time no fixed job awaits me. Rather, I have the opportunity to explore different options, try out my freelance skills and at the same time live with the person dearest to my heart.

I must admit that I know very little about Bonn. Both in general but also when it comes to the activities in science communication and in public health. Actually, I know very little about the status of science communication in Germany in general. However, since I plan to stay in the field of Public Health Science Communication, which I find to be both super interesting and a an important topic for public health, I truly can say that look forward to exploring it.

Apart from finding out what goes on in Science Communication in Germany, I still plan to have my feet planted into Danish Public Health Science Communication – as well as into global Public Health Science Communication. One of the wonders of social media (and the internet in general) is that it really doesn’t matter where you are – you are free to  work and stay connected with the entire world.

So far I haven’t got a clear-cut plan for my Bonn life, but lots of ideas, already a few assignments and a long list of opportunities. Bonn is a UN-city with a bunch of UN agencies present, so it is likely that I can engage with them. Especially due to the fact that I have experiences working with them already. The United Nations University is located in Bonn and several German Universities are close by (Bonn University, University of Cologne to mention a few) as well as a number of international NGOs and other organisations are based in Bonn. If they are not already working on science communication and social media then there is certainly a lot of new ground to made there!

Should any reader of this blog know of relevant people to in Germany to engage with,  Institutions working on science communication and social media, University courses related to science communication etc. please don’t hold back. I’d love to hear about it.

I promise to keep you all on posted on my doings in Public Health Science Communication in Bonn and in the rest of the world. So far assignments with the Department of Public Health, Medical Museion, and the Faculty of Health and Medical Sciences at University Copenhagen will take up my time as will communication assignments with the European Regional Office of the World Health Organisation (WHO). I would also love to explore opportunities for continuing teaching Public Health Science Communication. Perhaps the course Public Health Science Communication which I taught last year at University of Copenhagen can be adapted to other universities….

Anyhow, with this first blog post of 2013 I would like to wish you all a Happy New Year where ever you are based. Bonn adventures awaits and I look forward to you being a part of them. If not in any other ways, then by following my scribbles here on this blog.

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Exam in Public Health Science Communication

Wow, I can’t believe time has passed so quickly. Next to me is a pile of exam papers completed by the students of the graduate course in Public Health Science Communication at the University of Copenhagen. I feel like I just had the first introduction module, but yet I am almost done reading all these papers.

Until the students have received their results I will of course not comment on the actually exam, but what I would like to do is to share the assignment which the students were given with you. The exam was done through a course paper, where the students were presented with the task already on the first day of the course. They have therefore had the opportunity to let it simmer in the back of their minds through out the course.

Course paper in Public Health Science Communication

Assignment: Write a short introductory chapter on science communication for an imagined new textbook on Public Health Sciences. The imagined textbook is directed both to public health students and medical students. The chapter should provide a broad overview of principles of science communication and explain the relevance of looking specifically at public health science communication.

Requirement: Reference needs to be made to at least 60% of texts in the syllabus. Other literature (book chapters, blogs, articles etc.) may also be included, with clear references.

Language: The course paper can be completed either in Danish or in English.

Maximum length: 1 student: 10 normal pages, 2 students: 16 normal pages, 3 students: 20 normal pages

Evaluation: The paper will be evaluated on a 7-points scale

Additional guidance

In addition, the students were given the following guidance:

  • The course paper should illustrate that you have obtained a broad understanding of the principles of public health science communication (not public health communication) and its many dimensions. This means that you know of different medias, different target groups and different objectives/motivations for communicating science.
  • Since a requirement for the exam is that you have to refer to at least 60% of texts in the syllabus, your job is to put the texts into play with each other and demonstrate how their content are relevant for public health science communication – please also feel free to include other references (articles, blog posts, illustrations, radio programmes) if you find that relevant and as long as the references are clearly indicated in the reference list.
  • Apart from living up to the reference requirements and from demonstrating that you have understood basic principles of science communication, the evaluation of your papers will include how you combine your knowledge of public health sciences with your knowledge about science communication.
  • As the assignment is to write and introductory chapter to science communication, you will of course not be able to go into very specific details, but how you weigh different themes, topics etc. is entirely up to you.
  • As for the form of the paper, there are no requirements, rights or wrongs. You may want to write an introductory chapter as you would like to read it yourself (the target group for the paper is yourself and other students of public health related sciences) or try out a new style.  You can choose to write academically, personally, journalistic, with a dash of humor. It is up to you. Please also feel free to include figure, boxes, pictures and other illustrations if you find it relevant for your text.
  • There is no ideal way to complete this assignment and no rights or wrongs when it comes to format, disposition, language or structure for the paper.
  • You are also free to choose what reference system you like, as long as they are clearly marked and complete.



No simple recipe for translating science

The second module of the course in Public Health Science Communication focused on Translating Science to Traditional Media. On paper a nice and concrete topic – but both choosing literature for the syllabus and preparing for the class proved a little bit more challenging. Because what does ‘translating science’ mean? And is there a recipe for doing so?

The simple answer to the last question is: no. There is no formula to follow or an optimal way of doing it. It depends on the scientific topic, the scientist, the context, the targeted audience and the chosen media. This was one of the take home messages for the students. Not a very helpful message I fear. Hopefully, they did get something out of the module despite the lack of clear-cut facts and recipes. As a theoretical background, the students were presented with some perspectives on historical developments in the theories of public communication of science. The idea was to show the students how motivations behind communicating to the public had changed over time, and how the perception of the public influences how and why scientists communicate. For me personally, understanding developments in different approaches to translating science helps me think about how science can be translated today.

Framing

The power of ‘framing’ in translating science and reaching target groups was also talked about. The article by Myers, Nisbet et al A public health frame arouses hopeful emotions about climate change gave a nice public health context and demonstrated the power of health topics which is something all people can relate to. It was however just an appetizer for the extensive ‘framing’ approach.

We also had a nice discussion about whether and why scientists should communicate to the public. And what advantages the scientist may have for communicating (as the common perception is that scientists are bad communicators). The discussion was helped along by the article Of course scientists can communicate by Tim Radford. Again, there is no right or wrong answer for this, but the discussion gave a good feel for the challenges in translating science, but also some of the mechanisms that could help this communication along.

A lot of video clips, sounds clips and images were used to inspire and illustrate different ways of translating science:

Some more examples were shared by readers of this blog in the comments section. Thanks to all, and keep’m coming.

Some practical writing tips and tools

Although the course is not a practical communication or writing class I chose to spend some time on some basic communication tricks. Tricks that I was introduced to at the Danish School of Journalism and which I have found useful – especially for my written language. Many of the concrete writing tips can be found in Roy Peter Clark’s book Writing Tools – 50 Essential Strategies for Every Writer (short online version is available and podcasts). Simple things like thinking about making your verbs active, choosing your verbs with care, walking up and down the ladder of abstraction, remembering the inverted news triangle, reading your text aloud while walking etc. It was all a bit rushed and a whole writing course would have been relevant – but unfortunately it could due to time restraints only be an appetizer.