Product Details

Author Information

Corresponding Author
Randolph Rowel
Morgan State University SCHP
1700 East Cold Spring Lane, Portage Bldg., Rm 207
Baltimore, MD 21251
United States
p: 443-885-3138
f: 443-885-8024
randolph.rowel@morgan.edu

Authors (listed in order of authorship):
Payam Sheikhattari
Morgan State University SCHP

Tanyka Barber
Morgan State University SCHP

Myrtle Evans-Holland
Morgan State University SCHP

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences

What specific topics does your product address?

Community engagement, Curriculum development, Health disparities, Poverty

Does your product focus on a specific population(s)?

Uninsured

What methodological approaches were used in the development of your product, or are discussed in your product?

Community needs assessment, Focus group , Qualitative research, Quantitative research

What resource type(s) best describe(s) your product?

Manual/how to guide

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

The Guide to Enhance Grassroots Risk Communication Among Low-Income Populations is intended to enhance current risk communication systems at the local and state levels by helping these systems become more proficient in addressing the needs of low-income populations. The Guide serves as a resource for public health and emergency management practitioners who plan and implement emergency disaster risk communication activities that entail collaborating with grassroots organizations serving low-income populations. Although the primary focus of the Guide is to provide practical, step-by-step instructions on how to work with grassroots organizations in order to deliver critical information to low-income populations before, during, and after a disaster, suggestions on how to engage these groups in other activities are also provided. The Guide also serves as an additional tool to help public officials upgrade their risk communication system by incorporating grassroots risk communication components.

2. What are the goals of the product?

The goals of the Guide to Enhance Grassroots Risk Communication Among Low-Income Populations are to: 1) provide strategies and guidance to assist local and state agencies in upgrading their risk communication system into a grassroots risk communication system; and 2) improve the effectiveness of traditional risk communication system by outlining an approach that relies on trusted agencies and leaders to educate and warn low-income communities about possible threats.

Risk communication systems are an integral part of emergency preparedness activities. Local health departments and local emergency management agencies are largely responsible for educating the public and communicating risk about disasters. Low- income populations are among the most vulnerable groups during a natural disaster. Some of the vulnerability can be attributed to the ineffectiveness of traditional risk communication systems in reaching this population. Many low-income communities are distrustful of government agencies and those who typically communicate risk messages. Consequently, traditional risk communication systems are not as effective in reaching low-income communities before, during and after a disaster. Authors of this Guide define a “grassroots risk communication system” as a partnership which enables public health and emergency preparedness officers to involve grassroots organizations such as faith-based, community-based, and business organizations serving low-income populations, in risk communication activities during pre-disaster, imminent danger (warning), response and recovery phases of disaster. Through incorporating the principles outlined in the Guide, public health and emergency management practitioners will be equipped with the necessary tools to develop a risk communication system to more effectively meet the needs of low-income communities before, during, and after a disaster.

3. Who are the intended audiences or expected users of the product?

The Guide is intended for use by state and local public health and emergency management practitioners who are responsible for planning and implementing emergency disaster activities.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

Authors urge users of this Guide to not assume that being poor, in and of itself, makes one vulnerable. Conditions that often accompany poverty such as, being dependent on others due to ones health status, lack of resources, environment, and inadequate access to health care, also determines vulnerability. In addition, although this Guide offers an approach that can improve risk communication efforts targeting low-income populations, principles in the Guide can easily be adapted to address the needs of other vulnerable communities that are also impacted more in the aftermath of a disaster.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Research indicates that low income, Spanish speaking populations, and other minority groups are more vulnerable during disasters than other groups due to factors such as lack of preparedness knowledge, place and type of residence, building construction, language barriers, and social exclusion.1,2,3,6,7 This situation was also found among low-income African American and Spanish speaking populations that experienced Hurricane Isabel and a tornado in southern Maryland in 2003.8 Traditional risk communication systems have not been quite as effective in addressing the needs and realities of low-income and minority households.

A recent study by RAND Health5 examined risk communication efforts for at-risk populations. To help at-risk populations prepare for an emergency, take appropriate actions when a disaster occurs, and respond adequately to risk communication messages during an emergency, the study found that: 1) community-based participation strengthens emergency preparedness, response and recovery for at-risk populations; 2) including at-risk populations in risk communication exercises and drills may improve response to future disasters; 3) systematic evaluation of risk communication programs to assess how at-risk populations are impacted is needed; 4) effective risk communicators must be trained to understand emergency risk communication, know their stakeholders, and be trusted in the community; and 5) reaching at-risk populations requires the use of multiple channels, formats, and tools.5

The need to address similar issues to improve risk communication among at-risk populations was also recognized in Standing Together: An Emergency Planning Guide for America’s Communities.4 However, implementation of these principles requires a system that is based on trusted grassroots organizations as new channels of communication which are integrated into the traditional risk communication system. The Guide to Enhance Grassroots Risk Communication Among Low-Income Populations is intended to address many of the findings noted in the RAND Health study through enhancing current risk communication systems at the local and state levels by helping these systems become more proficient in addressing the needs of low-income populations.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. Blaikie, P., Cannon, T., Davis, I., and Wisner, B. (1994). At risk: Natural hazards, people’s vulnerability, and disasters. New York, NY: Routledge.
2. Eisenman, D., Wold, C., Setodji, C., Hickey, S., Lee, B., Stein, B., et. al. (2004). Will public health’s response to terrorism be fair?: Racial ethnic variations in perceived fairness during a bioterrorist event. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2(3): 146 – 156.
3. Fothergill, A., and Peek, L. (2004). Poverty and disasters in the United States: A review of recent sociological findings. Natural Hazards. 32, 89 - 110.
4. Joint Commission on Accreditation of Healthcare Organizations. (2005). Standing together: An emergency planning guide for America’s communities. Retrieved September 11, 2009 from http://www.jointcommission.org/PublicPolicy/ep_Guide.htm.
5. Meredith, L.S., Shugarman, A.C., Chandra, A., Taylor, S.L., Stern, S., Beckjord, E.B., et al. (2008). Analysis of risk communication strategies and approaches to enhance emergency preparedness, response, and recovery. Santa Monica, CA: RAND Corporation.
6. Morrow, B. H. (1999). Identifying and mapping community vulnerability. Disasters, 23(1), 1-18.
7. National Consensus Panel on Emergency Preparedness and Cultural Diversity. (2008). National consensus statement on integrating racially and ethnically diverse communities into public health emergency preparedness. Philadelphia, PA: Drexel University Center for Health Equality.
8. Rowel, R. (2005). Maryland special population bioterrorism initiative. Baltimore, MD: Morgan State University, School of Community Health and Policy.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The Grassroots Risk Communication (GRC) Project was designed to assist in upgrading state and local public health jurisdictions' preparedness for and response to bioterrorism, outbreaks of infectious diseases, and other public health threats and emergencies. The GRC Project was conducted from June to August 2006. Prior to developing the Guide, a 2 phase project was implemented. The first phase consisted of: 1) collecting information from low-income African American populations and other stakeholders to further assess disaster service needs, perceptions about pandemic and avian flu, and the impact Hurricane Katrina had on their perceptions about disaster preparedness, response, and recovery; and 2) developing a Grassroots Risk Communication Network for Low-Income Populations. With the assistance of community-based organizations and the public housing authority, study participants were recruited from Somerset County, Baltimore City, Anne Arundel County, and Charles County in Maryland. Both quantitative (250 participants in a survey) and qualitative (4 focus groups) data were collected. The survey explored the impact of Hurricane Katrina among low-income African Americans based on indirect exposure by way of mass media. Findings most relevant to the development of the Guide were used.

Phase two of the project involved hiring a Community Outreach Specialist (COS) to assist with coordinating the development of the Grassroots Risk Communication System at the local level. Although data were collected from several low-income communities throughout the State, Anne Arundel County was selected as the site to develop the risk communication strategy. Project staff and the COS worked to build on existing and establishing new relationships with agencies serving low-income populations. During the one-month period, 25 agreements were obtained from faith and community-based leaders and government agencies that serve low-income populations who agreed to serve as distribution points for risk-related information before, during, and after a disaster occurs. This phase of the project demonstrated the willingness of grassroots organizations to participate in risk communication activities. As a result of the GRC project, it was recommended that public health and response agencies should do the following: 1) assess their community involvement and increase the representation of minority and vulnerable populations; 2) strengthen relationship between agencies, minority groups, and other vulnerable populations; 3) partner with a network of grassroots organizations that are trusted in the community to eliminate the perception and occurrence of biased responses; and 4) conduct more research on disaster preparedness and response among vulnerable populations and develop practice guidelines and programs based on research results.

Following the collection of information in Phases 1 and 2, the design of the Guide (Phase 3) evolved. The intent of the Guide is to address these concerns as well as those raised by other stakeholders.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

Building upon the findings from the qualitative and quantitative data collection efforts, the Grassroots Risk Communication (GRC) project ultimately sought to assist in the development of emergency-ready strategies for emergency management and public health agencies. The steps employed by the project staff (which included the Community Outreach Specialist) to develop the Guide were as follows:

1. Conducted a literature review to identify research and a risk communication framework to support the development of the Guide.
2. Developed an outline for the Guide.
3. Assigned chapters and developed first draft of the Guide.
4. Sent draft Guide to local stakeholders (Anne Arundel County Health Department, Annapolis Office of Emergency Management, and Annapolis Police Department) for review and feedback.
5. Met regularly to refine the final draft of the Guide.
6. Sent revised document to Maryland Department of Health and Mental Hygiene for review and feedback.
7. Sent document to the National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities for review and feedback.

The feedback received from these groups was invaluable and helped to ensure that the document met the needs of the target population.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The significance and potential impact of this document cannot be overstated. Recent publications noted the need to engage grassroots organization in risk communication to ensure low-income populations are informed about impeding public health threats included the H1N1 pandemic flu (Quinn et al., 2009; Meredith et al., 2008). Appropriate risk communication procedures can serve to generate the trust and confidence that is imperative in a crisis situation. However, research has established that traditional risk communication systems are ineffective in meeting the needs of low-income populations during a disaster. Many low-income populations lack of confidence in public health systems and are distrustful of government agencies and those who typically communicate risk messages. By working with grassroots organizations to establish a grassroots risk communication system, emergency management and public health officials can establish relationships in low-income communities before a disaster occurs. These relationships can serve to counter any marginalization that may occur among low-income populations by helping public officials establish ongoing communication channels that ensure the continuous flow of information to low-income communities before, during, and after a disaster. As a result, this will also serve to decrease the time needed to deliver critical messages to this population. In addition to informing low-income communities about how to prevent the spread of the H1N1 virus, we also anticipate that the grassroots approach proposed in this Guide will be used to encourage this population to get the H1N1 vaccination when it becomes available. Because low-income populations have high rates of chronic illness and distrust the health care systems more so than other groups, it is imperative that other strategies are employed to ensure they are adequately vaccinated.

Although the Guide was recently submitted to the Maryland Department of Health and Mental Hygiene and posted on the website of the National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities, project staff has no knowledge of its use or effectiveness. However, the Natural Hazards Center recently introduced the Guide in the November 2009 issue of its monthly newsletter, Natural Hazard Observer, as a useful and effective resource which has a high impact among emergency preparedness stakeholders (available at: http://www.colorado.edu/hazards/o/archives/2009/nov_observerweb.pdf) (see page 21). As a result, considering that this is hurricane season and the public health threat of the H1N1 virus, we anticipate significant use of this Guide by public health practitioners to communicate risks among low-income populations.

10. Please describe why you chose the presentation format you did.

The presentation format was chosen because the authors wanted to present the information in a user-friendly, practical manner. Because we intended to have this document posted on websites to create easy access to our target audience, having the document available in pdf format was essential. The layout of this product was also given careful consideration in its development. In recognizing that many state and local public health and emergency management practitioners may have inadequate experience working directly with low-income communities and grassroots organizations that serve them, the authors sought to develop a document that could serve as a practical resource while providing step-by-step guidance for developing and maintaining relationships with grassroots organizations. Thus, in addition to the instructional narrative, the Guide incorporates real-life scenarios and profiles to provide practitioners with a sense of some of the issues they may face. Additionally, the Guide provides sample letters and agreements that can be used as templates to establish relationships with grassroots organizations. A sample culturally appropriate H1N1 flu warning brochure for use in low-income communities is also included.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

The strengths of this product far outweigh any limitations of the Guide. Cited by many researchers as a gap in practice, the Guide fills a void as there are few, if any, resources that address this issue. The Guide offers resources to public officials on the principles of developing risk communication systems through collaboration with grassroots organizations serving low-income populations. By incorporating the concepts outlined in the Guide, public health and emergency preparedness practitioners will be better equipped to establish and maintain partnerships with grassroots organizations such as faith-based, community-based, and business organizations that serve low-income populations. The Guide also provides step-by-step guidance on how to engage grassroots organizations in risk communication activities during pre-disaster, imminent danger (warning), response and recovery phases of disaster. Further, the feedback received from individuals in low-income populations, emergency management personnel and grassroots leadership before, during, and after the development of the Guide is also a strength as it allowed for the Guide to be better tailored towards the target audience.

While the Guide addresses barriers and common challenges and solutions that may occur when working with grassroots organizations, this topic could not be discussed in great detail. Thus, public health and emergency management practitioners, particularly those who lack experience working directly with low-income communities, may need to seek additional resources in this area. Another limitation of the grassroots risk communication approach is its reliance on volunteers from grassroots organizations to do what they committed to do in the signed agreements.

Having limited evaluation data regarding the Guide is a potential limitation. Authors are currently in dialogue with the Maryland Department of Health and Mental Hygiene to conduct a table top exercise to test this approach. However, if the principles and instructions are followed, the Guide will result in the formation and dissemination of information messages and materials that are developed using community stakeholder input. This, in turn, will lead to vulnerable populations being able to obtain reliable information from trusted sources within the community thus allowing these populations to be better equipped to deal with disasters. The grassroots risk communication approach will also provide for the mutual flow of feedback from the community thereby allowing public health officials to identify and address areas of improvement for future emergency preparedness and recovery activities within low-income communities. Furthermore, incorporating the principles outlined in the Guide will lead to the integration of grassroots organizations into state and local emergency preparedness efforts which will help put together disjointed activities and create a more efficient comprehensive grassroots risk communication system for low-income communities. This will ultimately result in ensuring the safety of all groups during a disaster, regardless of socioeconomic status or ability to speak English.

Strengths and limitations were also noted in the quantitative and qualitative data collection methods used to guide the development of this product. Three limitations of the quantitative component of the study design were: 1) small sample size; 2) non-randomized sample, and; 3) cross-sectional research design. Together they prohibit the ability to make inferences to the general population of low-income African Americans. On the other hand, strength of the study was that the data were collected among respondents that have two characteristics of vulnerable populations, namely low-income and minority (African American).

The use of focus group sessions to probe survey findings was another strength of the study. A mixed methods approach allowed researchers to address reliability and validity issues by employing at least two strategies recommended by Creswell (2003): triangulation and the use of rich and very descriptive data.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Collaboration on the Grassroots Risk Communication (GRC) Project, which resulted in the development of the Guide to Enhance Grassroots Risk Communication Among Low-Income Populations, embodied principles of mutual respect, shared work, and shared credit from the very onset of the project. During the data collection phase, community-based organizations and the public housing authority were contracted to assist with recruiting study participants and administering the survey to low-income populations in Somerset County, Baltimore City, Anne Arundel County, and Charles County in Maryland. Once the data were analyzed, project staff also returned to the communities to share study findings with study participants and to solicit additional feedback.

Principles of mutual respect and shared worked were also reflected in Phase 2 of the project. The Community Outreach Specialist (COS) hired to work on this project was from an organization that works extensively with low-income populations in Anne Arundel County. In this capacity the COS, a director of a non-profit agency, was able to share his insight as a leader in his organization and as a service provider for low-income populations. The COS attended all project staff meetings including those involving Annapolis and Anne Arundel County government agencies.

Feedback from stakeholders during Phase 3 was greatly appreciated and without it the Guide would have very little meaning to the intended audience. This product has come out of a collaborative effort and is intended to further improve the level of the partnership and collaboration between grassroots organizations, larger community, academic institutions, and the government. All stakeholders and project staff who contributed to this effort were recognized on the acknowledgement page of the Guide.

After feedback from the State agency and the National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities, all collaborators on the Guide were sent a copy of the Guide, notified, and are supportive of the Guide being submitted to CES4Health.info for peer review.

The project resulting in the development of the Guide to Enhance Grassroots Risk Communication Among Low-Income Populations was approved by the Morgan State University and Maryland Department of Health and Mental Hygiene Institutional Review Boards.


13. If there are individuals to whom you would like CES4Health.info to send an announcement of your successful publication through CES4Health.info, please include name, title and email address. Individuals might include department chairs, promotion and tenure committee members, deans, organization executive directors, supervisors, etc.