Prescribing a dose of information to restore public health
Atypical pneumonia has created mass anxiety in Hong Kong - understandably. Information management plays a crucial role in keeping people calm, as the hoax that triggered panic buying demonstrated. Decades of research leave psychologists in no doubt as to the basic ingredients of an effective programme of public-alarm management. But these principles are rarely applied, as the handling of anthrax cases and terrorist threats in the United States reminds us. Lessons learned there could help Hong Kong.
The US authorities violated some basic psychological rules, claims former American Psychological Association president Philip Zimbardo. Citizens were sent two conflicting messages at once. One was to be alert; although they were not given explicit instructions about what action to take. The second was to go about their business as usual. For much of the public, these pieces of advice clashed, causing what psychologists call cognitive-emotional dissonance. Anxiety was heightened due to sustained levels of alert, and led to what Dr Zimbardo calls 'pre-traumatic stress syndrome'.
The whole experience confirms that the trick to handling widespread public danger is fine-tuned communication. In Hong Kong, during the current crisis (worsened by the underlying anxiety of the war on Iraq) it is crucial for authorities to send out the right level of alarm. Too low means that advice will not be acted on. Too high creates destructive emotional overload and possible panic.
How can the alarm bells be accurately pitched? First, the source of information must be irreproachably and consistently reliable. This does not mean the source can never be wrong or never change its view. Obviously, information and advice has been modified as more has been discovered about the disease and its spread. But new information needs to be communicated promptly, calmly and in the right way.
For example, misinformation needs to be corrected immediately and fresh or contradictory news announced with careful preparation of the context in which it is presented. This means there first needs to be a debriefing to clear the air so that the changed position can be understood in its proper light. When a new position is taken, such as the quarantine order imposed on Amoy Gardens and, later, the relocation of residents, these decisions should be fully explained. This is necessary to reinforce people's confidence in their leaders, giving them the sense that they are privy to the logic and evolution of their decision-making. This reassures the public that the fight against the disease is collaborative.
That sense of community collaboration is one of the most effective tools in controlling an epidemic, behavioural psychologists agree. When information is disseminated, the sources should be made very clear. This also helps maintain confidence and calm as knowledge of the health risk advances, sometimes unpredictably. Information, if possible, should be gathered from more than one source.
Psychologists agree that recommendations need to be as concrete as possible. One good example was the recommendation given during the early stages of the crisis in Hong Kong. The authorities advised citizens to stay at home one Sunday, if possible, and to make it a family home-cleaning day.
This has the merit of being a useful and concrete action and also serves as a binding activity that raises awareness in the whole family about levels of hygiene inside and outside the home.
Sometimes a hierarchy of precautions gives some reassuring order to the changes a threatening epidemic presents. For example, wearing a mask might be important for those who have already contracted the disease or who have other respiratory tract infections, which may contribute to the severity of atypical pneumonia. Avoiding crowds and washing hands frequently with soap throughout the day may be a priority for others.
Psychological studies in the US following the threats of biological attacks confirm that the behaviour of public leaders is important. Inaction breeds uncertainty. But leaders can prevent panic by providing timely and accurate information and clear instructions. This empowers the relationship between the public and its leaders and gives the public confidence to make informed decisions.
Finally, Monica Schoch-Spana, a senior fellow at Johns Hopkins Centre for Civilian Biodefence Strategies in Baltimore, recommends leaders develop collaborative relationships with the media to ensure an open flow of information during an emergency.
It is a mistake to ignore the power of disseminating information or for leaders to view the public as bystanders during a crisis. It is more realistic and useful to engage people psychologically to effectively teach them strategies that will allow them to cope and, vitally, to enlist their practical help.
