Efficient health communication about COVID-19 can raise awareness and motivate more people to engage in health-protective behaviour.
For this purpose, governments disseminate two types of public health messages: (1) Public health campaigns on infection prevention and (2) Official communications to inform the public. To ensure wide coverage and maximum impact of these messages, countries have to use a mix of different communication channels. This policy snapshot outlines the most commonly used communication channels in the European region and draws comparisons between strategies. Information was collected from the COVID-19 Health Systems Response Monitor (HSRM) (up to 25 June 2020).
Governments are using traditional media, social media, websites and direct messaging to reach their population
Most governments traditionally use TV or radio broadcasts to address their citizens in times of crisis. This also applies to the COVID-19 pandemic. Public broadcasting services air regular press conferences of high-ranking politicians announcing and explaining measures to the audience. These are usually supplemented by press briefings with experts from public health authorities who explain details on the epidemiological situation and outbreak severity. Additionally, health advice and interviews with central actors are also commonly featured in newspapers and magazines. Targeted spots and advertisements are used to further amplify these public health messages.
Social media platforms, such as Facebook, Twitter, Instagram, and YouTube are central to most public health campaigns. They target a young and middle-aged audience with banners, informative articles, videos, and infographics. Often, hashtags (such as #StayAtHome) and social media influencers promote the respective campaign. With paid ads and targeted placement of content, social media users are directly and frequently addressed. Additionally, several governments use social media for posting statements or livestreaming press briefings.
Official websites are another pillar of communication. In almost all countries, ministries, public health agencies, and other public entities have added special sections on their websites with regularly updated information on outbreak severity, health advice, or explanations for government measures. Many governments have also created a dedicated website for COVID-19 which acts as an online information portal with frequently asked questions (FAQs) and supportive advice. Some countries have specific online portals targeted at health care professionals, i.e. Austria, Bulgaria and Ukraine.
Several countries employ direct and personal channels for communication. The most common approach is setting up hotlines providing information to the public on COVID-19 and the measures taken. Another approach is sending health advice alerts directly as emails and text messages via SMS, WhatsApp, Viber, or Telegram. In some cases, this process has been automated with chatbots based on artificial intelligence. In Bulgaria a chatbot channel on Viber was launched as part of the official COVID-19 web portal which provides information about the spread of COVID-19 and its symptoms, along with offering users to download an app where they can report symptoms and will automatically inform their general practitioner if a potential risk is detected. In Estonia a cascade of emails with instructions and SMS alerts were sent to the population. In parallel, an online self-assessment website was made available to help people with judging their risk of becoming infected and providing individualized recommendations on how to act in their situation.
Other common channels to convey COVID-19 information include public dissemination of information in the form of posters, billboards, or public service announcements (PSA) in health care institutions, public spaces, or public transport. A few governments also addressed their citizens with letters or information leaflets posted to each household, such as in the United Kingdom, Ireland and Poland.
A mix of channels is used to increase coverage, yet approaches can be uncoordinated
Although counties across the European region have chosen a different mix of channels, certain trends are apparent. The chosen channels usually align with local communication cultures. For example, countries with a strong eHealth tradition, such as Denmark, Estonia and Finland, utilize more online-based and individual communication. Moreover, the number of channels and intensity often corresponded to the perceived health risk in the respective country.
Generally, official communication intensified as the pandemic progressed. In late January and early February, many countries started to communicate advice on hand-hygiene and respiratory etiquette to their population, using mostly traditional channels. Communication activities usually increased and were spread out across traditional and non-traditional channels after the confirmation of first cases, such as in Iceland, Turkey, Portugal and Sweden. Some countries started rather late, such as France where the first case was detected on January 24th and official advice on hand-hygiene and respiratory etiquette was only issued in mid-February.
However, the utilization of multiple communication channels often lead to inconsistency and fragmentation of official public health messages. An example for this is advice on the use of masks for the general population. In many countries, this message was unclear and varying across channels, which created public confusion. A main reason for inconsistencies is the distribution of competencies among public actors. They often act autonomously and use different channels, spokespersons, and material. This increases the risk for inconsistent public health messages. A solution could be a national communication strategy with a coordinated messaging plan for all involved public actors. This could ensure consistency across channels, yet, only few countries have developed a plan. Examples are the national communication strategies of Azerbaijan and Montenegro, both with inter-ministerial messaging plans that are shared with a wide array of communication partners.
The multitude of websites created by government authorities can help to provide transparency and make specific information available; however, this can easily create information overload and confusion about the appropriate source. Only Malta has a cross-government COVID-19 website, which pools daily information related to different government authorities, such as health matters, the economy, employment, and the current mitigating measures.
Lastly, despite the aim to achieve wide coverage with multiple channels, most governments fail to address exclusion factors. For example, only a few countries make their information available in foreign or minority languages, excluding people who are not fluent in the official language. Moreover, many public health messages are “one-size-fits-all”, not specifically targeting specific groups, such as immigrants or children. A forthcoming post will look how countries have targeted COVID-19 health
communication to specific vulnerable groups.
The utilization of digital communication channels requires a structured and thorough strategy
COVID-19 is the first pandemic of its kind in the age of new media. This analysis has shown that most countries have moved beyond traditional mass communication, such as televised speeches by leaders.
Instead, a general trend towards digital communication through websites, social media and messaging services can be observed. The previously dominant top-down approach of official communication is changing, as more countries are experimenting with interactive elements, utilizing the functions of social media channels, hotlines and chatbots.
However, as more and more communication channels are used for COVID-19, countries need to ensure their transparency, consistency, comprehensibility, and inclusivity. For this purpose, standard operating procedures, dedicated spokespersons, and communication chains across different channels should be established to foster more effective and coherent communication processes. Additionally, ongoing monitoring and evaluation of the impact of public health messages across different channels is necessary for adjustment, such as in Montenegro.
As laid out above, various best-practice approaches for these challenges are already employed in single countries. Thus, countries should review strategies from others as they use new communication channels and modify existing strategies.
ASPHER COVID-19 Taskforce
Tobias Weitzel and John Middleton