This 86-page document explores strategies for risk communication gleaned from participatory dialogues held in October and November 2006 in 4 United States (US) cities as part of the Public Engagement Project On Community Control Measures for Pandemic Influenza. The report presents and assesses a model for involving citizens in the public policy process as part of an effort to investigate and ensure the soundness and effective implementation of plans to slow the spread of pandemic influenza.

As detailed here, the project's sponsors (16 governmental and non-governmental organisations based in the United States) made use of the Policy Analysis CollaborativE (PACE), a model for facilitating the participation of both the stakeholder public and the general public. Two to 3 representatives from the organised stakeholder public were chosen from approximately 10 major sectors likely to be affected by the control measures (e.g., the education sector, health professional organisations, the faith community), to form a 50-member national-level panel. To outreach to the larger public, a sample of approximately 260 citizens (representative by age, race, and sex) were recruited from each of the 4 principal geographic regions. The group processes were structured to provide essential information to the participating citizens, to encourage the diverse participants to engage in discussions with each other in small groups, to weigh tradeoffs, and to reach a collective viewpoint on whether or not US jurisdictions should implement a package of 5 community-level control measures in the event of a pandemic flu outbreak. In addition, participants were asked to identify the anticipated challenges in implementing such control measures, and what solutions might be possible for these challenges.

As detailed in this report, what emerged from this process was a consensus that control measures should - and can - be implemented. There was a high level of support for the control measures, and citizens and stakeholders were able to think of a number of possibly effective and practical solutions to assure successful implementation or to mitigate against their socially disruptive effects. The stakeholders worked through all of these ideas, distilling them into 13 priority recommendations in 4 categories of challenges that they felt must be addressed by decision-makers preparing federal recommendations on these topics; here is an abbreviated list:

Planning & Preparation

• 1. Engage different levels of government and all key sectors of the community in the development of a detailed and fully coordinated plan.
• 2. Conduct the planning work in the most transparent and highly visible ways possible to build public trust.
• 3. Conduct needs assessments to measure and track "pandemic wellness" or "pandemic readiness" scores for both individuals and communities.
• 4. Create incentives for employers to conduct business "continuity of operations" plans and communicate effectively what employers will expect from their employees and what supports employers will make available to lessen the burdens of the pandemic on employees.
• 5. Train elected officials for leadership roles they will have to fulfill in a pandemic emergency.
• 6. Develop special focused plans for maintaining the personnel and infrastructure that will be needed to meet surge in demand for health care and the disruption of critical community services.
• 7. Develop clear and useful guidance for making ethical decisions around the use of scarce resources and other difficult value-laden choices in a severe pandemic.




Economic Solutions


• 8. Modify workplace policies or create new programmes to relax the requirements on employees and to make it easier for them to bear the financial and family care burdens of the pandemic.




Information Solutions


• 9. Conduct an ongoing public education campaign before the pandemic strikes that provides necessary and straightforward information about the control measures, pandemic influenza, and preparedness.
• 10. Create messages prior to and during the pandemic that motivate individuals to comply with control measures and reinforce the expectation that compliance is a socially desirable and necessary behaviour with positive benefits for all.
• 11. Establish specific mechanisms at the federal, state, and local levels for "just in time" communication when the pandemic arrives.




Social Solutions


• 12. Connect community organisations and volunteer groups to social networks that can deliver information, services, and social or psychological support needed to weather the pandemic.
• 13. Link providers in the social networks in advance of the pandemic with the people in need, paying particular attention to the most vulnerable populations.

A full, independent evaluation of the project - carried out by the University of Nebraska Public Policy Center (date: March 23 2007 ) - is included in this report as Appendix B (beginning on page 26). In short, the report concluded that the project met its major goals. For instance, the process was found to be successful in attracting citizens to engage in the process (particularly since they were not compensated for their time). In addition, citizens participating in the meetings appeared to represent a diversity of perspectives and expressed a variety of views. Evaluators learned that citizens were motivated to participate by a sense of civic responsibility or by a belief that their input would have an impact on public policy. Many of the participants had a personal or professional interest in pandemic influenza preparedness; some were in the health care profession or involved in health care planning, while others had a connection to high-risk groups. Most citizens indicated they had received information about the meeting through email from listservs or groups to which they belonged. This method of recruitment may have contributed to some demographic groups being under-represented (e.g., persons with lower levels of education). Strategies to increase participation and diversity in future public engagement processes include providing more advanced notice of meetings, holding meetings on weekdays instead of weekends, advertising through alternative sources, and paying stipends to participants.

Going beyond the category of access, evaluators found that the process led to an increase in knowledge. They determined that the presentation of information about pandemic influenza and community control measures enabled the citizens and stakeholders to engage in informed deliberations. (Many participants reported reading pandemic influenza materials before attending the meeting, so - according to evaluators - it is likely the participants had higher levels of knowledge about pandemic influenza prior to the meetings than the average citizen). Evaluators concluded that "the overall public engagement process was successful in producing a high quality deliberative procedure from the perspective of the participants. Citizens generally believed that participants felt comfortable talking in the meeting; the discussion was fair to all participants; the process helped them understand the types of trade-offs involved; the process produced credible and independent information; the process was not dominated by one person or a small group of people; and no important points or perspectives were left out of the discussion. Overall, stakeholders also thought the process was of high quality, although less so than citizens....There were mixed reviews about the inclusion of electronic polling as part of the process. Some found it valuable, while others thought it detracted from the process, taking time away from deliberation and discussion."

In terms of changes in attitude, evaluators surmised that "[p]articipation in the meetings changed participant perspectives about social values and the acceptability and likelihood of compliance with community control measures. For citizens, social order, responsibility, utilitarianism, and equality increased in importance following the deliberation. Many of the community control measures were significantly more acceptable after the deliberations....After the public engagement process, participants were more likely to believe that local units of government should make determinations about community control measures. These findings support the hypothesis that providing information to citizens and stakeholders engaging them in discussions about policy issues produces different results than public polling or opinion surveys."

In addition, the evaluation indicates that citizens contributed useful information for the stakeholder deliberations, and that stakeholders considered and integrated citizen input into their recommendations; stakeholders generally believed that citizen input added legitimacy to the process and helped generate policy maker support for the recommendations. Citizens and stakeholders generally thought the input provided would be used by policymakers.

Organisers add that, "according to some participants, The Public Engagement Project on Community Control Measures for Pandemic Influenza may itself have served as a trust-building exercise for the small number of citizens who participated. Greater use of this model or other such participatory and transparent group process mechanisms may be needed to assure both the soundness and the implementation of plans to slow the spread of pandemic influenza."

University of Nebraska Public Policy Center website; and The Keystone Center website.