Ülla-Karin Nurm, Senior Expert, European Centre for Disease Prevention and Control


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  • ECDC's mission is to identify, assess and communicate current and emerging threats to human health posed by infectious diseases. We also support and help coordinate European Union countries’ preparedness and response capacities. With TESSy and EWRS, ECDC established a two-way approach to disease surveillance and monitoring:EWRS is our system for real-time event monitoring. And TESSy is our database system for long-term disease monitoring and analysis.EWRS relies largely on reports from the Member States. It proved particularly effective at the start of the influenza pandemic in 2009, and ensured real-time dissemination of this emerging health threat.
  • social marketing,risk communication, health advocacy, new technologies for disseminating health communication messages, systematic use of evidence and evaluation in informing practice,needs assessment
  • Acknowledge that this is one of the areas the Centre work’s in, main focus is on surveillance, data collections, scientific advice and outbreak prevention and control.Increasingly the role of health communication is being recognised as integral to the effective public health response to the continuing threat posed by communicable diseases.ECDC is building a knowledge base and developing a variety of initiatives, in order to support countries in their own disease prevention activities.CSS coordinates ECDC activities related to risk communication, behavioural science and health promotion by developing scientific guidance, offering technical support and tools as well as facilitating capacity building and exchange of experience and innovative practice to effectively prevent communicable diseases and promote health.
  • The CSS Section isproviding country support: European level  country levelHealth communication is about turning information to knowledge  knowledge to actionECDC providing support to countries:Within our mandate we do not run specific interventions or ‘campaigns’ –communicating directly with the public is in the Member State remit.We work in a complex and diverse context in EU: Variety of countries, languages, cultural diversity. Therefore:We provide evidence base, prototypes, templates etc. and countries adapt and develop their own initiatives according to their specific needs and contexts.Continuously advocate for the value of science based health communication being an integral part of disease prevention strategies.Welcome international expert’s input in identifying potential future gaps and needs in this field and to develop partnerships.
  • Another project in the pipeline is: ‘Review of the determinants for vaccination uptake among Roma’, which included:- Literature review- Semi-structured interviews with Roma parents- Interviews with healthcare providers- Focus groups with Roma parents
  • Meetings with groups of countries with largest Roma population in the EU, to share experiences and discuss challenges in promoting health and in particular in addressing low vaccination coverage.2011, Vienna: BG, CZ, ES, HU, EL, RO, SL (10 pers/ MS)2012, Dublin: AT, BE, BG, CZ, DE, EL, ES, FR, HU, IE, IT, NL, PL, PT, RO, SE, SK, UKTop ten interventions: Invest in education for physicians and nurses to communicate more efficiently and emphatically; Make remembering easier, e.g. efficient alert systems to remind people about vaccination; Include measles under broader concerns about children’s health and support the role of mothers as key opinion leaders on health issues in their families; Address stigma and discrimination; Cooperate with field workers;Make vaccination more accessible, i.e. offer immunisation days/campaigns in various locations; Motivate local authorities and non-governmental organisations to cooperate on community-based interventions, particularly targeted to underserved groups; Conduct epidemiological analyses of the risk groups for lower vaccination uptake; Use mass media, e.g. insert measles-related messages in television soap operas, encourage wider collaboration between public health and the film and TV industry; Monitor the web to understand concerns on vaccination and provide answers based on trusted web sources.
  • Communicationguides: Support in the planning and development of communication activities.-1st guide developed: Input on communication strategies to increase MMR vaccination coverage and address obstacles to vaccination. Provides background information and evidence based approaches on how to plan and implement communication campaigns on specific diseases, which can serve for countries that have not yet developed specific campaigns on a certain issue or which present ideas/suggestions of other approaches for those countries who already have implemented campaigns.The first output in this new area is the communications guidance on measles, mumps and rubella vaccination, to support the goal of increasing coverage in order to reach elimination goals.This includes for example addressing existing obstacles to vaccination via communication initiatives in hesitant populations.
  • The guide ‘Let’s talk about protection’ is a communication support tool for Health Care Providers (HCPs) to help them enhance vaccination uptake during their daily practice. Its development involved a three stage process: evidence gathering (literature review); peer review (Advisory group); stakeholders’ review. It is aimed to be used with: other physicians; mothers and grandmothers; underserved population groups; media. Available in html format now + flip book in the future.Cultural adaptation process: Pilot in Bulgaria, Czech Republic, Hungary and Romania, with translation, adaptation and comprehensiveness testing among beneficiaries. Provides a package: Communication guide for primary healthcare practitioners,flip book to be used by these,adaptation methodology.
  • Among the communication activities, we cooperate with and support MS on public information campaigns.It needs to be clearly stated that the toolkits do not replace national campaigns, and they do not represent an EU wide campaign on a specific disease.To run EU wide health campaigns is not in our mandate, public health policy is a remit of the Member States. We gather scientific evidence, share good practices, support countries’ activities.Toolkits provide template materials for adaptation. It’s a “kit”, meaning that texts, images, layout can be used as a whole or the materials can taken in parts, to be adapted according to national strategies and needs for the countries to develop their own initiatives.The meeting on behavioural aspects: Exchange countries’ experiences and recent evidence-based research on behavioural aspects, and discuss with participants strategies to promote influenza vaccination.The Estonian intervention also included: Behavioural study to gain understanding of healthcare workers attitudes and beliefs toward influenza vaccination. Some results:Vaccination was seen as necessary for the entire population1 with the exception of young children (<2 years old) – 37.4% rather necessary & 44.0% rather unnecessary. HCWs were divided on the necessity of vaccination for pregnant woman – 43.6% rather necessary & 30.2% rather unnecessary. 85.8% of HCWs, faced situation where patients refused vaccination. Main reasons for refusal were mistrust in vaccine effectiveness and personal beliefs (anti-vaccination beliefs) 53.7% & 68.8% respectively. Price of vaccine only came in 4th place (vaccine is not free; its administration is free of charge only for some).
  • Developing training “The role of communication in mitigating perceived risk related to vaccinations (measles)Participants: Public health experts working as ECDC Communication Contact Points in EU MSTraining objectives: - to explore existing knowledge on benefit-risk related to vaccination - to provide scientific facts and argumentation to vaccination risk communication - to support informed decisions about vaccination and vaccine uptake - to mitigate perceived risk related to vaccination by providing evidence-based messages - to build capacity in risk communication that refer to social and behavioral factors determining people’s decisions “vaccinate or not” - to acquaint participants with strategies, methodologies and professional practice in vaccination risk communication.Added value for MS: - access to risk communication research related to MMR and seasonal influenza vaccination - access to condensed information embracing key facts and evidence-based arguments supporting risk communication in the field of vaccination in MS - access to on-line training materials (serving as an open source) for public health experts who plan and organize health communication interventions in the field of VPD and /or who remain main facilitators of vaccination in their countries. Expected outcomes: - through ECDC intranet extension of training materials (as an open source) to a wide group of public health experts and health care workers in MS - through the network of ECDC CB extension of training materials to institutions and organizations involved in health communication activities in MS - promoting ECDC as provider of a quality standard for effective risk communication in the area of VPD - feedback from MS and training evaluation
  • These are our contact details for further information.
  • Ülla-Karin Nurm, Senior Expert, European Centre for Disease Prevention and Control

    1. 1. Opportunities and challenges of communicabledisease prevention in EU, ECDC perspectiveHelsinki, 13.06.2013Ülla-Karin NurmSenior Expert, Head of Communicastio Science Support SectionEuropean Centre for Disease Prevention and Control
    2. 2. Content• Scope of ECDC work• Supporting countries on effectivecommunication, examples of our work:• Sharing experiences• Guidance on effective communication• Evidence and compilation of best practices• Providing tools• Capacity building• Challenges we face in this area of work• Future activities3
    3. 3. The European Centre for Disease Prevention and Control(ECDC) was established in 2005 aimed at strengtheningEuropes defences against infectious diseases.
    4. 4. Disease and event monitoring:our health radar5collect,analyse,interpretcapture,filter,validateassessinvestigateSignalCommunicateand controlAlertdisseminateTESSy1Disease monitoringEWRS2Event monitoring1 The European Surveillance System – a database system2 Early Warning Response SystemEventsCases
    5. 5. Our aim:Behaviour change is seen as valued contributorto disease preventionBy introducing healthcommunication knowledgeand evidence-basedstrategies to diseaseprevention,we are aiming atsupporting and guiding thework of those who areresponsible to improvehealthto be better prepared tomanage the complexchallenges of public health
    6. 6. Scope of ECDC’s work in supportingeffective communication• Section on Communication Science Support• Support Member States in risk communication,health promotion, behavioural sciences, to moreeffectively prevent diseases and promote health.• Approach: Develop scientific guidance, practicaltools, capacity building initiatives, and fosterexchange of experiences and innovative practices.7Key area: Communication on immunisation(behavioural aspects, communication science)
    7. 7. Scope of ECDC’s work in supportingeffective communicationMaking evidence-based informationon healthcommunicationeasily accessiblePromotingcommunicationskills and providingexpertise in healthcommunicationProvidingresources for thedevelopment ofcommunicationactivitiesBuild a bridgebetweencommunicationscience andpublic health
    8. 8. Providing evidence and compilation ofgood practices• Reviews of evidence and compilation of good practicesto support effective communication for the promotion ofimmunisation
    9. 9. Sharing experiences and best practices:Roma health10Meetings on Roma health andto address challenges inimmunisation:• 2011 - Vienna• 2012 - Dublin• Providing a forum for sharing experiences: public healthsector, NGO’s, Roma, international organisations.• Agree on 10 top interventions that can contribute toincrease vaccination in the EU:• Nr. 1: Investing in healthcare practitioners’ educationto communicate more effectively.
    10. 10. Setting goals andobjectivesIdentifying targetaudiencesIdentifying knowledge,attitudes and barriersDeveloping and testingkey messagesProducing materials andtoolsReaching the targetaudienceAssessing campaigneffectivenessCommunication guide on MMR vaccinationKey steps for a successful healthcommunication programme
    11. 11. Communication guide ‘Let’s talk aboutprotection’Guide• Communication support tool• Supports healthcare providers in their dailyconversations with patients (mothers andgrandmothers, underserved groups, media).• Addresses common concerns, questions and howpeople wish to receive the information.Culturaladaptation• Pilot project in 4 Member States.• Translation, adaptation and testing amongbeneficiaries.• Soon to be released for use by all interestedcountries.
    12. 12. Capacity building in risk communicationIntersectoral training ‘The role of communication inmitigating perceived risk related to vaccinations(measles)’- Build capacity in risk communication in relation to social andbehavioral factors determining people’s decisions onimmunization.- Acquaint participants with strategies, methodologies andprofessional practice in vaccination risk communication to beable to mitigate the perceived risk related to vaccination.•
    13. 13. Introducing SocialMarketing concepts– Understanding of and insightinto thecustomer/patient/citizen– Enabling, encouraging andsupporting behaviouralchange or maintenanceamong target audiencePrototype toolkit foruse in the planning,implementation andevaluation of anycommunicabledisease campaign orprogramme15
    14. 14. 16
    15. 15. Step forward- Innovative approaches• ‘Thinking out of the box’ – FreeThinkers forum withrepresentatives from othersectors of society• Reframing the issue• Re-engineering of services andsystems to support andfacilitate change• Identifying effective ways todevelop new approaches topublic /private partnerships17
    16. 16. ECDC Communication ScienceSupport Sectionwww.ecdc.europa.eu18Thank you!