Public salience and understanding of Zika virus in Guatemala: Implications for planning communication strategies
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RTI conducted formative research in Guatemala to inform Zika virus communication strategies, including focus groups and interviews. Key findings included widespread awareness of Zika but low knowledge of sexual transmission. Participants wanted more reliable information from official sources. News and social media analysis found information sharing spiked after major events. Lessons included that interest is ephemeral and effective communication requires understanding information environments and channel variations. RTI is currently studying Zika transmission and control methods to address the outbreak.
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Public salience and understanding of Zika virus in Guatemala: Implications for planning communication strategies
- 1. www.rti.orgRTI International is a registered trademark and a trade name of Research Triangle Institute. Public salience and understanding of Zika virus in Guatemala: Implications for planning communication strategies March 11, 2017 Sarah Ray, MA Bridget Kelly, PhD, MPH Brian Southwell, PhD
- 2. Background Part of an RTI effort to proactively address the emerging issue of Zika virus (ZIKV) using a variety of methods: – Surveillance – Qualitative research – Molecular biology – Economic analysis – Communication research (campaign evaluation, social media monitoring) 2 For communication, focused on how to provide insights to governments and other groups addressing Zika
- 3. Formative Communication Research in Guatemala Formative focus groups (8) and interviews (10) in urban and rural areas of Guatemala Key Zika prevention issues Awareness and knowledge Attitudes Behaviors Results analyzed to inform messaging Goal to increase awareness and mitigate the outbreak through behavior change Presented to Ministry of Public Health and Social Assistance and other partners 3
- 4. Formative Communication Research in Guatemala 4 Conducted in two departments affected by Zika Suchitepéquez (Mazatenango) Zacapa (Zacapa) Administration Focus groups – central location (e.g., hotel, restaurant) Interviews – at participant’s home
- 5. Formative Communication Research in Guatemala 5
- 6. Formative Communication Research: Highlights 6 “They didn't test me [for Zika]. It was only because of the symptoms: fever, couldn't move hands and fingers, red eyes ... when I got to the doctor he said it was Zika and gave me a prescription.” -Female, Zacapa, Urban Experience with Zika Widespread awareness Many reports of personal experience Official diagnosis Many had not received official diagnosis Some went for treatment but were not tested; others self-diagnosed. Difficult to know accuracy of self-reports Awareness of mosquito-borne transmission Mosquitos most commonly mentioned as source of the virus; noted that same mosquito carried chikungunya and dengue
- 7. Formative Communication Research: Highlights Sexual transmission awareness Low awareness that Zika could be sexually transmitted When possibility introduced, participants were eager for more reliable information from official sources Suggestions for prevention Condoms and abstinence most commonly mentioned Participants wanted more information Zika and pregnant women concerns Widespread understanding of threat to pregnant women and their fetuses Specific concerns about increased chances of miscarriage and “malformations” 7 “They haven't said if [sexual transmission] is true or not. For the moment we aren't worried, but if we find out that it can be transmitted sexually, it would be more alarming. We would have to protect ourselves externally.” -Male, Zacapa, Urban
- 8. Formative Communication Research: Highlights Communication Messages Eager for more information about Zika and protection for themselves and communities. Wanted more information about risks to pregnant women and fetuses Communication Channels In addition to radio or local news, participants suggested locally focused efforts, including community talks or events 8 “I would like to have more information because there isn't much. [I would like] to know what complications it can cause … what studies have been done … and how it can affect my health. They are already saying that you can get infected more than once, or that the virus doesn't leave your body.” (Male, Suchitepéquez, Urban)
- 9. News and Social Media Analysis in Guatemala Monitoring Zika-related news and social media discussion Coverage in major newspapers Social media discourse-Twitter Online searches Analyzed patterns of information sharing, engagement, and searching Results analyzed to guide communication message and dissemination strategies 9
- 10. Guatemala News & Social Media Analysis: Results 10 Spike during the week of 1/31 WHO’s 1/28 Public Health Emergency declaration Reported by Prensa Libre & Publinews Many retweets of news of the pandemic and recommendations by Latin American physicians to modify abortion laws to avoid secret abortions Trends Very similar patterns across 3 data sources throughout the first half of 2016 Suggests that events that generate news coverage play a key role in online conversations, online search behavior Peaks represent short windows of opportunity when people want, share more information
- 11. Guatemala News & Social Media Analysis: Results 11 Comparison of Number of Tweets by Individuals, Google Searches by Individuals, and News Stories about Zika Virus in Guatemala, January 1–June 30, 2016
- 12. Comparing results across three countries Southwell et al. (2016): http://wwwnc.cdc.gov/eid/article/22/7/16-0415_article For more information: bsouthwell@rti.org 12
- 13. Tying these findings to other infectious disease contexts
- 14. Lessons learned for communication efforts 14 Addressing spread of Zika virus will require we understand: Attention/interest can be ephemeral human behavior reflects more than factual knowledge public information environments can contain misinformation communication channels vary in reach, efficacy, trustworthiness and stability
- 15. RTI’s Current Zika Virus Projects 15 STUDY ZIP Zika in Infants and Pregnancy Drones vs. mosquitoes Aerosol transmission
- 16. 16 Bridget Kelly bkelly@rti.org Contacts: Sarah Ray Sray@rti.org Thank you! Discussion
Editor's Notes
- Many of these initiatives are self-funded
- Zika in Guatemala – a Study in 2 Parts Part 1 – was formative communication research in Guatemala, conducted as a way to: 1. Identify knowledge gaps, myths/misinformation, barriers 2. Determine which message concepts will be most appropriate for the target audience 3. Target appropriate communication channels To do this RTI conducted a series of 8 focus groups (5-7) and 10 interviews in urban and rural Guatemala in partnership with the Ministry of Public Health and Assistance. Discussions focused on: 1) awareness and knowledge, 2) attitudes, and 3) behaviors as they relate to Zika prevention. Also asked about awareness of communication efforts and preferred communication channels to help inform messaging.
- ID areas that had been affected by Zika (working with RTI staff in Guatemala & MOH). Conducted groups/interviews in rural/urban areas associated with 2 departments: Suchitepequez (Urban: Mazatenango) Zacapa (Urban: Zacapa) ….rural areas near urban centers Contracted with Guatemala-based research firm. Recruited using database and by canvassing communities. Invaluable resource on the ground Research administered in central locations (hotels, restaurants) for focus groups; individual’s homes for interviews Observational component
- Some photos of the IDI sites; used to provide context for some of the findings: Wash basin (left) – because access to fresh water is not a constant, wash basins are a challenge for these communities. Standing water breeds mosquitos, but water is scarce and may only come every few days Mosquito-eating fish, “dunks” Trash in river – some said they burn trash, but if it is too wet, they can’t. Trash may end up in the river Participant and bed net (interviewer on right). Young male participants… indicates bed nets
- Awareness widespread Virtually all aware of Zika and saw it as serious. In all groups and interviews, at least one said that they had personal experience with Zika; either them or someone close to them Participants also were able to identify common symptoms of Zika infection; several were concerned about lingering effects of Zika Official diagnosis not common Despite reporting experience, many who reported had not received an official diagnosis. Some went to a health center but did not have a blood test (woman in quote); others self diagnosed based on previous experience. Difficult to know accuracy of self-reports. Because many do not use health centers regularly, unclear if official counts capture everyone. Treated symptoms with acetaminophen (paracetamol), though A few (Zacapa), said health centers did not have medication and that recommended treatments were expensive High awareness of mosquito-borne transmission Mosquitos most commonly mentioned; pointed out that Zika mosquito= chikungunya and dengue There were a few who did not know how Zika was transmitted or questioned that Zika originated with mosquitos. Some believed it was also airborne/contagious and a few suggested that communities were part of an experiment where Zika was introduced intentionally.
- HIGHLIGHTS: Although awareness of the mosquito’s role, many participants were not aware of the potential for sexual transmission. Participants were eager for more information about the possibility that they or their sexual partners could be at risk. Abstinence and condoms were most commonly mentioned as methods to prevent sexual transmission, although participants wanted details on how long they should continue preventive measures with their partners or if only couples with a symptomatic partner were at risk. Low awareness of sexual transmission Fewer than half of interview and few focus group participants knew that Zika could be sexually transmitted Some noted that the possibility of sexual transmission was new to them. When this possibility was introduced, several said they wanted reliable information from official sources to confirm whether it was true. Condoms or abstinence suggested Those who previously knew about sexual transmission and those who learned about it during discussion suggested that avoiding sexual contact or using condoms with partners who have or have had symptoms would be best for protecting couples. At least 2 females were hesitant about the idea of asking their male partner to use a condom. Participants said they would look for symptoms in their partner to decide how to proceed, especially to protect women who could become pregnant. Some participants wanted to learn more about how long the virus stays in a body and how long they should continue preventive measures with their partners Times suggested ranged from a month or 2 to 6 months+. A few suggested there was no risk if neither partner was symptomatic. Concern about Zika and pregnant women Nearly all understood Zika as a particular threat to pregnant women and their fetuses. Specifically concerned about increased change of miscarriage and ‘malformations.’ Info based on what they received from: news, official sources, anecdotes in community Included microcephaly, brain damage, missing limbs, and convulsions.
- Awareness of measures to prevent mosquito-borne infection—both in vector control and in personal protection—was high. In particular, participants knew the recommended methods for eliminating mosquitos and areas where they could breed. Most participants, especially in focus groups, reported that because of their previous experience with vector-borne diseases, they knew the importance of throwing away trash and eliminating areas where standing water might accumulate. Many participants talked about thoroughly cleaning their laundry basin, although nearly all noted that it could not be done every day because of limitations on the water supply. Others mentioned that they have put “poison” or bleach in the basin to kill larvae but that it was expensive and donated supplies were limited. Participants also highlighted other issues with breeding sites in municipal or public locations or on private property in their neighborhood. Some of these participants talked about hidden garbage dumps, blocked drains, and industry and individuals who did not take action to eliminate stagnant water on their property. A few admitted that they occasionally became complacent and did not follow all recommendations. Suggestions included more enforcement and control and more communication and education to bring the community together to address the issue. Limited or only occasional access to running water in some areas was mentioned by many participants as a barrier to efforts to remove standing water. Some participants noted that they received water only once every several days. Therefore, the need to store water for household use makes it difficult to clean laundry basins daily, and messages urging cleaning more often are confusing for those affected.
- So to take these findings beyond Guatemala, we can compare them with results from other countries. And in fact, we did some of this in a letter published in Emerging Infectious Diseases, where we saw similar patterns for the U.S., Brazil and Guatemala.
- We can tie some of the themes we have found in the Zika work to other infectious disease contexts. For example, we conducted a survey of 1,018 Americans during the 2014 Ebola epidemic. Despite relatively reasonable perceptions of risk, knowledge about how to prevent transmission was very low. Fear may have played a role, as large numbers were in favor of policies like travels bans, which had not been recommended by govt officials Only 28% were confident in the U,S. government’s ability to prevent the spread of Ebola Only 18% confident in the media’s ability to accurately report on the epidemic.
- It is important to understand what types of information the particular audience is not only likely to be exposed to, but likely to share with others if the goal is to maximize the reach of your message
- REDS-III The objective is to give transfusion medicine experts and government officials more information to evaluate the need for blood screening implementation. RTI will also serve as the data coordinating center for a five-site study that follows pregnant women through pregnancy and other children through their first two months of life. The program is an add-on of the Global Network project funded by NIH NICHD, and will take place in Puerto Rico, Guatemala, Colombia, and Brazil. We have a drone piloting program: In areas plagued by the virus in Guatemala, RTI is flying drones to understand how these tools can be used to combat the spread of Zika. We believe drones are a cost-effective tool to map mosquito breeding sites, particularly in cisterns, tires, pots, and stagnant pools. Better maps will allow responders to more effectively target insecticides at breeding sites. Currently, Zika diagnostic tests are done only when symptoms are present and samples must be taken in a clinic and then refrigerated, which can be costly and cumbersome to administer. RTI is looking to develop a method to detect Zika virus from dried blood spot testing, which could provide an easy way to collect and store samples and therefore provide greater opportunity to understand the real prevalence and impact of Zika. RTI is also conducting research on the virus to determine whether Zika can survive in respiratory, oral, and salivary environments; whether the cells from the oral and respiratory tracts allow for propagation; and how long the virus can persist in saliva. Our early findings from this study suggest that Zika can be transmitted through infectious saliva to the oral and respiratory tracts. I using drone technology to map four Guatemalan villages and code possible breeding sites.
- If you have any additional questions on this presentation after we have finished today, you can contact Sarah or myself at these addresses.