Improving Vaccine Risk Communications6
Several speakers and participants suggested ways to improve communication about vaccine risks and benefits, including tailoring messages to audience needs, biases, abilities, and interests; improving the appearance or organization of written materials; presenting information in a nonbiased manner; referencing statements; providing estimates of the likelihood of the better-defined risks; and stating the uncertainty of other risks.
To be effective, risk communication about vaccines needs to take into account what people already know or believe about the risks and benefits associated with immunization, said several participants. A risk communication expert proposed a progressive research strategy to improve vaccine risk communication. The first step involves conducting nonstructured interviews of individuals who represent the audience to which communications are directed. These interviews are an effective means of elaborating the most pressing concerns or beliefs of the interviewees. Subsequent questionnaire surveys based on interview results could quantify the prevalence of certain beliefs. Risk communication messages could be developed based, in part, on the results of the interviews and questionnaires and then tested, possibly with focus groups. Such evaluation could assess whether the information was easily understood and accepted and whether it is likely to foster a behavior change.
Several speakers suggested that, as with all risk communication, vaccine risk communications need to be well organized and accessible. A risk communication expert said that studies show that such devices as summaries and clearly marked section headings promote comprehension and retention of the information presented (Atman et al., 1994). One speaker, a member of the consumer-oriented press, suggested designing the VISs in a visually appealing, contemporary, and upbeat fashion. A pediatrician involved in the development of the VISs noted that a researcher at Louisiana State University who produced a simple, colorful vaccine brochure with explanatory drawings found that parents learned as much from her brochure as they did from the VIS (Davis et al., 1996).
It was also suggested that vaccine risk communicators consider the varied information needs of the audience. Some recipients of risk communication material prefer short, simple messages that explain the risks and benefits of vaccines in nontechnical language; others want as much scientific information as is available. Currently, the primary sources of consumer information on vaccines are
the VISs (criticized by some as being too simplistic and not inclusive enough) and the vaccine package inserts, which may have too much technical information for some people to understand and process effectively. To bridge the gap, it was suggested that vaccine risk communicators consider preparing intermediate messages about vaccine risks and benefits that have more detailed information than the VISs but that are less technical than the package inserts. The package inserts might also be reorganized so as to be more accessible to consumers.
Another possibility is an interactive or computerized information system, in which users can access the level of information that is appropriate for their needs and abilities. Such a system was developed by researchers at Ohio State University and the Mayo Clinic (Raman et al., 1996). The system was arranged in a hierarchical fashion with five levels of increasingly complex information, all written at an eighth-grade reading level. The system was tested in a middle-class medical practice, and although 13 percent of the parents declined to participate, there was great variability in the level of information requested by those parents who did participate. Those who agreed to use the system expressed a high degree of satisfaction with it (Ramen et al., 1996).
Several speakers and audience participants suggested that vaccine risk communications include references to the scientific literature, so that readers who question the information presented or who wish to know more can examine the original source for each statement. It was also suggested that all the evidence regarding a specific topic be presented, including information that does not support the position of the person or organization conveying the information.
As discussed previously, many participants noted that there is often uncertainty about estimates of the risks of vaccines. This uncertainty reflects the generally low risks of serious adverse consequences; if the risks were high, the product would not have been licensed. To promote effective risk communication, several speakers and participants felt that risk messages should acknowledge the uncertainty about the existence and magnitude of many of the potential risks associated with vaccines, with the inclusion of estimates of the incidence of the better-defined risks to the extent possible. A risk communications expert added that "in almost every policy forum that I can think of, the ultimate conclusion has been that it is essential for good public policy to communicate uncertainty, even if it is difficult." She suggested that vaccine risk communications include statements regarding what assumptions were made to define risk estimates and whether there is consensus among various groups of experts and the public about the accuracy or uncertainty of the estimates provided.
Other participants suggested that it be emphasized in vaccine risk communications that research is under way to improve understanding of those risks. A CDC representative suggested that much of the problem is inherent in the gaps in knowledge identified in previous IOM reports (1991, 1994a, 1994c), and