The 10th European Medical Writers Association (EMWA) symposium, entitled ‘Communicating with the public – what has the COVID-19 pandemic taught us?’ took place on 5 May. The symposium explored this topic through presentations and panel discussions, focusing on insights relevant to medical writers and communicators.
A summary of sessions 1 and 2 of the symposium is provided below to benefit those who were unable to attend, and as a timely reminder of the key topics for those who did.
You can also read our summaries of sessions 3 and 4.
Introduction and welcome
- Health messaging has evolved to become more patient-centric, with trust, transparency, and consistent communication key.
The symposium was opened by Lisa Chamberlain James (Trilogy Writing & Consulting) and Tiziana von Bruchhausen (Boehringer Ingelheim Pharma), who noted that scientific misinformation is not a new phenomenon; however, the speed and voracity with which it is propagated, particularly via social media, is a concerning trend.
To set the scene, Suzann Johnson (Janssen) provided a historical overview of health messaging to the public, beginning with the era of the ‘charismatic influencer’ in the 1980s, epitomised by the founder of Weight Watchers. The advent of direct-to-consumer advertising in certain countries in the 1990s was a key milestone that brought an increasingly scientific approach and increased recognition of the benefit of patient support programmes. Johnson outlined the transition to a more holistic view of patients with the rise of the wellness movement in the 2000s, and subsequent efforts to support patient empowerment in the 2010s, which continues to evolve into an increased focus on patient centricity in the present day. This change in thinking represents the important realisation that patient audiences are not one-dimensional and that each patient is an individual with a full and complex life, driving a shift away from doing things ‘to’ or ‘for’ patients and towards doing things ‘with’ patients, in a manner rooted in trust and transparency. From a present-day perspective and particularly considering COVID-19, Johnson noted the importance of clear communication from a trusted partner, transparency, and delivery of consistent messaging via different formats and across diverse channels.
An increased focus on patient centricity in the present day…represents the important realisation that patient audiences are not one-dimensional…driving a shift away from doing things ‘to’ or ‘for’ patients and towards doing things ‘with’ patients.
Fake news and data misreporting in the COVID-19 pandemic
- Misinformation may be nuanced, based on inaccurate interpretations. Asking ourselves what mistakes could arise when audiences engage with our content could help mitigate this.
John Kerr (Winton Centre for Risk and Evidence Communication) provided perspectives on misinformation during the COVID-19 pandemic, and what can be done to prevent misinformation appearing and spreading.
Kerr began by differentiating between misinformation that is intentionally false and misinformation that may be more nuanced or complex. Blatant COVID-19 misinformation may be widely shared, but often remains a fringe belief. However, people exposed to these ideas may subsequently endorse increasingly counter-scientific positions or become more vaccine hesitant; thus, combatting such misinformation is paramount. Social media companies are increasingly removing deliberately false information, and from the audience side, gamification approaches such as Go Viral! have been shown to improve the ability to spot misinformation and reduce the likelihood of sharing. Kerr also discussed examples of complex misinformation, for example where information is factually reported but the audience may read it and form a misleading impression, or where statements are made in good faith but based on an inaccurate understanding of the data or using faulty statistical assumptions. Such information from otherwise credible sources may then be picked up and widely spread by conspiracy theorists. Tools to help prevent similar errors include RealRisk!, which converts relative to absolute statistics and may be useful for both public audiences and science communicators.
Kerr also signposted the audience to the five rules for evidence communication: inform, not persuade; offer balance, not false balance; disclose uncertainties; state evidence quality; and inoculate against misinformation.
Five rules for evidence communication: inform, not persuade; offer balance, not false balance; disclose uncertainties; state evidence quality; and inoculate against misinformation.
Kerr noted the particular importance of the last rule and asking yourself what mistakes your audience might make in data interpretation or what inaccurate conclusions might they draw when engaging with your content. Kerr closed the presentation by highlighting the Harding Prize for Useful and Trustworthy Communication, which aims to showcase examples of effective information communication.
EMA’s reaction and communication initiatives throughout the pandemic – COVID-19 vaccines as an example
- The EMA has used strategies including increasing transparency, rapidly sharing contextualised information, and engaging in two-way dialogue to help combat COVID-19-related misinformation.
In the final talk of the first session, Morgane De Verdiere (EMA) provided a regulator’s perspective on communications during the pandemic. Although the EMA had practices in place following previous public health crises, challenges arose in the form of polarised views on vaccines, increased public scrutiny, ambitious plans for vaccine delivery (coupled with differences between individual member states’ approaches to how vaccines were used), and the unprecedented wave of misinformation. From the WHO declaration of the pandemic in March 2020 to the end of the year, the EMA had approved 4 vaccines, and within the following 9 months, extended licences to cover children and booster vaccinations and renewed licences granted under conditional marketing authorisations. This effort was enabled by collaboration within existing networks, instigation of a dedicated multistakeholder COVID-19 task force to assess vaccines and therapeutics, and collaboration with national and international bodies such as the Centers for Disease Control and Prevention.
Substantial efforts to increase transparency were put in place to help combat perceptions that accelerated development meant corners had been cut, including shortening timeframes to publication, publishing extra information such as clinical trial data and monthly safety updates, and providing additional information on the EMA website. Information gap identification and content development were driven by public concerns and queries. De Verdiere noted that a high volume of misinformation was identified via media and social media monitoring and queries from the public. The EMA aimed to address this via providing and promoting reliable information and engaging in a two-way dialogue.
De Verdiere noted that demand for safety information on COVID-19 vaccines was high. There was regular scrutiny of adverse event reports in the context of the full scope of available scientific data to evaluate the ongoing benefit/risk ratio for a particular vaccine, and extra resource allocated to these important efforts. The EMA had followed transparent communication practices for several years prior to the pandemic, which provided a foundation of trustworthiness for communicating on COVID-19 vaccine safety concerns. De Verdiere highlighted the importance of rapid dissemination of key information with appropriate context, not avoiding uncertainties, communicating strength of evidence, and stating when further information is expected to emerge.
De Verdiere highlighted the importance of rapid dissemination of key information with appropriate context, not avoiding uncertainties, communicating strength of evidence, and stating when further information is expected to emerge.
De Verdiere concluded that within the past 2 years, multiple treatments and vaccines for COVID-19 have been approved. The EMA has remained a technical and scientific authority, with a high regulatory standard that remained unmodified for vaccine approvals. Efforts are ongoing to prepare for the upcoming winter season, and the EMA has an important role in continuing to combat misinformation and managing future public health crises.
The importance of visualisation
- Using visuals in healthcare communications can enhance understanding, retention, and trust in information.
The second session of the morning started with a presentation by Carola Krause (Codex Biomed) on the importance of presenting data visually when communicating with the public.
Visual information can be an impactful medium for scientific communication, as people retain 80% of visual information compared with only 20% of read information and 10% of heard information. Images are easier to decode than text: individuals with low literacy levels can often better engage with visuals, making them an inclusive tool for communication. Visualisation, both in form and content, can communicate complex information in a more appealing and easily understood way. Visualisation can also contextualise the storytelling aspect of communication.
Images are easier to decode than text: individuals with low literacy levels can often better engage with visuals, making them an inclusive tool for communication.
Visual representations accompanying text are particularly important for health authorities communicating health risks to a diverse audience, as explored for the H1N1 swine flu and COVID-19 pandemics in a recent article in BMC Public Health. Easily assimilated and effective communication is particularly pertinent during periods of crisis. In the context of public health emergencies, combining plain language text with visuals of non-visible entities (such as viruses) can increase audience trust and understanding of healthcare communications.
Combining plain language text with visuals…can increase audience trust and understanding of healthcare communications.
The WHO Strategic Communications Framework provides a set of standards for communicating with the public, recommending that materials are:
Krause finished by highlighting that there is a general ongoing trend for information to be delivered in shorter-form communications. Text information has reduced from book to publication, and further into tweets that place increased limitations on word count. In parallel, visuals have also evolved, from drawings in books to the posters of the conference era, and then into graphical abstracts and infographics to meet the demands of social media. In the future, this will evolve further into more visually engaging media, such as:
- animated graphical abstracts – for example, where parts of visuals are sequentially highlighted to emphasise a particular point
- interactive graphical abstracts
- augmented reality
- virtual reality.
Presentation of a checklist for writing in social media channels
- Social media offers many positive attributes, and guidelines exist to help maximise its potential while avoiding potential pitfalls.
Nicole Bezuidenhout (Uppsala Monitoring Centre) provided some useful advice for navigating the social media world of misinformation and disinformation.
Firstly, Bezuidenhout outlined the many positive attributes of social media:
- It has a wide and fast reach, which is why researchers chose media such as Twitter to post news of the first genome sequencing of the COVID-19 coronavirus.
- It can facilitate targeted communication through algorithms that direct content to users based on their preferences and activities.
- It allows for two-way communication, making it both interactive and fun.
- Importantly, social media platforms are mostly free to use.
One drawback of social media is the propensity towards information overload, with an overwhelming and often confusing volume of content. Posts mandate concise language, leaving little room for nuance, which can result in misunderstandings. There is little quality control, so misinformation can be rife; this also provides an opportunity for those wishing to spread disinformation. The two-way communication that can facilitate great discussion and collaboration can also misfire, creating a ‘social media storm’.
To avoid potential pitfalls while maximising the potential to rapidly reach a wide and engaged audience, guidelines such as the Quality and Effectiveness in Science and Technology communication checklist (QUEST checklist) can help researchers to communicate about science effectively and responsibly on social media.
Bezuidenhout has also composed her own checklist, applicable to all communications, but particularly relevant for social media:
- Define your message and aim, considering whether you are trying to convey information or persuade the audience.
- Define your audience and consider their preferred platform and format for information.
- Fact-check content, reading it fully, and use the Source, Headline, Analyse, Retouched, Error checklist (SHARE checklist) to ensure you only link to credible sources and references.
- Follow ethical standards.
When considering how to target the right audience:
- Select the best communication channel for the audience and tailor content.
- Use clear, concise language.
- Consider the frequency of posts so the audience stays engaged and your posts remain visible.
- Consider the optimal timing of posts (although seeing when readers are active may only be available for those with a business account).
- Use hashtags, mentions, and links to drive traffic to the site.
- Ask permission before tagging people.
- Include a call to action that gives people the option to comment or share the article.
- Interact with your audience and online community, engaging with other people’s content and adapting to what is going on in the wider online community.
To tackle misinformation, be proactive with pre-bunking activities instead of reactive debunking, thereby helping to populate social media with good quality information.
To tackle misinformation, be proactive with pre-bunking activities instead of reactive debunking, thereby helping to populate social media with good quality information.
Bezuidenhout concluded her talk with some tips for readers, also recommending the Go viral! game as a tool that can help readers identify COVID-19 misinformation techniques and make them better able to discern credible information. The WHO also offers guidance on reporting misinformation online, covering the most popular social media sites.
- Establishing trust and tackling misinformation on social media platforms are crucial for communication with the public to be effective.
The morning of the symposium closed with a panel session chaired by Art Gertel (MedSciCom, LLC). Speakers from the morning sessions (Kerr, De Verdiere, Krause, and Bezuidenhout) were invited back to further discuss how best to communicate with the public.
The panel identified establishing trust as an important aspect to communicating with the public. Since there are cultural differences in preferred sources of information, it is important to be consistent across authorities, including both traditional sources of valued communication in science and medicine, and less conventional ones. To build trust, it is important to include balanced and impartial information that tries to convey, not persuade. Sources of information that are transparent about uncertainties in the data are more likely to be perceived as trustworthy, particularly when communicating to those sceptical of the topic.
To build trust, it is important to include balanced and impartial information that tries to convey, not persuade.
The role of preprints in the spread of misinformation was discussed in light of the proliferation of misinformation narratives during the COVID-19 pandemic. It was felt that journalists were generally good gatekeepers, did not report on preprints unless advised by independent experts, and included clear caveats about the non-peer reviewed nature of the information, that the conclusions of the research are not established, and that it should not be used to guide patient care. Nevertheless, non-experts need a clearer explanation of preprints, which will stem from a better understanding of the peer review process and the significance of research that has not undergone this quality control process. The American Medical Writers Association (AMWA), EMWA, and International Society for Medical Publication Professionals (ISMPP) joint position statement on medical publications, preprints, and peer review addresses concerns of speed versus accuracy, and the risk of misrepresentation of data derived from preprints.
Identifying trustworthy content on social media can be achieved by using universally credible sources, such as the EMA and WHO. It is also necessary to trust peers within the scientific community to share information from credible sources.
Nevertheless, social media platforms and users are still working out how to curb misinformation and the misuse of social media platforms. The WHO has several ongoing initiatives to combat misinformation online, including development of their global principles for identifying credible sources of health information on social media. Indeed, the first step to combatting misinformation is to identify which ‘fake news’ or conspiracy theories are gaining traction or the most attention. Efforts should then be focused on debunking these, which is best achieved by providing alternative theories and highlighting the truth, rather than merely arguing that the misinformation is wrong.
[Debunking misinformation] is best achieved by providing alternative theories and highlighting the truth, rather than merely arguing that the misinformation is wrong.
Writing in simple language when communicating to a lay audience can simply be achieved by avoiding the use of jargon. If readers are left puzzled or irritated by a piece, this can erode their trust in the content. The panellists noted that there is a lack of statistical literacy in the general population, particularly when comparing fractions or probability. To check that a piece is correctly pitched, the panellists recommended undertaking informal review (by asking someone to look at it) or more formal review (using a focus group) to check that the content is being understood in the way intended. EMWA workshops on writing for a lay audience are also available. In closing, the panellists noted that to ensure success, it is particularly important to try to understand the audience, their prior experience, and any misconceptions they may have about science.
Why not also read our summaries of sessions 3 and 4.
Written as part of a Media Partnership between EMWA and The Publication Plan.