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Table 2 Principles to guide decisions by health authorities about whether to persuade

From: Health communication in and out of public health emergencies: to persuade or to inform?

Principles Questions Explanations
Evidence What is known about the potential impacts of the behaviour? Decisions about what to recommend should be based on the best available scientific evidence about the effects of the targeted behaviour, based on up-to-date systematic reviews whenever possible [58]. This is not always possible in the context of public health emergencies, but such reviews can be done rapidly [59], and experience using a structured approach to make and justify recommendations outside of emergencies can make it easier to do this in an emergency
What is known about the potential impacts of the communication strategy? Decisions about how to inform or persuade people should also be informed by the best available scientific evidence. It is possible to systematically review this evidence outside of the context of emergencies, so that it is readily available as evidence-based guidance [1, 6, 50], and experience using a structured approach outside of emergencies can also make it easier to do this in an emergency
Participation Does the message reflect the values of those affected? Decisions about whether and how to persuade depend on judgements about how much people value the potential benefits and harms. Stakeholders—those who are affected by the decision—should be involved in those decisions.
For this to be practical in the context of emergencies, it is likely necessary to have established effective mechanisms to facilitate participation or participation in planning when not in the emergency [55,56,57,58,59]
Equity Are the potential impacts of the message on different populations fair? A decision to persuade (or not to persuade) should not affect segments of the population, particularly disadvantaged ones, unfairly. The benefits, harms and burden should be distributed fairly
Transparency What is the justification for the message? The justification for a decision to persuade should be transparent and readily available to the public. This should include the criteria used to make the decision, the judgements that were made for each criterion, and the basis for the judgements [30]
Precaution Is there a credible threat of serious harm that warrants an urgent message? In response to urgent and credible threats of serious harm, proportionate precautions should be taken. This principle is especially relevant in the context of public health emergencies. This is a complex principle that requires judgements about the urgency of a threat, the credibility of the threat, the likelihood and seriousness of the potential harms, and the potential benefits and harms of the intervention [60].
When the precautionary principle is applied, it should include evaluation to address important uncertainties, so far as possible [48]
Proportionality Is the message appropriate for the level of risk? The proportionality principle is used in a variety of contexts and has been defined in different ways [61]. The general idea underlying the principle is that responses to threats or risks should be appropriate for the level of risk and not excessive
Flexibility Is the message tailored to key target audiences and their contexts and can it be modified as new information becomes available? Messages should be tailored to address important cultural, socioeconomic and language differences. Attention should be paid to minority groups, their ability to access and understand messages, and their ability to act on messages. Choice of communication channels (e.g. websites, social media, mass media) should also be tailored to targeted audiences. Thresholds (e.g. for COVID-19 infection rates) and other reasons for changing the message should be communicated as clearly as possible, and it should be possible to reconsider and change messages and how they are communicated in response to changing conditions or new evidence
Testing Has the message and how it is communicated been tested? Important public health messages—whether they are designed to inform or persuade—and ways of communicating them should be tested with people from key targeted audiences, including minority groups, to ensure that they are correctly understood and helpful [42, 43]
Uncertainty Are there important uncertainties about the impacts of the message? Important uncertainties should be identified. When there are important uncertainties, the impacts of decisions should be evaluated as rigorously as possible