Appendix III

PHS Implementation Strategies

PHS Agencies

  • National Institutes of Health (NIH)/National Cancer Institute (NCI)
  • Health Resources and Services Administration (HRSA)
  • National Institutes of Health (NIH)/National Library of Medicine (NLM)
  • National Center for Environmental Health (NCEH)/Centers for Disease Control and Prevention (CDC)
  • National Center for Health Statistics (NCHS)/Centers for Disease Control and Prevention (CDC)
  • Agency for Toxic Substances and Disease Registry (ATSDR)
  • Food and Drug Administration (FDA)
  • National Institutes of Health (NIH)/National Institute of Environmental Health Sciences (NIEHS)
  • National Institute for Occupational Safety and Health (NIOSH)

    National Institutes of Health (NIH)/National Cancer Institute (NCI)

    PHS Agency Recommended
    Implementation Strategies    		 Applies to Recommendation Number
    National Institutes of Health(NIH)/National Cancer Institute (NCI) 1. Use the Cancer Information Service (CIS) as a tool to carry out health communications campaigns. One
      2. Refer to planning models and theories contained in Making Health Communications Programs Work: A Planner's Guide. One
      3. Develop partnerships with the "Federal Health Communicators," a coordinating committee of the Office of Disease Prevention and Health Promotion (ODPHP). Three
      4. Conduct pretesting to determine the most effective messages, formats, and channels to reach audiences with health information. Two
      5. Recruit staff evaluation specialists who are experts in evaluating all aspects of health communications programs. Utilize information from focus groups, in-depth interviews, and quantitative surveys. Four

    Health Resources and Services Administration (HRSA)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    Health Resources and Services Administration (HRSA) 1. The Bureau of Health Professions (BHPr), Division of Associated, Dental, and Public Health Professions would consider developing a focus specific to health risk communications in its existing environmental health responsibilities. Specific action steps include:
    • Name a coordinator for this initiative from BHPr
    • Coordinate activities with the Office of Public Health Practice, HRSA
    • Name representatives from each bureau
    • Meet with these representatives
    		One
      2. The BHPr coordinator intends to develop generally accepted practices and guidelines in conjunction with each Bureau environmental health risk communication and education representative. Specific action steps include:
    • Draft generally accepted practices and guidelines in conjunction with all Bureau representatives
    • Review by all Bureau directors
    • Print and distribute generally accepted practices and guidelines
    		Two
      3. Have ATSDR develop and conduct a series of risk communication workshops for each PHS EHPC member agency. Three
      4. ATSDR should have as one of its goals the continuing development of evaluative methods of these communications activities and products. Three and Four

    National Institutes of Health (NIH) / National Library of Medicine (NLM)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    National Institutes of Health (NIH)/ National Library of Medicine (NLM) 1. Promote use of an extensive network of 3,600 health sciences libraries and more than 40 online databases covering all aspects of biomedical research and health care delivery. One and Three
      2. Package the information to conform to the characteristics of the communications channels that carry the messages. MEDLINE citations, for example, will have added to it by NLM some 10-15 index terms that serve to identify its unique characteristics and facilitate its retrieval. Two
      3. Strengthen the capacity and focus of the Office of Health Information Programs Development/NLM to evaluate the efficiency and effectiveness of its communications programs. One and Four
      4. Conduct formative research to understand the information needs and requirements of NLM's various user audiences or receivers. One example, is a nationwide sample survey of user satisfaction or convening small focus groups (e.g., field trial of an expert system in rheumatology). Two
      5. Use a set of generally accepted practices and guidelines, such as the "Critical Incident Technique," "efficacy testers" and "alpha" and "beta" testing to evaluate communications activities, prototype systems, and products. Large-scale inhouse process, outcome, and impact evaluations using a matrix management approach are carried out as well. Four
      6. Place NLM's evaluation efforts in the context of a to-be-developed overall PHS evaluation plan that examines all aspects of health risk communications including mechanisms and the channels used to disseminate messages. Three and Four

    National Center for Environmental Health (NCEH) / Centers for Disease Control and Prevention (CDC)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    National Center for Environmental Health (NCEH) / Centers for Disease Control and Prevention (CDC) 1. CDC proposed the development of the Office of Health Communication (OHC) in the Office of the Director, CDC, to provide leadership and support to CDC programs. In addition, a working group was created to develop a framework for accomplishing the agency's health communications goals. One
      2. The OHC working group developed a process model for planning, implementing, and evaluating health communications activities at the CDC. Endorsement of the model will result in generally accepted practices and guidelines. Two
      3. The EHPC Subcommittee on Risk Communication and Education has endorsed an interagency initiative aimed at increasing awareness and visibility of health risk communications issues through the planning of a PHS-wide health risk communications workshop. Three
      4. The National Conference on Lead Education is a further example of an interagency effort in health risk communications as it relates to childhood lead poisoning prevention. This initiative involves many federal agencies, including CDC, NIEHS, ATSDR, MCH, EPA, and HUD. Three
      5. Integrate the process model developed by the OHC working group into the evaluation of each CIO's health risk communications activities and products. Four
      6. Share EHPC risk communication recommendations with the new CDC OHC once it is formally established and operational. Four

    National Center for Health Statistics (NCHS)/Centers for Disease Control and Prevention (CDC)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    National Center for Health Statistics (NCHS) / Centers for Disease Control and Prevention (CDC) 1. Enhance NCHS's responsibility and expertise in health risk communications as it relates to ascertaining:
    • the exposures of various populations to various health hazards
    • public perceptions of health risks resulting from exposures to such health hazards
    • the connection between behavior relating to particular hazards and perceptions of risk in various populations
    		One
      2. Provide methodological consultation and data collection services to agencies (EHPC) evaluating the impact of health risk communications strategies and programs. Two and Three
      3. Promote the use of environmental exposure databases as a means to methodological improvements needed in the exposure arena. One
      4. Advance research efforts in the area of public perceptions of risk, in particular, the processes through which beliefs about risks influence behavior and the stability and strength of such beliefs about risks (e.g., radon exposure). One
      5. Use a personal services contract as a first step in a program of research aimed at increasing the effectiveness of NCHS's collaboration with those conducting health risk communications programs. The contract will be used to conduct an assessment of the state of the art regarding how people perceive and understand educational messages about health risks. Three and Four

    Agency for Toxic Substances and Disease Registry (ATSDR)

    PHS Agency Recommended Implementation
    Strategies

    Applies to Recommendation Number
    Agency for Toxic Substances and Disease Registry (ATSDR) 1. Create the Health Communications and Evaluation (HCE) Branch for the purpose of expanding ATSDR's capacity to design, disseminate, market, and evaluate the effectiveness of ATSDR's health risk communications programs. One
      2. Established the ATSDR Health Risk Communications Committee in 1991 to help define and develop a clear sense of health risk communications as it relates to ATSDR's mission. One
      3. Jointly develop with the CDC in FY 94 an interagency health risk communications training course that promotes methods development, utility, and evaluation of ATSDR/CDC communications messages, materials, and campaigns. One and Three
      4. Design and pilot a comprehensive internal training course in health risk communications for ATSDR staff in FY 94. One
      5. Design and produce a Primer on Health Risk Communication Principles and Practices. The purpose of the guidebook is to provide an overview of principles and methods of risk communication which can be helpful when dealing with public concerns about health risks. Two
      6. Support and promote increased coordination of health risk communications activities across PHS agencies through the EHPC as an organizing mechanism (e.g., proposed PHS risk communications workshop). Three
      7. Refine and improve methods for evaluating health risk communications processes, outcomes, and impacts. Four

    Food and Drug Administration (FDA)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    Food and Drug Administration (FDA) 1. Emphasize EHPC's role in advancing an understanding and more effective practices involving health risk communications to the benefit of both PHS and the public. Three
      2. Support and promote the Subcommittee on Risk Communication and Education's role in fostering the commitment, training, and interchange that is needed to address major public health issues which require a strong health risk communications component.

    Possible initiatives that EHPC could undertake through the Risk Communication Subcommittee include:     		Three
     
    • Formalizing an established exchange among PHS and institutions in other sectors (public, private, government) to discuss practical and workable strategies for health risk communications using case studies and how-to approaches;
    		Three
     
    • Using the Risk Communication Subcommittee, develop workshops/briefings to discuss various aspects of health risk communications—e.g., knowing when you have a health risk communications issue, planning an effective health risk communications strategy, the role of the evaluator in health risk communications strategies, etc.
    		 Three
     
    • Widely distribute the Recommendations to Improve Health Risk Communication throughout PHS and to its interested constituencies with a possible outcome of involving health risk communications experts and practitioners in a forum/exchange on the ways to carry out the recommendations;
    		Three
     
    • Continue to build on the case studies presented in the Recommendations to Improve Health Risk Communication and consider compiling these case studies in an annual publication or publication in PHS Reports; and
    		 Three
     
    • Establish a "consultant" roster as a resource for PHS agencies to use in planning health risk communications strategies or dealing with health risk communications crisis—this roster could include "consultants" from both inside and outside PHS.
    		 Two and Three
      3. Create team structures within PHS centers to develop effective health risk communications strategies. FDA's Office of External Affairs is the principal focal point for planning and implementing strategies in response to health risk communications issues on a case-by-case basis. One
      4. Commit to public participation and involve various publics as often as possible in advising and assisting in both the planning and implementation stages of health risk communications strategies. One and Two
      5. Invite health risk communications experts to address risk communications principles and practices within PHS agencies. FDA invites expert presentations to its Policy Board, training for field staff, and training workshops sponsored by several FDA centers. One and Two
      6. Use focus groups to pilot messages and materials and both formal and informal approaches for obtaining consumer views to identify areas of real consumer concern, outrage, and uncertainty for any given issue. FDA gauges the level of consumer understanding based on the types of questions that are asked both before and after health risk information campaigns are initiated. Four

    National Institutes of Health (NIH) / National Institute of Environmental Health Sciences (NIEHS)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    National Institutes of Health (NIH)/National Institute of Environmental Health Sciences (NIEHS) 1. Embrace risk communications as a value in the NIEHS mission and as a central arm in a broader health communications strategy. One
      2. Reevaluate (e.g., National Toxicology Program) how and when preliminary results of toxicological studies should be communicated and transmitted (e.g., lessons learned from the fluoride case study). Two
      3. Promote communications relationships that allow for a two-way flow of information outward and public concerns and needs inward. NIEHS is active in community outreach through environmental health centers. Two
      4. Develop innovative strategies (e.g., electronic bulletin board) for interrelating with peer organizations, sister agencies, and the general public. Three
      5. Strengthen coordination and collaboration broadly through EHPC, FIXIT, the National Toxicological Program, and other Committee structures. Three
      6. Stimulate informal networking (e.g., research summits) through joint communiques; working with professional societies; conducting risk communications conferences; and making in-roads by way of education (e.g., schools). Three
      7. Consider a range of "ethical" issues and values, such as beneficence, justice, and equality in planning and implementing health risk communications. Assess how to balance the value of information with the uncertainties associated with scientific information. NIEHS emphasizes priniciple— and ethical-based communications as part of mission statements and the strategic planning process. Two and Four
      8. Integrate systematic evaluation into the program planning culture. A major task at NIEHS is to move from a case-by-case to an institute-wide evaluation approach. Comprehensive evaluation will cover the refined marketing research in the planning phases to assess the overall effectiveness of communications outreach efforts. Four

    National Institute for Occupational Safety and Health (NIOSH)

    PHS Agency Recommended Implementation Strategies Applies to Recommendation Number
    National Institute for Occupational Safety and Health (NIOSH) 1. Initiated efforts in FY 93 to develop and evaluate a health communications campaign to assess public opinion and increase awareness of traumatic occupational injury as a serious but preventable public health problem. The goal of this campaign will be to influence the safety-related behaviors of employers and employees. One and Four
      2. Informs the Secretary of Labor of the NIOSH recommendations for a comprehensive occupational standard and communicates NIOSH risk assessments through the "criteria document." Two
      3. Publishes documents that have a risk communications focus. The "Current Intelligence Bulletins," contain updates on previous recommendations and reviews of significant new findings on a hazardous chemical or harmful physical agent; the "NIOSH Alerts," are designed to call attention to hazardous conditions in the workplace and request assistance from workers and employers in controlling the hazards associated with these conditions. NIOSH also disseminates other publications including policy documents (e.g., risk communications procedures for workers), occupational guidelines, reference and research material, and educational material for training occupational safety and health professionals. One and Three
      4. Communicates the results of NIOSH studies indicating that a risk of a material impairment of health exists to workers as a result of their employment. One and Two
      5. Presents testimony at informal public hearings conducted as part of the rulemaking activity by the Secretary of Labor. One and Two
      6. Maintains two computerized databases. Maintenance of the Registry of Toxic Effects of Chemical Substances (RTECS) is mandated by the OSHACT. The second database, NIOSHTIC, is an abstract service for scientific articles related to occupational safety and health that presently contains over 190,000 citations. One
      7. Maintains the toll-free number (1-800-35-NIOSH) as a service to the occupational safety and health community and serves as a clearinghouse for available information on subjects of concern to individual health professionals, employers, or workers.  

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