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OPEN ACCESS EC EMERGENCY MEDICINE AND CRITICAL CAREEC EMERGENCY MEDICINE AND CRITICAL CARE
Research Article
Introduction
The novel coronavirus pandemic (COVID-19), without a vaccine yet, has been menacing health around the globe with more than 9 mil-
Structuring a Communication Framework to Address the Challenges of
Vulnerable Communities for Building Trust and Ensuring Access to
Emergency Health Messages for Compliance during COVID-19
AKM Alamgir1*, Sibghat Usmani1, Shafi Bhuiyan2,3 and Axelle Janczur1
1Access Alliance Multicultural Health and Community Services, Toronto, Canada
2University of Toronto, Toronto, Canada
3Ryerson University, Toronto, Canada
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
*Corresponding Author: AKM Alamgir, Access Alliance, Toronto, Canada.
Received: November 23, 2020; Published: January 19, 2021
Abstract
Pandemic health emergencies require timely awareness by credible information and trust in the operational system to inform,
instruct, promote protective behaviour, and dismantle rumours to mitigate the impact, particularly in the absence of a vaccine dur-
ing this current COVID-19 situation. Various government and non-government organizations generated an overwhelming number of
communication materials (infodemic) for diverse populations around pandemic related practices. However, access to and utility of
communication materials have been limited for the vulnerable populations due to social determinants of health such as linguistic or
technology barriers as well as trust on communicated messages.
A systematic review was conducted in June-September of 2020 adopting a scoping review framework and PRISMA-ScR model.
Collecting primary data from conveniently selected relevant service providers or policy planners during the COVID-19 pandemic
followed this. Social determinants of health as social marginalization and health-related complexities were found to be associated
language barrier, lack of trust towards public health interventions, structural and personal factors, and lack of equity-informed plan-
ning of communication strategies.
which meant a participatory and inclusive process of planning and implementing emergency risk communication materials that
aimed at reducing the barriers and in turn reducing the vulnerability of subgroups. The preparedness plan anticipates the limitations
of the communication materials from an end-user perspective and reinforces the desirable practices for prevention. The strategy sug-
to access information and act upon the recommendations. This 360-degree-approach framework emphasized the active participa-
tion of the target audience from the beginning of the process of communication material design for the pandemic.
Keywords: Infodemic; COVID-19; Vulnerable Community; Language Barrier; Accessible Communication
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
which is increasing every day. We assume that certain subsections are disproportionately vulnerable and affected in such health emer-
higher death rates were noted among the African American population with pre-existing systemic health inequalities. They are minority
groups and constitute a major share of essential workers in retail, grocery stores, transit workers, and many other frontline positions and
others such as farmworkers, who do not have capacities to “stay home” and fear of losing work makes them vulnerable in this pandemic
situation. Additionally, immigrants and refugees experience the challenges of lack of health insurance, unavailability of medical services
compared to their Canadian-born counterparts. The percentage of positive testing was higher among immigrants, while refugees had the
long-term residents). Another major concern is the issue of ‘infodemic’ meaning “an overabundance of information, both online and of-
-
accessibility and trust of certain groups or communities to communication materials during this health emergency, this review aims at:
1. Exploring the communication resources available in Canada around COVID-19 targeted to different subsets of the vulnerable
population.
2. Identifying the social determinants of health that impact accessing and practicing on communicated preventive measures.
3. Developing an equity-informed framework to enhance communication among the vulnerable population in such a novel pan-
demic.
Methodology
-
PubMed, Springer, and various government websites) and the most powerful Boolean search operators. Backward referrals were also
included in the relevant studies.
Eligibility criteria
Considering COVID-19 as a novel pandemic, earlier publications around emergency risk communication on pandemics such as H1N1,
-
talked about social and demographic variance impacting vulnerability during a pandemic were other inclusion criteria. Articles related to
communication for vaccines and the HIV/AIDS epidemic was excluded.
Grey literature included websites of the Public Health Agency of Canada, Health Canada, The Canadian Red Cross, Federal Emergency
-
cies, and the WHO. In addition, a scan of news reports was done for COVID-19 related communications as well as the neighbourhood
services.
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
for collecting primary data around their experience while planning programs during the COVID-19 pandemic for vulnerable people in-
cluding newcomer immigrants and refugees. Some of them were service providers, while others were policy planner or experts having
insight into the utilization of available communication resources, their implementation and strategies to improve the access to resources
and communication guidelines. Anecdotes from service providers were captured to provide narratives to the vulnerable situation of
groups and communities during the pandemic. Permission was taken from the service providers while using their names and quotes as a
part of validation from an ethical perspective.
Results and Discussion
Communication resources available in Canada during COVID-19 for different subsets of population
The Canadian government and many civil society organizations have prepared, and published communication materials related to CO-
-
tance to talk to a representative to help with the query (Canada.ca/coronavirus). Toronto Public Health (TPH) has launched a COVID-19
Outreach Rapid Response Team (CORRT) to raise awareness about prevention, testing, capacity building of community agencies, and
needs of diverse resident groups and community organizations. It also entails collaboration with various organizations to promote test
sites and COVID-related educational opportunities. As Canada has a pluralistic population translation services are also available at www.
reo.network.online.ca which has a language repository for the materials in almost 120 languages. In order to update essential informa-
on information documents that people can scan with their cell phone and then their language comes up on the phone. Access Alliance, a
multicultural community health organization has developed a multilingual health library online accessible by all service providers and
the public with the help of an app. Anyone can download the entire interface and navigate the library in their language.
Importance of information and critical health literacy
health messages for compliance, to prevent the spread of the disease, is very critical in the absence of a vaccine during this current CO-
VID-19 situation. Overall, the government and various organizations generated a huge number of communication materials for diverse
populations around pandemic related practices. Some communities experience an overwhelming number of communication materials, as
-
tions and groups with limited resources and capacities. Therefore, access to and utility of communication materials have been limited for
such subsets of the population because of credibility on one side while linguistic or technology barriers in accessing these resources on
the other. Pandemic communications ideally require people’s participation and make them major stakeholders, who act as partners in the
process of prevention, control and furthering resistance and recovery of the aftereffects of the pandemic. However, responses to any such
information are affected by socioeconomic, cultural and health factors that affect the individual’s capacity to interpret the information
and act accordingly.
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
09
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
Immigrants are among the most vulnerable yet experience major barriers to accessing and using health information
Communication materials and media are critical during a pandemic and are expected to reach everyone in the community. However,
-
vices to mitigate the impact of the pandemic. Determinants of such vulnerability are social marginalization or health-related complexities
or a combination of both. The COVID-vulnerability can be interpreted as the likelihood of getting non-proportionally higher exposure to
the infection and not-receiving adequate and timely medical assistance along with required information and social support to manage
-
enced by certain groups and populations such as new immigrants (someone who has been in the country for 5 years or less- Statistics
Council for refugees, 2010). Other determinants of vulnerability are poor living conditions, low educational level, and language barriers
the crisis of displacement, the COVID-19 pandemic and the risks they experience simply because they are young and female….we need to
hear the voices and solutions of those impacted…”.
Figure 1: Vulnerability model of marginalized population in any pandemic like COVID-19.
The social determinants of health, as vulnerabilities, that impact accessing and practicing on communicated preventive mea-
sures
Some of the identifying characteristics of these neighbourhoods were higher rates of poverty, substandard housing, lower education,
people mostly employed in the sector of sales, service, and manufacturing, such as personal support workers, cashiers, or work in grocery
stores. These areas also have the most crowded public transport and people commute to their jobs even in COVID-19, as they cannot af-
ford to stay at home. Similarly, Calla of Toronto Public Health issued an equity report focused distribution of COVID-19 prevalence in the
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
10
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
reported among low-income households (CAD 0-29,000/year) while the higher-income households (CAD 150,000 and above/year) expe-
of the people as simple as food, clothing, and medicine for chronic conditions. During pre-COVID-normal circumstances, communication
and delivery systems took care of these supports, which are dismantled or delayed sometimes due to paucity of the funds and change of
priorities during a pandemic.
Therefore, during any pandemic, the primary focus is to keep people safe and contain the outbreak. This would also mean starting
from the right communication from preventive stage to post-infection medical care measures such as providing hospitals with supplies,
providing services in pandemic situations:
• Socio-cultural barriers: -
Customary rituals, obligations towards the community, and participation in their ethnic avenues are strong components of social
• Structural barriers: Inequalities in any society, as a social determinant of health, restrict vulnerable people to practice pre-
ventive measures such as social distancing, accessing medical care and other support services rendering higher infection rates
among certain sub-groups and reduced capacities to mitigate the impact of the pandemic. In addition, measures such as social
distancing, hand washing, wearing protective equipment such as masks and gloves may appear simple but can be challenging
to procure for some groups. There have been reported cases of hoarding and hiked pricing of protective gear such as gloves and
-
tion and quarantine facilities for people with COVID-19 could be triggering. Employment engagements, economic insecurity, so-
cial safety, behaviour seeking health care, access to medical and supportive care, impact vulnerable communities disproportion-
• Language barrier and literacy level: An appropriate accessible message is very important to disseminate information for
compliance by communities. Diversity of the audience regarding language, social media use and culture shapes the comprehen-
practice it. Similar challenges remain around the accessibility of owning a phone, internet, spoken language, and level of health
literacy among different groups of people. To access online and toll-free information helpline support available in English and
• Technical barriers related to the medium of communication: The medium of communication implies the audience like
to access information tailored to their needs and capacities in terms of language and culturally sensitive presentation of the
-
-
propriate device and adequate data plan. There is also an issue of the literacy of vulnerable subsets of the population around
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
11
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
their comfort for using those technologies and using digital platforms to access information (Digital Divide). In addition, social
media is used extensively to disseminate information about COVID-19, it is also a conduit for propagating misinformation; as a
platform of knowledge mobilization it always bears a risk of standing, where no credibility check of the information is done if it
is not coming from an authentic source. This can lead to misinformation, rumours and faulty practices that adversely affects the
management and health outcomes in the pandemic.
• The credibility of the information: Another challenge in COVID-situation is constantly changing information, which requires to
be updated on all forums accordingly. Sometimes, there might be a lapse or delay in updating information on various platforms,
which creates confusion and distrust among communities. For example, in March 2020, masks were largely recommended only
masks or masks should be used where social distancing cannot be practiced. These changes are critical and need to be provided
in time adequately. Sometimes the request changes can be confusing and adversely affect the safe behaviours as well.
• Lack of trust towards public health interventions: Trust and credibility of the source providing the message is crucial for
-
ous accounts such as multiple sources of contradictory information, delayed decision-making, and political strife related to
through non-pharmaceutical intervention is the best possible chance in the pandemic, which requires trust in the health infor-
communicated by government agencies with limited support systems, is challenging for vulnerable groups, because usually vul-
nerable populations do not have a very strong and trusted relationship with government(s). Additionally, the history of oppres-
sion, colonialism, and racism in Canada is not acclaimed in favouring vulnerable groups, which might make people suspicious,
families and might be triggering for some groups such as refugees.
Equity-informed framework to enhance communication among vulnerable populations in such a novel pandemic
It is important to acknowledge that in a systematically unequal society, an equal approach disproportionately affects people who
neutral pleas for people to stay home, or stock up on necessities, are meaningless for the poor or homeless- as we saw during the Gulf
Coast hurricanes when the poor and vulnerable lacked the means to follow public health advice to “evacuate” or “shelter in place” (p-3)”
greater onus of any sickness and it is correlated to poverty, gender, race, ethnicity and social status as well. Nutrition quality, dependency
on public transportation, an existing association within a society such as immigrants and refugees being treated outsiders and resources
The World Health Organization also suggested an equity approach framework to prioritize such vulnerable populations for access to
“COVID-19 and Human Rights: we are all in this together” highlighting the vulnerability of groups in the pandemic and importance of an
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
12
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
-
tatives of community organizations delivering services to vulnerable groups, where they highlighted the need for coordination, merging
the top non-English, non-French languages that we need to put information out there”.
Based on the above-mentioned evidence and anecdotes a communication preparedness and strategy framework have been developed
on the principles of equitable participation and inclusiveness (Table 1). It suggests the process of planning and implementing emergency
risk communication and considerations around communication to reduce the barriers and in turn reducing vulnerability of subgroups.
This framework locates the process of initiating communication for pandemic and ensuring participation of the target audience as key
factors for effective communication strategy from the starting phase and situations of a pandemic for preparedness.
Strategy Description
1. Assessment
of the phase of
the pandemic for
communication
This would include time, space, and the wave of the epidemic, which means timely providing of adequate
information for the prevention, treatment, and support to cope with the pandemic situation. The message
needs to be inclusive and accessible to be understood by the target audience who are at high risk. Delayed,
partial or incomplete messages create panic and distrust among people. Therefore, assessment of who to
reach, how to reach and what to be communicated at what stage are important considerations for a risk
communication process.
2. Ongoing
communication
strategy
Communication during a pandemic need to be consistent and continuous for re-enforcing the right
information. Agencies and social institutions, which are interacting directly with vulnerable people, are
platforms for ongoing communication. These include schools, workplaces, service providers and religious
organizations, which work as support systems for people at high risk. In a pandemic situation, communi-
cation items may change rapidly; therefore, agencies and social institutions can play a vital role to reach
vulnerable communities in such a fast-paced variance situation.
3. Medium of
communication
Choosing the right medium for communication with vulnerable people is strategic during a pandemic.
There are multiple channels of communication such as print, social media, broadcasting but they are not
accessible equally by everyone. There is also a question of the credibility of the information in open space.
Thus, multiple channels of communication can be used in combination to disseminate consistent and
accurate information. This can avoid overload of information by making it simple, available in multiple
languages, using infographics, issue-based and culturally suited for the diverse population.
-
ticipation
The effectiveness of any communication strategy is determined by the level of participation of the target
population. Participation links empower and build the trust of the people in the system. Such a participa-
tory approach helps in identifying trusted community leaders and resources to be used effectively for
emergency risk communication. Social relationships and connections build social and emotional resilience
for vulnerable communities to cope with the pandemic and practice safe behaviour.
Table 1: Communication preparedness and strategy framework.
Conclusion
-
there is an indication that subsets of people are left out in the process of emergency risk communication making them vulnerable to the
Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
13
Citation: AKM Alamgir., et al. “Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for
Building Trust and Ensuring Access to Emergency Health Messages for Compliance during COVID-19”. EC Emergency Medicine and Critical
Care 5.2 (2021): 07-16.
emergency. In addition, social determinants of health contribute to health inequalities and in turn affect the accessibility, reception and
comprehension of the information provided during health emergencies.
and lack of equity in communication approach are some of the barriers to effective communication during public health emergencies.
Besides these, personal factors also restrict the communication to be comprehended and followed by vulnerable subgroups. With govern-
ment and civil society taking multiple efforts to reach out to a diverse population, they face challenges around adequate availability of
communication resources on one hand and technological hitches with an overload of information on the other. Navigating such informa-
tion with limited language and digital skills turns out to be challenging for service users in general to seek information. Therefore, a com-
munication preparedness and strategy framework have been developed to make the communication process more effective, appropriate
and inclusive to reach out to large and diverse audiences.
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Volume 5 Issue 2 Febuary 2021
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Structuring a Communication Framework to Address the Challenges of Vulnerable Communities for Building Trust and Ensuring
Access to Emergency Health Messages for Compliance during COVID-19
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