Communication without compromise: Maintaining health education standards during a crisis

BACKGROUND: In April 2009, H1N1 flu caused the Los Angeles County Department of Public Health (DPH) to activate its Incident Command Structure (ICS). DPH's initial flu response highlighted the need to strengthen organizational capacity to effectively communicate with media, clinicians, community based organizations, DPH employees, and residents. As a result, a Communications Branch (COMM) was integrated into ICS in October 2009 to lead communications efforts during DPH's mass H1N1 vaccination campaign. METHODS: As part of ICS, COMM staff used their specialized skills (e.g application of health education principles) and programmatic capacities (e.g. relationships with community-based partners) to fulfill three responsibilities: message development and dissemination; inquiry management; and clinical messaging. RESULTS: A suite of 60 DPH-branded print materials, web-based content, public service announcements, and training materials in 12 threshold languages developed over a 4 month period. All messages and materials incorporated health behavior theories (e.g. Health Belief Model and Stages of Change) and conformed to readability (8th grade or lower), layout, and community testing standards despite less than 24 hour development, review and approval deadlines. CONCLUSIONS: It is challenging but not impossible to maintain basic health education principles at the forefront of message development while satisfying emerging needs of diverse stakeholders. Effective new infrastructure can be created in large bureaucratic systems by mobilizing in nontraditional ways and can (1) improve communication and (2) spur collaboration among internal and external stakeholders beyond emergency response situations.