Guidance on Community Engagement for Public Health Events Caused by Communicable Disease Threats in the EU/EEA

"Development of trust is the crucial precursor for effective engagement and collaboration during a public health emergency."

This guidance on community engagement for public health emergency preparedness is meant to provide step-by-step technical support to Member States in European Union (EU) and European Economic Area (EEA) countries who are initiating or professionalising their core community engagement capacity. It is organised according to the 3 core stages of the preparedness cycle: anticipation, response, and recovery.

The guidance emerges from a project carried out by the European Centre for Disease Prevention and Control (ECDC) as part of the process of optimising preparedness for serious cross-border public health threats (for instance, COVID-19). The focus of the effort is on synergies between communities affected by public health threats and the institutions mandated to prepare for and respond to them. The premise of the project is that communities are increasingly recognised as key partners that can be engaged with during public health emergencies, and that the capacities and experiences that reside within community networks should be harnessed as an important part of the response. Similarly, the ECDC contends, it is important to understand how, and the extent to which, institutions in the health and relevant non-health sectors at national, local, and regional levels can collaborate in such community-oriented work.

ECDC defines "community" as not only at-risk groups who are physically or geographically affected by public health threats but also as those stakeholders who are linked to these affected populations and who may be able to assist in the process of solving or mitigating the problem. Engaging these communities is a process that ECDC conceives of as moving along a continuum (see above): from involvement of community-based partners and at-risk communities in the exchange of risk information, to the gradual development of longer-term partnerships with shared decision-making that can address a wider range of social, economic, political, and environmental issues relating to health. As one moves along the continuum, increasing levels of trust and engagement can develop.

The document offers strategic guidance built on generic principles to be operationalised in specific country-system contexts, according to local, regional, and/or national requirements and jurisdiction. More specifically, ECDC urges adaptation of preparedness and response planning according to country-specific cultural, epidemiological, and political contexts, and according to the specific mandates of public health authorities.

All 14 guidance points were derived empirically from the field work of case studies, informed by the findings of a literature review and further refined during an expert consultation. Each of the 14 points is presented in the document with lists of relevant actions that can be considered, along with links for further information. They include:

Through all 3 phases of the preparedness cycle:

• 1. Recognise the community as a partner. (Example: Local or regional After Action Reviews (AARs) are a means to learn, listen, and share experiences of community-based partners who have supported response coordination.)
• 2. Develop understanding of community perceptions. (Example: Monitoring community perceptions not only enables authorities to respond to misinformation or rumours about an issue that may emerge throughout the population but may also allow for better understanding of the logic behind community attitudes.)
• 3. Optimise communications with at-risk communities. (Example: It is important to apply audience segmentation in risk communication, as different communities may perceive a given health threat in different ways, have different health literacy levels, and be different in the way they respond to control measures that are implemented.)
• 4. Invest in a trusted spokesperson and long-term media relations. (Example: Journalists can be important sources of information for what is going on in the community, while also disseminating key information to at-risk populations.

Anticipation phase:

• 5. Map stakeholders and integrate them into preparedness planning. (Example: This increases ownership and "buy-in" on behalf of community partners, and it facilitates collaboration and adoption of needed practices, behaviours, or technologies, as well as the inclusion of newly emerging relevant community partners.)
• 6. Develop an accessible and inclusive preparedness and response training programme. (Example: Community-based actors need to be included in training and development of response training materials.)
• 7. Cultivate relationships with communities engaged in disease surveillance. (Example: Citizen science initiatives that are explicitly focused on obtaining surveillance and research data through public participation hold the potential for collaboration, and, when in the form of online platforms (e.g., the Dutch online "Tick Radar"), can provide the added benefit of disseminating risk communication messages.)
• 8. Engage with pre-existing community networks and infrastructures. (Example: Groups like hunters or farmers can anticipate training needs, anticipate where aid is required, and may have networks of experienced or even pre-vetted volunteers.)
• 9. Set research agenda in collaboration with community partners. (Example: Including community partners in proposal development, for instance, has the advantage of attaining a more careful weighing of social and epidemiological priorities by seeking synergies and building on mutual understanding.)

Response phase:

• 10. Coordinate distribution of information, protective equipment, and other resources for and with community partners. (Example: Poorly trained or insensitive volunteers can lead to mistrust of public institutions, so it can be helpful to support organised volunteers who are vetted, as well as to award and acknowledge innovative volunteer programmes.)
• 11. If using an all-hazards approach, recognise the special character of infectious disease outbreaks, and act accordingly. (For example, decisions to activate response systems may be more difficult to make during what could initially be a small outbreak in comparison with the more immediate impact of a natural disaster.)
• 12. Facilitate resolving of possible issues with community-level financial losses. (Such financial burdens can severely affect community organisations, groups, households and individuals, and they can also undermine future adherence to or engagement in response activities.)

Recovery phase:

• 13. Integrate and document community engagement in evaluation processes. (A synthesis of the recommendations from previous outbreak reports, along with a broad dissemination process could help to ensure that the lessons learned from previous experiences are remembered, referenced, and acted upon.)
• 14. Promote community debriefing, dialogue, and a culture of shared learning. (Debriefing sessions should motivate dialogue about what happened and what was done, verification of observed community impacts, and possible improvements for next time, without judgments or taking criticisms too personally.)

ECDC notes that "Community engagement requires skilled practitioners, dedicated to fully engaging and integrating with the preparedness and outbreak control team and supporting implementation of the community engagement concept." This document is an attempt to help support that work.

Provided by The Communication Initiative, the above is a summary of "Guidance on Community Engagement for Public Health Events Caused by Communicable Disease Threats in the EU/EEA", whose copyright is owned by the European Centre for Disease Prevention and Control (ECDC). The original document was drafted in English and is available here. ECDC does not hold any responsibility with regards to the accuracy of the summary.