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1.  The Potential Impact of Directionality, Colour Perceptions and Cultural Associations on Disaster Messages During Heatwaves in the UK 
PLoS Currents  2015;7:ecurrents.dis.775c310222d5829cb29b7a414370ca50.
The health risks posed by heatwaves have been well documented. In the UK, before and during a heatwave, alerts are issued to the general public based on a tiered warning system integrating the use of colour and number sequences. There has of yet been no formal assessment of the public response to these messages. Cultural and language barriers make some members of ethnic minority communities particularly hard to reach. These may be less challenging amongst younger community members, who may be well placed to instigate the circulation of warning information to those less able or willing to use conventional channels. This qualitative study assesses the role of age and ethnic and cultural background in the conceptualisation of the number and colour systems used as part of the Heat-Health Watch System (HHWS) and the National Severe Weather Warning Service (NSWWS). Young and older participants were recruited from the Bangladeshi and white British populations of Tower Hamlets. All participants were given a cognitive task that required them to identify and draw associations between 12 cards depicting the four colours and numbers used in the warning system and four pictures providing contextualisation in terms of heatwave risk. A qualitative analysis of the heuristics used in the group discussions provided insights into the conceptualisations basic to interpreting colour and number sequences as representations of risk graduations, and how interpretation might be influenced by age and ethnic and cultural background. There were considerable differences in the interpretation of young Bangladeshi and older white British participants, on the one hand, and older Bangladeshi participants, on the other. Young Bangladeshis and older white British participants conceptualised the colours and numbers as a vertical scale, with the numbers/colours at “the top” corresponding to representations of higher temperature. This conceptualisation was mainly based on strong associations between colour and temperature, with risk only associated with the upper limit of the scale. Older Bangladeshi participants, on the other hand, conceptualised the numbers and pictures as a narrative sequence and disassociated the colours from the other cards. The differences between groups suggest potential cultural barriers to the “intended” interpretation of the colour and number sequences for older Bangladeshis but not for young Bangladeshis. The fact that the predominant association for the colour sequence for both young Bangladeshis and older white British participants was with graduations of temperature rather than risk raises questions about the applicability of using colours in a tiered warning system.
doi:10.1371/currents.dis.775c310222d5829cb29b7a414370ca50
PMCID: PMC4404266  PMID: 25932346
2.  The Causes and Circumstances of Drinking Water Incidents Impact Consumer Behaviour: Comparison of a Routine versus a Natural Disaster Incident 
When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.
doi:10.3390/ijerph111111915
PMCID: PMC4245651  PMID: 25411725
public health communication; compliance; routine incident; human error; natural disaster; drinking water
3.  Communication, perception and behaviour during a natural disaster involving a 'Do Not Drink' and a subsequent 'Boil Water' notice: a postal questionnaire study 
BMC Public Health  2010;10:641.
Background
During times of public health emergencies, effective communication between the emergency response agencies and the affected public is important to ensure that people protect themselves from injury or disease. In order to investigate compliance with public health advice during natural disasters, we examined consumer behaviour during two water notices that were issued as a result of serious flooding. During the summer of 2007, 140,000 homes in Gloucestershire, United Kingdom, that are supplied water from Mythe treatment works, lost their drinking water for up to 17 days. Consumers were issued a 'Do Not Drink' notice when the water was restored, which was subsequently replaced with a 'Boil Water' notice. The rare occurrence of two water notices provided a unique opportunity to compare compliance with public health advice. Information source use and other factors that may affect consumer perception and behaviour were also explored.
Method
A postal questionnaire was sent to 1,000 randomly selected households. Chi-square, ANOVA, MANOVA and generalised estimating equation (with and without prior factor analysis) were used for quantitative analysis.
Results
In terms of information sources, we found high use of and clear preference for the local radio throughout the incident, but family/friends/neighbours also proved crucial at the onset. Local newspapers and the water company were associated with clarity of advice and feeling informed, respectively. Older consumers and those in paid employment were particularly unlikely to read the official information leaflets. We also found a high degree of confusion regarding which notice was in place at which time, with correct recall varying between 23.2%-26.7%, and a great number of consumers believed two notices were in place simultaneously. In terms of behaviour, overall non-compliance levels were significantly higher for the 'Do Not Drink' notice (62.9%) compared to the 'Boil Water' notice (48.3%); consumers in paid employment were not likely to comply with advice. Non-compliance with the general advice to boil bowser water was noticeably lower (27.3%).
Conclusion
Higher non-compliance during the 'Do Not Drink' notice was traced to the public's limited knowledge of water notices and their folk beliefs about the protection offered from boiling water. We suggest that future information dissemination plans reduce reliance on official leaflets and maximise the potential of local media and personal networks. Current public health education programmes are recommended to attend to insufficient and incorrect public knowledge about precautionary actions.
doi:10.1186/1471-2458-10-641
PMCID: PMC3091565  PMID: 20973959

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