title: Public health communications and alert fatigue.
abstract: BACKGROUND
  Health care providers play a significant role in large scale health emergency planning, detection, response, recovery and communication with the public. The effectiveness of health care providers in emergency preparedness and response roles depends, in part, on public health agencies communicating information in a way that maximizes the likelihood that the message is delivered, received, deemed credible and, when appropriate, acted on. However, during an emergency, health care providers can become inundated with alerts and advisories through numerous national, state, local and professional communication channels. We conducted an alert fatigue study as a sub-study of a larger randomized controlled trial which aimed to identify the most effective methods of communicating public health messages between public health agencies and providers. We report an analysis of the effects of public health message volume/frequency on recall of specific message content and effect of rate of message communications on health care provider alert fatigue.
  
  
  METHODS
  Health care providers enrolled in the larger study (n=528) were randomized to receive public health messages via email, fax, short message service (SMS or cell phone text messaging) or to a control group that did not receive messages. For 12 months, study messages based on real events of public health significance were sent quarterly with follow-up telephone interviews regarding message receipt and topic recall conducted 5-10 days after the message delivery date. During a pandemic when numerous messages are sent, alert fatigue may impact ability to recall whether a specific message has been received due to the "noise" created by the higher number of messages. To determine the impact of "noise" when study messages were sent, we compared health care provider recall of the study message topic to the number of local public health messages sent to health care providers.
  
  
  RESULTS
  We calculated the mean number of messages that each provider received from local public health during the time period around each study message and provider recall of study message content. We found that recall rates were inversely proportional to the mean number of messages received per week: Every increase of one local public health message per week resulted in a statistically significant 41.2% decrease (p < 0.01), 95% CI [0.39, .87] in the odds of recalling the content of the study message.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to document the effects of alert fatigue on health care providers' recall of information. Our results suggest that information delivered too frequently and/or repetitively through numerous communication channels may have a negative effect on the ability of health care providers to effectively recall emergency information. Keeping health care providers and other first-line responders informed during an emergency is critical. Better coordination between organizations disseminating alerts, advisories and other messages may improve the ability of health care providers to recall public health emergency messages, potentially impacting effective response to public health emergency messages.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA. jbaseman@uw.edu
authors.forename: Janet G
authors.initials: JG
authors.lastname: Baseman
authors.forename: Debra
authors.initials: D
authors.lastname: Revere
authors.forename: Ian
authors.initials: I
authors.lastname: Painter
authors.forename: Mariko
authors.initials: M
authors.lastname: Toyoji
authors.forename: Hanne
authors.initials: H
authors.lastname: Thiede
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Duchin
mesh_terms: D000328:Adult; D003142:Communication; D016001:Confidence Intervals; D004190:Disasters; D034742:Electronic Mail / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D005222:Mental Fatigue; D011939:Mental Recall; D008875:Middle Aged; D011634:Public Health; D036301:Qualitative Research; D060145:Text Messaging / Q000706:statistics & numerical data; D014861:Washington
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