title: Risk Communication Recommendations and Implementation During Emerging Infectious Diseases: A Case Study of the 2009 H1N1 Influenza Pandemic.
abstract: OBJECTIVE
  To examine their implementation, we analyzed World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines from 2005 to 2008 for risk communication during an emerging infectious disease outbreak, WHO and CDC reports on implementing the guidelines worldwide after the 2009 H1N1 pandemic; and a case study of a member state.
  
  
  METHODS
  A qualitative study compared WHO and CDC guidelines from 2005 to 2008 with WHO and CDC reports from 2009 to 2011, documenting their implementation during the H1N1 outbreak and assessed how these guidelines were implemented, based on the reports and Israeli stakeholders (n=70).
  
  
  RESULTS
  Eight risk communication subthemes were identified: trust, empowerment, uncertainty, communicating the vaccine, inclusion, identification of subpopulations and at-risk groups, segmentation, and 2-way communication. The reports and case study disclosed a gap between international guidelines and their local-level implementation. The guidelines were mostly top-down communications, with little consideration for individual member-state implementation. The WHO and CDC recommendations were not always based on formative evaluation studies, which undermined their validity.
  
  
  CONCLUSIONS
  In formulating effective communication strategies, the first step is to define the goal of a vaccination program. We recommend implementing conceptual elements from the most current theoretical literature when planning communication strategies and increasing organizational involvement in implementing guidelines in future health crises. (Disaster Med Public Health Preparedness. 2014;0:1-12).
authors.affiliation: School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gesser-Edelsburg
authors.affiliation: Centre for Science, Society and Citizenship, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Mordini
authors.affiliation: Center for Public Health Preparedness and Disaster Response, American Medical Association, Chicago, Illinois.
authors.forename: James J
authors.initials: JJ
authors.lastname: James
authors.affiliation: World Health Organization, Centers for Disease Control and Prevention, and European Centre for Disease Prevention and Control, Rome, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Greco
authors.affiliation: School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
keywords: H1N1; emerging infectious disease (EID); guidelines and procedures; implementation; qualitative study; risk communication; stakeholders