State and local health departments get mixed marks for efforts to convey information about the H1N1 virus to the public using their Web sites immediately after U.S. officials declared a public health emergency in April, according to a new RAND Corporation study.
While 46 of 50 state health departments posted some information about the outbreak within 24 hours of the federal announcement, the performance of local health departments was inconsistent. Just one-third of the 153 local health departments studied posted information to their Web sites within 24 hours of the announcement, although larger jurisdictions did better, according to the RAND Health study published online by the journal Health Affairs.
Performance varied widely among local health departments across the five states that had confirmed cases at the outset of the epidemic -- California, Texas, New York, Ohio and Kansas. While 73 percent of the California counties sampled provided some online information, just 8 percent of the counties in Kansas and 18 percent of the Texas counties quickly provided information online, according to the study.
Researchers say the outbreak of the H1N1 flu provided a rare opportunity to evaluate the performance of state and local health departments during an actual emergency.
"We found that the capability to conduct basic crisis and emergency risk communication is quite good at the state level, but there remains significant variation at the local level," said Jeanne Ringel, lead author of the report and a senior economist at RAND, a nonprofit research organization. "We concluded there is room for improvement at all levels, particularly in the area of providing information in languages other than English."
Since 2001 federal, state and local governments across the United States have invested heavily in preparing for public health emergencies and measuring how well the nation is prepared. RAND researchers examined health agencies' use of Web-based communications directed to the public because crisis and emergency risk communication is one of the central components of emergency response.
RAND researchers examined the Web sites of state and local departments 24 to 30 hours after the U.S. Department of Health and Human Services declared a public health emergency on April 26 because of the rising risk posed by the global spread of the H1N1 flu virus. They reviewed Web sites to see whether information was provided, how easy it was to access and whether the information available contained critical pieces of information.
In addition to surveying all state health Web sites, researchers sampled local health department Web sites from the five states where cases of the H1N1 flu had been diagnosed at the time of the federal announcement and from local health departments taking part in the Cities Readiness Initiative (a federal effort to improve disaster preparedness in the nation's most-populated areas).
A majority of the state health departments posted content judged to be high in quality, according to the study. Most state departments (43 out of 47) provided information about how individuals could protect themselves or their family, although fewer provided information about when to seek treatment (36 out of 47) or who should take antiviral drugs (27 out of 47).
In addition, 30 states provided information for healthcare providers -- 14 provided their own information and 16 linked to information posted by the U.S. Centers for Disease Control and Prevention. Slightly more than half posted a news release and nine states provided information in languages other than English.
RAND researchers found that among the 34 percent of the local public health departments that posted information to their Web site within 24 hours of the federal announcement, more than half (54 percent) accomplished this by linking to the CDC or their state health department Web site.
Performance was better among local health departments involved with the Cities Readiness Initiative. More than half of those health departments posted information to their Web sites, while only a quarter of smaller local health departments did so. Being able to communicate with the public quickly during an emergency is a key measurement used to evaluate agencies' preparedness.
Researchers say that one significant shortcoming highlighted by the study was the need to communicate in multiple languages. The need for Spanish language communications was particularly important in the H1N1 outbreak because the virus emerged in Mexico and much of the initial discussion in the media was about border and immigration issues.
"While providing information online is just one of many actions public health agencies might take during an emergency, we believe this study provides some insight into how well the public health system is reacting to the H1N1 flu outbreak," Ringel said.
Other authors of the study are Elizabeth Trentacost and Dr. Nicole Lurie. The study was conducted in the public interest and supported by RAND using discretionary funds made possible by the generosity of its donors and the fees earned on client-funded research.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics. RAND Health is the creator of COMPARE (Comprehensive Assessment of Reform Efforts), a one-of-a-kind online resource that provides objective analysis about national health care reform proposals. Visit www.randcompare.org to learn more.
The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. To sign up for RAND e-mail alerts: http://www.rand.org/publications/email.html
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Health Affairs