Infodemics, trust, and communication about COVID-19

WHO has identified an infodemic around COVID-19. To be sure, it can be tough for anybody to make sense of the information flooding around the coronavirus. This episode looks at what trust has to do with communicating information. You’ll learn what you can do to help your communication reflect trust.

Over the years I’ve spoken with many health care workers, and many times have heard a version of this question: how can we say something that will get through?

Especially now with the coronavirus, I appreciate the sense of urgency in that question, and recognize health professionals’ real desire to help. As health professionals, you want to communicate good information in such a way that it enters people’s decision-making process and, ideally, informs their thinking and action.

Good information can help flatten the curve. Bad information, on the other hand, can lead to negative health outcomes for individuals and groups. But there are several related issues here, and today I dig into one of them: trust.

This is 10 Minutes to Better Patient Communication and I’m Dr. Anne Marie Liebel.

NPR’s Goats and Soda recently reported on the fact that the WHO described an ‘infodemic’ around COVID-19. Here’s what WHO means by that.

“Infodemics are an excessive amount of information about a problem that makes it difficult to identify a solution. Infodemics can spread mis and disinformation and rumors during a health emergency. Infodemics can hamper an effective response and create confusion and distrust among people.”

Infodemics arguably are not limited to the coronavirus. We’re swimming in information now about all sorts of health topics. And the public are surely not the only ones experiencing these “difficulties in identifying a solution.” For instance, a physician-administrator at a large metro health system just told me about the very good questions being asked by health systems insiders about the coronavirus crisis. But for today’s episode, I’m going to stick with the scenario of health professionals seeking to communicate with patients or the public.

The WHO has a new approach, called EPI-WIN. In it, WHO is paying attention to who people already trust. That’s because they are trying or hoping to take advantage of what they call the ‘trust chain’ saying:

“During emergencies demand for information is high, there are often many unknowns and people will seek information from sources and individuals and entities they trust. WHO will identify these trusted sources and engage them as amplifiers of accurate, timely information. This information will be tailored to different audiences, answering pertinent questions as the event unfolds and providing access to additional response assets.”

There is much in this approach, I think, to like–at least from a language, literacy and education perspective.

This WHO plan to identify “trusted sources” is itself an interesting starting point. As well as building and maintaining trust in WHO itself, they are also going to places where trust already exists. Where, you may ask? Well, they are leaning on A worldwide 2019 public relations study of people’s trust in institutions. This study found that, lately, people trust their employers most. More than NGOs, other businesses, government, and media. Therefore, WHO believes there’s value in making use of employers as sources of reliable health information.

I think it’s a safe assumption that the WHO will give these employers some guidance not only on this information and how, when, how much and in what forms it might be shared. And they’re starting with employers because employers are trusted. But I argue it can’t stop there. That’s because whatever guidance the WHO provides could have an impact on the trust that already exists.

So I’m going to share here something I hope WHO addresses but I’m sharing it because it might be helpful to you, as you communicate with patients or the public.

It might go without saying that good information is incredibly valuable. A focus on giving good information is appropriate. But it can be easy to fall into delivery mode, and I’ve talked about before.

I’ve found, especially in times of high stress, that it can be tempting to think about communication as a simple transfer of information. As if we were maybe sharing some chocolate, like “I have it, and I give it to you, and now you have it.”

It’s just, ideas and information don’t travel between people quite as neatly as pocket snacks. Yet too often, a simple transfer of information—here, read this, listen to this–seems to count as communication.

Communication is not simply a transfer of information. There’s much more going on here. So let’s look under the hood.

Part of the advantage of utilizing employers is that, according to that study, trust already exists in the employer/employee relationship. We can assume whatever trust is there was built through words and actions, over time. Job security, consistent and timely paychecks, managers who follow through on promises, all those words and actions matter.

For example, I was talking with a manager at a large US retailer after she participated in a conference call in which corporate leadership addressed the coronavirus, gave some guidance, and described steps they were taking. I asked her what she thought about the call. She expressed her belief that her employer would act in the employees best interest, even putting employee safety before selling the products. I asked her why she felt this, and she gave me examples from her experience over the years when her employer had acted in ways that prioritized employees.

As a health professional, you work hard to gain people’s trust. You want to maintain that trust. Employers probably want to maintain the trust that employees have in them, including any times they’re relaying health information.

When it comes to trust, actions matter. So do words. And that’s where I want to zoom in. It turns out that the words and phrases we use have relationship-building properties. Critical discourse analysis shows how we’re always doing more than just talking or writing. Linguist James Gee points out that we are always building things through language. He identifies “seven building tasks” of language. I’ve talked about some of these before. Because Today’s episode is about trust, I’ll focus on one language task called “building relationships.”

Here’s what Gee says about the words we use when it comes to building relationships:

“We use language to signal what sort of relationship we have, want to have, or are trying to have with our listeners(s), reader(s), or other people, groups, or institutions about whom we are communicating; that is, we use language to build social relationships. For example, in a committee meeting, as chair of the committee, I say “Prof. Smith I’m very sorry to have to move us on to the next agenda item” and signal a relatively formal and deferential relationships with Professor Smith. On the other hand, suppose I say, “Ed, it’s time to move on.” Now I signal a relatively informal and less deferential relationship with the same person.”

So our choices of words and phrases are always in the process of building, maintaining, or eroding relationships. Sometimes this happens without our notice.

So what might this mean for employers—or for you—when seeking to maintain good relationships and the trust between them, when communicating with people about COVID-19 or any other health matter?

• Remember the relationship-building quality of the words and phrases we use.
• Don’t take any words or phrases for granted. Look carefully at all of them. Do these words reflect the trust you have in people, as well as the trust they have in you?
• Look at the assumptions you’re making about your audience. Specifically, assumptions about:
  • what they already know and believe,
  • what they already think about you or your organization, and
  • who they already trust.
• Let this inform your choices of words and images.

If you’d like some help in this, contact me. Go to healthcommunicationpartners.com and click ‘contact.’ Find me on twitter @amliebel. This has been 10 Minutes to Better Patient Communication and I’m Dr. Anne Marie Liebel.