Alexandra Latham¹, Ana Gil Luciano², Alberto Martín-Pérez Rodríguez², José Antonio Jiménez³, Marlen Menéndez³, Afroditi Veloudaki ⁴, Ioannis Koutelidas⁴, Eleni Fagogeni⁴, Pania Karnaki⁴

¹EuroHealthNet

²Ministry of Health, Spain

³UNGA Association, Equi-Sastipen-Rroma Network)

⁴Prolepsis institute (Greece)

Introduction

The aim of this article is to explore some of the ways public health agencies and services communicated with specific groups during the COVID-19 pandemic. In doing so, we look at how communication professionals are collaborating and addressing the urgent questions for public health about how to design open, constructive dialogue in our changing world.

The way people communicate is changing rapidly thanks to new technologies and social norms. Before the pandemic, parts of the public health community were already grappling with how to operate in these new environments. The emergence of COVID-19 added urgency to this work.

There are multiple questions to address concerning public health communication. These include classic questions about how to create clear and evidence-based messages, and how to deliver them to the right audiences. There are also specific questions, for example about how to effectively create new forms of (social) media, work with new online platforms, and moderate new (online) spaces. Further, there are wider questions about how to move from one-way communication to dialogue. This latter question is linked to a growing appreciation for the need to address health inequalities and to co-create policies and interventions by involving target populations, in particular those whose experience has been marginalised or ignored in the past, those who feel ‘left behind’, and those who fall victim to misinformation.

One fundamental question is: can we talk?

-          Do we have the technical skills and the spaces to have constructive dialogues?

-          How can we create those skills and moderate those spaces?

EuroHealthNet’s communication network, which brings together communication professionals from European public health bodies, has addressed many of these questions in recent years. This article describes the work of this network and the innovative work of some of its members. The article provides a concrete example from Spain of public health professionals’ work on innovative communication to specific groups during the pandemic, and an example from Greece on supporting older people.

A network for communicators to share, compare, and understand common challenges

The EuroHealthNet partnership brings together Europe’s public health institutes and authorities to work on health equity and wellbeing. It covers public health policy, practice, and research. One of its activities is hosting a communications network, which brings together the responsible press officers and communicators from member agencies. By late 2021, there were around 50 individuals from across Europe involved.

At the outset, in 2018, the purpose of the group was threefold:

1. To bring local, regional, and national issues to the European level. This involved identifying and amplifying members’ messages and campaigns in the European sphere.
2. To bring European issues to the national level. This involved bridging the information gap between the EU and the national level.
3. To facilitate international exchange. This involved giving partners an opportunity to share and exchange their ideas, work, problems, and solutions.

In practice, the need for international exchange has gained importance. As the group has grown in number and experience, it has increasingly become a space to share, compare, and understand common challenges. This network was able to quickly mobilise when the pandemic hit European countries.

Case Study 1: ‘Why do I get vaccinated?’ - COVID-19 vaccination and the Roma population in Spain

It is well understood that Roma people face disadvantage, discrimination, and experience health inequalities compared with other populations. This campaign to improve communication on COVID-19 vaccination amongst Roma was developed by Roma people, in collaboration with the Spanish Ministry of Health. It involved a multi-media campaign.

With the aim of improving communication on COVID-19 vaccination among Roma population, the Equi-Sastipen-Rroma Network in Spain developed a vaccination campaign in June 2021, with the active participation of the Roma population.

The Equi-Sastipen-Rroma Network is composed of 22 Roma associations and federations across Spain that develop health projects (UNGA Sociocultural Association of Ethnic Minorities., n.d.). The Network is coordinated by the UNGA Association. This Network has been recognised by the World Health Organization (WHO) as an inspiring example for creating resilient communities (Ministry of Health of Spain, 2018) and in 2020, was awarded the Nelson Mandela Award on Health Promotion by WHO (Ministry of Health of Spain, 2020). The Spanish Ministry of Health supports the Network, with the aim of advancing health promotion and social participation as key elements to achieving health equity for the Roma population.

The Network developed the vaccination campaign in collaboration with the Ministry of Health around messages linked to the main question: “Why do I get vaccinated?”. The campaign is composed of short videos to enable better dissemination on social media. The participants in each video are Roma and non-Roma people that work on Roma social inclusion, with different ages and backgrounds. In the videos, the participants explain why it is important to get vaccinated and present their personal motivations to get vaccinated. In total, 13 videos were recorded, and a final compilation video of all of them was made available.

The campaign was launched on 15 June 2021 with the title ‘I get vaccinated. I’ll tell you why…’ (Yo me vacuno. Te digo por qué). It was published on the Ministry of Health website (Government of Spain, 2021) and in the UNGA Association YouTube account (link) (UNGA Sociocultural Association of Ethnic Minorities, 2021). Dissemination was conducted throughout the summer of 2021 on social media (Instagram and Facebook (link)).

Case Study 2: Talking with and supporting older people during the pandemic

Older people have been affected immensely by the pandemic, given that they are among the most vulnerable to COVID-19.  Prolepsis Institute (link), a non-profit public health organisation established in Greece in 1990, implemented several actions to help older people in Greece cope with the ‘new reality’ caused by COVID-19.

More specifically, the Prolepsis Institute implements a project aimed to combat loneliness and social isolation, the Friendship at Any Age (link), the onset of which coincided with the COVID-19 pandemic. The program includes: 

• Interconnection of older people and volunteers. Volunteers connect with older people, aiming to develop bonds of friendship, through telephone communication on a weekly basis (and/or make home visits, if possible).
• Α helpline to combat the loneliness of older people – +30 210-6101300. The helpline is available to older people who feel lonely, as well as to their caregivers, friends, and relatives.

Due to the pandemic and related social distancing measures, the program was adapted. Home visits were replaced with weekly telephone communication, aiming to relieve feelings of loneliness and isolation felt during lockdown periods. At the same time, volunteers who participated in the program received training and support. Among other things, they learned about health promotion among older people, how to communicate about COVID-19, protective behaviours, and vaccination issues. For the purposes of dissemination and sustainability, the program cooperates with a vast network of social partners. This includes municipalities, care units for older people, and civil society organisations. The founding donor of the Friendship at any age program is the TIMA Charitable Foundation.

Next, with the support of two private clothing companies, Prolepsis Institute offered protective cotton masks for 2,000 residents of retirement homes and 1,000 inmates of a female prison.

Also, in collaboration with a private energy company in Greece, Prolepsis Institute supported older people during lockdowns by covering their basic needs. This helped people to stay at home safely. The Prolepsis Institute set up a service through which beneficiaries were contacted on a weekly basis and were offered services. This included having their shopping done and delivered to their homes, their medication delivered, and their bills paid (e.g., electricity bills). Also during the pandemic, the Institute worked on raising awareness with regards to the needs and challenges that older people face through announcements, social media posts, and interviews in local and national media.

Conclusions

The case study from Greece shows how important it is during times of public health emergencies to support vulnerable people, especially those who are lonely and isolated, and to communicate the urgency of the situation in a pragmatic way, supporting them to make the right decisions that will enable them to protect their health and safety.

The case study from Spain shows that it is important to carry out tailor-made communication with a participatory approach. It must respond to the specific needs of the population and consider the specific important reasons to get vaccinated.

While the pandemic has been a time of uncertainty, there were also many ‘knowns’ – we had the benefit of a great deal of pre-existing knowledge. We will need to collectively decide where we have used the ‘knowns’ for good, and where we must do better in the future. For example, we knew before the pandemic about some of the communication challenges we face, and that Roma and older people experience vulnerability and health inequalities. While COVID-19 was a new virus, we had a wealth of knowledge about how pandemics progress, as well as expertise in infectious diseases, public health, and epidemiology.  We also know health issues are rarely black and white, and that doubt has a crucial role in science. While this may complicate messaging, it is important to acknowledge, if we are to be truthful and clear.

References

Ministry of Health of Spain. (2018). Spain: Strengthening resilience in the Roma community. In: World Health Organization, Regional Office for Europe: Health 2020 priority area four: creating supportive environments and resilient communities. A compendium of inspirational examples. https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/promocion/desigualdadSalud/Comunidades_Resilientes.htm

Ministry of Health of Spain. (2020). Recognition of the WHO to the Equi-Sastipen-Rroma Network with the Nelson Mandela Award for Health Promotion. [Reconocimiento de la OMS a la Red Equi-Sastipen-Rroma con el premio Nelson Mandela de promoción de la Salud]. https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/promocion/desigualdadSalud/PremioNelsonMandela.htm 

Ministry of Health of Spain. (2021). Vaccination campaign against COVID-19 aimed at the Roma population. [Campaña de vacunación frente a la COVID-19 dirigida a población gitana]. https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/promocion/desigualdadSalud/campanaCOVID19.htm 

UNGA Sociocultural Association of Ethnic Minorities. (2021). I get vaccinated. I’ll tell you why [Yo me vacuno, te digo por qué]. https://asociaciongitanaunga.com/2021/06/15/yo-me-vacuno-te-digo-por-que/

UNGA Sociocultural Association of Ethnic Minorities. (n.d.). The Red Equi-Sastipen-Rroma. https://asociaciongitanaunga.com/red-equi-sastipen-rroma/