Public Affairs in Health (PAH)

Original Research

Crisis and Emergency Risk Communication: Bandura′s Social Cognitive Theory and Pandemic Influenza Response

Barbara Reynolds, PhD

Abstract

Albert Bandura’s social cognitive theory stresses the importance of observational learning and the concept of self-efficacy (Grohol, 2004). One’s self-efficacy, or one’s confidence in one’s ability to perform, stems from four sources: personal physical and emotional states, mastery experiences, vicarious experiences, and social persuasion. Public health can apply social cognitive theory to help protect communities during a severe influenza pandemic. The effort to build or raise personal and group efficacy is worthwhile because a severe pandemic will touch nearly every person and community for an extended length of time. To save lives and the societal infrastructure, any advantage offered by social cognitive theory to ensure individuals and entire communities believe their use of NPI strategies are valuable and that they have the ability to take recommended actions is worthwhile. Knowledge alone is not enough; knowledge must be combined with self- and group efficacy for people and groups to engage in successful health behaviors. Social cognitive theory is foundational to the CDC’s crisis and emergency risk communication (CERC) framework and should be considered when communicating about NPIs.

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Introduction

Editor’s Note: Since this paper was written and accepted for publication, the public health community has recognized a novel influenza type A/H1N1 virus as causing illness and death among humans. The novel H1N1 flu virus is being confirmed as causing illness among humans in nations around the globe, and The World Health Organization has moved to Phase 5 of the global pandemic plan. The CDC has cautioned that, while planning for the possibility that avian influenza H5N1 would emerge as a pandemic influenza strain, other influenza viruses with the potential to cause an influenza pandemic could emerge. With that understanding, the preparation for H5N1 or any potential pandemic virus is critically relevant today as community mitigation measures are being instituted and recommended.

The world is preparing for the next pandemic of influenza (CDC, 2007). If the next pandemic is as severe as the 1918 pandemic, the Centers for Disease Control and Prevention (CDC) estimates that approximately 2 million Americans could die. Concern is heightened because the H5N1 avian influenza virus circulating now and causing deaths among humans and birds is highly virulent. The H5N1 virus does not yet meet the criteria to be declared a pandemic strain. For an influenza virus to qualify, it must be novel (i.e., the human population has no immunity to it through earlier exposures), virulent, and easily transmitted from person to person. At present, the H5N1 virus is not easily transmitted from person to person (DHHS, 2008). A pandemic influenza vaccine can not be manufactured in pandemic quantities until the pandemic influenza strain emerges. This leaves public health officials with the quandary of how to protect people from the influenza virus during the early phase of a pandemic when vaccine and antivirals will be in extremely short supply. The answer at this time is the implementation of nonpharmaceutical interventions or NPIs (Bell, 2006; Stohr, 2005).

The NPIs currently under consideration require changes in individual and community behaviors. The goals of the NPI behaviors are to limit the spread of the pandemic, reduce illness and deaths, and lessen the impact on societal infrastructures such as reducing workplace absenteeism and numbers of hospitalizations. CDC has identified the following four pandemic mitigation interventions: isolation of ill people in their home or the hospital; voluntary home quarantine of non-ill family members for at least 4 days (i.e., two transmission periods) when a household member is presumed ill with pandemic influenza; dismissing students from school attendance and closing child care programs; and social distancing to reduce contact among adults (e.g., cancel large public gatherings and telecommute to work). Retrospective studies of behaviors by individuals and U.S. cities during the 1918 pandemic suggested that this approach would achieve the stated goals. For this strategy to be effective in a severe pandemic, individuals and communities would have to adopt these behaviors early once the virus arrived in their community and be willing to sustain them for possibly as long as twelve weeks. Therefore, for this plan to be a viable option, individuals and entire communities must believe the program is effective and that they can meet its requirements.

Albert Bandura’s social cognitive theory may be an important psychological approach to public communication about NPI behaviors in a severe influenza pandemic. However, in relationship to the implementation of NPI strategies, the theory raises questions regarding cognitive aspects of learning, societal influences on individual behavior, individual and group efficacy, and the variability in behavioral responses for individuals when experiencing high emotional distress. This paper describes mechanisms of the social cognitive theory and suggests those most appropriate for use within the crisis and emergency risk communication framework as it relates to the use of NPIs in pandemic response.

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Cognitive Goal-Seeking, Social Cognitive Theory, and Efficacy

Social psychology uses approaches of inquiry from three disciplines: behaviorism, Gestalt, and cognitive psychology. Social psychologist Kurt Lewin described this interaction and espoused that there is a relationship between individual desires and situational opportunities (J. Feist & G.J. Feist, 2002).

Cognition and Goal-seeking

Cognitive psychology has provided social psychologists important concepts to describe mental activity related to perceptions and learning (Solso, 2001). A broad area of cognitive psychological research which also can inform NPI implementation strategies is how people develop and then work to achieve goals. For example, Chartrand and Bargh (1996) (as reported in Moskowitz, 2005, p. 398) suggested that priming, or the implicit activation of goals, is possible and that the goal desire could be triggered in a future context after being primed in the preconscious. This concept suggests that before a pandemic arrives, health officials could engage in education and persuasive appeals to boost the public’s ability to change their pandemic behaviors. Selecting goals and the persistence applied to reaching the goal depends on how appropriate the goal is in a given context (Moskowitz, 2005). For example, an inappropriate goal would be to have no contact with other people during a pandemic (i.e., eighteen to twenty-four months). There are, however, approach-related negative affects that can interfere with goal-seeking efforts (Carver & Scheier, 2005). When people fail and believe further effort is futile, their negative emotions (e.g., frustration, anger, sadness, and despondency) can be precursors of giving up.

Social Cognitive Theory

People will not change unless they believe change is important and they have the confidence that they are able to change (Miller & Rollnick, 2002). However, there are mindsets such as pessimism and chronic self-doubt that can threaten confidence and thwart behavior change. Social psychologist Albert Bandura developed the social cognitive theory to explain social and individual influences on behavior and the degree of effort and persistence people will put forth in pursuing an objective, especially under difficulty (Bandura, 1997). Importantly, social cognitive theory recognizes human agency in that humans can intentionally make things happen. It also recognizes that personality is molded in part by one’s environment. Social cognitive theory takes a step away from behaviorism by exploring personal influence within environmental forces and the application of forethought. In other words, “people set goals for themselves, anticipate the likely consequences of prospective action, and select and create courses of action likely to produce desired outcomes and avoid detrimental ones” (Bandura, 2001b, p. 7). A hallmark of social cognitive theory is the recognition of human plasticity or functional consciousness and the purposive use of information.

Self-efficacy

Central to social cognitive theory is the concept of self-efficacy, or one′s belief that one can execute a behavior that will produce a desired outcome (Bandura, 2001a). Self-efficacy influences what actions people attempt along with the degree of effort they put forth, the amount of time they will invest, and their persistence when faced with setbacks. People with high self-efficacy will choose more difficult tasks and put forth more time and effort in the face of obstacles. Efficacy is about confidence, not outcome expectations (Bandura, 1997). In fact, even in the face of disconfirming evidence, once a person feels confident about their ability to perform a task their confidence level tends to be stable (Carver & Scheier, 2005). In contrast, people with low self-efficacy do not believe they are capable of consequential behavior. High self-efficacy predicts higher achievement, better health, and greater socialization (Schwarzer, 1998). There are four main sources of personal efficacy: physical and emotional states, observational learning, mastery experiences, and social persuasion. Within all four sources, the individual will cognitively process information about oneself and the environment. In studies related to positive health behaviors, Rimal (2001) found that knowledge combined with self-efficacy predicted successful behavior. However, knowledge of the desired behavior alone was not enough to predict successful behavior.

Physical and emotional states

Physical and emotional states influence efficacy. Typically, strong emotions such as great stress, severe anxiety, and intense fear will lower performance. Interestingly, people may increase performance if they understand the fearful emotional state is realistic for the context. For example, a combat soldier facing a lethal enemy chemical attack may feel intense fear but still don a protective mask faster than when feeling less anxious during a non-lethal training attack. Fear and anxiety are two separate emotions (Craig, Brown, & Baum, 2000). Fear is a realistic, adaptive, and time-limited response that is usually not anticipated, where as anxiety is generally less adaptive, not-time specific, anticipated, and less realistic. Nonetheless, they both are alert signals that warn of danger. Fear triggers fight or flight. In contrast, anxiety primes fight or flight but does not engage it. The less agency or control a person perceives they have in a situation, the more anxious they may feel and their performance will suffer. Negative self-beliefs generate worry, avoidance goals, and negative emotion which can lead to self-handicapping and ever increasing anxiety (Zeidner & Matthews, 2005). The fight or flight response can be debilitated by chronic anxiety and increasing danger to self and others if performance declines.

Mastery experiences

Mastery experiences are the most influential of the four sources of self-efficacy (Bandura, 1997). Generally, a past successful performance raises self-efficacy: “I skied a black diamond before so I can do it again.” Past failures typically lower self-efficacy: “I wiped out on the black diamond so I can’t ski that run.” However, there are six aspects of mastery experience that correlate with those general rules: the more difficult the task, the more a successful experience will raise self-efficacy; tasks successfully done alone raise self-efficacy higher than if one had help; self-efficacy is lowered more if failure comes after having put forth one’s best effort; failure during strong emotional states is not as debilitating to self-efficacy; failure before mastering a task is more detrimental to self-efficacy; and, after mastery, an occasional failure is not as detrimental to self-efficacy. Importantly, failures may be task specific and not affect general self-efficacy (Smith, Kass, Rotunda, & Schneider, 2006). Smith et al. found in their experiment, which induced failure in a group (i.e., presented unsolvable anagrams), failure significantly lowered task-specific efficacy compared with the control group, but the failed group maintained their general self-efficacy in comparison with the control group. Bandura (1997) suggested that efficacy expectations involve generality (i.e., some experiences are generalized and others are limited to a task), strength (i.e., one persists if expectations of mastery are strong), and magnitude (i.e., level of task difficulty). However, self-efficacy is for the most part task specific.

Observational learning

While not as influential as mastery experiences, observational learning or social modeling is a source of self-efficacy. Most people learn through observation and not experience—which could be laborious at best and harmful at worst. Observational learning depends on whether one is attuned to the observed behavior, the degree of arousal in the observer, the ability for the person to retain what he or she has observed, and one’s degree of motivation to learn (Rimal, 2001). When an individual observes a person of equal ability achieve success, the individual’s self-efficacy goes up; but, it will go down if they observe the person failing. For example, if a peer fails his statistical exam, the observing individual’s self-efficacy could be lowered. People perceived as dissimilar will not affect self-efficacy. Of note, people in adverse situations can model prosocial behavior to help others succeed. “Seeing people in similar circumstances succeed by perseverant effort in the face of difficulties raiser observers’ beliefs in their personal and collective efficacy” (Bandura, 2003, p. 171). Efficacy beliefs influence resilience to adversity and the amount of stress or depression people may feel in coping with highly demanding environments. Self-efficacy beliefs, including empathetic and social self-efficacy beliefs, have a pivotal role in prosocial self-regulating behaviors. People will adopt an observed behavior if they value the results and if the model is perceived as similar to them and admired. This is often reflected in the influence of television commercials.

Social persuasion

Although social persuasion is not a strong source of individual or collective efficacy, research does show that efficacy can be raised or lowered through persuasion (Bandura, 1997). In response to disease outbreaks or major disasters, Hall et al. (2003) noted that effective risk communication to the public can reduce negative psychological responses. However, for persuasion to occur, the individual must believe the person and the source are credible, and the people being persuaded must be able to carry out the activity. For example, someone in the line of a tornado can not be persuaded to “go to the basement” if the person lives in a mobile home without a basement. The persuader’s status and authority can increase the likelihood that they can raise specific task efficacy in others. In addition, persuasion is more likely to work if it’s combined with past successful mastery experiences related to the current desired behavior. For example, people can be more easily persuaded by the county emergency manager to evacuate before a hurricane if they had done so successfully in the past. A cautionary note arises about persuasion in high stress or fear-inducing situations. While demand/suggestion is effective in less fearful situations, because the conditioned fear response can be so strong, persuasion will produce only weak and temporary effects if individuals are highly fearful (Bandura, 2003).

Group efficacy

Social cognitive theory also explores collective or group agency in that people can share a “belief in their collective power to produce desired results” (Bandura, 2001a, p. 14). The collective belief that the group can be successful defines group potency (Hecht, Allen, Klammer, & Kelly, 2002). People often pool their resources, knowledge, and mutual support to solve problems. Hecht et al. found a “strong positive relation between potency and performance” (p. 149). This was particularly important when the group faced complex tasks that required the efforts of every group member. Also, improving group performance may be better realized through promoting high group efficacy more so than by attaining high group goal commitment.

Self-efficacy, culture, gender, and age

The concept of efficacy among diverse cultures is supported by cross-cultural research (Bandura, 2001a; Lindley, 2006; Schwarzer, 1998). Efficacy is better expressed when systems for success are oriented to culturally supported social arrangements. For example, people acculturated to be individualistic in their efficacy beliefs will feel most efficacious in individually oriented systems. There are differences in levels of self-efficacy among ethnic groups. Euro-Americans were found to maintain higher self-efficacy in the face of career-related barriers than did ethnic minorities (Lindley, 2006). Interestingly, persuasion was as important as performance experiences in predicting math self-efficacy among African-American students, suggesting a deficit in positive social persuasion in this domain.

Socioeconomic status also influences personal efficacy (Fernandez-Ballesteros, Diez-Nicolas, Caprara, Barbaranelli, & Bandura, 2002). Those with socioeconomic advantages and, therefore, more resources and access to support structures are likely to have greater self-efficacy. The advantaged are also more likely to exhibit collective social efficacy. In contrast, the economically disadvantaged, including entire neighborhoods, may exhibit learned helplessness resulting in deficits in motivation and cognitive processes such as pessimism (Uomoto, 1986). They may be more depressed, anxious, and hostile. Helplessness evolves from prior experiences and lack of perceived control. Ohmer and Beck (2006) found that in poor communities greater participation in neighborhood organizations increased organizational collective efficacy but still did not increase neighborhood collective efficacy.

In addition to culture and socioeconomic status, gender and age influence personal efficacy (Fernandez-Ballesteros et al., 2002). Men are more likely than women to believe they can solve social problems such as terrorism and economic crises. Also, younger people have greater efficacy than older people related to solving social problems. Women are equally confident in their ability to manage life circumstances such as work, health, and family relationships. For task-specific self-efficacy, men have an advantage in areas where they have more experience. For example, in math-related tasks, women’s self-efficacy was raised to the level of men’s self-efficacy after specific success experiences with math (Lindley, 2006). Women’s self-efficacy was affected more than men from both success and failure experiences. Therefore, an individual’s task-specific efficacy may depend on the degree of experience in a particular domain, which may be limited because of different socialized life experiences.

There are also cultural differences in the inclination to behave prosocially (Caprara & Steca, 2005). Bandura (2001a) warned that changes in society (e.g., complex technologies and social fragmentation) may undermine collective efficacy. “Pluralism is taking the form of militant factionalism . . . thus [societies] are becoming more diverse and harder to unite around a national vision or purpose”(p. 18).

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Social Cognitive Theory Applied to a Pandemic Public Health Mitigation Strategy Using CERC

Social cognitive theory combines social context and human agency to explain and predict individual and group behavior. Pandemic influenza presents a threatening situational context for people everywhere. People fear and avoid threatening situations if they assess their coping skills as inadequate (Carver & Scheier, 2005). This suggests that people may be susceptible to maladaptive behaviors to compensate for their perceived lack of control and inadequate coping skills during a pandemic. Therefore, an effective pandemic influenza communication strategy requires careful consideration of the threatening context of pandemics and the psychological repercussions of an ill-prepared public. After all, enacting the four NPI mitigation behaviors can be difficult.

High self-efficacy is protective and has been shown to increase people’s chances of survival during disasters (Hall et al., 2003; Reissman et al., 2004). Self-efficacy is a hallmark of social cognitive theory and has four recognized sources: physical and emotional states, mastery experiences, observational learning, and social persuasion. Health officials offer four nonpharmaceutical mitigation behaviors that individuals and communities are expected to take to reduce the burden of the pandemic. These interventions can be explored in relation to the four sources of self-efficacy. An important question is whether self-efficacy can be raised among people to improve adherence to the behaviors, and which of the four sources may be most effective for each pandemic influenza mitigation behavior or NPI.

Physical and Emotional States

Anxiety lowers performance which can lower self-efficacy. Uncertainty provokes anxiety (Seeger et al., 2003) and a pandemic will be fraught with uncertainty. Therefore, officials should attempt to reduce anxiety when possible. Giving people things to do in a crisis that restores their sense of control reduces anxiety (Reissman et al., 2004; Sandman & Lanard, 2004). The challenge is to ensure that people have the ability to take the recommended steps. Therefore, officials must explore potential societal and individual barriers to success and remove them when possible. Officials should then compile those steps that are more universally possible and ask people to do them first so they gain mastery experiences before asking them to take more difficult steps. For example, ask them to check on their employer’s sick-leave policy for a pandemic before asking them to plan to stay home 4 days each time a member of the household becomes ill. To reduce anxiety, people should be told early in planning what will be expected of them (Aspinwall, 2005). Emotional states should be considered for all four NPIs because the situational context is so frightening. Likely, anxiety would be most disruptive for efficacy beliefs about NPIs involving extended child care and quarantine because of the logistical challenges.

Mastery Experiences

The most reliable road to task-specific self-efficacy is mastery experiences (Bandura, 1997). The NPIs that can be practiced in advance in incremental steps should be. For example, communities who would be expected to dismiss students from school for 12 weeks could practice during shorter durations how to maintain studies for students outside the classroom (e.g., homework assignments posted on the Internet or by automated calls to homes). While mass isolation can’t be practiced effectively in advance, voluntary home quarantine, school dismissals, and adult social distancing (e.g., increased telecommuting in the workplace) could be. Mastery experiences before the pandemic would be useful to raise efficacy around school and daycare dismissals, voluntary quarantine, and adult social distancing. Mastery would be important in raising efficacy for all four NPIs at the start of the pandemic. However, public campaigns must ensure that people, including the vulnerable, can master incremental steps. Of the four sources to raise self-efficacy among people in high emotional distress, mastery experience would be most effective because it is the most consistent of the sources, and action steps restore control and reduce situational anxiety (Bandura, 1997; Smith et al., 2006).

Observational Learning

An important source of observational learning would be to share evidence and tell stories about how the NPIs, enacted early in the outbreak by communities, saved lives during the 1918 pandemic. In addition, some individuals and communities will plan early on how to employ NPIs in a pandemic. Their successes should be collected and widely shared so people see how others are overcoming barriers. Because peer success raises self-efficacy, it is important that examples used are representative of diverse groups, including those populations that may be most vulnerable (e.g., those in poor communities). During the pandemic, admired community members can model the appropriate behaviors (e.g., staying home from work if a family member is ill). Observational learning would be useful during the pre-pandemic phase to reinforce the demonstrable NPIs. During a pandemic, observational learning would be most helpful for voluntary quarantine, school dismissals, and adult social distancing behaviors because these are more public behaviors where modeling of the behavior could be acknowledged. Observational learning would be less useful for the NPI of isolating the ill because it is a private health-care behavior.

Social Persuasion

Social persuasion is a weak efficacy source and the weakest source to help raise self-efficacy related to NPIs, especially if people are fearful. If persuasion is used, the demand/suggestion must come from a credible source and source credibility may vary among diverse groups. Of note, most national public health campaigns rely almost solely on social persuasion to change behavior (Hall et al., 2003). This strategy should be reexamined. However, Bandura (1997) noted that sources of self-efficacy can be combined, so social persuasion should not be completely abandoned and instead added to other sources. After all, people differ in their efficacy expectations despite experiencing the same mastery experiences, suggesting a variability in cognitive processing and multiple determinants of self-efficacy (Wheeler, 2005).

Because NPI mitigation behaviors involve community-level actions, group efficacy is also important and efforts to raise efficacy related to NPI behaviors should also include community organizations. There is much variability in efficacy levels for diverse groups and communities (Walsh, 2006). Officials should assess community efficacy and put forth more effort in communities that may have the lowest levels of group efficacy, such as poor neighborhoods. In addition, men and women enjoy high self-efficacy in different domains. Officials should engage both men and women in the community to reinforce efficacy related to all four NPI behaviors. For example, women may have higher efficacy in relationship to NPIs that occur in the home (e.g., voluntary quarantine) while men may have higher efficacy related to social change such as canceling large public gatherings. However, social fragmentation may make any appeals for NPIs from the national level less effective. Therefore, the national plan should be tailored to be implemented at the community level and should recognize diverse groups and their unique barriers to building efficacy and the ability to enact the NPIs. .

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Crisis and Emergency Risk Communication and Social Cognitive Theory

An open and empathetic communication style that engenders the population’s trust is the most effective communication style when a response official is attempting to galvanize the population to take a positive action or refrain from a harmful act during a crisis (Seeger et al., 2003; Wray & Jupka, 2004). To respond to communication failures during public health emergencies including the introduction of West Nile in the United States and the anthrax incident of 2001, CDC developed and adopted the integrative model of crisis and emergency risk communication (CERC) (Reynolds et al., 2002). Seeger et al. (2008) noted that CDC, after these failures, believed that risk communication alone could not provide the necessary communication approach for major public health crises. As noted by Seeger and Reynolds (2008), society today faces “threats that are dynamic, global, and becoming increasingly prominent. . . . A successful component of successful management [of these threats] is a more sophisticated, dynamic, and comprehensive approach to communication (p. 18).

The CERC model, based on experiential understanding and selected theories, offers a phased approach to planning and response, and encompasses the urgency of disaster communication with the need to communicate risks and benefits to stakeholders and the public (Reynolds et al., 2002; Reynolds & Seeger, 2005; Veil, Reynolds, Sellnow & Seeger, 2008). Reynolds et al. (2002) defined CERC as: . . . the effort by concerned experts to provide information to allow an individual, stakeholder, or an entire community to make the best possible decisions about their well-being within nearly impossible time constraints and help people ultimately to accept the imperfect nature of choices during the crisis (p. 6).

The CERC model emphasizes a participatory approach to communication and considers the social, psychological, and physical nature of the crisis context and proposes how to reduce harm to individuals and communities through communication. By focusing on the participatory nature of a crisis and encouraging action to aid in understanding, CERC also invoked the theories of sense making and cognitive learning. In addition, CERC offers the following six guiding principles for institutions or groups with official crisis response roles (Reynolds et al., 2002; Reynolds, 2004; Reynolds, 2006):

1. Be first. If the information is yours to provide by organizational authority—do so as soon as possible. If you can′t—then explain how you are working to get it.
2. Be right. Give facts in increments. Tell people what you know when you know it, tell them what you don′t know, and tell them if you will know relevant information later.
3. Be credible. Tell the truth. Do not withhold to avoid embarrassment or the possible “panic” that rarely happens. Uncertainty is worse than not knowing—rumors are more damaging than hard truths.
4. Express empathy. Acknowledge in words what people are feeling—it builds trust.
5. Promote action. Give people relevant things to do. It calms anxiety and helps restore order.
6. Show respect. Explain and empower decision making even when troublesome decisions must be communicated.

Seeger, Reynolds, and Sellnow (2008) noted CERC′s success in identifying preparedness and response activities for pandemic influenza and noted, “another area of success for the CERC model is its comprehensive view of risk and crisis. . . [and] addressing the complexity of audiences in risk and crisis situations” (p. 505), including often overlooked aspects such as empathy, self-efficacy, and uncertainty-reduction. While each of the six basic principles makes a critical contribution to successful communication to the public in a crisis, the principle to promote action is especially important when considering the need for the public to engage in non-pharmaceutical interventions during a pandemic. While CERC extols the value of promoting action, it is the social cognitive theory that gives communication professionals the elements to promote action in the most efficacious way for individuals and communities. How self-efficacy is developed and strengthened is a necessary step in ensuring that calls to action are more likely to be judged actionable by an anxious population. Each NPI should be matched to the appropriate ways to strengthened efficacy and selected based on contextual awareness of the population′s predispositions, level of fear, and resources.

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Conclusion

Bandura has asserted that self-efficacy is a unifying mechanism that explains common pathways to adaptive coping behaviors (1997). Since Bandura proposed self-efficacy and social learning theory in 1977, a body of work has reinforced their utility in understanding behavior change, especially as it relates to approach-avoidance. Public health communication professionals who incorporate CERC principles in their messaging have a means to ensure they are applying social cognitive theory effectively to help protect communities during a severe influenza pandemic. The effort to build or raise personal and group efficacy is worthwhile because a severe pandemic will touch every person and community at some level for an extended length of time. Any advantage offered by social cognitive theory and CERC to ensure individuals and entire communities believe recommended NPI strategies are effective and that they can take recommended actions is merited because they may save lives. Knowledge alone is not enough: knowledge must be combined with self- and group efficacy for people and groups to engage in successful health behaviors (Rimal, 2001).

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Corresponding Author

Barbara J. Reynolds, Ph.D.
Crisis Communication Senior Advisor
Office of the Director
Centers for Disease Control and Prevention

At CDC since 1991, Dr. Reynolds’ communication expertise has been used in the planning or response to pandemic influenza, vaccine safety, emerging disease outbreaks and bioterrorism. Internationally, she has acted as a crisis communication consultant on health issues for France, Hong Kong, Australia, Canada, former Soviet Union nations, NATO and the World Health Organization.

Dr. Reynolds is the author of the 2002 book Crisis and Emergency Risk Communication and CDC’s Crisis and Emergency Risk Communication course, which is now taught in universities and other settings nationwide and internationally. In 2004, she launched a version of the Crisis and Emergency Risk Communication course for leaders. Her research and writings are focused on emergency risk communication best practices, integrating models of communication for public health, and building community hardiness in the face of disaster. In the past, Dr. Reynolds served as a senior press officer specializing in infectious diseases and vaccine safety issues, working with national and international investigative and science reporters. She is also an adjunct assistant professor at Tulane University.

Dr. Reynolds can be reached at 404.639.0575 / breynolds@cdc.gov.

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