Digital dashboards visualizing public health data: a systematic review.

Introduction: Public health is not only threatened by diseases, pandemics, or epidemics. It is also challenged by deficits in the communication of health information. The current COVID-19 pandemic demonstrates that impressively. One way to deliver scientific data such as epidemiological findings and forecasts on disease spread are dashboards. Considering the current relevance of dashboards for public risk and crisis communication, this systematic review examines the state of research on dashboards in the context of public health risks and diseases. Method: Nine electronic databases where searched for peer-reviewed journal articles and conference proceedings. Included articles (n = 65) were screened and assessed by three independent reviewers. Through a methodological informed differentiation between descriptive studies and user studies, the review also assessed the quality of included user studies (n = 18) by use of the Mixed Methods Appraisal Tool (MMAT). Results: 65 articles were assessed in regards to the public health issues addressed by the respective dashboards, as well as the data sources, functions and information visualizations employed by the different dashboards. Furthermore, the literature review sheds light on public health challenges and objectives and analyzes the extent to which user needs play a role in the development and evaluation of a dashboard. Overall, the literature review shows that studies that do not only describe the construction of a specific dashboard, but also evaluate its content in terms of different risk communication models or constructs (e.g., risk perception or health literacy) are comparatively rare. Furthermore, while some of the studies evaluate usability and corresponding metrics from the perspective of potential users, many of the studies are limited to a purely functionalistic evaluation of the dashboard by the respective development teams. Conclusion: The results suggest that applied research on public health intervention tools like dashboards would gain in complexity through a theory-based integration of user-specific risk information needs. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=200178, identifier: CRD42020200178.

Food safety in the aging population: Qualitative findings on what to communicate and how.

The present study investigated older adults' risk perception, beliefs, and self-perception in the field of kitchen hygiene and food safety. A qualitative study with semi-structured focus groups was conducted. A total of 37 older adults (60-80 years of age) from Germany participated in four focus groups that were stratified by gender. Focus groups covered older adults' food-handling practices, their perceptions of vulnerability, and their informational needs in the field of food safety. A thematic analysis approach was adopted. The coding categories and subcategories were developed inductively by the researchers based on the data. The coded data were then used to identify overarching themes and subthemes. Main results showed that older adults had confidence in their knowledge and skills with regard to food safety, perceived their post-war generation overall to be resistant and other so-called at-risk groups to be more vulnerable. Moreover, they expressed low informational needs in the area of food safety. The results suggest that age-specific aspects play a role in older adults' risk perception and highlight the need to develop age-specific risk communication strategies that take into account older adults' beliefs, knowledge, and informational needs.

Effects of as-if risk framing of hazards on risk perception and its rebuttal.

BACKGROUND: The difference between hazard and risk is crucial in risk assessment but rather unknown by non-experts. Hyper-partisan activists could use this knowledge gap to amplify risk perception by framing hazards as as-if risks, i.e., describing hazards as if their exposure is critical. Thus, using this as-if risk framing can trigger impressions that a risk is present. Until now, this framing technique and its rebuttal was not empirically analyzed. METHOD: An experimental 2 × 2 factorial online study (N = 404) with repeated measures after intervention was conducted to investigate how framing (hazard vs. as-if risk) and stigmatization (stigmatized vs. non-stigmatized chemical agent) affects affective and cognitive risk perception using an example of exposure to drifting pesticides. RESULTS: As-if risk framing increased risk perception, effects of stigmatization were not observed. However, the a-priori risk perception influences the recorded risk perceptions after the experimental treatment. Rebuttal was successful, i.e., subjects with elevated risk perceptions due to as-if risk framing reduced their risk perception after receiving corrective information. CONCLUSIONS: As-if risk framing investigated here is not a sequestered case. Accordingly, the present study may offer general insights into correcting biased information that neglects the difference between hazard and risk. Risk communicators can benefit from these insights.

[Social acceptance of public breastfeeding over time: experiences and attitudes of the population and of breastfeeding mothers in 2016 and 2020]. / Die gesellschaftliche Akzeptanz von öffentlichem Stillen im zeitlichen Vergleich: Erfahrungen und Einstellungen der Bevölkerung und stillender Mütter 2016 und 2020.

BACKGROUND AND OBJECTIVE: Germany is only moderately breastfeeding-friendly, according to a systematic inventory from 2019. Based on a reference study, a survey on the acceptance of breastfeeding in public was conducted. The aim of the work is to capture perceptions and attitudes towards public breastfeeding in a periodic comparison. In addition, differences between the general population and mothers of young children as well as between mothers with different levels of education are considered. MATERIALS AND METHODS: In 2020, 1007 people aged 16 and older and 307 mothers with children up to 24 months were surveyed online about public breastfeeding. The results were compared with a previous survey from 2016. RESULTS: In 2020, a larger percentage of mothers breastfeed in public than in 2016; it is avoided less often. Mothers with lower levels of education are less likely to breastfeed, also in public, and more likely to report mixed reactions. Among the general population, acceptance of public breastfeeding has declined, for example, in gastronomy. About one in six (17%) explicitly rejects breastfeeding in public. Knowledge about the health effects of breastfeeding is lower among the general public than among mothers. As in 2016, knowledge about the positive effects of breastfeeding is associated with greater acceptance of public breastfeeding. CONCLUSIONS: The results underline the importance of measures, for example, to communicate knowledge to the population, show breastfeeding more frequently in mass media and through positive role models, and make the settings in which families live more breastfeeding-friendly. Measures should pay special attention to women with lower levels of education.

Personal Protective Measures during the COVID-19 Pandemic in Germany.

OBJECTIVES: The coronavirus SARS-CoV-2 is highly contagious and can only be contained if the majority of the population takes measures to protect themselves against infection. The present study aimed to investigate personal protective measures, their development over the course of the pandemic in Germany, and potential differences in behavior in terms of sex, age, and education. METHODS: Data from 20 waves of the serial cross-sectional study "BfR-Corona-Monitor" were analyzed. The total sample consisted of N = 20,317 respondents (about 1000 per wave). Data were collected through telephone surveys between June 2020 and March 2021. RESULTS: To protect themselves from infection, participants primarily relied on wearing covers for mouth and nose, keeping their distance from other individuals, and washing their hands thoroughly. Analyses over time showed a strong positive correlation between the number of measures taken and the national incidence rate. Sociodemographic differences also emerged, with women and those who are higher educated as well as younger respondents taking a higher number of protective measures. CONCLUSIONS: Our results indicated that in times of greater infection risks, individuals adapted accordingly and took more protective measures. However, on the basis of sociodemographic differences, campaigns should especially focus on older individuals, the male sex, and those with lower education to enhance their protective behavior.

[Risk communication of policy advising scientific organisations: a thematic outline using the example of the German Federal Institute for Risk Assessment]. / Risikokommunikation politikberatender Wissenschaftsorganisationen: Ein Themenaufriss am Beispiel des Bundesinstituts für Risikobewertung.

Regulatory scientific agencies, such as the German Federal Institute for Risk Assessment (BfR), are confronted with various challenges in their science-based risk communication. On the one hand, the communication of health risks is becoming increasingly complex and, accordingly, more demanding, which is why - among other things - questions about the health literacy of consumers and target group-oriented risk communication are gaining importance. On the other hand, the outputs of regulatory scientific agencies are increasingly exposed to politicisation and public criticism, which increases the relevance of questions about the objectivity and trustworthiness of expert opinion, risk assessment, and official statements, as well as the legitimacy and reputation of such organisations. This is further intensified by the emergence of new social media actors who produce and publish their own information and communication materials. The misinformation, disinformation and malinformation consequently distributed in this context represent another challenge, which is closely related to questions of adequate communication of health risks and of stabilising legitimacy, reputation and trustworthiness.The article discusses various approaches to solving these problems, including the optimization and visual enhancement of health information, enabling social participation as well as embedding these measures in strategic stakeholder and reputation management. The article concludes with a call for a more open discussion of inherent dilemmas.

Serial cross-sectional data on the public's perception on the coronavirus during the first months of the pandemic in Germany.

The coronavirus pandemic poses major challenges for governments and public health authorities. In order to implement appropriate measures, it is important to understand how the population is coping with the pandemic. This dataset contains serial cross-sectional survey data from the first months of the coronavirus pandemic in Germany. Data were collected between 24 March and 26 May 2020 in ten weekly surveys (ns ranging between 500 and 515, in total N = 5,076) as part of omnibus telephone interviews. Samples were drawn at random from landline and mobile telephone numbers. The main topics of the questionnaire were (a) the expected impact of the coronavirus on one's personal life, (b) perception of infection risk, (c) protective measures and (d) information behaviour. Data were weighted to ensure sociodemographic representativeness. To account for the rapidly changing situation of the coronavirus pandemic in Germany, the questionnaire underwent several adjustments during the data collection period.

The COVID-19 pandemic: agile versus blundering communication during a worldwide crisis: Important lessons for efficient communication to maintain public trust and ensure public safety.

Governments' measures to control the COVID-19 pandemic and public reaction hold important lessons for science and risk communication in times of crisis.

Communicating Food Risk-Benefit Assessments: Edible Insects as Red Meat Replacers.

Risk-benefit Assessment (RBA) is an emerging methodology in the area of Food and Nutrition that offers a simultaneous evaluation of both risks and benefits linked to dietary choices. Communication of such research to consumers may present a challenge due to the dual nature of RBA. We present a case study of a communication strategy developed for the NovRBA-project. The NovRBA-project (Novel foods as red meat replacers-an insight using Risk Benefit Assessment methods) performed a risk-benefit assessment to evaluate the overall health impact of substituting red meat (beef) by a novel food (house cricket), considering the microbial, toxicological and nutritional characteristics of the respective dietary choices. A literature review of risk perceptions and acceptance of beef and insects as food formed the basis of the communication strategy for the study's results, drawing on environmental and emotional as well as health-related motivations to consume or avoid either food and considering the sociodemographic characteristics of likely consumers. Challenges and future directions for consumer protection organizations communicating findings of risk-benefit analyses on food safety are discussed.

Kitchen Hygiene in the Spotlight: How Cooking Shows Influence Viewers' Hygiene Practices.

Poor hygiene when handling food is a major cause of foodborne illness. To investigate whether hygiene practices visible in television cooking shows influence viewers' kitchen hygiene, a study on the adoption of demonstrated hygiene behavior was conducted under controlled, experimental conditions. In a study ostensibly on cooking by following recipes participants (n = 65) were randomly assigned to one of three conditions, in which they watched a cooking video that differed only with regard to the hygiene behavior of the chef. In condition 1, the chef engaged in poor hygiene practices while preparing the dish, in condition 2 the chef's hygiene behavior was exemplary and in condition 3, the chef's hygiene behavior was not visible (control condition). After watching the video, participants were instructed to cook the recipe individually in the fully equipped laboratory kitchen. Cooking sessions were videotaped and experimenters blind to condition coded hygiene lapses committed by participants. The level of kitchen hygiene displayed in the cooking video significantly affected hygiene practices of participants cooking the recipe. Participants who had watched the cooking video with correct hygiene practices committed significantly fewer hygiene lapses than those who had watched the video with poor hygiene practices. From a risk communication perspective, TV cooking shows are well placed to convey knowledge of essential hygiene practices during food preparation to a broad audience. To facilitate behavioral change toward safer food-handling practices among viewers, visibly performing correct hygiene practices in cooking shows is a promising strategy.

[Risk perception and information behaviour of opinion leaders in the food sector]. / Risikowahrnehmung und Informationsverhalten von Meinungsführenden im Lebensmittelbereich.

Opinion leaders are people who can influence the opinions, attitudes or behaviours of others in their social environment. Especially in social networks on the Internet, they can also reach larger audiences and therefore represent a crucial target group for risk communication. An important prerequisite for successful risk communication is a precise knowledge of the risk perception of the relevant target group, so that this can be taken into account when developing communication measures. The present study therefore investigated the extent to which there is a connection between the risk perception of food issues and issue-specific opinion leadership. For this purpose, a representative telephone survey of the population in Germany was conducted (n = 1001). According to this, opinion leaders have a slightly higher risk perception of food risks for some topics than non-opinion leaders. They are also much more interested in these topics and access information on food issues more frequently via specific media. Opinion leaders also tend to be more active in social media. In the buzz of social media, they can thus offer valuable orientation for their social and digital environment through their special knowledge and opinions.

[Carbon monoxide-an underestimated risk? Awareness, perception, knowledge, and prevention activities]. / Kohlenmonoxid ­ ein unterschätztes Risiko? Bekanntheit, Wahrnehmung, Wissen und Präventionsverhalten.

BACKGROUND: Every year, hospitals in Germany treat roughly 450,000 people in the aftermath of poisoning incidents. To reduce the number of poisoning accidents, it is essential to inform the public about poisoning risks and the possibilities for prevention. OBJECTIVES: The goal was to examine risk perception of poisonings in order to derive insights into adequate communication activities from the results. As a special focus topic, the risk of carbon monoxide poisoning was chosen. METHOD: Telephone interviews were conducted with 1,012 persons aged 14 or over in Germany. They were asked about their awareness, perception, and knowledge of poisoning risks, particularly carbon monoxide. RESULTS: Most people are aware of risks such as accidental intoxications caused by alcohol, carbon monoxide, or mushrooms. Other risks that could be especially dangerous for children, like coin cell batteries, lamp oils, or liquids in e­cigarettes, are less known. Of the interviewees, 82% had already heard of poisoning incidents in connection to carbon monoxide and 41% estimated the risk of accidental carbon monoxide poisoning as rather or very high. However, only 15% had already installed a carbon monoxide detector. Although people are mostly aware of the main causes and identifiers of carbon monoxide poisoning, more than one third still believe that carbon monoxide can be identified by its odor, smoke, or the smoke alarm signal. In addition, there is a special need for information about the risks of carbon monoxide intoxication through indoor shisha smoking and indoor storage of wood pellets. CONCLUSION: The results offer first insights into the target groups and possible dissemination paths for future risk communication activities.

[Public perception of climate change and implications for risk communication]. / Wahrnehmung des Klimawandels durch die Bevölkerung und Konsequenzen für die Risikokommunikation.

Man-made climate change is associated with several weather and environmental changes that can influence the extent of certain health risks. The article gives an overview of the challenges of communicating these health risks. Theoretical considerations are linked with the results of a representative population survey, in which 1018 participants aged 14 years and above were polled about their perception of climate change and its associated health risks.According to the survey results, the majority of the population is convinced that climate change is actually taking place. However, the data suggest that respondents regard the topic with psychological distance. Health risks associated with climate change also play a relatively minor role in the participants' perception.The theoretical considerations in connection with the empirical results show that targeted communication measures are needed to enhance awareness of the health risks associated with climate change among the general public. This requires not only a comprehensive provision of information, but also instructions and action plans for the practical implementation of that knowledge. Communication measures should take into account factors that can influence risk perception and the willingness to act. They should also be embedded in a strategic communication concept that allows different target groups to be addressed.

[Is breastfeeding in public socially accepted? : Experiences and attitudes of the general population and breastfeeding mothers]. / Ist Stillen in der Öffentlichkeit gesellschaftlich akzeptiert? : Erfahrungen und Einstellungen der Bevölkerung und stillender Mütter.

BACKGROUND: Despite the undeniable benefits, breastfeeding in public has led in the past to controversies that gained a lot of media coverage. For this reason, the attitudes of the general population towards breastfeeding in public and the experiences of mothers who breastfeed in public were examined. OBJECTIVE: The objectives were to collect current data on the perception and acceptance of breastfeeding in public. MATERIALS AND METHODS: We surveyed 1003 respondents from the general population aged 14 years and over and 306 mothers with children of breastfeeding age on the subject of breastfeeding in public by means of computer-assisted web interviewing. RESULTS: Of mothers, 6% reported that their experiences of breastfeeding in public tended to be rather or very negative. Of the general population sample, 66% held the fundamental opinion that breastfeeding should be possible everywhere at all times, compared to 80% of mothers (p < 0.05). Special differences can be seen for breastfeeding in restaurants and cafes. Although only just under 50% of the population sample approves of breastfeeding in these locations, it is not avoided by the majority of mothers (54%). Overall, knowledge of the benefits of breastfeeding is associated with increased acceptance of breastfeeding in public. No special demographic characteristics were observed for the group of persons with a negative attitude towards breastfeeding in public (6%). CONCLUSIONS: No special target group for improving acceptance of breastfeeding in public can be identified in the population on the basis of the present findings. A conflict potential was identified for certain places and situations, however, which enables the development of strategies to increase acceptance.

Pesticide Residues in Food: Attitudes, Beliefs, and Misconceptions among Conventional and Organic Consumers.

Pesticide use and pesticide residues in foods have been the subject of controversial public discussions and media coverage in Germany. Against this background, a better understanding of public risk perceptions is needed to promote efficient public health communication. To this end, this study captures the German public's perception of pesticide residues in foods. A representative sample of the population aged 14 years and older (n = 1,004) was surveyed via computer-assisted telephone interviewing on their attitudes and knowledge with regard to pesticide residues. Based on questions regarding their typical consumer behavior, respondents were classified into conventional and organic consumers to identify differences as well as similarities between these two consumer types. As assessed with an open-ended question, both organic and conventional consumers viewed pesticides, chemicals, and toxins as the greatest threats to food quality and safety. Evaluating the risks and benefits of pesticide use, more than two-thirds of organic consumers (70%) rated the risks as greater than the benefits, compared with just over one-half of conventional consumers (53%). Concern about the detection of pesticide residues in the food chain and bodily fluids was significantly higher among organic compared with conventional consumers. Only a minority of respondents was aware that legal limits for pesticide residues (referred to as maximum residue levels) exist, with 69% of organic and 61% of conventional consumers believing that the presence of pesticide residues in foods is generally not permitted. A lack of awareness of maximum residue levels was associated with heightened levels of concern about pesticide residues. Finally, general exposure to media reporting on pesticide residues was associated with more frequent knowledge of legal limits for pesticide residues, whereas actively seeking information on pesticide residues was not. The possible mechanisms underlying these findings are discussed.

[Perceived risks of food contaminants]. / Risikowahrnehmung von Kontaminanten in Lebensmitteln.

BACKGROUND: Food contaminants can pose a serious health threat. In order to carry out adequate risk communication measures, the subjective risk perception of the public must be taken into account. In this context, the breadth of the topic and insufficient terminological delimitations from residues and food additives make an elaborate explanation of the topic to consumers indispensable. A representative population survey used language adequate for lay people and a clear definition of contaminants to measure risk perceptions with regard to food contaminants among the general public. OBJECTIVES: The study aimed to assess public awareness of contaminants and the perceived health risks associated with them. In addition, people's current knowledge and need for additional information, their attitudes towards contaminants, views on stakeholder accountability, as well as compliance with precautionary measures, such as avoiding certain foods to reduce health risks originating from contaminants, were assessed. MATERIALS AND METHODS: A representative sample of 1001 respondents was surveyed about food contaminants via computer-assisted telephone interviewing. RESULTS: The majority of respondents rated contaminants as a serious health threat, though few of them spontaneously mentioned examples of undesirable substances in foods that fit the scientific or legal definition of contaminants. Mercury and dioxin were the most well-known contaminants. Only a minority of respondents was familiar with pyrrolizidine alkaloids. CONCLUSIONS: The present findings highlight areas that require additional attention and provide implications for risk communication geared to specific target groups.

The distinction between risk and hazard: understanding and use in stakeholder communication.

A major issue in all risk communication efforts is the distinction between the terms "risk" and "hazard." The potential to harm a target such as human health or the environment is normally defined as a hazard, whereas risk also encompasses the probability of exposure and the extent of damage. What can be observed again and again in risk communication processes are misunderstandings and communication gaps related to these crucial terms. We asked a sample of 53 experts from public authorities, business and industry, and environmental and consumer organizations in Germany to outline their understanding and use of these terms using both the methods of expert interviews and focus groups. The empirical study made clear that the terms risk and hazard are perceived and used very differently in risk communication depending on the perspective of the stakeholders. Several factors can be identified, such as responsibility for hazard avoidance, economic interest, or a watchdog role. Thus, communication gaps can be reduced to a four-fold problem matrix comprising a semantic, conceptual, strategic, and control problem. The empirical study made clear that risks and hazards are perceived very differently depending on the stakeholders' perspective. Their own worldviews played a major role in their specific use of the two terms hazards and risks in communication.

State of the art in human risk assessment of silver compounds in consumer products: a conference report on silver and nanosilver held at the BfR in 2012.

In light of the broad spectrum of products containing nanosilver, the harmfulness of nanosilver to human health and the environment was intensively discussed at a conference held in February 2012 at the BfR. The conference agenda covered the aspects of analytics of nanosilver materials, human exposure and toxicology as well as effects on microorganisms and the environment. The discussion recovered major gaps related to commonly agreed guidelines for sample preparation and central analytical techniques. In particular, the characterization of the nanoparticles in complex matrices was regarded as a challenge which might become a pitfall for further innovation and application. Historical and anecdotal records of colloidal silver have been sometimes taken as empirical proof for the general low toxicity of nanosilver. Yet as reported herein, a growing number of animal studies following modern performance standards of toxicity testing have been carried out recently revealing well-characterized adverse effects on different routes of exposure in addition to argyria. Furthermore, recent approaches in exposure assessment were reported. However, consumer exposure scenarios are only starting to be developed and reliable exposure data are still rare. It was further widely agreed on the workshop that the use of silver may lead to the selection of silver resistant bacteria. With respect to its environmental behavior, it was suggested that nanosilver released to wastewater may have negligible ecotoxicological effects. Finally, the presentations and discussion on risk assessment and regulation of nanosilver applications gave insights into different approaches of risk assessment of nanomaterials to be performed under the various regulatory frameworks.