OP0324-PARE PATIENT INFORMATION IN TIMES OF CRISIS: LESSONS LEARNED FROM COVID-19 COMMUNICATION IN RHEUMATOLOGY
Authors: M. M. Bakker, T. Luttikhuis, I. Jansen, J. Rademakers, M. De Wit, A. Boonen, P. Putrik
Journal: Annals of the Rheumatic Diseases (2021)

Background: The rapid global spread of COVID-19 required swift action to provide people with rheumatic and musculoskeletal diseases (RMDs) with reliable information. Important issues included the risk of infection and severe illness, (continued) use of medication, temporary closure of clinics, and organization of (semi-) virtual care. People with limited health literacy are a particularly vulnerable group that might have difficulty accessing, understanding, and applying health information. Objectives: To evaluate (a) key aspects of crisis communication and (b) explicit consideration of people’s health literacy needs in communication to people with RMDs during the first wave of COVID-19 in the Netherlands. Methods: We conducted an explorative qualitative study including seven interviews in May and June 2020 with representatives of organisations (a mixed regional/academic hospital, the association for RMD professionals and two patient organisations) responsible for information provision to people with RMDs in the Netherlands. Interviewees were asked about preparedness (1) and strategy (2) for crisis communication, and content (3) and reach (4) of communication, considering principles of good crisis communication and health literacy. In addition, through systematic screening of websites, social media and emails, we identified and analysed 13 written communications provided to people with RMDs by these organisations during the first three months of the COVID-19 pandemic. We assessed comprehensibility and applicability with the Dutch adapted version of the Patient Education Materials Assessment tool (PEMAT), the outcome being a percentage of adherence to 24 criteria. We assessed difficulty level using an online assessment application (Figure 1), with Common European Framework of Reference for Languages (CEFR) level B1 being the highest acceptable level. Figure 1. Example of textual assessment using the application. Note: Dutch-language text was used for analysis; the English translation is provided as a reference only and might be of different difficulty. Results: While admittedly being underprepared, respondents generally perceived their crisis communication as adequate. They quickly adapted to people’s needs and changing circumstances and attempted to adapt written and verbal communication to people with limited health literacy. Respondents reported challenges related to the scientific uncertainty, lack of reach, difficulty simplifying information, and being unsure if their communication approach was adequate. Textual assessment showed great variation in applicability (range 60-100%) and comprehensibility (range 58-100%) of these texts, and 69% of communications were more difficult than B1-level. Considering principles of crisis communication and health literacy, we propose several lessons to be learned for future crises (Table 1 Table 1. Recommendations for improvement of crisis communication Preparedness: Use current experience to establish a future crisis communication plan Train staff and management in crisis communication and health literate communication Strategy: Collaborate with relevant organisations to ensure consistency in messages Inform people early and frequently Remain transparent about uncertainty Content: Adapt information to different people’s needs, considering e.g. age, cultural background Check difficulty level of written information (aim at B1) and adapt accordingly Ask your audience for feedback Make sure information is directly applicable in practice Combat fake news through acknowledgement and counterarguments Reach: Use multiple channels Use diverse outreach strategies to cater to a diverse audience Overall: Consider people’s health literacy throughout ). Conclusion: The rheumatology organisations mostly adhered to principles of crisis communication, and made efforts to adapt information to their audience’s needs, including health literacy needs. Nevertheless, important recommendations were drawn which are potentially also relevant for other clinical fields. Acknowledgements: We thank Mr. Tigran Spaan for providing free access to the online language assessment application. Disclosure of Interests: None declared.