CDC - Public Affairs in Health Issue Best Proctices, Health Disparity/Equity

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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