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Emerging Infectious Disease (EID) Communication During the 2009 H1N1 Influenza Outbreak: Literature Review (2009-2013) of the Methodology Used for EID Communication Analysis

Published online by Cambridge University Press:  17 April 2015

Anat Gesser-Edelsburg
School of Public Health, University of Haifa, Haifa, Israel
Nathan Stolero
Department of Communication, Tel Aviv University, Tel Aviv, Israel
Emilio Mordini
Responsible Technology SAS, Paris, France
Matthew Billingsley
BMJ Publishing Group Ltd, London, United Kingdom
James J. James
American Medical Association Center for Public Health Preparedness and Disaster Response, Chicago, IL
Manfred S. Green
School of Public Health, University of Haifa, Haifa, Israel
E-mail address:



This year alone has seen outbreaks of epidemics such as Ebola, Chikungunya, and many other emerging infectious diseases (EIDs). We must look to the responses of recent outbreaks to help guide our strategies in current and future outbreaks or we risk repeating the same mistakes. The objective of this paper was to conduct a systematic literature review of the methodology used by studies that examined EID communication during the 2009 H1N1 pandemic outbreak through different communication channels or by analyzing contents and strategies.


This was a systematic review of the literature (n=61) studying risk communication strategies of H1N1 influenza, published between 2009 and 2013, and retrieved from searches of computerized databases, hand searches, and authoritative texts by use of specific search criteria. Searches were followed by review, categorization, and mixed qualitative and quantitative content analysis.


Of 41 articles that used quantitative methods, most used surveys (n=35); some employed content analyses (n=4) and controlled trials (n=2). The 16 articles that employed qualitative methods relied on content analyses (n=10), semi-structured interviews (n=2) and focus groups (n=4). Four more articles used mixed-methods or nonstandard methods. Seven different topic categories were found: risk perception and effects on behaviors, framing the risk in the media, public concerns, trust, optimistic bias, uncertainty, and evaluating risk communication.


Up until 2013, studies tended to be descriptive and quantitative rather than discursive and qualitative and to focus on the role of the media as representing information and not as a medium for actual communication with the public. Several studies from 2012, and increasingly more in 2013, addressed issues of discourse and framing and the complexity of risk communication with the public. Formative evaluations that use recommendations from past research when designing communication campaigns from the first stages of crises are recommended. Research should employ diverse triangulation processes based on representatives from different stakeholders. Further studies should address the potential offered by social media to create dialogue with individuals and the public at large. (Disaster Med Public Health Preparedness. 2015;9:199-206)

Systematic Reviews
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

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Emerging Infectious Disease (EID) Communication During the 2009 H1N1 Influenza Outbreak: Literature Review (2009-2013) of the Methodology Used for EID Communication Analysis
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