What not to say: risk communication for botulism.

This formative research study used qualitative methods to test the suitability of messages about botulism for the general public. Nine focus group interviews and 27 cognitive interviews were conducted with diverse audiences to pretest radio, television, and fact sheet messages predicated on a hypothetical terrorist attack using botulinum toxin. Narrative data were collected, transcribed, coded, and analyzed using content domains based on risk and health communication theories. While participants accepted the need for materials, the messages produced contained images and references describing botulism as a toxin-caused illness spread both by food and water contamination as well as by airborne means. The audience's lack of understanding of the term toxin and an imperfect understanding of airborne transmission of a toxic substance meant that some people interpreted botulism as being an infectious disease rather than a type of poisoning. The communication materials did not clearly show how the set of botulism symptoms are unique and described the anti-toxin as "not a cure," thus compounding the audience's misunderstanding. Using models from cognitive and developmental psychology, our findings were interpreted to show that certain terms evoke or elicit long-held conceptual frameworks that lay audiences use to explain medical phenomena. Relevant to botulism, poisoning events are distinct from infectious diseases, but prepared messages did not reinforce these distinctions. Ignoring how people organize preexisting health information when trying to communicate new information is a prescription for failure, especially in a crisis risk communication scenario. Findings from this study have been used by the Centers for Disease Control and Prevention to reformulate pre-event crisis risk communication materials for botulism.